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.

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.

Office Managers: can be just like risk managers

Here’s are a few excerpts from my emails to the practice/office manager of my bariatric surgeon:

——– Original Message ——–

Date: Thu, 14 Feb 2013 20:00:07 -0500
Good morning (I apologize for not saying that):

Thank you.

He doesn’t have to respond. He didn’t on my last email regarding the situation. I had considered only plastic surgeon previously, but because of the communication between him and bariatric surgeon, I’m required to look for someone else. That makes a vast difference in care & my outlook, as 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 bariatric surgeon. In discussing this with others, as with my gallbladder, I am treated differently without medical basis for this fact.

Sent: Wednesday, February 13, 2013 4:52 PM
Subject: call from bariatric surgeon

I got a call at 435 my answering machine time, about 5-7 min. before I got home. bariatric surgeon had called. I called, answering service said you all were closed and didn’t care it would be another week before I could find out what was going on.

I work in cubicles and everyone knows your business if you call at work. I have to wait either another week until I work from home on Wed. to find out what he wanted or I have to schedule time to work from home.

I’m sorry I missed him. I had no idea he would call, otherwise I would have cancelled going to my board meeting. Please let him know. I don’t have caller id so I answer the phone if I’m home (or the ringer doesn’t work & that’s happened before).

> Sent: Wednesday, August 22, 2012 4:37 PM
> Subject: Followup
>
> Thanks. I will let the practice manager know that the main concern I have is that my GI doc told me he wouldn’t do anything without bariatric surgeon’s “ok”. My relationship to my GI doctor should be based on what I have told him are my symptoms and (especially as the directions given to GI doctor were not complete) a more thorough history. I was able to ask for a HIDA scan test before bariatric surgeon talked with GI doc, and now the GI doc won’t repeat the scan. If they feel that a false positive was given, repeating the test would take care of that, and also that has been pinpointed as the area/region giving me problems. As no testing is considered that involves food or digestive action (when the pain, problems occur) is being considered, I fail to understand the medical reasoning behind not conducting testing to find a surgical problem to be fixed or why the direction of the gallbladder issues was changed.
>
> I feel that the issue is that bariatric surgeon feels it is mental, anorexia nervosa, and that’s why testing is being refused. It is obvious that from the GI’s followup (a one month appt.) that he does not consider daily RUQ pain to be an issue.
>
> Should gallbladder removal occur and the pain subsides, this will be another example of the group surgeon who was told of reoccuring pain, correctly told the doctor what the issue was, the doctor said it was “mental” or not physical, refused to address it, the patient went to another doctor, the surgical fix was made, and the pain corrected. This should be a cause for concern for the practice. I know it would be for a patient.
>
> Thank you,

Sent: Wednesday, July 25, 2012 8:23 AM
Subject: question for you

I’ve put in my medical record the below notes (please also refer to the emails from earlier this week in my medical record). I wanted to make sure that this does not “fall thru the cracks” and does get addressed. Patients have rights and responsibilities & we let our medical personnel know the reasons for not being able to follow through on a plan. Living my life in pain just to be kept alive, being forced to eat & the manner of doing so so that it causes me pain, that’s how I perceive the situation, I have a problem with. I’m not the only one either, so trying to “play off” I’m crazy, well no one who is around me and *KNOWS* me, we’re not buying into that. Whether smiling through it or complaining about it, doesn’t matter, nothing works to get a plan that I participate in (especially its formulation) and am fully informed about.

Is this something that you can do or do I need to take this further? I’ve been several avenues, several methods, and after months, there is still no resolution. I’ve made comments that I’d just rather drop than to continue like this: with no end in sight to an expensive plan that I haven’t seen address the underlying pain issue. All I see is that I get a reputation for not following doctor orders (that I’m not fully informed about other options, tests, given a chance to participate in the creation of a treatment plan, etc.) and for being a difficult patient, when the fact of the matter is that if I felt like I was treated with respect and compassion, included (or even asked) about a treatment plan, things would be different.

We come back to a complain I had months ago: listen to me. Corrollary: take me seriously; work with me; don’t blow me off – or expect the same treatment in return.

Let me know if you get this message and whether or not its workable.

