Lawyers, HIPAA laws, profits, banning care

Seems the profit margins on bariatric surgery are in the 45% range.
I’d say a great reason to sell you services/products, wouldn’t you? However, think about losing care forever from below, where the law appears to provide no retaliation. Think about the reputation you get. Ask your surgeon and their group about this in writing.

http://www.generalsurgerynews.com/ViewArticle.aspx?d_id=77&a_id=10933
http://www.bizjournals.com/sanjose/stories/2007/09/17/story2.html?page=all
http://hbr.org/product/weight-solutions-clinic-bariatric-surgerycenter/an/KEL030-PDF-ENG
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1402352/
http://www.anh-usa.org/gastric-bypass-surgery-for-everyone/
http://calorielab.com/news/2005/06/19/hospitals-gorge-on-weight-loss-surgery-gravy-train/
http://blog.sermo.com/2014/01/14/peril-and-profit-for-weight-loss-surgeries/
http://www.bostonmagazine.com/2006/05/the-incredible-perilous-moneymaking-people-shrinking-machine/
http://www.fathomdelivers.com/blog/healthcare/marketing-bariatricweight-loss-surgery-online/
http://www.amednews.com/article/20120423/business/304239976/4/
http://abcnews.go.com/Health/100-million-dieters-20-billion-weight-loss-industry/story?id=16297197

http://articles.mcall.com/2012-09-24/business/mc-pennsylvania-ambulatory-surgical-centers-20120924_1_surgery-centers-fairgrounds-surgical-center-surgical-care
http://www.ncbi.nlm.nih.gov/pubmed/9793808
http://www.ascassociation.org/AdvancingSurgicalCare/ascpolicyfocus/pressroom/phc4reportmissestruestoryofascsvalue/
http://www.beckersasc.com/asc-turnarounds-ideas-to-improve-performance/10-signs-your-surgery-center-is-in-trouble.html

I alleged a HIPAA violation and was dismissed by the bariatric surgeons’ office 2 days later (proof in writing). I have no care in the area now. I have the phone records to prove that I called the publically posted helpline to lodge a complaint. Although the hospital group advertises that they will respond within writing in 7 days, they haven’t to this day, more than 1 year later. NEVER file a HIPAA violation or allege one unless done to the OIG. I also have my last records in writing from the office the day the office wrote it. All of which are complimentary.

Please contact me. I’d be happy to show the documents until they’re posted here – including my phone records showing I contacted them.

HIPAA regulations
§160.316 Refraining from intimidation or retaliation. A covered entity or business associate may not threaten, intimidate, coerce, harass, discriminate against, or take any other retaliatory action against any individual or other person for (a) Filing of a complaint under §160.306; (b) Testifying, assisting, or participating in an investigation, compliance review, proceeding, or hearing under this part; or (c) Opposing any act or practice made unlawful by this subchapter, provided the individual or person has a good faith belief that the practice opposed is unlawful, and the manner of opposition is reasonable and does not involve a disclosure of protected health information in violation of subpart E of part 164 of this subchapter

New links on patient rights: HIPAA antiretaliation
Understanding HIPAA rules
Culture coverups
Patient Partnerships
Common biases
HIPAA complaints
HIPAA guide

I’m going to post all my comments from encounters I have had with risk managers. The risk manager (now remember, I’m not suing them so I don’t need a lawyer, wonder why they do?) has a disclaimer on theirs, but I can repeat mine. This should give you some idea of what you might deal with, in my case filing a HIPAA violation & concerns about communication, direction, and then being dismissed and getting blamed for it, ending up with no care in the area and suffering for it.

When the doctor has told you, ‘I’m a big boy, I can take it, I had someone tell me Dr. Bariatric Surgeon, I just can’t work with you’, maybe the people should have done something.

Sent Sunday April 16, 2014

Well?

Privacy Officer included you, Risk Manager, in this email. I’ve not seen a justification why you all need lawyers to answer (or even copy them on):

1) why a publicized on the website statement says that I (from the Privacy Office) will get an answer in writing in X days but didn’t in my case
2) why it took longer than 60 days, the legal deadline, to get me an answer on my first records change (again dealing with the Privacy Office)
3) whether or not you are denying that I submitted a complaint on 4/17/13 and was dismissed from the practice complained about on 4/19/13 and whether or not you know that there is a law against retaliation for filing a HIPAA complaint (again Privacy Office)
4) whether Person Y is a bariatric surgeon representative, as I received a fax from Person Y but no other identifying information (which if it had to do with my case, would be a Privacy Office issue)

Bariatric surgeon didn’t need a lawyer to follow me three times in public, wearing their lab coat emblazoned with the groups’ logo, their name and title. The police handle those situations, not lawyers. So maybe someone can explain why a lawyer is needed because I’m failing to see why any one would need one. This is not about the bariatric surgery practice, this is about publicized hospital practices and HIPAA laws published on the internet that any one can look up. I’ve never authorized any lawyer to contact you so there is no evidence you have on my behalf that you need legal resources.

