Model Treatment or Service Plan

RIVERBEND CITY: TAD GREENLAW CASE STUDY

INTRODUCTION: WELCOME TO RIVERBEND CITY

Expository Text: Recent graduates of Beck University, Tad and Becca Greenlaw live in rural Dodd County and have recently had their first child. Tad and Becca have been struggling to maintain the small family dairy farm they inherited while also repaying student loans and dealing with the demands of parenthood. When a horrific farm accident results in the amputation of Tad's right hand, the couple face physical, emotional and financial challenges greater than they ever imagined.

Instructional Text: As you watch this case unfold, consider how different theoretical models could be employed and what issues are being illustrated by this case. Consider also the different systems — micro, mezzo, and macro — and what research topics within these systems are suggested by this case.

Characters in this Mission:

Lydia Candelario – Financial Counselor Jon Conklin – Hospital Social Worker Natalie Gilbert – MD–Dodd County Regional Hospital Becca Greenlaw – Farmer Tad Greenlaw – Farmer Bobbie King – RN–Nurse Manager, Dodd County Regional Hospital Curtis Payne – Physical Therapist

SCENE 1: DODD COUNTY REGIONAL HOSPITAL, EMERGENCY ROOM

Expository Text: In emergencies, medical treatment must be provided, regardless of a person's insurance status. What many people do not realize is that a patient may be billed later for those emergency services. When Tad Greenlaw arrived at the emergency room with a mangled hand, the financial ramifications of his accident were the furthest thing from his mind, but that quickly changed.

Instructional Prompt: Click on all highlighted characters to hear their perspective on the situation unfolding in the ER.

Dialogue 01: Becca Greenlaw seeks help for her badly injured husband, Tad.

BECCA:

Help … I need some help! My husband … his hand … he's hurt his hand… that stupid combine, he was fixing it again and I don't know what happened, I don't know… it's totally crushed his hand…

NATALIE:

Okay, Maam… I'm a doctor. Let me take a look. What's this…frozen peas?

BECCA:

I made him put it in ice…whatever I had that was frozen. Was that wrong?

BOBBIE:

No, that was good. We're going to need to take a look. What's your name, Sir?

TAD:

Tad Greenlaw. Oh man… it hurts so bad. So bad… I've never done anything this bad to myself before. This hurts worse than anything I've ever felt.

NATALIE:

I'm not surprised, Mr. Greenlaw… you've got some serious damage here.

BECCA:

Is he going to lose his hand?

NATALIE:

Not if I can help it, but we're going to need to get him to a specialist. We don't have the skills or facility to properly treat this. I want to get him to RCMC as fast as possible. Bobbie, page Max for me and get Donna to contact Med Air — we need to get him stabilized and on his way — STAT.

TAD:

Med Air..? Wait a minute… a helicopter? We can't afford a helicopter ride. Becca — you drive me there, okay?

NATALIE:

Mr. Greenlaw, air evac is the best choice. The sooner we can get you seen by orthopedic specialists at RCMC, the better your chances are to keep function in that hand. Med Air will have trained personnel who can help you.

Dialogue 02: Bobbie tries to calm the Greenlaws.

BOBBIE:

Mrs. Greenlaw … why don't you come with me so that we can start the paperwork before the ambulance gets here.

NATALIE:

Tad, do you have any allergies to medication? I want to give you something for the pain while we stabilize your injuries.

TAD:

No.. no allergies. But look … I don't have insurance. We kept planning to get it now that we have the baby, but we haven't gotten any yet. I can't afford helicopters and specialists. We're barely making due as it is.

NATALIE:

Let's worry about all that later. The important thing is to get you treated.

TAD:

Not if it puts us in the poorhouse. Does the hospital write it off if I don't have insurance?

BOBBIE:

That's more for the business office to deal with. Right now, we just need to get you on your way to someone who can help you.

BECCA:

Tad, stop arguing with them. They're just trying to do the best for you.

TAD:

Becca — this kind of treatment isn't free. Think about how much having Emma cost — this is going to be 10 times as much.

BOBBIE:

Mr. Greenlaw… you need to try to calm down. We can sort all this out later, but right now, your medical needs are the most important thing.

TAD:

Not if the damned hospital ends up taking my farm, they aren't. You don't understand. All you care about is what you're lookin' at, but there's more to it.

SCENE 2: RIVERBEND CITY MEDICAL CENTER, PHYSICAL THERAPY DEPARTMENT

Expository Text: Farmer Tad Greenlaw suffered a devastating injury and subsequently lost his right hand. With the wound healed, he is now receiving physical therapy and will soon be discharged. His physical injuries are in many ways the least of his problems. Anger, fear, depression and worry that his medical bills will result in the lost of his farm are all causing pressures for Tad and his wife Becca.

