Do not move Scott wrote on Jan 8, 2008 12:47 PM:Don't move Scott. The people from Blue Cross must hear a public outcry on his behalf. He is making progress daily and without the intensive therapy he is getting, he will not recover. Palomar Hospital is known for its medical prowess, and it is now time for it to be known for speaking out in behalf of one of its patients.

RAY wrote on Jan 8, 2008 12:52 PM:The problem is that there so much special interest with this insurance companies and our politicians that they would not do much. This requires a complex solution therefore they(politicians) will not do much. In the meantime insurance companies will keep giving us the short end because they will only insure their profits.

John wrote on Jan 8, 2008 1:58 PM:Best argument yet for taking health care out of the insurance middlemen's pockets and putting it into the people's hands. Get a clue local republican politicians... Your base is not Blue Cross! Sometimes you have to protect your constituents from the free market.

Jack wrote on Jan 8, 2008 2:15 PM:I don't know jack, but I hear tell that I'm a pretty nice feller. Those health insurance companies are just a bunch of bloodsuckers. For every person like Scott who gets a break due to public outcry, there are a million people who are quietly shuffled off to pasture.

NoNHS wrote on Jan 8, 2008 2:31 PM:Anybody who thinks this case is an argument for national health care should look closely at what England's National Health Service does with similar patients. They'd have moved him in November, and they wouldn't have cared about any public outcry, because they don't have to, they're the government. In fact, they're the same government that recently decided it wasn't really cost effective to change hospital bed sheets between patients. This is a coverage dispute between Scott's parents and his insurer. All insurers, even government insurers make cost/benefit decisions regarding their patients. Failing to do so would create a bottomless demand for services that no policy holder or taxpayer could possibly afford the cost of. If there's merit in the parents claim, hopefully Blue Cross will recognize that, but if not, moving a patient to a long term care facility with regular visits from therapists is hardly 'dumping' the patient.

Greenly wrote on Jan 8, 2008 2:48 PM:Why is the insurance company making this decision? Shouldn't it be up to the physicians on what is best for their patient? If money is making decisions like these for people, it is a sad state of affairs. Health Care should be a right not a privilege.

Karl wrote on Jan 8, 2008 3:08 PM:Don't give up the fight. As I posted on an earlier article my best friend was recovering from Leukemia treatment and died last year 2 weeks after being moved into a "home". He was doing fine in the hospital. If I had known about this I would have shown up. Is there a website that posts these events so that I might show up with my support?

GO FIGHT WIN.

Paul wrote on Jan 8, 2008 3:41 PM:Head trauma suffered by soldiers over in Iraq and Iran is also only funded to a certain level of monetary effort of recovery by our Government. Beyond that they are shuffled aside. The one bright hope is a facility called Casa Colina up in Claremont (I believe). Where they take these cases on and do wonders. However funding must be provided by donations. I pray for Scott's recovery and support your efforts, but please also remember our wounded veterans.

Go figure wrote on Jan 8, 2008 4:09 PM:This family is a hard working family that actually has insurance, ... I pray for him and his family and hope that he gets the care that he needs.

Robert24 wrote on Jan 8, 2008 4:34 PM:To "Go figure"; I'm sure that I can read between the lines of what you typed versus what was printed. Too bad Freedom of Speech doesn't apply to us.

Karl wrote on Jan 8, 2008 4:35 PM:"Paula" We all appreciate your sentiments. Please do not bring in the global problem. I do not know Scott's family but am touched by the situation. This blog is all about one indivdual. If Scott's supporters can beat the system it will bode well for a lot of people. Let's focus the energy on Scott.

To Karla wrote on Jan 8, 2008 5:11 PM:"Karla" we all appreciate your opinion but we also value freedom of speech. Rock on, Paul.

Becky wrote on Jan 8, 2008 5:21 PM:I commend Scotty's parents, family and friends for challenging Blue Cross. Scotty has continually made progress since he has been in the hospital. At first the changes were maybe one or two separated by weeks. The last month there have been several improvements. I say they should continue their fight and we the community are behind you all the way!!!

