Comments on Medical Care and Medical Insurance Issues
Below is our experience that led to an event at Community Care and Rehabilitation Center that spiraled out of control because no coherent system apparently exits within the many facets and levels of managed health care. In our situation, laws were broken, contracts were interfered with, and unethical behavior led to unethical treatment and care.
Looking beyond the selling points of medical pamphlets and rosy television ads, there is a reality. Our experience has been in the Riverside, California area, but we assume similar situations occur across the nation.
***These events are accurate from our perspective and contain information as we have experienced it or received it. As events progress we will continue to update.
Under emergency care, and up until Waly's release from Riverside Community Hospital, the level of care has been very good and her doctor's performance remarkable. That level of care significantly changed on the day of Waly's release from the hospital when Waly and family members where lied to by Waly's nurse at Riverside Community Hospital, and were confused by the lack or loss of transfer of medical information and orders between Riverside Community Hospital and Community Care and Rehabilitation Center, and dumbfounded by the realization that some local medical providers refuse to do business with Riverside Medical Clinic (RMC)(a Scan Health Plan contractor), and then we were told an entirely different set of expectations by Scan Health Plan. Welcome to the world of "Managed Care".On Waly's release from Riverside Community Hospital, we were told by Waly's nurse that a special alternating pressure mattress and pump her doctor ordered for Waly was already set up at the new facility by 3pm on the day of Waly's release. Waly was using such a mattress as part of her treatment and the mattress is necessary to maintain the blood circulation in Waly's legs as she recovered from multiple surgeries and skin grafts due to being mauled by 2 pit bulls. But when Waly arrived to Community Care and Rehabilitation Center (the new facility) at 9pm that evening, there was no such mattress. Staff at Community Care and Rehabilitation Center told us they knew nothing of the mattress order and that the facility has no such required mattresses. They eventually found an old air mattress that had a huge 2-foot circular stain in the middle of it in a storage room and they tried to pump it up for over an hour. Eventually, Waly's son put his hand in front of the pump blower and it wasn't even blowing air, even though the staff continued to insist that "it takes a long time to pump these up". On contacting Riverside Community Hospital to resolve the problem that evening we became aware that Riverside Community Hospital staff was going to do nothing regarding the issue and were told that if Waly attempted to return to Riverside Community Hospital for the evening, her only option was to go to Emergency and wait in a line of 14 others waiting for beds ahead of her. More phone calls with Scan Health Plan staff finally informed us that the facility must resolve the problem. Eventually a medical supplier SuperCare said they would deliver one, delivery was made around 1:30am (late that night). Waly's son signed for the delivery of the mattress. We thought the issue was finally resolved, but the next day Riverside Medical Clinic (RMC) staff told Waly that she no longer needed the mattress and tried to take it from her. An RMC nurse, claiming she was an R.N. had looked at Waly's wounds and apparently made the "medical evaluation". When asked for her RN license number, this Riverside Medical Clinic nurse refused to disclose her license number. Waly refused to let the mattress go, and again Scan Health Plan had to be contacted to reaffirm and approve the mattress as part of Waly's necessary care. After calls to Riverside Medical Clinic (RMC) regarding nurses' license numbers, we were told Riverside Medical Clinic (RMC) will not provide such license numbers on concerned requests. Not much to say, but this information made us very suspicious of the qualifications of Riverside Medical Clinic (RMC) staff and caregivers.
Also on the evening of Waly's transfer, while trying to have delivered the doctor ordered mattress, we were told by some other local medical providers we contacted that they refuse to do business with Riverside Medical Clinic (RMC). One reason given was that they will not allow Riverside Medical Clinic (RMC) doctors or caseworkers in their facilities. From our short experience we're beginning to understand why.
After RMC's R.N. refused to disclose her license number, we inquired about it and were told by staff at Community Care and Rehabilitation Center that they also have no record or even require a record of such license numbers by those who administer such care at their facility. After hours of phone calls, we still have not been told who is in charge of Waly's care and what their qualifications or license numbers are, and have only been directed to staff who give us the run-around while the process of denying and even removing elements of care moves forward.
As time progresses and again Waly is getting close to being released, now to her home, issues with her medical providers arise. Again the alternating pressure mattress is one of the primary issues, as is the issue of Waly being able to navigate the layers of steps up to the doors of her house which currently have no rails and the fact that Waly has had minimal stair therapy. Calls to Scan Health plan confirm to us that the mattress is part of Waly's care and the mattress is to go with Waly to her home. Waly's case manager at RMC confirms to me that there are specific items of medical equipment that must be available at Waly's house prior to Waly's discharge and release from Community Care and Rehabilitation Center, one of those items is the alternating pressure mattress and pump.
At one point in a conversation I had with a SuperCare representative, I was informed that these high value mattresses become issues because many times patients do not understand the medical equipment so supplied is contracted to the patient and that it is to go with the patient on release, because the patient is ultimately the responsible party to the contract. And that often times the facilities take advantage of situations were the patient does not understand this, and the facilities take these mattresses when "left behind" and then bill them to other customers for additional revenue. Apparently this so-called "taking" by facilities happens more than one might expect.
On the evening before Waly's release I received a message from SuperCare (the mattress supplier) that the mattress Waly is currently on is the one that will be going to her home with her.
