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Dear Dr. Frist,

Hi!  I'm Cassie. You don't know me, because I'm in Heaven.  I'm one of the new angels trying to get acquainted.  Trying to learn the ropes and robes.

When I died I was just 6 pounds or so - a 35 week old stillborn.  But they let me animate my soul up here into a 20 year old exterior.  So I'm able to kind of learn what my life would have been if ...  Anyway, I'm pretty artistic.

Well, I understand that you're a doctor and senator.  Congratulations!  Your Mom must be proud.

And you have the ear of President Bush on HMOs and stuff like that.  His main health adviser. So it would seem like you're the one I need to reach.  But I'm not allowed to really reach directly, just to inspire someone through the Net.  So I picked that loose cannon - Dr. Chuck Phillips - to type my letter. Needed someone not so shy with senators and all.

I'm worried about my Mom.  She lost a Kaiser arbitration this week.  Now she got the Big Zero and may even have to pay off Kaiser's high priced "experts." I guess she should have taken the $100,000 they offered (maybe really only
$50,000 to her after costs), but she just over valued me and said no.  She had too many dreams of what I could have become.  She trusted that the arbitration panel would get it right.

I don't think she understood from the Kaiser ads that everything is all speeded up in that system.  And the Kaiser contract doesn't say that either. It just says that when you learn what the care really is all about, your complaint goes to arbitration.

Actually, Kaiser is even allowed under "the law" (Earth law) to have secret conversations with one of the three arbitration judges. Kaiser admitted it. Can you imagine that?  Wouldn't that be like me flirting at the pearly gates?

So, okay, I'll get to the point.  My heart lung machine - the placenta - was a mixture of Mom and Dad surfaces.  And it set off, like it does so often, an illness called pre-eclampsia.  It's an immune war which makes blood vessels go into spasm and can kill either the Mom or the Baby or both.

In fact, pre-eclampsia accounts for 25% of baby deaths in the US.  So we've got to really watch out for it.  Well, I mean those of you still on Earth.

One day my Mom got this terrible blinding light in one eye.  Couldn't hardly see well enough to dial the Kaiser number.  She came to the Kaiser ER somewhere - in a kinda fancy city - at explained her problem while looking all pregnant with me.  In fact, we were both in trouble, but the triage nurse only talked to her.  Don't you think that we belonged in OB to be checked? There is always an OB doctor in the same hospital.

The doctor who saw us in the ER ...  Well, I can't tell you what he did, cause I had my eyes closed and all.   In fact, his report had the words "amended report" typed twice before the text even started.  Now doesn't that sound like he redid it twice after he later heard I stopped kicking?  He says no, but I'm going to check with the Chief up here someday.

Anyway, I've come to learn that a flashing light can be the spasm of blood vessels of this pre-eclampsia illness as it moves into a serious stage.  This should have been the clue that we were both in trouble.  But my Mom was told it was migraine and sinus infection.  I thought ER doctors have to work backward from the most threatening condition.

And why throw away the urine sample and do no blood tests?  What is the rush? Isn't the Kaiser ER volume kinda predictable?  Just need to staff to do things right.  Somewhere in the $15 billion, there must be a budget for
staff.  I did hear that the ER doctor just got promoted, so someone is getting paid.

Now, Kaiser would not allow the evidence that their own Clinical Practice Guideline (CPC) for care of the mother states that my Mom's blood pressure alone should have triggered a mandatory OB referral right then.  They said
the CPC was from a Kaiser division of "the federation" that was different from my Mom's home city.

I ask you - How can "Best Evidence" vary in each Kaiser location.  I thought this was the best evidence on Earth.   And I think were talking about a health chain with similar fries everywhere.

Well, I got to watch the arbitration process from up here.  Fascinating but frustrating.  I sure wanted to question Kaiser's OB expert.  I would have asked - like How much did you get for agreeing that my Mom and I should go home without seeing an OB doctor?  Would you have sent your pregnant daughter home with my Mom's symptoms and blood pressure?   I think you would have had your daughter's child delivered while there was still a chance of surviving this illness.

Anyway, I'm not asking you to help my Mom directly.  I want you to help all the other Mom's out there to get the right care in pregnancy so we don't fill up in Heaven with stillborns like me.  (And help the Grandmas to stay alive, too.  And let's catch those men before their lethal heart attacks - TUMS doesn't help.)

First of all, I think with your family so connected to managed care, you need to go on a new and BIG listening tour.  Just visit Kaiser ERs at 10 p.m. in any city and you will get an ear full.  I mean talk to the patients - exit interviews or lobby interviews; try to mix it up. Don't bother with the notebooks - that's just accreditation prom stuff.

Next, go through Kaiser's arbitration files with a tour guide who knows what Hippocrates had in mind.  Then make sure the patterns of medical damage by omission become very public.

Then, help stop this pre-agreement to arbitrate when only the health plans know what is in store for the patient; get the country back to the constitution where juries get to decide things;

Then, restore patient rights which were taken away in 1973 by the HMO Bill; oh, and withdraw your version since it actually weakens California patient protection;

When all that is done, come visit my Mom and tell her that you heard from an angel and made it all better for the rest of the nation.  She'll understand. And maybe, just maybe - you'll get to come up here at meet me someday.  I'd
like that.

                                              Yours truly,


 [written by Dr. Chuck Phillips of Fresno, California during a reflective and receptive moment]