Mission Hills Student wrote on Jan 8, 2008 5:21 PM:Thanks to everyone for their support and their views on the issue. It really is appreciated.

Speaking specifically to 'Karl', there really isn't a website set up for these kind of things. They're really just organized by us. His friends and fellow students keep each other updated, and when things like this occur, it's really just through word of mouth throughout our friends and family.

Karl wrote on Jan 8, 2008 5:23 PM:"To Karla" I assume you mean me "Karl". I am very sorry that I offended you. Peace out.

MHHS Student wrote on Jan 8, 2008 5:29 PM:Thanks to everyone for their support and their views on the issue. It really is appreciated.

Speaking specifically to 'Karl', there really isn't a website set up for these kind of things. They're really just organized by us. His friends and fellow students keep each other updated, and when things like this occur, it's really just through word of mouth throughout our friends and family.

Don't move Scott wrote on Jan 8, 2008 6:03 PM:The nursing homes around here (they shall remain nameless)are not fit to take care of him. My mother was basically neglected at a nursing home and at the hospital too. Fight this.

go to the Blue Cross website wrote on Jan 8, 2008 6:15 PM:look for the anouncement of who their new president is. Call the number on that announcement and complain about what they are doing to Scott. I DARE the censor to post this. Have a heart, public outcry is what will determine if Scott gets the help he needs.

Jeremy wrote on Jan 8, 2008 6:18 PM:This is discussting!!!!Scott needs to saty where he can get the best medical attention possible. Blue Cross, have some kind of compassion.Get well Scott!!

Sorry wrote on Jan 8, 2008 6:54 PM:Sorry about the situation. Just saw the video on tv and the young man is in bad shape. Best wishes to him and his family. Having said that, parents need to think twice about signing a waiver to let their kid play in a rough sport, because sometimes something like this happens, and they will have it to live with.

Tax payer and citizen wrote on Jan 8, 2008 8:34 PM:If I'm not mistaken there's still a burn victim from Mexico(?) at UCSD who is receiving top care! Has the insurance company look at his case yet...oh yeah that's right he is probably being paid for by the wonderful caring citizens of the US...he can have all the time he needs or his doctors feel he needs to heal!!!This boy and his family deserve to be treated better, they have insurance and have gone through the "proper" channels of life to deal with it. It's because of the insurance abuse out there and the idiots that need to run to the doctor for no reason other than attention that this boy and his family are being pushed out of the place where he should be. I just hope that these yahoo's who make the decisions can sleep at night!!!

chris wrote on Jan 8, 2008 9:37 PM:Blue Cross has a department that looks for errors and misstatements on its application questionnaires to try to find reasons to retroactively deny coverage. If they could find evidence of a previous head injury with him, they'd try to cancel his coverage. Then they would try to get reimbursed. They are evil. Ignorant people like No NHS (comment) are in la la land. We need a single-payer government insurance program for all citizens. The private insurance companies have us hostage. Vote for any Democrat any time to try to get national health care.

Jocko wrote on Jan 8, 2008 11:01 PM:I lived and worked in Britain for three years. The National Health Service ROUTINELY cuts off care to patients in exactly the same manner as Blue Cross and for the same reasons. Anyone who thinks a government single payer system is the way forward is the answer to their prayers is deluding themselves.

Just think wrote on Jan 8, 2008 11:29 PM:Luckily Scott has people rallying around him. But think about all the others that didn't have that kind of support...those with no family, the elderly, who were subject to being moved just when their health is precarious. So as you are rallying around Scott, see who else you can help.

Lisa wrote on Jan 8, 2008 11:48 PM:So those of us who have insurance, who pay the premiums are only able to use it for a period of time, decided by our insurance providers. And others from another country without insurance, not legally here, can stay in the hospital for however long to get back to health. DO WE SEE A PROBLEM HERE? Let the young man get the care he needs and deserves. This is just a needless distaction upon the family, taking away time and energy that can go towards Scotty.

