A past issue of Penn CURRENT, the University's faculty and staff newsletter, contains an article entitled "Wishing Barbaro Well," which recounts the gratifying outpouring of support for the Kentucky Derby winner and describes Penn's New Bolton Center, where he has been cared for since his terrible injury in the Preakness.
Although I am not a serious racing fan, like many people I have followed Barbaro's progress with interest and hope for his recovery. I, too, have been amazed by the efficiency with which he was taken to New Bolton and by the scientific advances and human creativity that were brought together there to provide the opportunity to save his leg and his life. The resources marshaled in his behalf have been extraordinary, and now the results seem to be bearing out the investment.
At the same time, I know that Barbaro's treatment has been special. I think of "R," the ten-year-old boy represented by our Child Advocacy Clinic. R was reported to the Department of Human Services (DHS) last fall because he could not see in school. He has severe cataracts in both eyes, and his glasses had been broken and not replaced. Within the preceding year, R's mother, stepmother and grandmother had passed away, and his father, deeply depressed, was using drugs.
In January DHS filed a dependency petition, and R was placed with a relative who promptly sought, with our help, to get him new glasses. The optometrist could not see him at first because we couldn't get the right insurance card. When with his caretaker's persistence he finally was seen by the optometrist, it became clear the he needed to see an ophthalmologist because his cataracts had worsened. Unfortunately, the ophthalmologist couldn't see him until he got a referral from R's primary care physician (PCP). But now that R was committed to DHS, his old PCP couldn't make the referral.
Our students called, wrote letters and even tried to make the appointments. When R finally saw the ophthalmologist, the decision to operate was relatively easy. Unfortunately, the hospital in which the ophthalmologist worked did not have the particular piece of equipment needed and had to arrange to borrow it from another hospital. We urged that R simply go to that other facility, but, no, that ophthalmologist was not in the same network as R's primary care physician and couldn't perform the surgery. That hurdle, too, was eventually surmounted, and R is scheduled to have his surgery next month.
While the "system" made sure that things were done its way, R has, effectively, missed a whole year of school.
I thought, too, of "T," an artistically and musically gifted thirteen-year-old boy, who was having problems at home and at school, fighting with family members and arguing with teachers. Things got so bad that DHS was called, and a petition was filed.
In January, the court ordered that T begin individual and family therapy as quickly as possible. Despite the best efforts of his aunt, with whom he was placed, and our clinic, we could not move the "system" to get T into therapy until about three weeks ago, after the court again ordered it. In the meantime, his behavior caused him to have to leave the school he had been attending and transfer to a new school.
And I was reminded of "P," a thirteen-year-old girl who suffers from serious mental illness. She was hospitalized and prescribed lithium. When her violent mood swings abated, she was transferred to a residential treatment facility (RTF). The doctor there, seeing certain physical changes in her, thought that her dosage might be too high and ordered a blood test to check. Unfortunately, according to DHS and the insurance industry, P's primary care physician was still the doctor at the hospital, so the doctor at the RTF could not get her blood drawn.
After three weeks of constant effort, we helped to get her PCP changed to the doctor at the RTF, and he had her blood drawn and her dosage reduced. The doctor also wanted a physical examination performed; however, the insurance company refused to approve it because she had been given a physical when she was first hospitalized six months earlier before she was medicated, and their guidelines provided for no more than one physical every six months. Who knows what she has suffered as a result of the system's rigidity?
And there are many, many such cases, locally and nationally.
So while I rejoice at the cooperation of science and human ingenuity and energy to save Barbaro's life, I weep for the millions of children throughout our country who are born into poverty and left to languish there, consigned to a life of grossly inadequate health care, chronic illness, hopelessness and premature death, because we, the people of the country who have the power and the resources to change their lives for the better, refuse to do so.
Editor's Note: Recently, Barbaro has developed an infection in his injured leg following a second surgery on July 8, which is being treated at the New Bolton Center. We wish him a continued recovery.
Guest columnist Alan Lerner is a professor at the Penn Law School. His e-mail address is alerner@law.upenn.edu.
