Ethics and medicine

Once they went together. Is that so true today and what you may want to watch out for.

Gang stalking: bariatric style

On 5/21/14, as I was going to sit in public property and hold a sign up about my blog & all, I found a guy smoking in a church parking lot on the way to the doctors’ office. I verified he shouldn’t be there.

Then, I have the security guard who is photographing me. Now you have to ask why they’re doing that? Outside of me stating to the risk managers’ that the doctors’ office was doing that from inside the office to outside on public property of former patients. All I’m doing is either sitting or standing with a sign. All legal by the cops, first amendment rights.

I noticed a couple of people sitting in front of the doctors’ office. Another lady drove in to the parking lot and greeted them and they talked until I packed up to leave. Then they started to. I stopped and fooled around and knew they were going to tail me so I waited around.

Next I know a guy on a bike is trailing me. I called the cops.

Ever heard of gang stalking?

What does this say about your bariatric surgeon if they do this? Research, research, research! Is this the type of person that you think will help you on a lifelong journey? Stick with you? If you have a not positive experience and you are honest about the facts, are you going to want to be stalked for asserting your first amendment rights?

Here is just one states’ listing of the definition of stalking using the following reference: Va. state stalking laws

Va. Code Ann. § 18.2-60.3. Stalking; penalty (2013)

A. Any person, except a law-enforcement officer, as defined in § 9.1-101, and acting in the performance of his official duties, and a registered private investigator, as defined in § 9.1-138, who is regulated in accordance with § 9.1-139 and acting in the course of his legitimate business, who on more than one occasion engages in conduct directed at another person with the intent to place, or when he knows or reasonably should know that the conduct places that other person in reasonable fear of death, criminal sexual assault, or bodily injury to that other person or to that other person’s family or household member is guilty of a Class 1 misdemeanor.

B. Any person who is convicted of a second offense of subsection A occurring within five years of a prior conviction of such an offense when the person was also convicted within the five-year period prior to the instant offense of a violation of (i) § 18.2-51, 18.2-51.2, 18.2-51.6, 18.2-52, or 18.2-57 and the victim of that crime was the same person who is the victim of the stalking activity in the instant conviction, (ii) § 18.2-57.2, or (iii) a protective order, is guilty of a Class 6 felony.

C. Any person convicted of a third or subsequent conviction of subsection A occurring
within five years of a conviction for an offense under this section or for a similar
offense under the law of any other jurisdiction is guilty of a Class 6 felony.

D. A person may be convicted under this section irrespective of the jurisdiction or
jurisdictions within the Commonwealth wherein the conduct described in subsection A
occurred, if the person engaged in that conduct on at least one occasion in the
jurisdiction where the person is tried. Evidence of any such conduct that occurred outside the Commonwealth may be admissible, if relevant, in any prosecution under this section provided that the prosecution is based upon conduct occurring within the Commonwealth.

E. Upon finding a person guilty under this section, the court shall, in addition to the sentence imposed, issue an order prohibiting contact between the defendant and the victim or the victim’s family or household member.

A few links on gangstalking:
Predatory gangstalking
Stalking
How to stop gang stalking
Account
How to fight back

Harrassment: Bariatric Style – The Emails

5/12/14

The items from several weeks to almost a month ago, in written communication, have not been addressed, in regards to putting items in my records. By HIPAA law, there is no time restriction.

I’ll pass on that your security guard photographs & logs me for asserting my constitutional rights to free speech, including the office watching me. The multiple times the police have gone out, they have never seen me do anything other than behave with dignity and respect. That includes how I treated a nurse politely with inappropriate questions & the bariatric surgeon following me on public property.

I have made it clear that I have no interest in money, being photographed, or lawyers, but in getting appropriate health care. Care that the bariatric surgeon appears to have been incorrect in saying I didn’t need, or that my other doctors have indicated I couldn’t use. All because I don’t want to see someone else also hounded and suffer for saying they are a human being who is worthy of respect and to assert their rights under the law and published policies.