I would like to invite you all to Colonial Baptist Church. We’re also a hospital: for sinners. We don’t need lawyers. We have one who pleads our case before Him: Romans 8:26,27.

On 4/9/2014 12:27 PM, wrote:
When it comes to retaliation for filing a HIPAA violation, that is a valid question. I will publicize my timeline with phone records & the dismissal date, so that others can review this, the law regarding HIPAA violation retaliation, and see that you have refused a timeline. I also have documentation that you were researching at the time I was dismissed.

((removal of identifying information) No written reponse was ever received although you advertise the above. I will publicize those facts also, since I’ve not gotten a response except the within 7 day dismissal letter.

I’ll also note how I lost all care, dropped by another doctor and refused at another group due to Bariatric Surgeons actions, but that hospital is making a profit by hiring Doctor Y, since that practice has people waiting months to get in. Its enlightening to know how the Bariatric surgeons’ practice treats those who’s suggestions adds to its bottom line.

Thank you.

—–Original Message—–
From:
Sent: Tuesday, April 08, 2014 12:23 PM
Subject: Re: Addition to records request status

I have requested the time line for that investigation. That is what has never been answered. I will let others know the multiple times of asking those questions w/no answers, so that they can see my evidence and be more educated about the bariatric centers practices as a whole. I’ve found other doctors to be different, several of which I recommend because of their knowledge, ability to access appropriate and valid resources when needed & ability to apply them, honesty, judgement, working with other doctors in collaboration, emotional control, non favoritism, clear and consistent directions, etc.

When an urgent care PCP and a specialist can figure out {{I am referring to complications of bariatric surgery}}, both from the patient and from medical research, indications of an issue, but the center cannot, then that is education for others as to fields of expertise, and allows greater knowledge for choices in where they might decide to spend their healthcare dollars.

From:
Sent: Tuesday, April 08, 2014 10:35 AM
Subject: Re: Addition to records request status

I’ve stated it multiple times. Do you need a lawyer to answer?

You received the complaint, investigated it, but never sent out a written response. Why not? I have sent my phone records showing that on 4/17/13, I filed a complaint. By your records, you were investigating at that point and a dismissal (retaliation) letter was sent out during that time. I had an appt. in June with Bariatric Surgeon, which I possess a copy of. The only change was the complaint/HIPAA violation allegation. The records for months before the dismissal that state I was in compliance with the directions, and actually if the allegations of noncompliance were true, then Bariatric surgeon would have gotten rid of me when they were made. They did not.

I also note the dates/times of the phone calls from the office indicate this is correct.

Hospital paperwork is where it indicates non retaliation. Does retaliation work only for patients?

I note that of the items I suggested, bariatric surgeon still holds their title (I stated I was not asking for them to be punished), you hired another MD (doctor Y didn’t even have certification and was working at the bariatric center until they got it, it is a highly successful thing as I hear they’re booked months in advance, thanks to me), and Nurse Practioner is helping out with some of the other hospital/patient duties.

Do you have any physical non changeable evidence that disagrees with the above facts? Also, the answer should be shareable to any one and every one.

Thank you,

—–Original Message—–
From:
Sent: Sunday, April 06, 2014 9:05 AM
Subject: Re: Addition to records request status

The second part of my question hasn’t been answered, as to why we are promised in writing (as I’ve proven before) that within X days an answer, and you never did that. Is the answer we get in writing a dismissal, therefore retaliating for making the complaint?

Thank you,

On 3/20/2014 8:46 AM, wrote:
Thank you. Since it is only 3 pages and doesn’t require anything but scanning in, why would it take so long to scan in? I can scan in a document in 5 min. or less.

I didn’t see the second part of my question answered. Is that because it would verify the retaliation for filing the HIPAA and like complaints, that go against Title II of the Federal Health Insurance Portability and Accountability Act (42 USC 1320d to 1329d-8, and Section 264 of Public Law 104191), and its accompanying Privacy Regulations, 45 CFR Parts 160 and 164, and hospitals Published Policy. Hospital X published paperwork does not say that retaliation for filing a complaint will not be tolerated. Has that policy changed? Retaliation will occur, then?

Thank you,

—–Original Message—–
From:
Sent: Thursday, March 20, 2014 8:30 AM
Subject: Addition to records request status

Good morning,

I am inquiring about the status of the mail I sent on Monday, March 17, 2014. I am also inquiring about why the Privacy Office refuses to put in writing what is guarenteed to us by hospital in its published documents. I am requesting the timeline (that could be independantly verified) that was never given to me of when your office started investigating the HIPAA violation complaints and the other complaints regarding the bariatric center.

