Wednesday, June 17, 2009

More on Flight 1549: What you don't know can hurt you

I once taught a mini-elective for upper elementary and middle school students on writing opinion pieces. We generated a list of what made a piece effective, and included that the piece should consider the opposing opinion and respond to what someone who disagrees might say. Then the kids went off to start composing. One student was writing about his support for gay marriage. He wrote, "Gay people should be allowed to get married. It's the right thing to do." I reminded him to respond to what someone who disagreed to him might say, so he added, "Anyone who disagrees with me is a moron."

The Monday Morning Crisis Quarterback thought of this yesterday when, after writing my piece about Tess Sosa's fight to get insurance coverage for her therapy following the crash of US Airways Flight 1549 on the Hudson River, when I stumbled upon an entry at Plastic Surgery 101 on the same topic. In a post entitled "Exhibit A in Why We Will Never Be Able to Control Health Care Costs," Dr. Rob Oliver, Jr., a plastic surgeon in Alabama, writes:

You think Mrs. Sosa and other passengers would count their blessing to be alive and be thrilled with the $5000 check US Airways issued each passenger in compensation (which they didn't even an obligation to do). Apparently this was not acceptable to Mrs. Sosa who is demanding the airlines insurer, A.I.G., pay for all costs associated with her psychotherapy for post traumatic stress disorder, the unprovable sinkhole of psychiatric diagnoses.

Now, to be fair, Dr. Oliver and I are both guilty of not responding to the opposing point of view, although we did not go so far as to state the other is a moron (at least not yet!). So I would like to address what he has to say a little more fully.

PTSD is, indeed, unprovable. So is pretty much every psychiatric disorder. There is no blood test for schizophrenia, depression, bipolar disorder or PTSD. That doesn't mean they don't exist. And if I were Ms. Sosa and I was interested in going after AIG to milk whatever I could out of a deep pocket, don't you think I'd be going for cash? I can't imagine someone saying, "Gee, you know what I really want? Not a car, not a house, not financial security, no, what I want is some EMDR."

Dr. Oliver goes on to question why the insurer is liable at all, since this was an "act of God," (presuming, here, that the same supernatural force that produces earthquakes and lightning produces massive flocks of geese, which I think is fair). Without looking at the policy, it's hard to know whether this incident as a whole is covered. The standard, though, should be whether physical injuries to passengers would be covered. As I said yesterday, if a broken leg is covered, then psychotherapy should be covered. If a broken leg isn't covered, however, then of course neither should mental health care be covered. All I'm suggesting is that we have parity. I'm guessing we don't.

Trauma reactions are real, and in some cases they are really serious. Someone with untreated PTSD is a ticking time bomb, whether it's a vet who shoots in a crowd or a plane crash survivor who crashes her car into yours. Presuming it isn't real and that people are faking is a very good way to increase the death toll from traumatic events, via homicide or suicide.

Oh, and I just have to say. A plastic surgeon blaming a PTSD patient seeking treatment for the rise in healthcare costs because that treatment may be unnecessary? People who live in glass houses . . .


Dr. Rob Oliver Jr. said...

Sorry, but you missed the point completely. In this instance you have a patient looking for unreasonable compensation for an uncontrolled act of god. Mrs. Sosa was actually given enough money to cover her deductible but apparently does not want to spend it on pscyhotherapy. This kind of entitlement is a distinctly American worldview and would be laughed at in most cultures. A culture full of such people is what is going to derail serious control of health care spending as they wish to remain insulated from the costs of care.

Monday Morning Crisis Quarterback said...

In fact, I didn't miss the point. I just disagree with you. US Airways gave her a check, that is true. What was that supposed to cover? Is that in lieu of any and all claims for anything? Again, had she broken her leg, would that treatment be expected to come out of the $5,000? If so, then I guess my argument is with the lump sum approach. If not, then what is the difference?

Let me put it another way. If a drunk driver hits my car and I wind up in the hospital, his insurance pays me for my treatment and I can sue him for pain and suffering for additional money. Ms. Sosa got $5,000 for pain and suffering, now she wants her medical covered as well. You can argue that the $5,000 shouldn't be for pain and suffering, but if that's what it was then that's what it was.

This may indeed be a flawed system, but it's not Ms. Sosa's fault any more than it is yours or mine. The way to change the system is to change the system, not yell at people who try to use it fairly and legally.

Anonymous said...

The check given to the passsengers of 1549 was to cover such things as lost luggage and inconveniences, NOT pain and suffering. She should pay for her therapy with some of that $5K. How would she pay for mental health care ifan uninsred motorist hit her and caused PTSD? I'm not sure her own uninsured motorist policy wouldpay for that either. Mine didn't.

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Naomi Zikmund-Fisher
is a clinical social worker, former school Principal and a Crisis Consultant for schools and community organizations. You can learn more about her at
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