Friday, August 17, 2018

Hold the Mayo - Part 1

Readers may be aware of a recent story from Minnesota involving a young woman with a brain injury, her parents, and the famed Mayo Clinic. The gist is that she and her family were (allegedly) unhappy with her care, and sought to obtain it elsewhere. The Mayo docs put the kibosh on that, so the young lady's parents devised a plan to arrange her "escape."

The folks at Mayo and those at CNN are at odds about what really happened; it seems to me that the latter have more credibility here than the former (yeah, I know).

But the reason for this post is to present a primer on the medical ethics involved in disputes such as this. Regular reader and FoIB tsrblke has a doctorate in this discipline, and offers this explication:

"Out of Minnesota we have an interesting case of a patient who left Mayo Clinic “against medical advice.” Was she kidnapped, or did she run away?

Well that depends on whether you’re the family or the doctors at Mayo. The crucial facts are as follows:

1) 18-year-old patient has a brain aneurysm on Christmas day.
2)  Eventually she makes it to Mayo, after a brief stay at a local hospital, where, against all odds she survives and enters inpatient rehab.
3) The relationship between the hospital and the patient/family breaks down and everything goes to hell.
Sadly, #3 isn’t entirely uncommon, though the escalation here was beyond nuts (we’ll get to that in a second.) It’s not entirely clear what caused the breakdown, but it seems to have started with a disagreement over pain management.

Now one could write an entire essay on pain management problems, and I don’t really want to get caught in what amounts to an aside, because what happened next is where the meat of this particular case is.

Basically, as the relationship between the hospital and family deteriorated beyond repair, the hospital escalated  the situation to the point of, allegedly, trying to have Ms. Gilderhaus declared a ward of the state. I want to emphasize how incredibly extreme this is. Even assuming for argument’s sake that Ms. Gilderhaus lacked mental capacity - that is, that her brain injury interfered with her ability to make decisions (which seems unlikely for reasons we’ll get to in a moment) - there are several possible surrogate decision makers that could be used prior to going to the state. Obviously, there’s the mother. Depending on various legal circumstances the stepfather may be able to fill that role. And there’s the biological father (who’s mentioned briefly in part 2 as being asked, but it’s never explained why they went for state control instead.) Based on the information given, none of these potential surrogates has done anything that would suggest they cannot handle the duties. Indeed, they’ve done everything thus far suggesting they care deeply for their daughter. So what was their great sin in the eyes of Mayo? They didn’t like the care and wanted to transfer her to another facility.

Let’s be clear, based upon the way it’s presented, they didn’t want to just up and leave (until the escalation reached stratospheric levels) they just wanted to go somewhere else. That’s not a crazy idea by any stretch. Nothing indicates she can’t be transferred, and there’s no mention of any reason they couldn’t find another provider. (Admittedly we only have one side of the story, but Mayo is refusing to say much at all despite all the HIPAA waivers, which suggests, to me at least, their defense would be weak.)

Now is a good point to introduce a term I’ve used among my colleagues: the “medical-legal establishment.” What is the medical-legal establishment?
"

We’ll explore that, and its implications, in Part 2.


Thanks, tsrblke!

Thursday, August 16, 2018

Making Strides Against Breast Cancer: v2018

Once again, I'm raising money with my team: Love, Hope and Faith. Our walk is Saturday, October 20th, and I'd really like to break the $500 mark.

Will you please help out by making a donation - Thank You!!

Thank you!

We've got questions

Some may recall the tragic story of a star-crossed love affair that ended tragically on the Hudson River on a Spring afternoon in 2015:

"[Angelika Graswald] pulled the drain plug on Viafore’s kayak while they were paddling on the Hudson River in 2015 and watched him drown."

This seems to have been as cold-blooded a murder as I've ever read of, and compounded by the fact that she and the victim, Vincent Viafore, were actually engaged to be married. He had apparently named her as one of the beneficiaries of his almost half a million dollar life insurance policy.

Okay, we know that criminals aren't allowed to profit from their crimes: arsonists don't get their houses paid off, murderers don't collect on their victim's life insur....

Wait, what's this?

"A woman dubbed the “kayak killer” -- who drowned her fiancĂ© by pulling the plug on the couple's small boat -- was awarded a portion of his $491,000 life insurance payout Monday."

