mariansmusings

[mariansmusings]

Telemedicine Blog: How to Know If You Are Speaking to a Licensed Doctor

Telemedicine is the latest, greatest tool in healthcare.  In this age of COVID, talking to your doctor via a phone, or an online video chat is more than just a convenience. The biggest plus? You don’t risk exposing yourself to COVID by going to a medical office. Telemedicine also saves time in travel and money on gasoline and parking.

 But what if the call is not with your own primary care doctor? What if it’s a physician you have never met who is taking care of your loved one in a hospital? You can’t be there to see this doctor in person because of the visitor ban. Your only option is to talk to the voice on the other end of the line.

 So, how do you know this voice is a real doctor? The answer is – you don’t.  The person on the other end of the line may not even be licensed.

 I discovered this issue first hand last September when my husband was in UC San Diego Health in La Jolla, California. It was torture to only get an update once every 24 hours from the hospitalist, whom I will call Dr. A.  She was sensitive to my husband’s condition, and lobbied to get him moved to a floor where he would get more individualized care.  I looked up Dr. A on the Medical Board’s website, and saw that it was clear, although that can be a false comfort; the Board only posts disciplines but not complaints. After a few days, Dr. A brought in another doctor to consult for possible radiation treatments. Dr. A introduced Dr. B as a “radiation doctor.” After discussing options and promising another update the next day, the doctors hung up.

 I looked up Dr. B on the Medical Board website, and was alarmed to find she was not listed.  I then called the Board’s consumer line and was told that Dr. B had no license of any kind in any state. That was disturbing. I did more research on this Dr. B and discovered that she was just a first year resident. In the state of California, medical residents are supposed to have a Post Graduate Training License, a PTL, within 180 days of enrollment in a three-year resident program. Dr. B. didn’t have a license yet.  (She wouldn’t get her PTL until December, 2020.)

 The next day when the doctors called with an update on my husband’s condition, I again asked what kind of practitioner Dr. B was, and for a second time was told she was a “radiation doctor.”  Instead of questioning her, I asked who would be doing the radiation procedure since she was a resident, and heard a gasp on the other end of the line.

 The thing is, I would have been fine if this resident had told me her status.  My husband and I had consulted with other residents at UC San Diego Health before who had been up front with their status. Why did these medical professionals choose to lie to me? Because of this choice, I lost all confidence in both doctors because I no longer could believe anything they said to me. This added to the stress of not being able to be with my husband in the hospital at a time when his health was in a nosedive.

 If I had been able to speak with these doctors in person, I could have seen their titles embroidered on their white coats, or on their ID badges.  But because our conversations were only over the phone, via “telemedicine,” I was at a disadvantage. I could only rely on what they told me.  .

 A friend of mine also recently dealt with the issue of doctor identity at a Nevada hospital. The doctor who called her used the name “Shaw,” or at least that’s what she thought.  As it turned out, the spelling of this doctor’s name was “Shah.”  She had panicked when she could not find him listed with the Nevada Medical Board.  My friend called me with her concerns, and I was able to track him down with the correct spelling and specialty for her. Had he fully identified himself when he first spoke to her, she wouldn’t have experienced this stress while her father was in the ICU.

 The confusion in titles comes from the medical profession itself.  People who have graduated from medical school are allowed to call themselves “doctors,” before they are actually licensed by state medical boards. Residents call themselves doctors, and even though most have that Post Graduate Training License, they are still not fully licensed physicians.

 I checked with the Medical Board of California about whether doctors have to identify themselves, and was told they are required to do so in person in their offices or hospitals.  However, there is currently no law requiring them to identify themselves on the phone or video chat via telemedicine.

 Interestingly, the Washington Medical Commission is currently considering a bill to require doctors to identify themselves as part of the informed consent protocol for telemedicine.

 Since telemedicine is now widely accepted, especially in this age of COVID, patients need to take the initiative when talking to anyone claiming to be a medical professional over a device.  This includes doctors, physician’s assistants, nurse practitioners, nurses, and even administrators. First, ask the doctor to say and spell their name. Then have them state their medical specialty and their license number. Keep a notebook where you can write down who spoke to you, what was discussed, and the answers to any questions you had.  This can be done pleasantly, and not in a confrontational manner.

 Most people would be upset to know that their Uber or Lyft driver just had a learner’s permit, or that the guy flying their jetliner was a student pilot. However, when it comes to doctors, consumers usually assume that title means they are licensed -- when that is not the case.

 Patients and their representatives have the right to know the identify of the person they are speaking to over telemedicine – and especially whether that person has a state license to practice medicine.  It should be part of the informed consent process. Until doctors are required to identify themselves, it is up to consumers to take the initiative to ask -- and then to verify that so-called doctor with the state medical board.

[mariansmusings]

Thoughts on Breast Cancer Awareness Month as Family’s Third Generation Diagnosed

Breast Cancer Awareness Month is taking on a more somber, urgent tone this year, at least for me it is.  Instead of just being the annual reminder to get checked, it brought the slap of reality that breast cancer is truly an ugly monster that stalks my family. That thought crossed my mind as I knelt in front of my younger sister last week and measured the liquid draining from the mastectomy tubes.  Noreen represents the third generation in my family that we know of to be diagnosed with breast cancer.  The fact that this disease had hit another generation made the diagnosis even more ominous.

 We knew our grandmother died from breast cancer. She was diagnosed in the mid-1950’s, at a time when doctors performed a mastectomy and sent the patient home, hoping for the best.  We rationalized her case as being a result of the time. This was before diagnostic tools like mammograms and MRIs, and treatments such as radiation and chemotherapy that save lives.  Then in 2000, our mother was diagnosed with inflammatory breast cancer – the worst type.  Because of dementia and her extreme Catholic modesty, by the time she told our father her breast was hurting, the tumor was the size of a tangerine. Since inflammatory breast cancer is extremely aggressive, it metastasized quickly, and we lost her within a year.  Still, despite our grief, we rationalized our mother’s case as being a rare fluke.  Inflammatory cancer is extremely rare, we were told, so the chance of other family members developing breast cancer was still slim.

 That was before Noreen went in for her usual mammogram in July.  It was routine, as far as she was concerned. She had felt no lumps during her monthly self exams. However, the mammogram showed a suspicious area in her left breast.  A follow-up MRI confirmed the need for a biopsy.

On August 9th, Noreen was told she had DCIS – ductal carcinoma in situ -- malignant neoplasm in her left breast.  Due to our family history, a double mastectomy was recommended, followed by reconstruction.

 The news stunned our family.  This elevated the risk of breast cancer for us to an entirely different level. It was real and serious now – a wake up call for everyone to be constantly vigilant since cancer had now invaded another generation. Noreen’s BRCA test came back negative, but the results did show an mutation that has yet to be identified.

 After the initial shock of the diagnosis, Noreen seemed to rebound quickly.  She has a strong support system where she lives; her friends, co-workers, and family rallied around her and showered her with love, advice, and gifts like blankets, pajamas, and flowers. Friends who are also breast cancer survivors gave her advice, and many started showing up almost immediately with meals.  Noreen focused on how fortunate she was to have found the cancer at an early stage, and felt confident in her team of doctors.

 I, on the other hand, was a basket case.  Noreen is my baby sister, the sibling I had prayed for as a kindergartener. Despite the fact that we now live on opposite coasts, we talk daily.  We have helped each other through a number of family medical crises such as heart attacks, broken bones, and knee surgeries – all via phone and Facetime.  The idea of her going through such an invasive treatment was heartbreaking for me.  Needless to say, I made arrangements to fly to Noreen to be on hand to help with drain tubes, doctor appointments, and anything else that needed doing.  While Noreen got the help she needed, being there was more therapeutic for me; it was reassuring that she had a great attitude, and despite her initial post-operative pain, was healing quickly from the double mastectomy.

 Noreen is a prime example on how being her own best advocate led to an early diagnosis. She has never missed a check-up in the past couple of decades– and this year it paid off.  Her message for others is to make your health a priority and don’t fear going in for a mammogram or any breast exam, particularly if you notice a change.

 In the meantime, Noreen and I will continue our daily calls (sometimes multiple daily calls) so I can keep up on her recovery and upcoming treatments. (I love to tease and guilt her that she has to take my calls over those from friends because I love her more.)  Our relationship is solid, made even stronger by her diagnosis and our commitment to keeping our family and friends vigilant and safe from breast cancer.

[mariansmusings]

Doctors Rail Against Licensing Fee Increase Despite Medical Board Insolvency

People dying because they can’t afford insulin.  An older couple choosing to end their lives together in a murder-suicide because they can’t afford medical treatment.  Patients going bankrupt because of surprise out-of- network medical bills.