We need change wrote on Jan 9, 2008 12:25 AM:Unfortunately, insurance companies are in the business of making money, not in the business of making health care. My insurance company (not Blue Cross) likes to dictate how often I can refill a prescription for a chronic condition -- unfortunately, it's not often enough. However, my issue pales in comparison with Scotty's. Has anyone written to Michael Moore about this? (Check out his movie "Sicko." It doesn't matter where you stand politically -- he shows that situations like Scotty's are way too common.) My prayers go out to Scotty's family and friends. And to his girlfriend: You are amazing for sticking by his side, and for organizing the rally. Stay strong.

We need change wrote on Jan 9, 2008 12:29 AM:Unfortunately, insurance companies are in the business of money, not health care. Has anyone written to Michael Moore about Scotty's situation? (Check out his movie "Sicko," regardless of where you stand politically. You will wonder who the "sick" people really are.) My prayers to Scotty's family and friends. To his girlfriend: I'm sorry you are dealing with this when you should be enjoying your teenage years. You are amazing for sticking by Scotty's side and for organizing this rally. Stay strong.

David wrote on Jan 9, 2008 1:01 AM:Here we go again...This is a decision by Blue Cross that means more about the dollars than the sense. Sure you have health care. You carry our card, but if you have to use our health care. You will get what we want to pay for. Not what you think that you have been paying for.

Mary wrote on Jan 9, 2008 7:30 AM:Chris said this best. No where but in the US do we each pay thousands of dollars in premiums for the priveledge of denying you the service you thought you were paying for. I have a friend who had cancer and was insured by his employer. His doctor gave him less than a year to live, his insurance company denied treatment, his doctor went ahead anyway and four years later he is just fine. The insurance company was all set to literally execute him. There are literally millions of these stories.

K wrote on Jan 9, 2008 7:35 AM:Seems like the doctor should know better than the insurance company whether the kid is making progress or not. Blue shield is obviously more concerned with money than the patient's well being ... A friend of mine just went through cancer treatment. She is now in remission! While undergoing treatment she received a call from her benefits dept to ask her to sign a cancellation agreement on the health insurance and admit she was as good as dead. It's so outragious.

To NoNHS wrote on Jan 9, 2008 7:39 AM:You know nothing...We lived in the UK for 14 years and had two kids, several operations, and routine medical care with first-class GPs. It is not perfect but a whole lot better than here. Big Pharma in the US makes billions and their lobbyists in DC own Congress.

fedup wrote on Jan 9, 2008 7:55 AM:thank you "taxpayer and citizen" this is what needed to be pointed out!

CR wrote on Jan 9, 2008 8:30 AM:Blue Cross is unfortunately just like all the rest of the insurance companies--driven solely by money. We had nothing but bad service by them, and I would not go back to them unless they were the ONLY health insurance company left. This is just a taste of what "national health care" under Hillary would be like--socialized medicine like England and Canada. You can't complain there because absolutely nothing will change.

To All Tax Payer's wrote on Jan 9, 2008 8:38 AM: This is a DISGRACE, SCOTT is a U.S Citizen and he deserve's to best of care!! Why do all the Hospitals give free Medical To those Illegals, and somebody who has a right to be here gets turned away? No I don't believe it's Just Blue Cross, but all Insurances. Hell isn't that what we pay PREMIUMS for and Co-Payments??? We as U.US. Citizens have taken way more than we should have, but to Give Excellent Medical Care to Illegals and not the Insured shows just how uh we as Citizens to th United States. I urge
all U.S. Citizens Get your Senators and Congressman involved, Scott did nothing wrong, he was doing what he loved......

Still curious wrote on Jan 9, 2008 8:57 AM:why no one is upset with the hospital. They set the rates not the insurance companies. Why doesn't the doctor offer to go to the nursing home daily on his own time? Why doesn't Scotty's team pony up some bucks to offset the costs? Everyone is on the insurance companies. Would you like them to be gone? They are the only ones who try to hold the hospital and doctors prices down.