How could this be? I get that the arrangement included her dropping her appeal, and the victim's family dropping their wrongful death lawsuit, but I didn't understand how this deal worked until I got to almost the end of the article:

"The criminal plea did not disqualify our client from taking these funds. They still had to prove that she recklessly or intentionally committed this murder."

Okay, but how would that work? I'm not aware of any law that says "well, if you commit just plain vanilla murder you get the cash, but if it's reckless or intentional you get zip." This seems ... illogical.

So I reached out to FoIB Brian D (a carrier rep of outstanding repute) for insight, and he offered this explanation:

When carriers have a disputed claim (such as a murder or other suspicious circumstance), they will pay it out to the state to be held in escrow until the matter is resolved. Looks like this is what happened with the Kayak Killer case here.

Thanks, Brian!

Wednesday, August 15, 2018

Another CanuckCare© success story

For certain values of "success," of course.

Friend of mine (Canadian ex-pat) just posted this on Twitter*:


"My cousin just called. She was diagnosed with thyroid cancer in March, was put on the urgent list for surgery. It’s mid-August. “Oh well I just have to wait”, she says. Every day untreated means progression of disease. #CanadaWaits #socializedmedicinekills"

Then:

"It’s “a good cancer to have”, in that typically they can just cut out the affected organ. But who knows if, in the ensuing time, it’s affection other systems?"

"I am so angry that people are treated like this. Six months almost with no surgery date. In a first-world, technologically advanced country."

From another friend in response:

"I’ve had arguments online w/Canadians about how this kind of thing doesn’t happen & I’m a stupid American & don’t know what I’m talking about. A friend of a friend came to the US for hernia surgery because he was in excruciating pain & the wait was 1.5 years."

And finally, from my ex-pat pal:

"My father’s first oncologist appointment was scheduled for after he died."

But hey: Free.

(*Anonymized to protect her identity)

A Triggering Scenario

Back in July, I posted my skepticism of a claim by Life Settlement industry players that insurers were (surreptitiously?) raising the cost of insurance in viaticated policies:

"Some life settlement companies have responded to universal life cost-of-insurance increases by suing the life insurers  that issued the policies"

Of course, they're free to pursue their own interests, but I suspect that they'll have quite the uphill battle.

Why's that, Henry?

Well, as I noted in that previous post, there's no mechanism for singling out specific policies for increases. For another, policies themselves have specific, stringent definitions on how, why and when these internal costs may be raised. I took the liberty of screencapping the relevant verbiage from one such policy I recently wrote (and which I believe to be fairly typical):


 [click to embiggen]

As one can plainly see, the cost of insurance (COI) is pretty well locked down, and applies to only a few specifically-worded populations, none of which are "life settlement brokers."

The other interesting thing to note is that the other internal costs are left more freely to the carrier's discretion, so it's possible that policyholders could experience those, regardless of the company's mortality experience. But again, there's no singling out of the life settlement folks.

Based on this, I don't see how they'll prevail.

But then, I'm not a lawyer, and I didn't stay in a ...

Tuesday, August 14, 2018

Medicare Open Enrollment

Medicare Open Enrollment. Not to be confused with Obamacare Open Enrollment.

Time to review you Medicare Advantage or Medicare drug plan.

Medicare supplement plans do NOT have annual enrollment periods in most states.


Medicare open enrollment begins October 15 and ends at midnight December 7.

Medicare Open Enrollment Pre-Planning


Before enrolling in Medicare at age 65 for the first time, or planning your next move during Medicare open enrollment, there are things you need to do first.


  • Make a list of all doctors including name, address, phone
  • List all area hospitals, especially the ones you have used
  • Make a list of all medications including dosage, refills, prescribing doctor and pharmacy
  • Be aware of the donut hole and look for ways to avoid that trap
  • Make use of generics and off plan purchases
  • Look for FDA approved generics and ask your doctor before making a change
  • If renewing, get your drug list ID and password date from your last drug plan finder
  • If renewing, study your ANOC for changes
  • Use Medicare.gov for reviewing Advantage and drug plan options
  • Avoid using Medicare.gov for drug plan comparisons prior to October 25
  • Medicare.gov and your state DOI site are essentially useless when comparing Medicare supplement options
  • Most Medigap quote engines only list a handful of options and rarely have plans with the best value
  • Many quoting sites will sell your information to numerous agents; some don't provide instant quotes


Never put anything on auto-renew unless you like unpleasant surprises.