 These are sad but true stories of healthcare in America.

 So it was shocking, to say the least, when doctors on the Medical Board of California were outraged when it was announced at the last quarterly meeting that their license fees would have to be increased or else the agency would soon be broke – or, as the executive director said, “insolvent.” 

 The outlook sounded dire.  Executive Director Kimberly Kirchmeyer pointed out that despite an anticipated annual budget of $75 million for this fiscal year, and $78 million anticipated for 2020/2021, it was still not enough to keep the Board financially viable.  That is, unless licensing fees were raised.

 Reaction from the doctor board members was swift, especially from those who also belong to the California Medical Association, the doctor lobby group whose primary purpose is to protect physicians’ financial interests.  Former CMA president Dr. Richard Thorp, one of the new board members, immediately claimed that increasing fees was unfair to doctors, saying, “There should be some other recourse to this rather than be handcuffed and held captive.”  The other former CMA president on the Board, Dr. Dev Gnanadev, called for a report on how much other states charge their doctors for licensing fees, suspecting that California could be overcharging.

 So just how much does California demand for a license to practice medicine?  No one could say initially. None of the doctors on the Board apparently knew.  Someone finally looked it up: $783 for a two-year renewal fee. That breaks down to a mere $1.07 per day.  Pocket change, really. Plus, these licensing fees have not been increased for 13 years – not since 2006.

 And what was the proposed increase?  While no final decision has been made, Kirchmeyer estimated that the higher fees could be between $1050 and $1150 for two years.  If the Board went with the higher figure, that would still make the daily cost of a medical license in California only $1.57 per day. That’s definitely less than a cheap cup of coffee, a gallon of gasoline, or a glass of inferior wine.

 The reason given for the license fee increase and the Medical Board’s financial woes was the Attorney General’s office, which had announced it was raising its fees after ten years. Beginning September 1st, the AG’s office will increase the hourly rate for attorney services from $170 to $220, which is an increase of 30%.   Paralegal fees were also going up a surprising 71%, from $120 to $205 per hour, and auditor fees were almost doubling.  While the Medical Board members did not begrudge lawyers a higher salary, they were definitely upset with the new paralegal pay.

 It was embarrassing to watch these Board doctors whine over such an insignificant increase in fees.  From the way they were acting, you would think they had been asked to relinquish 50% of their income, instead of a measly $1.57 per day.

 Not one doctor asked how this budget shortfall would affect patient safety and the Board’s ability to investigate patients’ doctor complaints.  Only Board member Kristina Lawson, J.D. asked how the agency would be able to fulfill its obligation of consumer protection, but that question went unanswered.

 It was odd that the Board as a whole seemed to be blind-sided by this fee announcement.  Don’t they read the materials for the meeting ahead of time?

 Finally, Californians are used to paying more for everything from housing to gasoline to even Girl Scout cookies. Why would a few extra cents a day to practice medicine rankle this Board? Given that California has more doctors than any other state (140,000 total, 115,000 living here), it makes sense that it would cost a tad more to regulate all of them.  Besides, if more doctors behaved, the Board would not have to investigate so many for infractions like personal addictions, overprescribing opioids, sexual misconduct, and DUIs.  (Gross negligence such as surgical errors make up a smaller percentage of disciplinary cases.)

 It was disheartening to see this Board more concerned about a possible 50-cent a day licensing fee increase than the financial viability of this regulating agency. Perhaps they need to re-evaluate the reason they applied to the Board.  Are they really interested in protecting the public – or more focused on protecting doctors?  It was obvious from this meeting that the safety of California consumers is a low priority compared to physicians’ wallets.

 Despite all this whining, any increase will still have to wait until next year to find out whether the state legislature will need to authorize one.  Until then, we will have to wait and see whether the budget problems affect the Board’s ability to protect Californians from dangerous doctors.

[mariansmusings]

Is Possible to Trust Doctors Again After Medical Harm?

Shattered trust. It’s a term people use to describe a betrayal in a romantic or professional relationship. A cheating partner. A back stabbing co-worker or boss. Most of the time it’s deal breaker, resulting in a break-up or someone leaving a job.

 But what happens when that shattered trust involves medical harm?  Would you ever trust a doctor again if he/she had operated on the wrong knee or kidney? What if you had been misdiagnosed or were sexually assaulted by a doctor? Even worse, what if that harm was deliberate?

 That’s what I had to confront after my father was deliberately harmed, which resulted in his death. This was not just one rogue doctor, mind you, but a concerted effort by a number of doctors and nurses at two hospitals and a nursing home to keep me unaware of what they were doing to him. 

 By going through medical records after my father’s death, I learned that his primary care doctor had drugged him with Risperdal, Haldol, Ativan, Tylenol with Codeine and Morphine after admitting him to the hospital to determine the cause of back pain. (Risperdal and Haldol are antipsychotic drugs, which carry FDA black box warnings that they are not recommended for seniors because they can cause serious side effects and death.) All these drugs had been given without my knowledge or consent as power of attorney. My dad’s doctor and all the nurses denied he had been given anything to make him suddenly lose his mind. That, I was told, was due to hospital delirium, common in the elderly; it was recommended that he go a nursing home for rehabilitation for his back and his mind for a few weeks.

 At the nursing home, however, the medical director prescribed more Risperdal and Haldol, along with double doses of Ambien and Vicodin – again, without consent or apparent need. That doctor never spoke with me about his care, refusing to return my desperate calls as my father went into a death spiral due to the deadly side effects of the antipsychotics.  When he was rushed to the hospital after his 7th fall in 12 days, the doctor slipped in and falsified a “Do Not Resuscitate” consent form.  The physician who was called in to consult denied any drugs had caused his mental decline; he turned out to be on the board of the medical malpractice company that insured the nursing home doctor.

 My father was dead less than two months after going into the hospital.  Ironically, the cause of his back pain was spinal stenosis, which could have been treated with outpatient physical therapy and over the counter medication.

 This betrayal of care had a profound affect on my entire extended family. No one trusted doctors or nurses anymore. My children were afraid to go to the doctor, and looked up anything they were prescribed for side effects before any pills were taken. My sister-in-law kept her father at home in his final years, not trusting any hospital or nursing home to care for him. Because I became a patient safety advocate after my father’s death, friends would call me in a panic if a physician recommended a nursing home for a parent.

 So it was terrifying when we suddenly had to deal with doctors again when my husband was diagnosed with GIST cancer and sepsis last year.  Because it was a hemorrhagic tumor, the doctors wanted to act quickly, wanting to do perform surgery the next day. It was hard not to panic at the thought of trusting my husband’s life to a surgeon we had not personally chosen.

 What helped is that in the three months leading up to that diagnosis, my husband’s doctors actually talked to us.  This was so different than the invisible doctors who deliberately harmed my father.  This time around, Ed’s cardiologist listened to our concerns, and tried to answer our (my) unending questions as we were referred to a pulmonologist, hematologist, and gastroenterologist.

 Several factors helped this particular doctor/patient relationship.  First, I was not afraid to tell my father’s story, basically as a warning that I knew patient rights; more importantly, these new doctors were outraged that one of their own would treat a patient that way. Second, this new set of doctors was a good 15 years younger than those who treated my father. It made me wonder whether younger doctors are more in touch with treating the whole patient, and are not as willing to force the traditional “the doctor is always right” attitude. I felt that we were tracking down the cause of Ed’s symptoms together, because each step was explained along the way. Finally, by this time, I knew how to look up doctors on the Medical Board of California website to see if they had any disciplines, malpractice lawsuits, or criminal convictions – and to see where they went to medical school. I had downloaded the new doctor app on my phone so I could look up any new physician we met along the way within seconds. (I am also aware that complaints against doctors are not listed, and some documents have been taken down and not replaced.)

 When we were told which surgeon would operate on Ed, this new group of doctors seemed genuinely pleased, almost relieved, that a reputable person would be taking care of their patient. Having that endorsement by other physicians we knew helped allay our fears.

 Later, when Ed developed a sudden fever a few days after being released, I rushed him back to the hospital, concerned about sepsis – and worried that I would have to fight to convince doctors he needed treatment immediately. I knew that there was a small window to treat sepsis, and that medical professionals often misdiagnose or ignore symptoms until it is too late. I dropped Ed and my adult son off at the emergency room door, quickly parked the car, and literally ran into the hospital, fully expecting a fight to get Ed prompt treatment.  I was stunned and relieved to find that Ed had already been given an IV and a dose of antibiotics.  He was septic, and spent another five days in the hospital – but he received treatment within that critical window.