Thanks,

I’m documenting the PICC line removal, etc. is directly due to pain (& other symptoms) that have either gotten worse, keeps coming back/not been resolved. The main reason I exercise is to take my mind off the suffering and to enjoy, with friends, the time left to me.

Need an appt. w/time to discuss the medical reasons why I haven’t been treated for pain, including tests performed to ascertain pain causes, why other doctors’ tests were/weren’t taken into account in making this decision, & timelines when it will be treated (or who I need to go for resolution). Also all diagnoses, course of treatment & timelines involved as to when this will lead me to full recovery, the alternatives, & where I am allowed to participate in my Plan of Care development & the way it is carried out. According to the group, “to have my pain appropriately & quickly assessed & effectively managed & to receive information regarding pain & suitable pain relief measures”. This needs to be addressed without delay.

Sent: Tuesday, February 19, 2013 11:06 PM
Subject: additions to medical record

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,

Risk Managers: Deny, Defend, Investigate Pt 6

Just a few more of the items that I’ve gone thru. Think again, would you want to deal with this, when you simply were trying to get care and get some answers? This is why you want to investigate the surgeon thoroughly.

Sent: Thursday, July 18, 2013 10:28 PM
Subject: Re: Results

I don’t want to drag things out, but there are questions that have been around for months, unanswered by the group. 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 the group HIPAA violation group? Do you have confirmation that I am not mentioned in any “secret” or nonpublicized database (EPIC or not) 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.

Thank you,

Sent: Sunday, July 14, 2013 7:19 PM
Subject: Results

I had some questions for you, a couple of which (what you do and how to send record discrepancies to you) should have been answered already, that haven’t been. Please let me know this week have when you will have those answers or what has been done on the issue. It has been 3 weeks and I’ve seen no action on the group’s part.

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.

——– Original Message ——–
Date: Wed, 19 Jun 2013 11:43:07 -0400

Good morning,

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 electronic health 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.

Thank you for you help.

——– Original Message ——–
Subject: Re: Information Request
Date: Wed, 19 Jun 2013 23:13:17 -0400

Good morning,

For a bit of clarification on surgery. I understand there is no bariatric care thru the group. If I was to need an appendix out, would that rule out any the group doctor? another surgeon was the original doctor I wanted for my bariatric surgery. I was refused going to him first for the bariatric surgery (just told I was to have bariatric surgeon, and that’s who I was assigned) and then that other surgeon’s office said he would not overrule bariatric surgeon’s refusal for the gallbladder removal surgery (my insurance called the office & bariatric surgeon did do the surgery). I was told something different by other admin. I have also been told that the reason I didn’t get another surgeon was that he is more of a general vs. bariatric surgeon. Several have said once one doctor operates on you, they don’t like to go in on someone elses’ work. A specific answer would be very helpful for me & to pass along to others, as I’ve been told one thing one time, a different one another time.

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

My Mother and I were told by 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 very congested major artery in rush hour traffic to get home. If you’re going to give me an answer, please keep it consistent.

I was told that plastic surgeon, a plastic surgeon, spoke with bariatric surgeon, then was told nothing was said, then it seemed there was conversation between them. That conversation was never in my notes, nor was there any documentation obtained on it. That is one of a number of questions I had about my care I couldn’t get answered while still a patient, or the answer would change. I’m looking at plastic surgery so if there is still an issue, I would expect to know about it.
Again, if there is any other problem or prohibition that I am missing, at least work with me professionally to find care before you throw me out. I’m having problems, my internists office told me that I had lost a “huge chunk of my care” and because of legal issues (not from me, non compete agreements?) no one else in the area will take me. After everything I’ve been through, if I can still find positive things to say about the office, please find that same spirit for me.

Thank you,

——– Original Message ——–
Subject: Re: ER – hospital
Date: Wed, 7 Aug 2013 10:15:41 -0400

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 the group 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.

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.

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,

Risk Managers: Deny, Defend, Investigate Pt 3

4/19/2014 3:44 PM:

Are there any laws, rules or regulations on taking photographs of patients? With or without their permission?

Reference http://www.slate.com/articles/technology/future_tense/2014/01/doctors_on_social_media_share_embarrassing_photos_details_of_patients.html

I can’t find any where we are guarenteed that the sort of behavior I see above in the link provided would never happen.

Could you please point me to any published information on that subject? Thank you,

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.

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—–
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.

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—–
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—–
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,