Delivery of Care

Putting your own life at risk

For a patient, what are the choices when the health care delivery system breaks down?

Photo by Richard Asinof

A portrait of the reporter after neck surgery at St. Elizabeth's Hospital in Brighton, Mass., a Steward Health Care facility, three days post surgery.

By Richard Asinof
Posted 2/12/24
A true-life tale of spine surgery at St. Elizabeth’s Hospital, revealing the risks a patient faces when the health care delivery system breaks down.
How soon will the General Assembly act on the request by OHIC to raise Medicaid rates for providers in the current budget year? What will the joint legislative oversight hearings reveal about the bureaucratic behavior at the R.I. Department of Transportation under Director Peter Alviti? What is required to find emergency housing for a woman who is six months’ pregnant in Providence?
The level of misogyny and violence against women keeps rising on social media, spurred in part by the romance between Taylor Swift and Travis Kelce – and the inability of right-wing trolls to control the narrative of a successful businesswoman and performer and a top-ranked professional football player in a highly visible romance. Our democracy is clearly under assault by authoritarians around the globe, but here in Rhode Island, we are blessed to have state legislators who are speaking out. ConvergenceRI keeps hearing about a brewing scandal regarding the failure by the Housing Department to pay invoices to providers of homeless services on time, and the onerous contracting hoops nonprofit agencies must jump through to get paid. Senate President Dominick Ruggerio may want to ask pointed questions of the Department of Administration honchos, such as “What’s going on?”

PROVIDENCE – This is a true story of health care delivery in 2024, where I am a participant and an observer, a patient and a reporter, a witness and a survivor.

I admit that it is humbling to be a vulnerable patient who has, as a reporter, spent much of the last decade documenting the financial and political reasons behind the breakdown of the health care delivery system, only to find myself at the mercy of that disrupted health care delivery system, dependent upon the kindness of strangers, nurses, and doctors.

The health care delivery system [if it is a system and not a market organized around extracting wealth, as Dr. Michael Fine, the former director of the R.I. Department of Health, once suggested to me in an interview more than a decade ago] now appears to be approaching total breakdown – overcrowded emergency rooms, understaffed hospitals and facilities, and an inability to access primary care providers. In the economic marketplace, many health systems around the country are teetering, financially unsustainable.

The facts are straightforward: I had cervical spine surgery at St. Elizabeth’s Hospital in Brighton, Mass., a division of Steward Health Care.

The surgery took place on Tuesday morning, Feb. 6, 2024. Following the roughly two-hour surgery and recovery, I was discharged. My adult son, who accompanied me, then drove me home to my apartment in Providence.

My talented neurosurgeon, Dr. Paul Glazer, performed the surgery, as he has done previously in 2008 [L4-L5], 2010 [C4, C5, and C-6] and again in 2019 [C-3, C-4, C-5, and C-6). The direct care I received from the hospital nurses and aides was always attentive and excellent.

The good news is that the surgery appears to have been successful, easing the compression on my spinal cord between C-6 and C-7, which had become significantly narrowed and had resulted in numerous debilitating symptoms.

My fingers and hands had been going numb for months, my legs were losing feeling, I had lost most of my range of motion in my neck, and I had shooting pains down both shoulders.

In short, my condition was a stroke waiting to happen, according to my neurologist, when I was examined on Friday, Feb. 2, four days before the surgery. The neurologist’s resident had displayed my condition on her laptop, showing me the severe narrowing that had been documented in the latest MRI. The surgery was necessary and warranted, the resident said.

Yet, all my knowledge and all the facts did not change the reality. The surgery was risky, very risky, in large part because the infrastructure of the hospitals managed by Steward Health Care and owned by Medical Properties Trust is falling apart.

Some members of my immediate family were extremely worried about my surgery. They were convinced that I was risking my life by having the surgery at St. Elizabeth’s Hospital.

A reporting colleague was relieved upon hearing the news that my surgery had gone well, but had urged me: “Please, never have surgery in a Steward hospital again, the infection risk is too high. Surgeons,” the colleague continued, “can’t control the microbes.”

Getting to the operating room.
Like many things in our disrupted world of health care delivery these days, the journey to get to the operating room was difficult, much like attempting to get answers from customer service at Amazon; the process is long, cumbersome and bureaucratic.

My surgery had been blocked not once but twice by the prior authorization firm, eviCore, deployed by my health insurer. The first time, in August of 2023, the cancellation came via a phone call less than 48 hours before the scheduled surgery.

What was the primary reason the prior authorization firm gave for the cancellation? The MRI the neurosurgeon had been using to make the determination was eight months old, beyond the arbitrary six-month limit set by the health insurer as a metric, and was considered out of date.

I was then required, as a patient with increasing painful symptoms of disability, to jump through more hoops – something that was difficult, given my deteriorating condition. I had to schedule an in-person office visit with my neurosurgeon; I then had to receive authorization and re-schedule a new MRI, which took more than a month.

