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on radio with music playing on radio and radio
A lack of care may have cost her her life.
She blames her HMO.
You don't give doctors incentives for not treating patients.
We got screwed.
Are some HMOs more interested in saving money than in saving lives?
Why would a doctor not bring in specialists, not conduct tests?
Well, fundamental reason would be to save money.
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We're going to talk about accounting today.
She was on the fast track.
I'm going to make you think.
And once you get used to it, it's not that.
Her employer hit the brakes.
Once I became pregnant, all of a sudden, it just changed.
Everything changed.
I'm going to find out.
I'm going to go to work today.
Now this teacher says she got a lesson in discrimination.
What is being pregnant called among women professors?
It's called academic suicide.
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Is this some girl called?
He grew up around legends.
I think here's Myrlansky, lucky Luciano, people like this.
But I had everything growing up, everything but the father.
But years later, he did meet his father.
When did you become suspicious of him?
I would say by the second day I knew he was dead.
What happened next made him a hitman.
Ta-da!
Stardom, a wedding.
On TV.
Do you love your father?
Absolutely not.
Not.
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Good evening and welcome to Street Stories.
I'm Ed Bradley.
We trust our doctors to make the right decisions to keep us well.
But what happens if your doctor decides the most important vital sign is really the dollar sign?
That's a question raised by Janice Bosworth.
She says her life has been put in jeopardy by her health maintenance organization, or HMO.
More than 38 million of us belong to HMOs which were designed to keep health care costs down.
But now there may be some unexpected side effects.
As Peter Van Sant tells us, because of the way that some HMOs are set up,
some doctors may be making a fateful choice between saving lives and saving money.
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Oh, I love you, I love you.
You're such a good little girl.
You know that?
I shouldn't be alive right now.
I should have been dead a while ago, I'm sure.
To me it's a miracle that I'm standing here and it's a miracle that I was able to take Christopher to his first day of kindergarten.
I, last year at the time I never thought I'd...
Janice Bosworth has cancer.
Is that your name?
And she's angry that her son may grow up without her because, she says, her doctor deliberately ignored her symptoms for months.
I lie in bed sometimes at night and I just cry thinking about Christopher not having a mother.
Have a good day, bye sweetie.
And I lie in bed at night and I think, and I should do this, but I think, boy, if I only take and think matters into my own hands.
Oh yeah, let me see.
It all started three years ago when Janice, then 29, says she found a lump on her breast.
Janice went to see her doctor who works with an HMO, a health maintenance organization.
I asked for a mammogram and he said, you do not need one at this time, let's wait a month and we'll recheck it.
Janice says her doctor told her it was just a cyst.
You know what? We're going to go home and eat lunch, okay Christopher?
I went back to see him the next month and I said, now I have two lumps.
Right by each other I have two lumps now.
And he looked at me and said, what are you doing here?
Janice says it took five months for her doctor to finally give her a mammogram.
So they called me back and they said, they said, oh, yeah we do have your mammogram, everything's completely fine, don't worry about a thing.
I said, are you sure? I mean, I would feel better at least if you, oh no, come back in four months and we'll recheck you.
Janice decided to get a second opinion.
And that doctor said her mammogram report and his examination clearly showed a problem.
I've never seen a doctor so upset.
He actually looked at me and said Janice, this is, it was very diplomatic, he said this is not a cyst, I don't know what it is.
He said, it needs to come out right now, you cannot wait.
Within days Janice's worst fears were realized.
Her cysts were cancerous tumors.
What were you thinking now?
You know, I just thought I did something different.
It's not your fault, you're not the doctor.
I know.
But I just felt like maybe I had to be the doctor.
I did read. Would you have ever told a woman or a man that came in with a lump and the symptoms that Janice had, would you ever say, well, let's wait four months?
No. No. Not with what Janice had.
Dr. Gary Davidson, a cancer specialist, is now Janice's doctor.
What does your gut tell you? Why do you suppose she was asked to wait?
