When to be Afraid of your Doctor – Part 1

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I get lots of questions and here lots of complaints from chronic pain patients about their doctors. Most of the time, once I get the details, it’s clear doctors are following guidelines and standards of care in a rational manner. Some doctors could improve their bedside manner and score more points, but without a medical background in healthcare, it’s difficult for some to grasp what doctors are up against in this age of opiate hysteria. Some complaints are justified though, it’s not that frequent but there are horror stories out there and this is one of them.

Here in Ohio, chronic pain patients can no longer get into to a pain specialist without a referral, making pain patients who take opiates an easy target for unscrupulous doctors to manipulate, fortunately this is an infrequent occurrence.

I interviewed six patients in detail and spoke briefly with another nine over the course of sixteen months between 2017-2018 from a clinic in southeast Columbus known as Comprehensive Pain Management. One of those patients was not being prescribed opiates but clearly needed them. Bound to a wheel chair following an auto accident and having uncontrolled spastic contractions of his left hip and leg, his leg would fly up into the air every 4-5 minutes and he would wence and cry out in pain. He had been like this for eight months, lost his home, car, job, had two surgeries,had to send his children to relatives to care for, had applied for Medicaid and been denied and was still getting no support and no treatment from this clinic. The doctor was telling him that opiates were not indicated for his medical problems, with the assumption being that because he is partially paralyzed from the waist down, he’s not having any significant pain. Mind you, there are no tests which indicate conclusively how much pain a person has, that is left to the judgement of the clinician and relies on a patients medical history.

For those who are prescribed opiates for pain, there are stories of exploitation and discrimination because opiates are involved. Those not requiring these medications report a much better experience and are quite happy with the doctor and the clinic. Many who do take opiates report the opposite.

Like many clinics new patients taking in excess of state guidelines are force tapered to levels compliant with those guidelines. And for many who don’t follow these regulatory changes, they become angry and resentful. For others already within state guidelines, they too are forced tapered or have medications and amounts adjusted without prior notice or discussion with the prescribers. Patients don’t find out about this until leaving the clinic when scripts are handed to the patients. Needless to say, this is both a shock and a betrayal of trust when your provider alters your medical care without informing or consulting with you.

Most practitioners would simply explain why this must be done, but in this clinic no explanations are given for in this clinic the attitudes and beliefs are, the prescribers impression and judgement are final, as if the providers there have unique ability to mind read the patients and know when a change in care benefits the patients. As you may well guess, they get it wrong most of the time since no one is capable of mind reading. 

Honest questions regarding these kinds of changes are dismissed with lies which are irrational, such as the answer I was given when I asked why. I was taking 30 MME less than the cap imposed in the state medical board of Ohio, so there was no regulatory reason.

When I asked the doctor why he was tapering, the answer given was, “What do you think it would be like if you lived in Russia”. Needless to say, such an answer is not a medical justification for such action, it is though dismissive, dishonest and unethical. To be blunt, patients paying for medical care who must live with the consequences of choices made, don’t deserve these types of answers to honest questions.

This post is about educating patients on how to spot a dangerous situation before they get in too deep or too dependent on a prescriber whose intent is to exploit them for reasons other than providing honest and compassionate medical care. In some states, once referred into a clinic, you’re stuck there, with no way out and no way to return to where you came from. 

When the state of Ohio made it mandatory for prescribers to access a report from the states PDMP database, called a NARX report, this clinic began requiring patients with elevated scores to lower dosages even further or come into the clinic twice monthly as opposed to once monthly, they also began insisting patients received injections, even though trigger point injections had no chance of relieving some types of pain.

The score on a NARX report is comprised of the number of prescribers who have written scripts, number of pharmacies filled at and the type of medications prescribed, all of these over a previous two year period. The algorithm used to compute the score is unknown but its purpose is supposed to improve the ability of prescribers to identify patients at risk of abuse or addiction.

I’ll be the first to admit there is some benefit in that, but what the report doesn’t take into consideration are facts such as, a patient has no control of which prescriber sees them on any office visit in a clinic with multiple prescribers, nor does it take into consideration, clinic closings, prescriber turn-over at a clinic, changes in insurance which force patients to change prescribers or pharmacies and other such nuances. As such, the report scores are artificially inflated when these events occur.

