You're sliced and diced and parsed as a medical patient ... and it's designed to fail."
Not surprisingly, Garza's efforts to find accountability have irked some officials and members of the bureaucratic corps. When he requested a copy of his arrest report from the Sheriff's Department, he received a mocking denial letter signed "R.N. Ratched," a reference to the asylum nurse in Ken Kesey's novel One Flew over the Cuckoo's Nest. As the Guardian reported in 2002, Sheriff's Department legal counsel Jim Harrigan eventually confessed to penning the letter, but only after Garza raised a fuss before the Sunshine Ordinance Task Force.
At Garza's urging, the Centers for Medicare and Medicaid Services (CMS) asked the California Department of Health Services to investigate his treatment at SF General. In a letter dated Nov. 13, 2006, CMS official Steven Chickering informed Garza that the DHS "found no violation of statue [sic] or regulations." Chickering concluded his letter to Garza by warning him to back off. "Your frequent communications have become disruptive, distracting, and nonproductive. Therefore I have instructed CMS Regional Office staff not to accept telephone calls from you in this matter."
Despite his setbacks with the CMS and other agencies, Garza pressed on. He contacted the Office of Inspector General at the federal Department of Health and Human Services and asked it for help. OIG spokesperson Donald White declined to discuss specific details of Garza's case, but he did tell the Guardian that "Mr. Garza came to [the OIG] directly, and we contacted CMS, and they conducted another investigation."
That second investigation found an EMTALA violation after all.
On April 19, Garza's relentless some might say quixotic or even crazy pursuit of what he calls the truth finally produced some results. Nearly six years to the day after his 2001 visit to SF General's PES, hospital officials inked a settlement agreement with the OIG in which SF General conceded that Garza had not been examined properly, a violation of section 1867(e)(1) of EMTALA. Section 6 of the settlement states plainly that the hospital "did not provide [Garza] with an appropriate medical screening examination on April 22, 2001."
The hospital agreed to pay a fine of $5,000. But Garza, as White told us, "is not a party to the settlement." In other words, he got nothing.
"That's the way EMTALA works," White said, meaning that hospitals found in violation of the law pay restitution to the government, not to the victim. "We took the steps required under the law."
Reached by phone, Iman Nazeeri-Simmons, SF General's director of administrative operations, acknowledged that hospital officials signed the settlement agreement but noted that in the course of the investigation leading up to it, "the state did give us a very thorough EMTALA survey and came out with no problems."
"It has been made clear to Mr. Garza that he is more than welcome to come back and access services here," she added.
Garza denied that he had received any follow-up calls from SF General offering services, and he balked at the idea of returning there: "That's like sending someone back to the priest that molested them." He told us he would like to pursue further legal action against the hospital and the city but still has not found a lawyer. After the settlement was signed, he claimed, he asked officials at the OIG "where I could go now for legal and medical help, and they told me, 'That's not our jurisdiction.' "
"So even though I'm dead right, I'm still without help because everybody's pointing fingers ... as opposed to getting me the help I need, because they don't care, they're unaccountable," Garza said.