When to be Afraid of your Doctor – Part 1

Dear-Doctor
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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 chronic pain patients to grasp what doctors are up against in this age of opiate hysteria. But some complaints are justified, it’s not that frequent but sometimes there are real horror stories out there and this is one of them, one which is my own personal experience.

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. My story is one of those rare occasions where it became a reality, as it has for dozens of other patients who have gone to this clinic.

I interviewed six patients in detail and spoke briefly with another nine over the course of sixteen months between 2017-2018. One 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, 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, the assumption being that because he is partially paralyzed from the waist down, he’s not having any real and significant pain.

For the others, once you’re in this clinic having been started on opiates from another clinic and the more complex your medical condition, you’re exploited and discriminated against only because you take these medications. Others not requiring these medication report a much better experience and are quite happy with the doctor and the clinic. Those taking opiates, report just the opposite.You may think this is an unsubstantiated claim, but I’m writing this post after sixteen months of going to this clinic interviewing many patients some who can corroborate the information I will share.

Like so many other clinics, new patients who are taking opiates when transferred in, are forced to taper to levels compliant with state medical board guidelines, if the amounts they take exceed those guidelines. And like many who don’t understand how the system works, they become angry and resentful. Most practitioners would simply explain why this must be done, but in this clinic no explanations are given. In fact honest questions regarding this are dismissed with lies which are irrational, such as the answer I was given when I asked why but with one difference. I was taking 30 MME less than the cap imposed in the state medical board of Ohio, so there was no regulatory reason for tapering and as a retired anesthesia provider, I know what’s appropriate.

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”. Such answers are dismissive, dishonest and unethical. To be blunt, patients paying for medical care who must live with the consequences of the 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 many states, once referred into a clinic, you’re stuck there, with no way out and no way to return to where you came from. If you should be able to leave for any reason, you are still punished for doing so, since most states now implement prescription drug monitoring programs which include a NARX score calculated in part on the number of prescribers who treat you.

The more prescribers who prescribe, the higher the score and therefore the higher the risk factor assigned to the patient. Such scoring systems are full of this kind of bias, with default assumptions built into the algorithm for the number of prescribers, pharmacies and such. The default assumption being that more than five prescribers in two years indicates drug seeking behavior, despite the fact that there are no formal definitions in healthcare for what drug seeking behavior looks like or how it operates.

With the doctor having the upper hand, the one with all the power, encouraged to discriminate with tools such as the NARX report, patients are still entitled to participation in medical decisions and to do so, must be given full and honest information on which to make those choices.  Chronic pain patients, for all practical purposes, are trapped in a system that could care less about the consequences they must endure, one designed to label them as something they are not, an addict, by a bureaucracy which makes no distinction between street addicts and chronic pain treated with opiates.

In the seventeen years I’ve been a pain patient, the worst provider I’ve ever seen comes from a clinic on the east side of Columbus Ohio, a small practice with one physician and four nurse practitioners. Like most, I arrived at the 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, unable to get a referral from this clinic to another and unable to simply walk away, 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 give me a referral to another pain 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, much like an adolescent would when acting out in anger.

It started on my third office visit with a four hour wait in the lobby and about ten minutes before being called into an exam room, I was handed a large stack of paper and asked to sign the forms. I counted the pages at 68, most of which required a signature and written in what was single spaced 8pt font on some pages and 10pt on others, in all, about an hour of reading.

Once in the exam room I would be checked on about every 5-10 minutes and asked if I had signed the forms, for which I said no, not without reading them all. I was 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 will finish this paper work in the lobby. I was then told I could not be seen until I had signed all the forms. So I told them they would have to wait. This continues for another 40-45 minutes now with 2 or 3 staff members coming in the room in an effort to speed me up. Asking me what questions I had, what was the problem, and trying to assure me there was nothing to be concerned about, that the forms were just routine. Getting late in the day, finally the doctor came in said that if I needed to return, I could reschedule and come back in a week or two and this is where some real pressure is applied. 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.

At this point I’m more than five hours at the clinic and I gave in and signed the forms and asked for copies, I was told they would do so and return them to me. 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 and simply on a maintenance amounts of pain 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 hint or 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’m at 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 this was an appropriate amount of medication for me. I objected by pointing out that he asked no questions short of what I had taking for the last decade and what my original injury was leading up to my current diagnosis. 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 using medical terms an average patient can’t pronounce much less 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. This is now looking like coercion, where the doctor is using the power he has over me to manipulate me for some unknown reason. While 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 as well as what standards of care were recommended by the CDC and the State Medical Board of Ohio. At which point the doctor replied with a sigh, “well, what do you think it’s like in Russia”?

At this point I’m beginning to feel like I’m in a lost episode of the Twilight Zone. So I replied, “we’re not in Russia, this is the U.S. maybe you should look out the window, 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 it and find another clinic or he will call the police and have me thrown in jail. Now I know I’m in a third rate horror film and I’m looking for the hidden cameras. Needing to rethink what has happened I opt for the scripts so I could reevaluate over the next 30 days.

