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.

Intimidation – Bariatric Style

So I believe in letting others know how the surgeon has acted towards me. I’ll document my previous encounters so people can see why you need to investigate your bariatric surgeon (or any doctor). If they treat someone else like this, how are they going to treat you? I know of someone the group performed surgery on and didn’t give any followups AT ALL. The patient called them requesting one and then it was over TWO MONTHS since the surgery before they got a followup.

Is that the sort of treatment you want?

I am protesting the bariatric surgeons’ treatment of me, which I believe did not follow the law (HIPAA violation retaliation, see resources below) and the American Society of Metabolic and Bariatric Surgeons’ & others’ guidelines on bariatric surgery aftercare (they are a Center of Excellence, I reported to them in 2012 there was no other care in the area) with multiple supporting resources below.

I go out and on public sidewalks, hold up a sign or talk (not screaming, cursing or giving people the bird) and sometimes tell people to ask questions, read & educate themselves. The funny part is that the center will watch me, but doesn’t help their prospective customers. On at least 3 occasions, I’ve had to tell people they were going in the wrong door. NONE of the staff were watching them. Even if I moved to be out of site of the door, the doctors would scrunch into the wall to see me.

But I’ve had to tell people who couldn’t get in the building what door they needed to go into.

In the past, I had the cops called on me twice and of course, acting in a manner consistent with the law and common decency, they’re not going to do anything. It is my constitutional right to disagree. So after getting followed by my former surgeon several times, I spoke with the cops and they said the next time I come out, to let them know. They would speak with my former surgeon. They did. They told him she has a right to protest, and to be on public property with a sign that isn’t nasty and not yelling profanities. They said “leave her alone” and “ignore her”. They haven’t.

Could that be because they don’t want people to know what they have done?

The next time, the same thing happened. The cops came out, spoke with me, and then spoke with them, saying basically the same thing. The time after that, I am sure I saw one of the nurses take a photo of me from inside the office. I sent a note to the risk manager & privacy officer saying I wanted it in my records to not be photographed and if that happened, why. So far, those questions haven’t been answered. The emails are below.

On May 7, 2014, I go out to do the same thing, except I brought a chair to sit because I’m weaker from malnutrition & complications the surgeon appears to have missed (seems a couple others caught it while I was with him). I hold my sign up. However, not only is the other surgeon watching me, but they now have a security guard out across the street with other buildings, taking photographs of me and writing down notes on me. I hold my sign up in front of my face & my hands/arms in front of my face, indicating I did not wish to have my photo taken.

Stay tuned: again there are DECENT, ETHICAL surgeons out there that work with you. I’m pointing out the need to really investigate your surgeon. Get the surgery! I can’t say that enough but the addition is INVESTIGATE THE SURGEON AND THE OFFICE PRACTICES THOROUGHLY.

HIPAA violation retaliation is illegal
Source 1
Source 2
Source 3

After care follow ups – I didn’t get an 18 month visit, since I was dropped after 16 months (although the surgeon could justify seeing me every 3 months or less after my Dec 2011 surgery, and had a June 2013 appt. scheduled when I left the 16 month visit followup). Yearly follow ups are always recommended in every center you see. Now if you can drop a patient, and you do, one with complications, what does that say about the surgeon?

Source 1
Source 2
Source 3
Source 4
Source 5
Source 6
Source 7
Source 8
Source 9
Source 10
Source 11
Source 12

Lawyers, HIPAA laws, profits, banning care

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

http://www.generalsurgerynews.com/ViewArticle.aspx?d_id=77&a_id=10933
http://www.bizjournals.com/sanjose/stories/2007/09/17/story2.html?page=all
http://hbr.org/product/weight-solutions-clinic-bariatric-surgerycenter/an/KEL030-PDF-ENG
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1402352/

Gastric Bypass Surgery for Everyone!