I, somebody would want to go through the potential expense of doing the surgery.
Janice is convinced that she is a victim not of bad medical judgment, but of a system that fosters greed.
Janice's doctor works for an HMO plan that uses what's called a shared risk pool, and it works like this.
Doctors set aside a pool of money to pay for tests and specialists, and at the end of the year, if they don't spend that pool money on patients,
they divide up what's left among themselves.
They split up the money.
They split up the money. That's correct.
Do you see something wrong with that system?
Absolutely. It's a conflict of interest. It's a different conflict of interest. That's it. Good.
Dr. Michael Palazzolo is the chief of staff at Granada Hills Community Hospital outside Los Angeles.
He sees the effects of HMOs trying to save money.
So there is an attempt on the part of the group to decrease the amount of admissions, to decrease the amount of surgeries, or to delay surgeries.
It almost sounds now like we're having an adversarial relationship between the patient and the doctor.
You got it.
You don't give doctors incentives for not treating patients. I mean, is that the way it's supposed to be? No.
Chris, do you want tuna fish?
Janice and her husband Steve believe her doctor's medical decisions were clouded because of the shared risk pool.
You both believe that at least in the back of his mind he was thinking, hold off on these tests because of this shared risk pool.
He didn't want to diminish it. He didn't want to take money out of his own pocket. You really believe that?
Oh, absolutely.
Yeah, and I don't think it was in the back of his mind either.
I think it was in the front of his mind.
I think it was right in his hip pocket.
Has her doctor's name come up as having this problem of undertreatment?
This is a problem. This is not an uncommon thing.
There is a major secret that is not being told. The patient should be told. There should be headlines.
Your doctor will be paid less if he refers you to a specialist.
Dr. Ronald Brunow is the president of Physicians Who Care, a national organization of 3,000 doctors.
Earlier this year he testified before a House committee where he warned that some HMOs pressure doctors to limit care.
The examples are nationwide. We have had personal experiences with hundreds of cases of obvious ways where patients were not referred to specialists where they should have been.
A woman who had chronic vaginal bleeding and was not allowed to see a specialist.
And it got worse and worse and the doctor said, look, you don't really need a specialist. It's going to stop.
She finally went to the emergency room of the hospital and it turned out she had metastatic cancer and it was too late.
Shared risk pools are a concept that is designed to encourage primary care physicians to pay attention to cost management.
They have shown to be of benefit or they would have been abandoned some time ago by everybody.
Dr. Bernard Mansheim is a spokesperson for the Group Health Association of America, which represents three quarters of the country's HMOs.
And the point I would make is that when this has been studied and it has been studied, there are several published articles,
there has not been shown to be any systematic reduction in services because of that form of reimbursement.
How can you study under treatment when the patient doesn't know what is under treatment?
The patient has no idea what should be done in any individual illness. All he knows is that the doctor tells him this.
You work for the third largest HMO in Florida. Does that HMO have shared risk pools?
No, it doesn't.
Why not?
We feel that the best approach is to work with the physicians to pay them for what they do under the circumstance where there is a temptation not to spend the money
because if he spends it, it comes out of his pocket effectively, he may decide against it.
So what you're saying basically is that your main concern with the shared risk pools is that a doctor may put money before treatment?
That's the potential and we don't want physicians in our plan to be in that position.
What is it that bothers you the most about the way your mother was treated or not treated?
The lack of treatment, no treatment, almost as if we were bothering them.
Betty Upbrook's 72-year-old mother Judy belonged to a different HMO than Janice Bosworth, but her case raises similar questions.
That's all you want in your life to achieve.
Betty and her stepfather Ted Weiss believe Judy's cancer wasn't diagnosed because her doctor didn't want to spend the money to treat her properly.
My wife couldn't sleep in bed. She couldn't lay down. She had to sleep in that chair over there, sitting up to breathe.
And things were getting worse.
Judy went to see her HMO doctor, who the family says told her that she was suffering from a case of viral pneumonia.
