Some Safety Net
Inside room 347 at the Broward County courthouse in downtown Fort Lauderdale, Vicki Lynch curls her arm around her husband Kenny's shoulders, smoothes his blond ponytail, then wipes the puffy skin beneath her eyes with the tips of her fingers. They wait for their names to be called.
This particular small-claims court smells like mothballs and old coats, and except for two suited attorneys, everyone here is dressed like the Lynches: T-shirts, worn khakis, sturdy jeans, the garb of working-class folk. All have gathered here to dicker glumly over unpaid debts with a representative from the North Broward Hospital District.
Unlike everyone else here, Kenny Lynch is unable to broker a payment plan for himself because he has extensive long- and short-term memory loss and significant comprehension problems. He can't remember how much he owes North Broward Medical Center, and he doesn't have the cognitive ability to distinguish a reasonable payment plan from outlandish retribution. His wife, Vicki, negotiates for him.
Plucking a pen from a clerk's desk is also impossible because Kenny has visual agnosia, a condition where the brain fails to recognize and remember what objects look like. He can say his ABCs, but the agnosia doesn't allow him to recognize specific letters on a page. Still, it's taken a year for him to relearn how to sign his name, and he's grateful for the chance to do it.
"It's a mess, but here it goes," he tells the court.
Last fall, after playing three innings of softball at Tradewinds Park, Kenny, then 44 years old, crumpled over from a massive heart attack. It took paramedics a scant eight minutes to arrive, but it took them more than half an hour to get his heart beating again and to get vital blood and oxygen to his brain.
"I was on my knees praying. They wouldn't let me near him. Even the police officer that was on the scene said, 'That guy's dead. He's not going to make it,'" Vicki recalls.
This month, almost a full year later, she's in court haggling with the hospital over a $4368 rehabilitation bill, a bill she can't afford to pay on her $10-an-hour salary as a deli worker for Winn-Dixie. Her battle with the hospital is just one part of a lethal Hydra whose many heads include an insurance company prematurely shucking its responsibility to an enrollee, state and federal governments that provide no forum for patients with grievances against their Preferred Provider Organizations, and a number of big-bucks charities incapable of assisting a man with an uncommon injury.
Kenny Lynch's cerebral injury stemmed from anoxia, a prolonged deprivation of oxygen to the brain. Because his entire cortex was damaged, Kenny's problems are complex and interrelated, and he can't figure out the sequence of everyday behaviors. Simple tasks like brushing his teeth become mind-boggling because he's uncertain what comes first, squeezing paste from the tube or popping off the cap.
"If he had anything more severe, he wouldn't be awake. Some people don't get any awareness, and they lose their personhood. He could have ended up like that," says Dr. Marc Swerdloff, one of Kenny's original neurologists at North Broward.
At the hospital Kenny survived two comas, pneumonia, and a chunk of time where he couldn't recognize his wife and children. Undaunted, his wife massaged his arms and legs, talked with him, and carefully parted IV and respirator tubes in order to lie with him in his bed. "She had his favorite music going on all the time by his bedside. She was always an inspiration for me," remembers Swerdloff.
Two and a half months after surviving his heart attack and his subsequent impairments, Kenny finally recognized his youngest son Joshua's voice, took his first drink of water on his own, and began, on September 28, 1999, what he and his family thought would be a crucial and generous stretch of rehabilitation.
The Lynches thought wrongly. Six weeks into rehab, Vicki Lynch was forced to remove her husband from the hospital because her Winn-Dixie-sponsored insurance company, American Heritage Life, reneged on its initial authorization for Kenny's rehabilitation. "The whole time he was on the rehab floor, we were under the impression that he was covered," Vicki says.
She isn't alone in her assumption. According to a preadmissions nurse on the rehab floor, North Broward won't transfer a patient to rehab without a green light from the insurance company.
"They didn't pay any of it. They told the caseworker at the hospital that they would only authorize three more days and then he had to be out," she says. "Actually, [the insurance company's] words when he was leaving North Broward was, 'He can walk and talk, so what's the problem?'" she recalls.
