With all the talk about health care reform recently, I had an experience this week that reminded me what a long way we have to go to truly create quality, accessible care.

Last week, a doctor in our clinic examined a two-year old with 2 small, red pimples on her chest. Because the patient is known to have methicillin resistant staph aureus (MRSA), she prescribed Bactroban, the only effective antibiotic ointment. Unfortunately her mother was rejected at the pharmacy because it wasn't covered by medi-cal.

Not knowing what else to do, the mother (who has 5 other children) treated the pimples with warm compresses. However, without antibiotic treatment, the infection simply advanced. On Thursday, her mother brought her back to the clinic where I examined her only to find that the infected pimples were now two large chest abscesses.

At that point it was clear that the patient would require a strong systemic antibiotic. I prescribed Clindamycin, which is effective against MRSA and works just as well when given by mouth as when given by IV. Sadly, 2 hours later I received a message that the pediatric formulation of this medicine was not covered by medi-cal and would require a treatment authorization which would take 3 days to process.

I spent 2 hours on the phone with the pharmacy, trying to get in touch with medi-cal and our local public hospital trying to find a way to get the medication for this patient. Ultimately, I had to send her to the ER, where they admitted her to the hospital for a two-day stay because there was no way to get her Clindamycin covered as an outpatient.

The result? The state will end up paying many thousands of dollars for an inpatient hospitalization simply because the original $7 tube of Bactroban and then the Clindamycin (less than $100) were declined coverage. On top of that, the real tragedy is the fact that a 2 year old girl had to suffer through an extremely painful infection of her chest wall and endure two days of being poked and prodded in the hospital when the entire thing could have been avoided with some common sense.