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How to Change Doctors

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  • How to Change Doctors

    I thought that I'd start a new thread about how to change doctors.

    My Dad is C3-C4, incomplete, on the vent. He has gone to a rehab hospital (which was very disappointing) and is now in a LT sub-acute/hospital. This is the only LT sub-acute/hospital which will take vent patients in my city -- and, my Dad was considered "lucky" to get into it (the approval may have stepped on a few toes).

    The LT sub-acute hospital had a great speech therapist - but unfortunately, this sub-acute/hospital does not specialize in SCI (for example, not knowledgeable about the abdominal binder -- almost a 4 weeks have passed and they've only put him in a wheel chair 3X and without a binder, so he had bp difficulties; nurses warning me not to touch or to 'stimulate' (by motion) my Dad because this will lower his blood pressure, etc.). Worse, even though their sister SCI unit offered to do a consult, my Dad's newly assigned doctor (internist) at this LT sub-acute hospital refused.

    The current discussion is to try to get my Dad to go home. The case manager says that we should change my Dad's primary care doctor to the newly assigned doctor (internist). The case manager says that this will help my Dad to get back into the LT sub-acute/hospital if something goes wrong and it's easier to get an "order." He also claims that no doctor will accept my Dad as a patient given his serious condition.

    I want to find an internist who is more knowledgeable and a good physiatrist to work with my Dad.

    Has anyone share experiences regarding how to best change doctors or how to find specialists who will take on a high-level injury, especially since my Dad is on a vent and not mobile?

    I'd appreciate any tips.

  • #2
    I can only recommend getting back to one of the better acute rehabilitation centers in your area (Santa Clara Valley Medical Center or Davies in San Francisco) and explain that you are now determined to take your dad home. See if they would reconsider admitting him for a limited short rehabilitation stay with a goal of getting him to the level where you could realistically take him home, and help train you and the other family members you would need to have available to provide his care 24/7.

    He may qualify for some attendant care through IHSS, although this is getting very difficult with the cut in funds to that program (the max hours now are 90 hours/month), and would depend upon him qualifying for Medi-Cal as far as his assets. How are you planning on being able to provide him with the level of care he will need?

    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.


    • #3
      What city do you live in? Is your dad eligible for the DPS?
      Where did he go for rehab? I am happy to try to assist and make suggestions but a bit more info would be helpful. Is your dad a veteran?

      Feel free to respond via PM if you prefer.
      Every day I wake up is a good one


      • #4
        I agree with the Nurse that you should do everything you can to try to get him moved to Santa Clara Valley Medical Center. Perhaps others on this board who have been there in the past or who had success in transferring from one rehab to another can give their advice.

        Even if they rejected him before, call again. Try to get a social worker.... or even the one speech therapist you like at the current site to help you. Get a doctor's name at Santa Clara from the SCI unit and just try to call them/email them directly. The trick is finding someone willing to help you. It does seem so so hard.

        Here is the link to the doctors who work there

        Re-iterate the lack of training at your current site in the basics of care for SCI, mistakes that have been made, your desire to maximize your father's function and learn everything to be able to bring him home, and your current physician's refusal to even ask for input from people more experienced with SCI. I also hope you file a complaint against this doctor, and speak to the patient liason/ombudsman and the rehab facility now, as sometimes this will lead to better care.

        Also, stall if you need to while fighting to get him to Santa Clara. They cannot discharge your father "home" without your consent. They may try to threaten you, but stand strong.
        Last edited by hlh; 02-25-2012, 09:02 PM.


        • #5
          Thank you very much for the advice on the short rehab stay.

          The LT sub-acute/hospital is giving advice on home care -- because we will need to pay out-of-pocket when the insurance lapses.

          What is IHSS and DPS?

          Cheesecake - may I send you a quick private email since I wonder if it's polite to mention the actual names of centers/hospitals which can be viewed by everyone? No, he's not a vet.

          Much thanks


          • #6
            Hey hlh,

            Thank you very much for the encouraging words... I need them.


            • #7
              Originally posted by Joey_SF View Post
              Thank you very much for the advice on the short rehab stay.

              The LT sub-acute/hospital is giving advice on home care -- because we will need to pay out-of-pocket when the insurance lapses.

              What is IHSS and DPS?

              Cheesecake - may I send you a quick private email since I wonder if it's polite to mention the actual names of centers/hospitals which can be viewed by everyone? No, he's not a vet.

