“Don’t ‘dump’ patients …”
In Marin County, most Medi-Cal patients receive their primary care through an organization known as Marin Community Clinic (MCC). While MCC is not the only primary care provider in the county, it is by far the largest. As in most managed health care systems, a patient has a primary care provider and then receives specialty care as approved by the primary care physician. Marin Pregnancy Clinic is a limited services pregnancy center and does not provide primary health care. As described above, however, it is a presumptive Medi-Cal provider, and provides specialty care related to pregnancy.
Staff at MCC have complained from time to time about patients who receive their primary care from MCC but go to Marin Pregnancy Clinic for prenatal care. Some patients, as a result of pressure from MCC, have decided to stop receiving their prenatal care at Marin Pregnancy Clinic. But the hostility from MCC reached a new height this Spring when a patient ended up in the emergency room.
On May 17, 2013, an expectant mother and patient at Marin Pregnancy Clinic called for advice because she was suffering from flu-like symptoms. Her symptoms were such that the staff encouraged her to get an appointment with her primary care provider. Since MCC was listed on the patient’s Medi-Cal card as her primary care provider, she contacted MCC to set up an appointment. Staff at MCC responded that since she was not going to MCC for her prenatal care, she would not receive an appointment for any other type of care. MCC’s nurse stated that it was unfair for Marin Pregnancy Clinic to “dump” patients on MCC and utterly refused to listen to the patient’s perspective.
Unable to see her primary care physician, the patient ended up in the emergency room. She describes her experience: “I had to go to Novato Community Hospital Emergency Room…where I was diagnosed with bronchitis, a bladder infection, and severe dehydration…I was very frustrated that I couldn’t be seen at MCC and I felt too sick and too weak to defend myself….”
Subsequently, a nurse in MCC’s maternity department called Marin Pregnancy Clinic on a diatribe about “dumping patients” on MCC. She spoke with Marin Pregnancy Clinic’s Director of Operations, Alison Oblites, and angrily expressed that she felt it was inappropriate for one of Marin Pregnancy Clinic’s patients to call MCC regarding anything, even if the patient was a patient of MCC’s primary care department. As Mrs. Oblites explains, “She made it clear to me that Marin Pregnancy Clinic’s patients would be turned away every time unless they transferred their care to Marin Community Clinic.” She refused to consider MCC’s duty to treat patients for whom it is the contracted primary care provider. Mrs. Oblites was stunned by the position MCC was espousing as well as by the unprofessional, vehement tone of the confrontation. She reported the conversation to Mrs. Strom.
Following this experience, Mrs. Strom felt that enough was enough. It was time to hold MCC accountable for its duty to its patients and its position as the largest primary care provider in the County. She asked Life Legal Defense Foundation to work with her in drafting an appropriate letter that would both complain about the offending conduct and demand that MCC accept and abide by its duty.
In researching the rules and policies that apply to a primary care provider in Marin County, LLDF attorneys found that—not surprisingly— MCC ‘s actions were exactly opposite of what they should have been. LLDF Staff Counsel Rebekah Millard comments, “Not only was MCC’s conduct unbecoming to a clinic providing care to low-income patients, it was also a failure to follow the policies applicable to a primary care provider.”
Under the applicable polices, pregnancy testing, counseling and prenatal care is entirely within the control of the patient and a primary care provider cannot insist that a patient go through their organization for such care. As if that were not enough, landing a patient in the emergency room for basic care is exactly what managed health care is intended to avoid. The letter asked that MCC take steps to properly train staff regarding patient choice so that such an incident would not occur again. “Our goal was to facilitate communication between Marin Pregnancy Clinic and MCC, so that the appropriate policies would be followed going forward,” says Ms. Millard.
Less than a week later, Mrs. Strom received a call from MCC’s CEO, Dr. Tavaszi, with her apologies and assurance that the incident would not be repeated. She expressed her desire that the two clinics work together in serving the community and asked that Mrs. Strom speak with the MCC clinic manager to find common ground going forward. Of course, Mrs. Strom was glad to agree—she had been trying for years to open a dialog with clinic management.
“The recent experiences of Marin Pregnancy Clinic show what can be accomplished by working together,” comments Dana Cody, President of LLDF. “We commend Marin Pregnancy Clinic and especially their director, Robin Strom, for the willingness to fight for what is right in both of these situations. We are proud at LLDF to be able to fulfill our mission by assisting Marin Pregnancy Clinic to more effectively defend life every day!”