The so-called problem was that the majority of improvement for a patient with a brain injury occurs in the first three months after the injury. "You can get improvements in functioning after that, but the slope of the improvement is much less," says Swerdloff.
American Heritage offers a vague response to Vicki's allegations. "We encourage you to speak with the patient's family or their health care provider. I'm terminating this call now," a supervisor says in the company's claims department. Winn-Dixie failed to return repeated calls from New Times.
With Kenny in desperate need of rehab, Vicki took him to HealthSouth Rehabilitation, the only brain-rehab facility her plan would approve. At the end of January, Kenny was booted out of there as well. "They told me that he no longer met the criteria for the Dade program for brain treatment. When I asked them, they said, 'He's not showing much improvement,'" says Vicki.
Frantic for help Vicki Lynch rang up established charities hoping, at the very least, that someone would point her in the right direction. What she got was more runaround. The American Heart Association, Easter Seals, and the Brain Injury Association, among others, did not know how to assist or even to respond to Kenny's type of injury. "I even called Alzheimer's [Association]," she laughs, but it's the choked laughter of someone tired of hacking through a thorny and impenetrable bureaucracy. "Everybody you could imagine -- no one referred me to anyone. They told me they never heard of anoxia brain injury."
Earlier this year, after eight fruitless months of minimal-to-no brain rehabilitation for Kenny, the Lynches pleaded their case against Winn-Dixie at a hearing in another Broward County court. After the presiding judge requested a subsequent meeting with all of Kenny's doctors at hand, Winn-Dixie relented. The company finally offered to subsidize treatment for Kenny at the Bridge, a well-respected, state-certified, brain-injury rehabilitation facility.
Five months of rehab at the Bridge have resulted in Kenny relearning how to shave with an electric razor and how to pour a glass of milk. He now writes the numerals one through ten and recognizes them, but despite his progress, the skills he's reacquiring are what most people would consider basic: discerning left from right, distinguishing the difference among a knife, a fork, and a spoon. "He's learning it, but it's hard for him, very hard," says Dr. Mark Todd, a neuropsychologist at the Bridge.
In a perfect world, Vicki Lynch should now be able to breathe a bit easier and focus on her husband's therapy, her sons' keen interests in softball and ROTC, and the family's fishing trips in surrounding Margate canals.
This isn't a perfect world. Vicki Lynch now lies in weighty debt to a legion of creditors. Her family's modest Margate home has narrowly escaped foreclosure. Because of the contrived, hooplike stipulations set by her insurance plan, she has to truck her husband from Margate to Miami Beach every eight weeks for rehab reauthorization from a doctor who's met with Kenny only once in three visits.
Even worse, the Lynches' plan won't allow him to renew his stay at the Bridge until the previous authorization is over, so Kenny's essential therapy lapses in the interim. Already Winn-Dixie attorneys have hinted that its company-assigned doctor will most likely terminate rehabilitation in November because at that time his treatment will no longer be medically necessary.
Vicki Lynch derides Winn-Dixie's speculations. "Kenny's now starting to notice the world around him. And he'll tell you, 'Watch out for the car. Oh, Vicki, there's a kid on a bike, look at the school bus.' He remembered when our anniversary was. How can you test those things?"
The Lynches have little legal recourse available to them regarding Kenny's rehab. A federal statute mandates that insurees can sue their plans for no more than the amount denied in claims. This might help Kenny Lynch with his bills at North Broward Medical Center, but it'll do zilch in terms of continuing his therapy. To date there is no ombudsman in Florida for PPO patients seeking impartial mediation over disputes, but recent federal legislation dangles hope for the Lynches and others like them. If the House-sanctioned Patients' Bill of Rights remains intact and pushes its way through to the White House, big-sum settlements exceeding claim amounts could quickly siphon dollars from employer-sponsored plans.
When the hospital district's representative attempts to explain all of this to Vicki, she grows impatient, presses her lips together, looks away. Congressional arm wrestling holds no place in her daily struggle to help her husband. "We have slipped through every single crack imaginable. People just tell you, you have to hold on, you have to fight. You know, I've fought harder than anybody I know," she says.
Contact Emma Trelles at her e-mail address:
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