if the whole thing wasn’t so appalling. Talking about Alex and his broken leg. Last Friday night just to jog your memory. And then the insurance people. The order of events is about as follows:

1. ER visit on Friday night. Splinted and told to see Ortho on Tues
2. Monday attempt to contact Ortho.
3. Tuesday – Insurance manager states: ER referral not good enough, you need a primary care doctor to refer you to Ortho
4. Wednesday – Alex sees a primary care doc who says “This is insane, of course a broken leg needs to be cared for by Ortho.” and expedites the referral
5. Thursday – insurance manager informs that “urgent referrals” can take up to 72 hours to process. And we have heard nothing by 2000 which is apparently as late as they work

If anyone needed a demonstration of how broken the US Health Care system is – I refer you to the above list. Yes, as a family physician in a rural area, I might have splinted, then casted a simple tip-fib fracture. But not in a complicated patient. Not in someone with previous surgery or fractures in that leg. It is just asking for trouble.

In their assumption that everyone is trying to get unauthorized care and spend their precious money (so that it doesn’t land in the senior executives’ pockets), the rigid protocols decrease quality of care and actually increase cost.

During my residency, before all the “managed care improvements” we would have splinted someone like Alex, admitted him for overnight evaluation and let Ortho take care of his leg during normal daylight hours. Or, in a rational society, he would have been routinely scheduled and seen on Tuesday when the Ortho person who saw him in the ER said he needed to be seen.

It will be interesting to see if we get what I expect – which is a phone call late Friday saying “yes, he needs his Ortho follow up.” Which means that he will be seen a week AFTER Ortho said he needed to be seen. Still with his leg in a splint.  Still with the unresolved question of whether or not he needs surgery to stabilize his ankle, still in a lot of pain.

George quietly informed the person on the phone that, should Alex have problems or complications that would not have occurred had he been treated early as directed, he was going to hold everyone who delayed the care personally responsible.

No, he doesn’t practice law in California, but he knows people who do. There are also various people in the state government who are going to hear about how their “managed care” is managing to not deliver care.

I stitched. I needed it!