 This experience with Ed’s surgery has helped to ease my fear of doctors and medical harm somewhat. It was not perfect though. I did report a hospitalist who refused to wash her hands and use gloves during multiple visits, declaring it “silly.” (She felt hand sanitizer was enough to kill superbugs.) However, I have gained confidence in dealing with doctors.

 As an advocate, I now read all the accusations and disciplines that the Medical Board of California releases, so I am acutely aware that preventable errors and bad doctors happen more often than we would like. By being vigilant and questioning every step of treatment, I believe patients and their families can make a difference in the outcome of any procedure. I also believe that it is critical for a doctor to communicate with the patient to discuss and agree on the best course of treatment.

 So has my shattered trust in doctors been repaired? No. Not even close.

I will always look up every doctor and verify everything I have been told. I just know better how to deal with the trust issue  – and the doctors that will cross our path in the future.

[mariansmusings]

How Do You Know If a Doctor is Good? (Pssst. It’s Not Easy.)

 “You should know better than to go to a bad surgeon.”  That was the comment made to a patient advocate who had just told his personal story of a twice-botched surgery to the Medical Board of California. The person who made that comment in front of the elevators was a member on that Board.

 It was a jaw dropping moment. In fact, it took a few moments for the words to register. For one, the flippant comment seemed so incongruous with the lofty goal of the Medical Board, which is supposed to be “to protect healthcare consumers.” Second, it made me wonder if the Medical Board really blames patients for choosing a bad doctor. Even worse, do Board members actually think people deliberately seek out bad doctors to botch our surgeries? The idea is ludicrous.

 So, how do we find out if a doctor is good or not? We are told to look up doctors, but that is not easy.  Most people have no idea where to research a physician’s history.

 Unlike members of the Medical Board who have insider knowledge of complaints and actions against doctors, the average Joe is at a disadvantage when it comes to knowing the Who’s Who of medical competence – or incompetence.

 A recent survey by the Federation of State Medical Boards found 1 in 5 patients experienced unethical or unprofessional conduct or substandard care by a doctor but that only about a third of these people filed a complaint. Of those who filed a complaint, only about a third of those contacted their state board.  At least half of those surveyed did not know their medical board regulates and disciplines doctor.  The FSMB site does have a link called DocInfo.org, but that basically takes you to your state board’s website. (More on board websites below.)

 A quick Google search will pull up doctor sites such as Doximity, Healthgrades, or Vitals, which mostly give educational backgrounds and contact information but rarely any disciplinary history.  Yelp reviews can be easily manipulated by doctors who are concerned about their online presence. (If you see a review that refers to the doctor as a “clinician,” you know it was written by a colleague or office employee.)

 The National Practitioner Data Bank contains the most complete reports on doctor disciplines and malpractice history.  Congress established the NPDB in 1986 in order to “improve healthcare quality, protect the public, and reduce health care fraud and abuse in the United States.”  The problem with the NPDB is that it’s confidential.  Patients are not allowed to access this valuable information.  Congress deliberately set up the NPDB so that only state medical boards, hospital administrators, insurance companies, and law enforcement can view doctor records, not based on a name, but a secret number. Congress trusted medical boards to use the information to prevent bad doctors from moving from state to state.  However, a recent article by MedPage shows that not all medical boards regularly consult the NPDB.

 Even if you did know that you could look up your doctor on your state’s medical board website, you won’t be able to find the most current information.  Most boards do not post whether a doctor has recent complaints filed by other patients or is under investigation for sexual misconduct, an addiction, or professional negligence that resulted in a patient death or permanent harm.

 It’s surprising to learn to learn that most medical boards move very slowly when it comes to investigating a doctor – and that most of the time, a doctor can remain in practice while being investigated. Even if a patient dies from a catastrophic error in the operating room, there is no immediate investigation and no indication on his/her medical board page that a complaint has been filed.  In fact, some medical boards, like California’s, can take as long as six months just to decide whether there will be a full investigation of a complaint.  The investigation itself can take three years or more.

 In contrast, the California Contractors State Licensing Board, lists complaints on its website, so consumers wanting a new kitchen or bathroom can check a contractor’s page and find out immediately whether he is under investigation, as well as what fines have been paid for violating state law. A CSLB probe can take less than a year. Ironically, both the CSLB and the Medical Board are under purview of the Department of Consumer Affairs.  So it appears that the state of California is more concerned about a consumer ending up with a botched kitchen than a botched surgery.

 Some state board websites have little more than a confirmation that a doctor has a license. But even those that are rated the best can come up lacking. California’s Medical Board website, for example, will reveal whether a doctor is on probation.  However, in order to determine why a doctor is on probation, consumers will most likely have to scroll through more than a dozen pages of legalese to find the actual violation.  Like most other state websites, California’s won’t reveal whether your doctor is currently under investigation, how many complaints have been lodged, or how many medical malpractice settlements have been reached, unless three or four have been settled in the last five years AND are more than $30,000 each. The Medical Board of California does not require doctors to report settlements under that amount.

 So, in getting back to that derisive comment by a Board member, it is impossible for any patient to know how safe or dangerous a doctor is at any given time, thanks to the roadblocks that medical boards and even politicians put in our way.

 A friend of mine whose son was permanently harmed by an unethical pediatrician put it rather succinctly.  He said finding a good doctor is basically “a crapshoot.”

 We deserve better than that.

[mariansmusings]

Women Dying in Childbirth:  Why Aren’t Doctors Held Accountable?

A woman in the United States today has a greater chance of dying in childbirth than her mother did in previous decades.  That’s the sorry state of maternal mortality in this country. During the pioneer days, women routinely died in childbirth in remote cabins.  You would think that those days are over, but they aren’t. Now women are dying in large urban hospitals, surrounded by what is touted as the best doctors and the most advanced medical equipment; more than 700 young mothers died in childbirth last year in the U.S. The data differs depending on which source you use.  Earlier this year a report by NPR and ProPublica used 2016 data from The Lancet that claims out of 100,000 women, 26.4 died in childbirth in America. Compare that to Sweden, which had 4.4, the UK , which had 9.2, or even Finland, which has the lowest death rate of 3.8 per 100,000.  Meanwhile, the CDC claims the U.S. 2014 rate was 18 deaths per 100,000.  But no matter what statistics are used, women are safer having their babies in any other industrialized country than they are in America, especially if the mother is a woman of color.

While grieving families and outraged patient safety advocates push for change, Congress did pass HR 1318 (Preventing Maternal Deaths Act of 2018). (This calls for a number of steps to track maternal deaths, such as making grants available for reviewing pregnancy and related deaths, establishing a review board to reviewing this information, and making this information public.) However, nothing in this bill called for state medical boards to hold doctors accountable for clearly preventable deaths. Often, doctors who are found responsible for the death of a woman in childbirth get no more than a slap on the wrist.

The Medical Board of California, for example, has been lenient with doctors whose patients have literally bled to death after childbirth. In the past six months two OB-GYNs have been given disciplines that were well below the Board’s own disciplinary guidelines. Take Dr. Arjang Naim, for example. Last fall, the Medical Board of California found Dr. Naim responsible for the death of Kira Johnson at Cedars Sinai Hospital in 2016. According to Board documents, Kira showed signs of internal bleeding within a short time after giving birth to her second son via C-section.  Investigators determined that Naim was grossly negligent when he failed to recognize symptoms of hemorrhaging. By the time Naim brought Kira into the operating room some ten hours after the C-section, there were more than three liters of blood in her abdomen, and her heart stopped.

Kira Johnson was not the only victim listed in the Board’s accusation for Naim. In the month before and after Kira’s death, two other women also nearly died under Naim’s care, including one whose heart also stopped on the operating table. Board documents also list three other women as harmed patients – a total of six victims. 

Despite the death, near misses, and negligent care, the Medical Board decided that only four years of probation were enough to discipline Dr. Naim. According to the Board’s own Disciplinary Guidelines, the minimum recommendation for one case of gross negligence is five years.  The Medical Board put no limits on Naim’s practice during the investigation into Kira’s death and harm to five other women, and there is no limit on his ability to continue delivering babies during his probation. Future patient will not be told of Naim’s discipline unless they look him up on the Medical Board’s website mbc.ca.gov or on 4patientsafety.org.

