essays and articles by david g allen

O Death, Where Is Thy Certificate Of Need?


Just before the holidays, I went to the doctor's office thinking I had a routine ailment. But while in the waiting room, I had one of those unexpected health scares -- a mortality check so to speak.

As a new patient, I had to fill out several forms. The first, of course, requests that all important personal identification information that consists of an identity thief's bonanza. The next three pages asked me "Have you ever had ... ?" With pen in hand, I checked boxes in the "Yes" and "No" columns.

The next page asked me the reason for my visit. So I wrote: ingrown toenail.

It was page six that explained the doctor's privacy policy in fine print. Though difficult to read -- the copier must have been low on toner that day -- I still had to acknowledge receiving an explanation of the policy with my signature.

At this point, I thought this podiatrist's privacy policy ought to include advice on keeping one's feet covered while in public. I have seen so many sandal-clad, ugly feet that I wish people would learn, once and for all, that Birkenstocks only make their naked feet look mangier. And then there are painted toenails, especially the ones that are half grown out, that really make me cringe.

Then came the killer. Page seven wanted to know if I had a living will and a medical power of attorney. When a podiatrist wants to know this information, then one has to confront the seriousness of any medical condition.

I had been derelict in executing a medical power of attorney because I never felt comfortable with asking someone to end my life. That is such an awesome responsibility to dump on someone else.

But who wants to live Terri Schiavo's life? Nobody wants family and friends to end up in court trying to decipher his or her last wishes.

While sitting in a foot doctor's office, I confronted my dereliction of duty and boldly selected my medical power of attorney-- the West Virginia Health Care Authority.

I didn't even know that the HCA existed until Clarksburg's United Hospital Center decided to move to a new location about five years ago. I live very close to UHC, and I was hoping that the hospital would stay put.

To move, however, UHC had to seek the HCA's approval of a new certificate of need. The process was time consuming and finally had to be decided by the state Supreme Court of Appeals. The court invalidated UHC's certificate of need because the HCA broke its own rules in granting it.

The HCA rules specifically stated that a replacement hospital had to be built within a five-mile radius of the existing facility. UHC's new location was eight miles distant. The HCA has since amended the five-mile rule to accommodate UHC.

Initially, I was mad at the HCA for approving the move. But then a paramedic set me straight. He told me that I lived too close to the hospital to be Life-Flighted. He also said that even five miles was too close to call in the Life-Flight helicopter. But eight miles meant that the chopper could pick me up.

In essence, the paramedic told me the HCA was doing me and everyone else who lived in Clarksburg a favor. I agreed with him and began thinking about the HCA in a positive way.

More recently, the HCA has been involved with deciding who can own and operate CT scanners. It seems that a bunch of greedy doctors want to take that business away from hospitals. Charleston Area Medical Center has said that it makes an annual profit of $45 million from its CT scanning business, which it uses to subsidize money-losing procedures. Doctors, if allowed to own scanners, would just subsidize their already extravagant lifestyles.

I don't know how the CT scanner issue will play out. But I do know this: Only the HCA has the ability and the wisdom to know exactly how many CT scanners we need and, more importantly, where those machines need to be located.

In short, the HCA -- and only the HCA -- knows exactly how much health care each West Virginian needs. This is why I chose the authority to implement my end-of-life directives. The HCA won't keep me alive any longer than I need to be or will it pull my plug prematurely.

David G. Allen
     Clarksburg, WV

"O Death, Where Is Thy Certificate Of Need" originally appeared in the January 18, 2008 issue of the West Virginia State Journal.




Copyright 1990-2008  David G. Allen