http://calorielab.com/news/2005/06/19/hospitals-gorge-on-weight-loss-surgery-gravy-train/
http://blog.sermo.com/2014/01/14/peril-and-profit-for-weight-loss-surgeries/
http://www.bostonmagazine.com/2006/05/the-incredible-perilous-moneymaking-people-shrinking-machine/
http://www.fathomdelivers.com/blog/healthcare/marketing-bariatricweight-loss-surgery-online/
http://www.amednews.com/article/20120423/business/304239976/4/
http://abcnews.go.com/Health/100-million-dieters-20-billion-weight-loss-industry/story?id=16297197

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

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

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

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

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

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

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

Sent Sunday April 16, 2014

Well?

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

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

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

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

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

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

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

Thank you.

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

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

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

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

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

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

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

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

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

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

Thank you,

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

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

Thank you,

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

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

Thank you,

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

Good morning,

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

Thank you,

Medical Research

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

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

Bariatric Followup:

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


Bariatric Follow-Up Care


Follow-up of Nutritional and Metabolic Problems After Bariatric Surgery

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

Neurological Complications:
Neurological disorders associated with malnutrition

Psychiatric Care:

Psychiatric Evaluation and Follow-Up of Bariatric Surgery Patients

My medical records

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Health Care & Money, Bad docs, Medical Research, Obesityhelp.com warning,blogs

I had heard (and of course, always check things out) that obesityhelp.com sends reviews back to the surgeon. If they don’t like it, obesityhelp.com will delete it and not allow you to post. This is the surgeon experience form. When I asked about this, the response I got on 3/18/2014 at 11:14 am from membermail said, “Send us what you want to post and we will review it before you post it. Also let us know what surgeon it’s for.” Now if I have to have it approved, do you feel obesityhelp.com is a fair place to get ALL comments about a surgeon or is it only going to list their good ones. How can you learn if you only have good and don’t see how they deal with the not so good ones?

THE LATEST:
On 3/22/2014 5:32 PM, ObesityHelp Staff wrote:

When a member writes a testimonial on a surgeon, the surgeon receives a notice that a testimonial has been left on their profile. We do not review testimonials before or after they are written. We will conduct a review if a testimonial violates our Terms of Service and is reported to us by a member, a lurker or a professional. Unless a testimonial violates our Terms of Service, is slanderous or involves a potential legal action, we do not remove testimonials. If a testimonial is removed for slander or a legal issue, we do so for the protection of our member. Whenever a testimonial is removed, we notify the member by PM.
Member Services

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.

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.”

“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.”

*** Just so you know, my blog links to items showing a 45% profit rating

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?”

*** Note that in Virginia, a doctor can “plea bargain” something from the Medical Licensing Board. There is a doc in Va. named as a “top doc” in the DC area that is on the brink of their license. Nothing in the public record for 3 years. Someone mentioned in another list that they should rename boards to something like a Protective Agency. In Florida, the doctor can see your complaint but you can’t see the doctors’ response. So if they lie, the lies are *protected by the state* as the *physician*. It is the same in Va. where you can’t comment on anything. They also don’t consider anything other than their own reports, nor how or where they get specialists to review other specialists, and whether there are conflicts of interest.
Boards of licensing are not transcribed/recorded. The doctors know this. Wonder why they get told that? They’re not sworn to tell the truth either.

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.”

New WellPoint CEO Swedish Took Home $17 Million in 2013
(with Table: 2013 Compensation Among Five Highest-Paid WellPoint Executives)

General items:

Your rights and responsibilities according to Blue Cross Blue Shield.

Patient Advocacy:

Activated Patient
Patients are people too
Patient Visit Guide
Health Coaching

Protein Issues:
How much protein do I need each day?