Instructional Prompt: Click on all highlighted characters to learn about their concerns and issues.

Dialogue 03: Tad erupts in anger at the end of a difficult physical therapy session.

TAD:

Son of a GUN!!!

[sound of something clattering to floor followed by sound of other stuff being thrown across room.]

CURTIS:

All rightie, then … is that your way of saying you've had enough for today?

TAD:

Yeah, I'm done. I'm sure you think it's really hilarious watching me screw up again and again and again. Big yuck-it-up-time, right?

BECCA:

Come on, babe … don't talk that way. Curtis just wants you to get better.

TAD:

Becca, why don't you shut your face? If you don't know what you're talking about, just zip it, okay?

CURTIS:

Look, man … I know this is frustrating and I know it hurts like the dickens. That's no reason to be nasty. Not to Becca and not to me.

BECCA:

He's just frustrated, Curtis, it's okay.

CURTIS:

No … it isn't okay. Tad, I'll let the orderly know you're ready to go back to your room. Becca — you aren't a punching bag. Don't forget that.

BECCA:

Tad … he's right, you know. It's like you're always angry.

TAD:

I am always angry. I'm scared half to death about how I'm supposed to provide for you and Emma. I've got a hand that's not there that always hurts, and I have a wife who's supposed to be my shoulder to lean on who can't stand for me to be anywhere near her.

BECCA:

How can you say that? That's totally not true.

TAD:

Just leave me alone. Go over to your folks' house and tend to Emma, and leave me alone, okay?

SCENE 3: RIVERBEND CITY MEDICAL CENTER, MEETING ROOM

Expository Text: Jon Conklin, one of the hospital social workers, meets with Tad and Becca to help them begin planning Tad's discharge. Knowing that the financial burden of Tad's medical care is a primary concern, he has arranged for a financial counselor to join the Green law's care team.

Instructional Prompt: Click on all highlighted people to learn more about this case.

Dialogue 04: Jon begins facilitating a discussion with Tad, Becca, and Lydia Candelario, a financial counselor.

JON:

Tad … Becca … how are you both doing today?

TAD:

Better than a one-armed wallpaper hanger… oh, wait … maybe 'bout the same.

JON:

Normally, I'd laugh, but I'll be honest — I'm not sure if that's humor or anger. Various people on the staff say you're angry a lot of the time.

TAD:

I suppose. It's not something I have a whole lot of control over.

JON:

no, but it's something we can help with. You're going to be discharged fairly soon. I'm told that barring suprises, it will be sometime in the next couple weeks. We need to talk about what your needs are going to be and what resources are out there to provide support.

BECCA:

We feel like we're caught between a rock and a hard place — we don't have insurance, but we're not really poor. We're kind of land poor, but obviously we don't want to give up the farm.

TAD:

Becca, don't beg.

JON:

Tad, that didn't really sound like begging to me. It sounded like she was being honest. Can I be honest with you? It seems like you have some serious anger issues that could really cause problems for you and your family. Becca is your main helper and support right now, but I've been seeing you pushing her away. That's too bad, because while she's your support; she needs support and encouragement, too, and she's sure not getting it from you right now. I am worried about what you two are going to do when you're back home and you're in each other's faces 24/7.

LYDIA:

I'd like to address the financial issue. My name is Lydia Candelario and I am with Patient Financial Services in the hospital. What I do is help people who are either underinsured or uninsured in finding help to reimburse the hospital for their care. That might mean determining if you're eligible for state-funded programs such as the StateCare plan or various free-care programs.

TAD:

Free-care programs. Sounds like charity or welfare to me

LYDIA:

Yes, it probably does and I can tell that's something that is hard for you to accept. The bottom line is that we will work with you to find a solution that you can live with. You're not the first farmer to be injured and you won't be the last. Quite frankly, the hospital isn't in the business of running a dairy farm. There are a lot of options and resources that we can explore before we need to start talking about selling the farm.

TAD:

I'm not about to start taking handouts. Get that straight.

JON:

No one is talking about handouts. I think the first thing to talk about is counseling. I really think you need some help in processing what's happened and how you're going to deal with it.

[cell phone rings]

BECCA:

Oh, that's my mom… can I take this please? She's got the baby.

JON:

Sure. Tad — Lydia, would either of you like some coffee or a coke or something while we wait?

MISSION SUMMARY

Congratulations on completing the Tad Greenlaw Case Study. You will have an opportunity to talk about this case with your classmates in a discussion question in the course, and you may choose to use this case to generate a topic for your annotated bibliography. As you consider the case, ask yourself the following questions: What skills and resources could you offer as a generalist social worker if you were responding to this situation? What are some of the key concerns you'd want to address? What social issue does this case highlight at the micro, mezzo, or macro levels?

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