| News - Friday, July 27, 2007
Catch 22 at El Camino Hospital
Doc: Administration did more harm than good in case of Jimmy Campbell
by Alexa Tondreau
Editor's note: Four weeks ago, the Voice reported that a patient at El Camino Hospital had been released after an unparalleled length of stay — five and half a years. Due to a technicality in his Medi-Cal coverage, Jimmy Campbell, 43, who has a degenerative neurological disease called spinocerebellar atrophy, was unable to receive full coverage for the 24-hour at-home nursing care that his doctor prescribed.
Without the full coverage, said Dr. Ron Hoffman, Campbell's neurologist and personal physician, Campbell would have died, most likely from choking, as he is unable to properly swallow on his own.
The Voice sat down for an interview with Dr. Hoffman soon after that article was published. He described the unusual predicament of a patient unable to leave the hospital for his home, and detailed the conflict between the hospital's administration and Campbell's family and physicians — a personal story that Hoffman believes has larger implications for a health care system under stress.
Beginning at age 29, when he was first diagnosed with the neurological disease that would eventually leave him debilitated, life was not easy for Jimmy Campbell.
According to Campbell's family and personal physician, administrators at El Camino Hospital, where he would spend the next five and half years, didn't make it any easier.
Soon after Campbell was admitted to El Camino, in January 2002, administrators began to put pressure on his family and his doctor, neurologist Ron Hoffman, to have Campbell moved to a nursing home, Hoffman said. But because Campbell was unable to secure coverage to pay for round-the-clock care, Hoffman refused to allow him to leave.
For Dr. Hoffman, it was always obvious what should be done.
"It was Medicine 101," he said. "This person can't fend for himself. He needs tube-feeding, suctioning and someone to attend to his basic needs. Left unattended, he would have died."
Besides attending to his medical needs, a bedside attendant would alleviate some of the internal pain and stress that he goes through as a result of his condition, which has degenerated his body to the point of complete immobility while leaving his mind intact.
"It would be stark terror for him to be alone. Jimmy can't call for help, push a call button or move his arms and legs in any purposeful way," said Dr. Susan Hansen, a neurologist who also cared for Campbell during his time at El Camino Hospital.
Despite this, Hoffman said, the hospital requested that he sign orders for Campbell to be transferred to a nursing home, which the doctor refused to do.
Campbell's parents, Jim and Glenna Cecchini, became so concerned that Campbell might be moved to a nursing home while they were gone, or be left unattended, that in the first year of his hospitalization they lived at El Camino for almost five months straight, often sleeping on the floor of his room.
"We packed up a lot of our stuff, and we moved our clothes in. We hardly ever went home," Glenna Cecchini said.
They also allege that administrative staff did not inform nursing home staff as to the full extent of Campbell's disabilities, or the limitations of his coverage, when the hospital was trying to find Campbell a place to go.
"The first two years was a tremendous strain on us" said Jim Cecchini. "During this time period Jimmy's cost was the primary concern, not his care."
Physicians make the call
While the hospital would not comment on any aspect of Campbell's case directly, citing confidentiality constraints, administrators did describe the general process they follow when a patient like Campbell has been stabilized and no longer requires hospitalization.
"Our responsibility as an acute care hospital and facility, when the patient no longer needs that level of care, is to help them find an appropriate placement," said Diana Russell, vice president of patient care services.
Russell said numerous discharge planners and care coordinators are employed on-staff, and that it is their job to "help the family and physician evaluate the alternative levels of care."
But Russell stressed that whatever their findings, hospital administration cannot legally act in noncompliance to a doctor's orders.
"A physician must write a discharge order before any patient is discharged," she said.
Given the average length of stay for patients at a hospital like El Camino — 4.3 days, Russell said — it didn't surprise the physicians watching over Jimmy Campbell that administrators wanted to see him moved.
"The hospital was not the normal place for him to be. It was not unreasonable for the hospital to want another venue," said Dr. Hoffman.
But despite Campbell's unusual predicament, Hoffman said, there was little in the way of constructive assistance, and mounting pressure to discharge him. It was this interference by administrators that caused so much friction.
By law, Hoffman said, "A physician cannot be unduly influenced and has to have undivided loyalty to his patients. The difficulty occurs when the administrative or insurance company overreach in effect alters the will and intent of the physician's directions on behalf of his own patient."
Dr. Hansen agreed, saying, "There was an attempt to make us do what was best for the hospital's bottom line."
Though the hospital could not say exactly how much it cost to board Campbell, one indication is the minimum amount of insurance coverage needed to provide him with 24-hour care — $250,000 per year, the Cecchinis said.
Within the first two years of Campbell's stay, the Cecchinis went to then-CEO Lee Domanico and asked if the hospital could help with grants to bring Jimmy home. They said they were told the grants were not for individuals, but for the community.
Two weeks later, the Cecchinis said, the hospital offered the family $30,000 to move Campbell elsewhere. The Cecchinis rejected the offer.
Russell could not confirm the offer, but said it is not uncommon.
"We do have a hospital foundation that raises money for individual patients when it is needed. We have provided rent for patients, purchased wheelchairs and medicine for patients, and paid for hotel rooms for homeless patients," she said.
The bottom line
To Dr. Hoffman, a nonprofit hospital like El Camino has a mandate to provide charitable care in appropriate circumstances.
"It has to be remembered that it is a tax-funded hospital. They do not exist unequivocally to make a profit in every instance."
Hoffman believes the Cecchinis would have benefited from a concerted effort by the hospital to appeal to the state, the Medi-Cal system and charitable means to find Campbell coverage. As it was, the Cecchinis were finally able to secure financing for Campbell through the help of Assemblywoman Sally Lieber, who managed to amend the waiver that prevented patients like Campbell from getting full coverage.
After five and a half years, the Cecchinis were overjoyed to welcome Campbell home last month. But they said the experience has left its mark on them.
"I feel disillusioned about hospital care. I've seen behind the scenes, and what they were telling me is, 'Our bottom line is money. You're wasting our money, so get out,'" Glenna Cecchini said.
Drs. Hoffman and Hansen said bottom-line priorities are hardly unique in the health care industry.
"There's been a gradual erosion of physician authority in hospitals," Hoffman said. "There are interferences coming from every sector of the medical community." As an example, he said, "Insurance companies reserve the right to deny payment for tests deemed appropriate by the treating physician."
Hansen agreed, saying, "There needs to be a change in medicine. It is what the doctor orders that needs to happen. We bear the special burden and privilege of working to save a patient's life."
The Cecchinis site both doctors as their "heroes," and say the sixth-floor nursing staff where Campbell was stationed treated Campbell like family and provided him with excellent care.
Hoffman said he was just doing his job.
"It's such a simple story. A doctor gives orders and one would hope all dedicated to the execution of those orders would rally around it. There are no heroics here."
E-mail Alexa Tondreau at atondreau@mv-voice.com | 
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