Red Tape Stymied Skull Surgery

Briana Lane says she likes having her skull back.

One morning in January, the 22-year-old woke up in the hospital with her long hair pulled up on one side into a ponytail. On the other, she was bald, with only skin and sutures covering an area where nearly half her skull had been removed.

She stayed that way for almost four months, a dent in her head showing where her skull was taken out to save her life after a car accident.

After Lane was released from the hospital in February, her skull remained in a hospital freezer while paperwork passed hands between the hospital and the Medicaid health insurance program to determine who would pay for the surgery to make her whole again.

"When you think of weird things happening to people you don't think of that," said the former waitress. "It's like taking out someone's heart -- you need that!"

Today, Lane's close-cropped hair barely covers the long curved scar on her scalp where her skull was finally replaced on April 30, months after the accident on an icy road that sent her to the emergency room.

Lane has lost hearing in her right ear and speaks in a soft, raspy voice, having damaged her throat after repeatedly ripping out oxygen tubes while under medication. She considers herself lucky for surviving the accident but says the months spent living at home without a portion of her skull were excruciating.

Waking up in the morning, she would notice how her brain had shifted during the night to one side. She was given a plastic street hockey helmet to wear during the day for protection.

"You'd think they could give me something better protective," said Lane, adding, "Like a skull, perhaps."

Lane blames the delay in her surgery to bureaucratic red tape between the University of Utah Health Sciences Center and Medicaid. Without funds to pay for the surgery herself, a frustrated and unemployed Lane eventually contacted a local television station, a move which she believes hastened the surgery.

"All of a sudden -- top of the list!'' she said.

Hospital spokeswoman Anne Brillinger said she could not comment on Lane's case under federal patient privacy guidelines.

But, she said, an uninsured, low-income patient in Lane's situation must wait for a Medicaid disability ruling to come through, a process that takes 90 days from the time of the initial discharge from the hospital. Alternately, the physician could expedite the surgery by considering it an emergency and signing a certificate of need, but the patient would still be responsible for payment. The hospital did not initially consider the second surgery an emergency, Brillinger said.

Medicaid refused to pay after it was decided Lane did not meet the insurance program's disability requirements, said Robert Knudson, Utah Department of Health's director of eligibility services.

To qualify, Lane would have to meet the Social Security's definition of disabled, which means totally disabled with the disability expected to last one year.

"It's not trying to be bureaucratic about it but it is a requirement of the program. The only way you can get on it is to meet that definition of disability," Knudson said.

Lane's situation is not unique, Knudson said.

"These tragedies happen every single day and Medicaid is one source, but it doesn't cover everybody."

Lane doesn't know who paid, or will pay, for the recent surgery, but said she recently signed up on her mother's insurance, which kicked in two weeks ago.

Hospital spokeswoman Brillinger said the surgeon decided that it was the "ideal time to have the surgery," and signed a certificate of need, which indicates to the hospital's financial department that "this is important to the continuation of her care.''

"Even the financial arm of the hospital never would do anything to jeopardize the health of a patient, especially in this case a patient whose life we saved," Brillinger said.

More than a week after the surgery, Lane is starting to live a normal life. The frequency of blackouts and dizziness are decreasing and simple tasks like bending down are no longer excruciatingly painful.

The experience has left Lane sympathetic to low-income people like herself confronted with the difficulty of paying for major medical care.

"Just because they don't have money doesn't mean they should be treated differently from anyone else," Lane said. "I'm a good person, I just happen to be not as rich as some of them."

By Alexandria Sage