At Comprehensive Pain Management no such allowances of common sense are given for such events, for the prescribers at this clinic are overtly paranoid and as such, assume the worst despite facts which clearly contradict what is implied on such a report. Patients pay for this in the form of unneeded procedures, being under medicated even when appropriate dosages are well within state guidelines and patients pay in the form of more frequent office visits and lab tests.

In the US patients are still entitled to participation in medical decisions and to do so, must be given full and honest information on which to make choices.  Chronic pain patients at this clinic though are not always given honest information. There were times when I asked questions or asked for explanation and the doctor simply walked out of the room or refused to answer, on other occasions the doctor lied, whether it was by intent or due to being poorly informed, poorly educated or for other reasons, is unknown. But based on my experience as an anesthesia provider, I’m convinced that at times the falsehoods were known and given with full knowledge that they were dishonest answers. Medical judgments there favor the clinic and clinician first, even if doing so results in substandard care for patients.

Like most I arrived at this clinic expecting what any other patient expects, honest information on which to make rational choices. What I unknowingly fell into was a well throughout trap designed to quickly snare me and keep me captive and under control.

Unable to return to my PCP and unable to get a referral from this clinic, I realized in time that the only way out was to force my provider to discharge me from his practice, at which point my PCP would have to take me back and refer me to another clinic. It took sixteen months to finally frustrate this doctor enough that he cut me loose and when he did, rather than just saying he no longer wanted me as a patient, which he has the right to do, he chose to fabricate a lie to justify his actions.

It started on my third office visit, I was handed a large stack of paper and asked to sign the forms. I counted the pages at 66, most of which required a signature acknowledging that I had read them.In all it took about an hour to read all pages, understanding them was something else as much of the information on them was repeated multiple times in multiple places, while other conditions were ambiguous, confusing or simply unethical or a violation of rights and due process. The only thing I could be certain of, whoever wrote these conditions was paranoid and rather than dealing with the requirements placed on the prescriber for how they practiced, the prescriber turned those into excessive and overbearing demands placed on patients.

Once in the exam room someone would check on me about every 5-10 minutes and ask if I had signed the forms. For which I said no, not without reading them. I would be reminded that other patients were waiting to be seen and they needed to get me in and out as quickly as possible. To which I replied, then get me seen and I’ll finish this paper work in the lobby. I was then told I couldn’t be seen until I had signed all the forms. This continues for another 40-45 minutes and now with 2 or 3 staff members coming in the room in an effort to speed me up, asking questions about what was the dely and trying to assure me there was nothing to be concerned about, that the forms were just routine. Finally the doctor came in said that if I needed to return, I could reschedule and come back in a week or two, to which I replied I would be happy to do so but would need a script to get me through until that time. For which he replied, he can’t prescribe until all the paperwork had been signed.

So I asked for some explanations regarding some of the terms and conditions on the forms, and again I was assured they were just routine. I pointed out that nothing is routine if I don’t understand what is being asked of me. As I pointed out some of the items I was concerned about, the answers I got were dismissive and as a healthcare provider, I knew some of his answers were deliberately misleading.

The rest of the exam with the doctor went without incident, was quick and to the point as I am seventeen years now a chronic pain patient who simply needs maintenance medication. When I went to the front desk to schedule my next appointment that is when I was confronted with how bad this situation was going to be. With no previous discussion from the physician I now find out that he has changed my medications to something else and tapered down 15 MME.

In Ohio the cap on pain medication is 120 MME, I was taking 90 MME, so I was well within the guidelines, there was no regulatory reason for tapering, no medical problem I had expressed to justify this and no indication from the doctor that my care plan of the last six years would be changed. I naturally objected not having discussed any of this with the doctor while he was in the room, so I asked to go back and discuss it.

Back in an exam room the doctor returned and was short and to the point. It was his professional judgement that I was taking more medication than I needed. I objected by saying how could he come to this conclusion having not asked any questions other than how am I doing on the medication prescribed. Clearly he did not have enough information on which to justify a change in my plan of care. At this point it was obvious he was agitated by my forwardness, but also puzzled as I was speaking in medical terms an average patient doesn’t understand, pointing out that his decision appeared arbitrary and baseless.

