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Medicare Benefits Exhausted : Stroke Patient Stuck in Bureaucratic Tangle

December 08, 1988|DAVID HALDANE | Times Staff Writer

Marguerite Cronin has spent the last 6 months in a hospital room.

Attached to a machine that monitors her heartbeat and oxygen intake, she breathes through a tube in her throat and rests on a special bed that automatically shifts every 15 minutes to prevent her lungs from congesting. Because of a stroke, complicated by bronchitis and frequent bouts with pneumonia, her life depends on the constant care of health professionals.

For the first 5 months, the 82-year-old woman's stay at Memorial Medical Center of Long Beach was relatively uneventful.

Then came a twist. Her Medicare benefits ran out. The federal health-care program for senior citizens had been paying Cronin's medical bills, which averaged about $1,500 a day.

Since then, Cronin has been at the center of a controversy involving her family, the hospital, state health officials and private health-care providers.

The issue: What kind of permanent care does she need and who is willing to pay for it?

On one side is her family, which wants the hospital to keep Cronin until arrangements for suitable home care can be made. On the other is the hospital, which at one point was prevented by a court order from releasing her against the family's will to a nursing home.

Somewhere in the middle are the state Department of Health Services and private health-care firms. The state department administers a home-care program designed to care for patients such as Cronin at a fraction of the cost of hospital treatment. Private firms provide the home-care services, and the state reimburses the companies. But many private providers apparently are reluctant to participate because they believe the state does not pay enough to make it economically feasible.

The controversy, besides triggering the temporary court order, is also likely to result in a lawsuit by a health advocacy group.

To make matters even more confusing, Cronin's condition has recently deteriorated to the point where her treatment is on hold, hospital officials acknowledge.

"She's a fighter," says her son, John P. Cronin, 38, a bank vice president. "But lately she's been getting very depressed."

The woman's medical problems began in May when she experienced breathing difficulties. John Cronin said he feared for his mother's life and took her to Memorial where she was put in an intensive care unit and eventually was treated for pulmonary stress. A resident of Los Alamitos, she lived with her husband, Thomas, an 83-year-old retired accountant, on a fixed income.

Sometime during her first weeks in the hospital, doctors believe, she experienced a stroke that permanently impaired her ability to breathe and perform other bodily functions. Doctors performed a permanent tracheostomy--an incision in the throat to aid breathing--and put her part time on a respirator.

State Denies Application

After her Medicare benefits were exhausted about a month ago, John Cronin said, the hospital applied to the state to have the Medi-Cal program pay the costs of providing acute medical care--defined as treatment that can only be provided in a hospital. The application was turned down.

At that point, John Cronin later said in a deposition, he received a telephone call from a hospital employee, Dorothy Jackson, who told him that his mother was a "trespasser" on hospital premises and would be physically removed by security personnel unless he paid $2,000 the next day. Jackson, who works in the admitting section, declined to comment.

Ron Yukelson, a hospital spokesman, said he was unable to substantiate that such a call was made and would "dispute that somebody from Memorial Medical Center would say that to a patient's family."

But Cronin was alarmed enough to go to Los Angeles County Superior Court and obtain a temporary restraining order preventing the hospital from discharging her until an appeal can be heard in January regarding her Medi-Cal eligibility.

And Jane Perkins, an attorney for the National Health Law Program, a health advocacy firm based in Los Angeles, said her group plans to file a lawsuit on behalf of Marguerite Cronin and at least one other patient to permanently prevent the California Department of Health Services from withholding Medi-Cal payments without due process from patients undergoing acute life-giving care.

Condition Is Low Again

In the meantime, according to Yukelson, the elderly woman's condition has again deteriorated to the point where the hospital now acknowledges that she needs to stay there. As a result, Medi-Cal is paying her medical costs for now. But hospital officials fear that they will never be paid for 3 weeks in which no coverage was approved.

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