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He had ‘insurance.’ It didn’t help

By Carol Gentry
7/15/2009 Health News Florida

Because half his face is missing, Jerry Kidd of Pompano Beach hasn’t left the house much in the past three years. He doesn’t like being stared at, and at 6-foot-4, he’s hard to miss.

What cost him his face was a 10-week delay between his biopsy -- which showed aggressive squamous-cell skin cancer -- and treatment. By the time he was referred to a surgeon, records show, the cancer had doubled in size and invaded the bone and face muscles.

It took radical surgery and 31 radiation treatments to get rid of it. Now there’s nothing much left of that side of his face but fatty tissue; his eyesight on that side is gone and the lid won’t close. He can’t keep tears from rolling down his left cheek.

Today, if all goes well, Kidd will finally get his face back, or at least a semblance of it. A plastic surgeon at Memorial Regional South plans to “debulk” the puffed-up cheek, fill in dents and make an eyelid out of extra skin – one that will close.

“They tell me I’ll be surprised at how much I’ll look like I used to,” said Kidd, 57. “I’ll be able to go out and ride my Harley again.”

The delay between biopsy and treatment was caused, in part, because Kidd couldn’t buy normal health insurance. The policy he had, called “limited insurance,” covered practically nothing outside a doctor’s office. (That product, which was called MediClassic, was being sold from an office in Coral Gables, but is apparently no longer available in Florida. The Web site was taken down today after Health News Florida asked the state Office of Insurance Regulation about it; a spokesman for OIR said the state has no record of the company.)

After the treatment, Kidd had to wait two years to qualify for Social Security disability so that he could get a Medicare card. The federal program is paying for today’s operation.

A former mechanic, Kidd lost his job and health insurance in his 40s after getting getting hepatitis C and undergoing a liver transplant. The drugs that kept his body from rejecting the liver suppressed his immune system, which is why he was vulnerable to skin cancers.

In April 2006, his primary-care doctor said he needed to be seen by a dermatologist to have numerous lesions on his chest, shoulders and face removed. His insurance provider list guided him to Melanie Schwartz Hecker. On April 27, Department of Health records show, Hecker performed biopsies and sent them to a Miami lab that contracted with Kidd’s insurer, one she hadn’t used before.

The lab says it sent the report of squamous-cell cancer back to Hecker’s office May 4, according to a DOH complaint, but Hecker would later tell investigators that she didn’t see the results until weeks later.

The failure of doctors’ offices to tell patients about abnormal test results is actually surprisingly common, according to a recent report in the Archives of Internal Medicine. That study found about 1 in 14 such reports falls through the cracks.

Kidd found out about the results on his next office visit, June 6, 2006, when he came in to get a spot on his right chest taken off, the DOH complaint says. On that day and several times afterward, when Kidd came in to get the other lesions removed, Hecker told Kidd he needed the one on his temple taken off.

The problem, Hecker said, was that she couldn’t remove it because it required an intricate technique called Moh’s surgery, which she couldn’t do. But Kidd’s insurance provider list had no one with that skill.

Hecker said one of her colleagues in the Leavitt Medical Group would do it when he was next in town, in a few weeks.

Because Kidd’s immune system was suppressed, the cancer grew much faster than it would have in an otherwise healthy person. By the time he saw the surgeon on July 12, records show, the sore was open and festering, almost 2 ½ inches in diameter, the size of a tomato.

It was too late for a Moh’s technique – or any other treatment outside a hospital operating suite. Kidd went through the emergency room at Broward General Medical Center, which is where he underwent a series of operations in the fall of 2006.

Fort Lauderdale attorney Loreen Kreizinger filed a lawsuit on Kidd’s behalf against Hecker and the Leavitt Group. It ended seven months ago in a settlement of $600,000, plus $300,000 for Kidd’s medical costs, state insurance records show.

The settlement notice triggered the DOH investigation. At the request of the state, Tallahassee specialist Armand Cognetta Jr. reviewed the medical records and said he felt Hecker failed to provide adequate care for Kidd by letting an emergency drag on. The result, he wrote, was “disastrous.”

Hecker’s defense – that Kidd’s insurer forced constraints -- didn’t sway Cognetta. He felt Hecker should have confronted the insurer or, if that didn’t work, recruited help from colleagues. 

“All physicians have to deal with patients whose insurance company makes life difficult…,” he wrote.

In June, Hecker’s case came before the Florida Board of Medicine at a meeting in Fort Lauderdale. Hecker and DOH brought the board a negotiated settlement, which carries no admission of wrong-doing.

Most patients involved in medical-board cases don’t show up for hearings, which usually occur years after the incident that triggered them. Kidd did, though.

He told the board he suspected that Hecker’s delay in arranging the surgery had to do with a desire to keep the revenue inside her medical group. But Hecker said he had only Kidd’s welfare at heart, that any delays were inadvertent. In the end, despite an emotional appeal from Kidd to "stop her before somebody else is hurt worse," Hecker got the settlement she wanted.

It includes a fine of $7,500, a “letter of concern,” some courses and community service. The medical board also told Hecker to have a risk-management consultant review her practice.

Because no probation or reprimand was imposed, Hecker's case will not be reported to the National Practitioner's Data Bank, the place where hospitals, health plans and licensing boards look when they receive an application. However, said DOH spokeswoman Eulinda Smith, it has been posted on the state's Medical Quality Assurance "Practitioner Profile" and will be reported to the National Federation of State Licensing Boards. That body sends such reports to other states where practitioners hold licenses.
 
--Carol Gentry can be reached at 727-410-3266 or at this e-mail.