The doctor refused to explain himself or cite any medical rationale for his decision, he simply said that if I wanted to, I could go to another clinic but I would have to surrender the script before leaving. Such a statement is coercion, where the doctor is using the power he has over me to manipulate me for some unknown reason. All along he continued to assure me that he believed this is what’s best for me, I interrupted, letting him know I was a retired anesthesia provider and knew what was appropriate and indicated in this situation and that his refusal to answer my questions was not standards for medical practice. At which point the doctor replied with a sigh and said, “well, what do you think it would be like if you lived in Russia”?

I replied, “we’re not in Russia, this is the U.S. maybe you should look out the window, as it sounds like you’ve been in the office too long”. He responded by taking the script from my hand and walking out of the room. At this point I’m a little more than agitated, so I follow him and confront him in the hallway, well within his comfort zone, so he’s backing up. He pulls me into his office where we have a calmer but frank conversation.  At this point he makes it quite clear that I have these options, I can take the script and schedule another appointment, leave and find another clinic or he will call the police and have me thrown in jail. I’m now looking for the hidden cameras. Needing to rethink what has just happened I opt for the scripts so I could reevaluate over the next 30 days.Such response as this are coercion when all the patient is doing is asking for the medical justifications for the doctors choices.

I return to the front desk where I ask for copies of the forms I had signed earlier only to be told they are too busy to make copies and they will be available on my next office visit. So I ask for unsigned copies to which I get the same answer. Undeterred, I continued my demands, refusing to step aside to allow other patients to the window until I got what I wanted, all along being threatened that the police would be called because I was being disruptive. Finally the doctor came in and instructed the staff to give me the blank forms.

Over the next several days I tried to make heads and tails of these documents and like the answers I got from the doctor about what it would be like to live in Russia, the forms I was asked to sign read pretty much like that answer. That’s when I realized I had signed on to a real nightmare of a situation with no way out.

There is little anyone can do when walking into such a well-planned and orchestrated trap, it does underscore how dangerous the real world has become for chronic pain patients. If you can spot such a trap, the best advice is to walk away but few can when it is conducted in this manner.

But more importantly as chronic pain patients, when establishing service with a new provider, never sign anything until you’ve read and understand it, this should be a hard line for which there are no exceptions.

I’ve taken the Terms and Condition from some of those 66 pages and listed them below. Some statements are exploitive or too generalized or all-inclusive as to mean anything the clinic wants them to mean. Some may seem innocuous but there are others which make no sense at all except to render some type of protection for the provider at great consequence for the patient. 

I later reviewed this contract with an attorney to get an opinion. He was quite clear that as a private business the physician can operate it almost any way he likes. That said, if my concerns were strong enough the only option available to me was to file a complaint with the state medical board. He went on to say that in this current climate, at both a state and federal level, a single complaint is more likely to end up in the trash as opposed to being taken seriously. He then began addressing my concerns from a point of view for multiple patients, saying that if I could get at least ten other patients who could corroborate similar treatment, I could then file a complaint with the state medical board which they would have to take seriously.

If you are a chronic pain patient living in the Columbus Ohio area, who’s attended Comprehensive Pain Management on the east southeast side of Columbus, have been summarily discharged from the clinic, discharged without a referral or a script, believe the clinic has operated in an unethical manner, contrary to the standards of care and wish to participate in filing a group complaint with the State Medical Board of Ohio, contact cergm@carter-brothers.com. Please include your full name, address, telephone number, email address, date range for when you attended this clinic and a brief description of your complaint. You may also send questions to the same address.

 

Comprehensive Pain Management

PATIENT CONTRACT

To receive treatment with or without narcotic pain medication, the patient must meet the following CONDITIONS/TERMS.

1.The patient has never been diagnosed with, treated, or arrested for substance dependence, abuse or trafficking. I am a resident of the state of Ohio.

