I sent a letter recently to HMSA, regarding its new MRI approval/denial policies, thanking it and chief medical officer, Dr. Mark Mugiishi, for protecting my patients from my lack of medical judgment and clinical skills.

His recent commentary (“Preauthorization protects health, safety of HMSA members,” Island Voices, Jan. 28) and personal letter four days after explained in detail that “obviously we weren’t successful at communicating … HMSA’s motivation.”

Despite my being board-certified in orthopedic surgery for 24 years, a fellow of the American Academy of Orthopedic Surgeons, a former assistant clinical professor of orthopedic surgery at the University of Hawaii School of Medicine, and team physician for the University of Hawaii-Hilo Vulcan athletes, one just cannot be too careful.

I was especially grateful to HMSA for protecting my patient from me recently. Despite her 13-year history of knee pain, nine-month recent disability from such and X-rays that were not definitive, I foolishly wanted to get an MRI to determine the best option to spend resources and her time before proceeding.

Surgery, or physical therapy? Both are expensive and require a significant commitment of time and effort by the patient.

I carelessly thought an MRI would best resolve the dilemma.

I was especially grateful to have HMSA defer to NIA (National Imaging Associates) Magellan to provide a non-orthopedist, a Dr. Arrowwood, of very limited experience, and five time-zones from here, to decide for me.

She had not read the clinical information already sent to NIA as requested, so I was delighted to bring her up to speed on my patient, informing her of all the info already sent — but that extra 10 minutes of personal touch is so much more professionally collegial and efficient, isn’t it? I just would have wasted the time on actually incompetently caring for another patient, probably?

I am so grateful to be enlightened that “without proven instability or a failure of physical therapy,” an MRI was not appropriate medical care and would not be approved.

Brilliant — 13 years, some nine months of increasing pain and disability, and near-normal X-rays were such a meaningless distraction! My bad.

Unfortunately, she refused to actually assume care for the patient going forward after my bumbling attempt. Perhaps HMSA will instead? Not. It does have an app for that, though.

My staffers are also grateful they had to spend five minutes completing the online request (denied), then an additional 10 minutes providing requested records (denied again 24 hours later). Those 15 minutes would have just been wasted on frivolities like other patient care.

And I am grateful that HMSA is not paying for those efforts, nor my time on the phone with Dr. Arrowwood, as that clearly would not be in the spirit of “developing a sustainable community health system together moving forward.” I now totally understand what sustainability is all about: cost-shifting to the doctors and denial of care to patients.

As HMSA clearly had lost all confidence in my ability to properly care for this patient, I had to regretfully inform her primary care doctor that I would not be able to proceed as I was too stooopid to be officially trusted.

I suspect he will now go ahead with automatic physical therapy, after which, if she fails to improve, an MRI will be requested. Again.

And then if she needs an operation, months of disability and pain later, post-op physical therapy hopefully will not be denied because she exceeded her allotment for such already.

As happens a lot.