Sick of the fraud wrote on Jan 9, 2008 9:12 AM:In my opinion the behavior of today's major medical insurers is fraudulent. They sell coverage and peace of mind and deliver nothing of the sort. This egregious behavior is solely in the interest of their corporate bottom line, and they get away with it only because they line the pockets of every wannabe politician. This is a hardly a "free enterprise" system. It's time for THE PEOPLE to take charge.

Sicko wrote on Jan 9, 2008 9:14 AM:Once again, Michael Moore is the Voice of the People.

Get a Clue... wrote on Jan 9, 2008 9:53 AM:OK, so you guys think that insurance automatically provides you with unlimited care? Any of you actually read the policies you buy? Obviously not! Basic insurance coverage is exactly that...basic. It has dollar limits associated with it. If you go above the limits, you're on your own. Regardless of what the doctor thinks, if that's the economic deal you struck, live with it! If you want more coverage, buy more insurance! You can get catastrophic insurance that can kick in after basic coverage is depleted. How many of you have that? Now, I'm not defending the insurance companies, but they are a business. They sign contracts, and for the most part they abide by them. If they don't, you sue them - it's the american way. Also, many of your retirement funds invest in insurance companies, so overall, you do benefit from their decisions. It's too bad about this kid, but we live in the USA, where there is no shortage of individual compassion, and every increasing corporate returns.

greeneyes wrote on Jan 9, 2008 10:10 AM:I would think since his progress is coming around, going home with ins-paid help would be nice. I'm wondering why all those people were in his face yesterday on the news. He looked like he neede some space.

Chris wrote on Jan 9, 2008 10:43 AM:Although I am not a fan of the insurance companies it may make sense to move him to a long care facility. I kept hearing about all this progress he is making but after seeing him on the news I don't see much progress. He can't speak, or move and just was proped up and just layed there with his mouth oppen. So I would withold jugment on what the insurance compay is trying to do.

To Everyone wrote on Jan 9, 2008 10:53 AM:PPH (Palomar Medical Center) Received $496Million Dollars from us Taxpayers (Prop BB) Why won't they do the right thing?

Dana wrote on Jan 9, 2008 11:09 AM:I have a 25 year old who is a quadriplegic and requires total care for all his basic needs.He lives at home. At 7 years old our insurance company cut out his occupational and physical therapy because he was "not progressing" This turned out to be the worst case scenario. Because he was not kept in pt and ot he developed scoliosis,he was crushing himself and couldn't breathe, he required painful and extensive back surgery and has steel rods in his back and the worst case is he lost everything he had learned up to that point. We found out a fact back then. Out of 100 families 80% of you will walk away when the insurance company declines to pay. 15% will fight it and eventually walk away because it is so taxing to be in this situation and then your resources financially and your energy run out. 5% will continue to fight and you will win. We have won every time! It is not easy but the insurance companies will risk the problems with 95% of us and only have to pay for 5% of us. They consider that a win. You know, you could ask the insurance co to pay for round the clock nursing, in home support, modifications to your home, respite for caregivers, OT, PT, Tutoring at home, modifications to your vehicle, psychologist, psychiatrist, family counseling, durable medical equipment, physical and occupational equipment,visiting docs and nurses etc.. and then staying in the hospital looks like a piece of cake. I would say he could leave the hospital when all of the above are done! He needs a patient advocate, attorney, social worker, now if he does not already have one! Free of charge to him in the state of CA right now! Keep fighting. ... They will drag their feet forever. This very situation is why people have health coverage. You are doing the right thing, do not give up!!!!!!!!! Our whole lives have been changed because of our son, it is not the life we dreamed about for him or us but it is the life we have and there is alot of beauty in it amongst all this insurance bull crap. Do not ever give up! We have a party every time we win against the insurance companies! Half the time they do not even show up at the appeal process!!!! Do not give up! If they do show up you will get a lecture about how life isn't fair every time!!!!! It is absolutely disgusting!!!!!

