Asides & Insides

Patient advocates are crying foul over a first-of-its-kind coverage policy instituted by Blue Cross and Blue Shield of Tennessee—one that requires seriously obese members to undergo intelligence testing before being approved for bariatric surgery.

The Obesity Action Coalition has called for the Tennessee Blues to immediately scrap the test, part of a rigorous medical and psychological screening process prior to the procedure. The coalition claims that the policy, implemented by the Chattanooga-based company in April 2006, is discriminatory and sets a dangerous precedent of denying access to care based on a patient’s intellect.

“They’re perpetuating the ugliest of stereotypes associated with obesity today—that the obese are somehow of lower intelligence than the general public,” says coalition spokesman James Zervios. “It’s just another hurdle for the obese patient to overcome in trying to access life-saving treatment.”

By its own account, the Tennessee Blues is the first known insurer to require IQ testing to access any medical procedure, bariatric or otherwise. But the 4.6 million-member company insists it has never denied coverage based on a patient’s IQ score; rather, the test results are used to ensure that patients are “mentally equipped” to undergo a major procedure that will require them to make lifelong changes in diet and exercise.

“There is nothing in our policy that indicates you cannot have the procedure if you score below a certain level,” says Tennessee Blues spokesman Mary Thompson. “But based on what a person’s score is, we know how much follow-up they will need or how intensive the case management should be. If a person’s IQ is deemed low … it could have a bearing on the level or method of (preoperative education) and follow-up they require.”

The new policy comes as health insurers, deluged by bariatric-surgery claims, have been moving to restrict coverage of the $25,000 procedure. Some insurers have stopped paying for the surgery altogether, while a growing number of others now require patients to either lose 10% of their body weight or prove they failed a medically supervised diet program.

Zervios fears that the Tennessee Blues’ new policy could create a snowball effect among insurers desperate to cut costs. “This is something that needs to be stopped before it catches on anywhere else,” he says. “Otherwise, what’s next? Denying cancer patients chemotherapy if their IQ scores come back too low?”

Peter Manous didn’t last long as chief financial officer for Hind General Hospital in Hobart, Ind. The for-profit hospital hired him in December to oversee its finances and pay vendors. A month or so later, he was gone, and nobody would say whether there was a relationship between his departure and his track record of absconding with other people’s money.

Hind, which opened last year on the site of a now defunct Charter psychiatric hospital that closed in 2000, quietly employed Manous, who also has a law degree, shortly after his release from federal prison. He pleaded guilty in U.S. District Court in Hammond, Ind., in 2004 to giving and receiving kickbacks in connection with a failed $10 million property development financed by a union pension fund. Manous, a former chairman of the Indiana Democratic Party, resigned that post in 2003.

After learning of the hiring, the local Gary (Ind.) Post-Tribune newspaper had a field day, noting the ease with which Manous and numerous other convicted Democratic politicians in heavily Democratic northwest Indiana quickly find employment with political benefactors after prison.

Manous, who remains on probation, “resigned for personal reasons,” says gastroenterologist Navin Barot, a Hind co-owner and the president and CEO of the hospital. Manous could not be reached for comment.

When asked why he hired a convicted felon to oversee finances at his hospital, Barot says: “I didn’t know a lot about his past. But he found the hospital site for us several years ago and knows the area well.”

Slips and falls inside hospitals frequently cause preventable injuries. But it was the potential for falls in the hospital parking lot that steered Ripon (Wis.) Medical Center to a classic American solution: the drive-through blood draw. Hospital phlebotomist Sharon Schlueter “noticed patients were having problems,” says the facility’s laboratory director, Connie Sina.

The critical-access hospital, located nearly 80 miles northeast of Madison, lets the emergency bay double as a stop for those with scheduled phlebotomy appointments. Donations helped Ripon Medical Center buy a mobile blood-draw cart that can be wheeled up next to the passenger-side window.

Stroke survivor Bob Levonowicz became the first to test the service in December. Levonowicz lost the use of an arm and leg and relies on his wife, Judy, to help him move from car to wheelchair and back again during monthly visits to the medical center for blood work. “I roll down the window in the car and stick my arm out,” he says. Schlueter “comes over and draws the blood. And that’s it. It’s convenient and safe.”

In case you missed it: A New Orleans doctor stood trial for allegedly euthanizing patients during Hurricane Katrina. Even though the judge clearly thought the defendant was guilty and didn’t hesitate to tell her that to her face in his chambers, the jury sympathized with the defendant who braved unconscionable conditions to stay with the patients. The jury found her not guilty thanks to the heady work of a well-known Boston law firm.

OK, so the Jan. 9 episode of ABC’s “Boston Legal” was fiction. The scenario is close to what transpired in New Orleans, where a doctor and two nurses have been charged with four counts of second-degree murder. Not much to report on the real legal drama other than that one source says a grand jury will be impaneled in the next couple of months, which should give the defense enough time to study Alan Shore’s impassioned closing arguments from the TV courtroom drama.

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