Other patients blogs:

Was a bubble butt.
Ad Winters
Bariatric Beginnings
Beauty & the Bypass
Judi’s great spot
Bariatric Girl
What another patient went thru
Another link from Gary

Information on the bariatric surgeries from less than 6 months ago:
BMI Loss Lasting w/3 Bariatric Surgery Options.
Firing of Rex doctor

Vitamins: Bariatric offices & Flintstones

One item I’m seeing popular is the selling of vitamins and the like by bariatric groups. They have their own or you can purchase vitamins and the like from them. The question is why? When any of the vitamins will do, why do they have this “amenity”? Is it due to profits? Getting people back in for visits so that profits can be made? What about associated exercise centers? Do you have to pay for those? Are they part of your “surgery package”?

The main question being: is this for my health or does it provide a bigger profit range, or even both? If so, how do you know this is for you? How many people take advantage of these “amenities” and if so, what are the demographics? That might help you to know whether or not it is going to help YOU in your INDIVIDUAL journey.

Flintstones aren’t compliant with the Guidelines of the ASMBS (American Society for Metabolic and Bariatric Surgery). Some “Centers of Excellence” do recommend them, but ask why.

ASMBS Guidelines for the surgical weight loss patient/
Vitamin & Nutritional Guidelines

After a bypass, we need about 200% of the RDA of most vitamins and minerals. The reason for this is because part of the intestine is bypassed and that’s where a lot of vitamins and minerals are absorbed (some but not all). So you’ll have to take extra.

If you look at Flintstones vitamins, you’ll see that getting 2 of them a day is not going to give you 200% of the RDA for most vitamins and minerals. Some but not all. You’ll only get 120% of Vitamin A, 25% of biotin, 150% of niacin and nothing for Vitamin K (btw, the author took this vitamin and at 2 years post op, was so Vitamin K deficient blood levels didn’t register in tests, along with bleeding episodes). If you have to take more than one in a day, you’ll end up getting a lot more of some vitamins and minerals than others. Vitamin toxicity can be an issue – as can too much iron (Iron overload or hemochromatosis and a href=”http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=total_copper_blood”>copper).

Just an FYI: the type of Vitamin A is beta carotene. This is not Vitamin A but turns into it in the body. There is a lot of beta carotene you need to turn it in to Vitamin A (also known as retinol). Children can convert this into Vitamin A easier than adults. So its more suited for kids than adults. So if you take 4 Flintstones and get 240% of beta carotene, which may not be enough to turn into retinol.

Ask your surgeon why they still recommend Flintstones for post surgery bariatric patients. If they’re not up on this data, or their group isn’t, how up to date are they going to be on other items?

If a doctor treated you this way, how would you feel?

I have several examples. I’ll leave things like a doctor operating on you and never calling for a followup appointment. You end up calling and getting an appointment TWO MONTHS LATER.

First example:

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 (and other baby items) cake class. The teacher agreed to allow me to make the doctors’ bag versus the diaper bag (and; other baby items). I attempted to contact the bariatric surgeons’ nurse, a couple of weeks before, to make sure my bariatric surgeon would be at work on that Friday. 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 the nurse 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 electronic health record (in case the bariatric surgeon would see it). 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. Now here I’m getting chewed out for doing something NICE for this doctor! Then that Friday, I got to sneak the cake in, with the help of the staff. I had a few other things made also. I was waiting in a room (no appt.) and the nurse 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. ) Not one word of apology, ever, for chewing me out, instead it was laughter. What do YOU think about what this says about a bariatric surgeon, a surgeon, or even any doctor?

Second example:

Another interaction with my bariatric surgeon: I didn’t want to be weighed because I had been losing so much weight. I finally said no to getting on the scale. This group is part of a system that, on the internet, guarantees you can refuse tests/care and still be treated. Legally you do have the right to refuse. Well, when I refused, the nurse said she would get the doctor. He comes in with his nurse. He ends up telling me ‘if you don’t do as I say, I will put it in your records. Other doctors will see it and wonder why’. Now if someone is concerned, and they’ve been mentally, negatively, been treated about the loss of so much weight in such a short time, would this make you feel better? To be coerced against your will against taking a medical test that you legally have the right to refuse and still get care? That they would do this to put a wedge between you and your other doctors?

