Four months later, woman has skull back in one piece

  1. Four months later, woman has skull back in one piece
    Insurance dispute delayed surgery
    Associated Press
    MIDVALE, Utah -- After a lot of red tape, Briana Lane has her skull back in one piece.

    The 22-year-old woman was injured in an auto accident in January, and doctors temporarily removed nearly half her skull to save her life.

    But for nearly four months afterward, the piece of bone lay in a hospital freezer across town -- and Lane had to wear a plastic street hockey helmet -- because of a standoff with Medicaid and the hospital over who would cover the surgery to make her whole again.

    The surgery finally came through after an excruciating wait, during which she suffered extreme pain just bending down and would wake up in the morning to find that her brain had shifted to one side during the night.

    "When you think of weird things happening to people you don't think of that," Lane said. "It's like taking out someone's heart -- you need that!"

    Sonya Schwartz, a health policy analyst for Families USA, a consumer health care group, said insurance horror stories happen every day. But "this particular story is outlandish."

    On Jan. 10, Lane's car rolled over on an icy canyon road above Salt Lake City. Lane, who was not wearing a seat belt, was thrown through the windshield. (She was later charged with driving under the influence and not having a driver's license.)

    Doctors at the University of Utah Health Sciences Center in Salt Lake City removed the left side of her skull to treat bleeding on her brain. Lane's doctor originally scheduled the replacement surgery for mid-March, a month after her release from the hospital, said her mother, Margaret McKinney, a nurse who works in another division of the medical center.

    But the operation was canceled the night before because the hospital was waiting to see whether Medicaid would cover it -- a process that can take at least 90 days.

    Lane, a waitress with no insurance, was sent home from the hospital with a big dent in her head where the bone had been removed but the scalp had been sewn back into place. She stayed at home, able to walk around but not go to work, and had to wear the helmet during the day.

    During the wait for a decision from Medicaid, the hospital could have declared an emergency, moved ahead with the surgery, and figured out afterward who would pay -- the hospital, Medicaid, or the patient.

    But the hospital did not do so.

    Lane's mother said that she argued with the hospital: "We just want what you've taken away. Can you just give us back the skull and we'll go on with our lives?"

    After months of delay, Lane contacted a local TV station, a move she believes hastened the surgery. "All of a sudden -- top of the list!" she said. The operation took place April 30.

    Exactly what broke the impasse is unclear.

    The operation took place after Lane's mother's insurance decided to cover the surgery, as well as her nearly $200,000 in medical bills.

    But hospital spokeswoman Anne Brillinger, while refusing to comment on certain specifics of Lane's case because of federal privacy rules, said the medical center decided to go forward with the surgery before it learned the insurance would pay.

    Utah's Medicaid program has yet to decide whether Lane qualifies.

    Robert Knudson, director of eligibility services at the Utah Health Department, which oversees Medicaid, said the agency has not yet seen enough evidence to decide whether her injuries entitle her to benefits under the law.

    He would not comment on whether her four-month wait was unreasonable. But he said the decision over how fast Lane should have gotten treatment was up to the doctors, not Medicaid. "We only pay the bills," he said.

    A neurosurgeon at Indianapolis' St. Vincent Hospital, Ronald Young, said such surgery would not be considered an emergency, but is typically performed within three to four weeks -- the swelling has to go down first -- because the risks to the patient are high.

    "There's no reason not to replace that as soon as you can," Young said. "I don't like to have people who are walking not have their skull."

    He added: "For a person who is walking, who is ambulatory, to not have their skull is a problem because you get a lot of brain shift. A simple fall, hitting her head or something could be horrendous."

    Today, Lane's close-cropped hair barely covers the long curved scar on her scalp. The blackouts and dizziness are happening less often, and simple tasks are no longer excruciatingly painful.

    But she said the experience has left her a little more cynical about the health care system.

    "Just because they don't have money doesn't mean they should be treated differently from anyone else," she said. "I'm a good person. I just happen to be not as rich as some of them."
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  3. by   catcolalex
    I work at the university hospital where this took place, my opinion on this may be unpopular, but the first thing that comes to my mind is dont bite the hand that feeds. this woman made several choices here. 1-to drive under the influence, 2-no seatbelt, 3-no health insurance, and 4-no driver's licence. I don't know but does no one want to talk about what she did wrong, or is it always the big bad hospital that just so happened to save her life for free? I agree, 4 mos without half a skull seems a bit long, but at least she is alive to complain about how poor a job this hospital is doing in managing her free care. give me a break. Im glad we can add one more free craniotomy to the uninsured, which will eventually help my health insurance premiums to rise.
  4. by   NeuroICURN
    I have to say that I'm with you on this one Cat. I have absolutely NO sympathy for people that drink and drive.
  5. by   jemb
    Have to agree that the woman was irresponsible, not the facility.

    If the patient and/or her mother were so adamant about having the surgery right away, seems like either or both of them could have signed a contract to pay for it over time. Instead they chose to wait for Medicaid, or as it turned out , the mom's insurance approval.

    Hope her insurance turns around and sues the daughter for reimbursement... not that they'd ever get paid, but on principle it would make sense.
  6. by   traumaRUs
    It is sad that this woman's poor choices have landed her in a bad position. I know in Illinois - Medicaid is wrecking us!
  7. by   Audreyfay
    Speaking of bone flaps, I used to work in the operating room back in 1977-1980. I don't know how it has changed since then, but I remember working on a medical unit as a staff RN during an LPN strike at the hospital (in lower Michigan). One particular person I was trying to care for, ended up with a seizure, coma, and craniotomy due to a abscessed cyst on his eye lid. I remember feeling guilty for along time. I felt that this person's change in behavior would have been caught if the nursing care hadn't been so strained during the strike. I wondered if he would ever be the same. To make a long story short, a year later I was working in the operating room and the patient came back in to have the bone put back in. They didn't discuss anything about insurance or anything. But, they waited a year. Hmmmm? But, I was so relieved to find out that he was the same as he was before the incident. No residual. <SIGH> I felt like the weight was taken off my shoulders!