  1. The patient has never been involved in the illegal use, sale, illegal possession, dispersion, or transport of controlled substances, sleeping pills, nerve pills, or pain pills or under investigation or arrested for such activities. The patient is not in contact with people involved in these activities.
    • (A clinic should not be able to refuse treatment based on who a patient knows, either casually or otherwise. How could anyone know if another person was involved with illegal drugs, most family members don’t know when this is going on for a member of the family?).
  2. The patient certifies they are a legitimate patient needing legitimate care.
    • (What’s a definition of legitimate?)
  3. The patient certifies that they have not provided misleading or false information or false medical history to the referring physician or physicians at Comprehensive Pain Management and agrees they are not seeking treatment under false pretenses. The patient understand that physician based treatment relies, at least 50% on history and if it’s found that the patient has provided false statements they may be released. The patient agrees they (or anyone with them) do not carry concealed weapons, tape recorders, cameras, and other devices.
  4. The patient certifies they are not appearing to seek care as part of an ongoing investigation or threat of prosecution. The patient agrees to see a goal such as decreased pain, improved function, return to work, or return to school.
    • What is a definition of improved function? If you’re bound to a wheel chair, how would an improvement in function be measured? Most chronic conditions have no room for improved function, that’s why they are chronic. 
  5. Patient certifies that if medical issues arise after office hours they will immediately call their primary care physician or go to the local emergency room.
    • (If related to pain management, such actions only get you referred back to the doctor who prescribes for you.)
    • (Further down are conflicting instructions which state that doing these things is grounds for discharge from the clinic, so which instructions are the correct course of action?)
  6. FEMALE ONLY – the patient certifies that she is not pregnant. The patient agrees and understands that it is her responsibility to notify Comprehensive Pain Management immediately if she is planning a pregnancy, or believes that she may be pregnant and agrees not to take any medications without approval of OB-GYN doctor, if pregnant.
  7. The patient understands that an accurate diagnosis requires an accurate history, physical exam, and imaging. Therefore, treatment recommendations are not made over the phone, only in person after being seen by a physician.
  8. The patient agrees to random urine and / or saliva and / or blood testing.
  9. The patient agrees to not to take over the counter medications (i.e. Tusinex, Robitussin, Vicks Inhaler, etc.), Marinol, hemp oil, and or Chinese herbs.
    • (This is unreasonable on any level, denying a patient the right to provide self-care for things such as the common cold is an unreasonable requirement. Since pain specialist are limited to treating pain, this request is outside his area of expertise)
  10. We reserve the right to require the patient to submit to a psychological / psychiatric evaluation and or patient profile and release this information as part of any medical records request.
    • (Most clinics have a separate form for release of medical information, so this requirement does not follow HIPAA guidelines. Patients have the right to select what information can be released to who and in what the time frame, so an all inclusive release such as this does not follow HIPPA guidelines)
  11. The patient agrees to supply to Comprehensive Pain Management, name, address, and telephone number of the pharmacy that is filling the prescription opioid pain medication and will use only one pharmacy.
  12. The patient agrees to have his/her prescriptions prescribed by Comprehensive Pain Management, bill by only one pharmacy. In the event a pharmacy does not cover prescribed medication, the patient will attend another office visit to complete appropriate paperwork for pharmacy change per our controlled substance treatment.
  13. In the event of an emergency requiring another physician’s attention, the patient will immediately inform his/her physician at Comprehensive Pain Management of such prescribing and dispensing pharmacy.
  14. The patient agrees to allow his physician at Comprehensive Pain Management to send a copy of this agreement to the patient’s pharmacy, referring physicians, all other physicians involved in the patients care and the patient’s Emergency Room.
    • (Since this document doesn’t contain any medical information a copy of a patient contract is not information another clinic would be interested in, it’s only relevant to the clinic which issues it and the patient who signs it, another doctor wouldn’t care as they have no obligation to adhere to it or inforce it.)
  15. The patient agrees to allow the physician at Comprehensive Pain Management to discuss his/her care freely with other physicians.
    • (Only if that physicians care relates to the treatment of pain or the use of other controlled substances.)
