Copyright 1999 The Tribune Co. Publishes The Tampa Tribune
The Tampa Tribune
View Related Topics
October 3, 1999, Sunday, FINAL EDITION
SECTION: NATION/WORLD, Pg. 1
LENGTH: 1249 words
HEADLINE:
HMO nightmare lingers long after father's death;
BYLINE: VICKIE CHACHERE, of The Tampa Tribune;
BODY:
TAMPA - Josef Waibel died when his
heart failed him, but his family says what really let him down was his
HMO.
Josef Waibel couldn't get the medical attention he needed when he
was alive, relatives say. Now that he's dead, they can't get health care
providers to leave him alone.
Waibel, 86, died of heart failure in May
after months of being denied a referral to a cardiologist, according to
his family. Two weeks later, an oxygen service telephoned to say it was
coming to his home for treatment. A doctor's office has called with
appointment reminders.
Just two weeks ago, a radiologist's billing staff
wanted to discuss a surgery he never had.
The calls have infuriated his
daughter and son-in-law, Monika and Butch Faltermayer, who described in a
recent interview how their family spent the last months of his life asking
unsuccessfully for him to be sent to a heart specialist. They were denied
by his managed care provider, they said, despite his typical symptoms of
heart failure.
"He said: "The medical profession has let me down,' " his
daughter recalled. "Those words stick in my head."
Like thousands
of other families nationwide, the Faltermayers are vocal about their experiences
because they hope that will push the managed care industry to respond to
consumer dissatisfaction or at least will mobilize elected officials to
act on proposed reforms.
The stories have political importance now as
debate will begin in Congress this week on a "patient's bill of
rights," which would let all patients in health maintenance
organizations sue their HMOs over denied care.
Congress has
dragged its feet in the past, said Adrienne Hahn, a lobbyist for Consumers
Union, but now "every imaginable horror story has been brought to light,
and that's why you see Congress taking action on this issue."
Industry leaders, portraying those stories as aberrations in a
cost-effective system of good care, warn that allowing more lawsuits would
lead to higher prices for consumers because the industry would have to
spend money defending itself.
In Florida, Medicare HMO plans can be sued
for malpractice, but only a surviving spouse or children younger than 25
can bring a case.
The Faltermayers complained to Prudential HealthCare
in July but have received no response other than the company saying it
would investigate. A complaint forwarded to Florida's Agency for Health
Care Administration, which regulates medical care, has not been
acknowledged.
A Prudential spokeswoman said the company has been
reviewing the complaint but could not comment on specifics. The review
process asks a panel of about a dozen doctors within the company's network
to decide whether a mistake has been made.
As for the strange
calls that have followed Waibel's death, Prudential would not remove such a
patient from its list until it is notified of the death by Medicare, the
government health plan for the elderly. That can take weeks, said
spokeswoman Marlene Baltar, although calls persisting for months would be
clearly unusual.
Waibel's doctor, Joseph Lanese, declined comment,
citing doctor/patient confidentiality. But medical records he prepared in
Waibel's last days show he considered his care appropriate.
"I defiantly
defend my practice, office and staff," Lanese wrote in May. "I told Ms.
Faltermayer that I would not tolerate being compared to physicians accused
of gross malpractice nor would I concede any wrongdoing by myself or my
office other than a questionable miscommunication on May 4."
Lanese
noted the family had every opportunity to change doctors. Monika Faltermayer
said she suggested that, but her father initially trusted the doctor and
believed it when he was told his worsening health was not caused by his
heart.
WAIBEL HAD NOT been well for a long time, but the retired airline
machinist had carved out a pleasant life for himself at the couple's
comfortable home in Town 'N Country.
"He was my best friend," said Butch
Faltermayer.
Waibel had suffered from emphysema since 1990, and five
years later he had a double bypass and aortic valve replacement surgery.
He needed a wheelchair to get around.
But he was well enough for daily
trips to the market, making friends with firefighters who worked at the
station down the block, and keeping company with the family dogs. He cooked
dinner each night and, at Christmastime, would spend hours in the kitchen
baking dozens of traditional German cookies.
In the summer of
1998, he joined Prudential's Medicare HMO because he needed the drug coverage
benefits to cover a $ 428-a-month prescription bill.
His daughter
said the company representative who signed them up recommended Lanese, praising
him as a popular doctor. An added benefit was that a cardiologist in the
company's network had an office in the same building as Lanese.
During her father's first visit, Monika Faltermayer sought a referral to
a cardiologist because she was worried his swollen ankles might be the
fluid buildup that comes with heart failure. With his history of heart
disease, she didn't want to take chances.
But the doctor turned her
down, she said, and kept doing so when she persisted in the following
months. In February, Waibel finally received a test in Lanese's office
that, while described in records as being of "borderline technical
quality," showed the transplanted valve working properly.
A few weeks
later, Waibel's condition plummeted. By late April, his body was swollen with
fluid and he was so weak he couldn't get out of bed, his family said.
Lanese's notes show Waibel was treated with a significant increase in a
diuretics, antibiotics and other medicines. Within a week, the doctor
considered him improved but, according to his notes, granted the referral
to a cardiologist May 4.
Monika Faltermayer said she never got that
message. On May 10, she called for paramedics to take her father to the
emergency room at St. Joseph's Hospital.
The diagnosis was heart
failure; St. Joseph's doctors found the valve that was declared fine in
February was blocked completely.
Waibel was on a ventilator for 13
days, conscious. His doctors told him he wasn't going to get better, and
he died after the machine was disconnected May 23.
"If a cardiologist
would have told my father a year ago that his new valve was blocked and no one
would operate on him due to his age, my father would have understood,"
Monika Faltermayer said. "He was a realist."
THE STRUGGLE with
Prudential didn't end there, however.
Two weeks later, the Faltermayers
said, Lanese's office left a phone message that it was seeking HMO
approval for another office visit, and a day later the office called again to
remind the patient of an appointment.
Three days later, a home
health agency called to say it was en route to provide an oxygen treatment
- the same company that was to have visited back in April but never showed up,
Monika Faltermayer said.
Bills continue to arrive in the mail, of
course, and the billing departments haven't stopped calling. The
Faltermayers say their only comfort these days are other messages that pop up
unexpectedly around their home.
For months they have been finding
little notes Waibel wrote and hid for them to find. The notes read: "May
God Bless and Protect You." Vickie Chachere covers medicine and can be
reached at (813) 259-7624.
GRAPHIC: PHOTO (C),
(C)
Monika and Butch Faltermayer have photos of her father, Josef Waibel, including
one of him in his German army uniform. Waibel came to America after World War II
and became a U.S. citizen. PHIL SHEFFIELD, Tribune photo
LOAD-DATE: October 4, 1999 