((I also mentioned that more than a year ago, I had suggested to the office in an email, that they needed to educate other healthcare personnel in bariatric after care)).

5/8/14

I politely answered the nurse when they went at distance length from the bariatric group staff door to initiate questions about what I was doing/intent/etc. on public property (not considering that I stated I was not a patient any longer, so why I was being asked such questions on public property raises motive questions) & was followed onto public property multiple times by the bariatric surgeon in another instance. I received a letter that contains incorrect facts, from my records, among other things. Most sad, considering I was extremely impressed by another one of your physicians I met.

I do not have the information requested below regarding another source for the HIPAA privacy people, as they have not responded to my photography related request. Prior history shows a difference between published practices & practices per se. What practices can we expect from the Privacy people is what I am looking for from another source. The same can be said for you, especially as to why you need lawyers when I bring legitimate concerns, with no lawyer in tow, that have never been completely addressed, & you have been given multiple opportunities to do so.

Please see second paragraph below, they stated nothing could be done for me. If regular doctors can’t deal with/recognize it, an ER doctor would not either. None of the Nutrition Journals use bloodwork as main indicators since 2011 for malnutrition, nor did you when you {a person who isn’t a doctor and never examined me} made your medical assessment that I did not have malnutrition in 2013, compared to a physician I had a history with and medical research to support the assessment. Do you have further information on who has experience dealing with a complication of bariatric surgery since the bariatric surgeon appears to not have, & non compete and “buddy” agreements don’t allow for care in the area from bariatric healthcare personnel? Or who doesn’t drop care when payments can’t be made, which is why a patient couldn’t make an office appointment, contrary to stated your policy?

Because our bodies are very good at compensating during tough times, doctors have observed that blood tests and external measures of illness are inadequate: there are very few indications a body is about to go into crisis until the damage has already been done. Too many families find out only after a life-threatening or fatal episode how close a loved one was to death. In PCM, however, the lymphatic system can’t keep up with the leakage, and the stomach area begins to bloat with its own waste fluids.

Starvation can cause (amongst other things) low blood pressure and poor circulation; osteoporosis leading to possible fractures, deformities, and pain; anaemia; stomach shrinkage, leading to uncomfortable stretching and feelings of fullness when more than a small amount is eaten; increased blood cholesterol levels due to lack of oestrogen; nerve and muscle damage; low glucose levels, which may lead to coma; kidney failure; and death through heart failure.

Thank you,

5/X/2014

> I’ve started getting a higher temperature, burning up at times, legs cramping & chest pains, a lot of problems eating and tonight, couldn’t eat without pain. My skin is breaking apart, my MPV and platelets are high for me, indicating thrombosis. I’ve not been able to take medications since November because when the albumin is low, drugs have nothing to bind to and are free in the plasma, amplifying the effects.
> Some of my bloodwork is high/low for me, meaning the effects of malnutrition are starting to show in the bloodwork because I can no longer compensate for illnesses that weren’t diagnosed & my care disrupted.
>
> Find me someone else who can answer the questions since I’ve been told there is nothing they can do for me. I’ll won’t make it through this because of the bariatric surgeon without any care in the area. They said that ‘if you don’t do as I say, I’ll put it in your record, and other doctors will see it, and wonder why’. They wanted to damage my relationships with other doctors. They succeeded. As an office worker said ‘YOU’VE lost a huge chunk of your care.” There were right. I will pay the price for that, although I even asked that the administration do nothing negative to the surgeon, and I’ve seen that the suggestions I made regarding the practice were implemented.

More notes on retaliation

Whistleblower lawsuit & what they did to the whistleblower
“Frohsin & Barger Qui Tam Suit Prompts Amedisys to Pay $150 Million
In 2009, Frohsin & Barger client, April Brown was a nurse and single-mother of two, struggling to make ends meet in the sleepy town of Monroeville, Alabama, best known as home to writer Harper Lee and the inspiration for her fictional town of Maycomb in To Kill a Mockingbird. Brown travelled rural Alabama caring for homebound patients: elderly shut-ins and the indigent infirm. What she witnessed about her employer’s Medicare billing, however, eventually caused her to become a whistleblower in the groundbreaking case of United States ex rel. April Brown v. Amedisys, Inc., CV-10-BE-0135-S (NDAL 2009), which today resulted in the largest home health fraud settlement in U.S. history, prompting the company – which denied all wrongdoing – to return $150,000,000 to the taxpayers, according to court documents.”

