Knees for the Needy: WC’s Adventures with American Medicine

Give my feet to the footloose 
Careless, fancy free 
Give my knees to the needy 
Don't pull that stuff on me  

— John Prine, "Please Don't Bury Me," 1973

WC’s right knee in October 2021; x-rays last week show it is even worse now

WC’s right knee is a train wreck. After an October 2021 MRI, the radiologist described WC’s right meniscus – the wad of cartilage that cushions the knee joint – as “macerated.” That’s an ugly word. Since then, the meniscus has just deteriorated further, to the point that today it’s a bone-on-bone joint and more than a little uncomfortable. Sometimes, at seemingly random moments, when a bit of the remaining meniscus gets jammed up, the knee doesn’t bend at all. WC’s ability to walk normally, to climb or descend stairs, or to carry any weight any distance, is shot.

Every physician who has examined WC’s knee says it’s time for a TKR, a Total Knee Replacement. WC agrees. Since February, WC has been trying to get the surgery scheduled. There’s still no date.

WC’s first orthopedic surgeon had planned to do the surgery at an outpatient facility. But that facility, looking at WC’s age and long list of health issues, and the fact that it doesn’t have an emergency department if something went sideways, declined to host the operation. That first orthopedic surgeon didn’t have “privileges” – authorization to perform the TKR – at St. Luke’s Hospital, the only hospital covered by WC’s HMO. Grid-locked by the health insurance industry, WC was referred to another orthopedic surgeon, specializing in knee replacements.

After the seemingly unavoidable two month delay to get HMO approval of the referral and an appointment with the busy physician, WC learned that it was a six month wait to get surgery at St. Luke’s; the earliest surgery could occur was in December 2022. Given the deterioration that’s occurred in the last six months, waiting another six months wasn’t exactly wonderful news.

It turned out that waiting list at St. Luke’s competitor, St. Alphonsus (St. Al’s) was a little shorter; the TKR could be done at St. Al’s in September. So WC contacted his HMO and asked for them to authorize the procedure be conducted at St. Al’s, an “out of network” procedure. You’d have thought WC was robbing a bank. The “patient advocates” at WC’s HMO – they use that term without any apparent irony – reacted in horror at the very suggestions. After two hours on the telephone with five different “patient advocates” WC was advised he’d have a response to his request in fourteen days. It only took ten. “No.”

So WC and his trashed knee remain in medical limbo. What everyone agrees needs to be done isn’t getting done, or at least not any time soon. Senator Mitch “Turkey Neck” McConnell (R, Hypocrisy), told us that America has the best health care system in the world. Unless he’s confusing WC’s HMO with the the heath care plan Congress has given itself, he’s mistaken. Or lying.

But right now WC has to go ice his knee.

Update: WC got lucky on Wednesday and stepped into another patient’s cancellation, getting a surgery date in late August. Still a bit of a wait but better than the six months otherwise. It doesn’t change WC’s opinion of SelectHealth or our health care system.