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Copyright 1999 The Tribune Co. Publishes The Tampa Tribune  
The Tampa Tribune

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October 3, 1999, Sunday, FINAL EDITION


LENGTH: 1249 words

HEADLINE: HMO nightmare lingers long after father's death;

BYLINE: VICKIE CHACHERE, of The Tampa Tribune;


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.

(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

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