              Much thanks
              Joey_SF: I have replied and given you an email address that you can use to contact me via work. I will check this weekend.
              I agree, it is generally best to leave out names of facilites, etc. in open conversation.

              DPS= Diaphramatic Pacing System. Santa Clara has een doing it on newly injured vent patients who might not otherwise get off a ventilator.
              IHSS is In Home Support Services.
              Every day I wake up is a good one


              • #8
                Joey_SF: Please continue to post questions here. The board members are a wealth of info and I am certain that there are other caregivers who have hit obstacles like you have but were successful in navigating the system.
                Every day I wake up is a good one


                • #9
                  Thanks for the suggestions -- I'll try them.

                  Btw, I called Davies -- the feedback is that if they let us into the short-term-home-goal program, there is an absolute requirement to keep my Dad at home and there's no turning back. If we do a "normal" home discharge, there is a possibility to transfer my Dad back to a facility.

                  I want to have my Dad at home -- but, I have zero medical training and am worried about the vent.

                  Hm, his current insurance offers 35 hours/week of home agency care. we can't qualify for MediCal at this time -- we've been told that MediCal is now very strict.

                  The case manager is pushing us to discontinue my Dad's insurance and to go with Medicare -- but, he also says that Medicare doesn't have any home coverage. He claims that Medicare is easier to negotiate with. He also says that if we have my Dad home for a minimum of 60 days (without being back in the hospital), Medicare will help cover my Dad's return to the subacute.

                  Each time I call Medicare, I seem to get a different answer.


                  • #10
                    I would be VERY WARY of canceling any insurance you have that is an option to Medicare. Especially if your insurance will cover 35 hours per week of a home help agency. If you aren't able to get Medicaid yet, then those 35 hours will have to be paid out of pocket, and since you would need nursing level care in light of the vent it would be very very very expensive. I cannot reiterate this enough.

                    What private insurance do you have at the moment? Is it from your father's employer? How long will it last? What is the problem the case manager is having with them?

                    Maybe KLD/nurses can pipe in but I cannot imagine why the case manager wants you to drop your insurance and is claiming Medicare is easier to negotiate with. There is no such thing as negotiating with medicare, when you are the patient. If they don't cover something, you can never convince them to cover it.

                    I also do not believe that there is no way you can take your father home and never get him admitted again to the hospital if things are getting difficult at home. Maybe Davies will not re-admit him to their specific training program again, but they can't prevent you from bringing your father to their hospital, or any other hospital, if he is "failing to thrive" at home and you are fearful of his safety.

                    I encourage you now to get very familiar with the details of your insurance coverage. Any caps/limits and the details of coverage. This can be painful, but only you can find out the truth of your coverage. Case managers and customer service reps at insurance companies make mistakes all the time. Document everything, ask to see the paperwork, be careful....


                    • #11
                      Thanks for the advice.

                      My Dad is retired so it's a Medicare Premium program, Secure Horizons -- so, according the case manager, we can be dis-enrolled in three days and switch to Medicare.

                      I read the coverage book -- so, I faxed the sheet about home health agency care to the case manager because he kept insisting that there was no such thing as a 35 hour/week coverage if my Dad didn't buy extra home care insurance. Odd, the case manager at the rehab center also insisted -- after I showed her the sheet, she was surprised at the "generous" benefit and told me she would follow-up. She later told me that the insurance rep who was handling my Dad's case wouldn't call back.

                      Thanks for the warning re the negotiation. I was very concerned about getting more PT for my Dad -- the case manager says that when my Dad gets home, there is a re-assessment regarding PT. When I asked about who would be responsible for asking for the re-assessment, the case manager said that he would be and would ask a home health agency to do the evaluation.

                      Has this worked out for anyone?


                      • #12
                        Just to let y'all know...

                        I was finally able to speak directly to a rep from my Dad's HMO insurance. Regarding the 35 hours, she informed me that this is the limit and that she'll allocate 1-1.5 hours per week for home visits for my Dad -- any additional hours is subject to medical necessity and must be ordered by the Doctor.

                        She claimed that this home visit benefit is also offered by Medicare. She was not a "customer-oriented" representative but instead she strongly recommended that we drop the HMO and switch to plain Medicare.

                        The Case Manager left a pamphlet re 2011 Medicare - under Home Healthcare "unlimited for part-time intermittent skilled nursing care, physical, occupational and speech therapies..."

                        I'd appreciate anyone's sharing of good or not-so-good experiences -- and any words of wisdom re this benefit.