Investigate: money, healthcare, misbehaving doctors, retaliatio.

Here are some recent items that go over money and health care, misbehaving surgeons & other doctors, selling nutritional supplements, and money/healthcare as a business. I also include retaliation that was done to a nurse, a single mom of two who had life miserable made for her due to whistleblowing when she served indigent & low income patients.

Ethics and docs: do they turn a blind eye:
Blind eyes
Unethical unprofessional behavior
Syracuse Hospital Says it may be sued over patient slapping

Hospitals turn a blind eye to bad physician behavior
“Hospitals often turn a blind eye to bad behavior by physicians, especially if the doctors generate a lot of revenue, according to Syracuse.com.”

Last week’s lawsuit by a Virginia patient who claims doctors mocked and defamed him while he was unconscious during a colonoscopy is just the latest example of disruptive doctor behavior.

A Syracuse, N.Y. surgeon allegedly slapped sedated patients’ buttocks and called them derogatory names and though staff complained, St. Joseph’s Hospital Health Center didn’t do anything about it until a formal complaint was filed in December, according to the publication.

“Although experts say the vast majority of physicians aren’t troublemakers, bad behavior clearly isn’t an isolated problem. There have been several cases of physicians throwing objects in the operating room, yelling and hitting patients, and sexual abuse, the Association of Health Care Journalists reports. However, in most of these instances hospitals didn’t investigate the claims, according to Syracuse.com.

Hospitals often don’t do anything about the problem because the accused physician brings in a lot of money, Michael A. Carome, M.D., director of health research at the nonprofit consumer rights advocacy group Public Citizen, in Washington, D.C told Syracuse.com. And when hospitals do report cases to state medical boards, it’s rare for physicians to receive more than a slap on the wrist for the misconduct, he said.”

“In many instances, the bad behavior distracts the healthcare team, which can lead to medical mistakes.

“When we allow bad physicians to remain in practice, that can ultimately expose hundreds if not thousands of patients to substandard and unprofessional care,” Carome said.”

Lawsuit on docs who mocked patient during anesthesia
The suit is emblematic of the decline in doctors’ professional reputations in recent years. “The once-venerable medical profession has taken quite a tumble from its pedestal, with the terms ‘untrustworthy’ and ‘greedy’ used to characterize doctors more often than ‘respected’ and ‘benevolent,'” Linda S. Ellis, M.D., of the Frank H. Netter M.D. School of Medicine at Quinnipiac University wrote in an opinion piece for Live Science.

Pressure on physicians to always be “right” contributes to a mistrustful culture where physicians fear asking questions or conceding mistakes, according to Ellis. “We tell one another and our students to never admit wrongdoing,” she wrote. “[E]ven worse, we model bad behavior to our medical students and residents, training new doctors to perpetuate behaviors that engender distrust.”

Hospitals bullies pose danger to patient safety
This isn’t just psychologically damaging to staff, according to Yurkiewicz; it also affects patient outcomes. For example, an abusive attending physician may discourage residents and nurses from openly discussing a patient’s problems, which gives time for those problems to worsen. “In a system dependent on hierarchy, it works like this: when anger and intimidation flow down, information stops flowing up.”

“This correlation echoes results from a 2013 study in the UK, which found that one in four doctors and surgeons and one in three nurses said bullying has caused them to behave in ways that are bad for patient outcomes”

Johns Hopkins unveils $11Billion hotel/hospital
Johns Hopkins today unveiled plans for a new $1.1 billion hospital with a “hotel-like” atmosphere, The Baltimore Sun reported. As one of the largest hospital construction projects in the country, the 1.6 million-square-foot building will feature 560 private rooms, 33 operating rooms, new adult and children’s emergency rooms and include gardens, artwork, sound-proofing, Internet and food options. The new hospital replaces the East Baltimore campus, constructed in the 1930s and 1950s.