Jamie wrote on Jan 9, 2008 12:12 PM:Insurance companies are not endless sources of money, and these cases that cost them millions, eventually show up in your rates. That being said, why is it they are not working on finding middle ground. The costs of Scotty being in an acute hospital setting are astounding. Why is it that he can't be transfered to a Skilled Nursing Facility, but have a seperate contract drawn up to cover a higher level of therapy than the normal contract? Skilled Nursing Facilities use Licensed Therapists with the exact same education and abilities as does an acute care hospital, so in fact there would not be any slowing of his progress if such an arrangement were made. Scotty needs to recieve the best care possible to meet his needs, and to be as aggressive as possible in his rehabilitation, however that doesn't mean it can't be done in a cost effective manner.

Concerned about Scotty wrote on Jan 9, 2008 2:42 PM:To the family, You are all in our prayers and stay strong and fight BC. Let us know when we need to show up and help you.

Rburgundy wrote on Jan 9, 2008 2:50 PM:To Taxpayer and Citizen, do you mean the abuses of the insurance companies or individuals abusing insurance? I hope it is the former because the latter is a red-herring. No one wants more health care than they can use. The solution is a single-payer financing mechanism, but to the person that wrote "vote for any Dem" you are dilusional if you think that's the key to achieving single payer. The frontrunner dems are only slightly better the Reps on Health and all off them want to keep wasteful, private insurance in. To those that want to blame PPH, go back to blaming gays or immigrants while you're at it. The hospital and the providers that work there are doing a phenomenal job. Lastly, to the friends and family - hang in there you can win. Look up Natalie Sarkisian. Unfortunatley her fight cost her her life but the people moved the insurance giant.

Jamie equals BC pr wrote on Jan 9, 2008 2:51 PM:You either don't know much about SNFs or are on BC payroll. Which is it?

Tax payer and citizen wrote on Jan 9, 2008 4:04 PM:I'm tired of people who abuse the insurance business. This in my mind has caused our problems! I have recently had to take my child to urgent care for a broken bone on a Saturday. I witnessed numerous "not feeling well all week" patients who decided to use the urgent care services rather than go to their doctor during the week, which I'm sure is much cheaper! Or how many perscriptions does one patient really need, maybe you need to go to another doctor for a second opinion when all he wants to do is shove another piece of paper at you for a "pill" fix. I've seen $400-$500 dollars worth of pills walk away with a $25 co pay. No wonder our preminiums are going up daily! I just hope Scotts family fights hard and gets whats best for him and his recovery. All he did was go out and play a game he loved he never asked to be put in this situation.

Jamie wrote on Jan 9, 2008 4:11 PM:I know alot about SNF,s and I am not on anyone's payroll. The same therapists in many of these SNF's moonlight in the Acute cares on weekends. (I know some that moonlight at both Tri City and Palomar). If the case manager for the HMO will negotiate with the SNF an individual contract with authorization for increased therapy, you can get the same amount of therapy as you would recieve at Palomar, seen it done many times. Scotty should have all the therapy he can possibly benifit from, I fully support the family in that quest. I also understand that the costs to keep him in an acute care are astronomical, he no longer needs the advanced medical care in an acute, but does need the higher level of therapy. I have seen many younger patients in SNF's sucessfully rehabed. What I am saying is that eventually, despite public outcry, Blue Cross is going to stop paying for acute care, I believe it would probably be in Scotty's best interest to start working with them on an individual contract to enhance his therapy in long term care. Without a contract negotiated directly between the Insurance and the SNF, he will get just basic services in the skilled which may be 1-2 hrs of therapy 5 x week or it could be none at all if they determine he is no longer making progress.