I return to the front desk where I ask for copies of the forms I had signed 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. I continue, quietly but firmly refusing to move aside until I get what I asked for, 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 answer 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 shit storm with no way out.

Over the next few weeks I will add to this post the remaining forms, for now, I’ve included only the Patient Contract to point out and substantiate the claims in this post.

There is little anyone can do when walking into such a well-planned and orchestrated trap, but 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 out the door ASAP, but for many who are caught in the bureaucracy of having to take pain medication, there is no way out. 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 no exceptions are made.

Some of the Terms and Condition below are inappropriate for a patient contract, they are exploitive or too generalized or all-inclusive as to mean anything the clinic wants to make up on the spur of the moment. I have underlined and placed in italics some terms and conditions which are questionable, some may seem innocuous but become clearer as we get to the end where most of the catch-all terms are defined.

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 the point of view of a class action civil law suit and said that if I could get at least twenty other patients who could corroborate similar treatment, I would then be able to file a complaint which they would have to take seriously. The purpose of such a complaint or even a class action civil suit, would not be for the purpose of monetary gain, revenge or punishment, but instead would be for the purpose of forcing the clinic to take corrective actions and improve care to patients.

If you are a chronic pain patient living in the Columbus Ohio area, who’s attended a clinic on the east southeast side of Columbus, west of Pickerington and Pataskala near Big Walnut Park, 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 us at 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.

 

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? This is essentially a form of McCarthyism)
  2. The patient certifies they are a legitimate patient needing legitimate care.
    • (How do they define legitimate and how would anyone know what this is? Patients can mind read the clinic staff, without a description or definition, mistakes are highly likely which would then be grounds for dismissal)
  3. The patient certifies that they have not provided misleading or false information or false medical history to the referring physician or physicians at CLINIC NAME 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? I suspect this is to weed out people with chronic pain who have been court order to recieve care or treatment for addiction) 
  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 so are 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 CLINIC NAME 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 problematic as some OTC and prescription meds can cause false positive results on a drug screen. Is also an unreasonable request, denying patient the right to provide self-care for things such as the common cold)
  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 and by HIPAA law, patients can select which groups information can be released to and the time frame in which the release is active.)
  11. The patient agrees to supply to CLINIC NAME, 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 CLINIC NAME, 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.
    • (This is normally done with a phone call, coming back into the office results in a full workup and charges.)
  13. In the event of an emergency requiring another physician’s attention, the patient will immediately inform his/her physician at CLINIC NAME of such prescribing and dispensing pharmacy.
  14. The patient agrees to allow his physician at CLINIC NAME 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.
    • (Normally a copy of a patient contract is not information another clinic would be interested in, since it is only relevant to the clinic which issues it and the patient who signs it. Again, this seems excessive and designed to address some fear the clinic has)
  15. The patient agrees to allow the physician at CLINIC NAME to discuss his/her care freely with other physicians.
    • (This does not conform to HIPPA guidelines unless the other physician is directly involved with your medical care.)
    • (A proper HIPPA release form allows the patient to specifically name which care givers may receive a copy of PIH and for what time frame. A patient is well within their rights to refuse an all inclusive release.)
  16. The patient agrees to allow his physician at CLINIC NAME to inform Emergency Rooms in the area that the patient is under the care of CLINIC NAME.
    • (This would be covered under a standard release of information form as defined by HIPPA)
  17. The patient agrees to take the medication only and exactly as prescribed by the physicians at CLINIC NAME. 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.
    • (This clause contradicts terms elsewhere in this contract and is also duplicated in other clauses.)
    • (On two occasions with me, the clinic prescribed medication 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 no last until the next scheduled visit.
    • (Redundant instruction 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?)
  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 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 if being treated for an emergency)
  26. The patient agrees to keep all scheduled appointments at CLINIC NAME. 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 CLINIC NAME 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 CLINIC NAME 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 and excessive 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 protected under state statues and can’t be rescinded by a private contract)
  29. The patient allows CLINIC NAME 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 CLINIC NAME may stop treatment and cancel any prescriptions if any of the following occur:
    1. The patient gives, sells, or miscues 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, but improved funationality can be achieved, Termination of care on this clause alone might be malpractice. )
    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 without significant risk to the clinic if the patients life or safety is at risk)
    4. The patient is released for any reason or fails to show improved function.
      • (The catch-all term which allows the clinic to fabricate any reason for discharging a patient from care.)
      • (A private practice already has this right, so as used here it’s an implied threat meant to intimidate and force compliance)
      • (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.)
      • (If discharged under this clause a patient could challenge it in court.)
  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 CLINIC NAME staff attentions.
      • (In short, F–k with me and I will F–k with you.)
      • This is direct coercion designed to prevent reporting of ethics violations, insurance fraud, 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.
      • (This is also coercion designed to discourage patients from asking questions, challenging the judgement of the provider, to discourage patient input on decision.)
      • (This clinic desires to make decisions which are not always based on medical facts, but gut feelings, or ideological bias and retaliate against patients without restraint.when their decisions are questioned, which they do routinely )
      • (This clinic actually spends more time and effort looking for hints or signs of drug seeking behavior, non-compliance with their rules or some other indication of illicit drug use than they do providing medical care.
      • I’ve tested this by presenting symptoms which should be investigated only to watch the staff ignore the symptoms and instead run an extra drug test for Cannabis in my urine, bring me in early for a drug screen and other actions. It’s really sad to watch and they can be led around by the nose with this kind of stuff, chasing windmills…)
  33. I understand that I should take the least amount of controlled medications to relieve 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 CLINIC NAME witnesses or is able to validate information of the patient driving under the influence (i.e. drugs or alcohol) the patient authorizes to CLINIC NAME to notify the authorities and not be held liable for any damages which may occur.
      • (A patient can’t be compelled to not operate an automobile by a private contract. An automobile is considered an item of necessity required for basic survival, ownership and operating privileges are protected under state statues and can’t be rescinded by a private contract)
  35. The patient agrees their records may be given to Narcotics Detectives, DEA, or other authorities and will hold CLINIC NAME 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 CLINIC NAME 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.)
  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 CLINIC NAME, 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.
      • (Contradicts instructions to take less as needed or taper off whenever possible)
  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 CLINIC NAME. 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, a physician who denies care based on this would be subject to malpractice)
  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 CLINIC NAME.
      • (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, a physician who denies care based on this would be subject to malpractice)
      • (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 CLINIC NAME if they have been or are currently receiving treatment in a pain clinic.
  45. The patient will notify CLINIC NAME if they have been or are currently receiving treatment from a psychiatrist.
  46. The patient will notify CLINIC NAME 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 CLINIC NAME.
      • (This is not HIPPA compliant, some types of medical records are protected by Federal law, portions of records related to an HIV, drug treatment or psychiatric disorders. HIPAA provides a specific release form such records with a designated time frame on when they can be obtained and for what purposes. Even oif this clinic requested everything, they wouldn’t get it for these kinds of diagnosises.)
  48. I agree with video and or audio recording of my visits.
      • (This is a HIPPA 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 CLINIC NAME physician and or nurse practitioner today and have no complaints regarding my diagnosis, treat plan, physician or staff at the of CLINIC NAME. 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 being such douchebags)
  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 CLINIC NAME 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 CLINIC NAME. 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 as clear an example of coercion as it gets, 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, as the patient you have little or none. As the physician he has the right to do anything as the patient you have no rights.

