Dr. Flamm at Northwestern was able to keep Linda’s esophageal bleeding under control by putting tiny rubber bands on the varicose veins with an endoscope two or three times a year. For six years, Linda got along well with her liver disease under the care of Dr. Butter and Dr. Flamm. And, in 2003, her professional success continued. Revenue for the Oak Lawn Center during 2003 was up to $1,321,174.42.
Between 2003 and 2008 Linda only required hospitalization at Northwestern Memorial on two occasions, once for a hemorrhoidectomy, and once for shingles. The shingles was unrelated to her liver disease, but the hemorrhoidectomy was caused by the same portal hypertension that gave her varicose veins in her throat. She had an episode of profuse bleeding from her hemorrhoid, and surgeon Amy Halversen removed it and corrected the problem. The hospital staff and her doctors took great care of Linda. Our only issues were with the insurance and billing, as you can see:
August 10, 2004
Ms. Joy V. Cunningham
Senior Vice President & General Counsel
Northwestern Memorial Healthcare
Suite 3-710
251 East Huron Street
Chicago, Illinois 60611
Via Fax To: 312-926-8287
Re: Linda
Account Number 57251126004
Dear Ms. Cunningham:
My wife Linda is a liver transplant patient at your institution. I regret the need to bother you with this letter, but the refusal of others in your organization to be of any help whatsoever makes it necessary.
We have received a dunning letter, enclosed, from Revenue Production Management, Inc. claiming we owe either your hospital or your faculty foundation physicians $347.65 for deductibles for Linda’s care and treatment, despite the fact each of us has Blue Cross/Blue Shield PPO coverage. The secondary policy should pay the deductibles and co-pays of the primary policy. I contacted your office yesterday by telephone, after attempting to resolve this incorrect bill through BC/BS for several weeks. I was directed to a Mr. Jeff Kurland, who was singularly unhelpful.
I offered to sit down with Mr. Kurland to discuss the bill, if only he would provide me with a printout of all the detailed information he was looking at on his computer screen as we conversed. On four separate occasions during our conversation he refused to provide me with all the information he has about the bill.
I merely want to meet with someone who can explain to me why your organization and BC/BS believe we owe this money. After more than 30 years as a trial lawyer, however, I know better than to come to such a meeting unprepared. It would only waste everyone’s time. I am willing to take whatever time I might require to review all the information available to Northwestern about this bill in advance of a meeting, but Mr. Kurland’s adamant refusal to send it to me makes intelligent discussion of any issues impossible.
BC/BS has provided only meaningless claim histories which contain only dates and money amounts, without any description of the nature of services provided or the identity of the physician providing them. I expected more from Northwestern as the source of these claimed charges. I cannot even begin to determine whether or not the charges are due without all the supporting detail. I explained all of this to Mr. Kurland, and even offered to sit down with him and look over his shoulder at the computer screen to review the information together, though having a printout in advance would be much more efficient for both of us.
The stress resulting from having this unresolved dunning letter in our credit file is damaging to my wife’s health. We need to resolve it promptly. I once again offer to meet with anyone you chose to discuss the bill, but only after I have had ample opportunity to review in detail all of the information which is available to the person I will be meeting with. I would prefer that the person who meets with me be an attorney, for ethical reasons, but I leave the final determination of that matter to you as the top lawyer at your client organization.
It would certainly be a shame for a dispute over $347.65 to end up in court, but if a declaratory judgment action is necessary for me to get, through discovery, all the details Mr. Kurland refuses to provide about this bill, I will pursue that course of action. I appeal to your better judgment in a last effort to avoid expensive litigation over information Northwestern should surely be willing to share with the patient from whom it is attempting to collect money.
I was also contacted by Mary Peterson of your office, who told me she was not the person I should be dealing with, and, like Mr. Kurland, refused to provide us with any details about the origin of the claimed charges of $347.65. I do not wish to handicap myself in discussing this bill by having less information about the charges than the complete detail available to the people representing Northwestern. An unqualified agreement to provide me with every bit of detailed information Northwestern has is what is required here. If refusal to provide this level of detail is indeed the policy of Northwestern Healthcare, let me know that and I will do what I must to get the information to which we are entitled. If it is not your policy, please put me in touch with someone who will provide the information I desire, and, after a thorough review, I will meet with that person in an effort to resolve this dispute.
I trust I have not been too long winded in bringing this unfortunate matter to your attention. I rely upon your renowned good judgment in assisting me to obtain the detailed information needed to discuss and resolve this matter to the mutual satisfaction of my client and your hospital.
* * *
Although Linda continued to work, she got a lot sicker beginning in February, 2009. She was hospitalized twice in February, and once again in March, 2009. She developed serious ascites – a condition in which fluids build up in the space between the two layers of peritoneum, the membrane lining the abdominal cavity and covering the abdominal organs. Ascites makes the belly swell up, and because the fluid which accumulates there is a perfect medium for growth of bacteria, it has to be removed or life threatening infection can develop. The removal is by a procedure called paracentesis. The doctor or nurse practitioner inserts a catheter into the patient’s belly, where the fluid is accumulated, and using a vacuum bottle, draws off the excess fluid. The paracentesis is usually followed by administration of human albumen, in an effort to keep the patient’s bodily fluids inside the arteries and veins instead of in the intraperitoneal space.
Because of the increasing amount of fluid on Linda’s abdomen, and the increasing frequency with which she required paracentesis, Dr. Flamm told us she was a lot sicker than her MELD score reflected. MELD [Model Endstage Liver Disease] is the mathematical model by which UNOS decides who in any particular region is the sickest tissue match on the list when a cadaver liver becomes available for transplant. We were told by Dr. Flamm that in the Chicago UNOS region Linda would need a MELD score of 30 or higher to get a cadaver liver, and that she was not likely to survive long enough to ever get a score above 30. Consequently, In the Spring of 2009, Dr. Flamm recommended we start looking for a live donor among our family and friends. This process brought us into contact, for the first time, with the head of the transplant surgery program at Northwestern Memorial, Dr. Michael Abecassis.
Screening of potential live liver donors at Northwestern is coordinated by Lori Clark. As the process was explained to us, any friend or family member with the same blood type as Linda could volunteer to be a donor of part of his or her liver to Linda by completing the program medical questionnaire and submitting it to Lori Clark. Lori and the physicians, surgeons and others involved in transplant donor screening meet every Friday to look over the questionnaires, and eliminate donor candidates whose medical history or condition would make it too dangerous for them, or for Linda, to use part of their liver in a transplant for her. If one of Linda’s volunteers passes that portion of the screening, the person is then invited to come to Northwestern Memorial for an educational session about what is involved, and lab tests and an MRI of their abdomen to finally determine if the live transplant surgery can be done using them as a donor.
Once a prospective donor has been approved, they are required to take a two week “cooling off” period to talk to their own friends and family and make sure they really want to go through with the surgery. Of course the transplant recipient’s insurance pays for all the testing, and for all the donor’s bills as well.
After questionnaire and screening processing of all the family and friends who shared Linda’s blood type, everyone we knew was ruled out as a prospective donor. So, Lori Clark introduced us to a website called “Matching Donors” which was established to match up willing live organ donors (kidney, liver, bone marrow) with recipients who need transplants. It was the process of working with the Matching Donors web site that the controversy with Dr. Abecassis began.
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