Risk Managers: Deny, Defend, Investigate Pt 5

There are the questions that were also never answered in terms of care:

I had a person who had their surgery also done with Bariatric Surgeon. They were given a gallbladder operation but I was refused it. I went to 2 different opinions who immediately diagnosed gallbladder disease, suggested surgery. I had my insurance call and inquire about it not being done in my case. The insurance told me that they were supportive of me. When I saw bariatric surgeon at that next appt. They said They wasn’t trying to dump me but if I didn’t like the care then go elsewhere, and other items along that line.

What I did not tell Them was that I had already tried to because of the differences in care I found between what others got and what I had, where I could read medical literature and not see reasons for those discrepancies. Also that I had contacted the doctors’ office and they said they wouldn’t overrule bariatric surgeon because They was in the same group, I was his established patient. The other groups in the area wouldn’t it, due to litigation/non compete agreements & because the other group had buddies.

6/24/13 to the risk manager

I received some documentation that I have a disagreement with, and was told I could send it to you. How may I do this?

I am finding that I’m missing some documentation requested of the administration. One of these items was documenting a call to the group on 4/17/19 that gave praise to the surgeon for his operating skills and his office staff. I said I had a hard time understanding the bariatric surgeon because of conflicting directions, with 2 examples.

It appears only part of the calls made to the group were documented and not all the conversation documented in there. Its not just that procedures were not followed in my case. There are a lot of specifics that are missing, like the factual rationale for diagnoses or why I still was not on a regular schedule for visits.

Contrary to the bariatric surgeons’ comments about my gastroenterologist in his letter, I got on my *4th* gastroenterologist before full testing was done. Results of an EGD/colonoscopy revealed esophagitis, gastritis, among other issues. The GI made a comment about reflux/GERD. Its in the bariatric surgeons’ records from last year when given PPI’s. Someone can please explain how and why my previous GI was endorsed when 99% of his business is pancreas related.

I visited a neurologist for upper body weakness. Her comment was neuropathy secondary to malnutrition. She asked me where my bariatric surgeon was, why it hadn’t been addressed, it doesn’t happen overnight. Malnutrition was also an issue in the past with the bariatric surgeon almost 1 year ago exactly. Who or what specialty is capable of diagnosing and dealing with that? I specifically asked for it to be discussed with the internist. It apparently was not, as I do have medical references that indicate malnutrition occurring. We are all trying to figure out the specifics regarding me not having malnutrition, considering I was never physically examined by the bariatric surgeon, or how wearing 4 jackets he could ascertain there is no problem with me.

Does the group remove patients that have issues following surgery so that any stats reported to any agency look more positive? Do you have data/statistics to support that assumption?

The money that the bariatric surgeon was given by a medical company, does the group use anything of that medical company in the bariatric program besides X?

I am sure we will have a few more for you.

One of the solutions of GERD (that does not resolve) in LSG is a revision to RNY bypass. The following items/timeline:

1) I say positive things about the office, ask for clarification w/examples of items, call you about a potential HIPAA violation
2) my surgeon dumps me,
3) am having problems getting answers to questions that should have been resolved when I was a patient & roadblocks now,
4) due to contracts/legal issues (non compete contracts?), I now have no care
5) obviously after 2 laparoscopies for endometriosis, a gastrectomy and lap choly for gallbladder within the past 18 months, no GI is not going to operate on me. GI’s do procedures not surgeries.

I think you can understand our changed outlook on the whole situation, given the GI problems & relation to the surgery(ies) without any care, & what honestly looks like retaliation due to the potential HIPAA violation. In that call, I said I didn’t want anything bad to happen to the bariatric surgeon, maybe he was overworked and needed another pair of hands. All anyone can see now is that someone who asked for mercy to be given to another, certainly hasn’t been given that by the same person they asked for clemency on.

Why don’t you make this known to people before surgery? One of your patients finally got relief after 2 years of pain, but without care, if it comes to having a recommendation of surgery, I will have none for the rest of my life. My church would say that is quite a “testimony” about the doctor, program. We thought one of the doctors was something else, but my doctors’ “witness” certainly makes a greater impact.

6/19/13

Thank you for speaking with me this morning.

One of my requests is that if there is any information regarding me and my patient care that I cannot access through my medical record, or has not been given to me already in the doctors’ office notes, to be provided a copy of that. This does not include billing information. Please feel free to let me know the different types of information that I may not have covered in this email, as I may not need that information.

If you could also let me know the outcome of the questions I had in regards to procedures for requesting record modifications/additions, that would be helpful.

I’m without care now, and the contract I signed was that I would return for follow up visits. If we don’t need care after surgery and can go elsewhere, then why did you have me sign a paper stating that?

My Mother and I were told by the bariatric surgeon that he would round on me the Tuesday afternoon I was in the hospital for my gallbladder surgery and never showed up. My Mom is 73 years old, and after several hours of waiting, had to drive home thru the a major artery in rush hour traffic to get home. If you’re going to give me an answer, please keep it consistent.

2/20/13 to the office/practice manager:

Good morning,

I have a couple of questions for you. These are general.

1) When it is noted that I’m responding or looking better, what facts are there to support that? Sometimes I am missing where those are in the notes.
2) When GI doc and bariatric surgeon spoke with each other, I didn’t always see a list of opinions or recommendations. I looked back over one area and found it but didn’t know if I missed others. I also didn’t see the ones where the plastic surgeon and bariatric surgeon spoke together.
3) Was there any disagreement on the treatment plan between the bariatric surgeon and the GI doctor? I got the impression that there was a difference from them, but was surprised in the notes to not see that.

Thank you for helping me understand what is going on,

2/19/2013 to the office/practice manager:

Good morning,

Thank you for allowing me to review my records. I have some notes that I would like to have added to my record. If the enclosed document could be added to my medical record, I believe it would be helpful. It should provide greater understanding for any one reviewing the record.

Hope you have a great day,

*** Note by law, you have the right to put items into your medical records. There is a procedure for this, which was NOT followed in my case.

2/14/2013 to the office/practice manager:

Good morning (I apologize for not saying that):

Thank you.

He doesn’t have to respond. They didn’t on my last email regarding the situation. I had considered only the recommended plastic surgeon previously, but because of the communication between him and the bariatric surgeon, I’m required to look for someone else. That makes a vast difference in care & my outlook, as this plastic surgeon supposedly is the best. Now I have to settle for less and scramble to find someone.

This is the second time where a relationship I had with a doctor changed due to discussion with the bariatric surgeon. In discussing this with others, as with my gallbladder, I am treated differently without medical basis for this fact.

*** I want you to note that there was question with this bariatric surgeon saying that They would do actions to make a difference in my relationships with other doctors.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s