    • (Under HIPPA a patient has the right to decide what PIH is relased and to who unless there is a medical emergency where the patient can’t provide such consent)
  16. The patient agrees to allow his physician at Comprehensive Pain Management to inform Emergency Rooms in the area that the patient is under the care of Comprehensive Pain Management.
    • (Only if and when the patient utilizes an Emergency Room service related to a condition managed by the pain clinic)
  17. The patient agrees to take the medication only and exactly as prescribed by the physicians at Comprehensive Pain Management. The patient agrees not to share medications with other individuals. The patient agrees that medications will only be prescribed that are on plan formulary. The patient will not drink alcohol with controlled medications.
    • (The first sentence contradicts terms elsewhere in this contract and is also duplicated in other clauses.)
    • (This clinic prescribed medications not on formulary including medication from a compounding pharmacy not covered by insurance)
  18. The patient understands that each prescription is for a specific number of pills, designed to last a certain amount of time. NO early refills, NO exceptions.
  19. The patient understands that NO refills will be given if the prescription does not last until the next scheduled visit.
  20. The patient understands that NO allowances will be given if the prescription does not last until the next scheduled visit.
    • (Redundant already addressed in previous numbered item)
  21. The patient understands that prescriptions will be dispensed only after a scheduled office visit, not over the phone.
    • (Redundant instruction)
  22. The patient understands that NO prescription for pain medication will be given over the telephone,
    • (Redundant information).
  23. The patient agrees that they will not seek pain medication at night, on weekends, holidays or prior to next visit.
    • (Does this mean a patient can’t take pain medication at these times?, Go to an ER for an emergency? Or see their PCP as instructed in other numbered items? Or seek a 2nd opinion?)
  24. The patient agrees not to obtain pain medication from any other physician or emergency room or other person.
    • (Conflicting instructions. What about instructions which direct a patient to go to an ER in the event of an accident, or when they can’t reach this clinic after hours?)
  25. I understand obtaining controlled medication from more than one physician/dentist/clinic is a felony.
    1. (Not so when being treated for an emergency)
  26. The patient agrees to keep all scheduled appointments at Comprehensive Pain Management. If the patient is unable to keep an appointment, he/she must give at least 24 hours’ advance notice. However, NO scheduled/controlled medication prescriptions will be called in.
  27. The patient agrees to see the physician at Comprehensive Pain Management if the physician feels it is necessary to change the patient’s dosage. If the physician suspects the patient is not following his/her orders when asked to cease use of controlled substances, the patient permits Comprehensive Pain Management to pursue remedies which will disable the patient’s driving privileges.
    • (This is giving the clinic absolute power on nothing more than a gut feeling,without evidence. Going after a patient’s drivers license is an abuse of power. This requirement is looking more like an implied threat meant to keep patients compliant.)
  28. The patient understands not to drive or operate machinery when taking controlled medications.
    • (A patient can’t be compelled to not operate an automobile. An automobile is considered an item of necessity required for basic survival, ownership and operating privileges are outlined under state statues and can’t be rescinded by a private contract with an individual)
  29. The patient allows Comprehensive Pain Management to call other pharmacies for poly-drug prescriptions and or usage. All patients are required to undergo mandatory drug screen at facility of choice (i.e. primary care physicians, hospital, or walk in clinic) and agree not to use Vicks inhalers, poppy seeds or cough/cold remedies.
  30. The patient understands that the physician at Comprehensive Pain Management may stop treatment and cancel any prescriptions if any of the following occur:
    1. The patient gives, sells, or misuses the pain medication or fails to keep appointments.
      • (Discharging a patient from care for a missed appoint is within the clinics power but is considered unethical)
    2. The patient fails to reach goals such as decreased pain.
      • (As pain can’t be measured, how would a doctor prove that pain has not decreased? Furthermore, other items below state that decreased pain is not always possible, instead successful treatment is measured by improvements in funationality,)
    3. The patient attempts to obtain pain medication at night, on weekends, on holidays, sooner than next office visits, from any other physician, emergency room or other source.
      • (This item as applied to emergencies can’t be enforced unilaterally as emergency medial treatment is based on the judegement of the ER physician)
    4. The patient is released for any reason or fails to show improved function.