Anyone who thinks this way is a predator and when given broad powers, most of which rely only on his judgement as a physician, this is an individual who’s as likely to act out as a criminal if pushed to hard, as any street addict would. 

So how did I get out of this contract and clinic? Understanding how the healthcare 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 frustrated enough by asserting my legal rights, he fabricated a lie, claiming I had failed to keep an appointment, then discharged me from care without a referral or a script one day before my next office visit, clearly a retaliatory act.

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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 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 a term and condition on subsequent office visits, providing different response from those on previous office visits. Which paperwork then represents the patients true intent? Which fact are the true facts?

I’ve seen this before with other clinics who operate 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 the exam and care provided before it is rendered. Failure to sign is grounds for denying care.
  • 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 a clear 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 and unethical acts.
    • The waiver will be included in another post.
  • 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 all liability in treatment failures.
  • Causes for discharging 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 the 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, exercise control over their bodies through risk management, except to leave and refuse treatment.In fact there are several clauses which explicitly deny the patient the right to participate in medical decisions.
    • 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, often recommending contraindicated procedures due to a failure to be fully informed with patient specific medical conditions for which they are being treated.
    • Staff routinely encourages (sells) injections and other procedures even when patients have no problems in these areas.
  • Some patient forms require an acknowledgement that copies of these forms are offered to patient when in fact they are not. Requesting copies requires physician approval before they are given to patients. It took me nine months to get a copy of these records.
  • On the combined forms, all sixty or so pages, more time, effort and emphasis are placed on concerns about:
    • Addiction
    • Non-compliance with rules and guidelines.
    • Minimizing or eliminating the medical liability of providers
    • Asserting justifications for discharge from the practice or discontinuing medication
    • Addiction concerns are mentioned 13 times.
    • Misuse of Narcotic medication is mentioned 23 times, i.e. discharge.
    • Causes for weaning or tapering are mentioned 7 times.
    • Consequences for lost or stolen medication 7 times, i.e. discharge
    • 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.
  • Staff never spends more than 10 minutes in an exam room, even when performing injections, making it impossible to complete all tasks outlined on the 60 plus pages and forms.
  • 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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