Word: trotters
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Such confusions are the loose cog in the vastly complicated machinery of managed care, and the cause of more breakdowns--and personal agony--than anyone would care to admit. "This is reality," says Duke's Trotter. "This happens all the time...
...Brookwood Inn, about 500 yds. from the Duke Hospital entrance. On Friday, a biopsy revealed that Todd was deteriorating fast, headed toward "fulminant hepatic failure." Without a new liver soon, he would die. The family was in no mood to learn, as they did that afternoon from Trotter, that PHP wanted Todd moved to a hospital where it had a capitation contract limiting their financial exposure. Trotter would not tell Kim exactly where they wanted him to go, but it was the University of Alabama Medical Center, approximately 600 miles away...
Hepatologist Trotter told Richard O'Connor, PHP's medical director, that Hunter was too sick to travel. O'Connor replied that the patient could stay at Duke through the weekend, but if he stabilized during that time, PHP wanted him flown to Tuscaloosa, Ala., on Tuesday. O'Connor also told Trotter, according to the insurer, that if Hunter's condition worsened over the weekend, Duke was "authorized" to perform a transplant...
Then, within hours, O'Connor was back on the phone telling Trotter that PHP wanted Hunter moved--not to Alabama this time but to the University of North Carolina Medical Center, a mere 20 minutes away...
...Trotter and Betsy Tuttle, the transplant surgeon who would eventually operate on Hunter, were determined to do what was medically necessary. But on the business end, there was no agreement about payment...