      • (This catch-all term which allows the clinic to fabricate any reason for discharging a patient from care.)
      • (Some medical conditions can be severe enough that improved function is not an attainable goal. A patient in a wheelchair is not likely to improve if the medical problem is permanent)
      • (A private practice already has this right, so as used here it simply appear s to be more coercion)
      • (Failure to improve function is not synonymous with improved pain control or lack thereof, some physical disabilities which are painful will not show improvement even though pain relief is obtained.)
  31. I understand that all medications and any refills will be canceled immediately if, in the opinion of the physician/staff, any allegations, suspicious information, or investigation is initiated by anyone regarding potential violations of this contract is brought to Comprehensive Pain Management staff attentions.
      • (In short, do something I don’t like and I will retaliate by denying you medication)
      • This is obvious coercion designed to prevent reporting of ethics violations or insurance fraud from unnecessary procedures, to discourage law suits or any other wrong doing on the part of the clinic)
  32. The patient agrees that physician/staff may cancel medications at any time without cause and without warning for any medical or non-medical reason, suspicion of incarceration, or even without a specific reason, and understands to see primary care provider, mental health provider immediately when medications are cancelled or treatment discontinued.
      • (The all inclusive, unconditional statement of we have the power and you don’t so don’t piss us off, which is also coercion, designed to discourage patients from asking questions, challenging the judgement of the provider, to deny patient input on decisions)
  33. I understand that I should take the least amount of controlled medications to relieve the symptoms and should never exceed the prescribed amount and should slowly taper off all controlled substances over several weeks whenever possible. I understand these medications are only to be taken as needed. I understand the risks of taking controlled medications up to and including death. I will take the minimal amount of medication to improve function.
      • (Contradicts other instructions to only take medications as prescribed, i.e. as labeled on the medication bottle).
  34. The patient will adhere to the advice of the physicians regarding operations of motor vehicles or any other machinery. If Comprehensive Pain Management witnesses or is able to validate information of the patient driving under the influence (i.e. drugs or alcohol) the patient authorizes to Comprehensive Pain Management to notify the authorities and not be held liable for any damages which may occur.
      • (How convenient. A patient can’t be compelled to not operate an automobile by a private contract. And just as proof of driving under the influence of alcohol can’t be made without a test  confirming it, there are no legally defined limits set for what constitutes driving under the influence of pain medication) 
  35. The patient agrees their records may be given to Narcotics Detectives, DEA, or other authorities and will hold Comprehensive Pain Management harmless and patient agrees to random drug testing.
      • (A mute point considering that private health data is not protect from a criminal investigation, clearly this doctor is preoccupied by liability concerns)
  36. I authorize Comprehensive Pain Management to obtain narcotic profiles from DEA, and reports from the State Boards of Pharmacy and release all past, present and future profiles to anyone with written authorization to receive medical records and understand that obtaining controlled medications from more than one physician is a felony.
      • (Unless formally charged with a crime which goes to trial, law enforcement records, investigations, arrest records and such are protected from public access and can’t be obtained without a court order. so this authorization isn’t even legal)
  37. I understand that controlled medications including, but not limited to Tramadol, Codeine, Tylenol #3, Darvocet, Propoxyphene, Lortab, Lorcet, Vicodin, Norco, Hydrocodone, Percocet, Roxicodone, Oxycodone, OxyContin, MS Contin, MSIR Kadin, Avinza, Morphine, Dilaudid, Methadone, Demerol, Duragesic Patch, Fentanyl Patch, Stadol, Actiq, Floricet, Ambien, Chloral hydrate, Dalmane, Lunesta, Rozerem, buSpar, Valium, Ativan, Xanax, etc. have risks associated with their use, such as drug interactions, respiratory depression, death, addiction, drowsiness, allergic reactions and agree to discuss all risks/side effects with my pharmacist, family members, family physician, other treating physicians, before and during treatment.
      • (A physician can’t compel a patient to discuss their medical condition with others, Federal HIPPA privacy laws trump any private contract with a provider on this subject)
  38. The patient understands that physical dependence is a normal response to many types of medications including steroids, antidepressants and controlled medications and tolerance to pain relieving can develop.