Then there was the case of Dr. Long-Dei Liu of Garden Grove, California. In 2014, a Chinese woman, Huanda Hong, traveled to Southern California to have her baby in the hope of having excellent medical care. Medical Board records show that Huanda began hemorrhaging shortly after the birth of a son via C-section. Dr. Liu left the hospital, thinking another doctor would cover, but investigators say he left no instructions indicating the transfer of care to another doctor, nor did he speak to anyone about Huanda’s condition.  She continued to hemorrhage, resulting in kidney failure and ultimately anoxic encephalopathy (brain damage due to lack of oxygen.) Her family decided to take her off life support a couple days later.

The Medical Board initially gave Dr. Liu five years probation for the death of Huanda Hong and harm to three other patients. However, Liu appealed that decision in January.  He claimed it was not his fault, but rather the fault of the nurses for not calling him about his patient. The panel evidently agreed with Liu, and lowered his probation to just 35 months – less than three years.  This probation time is not even an option mentioned in the Board’s Guidelines.  The Hong family sued Garden Grove Hospital and Dr. Liu, and received hefty settlements for Huanda’s death; Liu also lost his privileges at the hospital, most likely because the health department fined the hospital $75,000.   However, he is still free to deliver babies at other hospitals.

Given these two lenient disciplines, it will be interesting to see what the Medical Board does with the dual complaints against Drs. Audrey Toda and Linda Degusta. Both doctors have accusations pending for the bleeding death of a San Leandro woman after a c-section.  What is surprising about this case is that their patient died in 2013 – and the Medical Board has taken no action against either doctor until just recently. Under the law, Board complaints have a statute of limitations of seven years, which includes the time to investigate.  The accusation against Toda was released last July while Degusta’s was just posted in late March.  According to the Board’s own timeline, a complaint of this nature would be thrown out due to lack of time. However, someone has decided that after all these years, it was time to look into this unnamed woman’s death. Both Toda and Degusta have been practicing and delivering babies unfettered for the past six years, despite the catastrophic event that took the life of a young mother.

It’s time that our federal and state legislators make medical boards responsible when preventable maternal deaths occur – and that they in turn hold the doctors accountable. Everyone, state boards and legislators, should stop wringing their hands over this devastating issue of maternal mortality and actually decide to take action. This country owes young mothers and their families the best of care and they deserve better than what they’re getting. If we don’t end this alarming increase in maternal mortality now through accountability, more young mothers will die in childbirth.

[mariansmusings]

We Are All Neighbors: Thoughts on the Tree of Life Synagogue Shooting

 Like most West Coast people, I woke up Saturday to the terrible news of yet another mass shooting. My heart sank as I learned that it happened in a synagogue, a place where people would expect to be safe. My despair grew as the names and ages were released. They reminded me of the wonderful neighbors I had as a child and young adult, people who surrounded me with love and support as I grew up.

            We were the only Catholic family on our little block on 59th Street in San Diego when my folks first moved in. A couple of other Catholics eventually moved in, but for a long time it was just us. Almost all of our neighbors were Jewish.   Even though I went to a parochial school, when I came home, I played with my neighborhood friends, who all happened to be Jewish.. The term “politically correct” had not been coined.  There were no “issues.” We were friends and neighbors first and foremost.  The religious differences just made it more interesting.

 From my viewpoint as a child, there didn’t seem to be that much of a difference between the Jewish and Catholic religions. They used Hebrew as the language of their religion, while in my early childhood, we had Latin. We all had holy days and foods we couldn’t eat at one time or another – and we all had to fast. My siblings and I learned the significance the menorah when we went to our neighbors’ houses during the holidays, and often we would exchange presents under our Christmas tree. One year, we were all delighted when Christmas Day and Hanukkah fell on the same day. We shared the rites of passage like bar and bat mitzvahs, baptisms and first communions.

 We kids were unconditional friends. Our parents were just moms and dads, as far as we were concerned.  But then there was a group of Jewish neighbors about half a generation older than our folks that we quietly revered – because they had survived the Holocaust.  Dorothy Goldberg had joined the first group of WACs during World War II; she had helped intercept Nazi messages from a base in Britain.  Samuel Kurtz has escaped from a concentration camp and joined up with the resistance to fight guerrilla style in the German forests; he still had the numbers from his time in the camp seared on his arm.

 The most impressive story, though, was that of Charlotte Haas.  She had actually survived a personal encounter with Adolf Hitler himself.  Her husband had escaped Nazi Germany when his company arranged for him to be transferred to a different country. He was working to get Charlotte and their baby boy to join him.  Complicating this tense period was the fact that she lived across the street from the Reichstag, the Nazi headquarters in Berlin. One day, while Charlotte was walking her baby in a pram, she spied Hitler and some of his henchmen walking toward her on the sidewalk.  Not wanting to attract attention by making a dash across the street, Charlotte continued walking casually toward Hitler.  He stopped to admire her baby boy, who just happened to be blond and blue-eyed.  Hitler praised the child at being the epitome of the Aryan race.  She thanked him, her heart no doubt racing, and continued walking down the street.  She clearly used her wits to survive this encounter.

 My only regret is that I didn’t hear of these stories directly from our neighbors.  My siblings and I only heard versions that our parents told us.  We were warned not to ask about these war experiences because it might make them sad to remember.  Out of respect for our neighbors, we never asked.

 We all supported each other through challenging times in our lives. When my brother, Dennis, was wheelchair bound due to pediatric arthritis, our neighbor Frank Stein took the time to introduce him to stamp collecting. The two of them spent hours pouring over stamps. My father spent time talking to Seymour, the son of Samuel Kurtz, about dental schools, and wrote him a glowing letter of recommendation to the school he ultimately attended. 

 Not that long ago, while visiting my parents’ house, I saw a familiar face walking toward me up the street.  It was Seymour. We hugged and reminisced about the neighborhood, and how fortunate we felt to have been raised in such a loving, supportive environment on 59th Street.

 Those were all the memories that came flooding back to me when word of the Pittsburgh synagogue shooting hit the networks.  It was as if someone had murdered my beloved neighbors.  In reality, they were someone’s beloved neighbors, people who had given to their communities with the hope of making them better.

 We are all neighbors. It’s time we remember this and teach that sense of community to our children.

 Please don’t let their deaths be in vain.                        

 Joyce Feinberg, 75

Richard Gottfried, 65

Rose Mallinger, 97

Jerry Rabinowitz, 66

Cecil Rosenthal, 59

David Rosenthal, 54

Bernice Simon, 84

Sylvan Simon, 86

Daniel Stein, 71

Melvin Wax, 88

Irvin Youngner, 69 

[mariansmusings]

Medical Board Can Do Better with San Diego Doctor Cases

As the Medical Board of California prepares for a quarterly meeting in San Diego this week, its track record of local cases brings up the question of whether the agency is living up to its purpose of protecting consumers.  In reviewing doctor investigations over the past few years, it seems that the Medical Board has consistently sided with local doctors over the safety of patients.

 Take the 2014 case of Dr. Jeffrey Abrams, for example. A patient had come forward with a complaint in January of that year, claiming Abrams had touched her inappropriately.  By July, documents show the local investigator knew that Abrams had 1,300 illicit pictures of female patients including a child on his phone. Despite this, a decision was made to allow Abrams to remain in practice – putting more patients at risk – while the investigation continued. It wasn’t until a victim went to the local media, which broke the story, that law enforcement got involved and the Board finally acted to suspend his license. (It should be noted that the Medical Board is not required to notify police in cases of sexual misconduct, unless children are involved.)

 Another case involved El Cajon pain specialist Naga Thota. The Board put him on seven years probation in 2016 for overprescribing opioids.  Just a few months later, the Drug Enforcement Agency (DEA) raided Thota’s office and arrested him for a “sex for drugs” scheme with patients.  The Medical Board’s own years long investigation seemed to have missed that aspect of the case.  Even after Thota made bail and returned to practice, it took the Board a couple of weeks to suspend his license.

 The Medical Board also seems to have dropped the ball a couple of times with Dr. Egisto Salerno. He lost his license for a personal addiction in 2001, but was able to win reinstatement just a few years later, based in part on a recommendation from Dr. James Grisolia.  The Board either didn’t know or ignored the fact that at the time Grisolia wrote the letter of recommendation, he was under investigation himself for overprescribing; his victims included his own wife who died of an overdose.  By 2017, Salerno again faced a Board accusation, this time for overprescribing. While the Board pondered Salerno’s discipline, the DEA swooped in and arrested him last March on charges of running a pill mill along El Cajon Boulevard.

 Last July, psychiatrist Mark Zweifach was able to convince the Medical Board to reinstate his license. He had surrendered it in 2007, after admitting to a sexual addiction and to viewing child pornography on his work computer.  One of Zweifach’s letters of recommendation was from Dr. William Power, a medical school friend, who had also been disciplined for sexual misconduct. 