Here's a question wrote on Jan 9, 2008 4:57 PM:What do his doctors say about him moving to another facility? The article doesn’t mention it. And the medical director of rehabs statement doesn't count. He's knows full well that everyone who no longer needs a hospital stay, but still needs rehab, will go to a rehab facility or a SNF. Is he implying that everyone who is placed in a SNF for recovery is not as well served as being in a hospital because the doctors don't come in as often? Fact is that Palomar Hospital is making a TON OF MONEY off this kid...maybe they don't want the gravy train to pull out of town. I mean how often do you get a young man with an injury like this, that brings all kinds of attention to your hospital, and he's covered by a third party payer, and he has friends and family who will use emotional appeals to cause enough public outcry that the insurer has to continue to eat costs with little evidence that further expensive care is what he needs? Of course you get MORE care at a hospital, but is it necessary? It seems that he has been in the hospital for some time, and while everyone would like to demand unlimited access to the highest level of care, it may be time for him to move to a facility for less acute patients. Is the level of care he's receiving now necessary, or is it simply being provided because people are making a big deal about it? Longer stays in acute care hospitals do not necessarily result in better outcomes. In fact, longer stays in acute care hospitals put the patient at risk for contracting things like MRSA, an antibiotic resistant staff infection.

Americans are clearly stupid wrote on Jan 9, 2008 5:00 PM:When I see blogs like these, it makes me sad to be an American. People are so clueless and easily swayed by emotion. Here is the problem with Americans and healthcare: Everyone wants extremely high levels of care, but no one wants out of pocket expenses. Should Blue Cross pay for a CAT Scan for a 25 year old female with no medical history who bumped her head on a hanging plant and has no signs of a closed head injury? No, it's not appropriate. But people demand CAT Scans for such injuries. And doctors order it so they won't be sued. This drives the cost of healthcare up. At some point we have to realize that MORE healthcare is not necessarily positive. At some point it becomes overkill.

Single payer lemmings wrote on Jan 9, 2008 5:01 PM:And then we have idiots who are using this situation to advocate for a single payer system. Have you guys ever been to a socialized country and waited in the queue? I bet not. And if you did, I sure hope you didn’t have a serious illness or injury like this one. You wouldn't have made it. Single payer systems don't work. People demand too much healthcare and have no incentive for controlling cost.

Stay classy RBurgundy wrote on Jan 9, 2008 5:06 PM:For people like "Rburgundy", the answer is: Yes, people do want more healthcare than they need. Zero or little out-of-pocket costs provide no incentive for people to be choosy about the amount of care they are receiving. On the supply/demand curve for healthcare, when the out of pocket price of healthcare drops, the demand curve shifts right. When this happens, the amount of care demanded exceeds supply. When it exceeds supply, costs go through the roof. To counter this effect, the government inevitably rations care. It's called economics--you might want to look into it. However, it is not Rburgundy's obvious misunderstanding of healthcare economics that bothers me most, but that he uses a blog name of one of the greatest movie characters of all time to publish his nonsense. Try using "Brick Tamland" instead...it's more fitting.

mission hills student wrote on Jan 11, 2008 5:06 AM:Every student from mission hills has donated money towards scotty. We have all come together to support a student who has been seriously injured. Everyone needs to think about if this was their child. Wouldn't they want the best? That's what the Evelands are trying to get for their son. They're trying to get him the best treatment they can because they have been at the hospital everyday and have seen him since the day it happened. They saw what he looked like on that day and they have seen the progess. No one has the right to say that he has not improved because there's no one who could prove it. You could watch his stories on the news but that still doesn't compare. Yes he can walk. He goes through hard therapy. He can move too. This kid was just trying to play a sport he loved and a sport that many people love. This kid has a life just like you..his progress improves day by day. He needs to stay in this hospital for as long as he can..because if he doesn't..who knows it could change the way he remains for the rest of his life. Put yourself in the position of the Evelands. What if this was your child? How could anyone not want the best for this kid..he was only playing the game he loves.

to taxpayer & citizen wrote on Jan 13, 2008 12:48 PM:just a little note: since you want to bring up the unfairness of the immigrant in the hospital...his injuries came from helping a helpless 3 year old boy who had already been out by himself for an unknown amount of days during the rage of our fires, becuase his mother had a car accident and died as a result of it. This man was "breaking into " the states but had to abort his own mission because he saw this helpless little boy. So before you go crying about undocumented immigrants recieving unfair medical treatmen, i think you should look at better examples to give than this one, cause it's a REAL poor one. thanx..