  39. The patient realizes pain medication may interfere with endocrine function, i.e. interference with libido, sexual function, etc. and the patient agrees to see their family physician or endocrinologist if they have any of these problems.
  40. If I develop any feelings of hopelessness, suicidal thoughts or desire to hurt myself or others, I agree to immediately seek psychiatric care and notify Comprehensive Pain Management, and my primary care provider. I will return all medications to the office if these feelings occur.
      • (Seriously?  So I’m sick enough to want to kill myself or others but I’m expected to be rational enough to report it and seek help, and Oh yes, return my medication to the office so I don’t harm myself.)
  41. I understand that not taking medications as prescribed or overdosing on medications can cause death.
  42. I have told (or will tell) my family members and caregivers of my use of controlled medications for treatment of pain and they are in agreement with my treatment plan and agree to hold harmless physicians of Comprehensive Pain Management. I agree to discontinue treatment if family is not in agreement or my family physician is not in agreement or if I fail to reach goals.
      • (A physician can’t compel a patient to discuss their medical condition with others, Federal HIPPA privacy laws trump any private contract with a provider on this subject)
      • (An adult of legal age does not require the permission from another family member or another physician for treatment of a medical condition, regardless of what medications are used)
  43. I will discuss my diagnosis and treatment with family, family physician, mental health provider, second opinion physician, and if they are not in agreement, will discontinue treatment and notify Comprehensive Pain Management.
      • (A physician can’t compel a patient to discuss their medical condition with others, Federal HIPPA privacy laws trump any private contract with a provider on this subject)
      • (An adult of legal age does not require the permission from another family member or another physician for treatment of a medical condition, regardless of what medications are used)
      • (In psychiatric circles, this is called gathering your forces, it’s done by people who know they have a weak or baseless claim for what they want, so they enlist the approval of others to get it.)
  44. The patient will notify Comprehensive Pain Management if they have been or are currently receiving treatment in a pain clinic.
  45. The patient will notify Comprehensive Pain Management if they have been or are currently receiving treatment from a psychiatrist.
  46. The patient will notify Comprehensive Pain Management if they are currently receiving treatment in a Methadone or Suboxone Clinic.
  47. I hereby authorize any pharmacy, Emergency Room of record to release any and all information to the physicians and or staff of Comprehensive Pain Management.
      • (This is not HIPPA compliant, some types of medical records are protected by Federal law, portions of records related to HIV, treatment or psychiatric disorders.)
  48. I agree with video and or audio recording of my visits.
      • (This is a privacy violation, a patient can’t be compelled to submit to video and audio recordings of medical procedures.and if taken anyway, are not admissable as evidence for any reason except a criminal investigation)
  49. I agree that I have been seen and examined by Comprehensive Pain Management physician and or nurse practitioner today and have no complaints regarding my diagnosis, treat plan, physician or staff at the of Comprehensive Pain Management. If I do have problems, I will hand deliver in writing to the Office Manager today. I agree to discontinue treatment if I don’t reach set goals such as decreased pain, improved functions, return to work, and return to school.
      • (Since this clinic requires patients to sign this form before being seen and treated, they are in fact extracting an agreement and consent of approval under duress. A patient in need of medical care must approve of care and can’t acknowledge answers for questions which haven’t been asked)
      • (This is a dirt ball designed to discourage complainers, which this clinic gets a lot of because of the manner in which they abuse basic rights of patients)
  50. I have read the conditions and terms stated above and have had all of my questions regarding these conditions and terms explained to my satisfaction. I have met the conditions and I agree to honor all of the terms unconditionally. I also understand that if I violate any term of this agreement, it is cause for the physicians at of Comprehensive Pain Management to refuse prescriptions and or treatment. I agree that if I am unable to read or write that this has been verbally explained to me to my satisfaction. I have met the met the conditions and I agree to honor all of the terms unconditionally. I also understand that if I violate any term of this agreement, it is cause for the physicians at of Comprehensive Pain Management. To refuse prescriptions and or treatment. I agree that if I am unable to read or write that this has been verbally explained to me to my satisfaction.
    • (This is a clear example of coercion, especially when the signature is required before questions are asked and answers given)