 And just last week, the Medical Board made a deal with Dr. William Buchner, allowing him to serve two probations concurrently.  Buchner was given five years probation in 2016 for three alcohol related arrests, including a DUI.  This year, Buchner was found responsible for gross negligence – harming patients – in another complaint.  Instead of adding three years probation to Buchner’s previous five years, the Board apparently thought it was appropriate for him to serve both disciplines at the same time.

 How can the Medical Board claim it puts the consumer safety first when it gives preference to doctors in each of these decisions? Sadly, the Board has been criticized for decades for putting doctor “rehabilitation” ahead of patient safety.

 In reviewing last year’s statistics, the Medical Board took in almost 10,000 complaints, but only investigated 15% of them.  Only 4% of complaints resulted in a doctor discipline. 

 Consumers deserve better than this from the Medical Board.  We deserve an agency that will truly put patients first.

[mariansmusings]

Medical Board Played the Fool with Doctor Reinstatements

When a doctor is found to be such a threat to society that his/her license is revoked, you would expect that the state medical board would never let that person practice again. And in the event that this doctor did try to get that license back, you would  expect that the Medical Board  would be extremely skeptical, that the application would be scrutinized carefully.  Unfortunately, that doesn’t always happen with the Medical Board of California.

Surprisingly, it is not unusual for a doctor in California to get a license reinstated.  Even in egregious cases such as sexual misconduct or patient deaths, all a physician has to do is bide his time for a few years before submitting a request for reinstatement. Medical Board members may be so willing to give a doctor a second chance to practice that they may not give as much attention to details as they should.

A case in point is the recent reinstatement petition of Mark Zweifach of San Diego.  According to Medical Board documents, he had surrendered his license in 2011 after admitting to having a sexual addiction and to looking at child pornography on his work computer. Zweifach never faced any criminal charges nor did he have to register as a sex offender. He was allowed to just walk away from his practice. Because there were no limitations on his activities, Zweifach kept busy acting in community theatre and working with a puppetry guild that often entertained children at schools.  The Medical Board seemed to believe Zweifach’s remorse for his actions, and was even willing to overlook his two admitted relapses.  So, it was no surprise when Board members decided to grant Zweifach his license once again. Even though the Board’s Disciplinary Guidelines recommend 7 years probation for any sexual misconduct findings, Zweifach’s probation was only 5 years.

                                             Mark Zweifach 

Now, if these Board members had been a little more judicious in their review of Zweifach’s petition, they may have realized that their decision was based in part on a letter of recommendation by Dr. William Power who had been disciplined for sexual misconduct himself.  Power and Zweifach have been friends since they met in medical school. According to Board documents, Power was put on 7 years probation in 2002 after being found responsible for having a sexual relationship with a patient and giving her psychotropic drugs without proper documentation; he was able to persuade the Board to terminate his probation early after only 3 years.  So, it’s safe to assume that Power was instrumental in guiding Zweifach’s reinstatement request.

This is not the only time a doctor has slipped a secret past the Medical Board.  Documents show Dr. Egisto Salerno of San Diego surrendered his license in 2003 after he allegedly attacked his wife while under the influence of cocaine. By 2006, though, he was successful in getting his license reinstated.  That Medical Board decision was based in part on a letter of recommendation written by Dr. James Grisolia, who at the time was under investigation for overprescribing opioids; Grisolia’s victims included his own wife, who died from an overdose. The Board’s rash decision backfired.  By August of 2017, Salerno was in trouble once again with a formal accusation, this time for overprescribing painkillers. While the Medical Board was deciding what to do with Salerno, the Drug Enforcement Agency, which was conducting its own investigation, swooped in and arrested him on charges of running a pill mill out of his office.

                                            Egisto Salerno

If these two cases got past the Medical Board, how many others have? You have to wonder who looks at details of these cases and why letters of recommendations from troubled doctors were even accepted in reinstatement cases. Board members are mostly physicians and attorneys, the kind of people who usually pay attention to minutiae.

While no investigation is foolproof, it’s important that the Medical Board is not played for a fool when considering a second chance for a revoked doctor.

[mariansmusings]

Infection Control in Hospitals: Good or Just “Good Enough?”

By Marian Hollingsworth

 According to the Center for Disease Control and Prevention (CDC), one out of every 25 patients in a hospital gets at least one infection[jg1] . In my experience, these numbers are considerably higher. Spend any amount of time in a hospital, and you will quickly understand why.

 I first became acutely aware of MRSA infections (antibiotic-resistant staph infection) when my father contracted a MRSA eye infection at a nursing home that quickly spread to his lungs. Soon afterwards, at the hospital, he acquired another superbug called VRE. At one point we were told he also may have a bacterial infection called C-diff, but that was never confirmed.

 During this time, we always had to put on gloves, masks, and gowns in my father’s room to protect ourselves and keep the infection from being spread outside the room. However, I quickly noticed that the nurses and even the doctors often didn’t wear protective clothing; some didn’t even wear gloves. When I asked, the response was consistently that the infection risk was “not that bad.”

 That experience made me more cautious in hospitals. When my husband, Ed, had spinal fusion surgery last year at a different hospital, I knew we needed to take precautions. The minute we got to his room, I grabbed the industrial-strength wipes and cleaned all the obvious items he would touch: the call button, the phone, the bed rails, the sink faucets, etc.

 I also started a routine of walking around the ward each day to check for the number of “contact precaution” rooms – ones that contained patients with contagious infections such as C-diff and MRSA. This ward had 9 out of the 36 rooms – 25% – on contact precautions, a much greater amount than the CDC-cited 4%. When my husband went to that hospital a few months later, I did another count of contact precaution rooms and found that 11 out of 32 rooms (about one third of the patients!) had infectious conditions.

 While the floor nurses were attentive and caring, there was a consistent lack of concern about taking precautions to prevent infections. For example, a nurse would enter Ed’s room and put on fresh gloves, then flip on the light switch, position the mobile computer with both hands, pull the curtain closed and move the bed table before attempting to change the bandage on Ed’s incision. I would frequently see nurses or doctors inside a contact precaution room without wearing the required gown or mask. The nurses had no problem allowing patients to walk around the ward in the hospital socks, then put them to bed in those same socks – not exactly a good infection control practice for someone with a large incision. (We asked for a second pair of socks to wear in bed.) 

The hospitalist assigned to Ed was the most blatant offender of infection control. She didn’t see the need for gloves. The first time she came in to see Ed, she actually put her bare hands on Ed’s incision. When I called her on it, she claimed using antibacterial gel was “good enough.” I pointed out that if the gel was that effective, there wouldn’t be as many infectious rooms on that floor. Her attitude remained unchanged. When I insisted that she use gloves before touching Ed, she sighed heavily, grabbed some gloves, and muttered, “This is silly.”

 Another source of the concern was the catheter Ed needed for two weeks. I asked the surgeon about the risk of infection; his response was that in Ed’s case, the benefits outweighed the risk of infection, which he felt was very low.

 Again, we were relieved when Ed was finally released. Ed was even more relieved to get the catheter out three days later. But all that was short lived. Five days after being released, Ed suddenly spiked a fever. We rushed back to the emergency room, where Ed was found to be septic with a UTI and an abscess where his colon was resected.

 Ed was again hospitalized on a different floor, where 8 out of 20 rooms (40%) were on contact precaution. When I asked the charge nurse about this, she commented that “it’s normal” to have that many rooms with infections.

 My husband survived his sepsis infection because of two factors: 1) I had reviewed the symptoms of sepsis before Ed’s surgery as a precaution, so we didn’t waste time in seeking help when he developed a fever and 2) The emergency department doctors responded immediately by putting Ed on IV fluids and antibiotics even before they sent him for a CT scan. Because of this, we didn’t miss the critical window of care required for sepsis patients.

 My biggest takeaway from this experience was that health care professionals in some hospitals are not that concerned about infection control until it becomes life threatening. Until then, taking recommended steps to prevent infections are considered an inconvenience.

 I wrote to the patient relations department at the hospital, as well as to the president of the board of directors (who happens to be a neighbor) about my concerns. They responded with versions of “Thank you for your comments and please come to our hospital again.”

 There is a big difference between being “good” and “good enough.” My experience with medical professionals and infection control is that they are content with being good enough, that they are willing to accept a high percentage of infected patients as being the norm. Until the medical industry acknowledges infections as a real, preventable health threat, patients will continue to suffer and die.

(This blog first appeared in the Right Care Alliance newsletter.)