But I told them that my wife had a history of lymphoma from UCLA.
Cancer.
But did they give her a test for cancer?
No, they didn't.
And why, Betty, do you think they didn't give her a test for cancer? She's showing all these symptoms.
I think if you get so much money for a patient and it doesn't pay for you to do any more for that patient, I think that's why. I firmly believe that.
When I was trained in medical school at Harvard, that was one of the lessons that were driven into me, is that you don't need to order an extra test.
It does no good for the patient, and extra tests give you extra information that may often be confusing.
Judy's doctor was this man, Bruce Barnett.
Dr. Barnett is chief executive officer of Family Medical Group, which cares for 10,000 HMO patients, half of them senior citizens.
We've asked you before how you felt about the eventuality of your heart stopping any time in the future.
And you've told us how you felt about being brought back to life with machinery and with resuscitation.
And what you are saying is you do not want to be brought back to life.
That's right. I don't believe in that either.
What are you telling me though about Dr. Barnett's decisions in terms of treatment of your mother?
There wasn't any real treatment there at the clinic.
There is a sense of order.
The Weisses went outside their HMO for a second opinion. That's where they learned Judy's cancer had returned.
They say only then did Dr. Barnett admit her to the hospital.
What happened to her then?
How long was it before she passed away?
Three days. By the time the 16th she died.
Three days later she died?
Yeah.
I think that he felt that maybe senior citizens were a burden at costing her fortune.
This doctor used to work for Dr. Barnett. He asked that we keep his identity secret.
He and other doctors we've spoken with who worked for Dr. Barnett say they were pressured to not order tests or specialists.
I think his philosophy was it's not so terrible to pass on if you've lived a long life, even if it was 65 instead of 80.
I hear many patients over and over again. They do not want to be kept alive just for the sake of being on a machine.
Patients will tell doctors to their face, don't do this to me. Don't resuscitate.
Don't resuscitate or don't even expose me to the surgeon unless you tell me what the chances are I'm going to make my life better.
I placed a person having a heart attack in the CCU who was about 70 years of age, alert, independent, not a burden to anybody.
They had Dr. Barnett come up to me and say, what the hell are you doing? You are costing me too much damn money.
And he tore my orders up and threw them in the trash saying this guy is over 65. He's lived long enough.
And that man took another sheet of orders and I saw him writing on it, do not resuscitate.
And why would he do that?
It's expensive when you try to revive people.
You don't want to talk?
We tried to ask Dr. Barnett about these serious accusations.
You came in, confirmed the doctor and said, what the hell are you doing? You're costing me money.
And that you went over, took the chart and wrote, do not resuscitate on the chart.
You're relaying some perception of someone else in terms of how they see it.
The fact that they remember this like it was yesterday.
Well, I'll tell you what we should do. I think to really talk about this properly and put it in a proper context, we should be, I think,
try to get back to the basic stuff I told you about.
I mean, I am absolutely certain that each and everything that we do in our organization is designed to reach out to the population that needs healthcare and give them what they need.
Do you believe your mother was left to die?
I do. Yes. Had my mother been at UCLA where she was originally.
She might be alive today.
Dr. Barnett has also been accused of questionable treatment by his fellow physicians.
Barnett used to work here at Granada Hills Community Hospital, but when he became the target of an investigation, he quit.
I will ask you about another.
Peter, you know what's happening? Peter, I need to ask you about this because it's important to do that.
My beep went off so I need to answer my beep. And then we can come back.
My beep went off and I need to serve my patients. I'll be back.
Hospital documents we've obtained raise serious questions about why Barnett didn't bring in specialists or order tests for some of his elderly patients.
Can we talk about these things?
Based on your experience, why would a doctor not bring in specialists, not conduct tests?
Well, the fundamental reason would be to save money.
You worked at Granada Hills Community Hospital. You were placed on probation.
Can we talk about that?
You don't want to talk about that? I want you to have an opportunity to defend yourself.