On the morning of Waly's release, with the mattress contract and receipt from SuperCare in hand, (that clearly lists Waly Nichols as the contracted responsible party to the mattress) we go to Community Care and Rehabilitation Center in Riverside to do as instructed. When I inform a nurse at Community Care and Rehabilitation Center that we have arrived to take my mother Waly Nichols home with her mattress, the nurse tells me that Waly has been discharged and is free to go, but that the mattress must stay at the facility. I tell the nurse the mattress is our possession and we're taking it with Waly, and that I have all the names and phone numbers of those to contact to verify. When we do take the mattress, nurses at Community Care and Rehabilitation Center call the police. I have a notebook full of contact numbers of all individuals I've contacted regarding our right to the mattress and try to explain with the hopes the contact numbers I have can be utilized to confirm the mattress goes with Waly. Then Riverside Police arrive. Within the next minute police have me in handcuffs. By this time my brother is on his way to Waly's house with the mattress and is contacted to come back to Community Care and Rehabilitation Center. In response to my receipt and contract from SuperCare for the mattress, Riverside Police tell me that I could have typed up the receipt and refuse to let me explain my side of the story or access my contact numbers. Rather they take possession of the notebook in my backpack and thereafter never allow me access to it. When my brother returns to Community Care and Rehabilitation Center he produces the original (pink duplicate) document of the contract for the mattress with SuperCare. Police don't seem to care, as he is also put into handcuffs. Waly's receipt and contract with SuperCare that indicates Waly to be the "Responsible Party" to the mattress and lists the serial number of the items is not enough to prove to the officers or Community Care and Rehabilitation Center that the mattress is contracted to Waly. At this point one has to ask themselves, is something wrong with this system when Riverside Police, Community Care and Rehabilitation Center, Registered Nurses, Directors, and upper level staff can't even understand a receipt and contract?
Eventually I'm told the Director of Riverside Community Care and Rehabilitation Center has signed a citizen's arrest, and am told Community Care and Rehabilitation Center wishes to press felony charges for theft of the mattress. Both my brother and myself are taken to Riverside Police Station and booked into jail. What should have been a day of celebration for my mother's home-coming turned into a horrible nightmare experience.
While at the police station I brought up the conversation I had with a SuperCare staff member who informed me about how the mattresses are "taken" by hospitals and facilities, when "left behind" by patients, and those facilities then re-bill them to other patients for additional revenues. The arresting police officer informed that he has heard the same thing. But since this is a citizen's arrest, he's obligated to arrest..
We were both charged with 487 PC (Grand Theft), a felony; and 182 PC (Conspiracy To Commit Any Crime), a felony, and spent the weekend in jail.
Adding further injury, Community Care and Rehabilitation Center's Registered Nurses, and other nurses and/or staff , took the mattress and pump valued at $5000.00, while having absolutely no legal rights to that property, and deprived Waly of the necessary treatment and care it provided. Waly Nichols was denied access to the medically necessary mattress after it was "returned" to Community Care. Waly was forced to wait without treatment in a wheelchair for several hours until Super Care could finally deliver a second mattress to Waly's house to fulfill the terms of Waly's discharge and release as ordered by Riverside Medical Clinic. While Waly was forced to wait in a wheelchair, her right leg that was healing from severe dog mauling and multiple surgeries and skin grafts started swelling up and causing considerable pain because she couldn't lay down or elevate her leg properly as doctors had told her she must do. When Waly asked for a simple pillow to put under her leg to help elevate it, Community Care and Rehabilitation Center nurses were reluctant to even offer that small bit of medically appropriate aid. Since this forced 5 to 6 hour wait by Community Care and Rehabilitation Center with no adequate medical care being offered from Community Care and Rehabilitation Center nurses or staff, Waly has experienced considerable and continued swelling and pain in her right leg.
Prior to this experiences, I had been under the impression that when a person becomes a nurse, there is a certain duty and care to the patient that is ethical and right. Apparently this is not the case at Community Care and Rehabilitation Center.
On release from jail I called SuperCare to inform them Waly's original mattress had been taken by Community Care and Rehabilitation Center. SuperCare reaffirmed that SuperCare has no contract whatsoever with, and that Community Care and Rehabilitation Center "Has NO OWNERSHIP RIGHT OR CONTROL to the mattress WHATSOEVER and that SuperCare will contact Community Care and Rehabilitation Center to make that absolutely clear and to have their driver pick up the mattress.
Quite an ordeal with Community Care and Rehabilitation Center in Riverside just to secure a so-called "approved level of managed healthcare" for one's injured and elderly mother.
Riverside Police Detectives have now told us their investigation proves Community Care and Rehabilitation Center and the Registered Nurse who signed the Private Person's arrest, did so without regard as to the true and legal ownership and control of the mattress. The final Police Detective's investigation proves that the mattress belongs to Waly, and Waly and her family were and are free to do whatever they want or wanted with the mattress.
Police detectives and others involved have told us they have tried to contact Community Care and Rehabilitation Center and the persons involved in the FALSE ACCUSATIONS, FALSE ARREST, FALSE IMPRISONMENT, and now an apparent FELONY GRAND THEFT charge that is coming back at them for the taking of the mattress that in fact belongs to Waly Nichols, but calls have not been returned. It appears that Community Care and Rehabilitation Center and their responsible nurses and staff have done nothing to mitigate damages in an expedited way to those so wronged , but rather have chosen to remain silent about their inappropriate actions in an effort of apparent cover-up and self-protection.
Police Detectives have determined all charges that were brought by Community Care and Rehabilitation Center against two of Waly's sons to be "UNFOUNDED" and have strongly suggested the family seek civil damages and other appropriate action against Community Care and Rehabilitation Center and the individuals involved for their wrongful and unlawful actions.
We are looking into all appropriate criminal, regulatory, and civil action against those involved.
*** These events are accurate from our perspective and contain information as we have experienced it or received it. As events progress we will continue to update.
We do seek clarification from the above-mentioned companies, medical caregivers, and providers, and will continue to update this page as information becomes available.
All those mentioned above and involved in Waly's care are encouraged to post comments to clarify their procedures in this public arena, as requests for clarification have not been adequately received privately.
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