 Marian Hollingsworth is a Public Member of the HAI Advisory Committee for the California Dept. of Public Health, Volunteer Patient Safety Advocate, and member of the Patient Safety Action Network.

[mariansmusings]

Should Medical Boards Allow Sex Offending Doctors to Practice?

Should a doctor who lost his license for sexual misconduct be allowed to get that license back?  That is the tough decision the Medical Board of California will have to make this week in not just one – but two cases.  In past years, such decisions were easier.  Most doctors were given a second chance, no matter how egregious the circumstance. But things are different now. This is the age of the #MeToo movement. The conviction of disgraced USA Gymnastics doctor Larry Nasser for abusing hundreds of young women is still fresh in the public’s memory, and the number of alleged victims of former USC OB-GYN George Tyndall is growing.  

 The two men asking the Medical Board’s Panel B for reinstatement are Mark Zweifach of San Diego and Sarath Witana of Moreno Valley in the Inland Empire.  Zweifach lost his license after he was caught viewing child pornography on his work computer at Kaiser in El Cajon.  He admitted to the viewing – and to having an addiction to pornography.  Police were brought in to investigate, but no charges were filed.  Zweifach was allowed to quietly surrender his license with no strings attached.  For example, he did not have to register as a sex offender.  The Board documents show that since his license was surrendered, he has been active in the theatre community as an actor and director.  However, documents do not include the fact that Zweifach is on the board of the San Diego Guild of Puppetry, a group that often performs at schools and gives puppetry classes for children.

 Sarath Witana license was revoked in 2013 for sexual misconduct, falsifying medical records, and lying about terminating his relationship with the patient/victim, according to Board documents. Witana was also convicted of a misdemeanor charge of sexual exploitation of a patient. However, now he claims he has been rehabilitated and wants to re-establish his practice.

 Both Panels A and B have track records of allowing doctors with sexual offenses to be reinstated. In 2016, Panel A gave Dr. Zachary Cosgrove of Bakersfield a second chance.  This, after he lost his license for sexual misconduct with three women; he was also accused of physical assault. According to Medical Board documents, Cosgrove told one victim, “You’d better just kill yourself…that’s going to hurt less than what I am going to do to you.”  However, after Cosgrove apologized for his behavior and said he was moving to Texas, Panel A members thought he deserved a second chance. Cosgrove later returned from Texas, and is now reportedly practicing again in Bakersfield.

 Panel B’s track record is even more alarming. Dr. Esmail Nadjmabadi was reinstated in 2015 eve though he had been found responsible for sexual misconduct with five women, including a minor. One of the more concerning cases is that of Dr. Hari Reddy of Victorville, who lost his license in 2003 for four sexual misconduct victims, also including a minor. His bid for reinstatement was rejected in 2008, but in 2012 things were different. His friend and colleague, Dr. Dev Ganandev (currently Board president) was now on the Medical Board – and on Panel B.  It’s not known whether this potential conflict of interest was addressed by the Board or for that matter, how Gnanadev voted, but Hari Reddy got his license back.  Shorty after that, Dr. Gnanadev and Hari Reddy’s brother-in-law, Prime Healthcare CEO Prem Reddy,M entered into a financial endeavor to open a new medical school in the Inland Empire, called California University of Science and Medicine.

 Dr. Gnanadev continues to serve on Panel B, so there will be considerable interest in advocate circles as both Witana and Zweifach plead their cases this week.

 The bottom line is doctors are treated differently than other members of society, and nowhere is it more obvious than in sexual assault cases. Doctors are put on pedestals whereas regular citizens aren’t. For example, teachers or police officers committing sexual misconduct usually face criminal charges, and are never allowed back in the classroom or on the beat again.  They are not permitted to return with a chaperone.  Doctors, however, are often allowed back in the exam room with a chaperone – which means someone else gets to watch him touch you.  

 The mission of the Medical Board is to regulate doctors so that the public remains protected. That ideology, however, is often shoved to the background, as the doctor majority often prevails when deciding the fate of its colleagues.  Is that doctor pedestal still alive and well with this Medical Board? Whose rights are more important?  The decisions on Witana and Zweifach could set a new precedent in this #MeToo era.

[mariansmusings]

When Informed Consent Isn’t

Informed Consent is a curious term in the medical world.  Federal law states that in order to obtain informed consent, a doctor must talk to the patient regarding all the risks, benefits, and alternatives for the treatment or procedure.  It is not just a signature on a piece of paper.   That works in theory in a medical setting.  However, when informed consent is applied in practice, it invariably falls apart.

 That’s because many nurses and doctor haven’t been consistently taught the law regarding patient rights when it comes to getting full consent from a patient.  And likewise, patients don’t know their rights most of the time either.  In most states, only doctors can obtain informed consent for surgical or diagnostic procedures.  In fact, the California Hospital Association’s Consent Manual specifically states that “It is the physician’s responsibility to obtain informed consent…Hospital personnel should not be involved in providing information necessary to give informed consent or responding to questions regarding the procedure.” 

 The issue of informed consent is the basis of all patient care in this country.  It is one of the issues closest to my heart, one that led me to become a patient safety advocate.

 I learned about all the ramifications of informed consent the hard way when I  investigated my father’s death.  In his nursing home records, I discovered that he had been given Haldol and Risperdal, two black box antipsychotic drugs that require informed consent because of the risks of severe side effects and even death. I also discovered a number of falsified consent forms, which stated that that various nurses had obtained consent for these dangerous drugs “over the phone” from me, even though I was at the facility every day.  Then in the hospital records, I was shocked to find the doctor had falsified a “Do Not Resuscitate” order, also claiming it had been obtain “by phone.”

 Later, in forced arbitration, the defense claimed that these consents were necessary for treatment.  The lack of my signature as power of attorney on these consent forms, along with phone records as proof the calls were not made, did not impressed the judge one iota, and we lost the case.  The Medical Board of California was only slightly concerned by the lack of documentation. It allowed the doctor to plea down to “poor medical record keeping” for the DNR, and was given a public letter of reprimand.

 This has taught me to be extra vigilant when signing any medical documents.  For example, a few years ago when having to undergo eye surgery for a hole in my retina, I read that the consent form included a clause that a “trainee” could do the surgery under the supervision of the surgeon.  I crossed out that clause and immediately spoke to the doctor, saying I would only consent if I knew for sure he would be the only surgeon.  However, despite being keenly cautious with consent forms, you never know when you will be blindsided.

 My latest “consent” experience occurred during an unexpected emergency with my husband.  Ed was in the hospital for a routine procedure when it was discovered he was severely anemic and bleeding internally.  His procedure was halted and we were sent to a room to await an emergency endoscopy to find the source of the bleeding.  Twelve hours later, with both of us stressed and exhausted, Ed was finally taken down to the endoscopy department.

 Nurse Bonnie approached Ed with a clipboard and pen and told him to sign the consent form.  I stopped her, saying we had not spoken to the doctor so he could not give informed consent for the endoscopy yet.  I had questions about the risks, especially about whether this hospital used an Olympus scope, the kind linked to a deadly superbug infection called CRE.  Bonnie seemed annoyed. The conversation went something like this:

 Bonnie:  He needs to sign the consent form.

 Me:  I want to talk to the doctor first about the risks before he gives informed consent.

 Bonnie: I can give informed consent.

 Me: Nurses can’t obtain informed consent.

 Bonnie: I do it all the time.

 Me: Well, legally, and according to state law, you can’t.

 It was obvious that this nurse did not understand the informed consent process.  She equated it with just a signature on a paper.  Just as I was about to dig in my heels with this nurse, the doctor arrived and was more than willing to answer all my questions.  Ed quickly signed the consent form, and was whisked down the hall to the procedure room.

 A few days later, once Ed had been diagnosed and treated, I realized that Ed was not given the time to read that endoscopy consent form before signing it.  It also bothered me that Nurse Bonnie had said she obtained informed consent all the time. I explained this to the Patient Relations person at the hospital, suggesting perhaps the nurse was confused about informed consent. A few days later, I received a written response that stated:

 “It is our understanding that the form you and your husband were asked to sign is the ‘Authorization for and Consent to Surgery or Special Diagnostic or Therapeutic Procedures’ form which is not informed consent.”

 ???

 I had two thoughts about this sentence. First, this facility thinks the consent form is not a consent?  If this was not a consent, why did Nurse Bonnie insist on Ed signing it? I felt like telling the Patient Relations person that I know some lawyers that would think otherwise.  Secondly, it appears that this person was getting stuck on semantics.  Yes, the doctor is the authorized person to obtain informed consent.  However, the process is not considered complete until the consent form is signed as proof that the patient was fully informed.

