"No different from tens of millions of disabled Americans, my medical needs are dependent upon publicly financed institutions" . . .
As a resident of South Florida, I’ve come to know the VA medical facility in Miami all too well. Witnessing frustrated military veterans waiting for delayed services, mirrored by a staff asked to do the impossible. Physicians, clinicians, nurses and all other support personnel whose efforts demonstrate fierce determination to “answer the call.”
Yet, their faces reveal unavoidable vexation. This is the result of two wars, with our combat veterans subject to stop loss orders, and multiple tours. Regrettably, dedicated medical professionals and administrative staff labor under a system overwhelmed by demand.
The Miami VA hospital increasingly added to the way in which war has affected me. One of the saddest days of my life was when my friend Bill, a decorated Vietnam Veteran left this world for the last time. He’d been trapped by mental demons that eventually proved too powerful. His final battle lost the day that was his last at the facilities psychiatric ward.
Bill killed himself later that night, and I wept, remembering the bronze star he had been awarded and his later distress over the fall of Saigon. In South Vietnam, Agent Orange and PTSD, post-traumatic stress disorder, caused him to become permanently disabled. The U.S. Dept. of Defense of the 1960’s and 70’s refusal to acknowledge this significantly advanced his demise.
Before his death, continual visits enabled me to do what little I could in the way of assistance. I came to know many Vietnam Veterans who suffered exactly as Bill had. Nonetheless, since the night Bill took his life, the Miami VA Hospital became a place I never wish to enter again.
I have not, and remain determined to stay far away from the facility – and Miami as a whole, (including UM-Jackson Hospital), even if it may translate to inferior care for my needs. The trauma that the Miami VA came to represent affected me in several ways. You see, I live with many of the same type of demons my friend Bill had.
In fact, those phenomena originally brought us together, and forged bonds so strong they became unbreakable. I loved Bill. He was my “brother.” We understood each others depression, anxiety, mood swings, and at the worst times, psychotic features characterized by a temporary detachment from reality.
My “buddy” did not die because the medical providers attempting to help him failed. For many residents agree that in So. Florida, the best available overall quality medical care is located in Miami, at UM-Jackson and the adjacent VA Hospital. He died because the memories he brought back from Vietnam overpowered him. He fought them to the very last minute, when every ounce of strength gave way to the disease that ended his life.
Far outweighing the singularity of my personal experience, multitudes of problematic situations challenge the delivery of services. With a population well over one million Miami-Dade County residents, publicly financed health care is never limited to military veterans. Irrepressibly, in the So. Florida county of Miami-Dade, criminality runs rampant. Puzzling questions bedevil officials when investigating the systemic culture of health care in Miami.
The public health care system consists of free hospitals and clinics, along with Medicare and Medicaid. This type of structure is little different from other locales. However, “free” is clearly a misnomer, while consumers who cannot afford to pay for either insurance or out of pocket expenses are able to access medical care, someone must pay for it. This states the obvious of course, and just as obvious, is the fact that Florida taxpayers disproportionally share the cost.
[Authors note: FL has neither state nor local income tax. Funding for all government services is entirely dependent upon property taxes and sales tax].
Paramount to any discussion of public health care in Miami is corruption. In order to understand the criminal systemic culture that is present in this environment, it is necessary to digress for a moment. Corruption in Miami had grown as large and as fast as the Cuban American population, which completely dominates life there. Let us shift focus for a moment, as this helps explain the preponderance of criminal activity.
The Miami International Airport, MIA, has been a leading topic of discussion for many decades, relative to corruption among elected officials, airport officials and individuals doing business there. In particular, the Miami Herald has done numerous exposes’ uncovering illegalities – in the process, helping end one episode of corruption, and then followed by another. Many time’s it has seemed endless. As one was discovered, and prosecution ensues, future criminal activities rarely diminish.
What has this to do with public health care?
Alas, some of the same forces propelling illegalities at M.I.A., surfaced as medical practitioners and medical insurers became ensnared by a web of ignominy that some have described as having no limits.
The Cuban American community in Miami has thrived and prospered in an unprecedented demonstration of success among a large immigrant populace. As a whole, they have contributed to So. Florida in wonderfully positive ways. They are worthy of congratulations for laudable efforts.
Nevertheless, the criminal element is systemic, and accusations of the existence of a “Cuban mafia-type” presence are common. One may argue that a virtual plethora of labels similar to these exist in nearly all major cities in the U.S. We have heard of the “Russian mafia, Mexican drug-lords, Salvadoran gangs, the Chinese syndicate, and of course, the precursor, the Italian mafia or Cosa Nostra.”
Unarguably, one of the worst transgressions placed upon the public health care system in Miami is the preponderance of illegal activity. Connections to organized crime and the appearance of a proverbial “Cuban mafia” are difficult if not impossible to dismiss. Too many recorded illegalities point to the powerful hold that these elements maintain.
