Risk Managers: Deny, Defend, Investigate. Pt 4

8/7/2013

Ma’am I’m talking about the blacklisting that appears to go on. I don’t want to come if we’re not going to treat me. I was recommended to go to the ER by the insurance nurse and the GI nurse. However, a PICC line is what is needed, and that would be a hospital stay. The only response I get is that my doctor tells me to go out of the area for care.

So I know what you say, but in practice, that’s not what is happening.

7/18/13 to the risk manager:

I don’t want to drag things out, but there are questions that have been around for months, unanswered. How many questions/emails (number) do you have answered so far, is there anything that you have called/emailed that has not been addressed in 3 days by another party? What are the ETA’s on those?

Do you have a timeline from the HIPAA violation group? Do you have confirmation that I am not mentioned in any “secret” or nonpublicized database that “flags” me in any way, and that I am not mentioned in any computer, database, or communication other than that available to me?

What do you need from me to further your investigation? When do you expect to be completed with the first phase? I can email you on Tuesdays and Fridays to check progress.

I was placed on prednisone for skin problems. Had the malnutrition been taken care of earlier, I wouldn’t have had this problem, as skin issues are another sign of PEM. Now I’m taking a medication that we have no idea if it will mess up my stomach, due to lack of care. GI’s do not have experience in this area. My internist, who I had to produce medical documentation to get testing that was to be done in June, would not know either. This is in direct conflict with the assertion that my internist and GI could care for me.

6/26/13 to the risk manager:

I had a cake that I was going to make that resembled a 3D doctors’ bag. It was from a 2 week long diaper bag (& other baby items) cake class. The teacher agreed to allow me to make the doctors’ bag versus the diaper bag (& other baby items).

I attempted to contact the bariatric surgeons’ nurse, a couple weeks before, to make sure they would be at work on Friday (11/16). I had a bit of trouble getting to her. Because it was to be a surprise, I was pretty anxious to talk to her because of the time involved & my own time & materials to make the cake. I told her after I got in touch with her why I was so insistent on talking to her right then. She understood and said she would keep it secret. I was having to call so that it wouldn’t be seen in my medical record. The bariatric surgeon called me up at home and fussed at me for needing attention right then, they get to me when they can, they paid more attention to me than any one else, etc. I didn’t say anything.

Then that Friday, I got to sneak the cake in, with the help of the staff. I also had a few items for the staff and others.

I was waiting in a room (no appt.) and she told him to go in, without telling him why. He came in and was very surprised but acted pleased. I told him that he got mad at me for being so insistent calling a few weeks ago, but this was for him.

He just laughed. (and then wanted my gelatin flower too! “Is that for me?” “No!” … I am not getting in bad with my church for him. ) If I get an apology for going off at me, that would be nice. If not, I know how everyone reacts when I tell them.

Thank you,

8/1/13 to the risk manager

Thank you. The other gentleman I requested information on, has never replied. I appreciate you doing so, and at least not giving me attitude in the voice when you’ve spoken with me.

I hope that you read thru this.

1) The GI’s at one group will not even give me an appointment. There’s one doctor in that group who was recommended by Bariatric Surgeon. That’s the only link. He’s not the doctor I wish to see, but I asked after him.
They set everything up for an appointment, etc. and then cancelled it & ‘there’s a note’ to refer me elsewhere.

2) Another doctor recommended by Bariatric Surgeon, I went to, They took my symptoms back in March, and had me come back in a month and referred me out. Now that They received a termination letter copy from bariatric surgeon:

a) everything is fine (although I’ve produced medical literature that disagrees).

b) wants me to go out of town for care, meaning taking blood work that the group gave me a list of. Someone else who doesn’t go to the group any longer had their PCP doc run bloodwork, no problems. I was also told that a doc could ask someone a question, in another field, its done all the time.

c) I’ve been told that ‘YOU’VE lost a huge chunk of your care’ by office staff. When asked if I was being blamed for this, I got no response.

d) I can produce peer reviewed medical studies showing what my symptoms are due to. No differential diagnosis is produced (like in March) for the symptoms. I’m told they’re not an “expert” in it, although everything I can find & every person I talk to, says this sort of doc can diagnose it.

e) I’ve been told all my symptoms were from being ‘mental’. I did produce medical evidence that my problems can be a side effect of the surgery. I also included the comments from people who know me saying we’ve seen this before w/bariatric surgeon (and another doctor). My neighbor said ‘you know that is a cop out’ and I said ‘yes’.

f) I had a swollen hand & finger with a bad rash all over. I have a history of asthma & allergies & carry an EpiPen due to life threatening reactions. I reported this & told “make an appointment”. I went elsewhere, was seen right then, and they put me on a 12 day course of steroids within 5 min. of looking at me. Prednisone is
catabolic. My total protein is the lowest in history and the albumin dropped by 1/2 a point. I’ve got a few other symptoms.