Thank you,

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Medical Research

I did a ton of research before I started figuring out that my bariatric surgeon (and others) didn’t give me a good feel that they knew the current research, especially where it concerns malntrition, neurological complications of bariatric surgery, etc. Either that or they didn’t explain it to me, because a lot of things I couldn’t find an answer for in my records OR in the research. So … in the interests of helping people out to a short/quick/dirty set of links to medical research (so you know when you’re getting someone who is up on the research) … here is what I have.

General guidelines:
American Society of Metabolic and Bariatric Surgery Guidelines.

Bariatric Followup:

Carrying for patients after bariatric surgery Apr 15, 2006 Table of Contents


Bariatric Follow-Up Care


Follow-up of Nutritional and Metabolic Problems After Bariatric Surgery

Iron Deficiency
IDA1
IDA2
IDA3
IDA4
IDA5
IDA6
IDA7
IDA8
IDA9
IDA10
IDA11
IDA12
IDA13
IDA14
IDA15
IDA16
IDA17
IDA18
IDA19
IDA20
IDA21

Neurological Complications:
Neurological disorders associated with malnutrition

Psychiatric Care:

Psychiatric Evaluation and Follow-Up of Bariatric Surgery Patients

My medical records

One of the reasons to get a copy of your records is potential problems. You do have the RIGHT (HIPAA rules) to get a copy of your records and review them for completeness and correctness. You can also add to those records BY LAW. I found a lot of differences between what was recorded and what I had. This can DRASTICALLY affect your care later on. Here is an example:
What was said: “The patient then crashed his car into a cement pole”. What was transcribed: “The patient then crashed his car into a semen pool”.

I’m working on getting my medical records scanned in and then showing people, hopefully they will see this and learn from these experiences. These are only the tip of the iceberg.

Claimed noncompliance with orders (among other things) but emails prove differently.

At my one year appointment, its interesting that I was labeled compliant in vitamins and exercise and that the next appointment, rather than being 6 months as normal, was 3 months. Also note that it says for problems, which the urgent care PCP wanted me to be seen on but were not noted here.

Neurological complications can happen after surgery. My PCP recognized mine in November 2012. The plastic surgeon I saw in Jan. 2013 did. The bariatric surgeon only had a problem with me coming to them for “PCP” type things. The problem is that my other doctors recognized signs of nutritional issues: dizziness, weakness, hypoglycemic symptoms, tiredness, lowered body temperature, the blood pressure staying low, etc. It is even in my urgent care PCP’s records that I was to work with the bariatric surgeon.

Note that the internist the bariatric surgeon worked with didn’t recognize them either. I’ve copied my records below and will add the screenshots of them.

November 21, 2012: Urgent Care PCP states in record, “suggested trying some vegetarian refried beans to see if that would help provide her some of the protein that I think she needs. Complains of this persistent neuropathy to the legs. Review of some of the literature shows that neuropathy brought about my malnutrition like this can respond over time and essentially it responds when nutrition status improves. Told to try to improve the nutritional status and continue to work with surgeon”

Jan. 4th, 2013: Saw bariatric surgeon. Bariatric surgeon was told I would seek plastic surgery, and stated, “Please be careful.” Discussed protein loading for 2 to 3 weeks before plastic surgery. Bloodwork performed, which surgeon states all is fine. Appointment made with them for April 10th, 2013.

Jan. 2013: Saw plastic surgeon who is the FIRST recommendation from this bariatric surgeon’s office. Discussion ensues about a surgery date. We did discuss nutritional issues.

Feb. 8, 2013: I am informed that due to nutritional issues, the plastic surgeons office will not consider me for surgery in late April/early May 2013. I am told to go back to the bariatric surgeon. I went back to the bariatric surgeons’ office, and they didn’t see the need for another appointment, nor for bloodwork at any time.

The end of this is that I was dismissed from the plastic surgeons’ office (and lost my out of pocket payment) because I didn’t trust the plastic surgeon enough to go back to the bariatric surgeon and get bloodwork done. I asked a lot of questions and apparently didn’t trust the plastic surgeons’ judgement.

(((Hmmmm I have a PCP telling me one thing, a plastics guy telling me one time I’m ok and one time I’m not, the bariatric surgeon saying everything is fine, and the medical research saying I’ve got a problem. None of the offices are talking to the other offices.)))

Surgeon’s office is notified. They diagnosed me with malnutrition less than one year earlier, but with TWO doctors of various specialties who said I had nutritional problems, they never did any other bloodwork after Jan. 2013. At this time I am being followed by a different internist, different FP, neurologist, hematologist, ALL indicating a nutritional issue that has grown worse.

Do you want a bariatric surgeon who knows what problems come up in the medical research/literature, ones that might be permanent? If so, consider asking them their exposure to research, what medical basis they use for decision making, and specific numbers/types of patients they’ve had with issue X, and how far out are they following them.

I know that of the 3 worst outcome patients, my bariatric surgeon might be following one. I can confirm that the 2nd person and myself are no longer with this surgeon.