Officials say the upgrades are needed to maintain business by luring patients and keeping doctors and other personnel, the article noted. “Our new facilities will enable us to provide that excellent care with greater comfort and private for our patients and their families in a state-of-the-art environment,” said Edward D. Miller, dean and chief executive of Johns Hopkins Medicine.

*** Maintain business?

Medicaid debt isnt stopping Maine hospital construction
“Hospitals in Bangor, Augusta and Portland found the capital and loans for major construction projects even though they’re owed $484 million in overdue Medicaid payments from the past four years. The construction boom comes as hospitals warn of having to phase out services or lay off workers to cope with the Medicaid debt, the paper notes.
Eastern Maine Medical Center in Bangor, for example, recently resurrected its plans for a $250 million addition, a project the state approved in 2008 but was delayed in part by Medicaid debt–now more than $75 million, according to the paper.”

*** So how much is spent on patient safety?

Patient litagation over insurance billing practices

“St. Luke’s Health System in Kansas City, Mo., will pay $3.5 million and attorneys fees after it refused to accept health insurance from hundreds of patients injured in car accidents in lieu of trying to collect potentially higher payouts from automobile insurers instead.

Three patients sued the hospital after it attempted to recoup payments they received from their automobile insurers for medical treatment. Such payments are often higher than what St. Luke’s can collect from health insurers because the automobile insurers don’t negotiate payment levels in advance, according to the Kansas City Star.

If the automobile insurer didn’t offer a settlement, St. Luke’s often filed liens against patients directly.”

Putting the Patient First
Putting the Patient First — Using the Expertise of Laboratory Professionals to Produce Rapid and Accurate Diagnoses

Doctors & ethics of selling nutritional supplements
Is It Right for Doctors to Sell Nutritional Supplements?

Great blog on how a hospital is facing lawsuits from patients who were lied to on mammograms.
In summary, Perry Hospital technician Rachael Rapraeger lied about the results from over 1,200 mammograms. In her plea deal with a criminal court, Ms. Rapraeger said she got behind in her work and created negative readings for over 1,200 mammograms….mammograms that were never reviewed by physicians. Patients were lied to. Ten patients actually had positive readings, and two have since died. Ms. Rapraeger apologized for her conduct and was sentenced to six months in jail, 9.5 years of probation, a $12,500 fine, and is banned from the healthcare profession for 10 years.
Perry Hospital is currently facing 30 lawsuits from Ms. Rapraeger’s actions, and the hospital issued the following statement after her plea deal: “We are pleased this component of Ms. Rapraeger’s unfortunate action is concluded.”

How rude! Workplace incivility hurts bottom line

CA senator demands hospitals reduce rampant medical errors

“Building a differential diagnosis is in several steps of John Brush’s 12 point diagnostic process outlined that’s been taught for over 100 years. Wouldn’t this help diagnostic errors?”

Aftercare: bariatric surgery’s failure

I was just over 13 months out from surgery. My surgeon never examined me … as I told the office. Do you still think they provide aftercare? Think again! ASK and know what your surgeon does and GET REFERENCES not just THEIR WORD.

Sent: Friday, January 11, 2013 12:38 PM
Subject: Re: Pls let the nurse know know

Well am I even going to get examined? I have a thing at 230 and I’ve not even seen bloodwork posted.
I would have thought that a surgeon with a patient who complained of a swollen belly would look at it but they didn’t.

Sent: Friday, January 11, 2013 6:25 AM
Subject: Pls let the nurse know

I wasn’t examined or anything last Friday. All that happened was he looked at the old labs and my weight, nothing else. He saw the papers not the patient.
I’m breathing more shallow now. Its not just when I eat.

Thanks,

If you don’t think its all about the money –

I sent this to the admin of the group I was with. I recognized that $$$ was a motive.