I’m aware of the term “blacklisting”.

3) We have the right to refuse medical tests (and still be treated, at least by what group has on its website). When I said something last year about refusing to do one, bariatric surgeon came in to the exam room
and told me that ‘if I didn’t do as They said, They would put it my chart so other doctors would see it, and wonder why’. Look in my medical records, the refusal documentation was put in there in 2013.

4) One of the issues that bariatric surgeon refused to address was favoritism complaints.

a) In my case, I requested a particular date (early August) for the original surgery (Dec 19th was the date I needed). I was told no because bariatric surgeon would be on vacation. It cost me 2 extra days of
vacation, because it happened on Dec 15th, that being the last day I was told They would do it). I find out that bariatric surgeon did a bypass & a sleeve on the 19th. They were scheduled after I got refused.

b) I had no inpatient care for my original surgery. I was told ‘I had a party to plan for’. I’ve seen reports about this person visiting others in the hospital though.

c) I know of another person who had a problem with a doctor in the practice, and they were transferred over to another one. That wasn’t done in my case, I complained to the ‘non retaliation’ hotline.

5) When I was told that I needed to be admitted to the hospital for malnutrition in June 2012, I asked Bariatric Surgeon, ‘what are you going to say (in my medical record)’? They replied ‘I don’t know yet’. Then when
I asked for my records, that is where I found out what They did. I had passed the psychology evaluation before the surgery. When They spoke to my mother about the diagnosis, her response was ‘she’s not like that’. My PCP at the time, told me that bariatric surgeon was sending notes to him. I said its not documented any where. The doc went to his office, came back and showed me the proof.

This is just the tip of the iceberg. If you’re wondering why I and any one I tell is so bothered by this, that’s why.

My GI doc was kind enough to give me some medicines to help deal with reflux & IBS. They did say that surgical changes (gastrectomy) were a cause (and that is proven in the medical literature). I said I don’t
blame any one for it, we never would have guessed this happening, it isn’t any ones fault. I just need care to deal with it. Given group’s part in all this, and seeing the above now happening, I think you can understand why we’d want to say something about this. I don’t want any one else to suffer like I have & will.

6/20/13 to the risk manager

One of the questions I had for the admin (I would address his full name so you would know who They was, but They would not give me his last name) that was not answered was what specifics can they point out in the allegations made against me in the reasons for dropping my care (with proven problems, that may count against a center of excellence) when they’ve had someone get pregnant against the time recommendations, the person stated they were “afraid” to tell the surgeon, but the whole office was delighted for them. Also, since patients do regain weight after the surgery, and it is due to overeating, whether or not they’ve treated those patients. Without a medical reason, in medical research, the reason is due to “bypassing” the bypass or overeating. This is basically not following the directions of the center in eating, drinking, and exercising.

I would also note, I was never on a timeline that is published by the center for follow ups. If there weren’t problems, why was I scheduled with appointment followups for my bariatric surgeon? I would note that some of my problems have been written up in the medical literature as known issues after bariatric surgery. This is something a bariatric surgeon would know, not a PCP nor an gastroenterologist, as the literature is not gastroenterology based but bariatric surgery based.

I have also never received a timeline of that I had a followup appt. in June with Bariatric Surgeon, from the April appt. and then when I discussed a HIPAA privacy violation, after that I was dropped from care. I believe I have the reason why group will not provide that timeline.

As a followup, I have been told that one of the other doctors in the group is more of a general surgeon. This was why I was not able to have Them do my bariatric surgery. I was then refused by his office to go to Them for the gallbladder surgery, although his office was the one I contacted first. The bariatric surgeries appear to go to my doctor and one other. Is that correct? What are the percentages of surgeries, bariatric vs. general that the 4 doctors listed in the practice do? How many codes was my insurance billed under that went for bariatric care vs. general surgical care? It seems group says you have to go to this doctor for this issue, but when they want to restrict care in practice, they’ll restrict it from all the doctors. All my care was listed under bariatric care for Bariatric Surgeon.

While it is listed in my records that bariatric surgeon would help my PCP and gastroenterologist, I can find no record of Them discussing any care with them. Is that correct? The only one I could find out was the yes I do/no I didn’t discrepancies with a former plastic surgeon.

Thank you,

6/20/13

On 5/8/13, I questioned bariatric surgeon about sources for help because the other centers can’t take me, and They suggested obesityhelp.com. So that is group’s recommendation from the Clinical Director of your center, that I seek help from an internet forum?

Please verify that with me. I know I made it clear to the office, in writing, that the former dietician you had on staff couldn’t help me and ended up asking on the support group. I had asked a supplimentation question back a few months ago to your bariatric coordinator and was told to ask my PCP. If this is true, why are we required to follow up with the office, if all that is done is bloodwork once a year (or 18 months and 24 months mark)?

Thank you,

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