No different from MIA their link to the public health care system is evident. Doctors, dentists and other health care practitioners open up offices and clinics minus a medical license and freely operate without oversight. In many other instances, illicit suppliers sell fraudulent documents; additionally, county officials have done so.
These medical providers regularly over bill for services rendered and bill for services not provided, adding patient names who do not exist. Medicaid fraud in Miami is big business with ties to an underbelly of organized crime that continue to defraud the system.
Despite hundreds of reports, and recorded documentation, criminal prosecution rarely takes place, bringing the criminal justice system itself into question as well. So widespread is the practice, that the drain on resources is estimated at $ hundreds of millions of dollars annually. When an occasional judge issues warrants, arrests made and indictments handed down, it barely makes a dent in the overall comprehensive domination by corrupt participants.
Part I of this series of articles discussed corruption in the public health care system throughout Florida at length. For example, in Broward County, which borders Miami-Dade to the north, pervasiveness of physicians illegally providing access to opiates for addicts discredits the medical profession. Media coverage calls these quasi-medical offices “pill mills” that have resulted in an epidemic of narcotic drug use. It is representative of the shortcomings that exist simultaneously with, (in certain cases), efforts that sustain a good quality of life. Pursuant to that duality, I would like to speak about my personal experience.
Having taken every aspect of all of this into consideration, I made life-altering decisions regarding my own health care. Purposefully, rather than in Miami, I access participating public medical facilities combining to form B.H.C.S., Broward Health Care System. This program provides medical services for the poor, disabled and many seniors. Funding in large part is through Medicaid.
It became my lifeline to doctors and all medical services. The care available is not comprehensive, or sometimes completely unavailable. Gaping holes make the safety net inefficient at best. I accepted it, considering myself fortunate, to have most of my primary needs addressed. Until I needed more, a lot more.
I found myself unable to stand or walk, wheelchair bound, and stuck in a system incapable of providing help. This is how the story unfolded . . .
At age fifteen, I hurt my left knee playing football. Nearly all the kids in my neighborhood played every sport, sometimes organized, most often unorganized, on fields, concrete playgrounds, in the streets, and in our living rooms. My knee hurt a lot, so I sought relief. The doctor said, “Synovial fluid” … whatever that is, my young minds only concern was getting back to my friends. He did nothing about my knee.
I ignored the pain, got older, and it worsened until nearing age sixty I could no longer walk. Spending the rest of my life in a wheelchair was unacceptable to me. Any solution involved publicly funded health care provisions, with their failed policies and practices.
In South Florida, (and the entire state), public health care is underfunded, inefficient, and privately administered; thus resulting in severe criticism by consumers, and the media. It is widely recognized that individuals who receive services from privatized medical care contractors are typically dissatisfied. Often, their health put at risk by a structure that just does not work.
My inability to function normally involved multiple challenges. One of which was getting from place to place. For me, special needs wheelchair transportation to and from doctor’s appointments was sporadic at best.
At least half of the time, I was either late or transport did not show up. Said appointment on those days, cancelled. Repeatedly after waiting an entire month or more for referral and authorization to see a particular medical provider.
In order to improve medical provisions for disabled citizens the Congress of the United States enacted federal legislation entitled The American’s with Disabilities Act, ADA. Lamentably, it has no seeming impact on the delivery of services to disabled American’s residing in Florida. This reality documented by my own personal experience along with millions. As pertains the severity of one’s illness - such may result in severe worsening of conditions or even death.
Dr. Matthew Moretti, my primary care physician and his staff worked tirelessly helping me find a surgeon to address my situation. For two years, my privatized health care program had only one available orthopedic surgeon. No reason given, but Dr. Burke refused to see me. Dozens of calls to administrative offices led to blind alleys and dead ends.
Worsening pain accompanied each day, my quality of life enervating. Dr. Moretti refused to give up, and sought a surgeon “Out of Network.” He eventually arranged for an examination by Dr.Yoldis. This surgeon gave me three minutes of his time, stating, “I cannot help you.” Dr. Yoldis is part of a practice that includes Dr. Kanell, and are the Orthopedic Surgeons who treat high profile professional athletes, apparently, not impoverished disabled Floridians.
Finally, living in a wheelchair, emotionally distraught, I sank into a state of severe depression. Dr. Moretti in his unyielding efforts, connected with Dr. Brian Cross, an Orthopedic Surgeon with a sterling reputation. He agreed to do the necessary procedure, (a full knee replacement), and accept Medicaid assignment as payment in full. Dr. Moretti deserves full credit for facilitating this.
The surgery went exceedingly well, rehab began the following day, and the nursing staff attended to my every need. Four days later, an infection began to show signs and symptoms. At Broward Hospital, formerly known as Broward General, now part of publicly financed B.H.C.S., they immediately called in a team of specialists, determined what was wrong, and the treatment required.