I rescheduled the surgery, this time for early December of 2023. Once again, eviCore, the prior authorization firm, cancelled the surgery. The reviewers at eviCore apparently had never spoken with the neurosurgeon in a peer-to-peer session; they had apparently never reviewed the actual MRI imagery. Further, they had never spoken with my primary care physician regarding my severe pain levels. [I discovered these “facts” during a successful phone appeal with someone from my health insurer, who thankfully found my arguments convincing and authorized the surgery.]

Translated, it took an additional six months after my first surgery had been cancelled to have the needed surgery.

Breathing out  
After the Tuesday, Feb. 6, 2024, surgery, when I was discharged, a hospital aide transported me in a wheelchair to where my son was waiting with the car. The hospital aide was singing, “What’s going on?” by Marvin Gaye, as he maneuvered the wheelchair out of the hospital.

I found myself singing along with him, catching him by surprise, because I knew the tune and the lyrics.

The aide sang:

“Mother, mother

There’s too many of you crying

Brother, brother, brother

There’s far too many of you dying

You know we’ve got to find a way

To bring some loving’ here today”

And, in a call-and-response, I sang back:

“Father, father

We don’t need to escalate

…War is not the answer

For only love can conquer hate…”

Then, together, we sang: “What’s going on?”

The impromptu, soulful duet in song captured our shared humanity, which somehow had triumphed, despite the ongoing breakdown of the hospital’s infrastructure. 

Breathing in  
I arrived the morning of my surgery at around 5:30 a.m. at St. Elizabeth’s Hospital, to meet the 6 a.m. check-in time for surgery. My son and I had departed Providence at around 4:15 a.m.

We parked the car in Parking Garage B, as instructed, which was unattended and filled with scattered debris. None of the elevators allegedly connecting the parking garage to the hospital were in working order, necessitating my having to walk to the nearest open building on the hospital campus. [Given my disabled condition, I used trekking poles to assist me in walking, and the journey from the parking garage to the hospital building covered more than 100 yards.]

Once inside, we were able to locate a friendly hospital worker who pointed us in the right direction and to a working elevator, which brought us to pre-op admissions for surgery.

While waiting to be checked in, fish in an aquarium in the waiting room checked me out, engaging with me in a conversation that I could not fathom.

I was then admitted; I said goodbye to my son, gave him a big hug, told him I loved him, and headed off with a nurse to take me to my surgical prep.

All the nurses were attentive and caring. When I asked one nurse as she put in my IV, how long she had been working at St. Elizabeth’s, she replied, “Forever.”

Just the facts
In recent weeks, The Boston Globe has reported at length the worsening financial conditions at Steward Health Care hospitals and the dramatic results when medical devices had been repossessed, allegedly contributing to the death of a patient.

No doubt the reporters at The Boston Globe may capture all kinds of journalistic prizes for their investigative stories, which outraged both legislators and citizenry alike.

The problem, from my perspective, is that the reporters were quite a bit late in shining the spotlight on the problems with Steward and Medical Properties Trust and the way that private equity investors were hollowing out hospitals.

Maureen “Moe “ Tkacik had done excellent job at reporting about “what’s going on” early in the summer of 2023, in her story “Quackonomics” in American Prospect Magazine, in which she had written: “Medical Properties Trust spent billions buying community hospitals in bewildering deals that made private equity rich and working-class towns reel.”

ConvergenceRI had conducted an extensive interview with Tkacik, published in July of 2023, entitled: “Has health care fallen under the sway of organized crime syndicates?” [See link below.] In the interview, Tkacik had asked: “Why has law enforcement not been more aggressive in pursuing crimes of fraud in health care delivery?” In turn, she had praised the legal advocacy of R.I. Attorney General Peter Neronha.

In early January of 2024, when Medical Properties Trust fell by more than 30 percent of its value on the New York Stock Exchange, following reports that Steward Health Care was unable to meet its loan repayments, Tkacik republished my interview on X, tweeting: “In honor of $MPW stock falling 31% today here is an interview @RichardAsinof conducted with me over the summer on ponzi hospitals.”

ConvergenceRI had published extensive interviews with R.I. Attorney General Peter Neronha, documenting his legal efforts to prevent Roger Williams Medical Center and Our Lady of Fatima Hospital from closing, including “AG Neronha weighs in on the future of health care.” [See link below.]

Breathing in, breathing out, breathing in 
Rhode Island has numerous paths ahead in its future regarding what kind of investments it wants to make in health care. As Attorney General Neronha has articulated the choices, “If we want the kind of health care system we appear to want, [where] all of us get great care, and grt it in a timely fashion, we are going to have to pay for that system.”

The good news is that I am continuing to persevere, to publish ConvergenceRI, happy to be on the road to recovery following my spine surgery. Upcoming stories include: an analysis of how the opioid epidemic has morphed and the way that the recovery strategies need to change; an interview with David Cicilline, president and CEO of the Rhode Island Foundation, and an analysis of what the 211 calls tell us about Rhode Island. Stay tuned.

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