You have questions. We have answers.

#MedicareOpenEnrollment




Monday, August 13, 2018

Promising Cancer Treatment Breakthrough

In a promising development, a new kind of weapon in the fight against cancer is about to be deployed:

"His oncologists delight in observing that if you saw Rulli on the street, you’d never guess he was sick. At 66, he still is 6-foot-1, still 215 pounds thanks partly to golf-course beer, still an easygoing husband and father of two children, now rejoicing in granddaughters"

In 2013, Bob Rulli was diagnosed with a glioblastoma, a rare but extremely nasty brain tumor. I know, because I lost my baby sister to one a few months ago. These are almost always a death sentence, and difficult to treat; the average life expectancy is about a year and a half.

Now, thanks to some true medical adventurers, there appears to be a real reason for hope, and so far it also appears to have few (if any) side effects):

"On that day in September 2016, for the first treatment, Rulli spent the day at UC with Wise-Draper and Morris keeping vigil for bad reactions. He had none. He felt fine."

Over the next year and a half, Mr Rulli continued to receive the medicine, called BXQ-350, in ever increasing dosages. Repeated MRI's showed that the tumor continued to shrink.

And then there was a glitch...

This is such a great story, I really recommend it. There's no rosy glasses here: there are definitely hurdles left. But so, so promising.

[Hat Tip: FoIB Holly R]

Oh, SNAP! (vs Medicaid)

So, FoIB Michael Bertaut offers 1,000 words on how Medicaid really reimburses providers, and its implication viz both Medicare and commercial health insurance:


[click chart to embiggen]

Money quote:

Friday, August 10, 2018

That was then, and this is now...

On the one hand (nine years ago):


On the other (6 years ago):



On the Gripping Hand (a few days ago, as tipped to us by FoIB Holly R):


Okay, wait a minute, "analysis" is very different from "results." What gives?

Ah:

"Confounding is a classic problem of selection bias ... But that’s hard to do with a wellness program."

And thus, when accounting for the actual variables being  measured, there "seemed to be no causal effects."

Which is, of course, disappointing to those with an axe to grind, but I'd also point out that there didn't seem to be any evidence, or even any suggestion, that engaging in wellness activities was harmful.

So we've got that going for us, which is nice.

Thursday, August 09, 2018

EBA whiffs it - Again

So the rocket surgeons at EBA (which, ironically, touts "benefits" in its very title) continue to double-down on the stupid:

"Here’s one option advisors can help them explore: health savings accounts. These accounts, which are offered in combination with high-deductible health insurance plans"

First of all, they keep conflating "High Deductible Health Plan" with "HSA-compliant" plan, thereby confusing laypeople (and irritating us pro's). As we pointed out on Monday:

"[U]ntil the age of ObamaCare, HDHP's meant HSA-compliant true Catastrophic coverage, no bells or whistles, just policies that paid for the truly disastrous claims (think cancer or brain surgery, for example)."

And second, they seem oblivious to the fact that HSA contributions are down for a very good reason: with premiums and out-of-pockets continuing to soar, who the heck has extra cash laying around to put in the account?

They even offer proof of this in their article:
[click chart to embiggen]

So, a 1,000 words in self-rebuttal.

Nice job, guys.

CanuckCare© Takes a Shot

So it seems that Britain's Much Vaunted National Health Service© has some competition in the race to the bottom. From our friend The Political Hat:

"Canadian Hospital Pushes Euthanasia on Disabled Patient"

As we've oft-noted, killing off pesky, expensive patients is a sure-fire way to rein in out-of-control health care costs.

(And by the way: have we noticed yet that even nationalized schemes have been unable to keep health care costs in line? Just wondering)

And it seems to be becoming a pretty routine, if final, "solution:"

"Foley tells the man that he’s “always thinking I want to end my life” because of the way he’s being treated at the hospital and because his requests for self-directed care have been denied."

This is far form Dr K's assisted suicide apparatus: no matter what one thinks of that process, at least it was (ostensibly) voluntary. This is full-blown actively pushing for the patient to pull his own plug not for his own betterment, but for the savings to the health "care" system.

Which begs the question: what, they ran out of ice floes?