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With her husband looking sicker by the day, Mrs. Dawson grew frantic. Thinking Mr. Dawson was suffering from a spine infection, she called her dentist, who she knew had back problems. He recommended going to the spine center at Seton Medical Center in Daly City.
On March 6, Mr. Dawson was admitted to Seton delirious and screaming. It was there doctors realized he had a staph infection that had spread through his bloodstream and invaded his entire body. His organs were failing and he was going into septic shock. A nurse told Mrs. Dawson her husband was very sick and might die.
Doctors at Seton began treating Mr. Dawson with massive doses of antibiotics but surmised they wouldn't be able to cure him unless they removed Mr. Dawson's pacemaker, which was encased in bacteria. Mr. Dawson had been carrying the device in his chest since 1995. The surgery didn't go well. One of the pacemaker's two leads, wires that connect the device to the heart, broke off as it was being extracted and remained stuck in Mr. Dawson's right ventricle. On April 20, Mr. Dawson was transferred to CPMC in San Francisco, a leading cardiac hospital in the region.
The Dawsons wouldn't find out until later, but the six-week stay at Seton was costly. The hospital billed Valero's health plan $1,135,633.84. After negotiating a $283,908.46 discount, Valero's plan paid $851,725.38. More than half of Mr. Dawson's insurance had been used up. A spokeswoman for Seton declined to comment about Mr. Dawson's case, citing the hospital's patient-privacy policy.
At CPMC, Mr. Dawson was operated on again. The plan was to remove the broken pacemaker lead and replace part of Mr. Dawson's infected aortic valve with the valve of a pig. Doctors also needed to repair another heart valve that had been damaged by the infection. Mrs. Dawson was told the odds were very low that her husband would survive the extremely complex operation.
But the surgery was a success, and Mr. Dawson pulled through.
Over the next few weeks, Mr. Dawson fought through various other complications and began to recover. Then on June 18, he went into cardiac arrest during a rehabilitation session. He was rushed into intensive care and revived. Doctors decided he would need another heart operation to implant a defibrillator.
On June 29, Mrs. Dawson says she was leaving the hospital when she was ushered into a small conference room by Ema Beronilla, an employee from CPMC's financial office. She says Ms. Beronilla told her that her husband's insurance had run out and showed her a sheet of paper indicating that they owed the hospital more than $1 million. Valero's health plan had just paid CPMC $553,727.12 for Mr. Dawson's care through May 19 and informed the hospital that he had maxed out his policy. Any additional bills were Mr. Dawson's responsibility.
A spokesman for CPMC, Kevin McCormack, confirms the meeting but says Ms. Beronilla was merely trying to help Mrs. Dawson understand her financial options, not pressuring her to pay the bill.
Ms. Beronilla handed Mrs. Dawson forms for hospital financial assistance and for Medi-Cal, California's Medicaid program. The hospital bill was equivalent to several times the Dawsons' assets, which consisted of equity in their house and a retirement-savings plan. Mrs. Dawson implored Ms. Beronilla not to tell her husband about the bill because she worried it would affect his still-fragile health.
Three days later, while Mrs. Dawson was away, a man came by Mr. Dawson's room and briefed him on the financial situation. Mr. McCormack, the hospital spokesman, says that Ms. Beronilla relayed Mrs. Dawson's request to her supervisor and that she doesn't know who informed Mr. Dawson. "We regret that this happened," he says. Mr. Dawson, always good-humored, took the news in stride.
Later that day, a representative for Health Care Legal Services, an organization CPMC employs to coach uninsured patients on their financial options, called Mr. Dawson's room to enroll him in Medi-Cal. Mrs. Dawson answered the phone and declined, thinking her husband's income was too high to qualify him. She also wanted to review their options with an attorney.
HCLS sent the Dawsons a letter stating that it was returning their account to CPMC "so that they can initiate their collection efforts." Under intense emotional stress, Mrs. Dawson says she interpreted the letter as a threat. An official for HCLS says it wasn't trying to intimidate the Dawsons but merely to educate them about available assistance programs and help them apply for them.