You admit you've made some mistakes in the past.
No, no.
You did to the ad hoc committee that looked into your work at Granada Hills Community Hospital.
I don't know where any information from any particular hospital is entered into any type of a format that you are supposed to be talking about.
I can't even discuss it.
These are public documents. We're very able to get copies of those.
I'm going to have to make some phone calls to help me out with this because whether it's a gynecological workup or a mammogram or a more advanced special test, they're always looking at the money.
It's not the quality of care, it's the money. And this is an outrage that this is allowed to happen, and it is certainly not rare.
I think that HMOs are grappling with how to manage costs. I think they're grappling with how to get physicians engaged in the responsibility to manage costs.
Hi, did you tell mommy about that song you learned?
Time means a lot to me right now. Time means that my son will know who his mother was. Time means that he will remember his mother. Okay, okay. Sing with me.
This old man, he played, he played, next on my seat.
It won't stop with me. It will keep going on with other men and women who don't know enough to, they just don't know. And too many people are going to die because they don't know.
Janice Bosworth is still fighting cancer after having a bone marrow transplant, and she's working with a support group to help other women facing breast cancer.
We want to stress that not all HMOs operate with this kind of incentive. If you're concerned, experts say the best advice is to simply ask your doctor or check with your HMO to find out if it uses a shared risk pool.
When we come back, it might be college football season, but we'll take you to one university where some say that not all the passes are being made on the field.
Essentially what he had said to me was if I had an affair with him, that he would help me to get tenure.
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Day, night, so sleepy yet. Dorothy's at the Golden Palace, but why is Sophia in a rest home? This is ridiculous. You can't stay here. Look at that tush. Ben could be a major bad upset, but how does Mac fit in? Finish blowing up these balloons. And Anthony's broken heart. He's crying into a $27 drink with a 10 cent umbrella.
Will a showgirl cure him? Ben, what are Bill Daly, Steve Lawrence, Dick Martin, and Tom Poston doing at Bob's? Will you marry me? Get out of here right now! Right ahead.
One year after Anita Hill, some workplaces are still feeling the aftershocks. This is a story about one of them and one woman near the epicenter. Her name is Seale Pillsbury. Tonight, Roberta Baskin brings us the story of this university professor who says the ivory tower has a glass ceiling.
I gotta go to work today. I know, I know, I know. It's barely dawn and Dr. Seale Pillsbury is about to leave for work. Good morning.
Seale Pillsbury teaches accounting at the University of Wisconsin's Green Bay campus, a two hour drive from her home near Milwaukee. It's a really long commute. So long she regularly stays overnight.
I'm away from the kids for two nights a week. And that's really hard. That's the really hard part. There is no alternative for me.
Seale Pillsbury has no alternative because two years ago she was forced to leave her job in Milwaukee at the University School of Business Administration.
We're going to talk about accounting today. She had reached the same crossroads most professors do. If within six years senior faculty hasn't voted a junior member tenure a job for life, that teacher must go elsewhere.
And once you get used to it it's not bad but it is very unnerving for the first few weeks. Pillsbury was denied tenure at the UW Milwaukee Business School and the reason she says,
I have charged that the business school discriminated against me because of my gender and because of my pregnancy in my tenure decision.
The University of Wisconsin has a reputation for being one of the most liberal progressive schools in the country. Probably one of the last places you'd expect to hear charges of sex discrimination.
And Seale Pillsbury isn't the type of person you'd expect to be making those charges. She describes herself as a conservative Republican and is married to a prominent banker.
Who are our volunteers for today? I think it was you guys, right? There's no debate. Seale Pillsbury is an excellent teacher. You're a nice crowd, nice crowd.
Her students scored highest in a nationwide CPA exam and she earned an Excellence in Teaching Award given by faculty and students at the business school.
Guys, you're supposed to be able to catch on to that answer. Tenure decisions are based on teaching and research such as having articles published.