 I contacted the director of the endoscopy department and politely asked for a copy of a blank consent form since it would take two weeks to get a copy of Ed’s records. She sent me a copy of the second page of the endoscopy consent form.  Thinking that maybe she had forgotten to send the first page, I contacted her again.  She was surprised; she told me she had never seen a first page, but would see if she could find one.

 So this hospital had been having people sign a consent form that was incomplete? One that was missing the first page of instructions?

 The Patient Relations person was also surprised when I called her back.  She suggested that the consent could be double sided, and that perhaps we just didn’t see the other side. She said she will get back to me regarding the first page of the consent form, and assured me that they are already “reviewing the process for completing the appropriate paperwork prior to procedures for all endoscopy patients.” 

 Good. That’s all I wanted – a full informed consent process for all patients.

 What I have learned from these experiences is that hospitals and nursing homes still have a long way to go in ensuring informed consent protocols are followed. All too often, transparency and patient safety are comprised in order to get a form signed faster. In my opinion, every facility should have an informed consent review every year for every employee, including doctors. 

 The bottom line is that patients should know their rights, and should make sure they do not sign any consent form for any procedure until they after speak to their doctor first.

[mariansmusings]

Medical Board Takes Full Year to Revoke Sexual Felon’s License

On Monday, April 16, 2018, the Medical Board of California sent out a press release proudly announcing that it had revoked the medical license of Dr. John McGuire of Escondido.  He had been convicted of 25 felonies and sent to prison for 14 years and 10 months for sexual misconducts.  His crimes included sexual battery, sexual exploitation by a physician, and sexual penetration by force.  The press release portrays McGuire as a sexual predator who preyed on unconscious women as they came out of surgery.  The release makes it sound like the Medical Board came to the rescue to protect vulnerable patients from doctors like McGuire.  But that is hardly the case.

 The truth is, McGuire’s license was not revoked for ONE ENTIRE YEAR after he was sentenced.  A judge suspended his license to practice a month after he was first arrested in August of 2015.  The Medical Board appears to have had nothing to do with the arrest and conviction of McGuire. Instead, it just followed the actions taken by the court. 

 So when did the Medical Board know about the McGuire’s indiscretions?  Was a complaint filed against the doctor prior to his arrest?  We will never know because the Board does not make complaints public until a formal accusation is filed.

 The first victim in this case reportedly went directly to the Riverside Sheriff’s Department in August of 2015, not the Medical Board, when she felt McGuire had assaulted her.  Sheriff’s investigators quickly determined that crimes had been committed and arrested McGuire.  Seven other victims also came forward. 

 Had the first victim gone to the Board instead of authorities, this case would have been handled much differently. That’s because the Medical Board is not required to notify local police when it receives complaints of sexual misconduct. Investigators are allowed to conduct their inquiries discreetly.  Most of the time doctors in sexual misconduct cases are allowed to remain in practice throughout the Board investigation, which can take as long as three years. If the doctor is ultimately put on probation for the misconduct, he is not required to notify his patients. (SB 1448 could change this and require doctors on probation for sexual misconduct to notify their patients.)

 An example of the Medical Board’s reluctance in revealing sexual assault investigations is the Jeffrey Abrams case.  According to state documents, the Board reportedly first received a complaint against Abrams in January of 2014. A victim claimed she was inappropriately touched and that pictures were taken of her private area. By July of that year, it was determined that Abrams had 1300 illicit pictures of patients on his phone.  Despite this, Abrams was allowed to remain in practice while the investigation continued.  In October, frustrated with the lack of progress, the victim went to the local news media, which broke the story.  Only then did the police and the district attorney get involved.  A few weeks after his arrest, Abrams’ license was suspended.  The Medical Board ultimately accepted Abrams’ surrender of his license nine months after he was sentenced.

 Given the Medical Board’s track record with slow investigations even in sexual assault cases, it is apparent that “consumer protection,” as mentioned in the press release, it not its primary concern.  Instead of just filing a complaint and waiting months, even years, for the Medical Board to act, consumers should be encouraged to go directly to law enforcement if they feel they were a victim of  sexual misconduct.  That way, they are assured of, swift action to protect themselves and the public.  A complaint can always be filed with the Board later, once a criminal case is established. 

[mariansmusings]

Medical Board Keeps Small Town Wondering for 4 Years

            In just two days, the Medical Board of California will announce its surprising disciplinary decision on a doctor with a substance abuse addiction.  It involves a long time family doctor named John Glyer in the tiny rural town of Willits in Northern California. His case also brings to light the extraordinary length of time it takes for the Medical Board to complete an investigation.

            According to Board documents, Dr. Glyer’s substance problem began in earnest in 2000 when he started using hydrocodone.  He managed to keep his addiction under wraps until 2010, when he showed up at the local nursing home with slurred speech.  In typical small town style, the nursing home staff called Glyer’s wife to come and pick him up.  Some of his colleagues had suspected Glyer was abusing opiates for years, but never reported him.

            Immediately after this incident, Glyer enrolled in a three month rehabilitation program out of state, followed by an intensive outpatient program for five years that included a 12-step program, regular meetings and therapy, and routine biological fluid testing.  Except for one test that showed positive for alcohol, Glyer has remained substance free, according to Board records.  During this time, Glyer remained in practice and even served as the medical director and board member at the local 25-bed hospital.

            The Medical Board’s investigation into Glyer’s substance abuse didn’t start until December of 2013, when it received a complaint regarding the nursing home incident, reportedly from a competing doctor.  It took the Board TWO YEARS to decide whether to file an accusation against Glyer, claiming the substance abuse “impaired his ability to practice medicine safely.” What is even more surprising is that Glyer wasn’t even interviewed for a year and a half after the complaint was received.   

            Despite this apparent concern for patient safety, Glyer was allowed to practice unfettered for TWO MORE YEARS before making a decision. During this time, Glyer continued his outpatient recovery program with a monitor.

            The Medical Board’s Disciplinary Guidelines recommend strong actions against doctors who put patients at risk by using drugs.  The minimum recommended discipline is five years probation, drug testing, psychotherapy, and classes.  The maximum discipline is revocation of license.

            On March 29th, the Medical Board will announce this unexpected decision: “The disciplinary proceeding against John R. Glyer, MD is terminated without imposition of discipline.”

            The Medical Board drags out an investigation for four years and four months only to conclude with no discipline?!!  While it’s logical to agree that Dr. Glyer has taken responsibility for his addiction with rehabilitation, it’s ridiculous that it took the Board and the Attorney General’s office so long to come to this conclusion.  How much money did this investigation cost?  Board members are always whining that they don’t have money to prosecute as many cases as they would like, yet they spend years on a case that could have been easily dismissed or withdrawn at any point in the investigation. 

            Given that the Board only investigates 15% of the complaints it receives anyway, why wasn’t this case dropped so that they could go after ones where patients were actually harmed or killed?  

                        What is even more concerning is how the decision not to discipline Dr. Glyer was made. The administrative law judge at Dr. Glyer’s hearing decided to ignore the Medical Board’s own expert, who had recommended at least two more years of a fully monitored program to ensure public safety.  Instead, the judge sided with the director of the rehabilitation program, who felt Glyer didn’t need any more supervision or treatment.  The decision was based on the fact that “probation would offer no benefit to the public that might weigh against the hardship it would cause respondent, to his colleagues, and to the community they serve.” So basically, any consideration of public safety was tossed aside so as not to inconvenience the doctor.

             Finally, the Medical Board is mandated by law to put consumer safety first. It could have disregarded the judge’s decision and put Dr. Glyer on probation for a couple years, as their expert recommended. However, after a four-year investigation, it seems the Board had tired of the case and simply sided with the judge.

             Dr. Glyer appears to have taken responsibility for his failings and fixed his own life.  Perhaps the Medical Board can be more responsible with its investigations and take less time, money, and resources to complete them – keeping in mind that consumer safety comes first.

[mariansmusings]

A Medical Board’s Epidemic of Opioid Failures

            If the recent arrest of a San Diego doctor is any indication, the Medical Board of California (MBC) is failing in its promise to protect patients and reign in doctors fueling the opioid crisis.  It’s also the second time in 18 months that the Drug Enforcement Agency (DEA) has arrested a San Diego area doctor on drug charges who the Medical Board felt was safe to practice.

             In the first case, the Board had put Dr. Naga Thota on a 30-day suspension and seven years probation in March of 2016 for overprescribing addictive painkillers, allowing him to remain in practice. Just five months later, the DEA arrested Thota at his El Cajon office for a “sex for drugs” scheme with several female patients. He ended up with a 30-month sentence and surrendered his license.