The hospital’s social worker advocated upon my behalf. She prevented discharge to a Nursing Home. Those facilities do not administer proper care. I may have lost my leg if not for her efforts.
Thankfully, the worst did not happen. She pushed through a transfer to Broward North Hospital, part of the same public system. I met Dr. Samuels, Medical Director of the Rehabilitation Unit, occupying the entire fourth floor. One of the most interesting men I have ever met; he is an outstanding doctor and administrator.
Dr. Samuels, a neurologist, oversees a team of health care professional’s second to none, in my estimation. The infection treated successfully; I underwent three hours of physical rehab every day, and discharged twenty-four days later. The infection gone, my new knee capable of full extension, a wheelchair no longer needed, as I began walking a half-mile daily, and increased to a full mile. The public health care system, [Medicaid] authorized extended Outpatient Physical Therapy, which is currently continued.
I may be getting older in years, however, I feel younger in spirit. Sure, I miss Bill, always will. So many from the Vietnam era are gone now. Both those sent to war, and many who stayed home, their lives torn apart by a nation then at war with itself. Killed in military combat, or by drug addiction, untreated mental illness, homelessness and combinations thereof.
I survived the insanity of the 1960’s and early 70’s. However, survival is not anywhere near the same as a good quality of life. Mental and physical health are not separate things; the brain not disconnected from the body. I suffered in both body and mind.
Prior to becoming disabled, I always worked hard, paying my fair share of taxes. When the time came for needs supplied by the system I had paid into, more often than not, they were either lacking or non-existent. Then, after years of misery and frustration, the public health care system in Broward County, Florida, successfully performed beyond reasonable expectation.
In Florida, making what transpired for me unlikely is largely due to underfunding. Gov. Scott rejected the Medicaid Expansion Formula of the A.C.A. The impact of his decision resulted in further privatization with less choice and increased gaps in coverage.
In the United States, life being what it is, politics plays a significant role in most everything. In Florida, the practice of medicine is no exception. The Republican Party overwhelmingly dominates the State Legislature in Tallahassee. These folks do not support health care for the poor, disabled and seniors who cannot afford Medicare supplementary coverage. To highlight the political stranglehold they enjoy, see the map below:
Ill-advisedly, the same applies in other states rejecting the A.C.A. Medicaid changes, affecting impoverished and disabled citizens nationally. In the U.S. today, while statistics map an improved economy, increasing numbers of American’s are living in poverty. Private philanthropy has never been able to handle the overwhelming numbers and needs of disabled persons. Therefore, the importance of publicly financed health care cannot be overstated.
While this article shines a positive light on the care I received, (albeit subsequent to injurious application), a full investigation of systemic intricacies shall follow. Part III expands this report to the nation as a whole. Future additions to this series of articles include interviews with health care providers. Along with insufficiencies imposed by private contractors and privatized oversight, as part of a comprehensive analysis.
“Thank you for your interest in this and other subjects, discussed in Jays Jewels.”
Medicaid Fraud: Crime, no punishment in Florida - … www.floridatrend.com/article/14833/crime-no-punishment
Cuban Mafia Medicaid Fraud … http://www.afrocubaweb.com/news/calatayud.htm
Florida Agency Crackdown on Medicaid Fraud … http://www.examiner.com/article/florida-agency-crackdown-on-medicaid-fraud
F.B.I. Report on Florida Health Care Fraud … http://www.fbi.gov/miami/press-releases/2013/supervisor-of-63-million-health-care-fraud-scheme-sentenced-in-florida-to-10-years-in-prison
Wikipedia / Miami Cuban Mafia … http://en.wikipedia.org/wiki/Jos%C3%A9_Miguel_Battle,_Sr.
Miami Herald / Miami International Airport Insurance Fraud … http://www.miamiherald.com/news/local/crime/article5562765.html
Miami Herald / Miami International Airport Corruption, Drug Smuggling … http://stopthedrugwar.org/blog/archives/2005/08/airport_corrupt.html
Miami New Times / Miami Cuban Organized Crime … http://www.miaminewtimes.com/2013-07-11/news/cuban-organized-crime-miami/full/
South Florida Business Journal / $ 1.7 Million Medicaid Fraud http://www.bizjournals.com/southflorida/news/2012/09/28/final-member-arrested-in-17m-south.html
- About the author: Jay H. Berman writes Jays Jewels. Due to illness, he is an infrequent contributor to dailykos.com, Thepoliticus.com, Buzzfeed.com and Chicken Soup for the Soul. Jays Jewels welcomes all comments, questions and concerns. Send them to email@example.com or, use the space provided by these publications. You can Follow Jay on twitter @BermanJ1