Subject: Ketogenx
Date: Fri, 4 Jan 2013 15:55:38 -0500

Admin

This is the stuff that came across to everyone, that I said I would tell you about.

KetogenX weight loss program .. includes visits with the physician, dietitian, exercise people & and optional support groups in one location and one price.

Record discrepancies pt 1

Here are just some of the confusing and odd medical discrepancies I had with my bariatric surgeon. I have had to make less corrections to most other doctors’ records, but remember once you get these things messed up, trying to get them corrected is near impossible. It also makes confusing records that much harder to try and get and coordinate care with others. When other doctors see records, they’re going to think the doctor is right, but if they can’t figure them out, you pays for that?

YOU DO!

——– Original Message ——–
Date: Wed, 29 May 2013 22:57:05 -0400

2/7/13 note: Email sent to bariatric coordinator stated reason for visit was to discuss whether or not I had messed up the sleeve gastrectomy. Celiac disease questions were directed at GI, however, he wouldn’t test at that time.

2/15/13 note: Note doesn’t include statements regarding the months of pain I endured due to misdiagnosis of gallbladder disease. I alluded to treatments prescribed without being given information about all options available, costs & benefits weren’t discussed. Due to those considerations, such decisions made without my input were stumbling blocks to compliance. No specific statements listed so that we can know whether the lab results were good/bad, or what actions I was to take in response to them.

3/27/13 note: GI indicated eating softer foods, less fiber, etc that conflicted with the foods/drinks recommended by the bariatric group. Allergist stated cutting out several food groups recommended by bariatric office. Compliance is next to impossible under these circumstances, and when the subject was brought up, was “blown off”.

4/8/13 note: Have medical documentation supporting that BMI is not a good indicator of health in athletes, nor is it accurate for us. Excess skin from weight loss, edema, bloating/gas from intestinal issues would skew weight results.

4/10/13 note: 5 months ago figure incorrect. Hospitalized for malnutrition in June 2012, 10 months ago. Didn’t eat a lot due to not being hungry and pain on eating from gallbladder. Food intolerances developed after this point in time. Confusing sentance: “She then went on to tolerate it she has very little upper body strength and is being and I waited by her primary physician for this muscle weakness. Have never reported being able to tolerate ground beef as stated in note. bariatric surgeon asked about chili previously, due to a chili contest I had mentioned. Stated coworkers had to help me back to my desk from being ill from attempting to eat chili. At this appt. he asked if I had tried anything else other than ground beef. I said no, he suggested steak. Discussion not in office notes. Confusing sentance: “She does eat significant amount of headaches”. Was not interested in “long” discussion about plastic surgery, just needed a list of items as to what the specific medical problem I had that needed to be fixed to get it done. I could never ascertain from any discussion, medical office notes, what the pinpointed problem was and how to solve it. This included 2 specific requests that were never answered, one for bariatric surgeon and one for nurse, for an appt. to discuss what their opposition specifically was. Confusing sentance, last sentance is one paragraph. In addition, states “she had not even been one year from her bariatric surgery”, when the second sentance of this office note stated I was 16 months postop. Confusing sentance: “severe plastic surgery sometime in the next few months”. Follow up in notes is for four months, but after visit, bariatric surgeon told his nurse to make an appt. in 2-3 months.

4/18/13 note: List was given. Note that the first plastic surgeon recommended had a 1.9 million dollar verdict against him due to death of a patient.

Note that in all these, the only physical exam was done by the nurse on my abdomen. Another nurse also took my blood pressure at the first visit.

New resource for being an active member of your health care team

Be An Active Member of Your Health Care Team

I was quite impressed by this. I’ve explained when I’ve had work, financial, or other issues that prevent me from completing doctors’ instructions. If I’m confused, I ask. The doctors you want to be wary of are those who don’t consider your comments. The fact is, many people don’t have sick leave or limited sick leave. Financial considerations are a huge part in this. If a doctor drops you because you have to juggle these items, tell others. Rank them and say why on doctor rating sites. The more you talk about how these people don’t consider the patients’ life, the better we can get change for all.