On July 9, a defibrillator was successfully implanted in Mr. Dawson's chest. While her husband resumed his rehabilitation, Mrs. Dawson drove to Palo Alto to see Michael Gilfix, a lawyer who specializes in estate planning. Mr. Gilfix told her Medi-Cal might be willing to cover the hospital bill retroactively. But to qualify, their assets, excluding their home, had to be less than $3,000. That meant they would either have to spend down their retirement-savings plan or donate the money in it to their son, giving up their retirement cushion.
In addition, Medi-Cal would require that the Dawsons contribute any monthly income beyond $900 to their medical bills. Mrs. Dawson decided to rule out Medi-Cal because, with a mortgage on their house, she says there was no way they could live on that small an income.
Valero continued to pay Mr. Dawson his full-time salary until state disability kicked in -- beyond the period it was obligated to, according to the Dawsons. Mr. Dawson was also told his job would be waiting for him, even though Valero could hire someone to replace him after six months, he says. Valero declined to comment on the case, citing its employees' privacy.
CPMC discharged Mr. Dawson on July 26, and Mrs. Dawson drove her husband home. As they entered their house, Mr. Dawson lost his balance and fell. Mrs. Dawson was trying to help him up when the phone rang.
It was Ms. Beronilla, the hospital's financial counselor. Mrs. Dawson says Ms. Beronilla reproached her for declining to meet with HCLS and fill out the Medi-Cal enrollment forms, and told her the hospital would start billing immediately. With her husband still splayed out on the floor, Mrs. Dawson remembers replying: "Do what you have to do."
Ms. Beronilla declined to comment. Mr. McCormack, the CPMC spokesman, confirms the phone call. He says Ms. Beronilla called the Dawsons at home only because she had unsuccessfully tried to get in touch with them before they left the hospital. The purpose of the call, Mr. McCormack adds, was merely to see whether the Dawsons had filled out the hospital's financial-assistance forms.
Effectively uninsured with his Valero coverage exhausted, Mr. Dawson still needed close medical attention. Fortunately, he had served in Vietnam so he was eligible for care from the Department of Veterans Affairs. Mr. Dawson enrolled in the VA system and began attending physical-therapy sessions at a VA hospital in Fresno three times a week. But the VA wasn't obliged to cover his previous medical bills.
Hoping to stall CPMC, Mrs. Dawson sent the hospital two checks for $30. Bills were also piling up from doctors, so Mrs. Dawson also sent them small sums to keep them at bay. The Dawsons weighed whether to declare personal bankruptcy.
Before they made any decision, Mrs. Dawson asked to see an itemized bill from CPMC. When she received it, she was shocked by how much the hospital had marked up inexpensive items like the stockings. CPMC charged Mr. Dawson between $2,225 and $6,675 a night for an oxygen mask to help him breathe while he slept. After he was discharged from the hospital, the Dawsons rented one from a medical-supply store for $250 a month. Mrs. Dawson resolved to try to negotiate the bill drastically down.
"I do not deny that our charges look insane," says Dr. Pont, CPMC's chief medical officer. But all hospitals operate the same way, he says. "It's the reality of the industry."
Once its operating costs are factored into an item's charge price, Dr. Pont says the hospital marks up that price by threefold to account for the fact that it only collects on average a third of what it bills in any given year. Although the nonprofit hospital reported $123.7 million in operating income last year, Dr. Pont says the money goes to charity care, cutting-edge medical equipment and new facilities to comply with the state's stringent earthquake-safety guidelines. CPMC says it dispensed $5 million in charity care last year and gave another $6 million to community clinics and health centers.
In her quest to know exactly what she was being billed for, Mrs. Dawson also asked the hospital for copies of all her husband's medical records. A copy service used by the hospital called to say the copies would cost $1,030. Mrs. Dawson was outraged. Further angering her, a letter from CPMC's foundation soliciting a donation came in the mail.
Earlier this week, Mrs. Dawson was contacted by a CPMC official with surprising news. The hospital said Mr. Dawson had qualified for financial assistance under its charity-care policy and wrote off his entire bill. Asked why the Dawsons hadn't been told they could qualify for charity care before a reporter contacted the hospital, CPMC said Mrs. Dawson never gave it the opportunity to explain its policy to her.
Told at one point that he would never walk again, Mr. Dawson is looking forward to going back to work at Valero in January. An avid car-racing fan, he recently went to see his son officiate at a race.  |