Third example: Another instance: on the day I was released from the hospital from malnutrition (a Monday, June 25, 2012), the surgeon told me to see him next Wed. Then he said oh wait, next Wed. is July 4th, see me that Friday (July 6). Ok I said. Well I got a call later on and someone was very unhappy because I didn’t call and make an appt. for Friday June 29th. I said it was “see him next Friday”. “Well I didn’t know what I was thinking”. Well neither did I but I was written up in my medical record! I was BLAMED for their MISTAKE.

Fourth example: After my gallbladder surgery, I was told 2 weeks before I could do anything (meaning swimming). Then a couple of days after the surgery and I had come home from the hospital, I asked and then it changed to three weeks. I said (from my electronic health record): “3 WEEKS? That’s not what he said before, it was 2! What was he smoking, toking or testing from the OR gas passers before he gave you that answer? After all the food I brought (didn’t go to bed Sun night & started some stuff on Sat night), even made fresh turkey/chicken wraps & got fruit/veggie trays with homemade potlatch seasoning for dip. And he says I push HIS buttons?

** I brought a boatload of food for the doctors & nurses in the surgical areas. The doctor had told me before that “I pushed his buttons”.

The response from his nurse was: “Ok, he said AT LEAST TWO WEEKS…..”.

How easy is it going to be to follow a doctor who changes your directions and then believes you were the one at fault for it?

Fifth example:
See example 4. When a doctor tells you you push his buttons, maybe the doctor needs to learn to be professional and not have patients that “push buttons” when people do their research and ask questions.

Sixth example:
I actually had my surgeon tell me, ‘You know I don’t like it when you do that’. Now since when does what a doctor LIKES matters? When a bariatric surgeon, says in a video publicized that they have all sorts of people who have surgery and names firemen as an example, that means that there should not be any problem doing any sort of physical activity.

Its not about:

the surgeon selling you a particular surgery because
: that’s the one they do
: or the one that makes them the most money
: or the one that gets them their quota of X surgeries for the year
: or keeps them coming back to you.

It is about what is right for you!

One note: sleeve surgeries are noted (as of 3/2014) to have a problem with reflux or GERD. This means if you already have it, or you don’t have it, you have a greater chance of getting it or keeping it or it getting worse with this surgery. You would need conversion to RNYGB (gastric bypass) possibly to fix it. So choose a surgeon who has NO vested interest in the $$$ from the surgery or one that keeps you coming back to them. You want what is best for you!

The other is the personality of the surgeon. If you like them, you’ll keep your followup appointments. Plus it makes working with them easier if they have a personality you can deal with. In my case, I had a very paternalistic surgeon. While that works for some, that surgeon stated once about a particular treatment he chose: “I did what I thought was right”. EXACTLY! What THEY thought was right by THEIR values, mores, and standards, not what worked best for ME and my life, job, friends, family, etc.

How many of you would allow the company to build your house to choose your carpet, wall paint, etc.? This is the same thing. The surgeon should be giving you the options and letting YOU make the decision. If not, are you going to be happy for the rest of your life having this person make decisions on your health?

THINK ABOUT IT!

One other item: a center of excellent (which all are in the Hampton Roads area) means that a group or hospital has hit certain milestones & fulfilled criteria. It means NOTHING as to whether or not a surgeon is good or not.

A big item is experience with the particular type of surgery you want done. I refer to this in my questions for surgeons categories of posts. One item about the RNYGB (bypass): the stoma, link from the pouch or stomach, to the small intestine, can dilate or become wider. That means a lack of restriction. This area is made to keep food in the pouch so that you feel full. Once it dilates, food isn’t held in the stomach and you’ll start to feel hungry. Since malabsorption happens within really the first 2 years (or less, the intestines “relearn” or adapt to be able to absorb more, regain can restart. The more intestine bypassed, the more malabsorption happens.