Pillsbury says she had been assured by senior faculty she was qualified for tenure. Where does the issue of discrimination come in?
Once I became pregnant all of a sudden it just changed. Everything changed.
Professor Pillsbury became pregnant with her second child just as the school was making its tenure decision about her.
About a month before my decision was made one of the senior faculty members came into my office and said you had better teach your husband to keep his pecker in his pocket or you're not going to get your research done.
He made that remark to me in your office and it was a serious... He wasn't laughing and neither was I.
Pillsbury says that same professor made a similar remark in front of others. And then he said no more of that now so you can get your work done.
No more of that meaning no more getting pregnant?
No more children.
Having a baby is not considered professional. What is being pregnant called among women professors? Some people call it academic suicide.
Some women professors refer to having children before achieving tenure as academic suicide. How do you react to that?
Well I've never been pregnant and obviously it's a tremendous strain.
John Schroeder is chancellor of the university's Milwaukee campus where Pillsbury was denied tenure.
I don't know that it's academic suicide because we have a number of women on campus who have been able to do both. But clearly it makes the process of getting tenure more difficult. There's no question about that.
Dr. Eric Schenker is dean of the business school.
In reality having a child is not the end. You know the child is home and it becomes more difficult at times for them to then achieve the tenure requirements.
But both administrators insist discrimination is not at issue in the Pillsbury case.
Discrimination is not tolerated. I think the Pillsbury case we're looking at here at the portfolio and research record. That's the issue.
They say that the quality of my research was not what they wanted.
Pillsbury had been up for tenure along with three male professors. She was the only one of the four rejected.
This is Auditing and Journal of Practice. This is a very good journal in my field. And this is an article that I single authored myself.
This was an article that I did with a group of other women. A very respected journal. Another single authored article.
I mean my contention is that I am as good or better than the males. That I'm not weaker. That I'm as good.
Pillsbury can't compare her credentials to any other tenured women in the Milwaukee Business School. There aren't any.
How do you feel about the fact that there are 59 professors here? There are 24 that are tenured and there's not one woman.
Well as I said, I don't feel good about this. I mean to me it is embarrassment and I'm doing everything possible to correct it.
Dean Schenker didn't want to discuss details of the Pillsbury case. However in a confidential report explaining its reasons for denying tenure,
the Business School's Executive Committee also personally attacked Dr. Pillsbury. This is their confidential report.
Right. This was their explanation. 19 pages that lead like the inquirer. At one SBA Christmas party on campus,
the appellant wore a sweater that had a small boot suspended from each breast. Was it provocative?
You'll have to judge for yourself. I think you have to have a wild imagination to view that as a provocative sweater. Especially on me.
This is the sweater that they're talking about. I asked Dr. Pillsbury to bring it out for me. Bulky sweater, she's got pointy boots.
You know what are these males thinking that they would look at this sweater and write something up as a reason for denying tenure to her?
Are they suggesting that she's provocative? Well let me say this. If anyone said anything, it is inappropriate.
And yet it went into this document from the School of Business Administration. It is a faculty, I don't know who wrote it.
It's the response to the Faculty Appeals and Grievance Committee as the reason for their defense.
But this is a, as I said, this has not come to the Dean. If that's in there, I think it's inappropriate.
Still Pillsbury isn't the only woman who's had difficulty advancing at the University of Wisconsin.
Women account for only 12% of the full professors at UW. Some departments have one or no women faculty.
Most women leave the university within a few years, a revolving door where young low-paid assistant professors come and go with little chance of ever achieving tenure.
I'm very pleased that so many of you could be here this afternoon to honor our 18 newly tenured women faculty here.
The university defends its record as comparing favorably with other schools, but admits there's room for improvement and says it's trying to hire and promote more women.
Denise Denton, Engineering. Yes!
But like Seale Pillsbury, some of these women say they too struggled with discrimination and harassment while trying to get tenure.
And you're representing the School of Engineering. Right. Where there are how many professors?
250. And how many of those are women who have tenure?
One.