            Then on March 12th, the DEA arrested Dr. Egisto Salerno for running a  hydrocodone “pill mill” from his San Diego office, along with seven other suspects.  A quick look at Salerno’s record on the MBC website shows he is no stranger to trouble.

            In 2000, Dr. Salerno was given a stayed suspension and two years probation for overprescribing opioids to seven patients. Then in 2003, records show Salerno surrendered his license after he was arrested for ingesting cocaine and threatening to kill his wife.  Just three years later, a remorseful Salerno asked to be reinstated.  The MBC believed Salerno when he said his “sincere wish is to lead a life of value and meaning,” and reinstated his license with seven years probation and a stint in the failed Board diversion program for his addiction.  This decision was partially based on a letter of recommendation from Dr. James Grisolia, who at the time was under investigation himself for overprescribing to a number of patients, including his own wife who unfortunately died from an overdose. (When Grisolia petitioned unsuccessfully to end his own probation early, he acquired a letter of recommendation from San Diego ENT Dr. Ted Mazer, who is now the president of the California Medical Association, the doctors’ lobby group.)

            By 2010, Salerno convinced the Board he was thoroughly rehabilitated, and asked to have his probation terminated early.  The MBC agreed, and claimed “probation was not required to protect the public.” With time off for good behavior, and now no accountability, it apparently didn’t take Salerno long to go back to his old ways.  By mid 2017, he again had yet another Board accusation for overprescribing, this time for three patients. However, while Salerno was still practicing and the Medical Board was still deciding how to discipline Salerno, the DEA swooped in and arrested him for running a pill mill. 

            How did the trained Board investigators miss both Salerno’s alleged pill mill and Thota’s sex-for-drugs practice?  The vow by MBC president Dr. Dev Gnanadev to educate doctors and reduce opioid deaths rings hollow with egregious failures like these. Given that the Medical Board only investigates 15% of complaints (almost 10,000 last year), and only disciplines about 4%, it’s likely that many more dangerous doctors have slipped through the agency’s cracks. 

            If the Medical Board is serious about its promise to control the opioid crisis in California and protect patients, it needs tougher discipline for doctors who overprescribe these dangerous drugs.  It can’t afford to be so gullible with doctors pleading for their license to be reinstated or probation shortened.  

            Above all, patient safety must come first.  There should be no more cases like Egisto Salerno and Naga Thota.

[mariansmusings]

Doctors and Sexual Misconduct: Revoking the Pedestal

Four men. All accused of sexual misconduct. Two get 25 years in prison.  The other two get to keep their jobs without serving any time.  What’s the difference? Two are doctors.

 The two men who were sentenced to prison on February 16, 2018 were both veteran police officers with the Los Angeles Police Department. The crimes were considered “particularly heinous” because of the authority officers have when they put on a badge.  If they get out early because of good behavior, they will not be able to work as cops again because most police departments have little tolerance for  ‘bad cops.”

 Not so with medical boards, which usually try to keep doctors in practice as long as possible, despite sexual misconduct complaints. To begin with, the Medical Board of California is not required to notify police when a complaint of sexual misconduct is received against a doctor.  The MBC can quietly investigate the complaint while the doctor remains in practice, then discreetly put him on probation without any requirement to tell his patients. Dr. Wilson Koo of Santa Clara benefitted from this approach.  Medical Board documents show he was found responsible for sexual misconduct and put on 5 years probation for findings which include watching a female patient undress and examining her private area with ungloved hands.  He was lucky.  The Board didn’t follow its own disciplinary guidelines, which say the minimum amount of probation should be seven years. No criminal charges were filed.

 If a doctor does lose his license for sexual misconduct, he can petition the Board to be reinstated in as little as two to three years.  That’s what a doctor who went by the name of Hari Narayana Ma Reddy did.  His license was revoked in 2003 after he was found responsible for sexual misconduct with four women, including a minor.  The Board did turn down a petition for reinstatement in 2008.  But in 2012, Reddy sent in another petition.  On the panel that reviewed that request was a new board member, Dr. Dev Gnanadev, who is also Reddy’s friend and colleague.  The panel voted to reinstate Reddy’s license, giving him seven years probation.  Shortly after that vote, Gnanadev entered a business venture to open a new medical school with Reddy’s brother-in-law, Dr. Prem Reddy, the CEO of Prime Healthcare; Prem Reddy donated $40 million to start the medical school. Hari Reddy’s probation is about to end in May of this year; he officially changed his name to Hari Mallam Reddy a month ago.

 The sordid story of disgraced Olympics gymnastics doctor Larry Nasser has raised the curtain on the issue of sexual misconduct in the medical field.  The pedestal physicians are put on often clouds the judgment of both medical boards and law enforcement, Nasser is an anomaly not because of what he did to hundreds of victims, but because he was actually prosecuted.  It’s rare for doctors to be sent to prison for sexual misconduct.  They are usually just allowed to surrender their licenses.  That’s what happened to Dr. Manuel Tanguma.  Even though 13 women came forward claiming he was improper with them, the San Diego District Attorney’s office declined to press charges.  The Medical Board allowed Tanguma to quietly surrender his license. He will be allowed to petition to have his license reinstated in a few years.

 The most alarming aspect of the sexual misconduct issue is that the Medical Board of California knows who these doctors are – but it won’t tell patients. The Board posts the disciplines on its website, and expects patients to look up their doctors before every single appointment.

 If this country has learned anything from the Larry Nasser case, is that doctors no longer belong on that pedestal.  They should be treated like any other citizen and be prosecuted to the full extent of the law if they betray their patients’ trust with sexual misconduct.

[mariansmusings]

California doctors are getting away with sexual misconduct

With the news full of stories about sexual misconduct, it’s worth mentioning

cases where the perpetrators have hidden in plain sight – with the blessing of the Medical Board of California (MBC) and the state legislature.  These are doctors who are allowed to continue practicing even after being found responsible for sexual misconduct.

 The Medical Board has disciplined more than 450 doctors in recent years for crossing the line with patients.  Surprisingly, MBC investigators are not required to notify law enforcement of a sexual assault complaint.  They can quietly investigate a doctor without any warning to the public.  Doctors usually remain in practice unfettered throughout the course of the MBC investigation, which usually takes about three years.  Some physicians do have their licenses revoked if the accusations are found to be true, but others are discreetly put on probation, ordered to take behavior classes, and have a chaperone in the examination room.  AND their patients are never told. The MBC feels that if patients are interested, they will take the time to look up doctors themselves.

 What is also surprising is that a license revocation is rarely permanent.  Doctors can petition for reinstatement within a few years.  At least three doctors found responsible for sexual misconduct have had their licenses reinstated; two of the cases involved underage girls.  In one notable case, Dr. Dev Gnanadev, the current MBC president, sat on the panel that reinstated the license of a physician he knew who had assaulted four women, including a minor. Records show that doctor, Hari Narayana Ma Reddy, had also pleaded guilty to battery, a misdemeanor, after being charged with felony sexual battery of the minor.  There was never an investigation of Gnanadev sitting on the panel by either the Department of Consumer Affairs (DCA), which oversees the MBC or the Business and Professions Committee.  An investigation is not likely now, due to the fact that the new director of the DCA, Dean Grafilo, used to work for the California Medical Association (CMA), the doctors lobbying association.  Gnanadev has donated thousands of dollars to the CMA, and is a former president of the group. 

 The Medical Board doesn’t bother to follow its own discipline guidelines for sexual misconduct case, which states physicians should get a minimum of 7 years probation, even when the relationship is consensual. Last year, a physician was given just 35 months probation, less than half the recommended time. for unwanted sexual contact with five female patients.

 California legislators have been complicit in the protection of these doctors, due in part to strong-arming by the CMA.  In 2016, lawmakers failed to pass SB 1033, which would have required doctors on probation for egregious cases to notify their patients.  Just last summer, an effort to insert a similar requirement into the SB 798 Sunset Bill failed when lawmakers watered down the reporting requirements so much that only a handful of doctors would qualify. The amendment’s author, Senator Jerry Hill, angrily yanked it out of SB 798 rather than have a weak reporting requirement.  The Sunset Bill then passed, allowing the MBC to continue without any changes addressing public safe.

 Will there ever be a bill to protect California consumers from doctors who assault their patients? Not if the current mindset persists.  Until then, consumers are told to look up their doctors on the Medical Board’s convoluted website before every single appointment.  And if there is an issue where the doctor has been improper, the consumer should go directly to the police – not to the Medical Board.