 

Several unspoken message are clear from these 50 terms and conditions. As the physician he has unlimited powers to do whatever he wants. As the patient you have little or no power and no rights. 

Some of these terms and conditions indicate a predatory intent, especially those which give the prescriber an unconditional right to do anything for any reason . Such individuals are likely to act out criminally if pushed hard enough, which is why these terms give them unconditional power to act.. 

So how did I get out of this contract and clinic? Understanding how the system works, knowing my rights and not being afraid to assert them in measure ways, I was a pain in the ass at every opportunity I could be. This doctor tried many times to trip me up and catch me braking one of these rules only to fail. Finally he became frustrated enough that he fabricated a lie, claiming I had failed to keep an appointment, then discharged me from care without a referral or a script and did so one day before my next office visit, clearly a retaliatory act.

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Indications of Paranoia

On each office visit patients are given a packet of forty four pages, this patient contract is not included; it is renewed on an annual basis. But many of the same terms and conditions are repeated in the forty four pages which must be resigned on each office visit.

Without realizing it, the clinic is putting themselves in a precarious situation if the patient alters an answer for a term and condition on subsequent office visits, which paperwork then represents the patients true intent? Which facts are the true facts?

I saw something like this years ago with other clinic who used paper forms in this way. If a term or condition is called into question, suddenly all the forms are lost except those which support the clinics point of view. All this repetition is obvious overkill and when the forty four pages from a single office visit are combined with this patient contract, these issues emerge:

  • Patients must sign all forms before an exam is performed, even though forms make explicit assertions on the quality and completeness of an exam and care provided before it is rendered. Failure to sign such forms is grounds for denial of care,. which is coercion since they can’t be answered factually until services have been rendered.
  • Patients must sign a Complete Release and Waiver of Liability, binding on all family members, heirs, administrators, assigns and legal representatives, or they are refused care.
    • This is an ethical violation. A person can’t be compelled for any reason to sign away their right to legal representation. So this becomes part of the scam, pressure the patient to hurry through signing the forms blindly and in doings so sign away their right to protect themselves from unlawful, unethical acts even acts of malpractice.
  • Failure of the clinic to improve quality of life or functionality is defined in these documents as grounds for discontinuing medications. This appears to be an effort to absolve the clinic of any liability in treatment failures.
  • Causes for discharging a patient from practice or discontinuation of prescription meds occurs 71 times across the forty four pages of forms, this is not counting the duplicated terms and conditions. Again this seems excessive by any standard and makes me question the integrity of the provider..
  • There are no specific terms or conditions which state the clinics obligations to the patient, other than improving functionality. What methods will be used to determine this are not addressed or defined nor is it documented on any paperwork given to the patient.
  • Determining what is considered an improvement in quality of life is an exclusive right of provider and subject to their judgement alone. The patient is not allowed input on this determination.
  • The contract has no provision for allowing patients to participate in medical decisions, just the opposite, the terms and conditions explicitly deny the patient this right. They are denied the right to exercise control over their bodies and manage risks, the physician assumes this right for them then waives the patients right to pursue justice with a waiver of legal rights.
    • Under all conditions the provider’s professional judgement is final and patients have no recourse available to them.
    • While informed consent is expressly mentioned in multiple places, in practice, staff routinely misdirects, misinforms, minimizes risks, and pushes procedures which are not medically necessary or justified, sometimes recommending contraindicated procedures due to a failure to be fully informed with a patient specific medical conditions for which they are being treated.
    • Staff routinely encourages (sells) injections and other such procedures even though not indicated or having failed to provide benefit, insist patients continue with such treatments.
  • Some patient forms require an acknowledgement that copies of these forms are offered to patient when in fact they are not. Requesting copies is met with excuses for why they can be provided, or they require a physician approval before they are given to patients. This is a violation of HIPPA guidelines. 
  • On the combined forms, patient contract plus the forty four pages signed on each office visit, more time, effort and emphasis are placed on these concerns than on others:
    • Non-compliance with rules and conditions.
    • Minimizing or eliminating the medical liability of providers
    • Asserting justifications for discharge from practice or discontinuing medications
    • Addiction concerns are mentioned 13 times.
    • Misuse of Narcotic medication is mentioned 23 times.
    • Causes for weaning or tapering are mentioned 7 times.
    • Consequences for lost or stolen medication 7 times.
    • Consequences for failure to keep an appointment, includes no medication until next regularly scheduled appointment or discharge, 16 times.
    • Patients are both instructed to use alcohol in moderation and not to use alcohol, so which is it?.
  • Staff never spent more than 10 minutes in an exam room with me, even when performing injections, making it impossible to complete all tasks outlined on these forms they required a signature for, this is another type of coercion.
  • Clinic does not provided a copy of HIPPA notice for review, just a notice that they follow HIPPA guidelines, each time I asked to see it, a copy was unavailable.
  • Patients will be charged $50 for a canceled appointment, as if they are renting room space. The patient contract explicitly states that it will bill for medical services and requires a release for assigning insurance benefits to the clinic. Providers are under contract with insurance companies to bill for and accept only covered services, rent for room reservations is not a covered service. If billed patients are not obligated to pay.
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2 thoughts on “When to be Afraid of your Doctor – Part 1

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