Monday, December 31, 2007

What Rewards for the Whistle Blower?....1/03

Saw an article about an Atlanta Hospital which settled with the government for $26 Million in order to avoid charges of Medicare fraud.

The whistle-blower, a former employee, collected almost $5 Million.

One of the charges in the lawsuit is that I accused PRMC of Medicare fraud. A comment said that it cost the hospital over $250,000 to clear itself during an audit. If that money was paid to the government, isn't that like deferred prosecution? You're guilty, but they just want you to clean up your act? They don't say that a hospital is guilty, but you can draw your own conclusions....

I didn't actually accuse the hospital, but one might characterize a guilty conscious as being overly sensitive...and you wonder if someone pocketed about $45,000!!!

Wednesday, December 26, 2007

A heart attack at PRMC's Emergency Room....8/9

I received this as an email which had the patient's name and a lot of additional information as to his identity. I suggested that he consider it carefully and he agreed to my removing overt identification. However, I'm sure that his friends and the hospital personnel know who he is and who they are.

On the morning of Aug 1, 2005, I awoke about 4am at home with severe chest pain. It was an intense pain I had never had before.

Heartburn is something I almost never have, but I got up and chewed a couple of Alka-mints. The pain did not go away and seemed to gain intensity, so I woke my partner, significant other or whatever you want to call him. We have been living together for over 33 years and we have lived in ____ 22 years. He is also an ex-EMT basic. He had me lie down and administered oxygen. This helped a little bit, but I still had chest pain and trouble breathing. We decided I needed to go to the ER in Paris.

He drove me there and we arrived at 5:46am. Once in the ER, I sat at a desk while a nurse took my name, address, etc. and finally I was laid down and hooked up to a monitor with my blood pressure all over the chart and pulse as low as 37. When my pulse dropped below 40, an alarm went off and no one came in. I had to tell the nurse that it had gone off. She just looked at me with a blank look on her face.

Over several hours, I was given an Xray, an ECG and had blood drawn. I was left unattended all of the time while they worked on a couple of more patients that they said were critical. I was there forty-nine minutes before I was given nitro several times with no let up of chest pain.

I was never given any aspirin or any other drug of any kind. I was never asked if I had a history of heartburn or upset stomach. Dr Hobbs came in only once for a very short visit. He never listened to my heart or lungs or asked any questions about my history. My partner was in the room with me when asked by nurse Debra Crews who he was. He replied that he was my significant other.

After that statement, the atmosphere seemed to change and I was left lying there with only occasional checks on the monitor. Thirty minutes after shift change at eight a.m., Dr. Rowe came and stood in the door. He said I had GERD and gave me a prescription for a prev-pak ($300). He said my sugar level was high at 146. I asked what should it be and he said "140". Then he sent me home.

All the time Dr. Rowe was in the room he didn't come near me. He never examined me or listened to my heart and lungs. He never asked me any questions or medical history. I went home and the chest pain mostly went away late that afternoon. This visit cost the VA over $2,500. I believed the doctor and thought I had GERD.

The rest of the week was spent in agony. My arms hurt, my legs hurt, I couldn't eat, my blood pressure stayed very low and averaged about 70/50 which is really not enough for kidneys to work properly. By Friday morning, August 5th when I went to Bonham to the VA clinic, my blood was toxic and my heart in really bad shape.

They did an EKG and sent me by ambulance to the Bonham hospital to stabilize me before I was sent to Wilson N. Jones Medical Center in Sherman to the emergency room to be sent to a heart cath lab. There I had one stent put in and angioplasty. They left some blockages because I was on the verge of kidney failure, and more dye would have probably shut down my kidneys. I was told by the renal specialist that I came very, very close to death. Fortunately, I have good kidneys and passed the toxins quickly.

I was released on August 7th. Two days stay at the hospital in Sherman cost the VA $140,000. Later the next week, I was charged over $43 for a copy of my medical records from Paris Regional Medical Center to give to my VA doctor. There were no strips from the monitor in the ER in these records or doctor notes.

When I picked up the records, I asked if I was getting a copy of everything in my medical records and was assured that I was. The ECG in these records clearly showed abnormal heart functions.

On August 20th, I had chest pain and it felt as if I had a heavy weight on my chest. I called the Dallas VA hospital and was told to call 911 or go to the nearest ER. I told them I would rather take my chances on the road to Dallas than to go to the ER in Paris again. I went to the ER at the Dallas VA hospital and was admitted and had another heart cath on Monday, August 22nd. They put in another stent and more angioplasty. I was released on the 23rd with medications for my heart and will do follow-up in the cardiology clinic there.

I believe I was denied medical care for the heart attack I was having when I came into the ER at Paris Regional Medical Center for several reasons. First, I did not have the blank check of Medicare or Medicaid. Second, the personnel at the ER seemed to have no training in treatment of chest pain (heart attack) patients which is simply an aspirin and nitro glycerin under the tongue immediately. Third, Dr. Hobbs and Dr. Lowe acted like they really didn't care about me at all and neither listened to my heart, lungs or asked any questions and seemed to have no training in ER procedures.

I truly believe that if my heart attack had been diagnosed properly at the ER at Paris Regional Medical Center, I would not have gone through so much pain and agony and damage to my heart would have been minimal. By not treating me at all, Paris Regional Medical Center has taken years from my life and is liable for all medical expenses, ambulance trips, medicine and all other expenses incurred by the Veterans Administration clinic and hospitals.
So this is the organization that wants to put in a specialty Heart Hospital? Is this the same place that put up the signs for 'The Chest Pain Center'...and then didn't bother to inform the ER, nor staff appropriately?

And the gay all Essent hospitals have a problem with that? Personnel need to park their personal beliefs at the door. A patient is a patient is a patient...and they need your care. If you can't provide that, you need to get out of the medical field.

Yes, patients can have their own beliefs--and we have to respect them. That's part of the job. That's part of your training. 'First: Do no harm.' That includes 'by omission', as well.

Tuesday, December 25, 2007

Christmas 2007....1/18

As in the words of Tiny Tim (A Christmas Carol):
"God bless us, every one!"

Merry Christmas.....frank

Friday, December 21, 2007

Interest Revived?....1/11

You wonder if Essent is back up on the block. Searches from several corporations that would seem directed towards that end. Even the Aussies appear back in play.

And, it would be a good thought: Buy low.

I have been thinking about the Essent finances. The first significant loss was with Crossroads. Their version of buy high and sell low. Now that happened prior to the blog, although I did mention in the postings around Nov.

Even before the blog got rolling, MVH had serious problems, and their gay rights lawsuit didn't help that a whole lot. I think the Lahey Clinic has positioned themselves well in any case.

Sharon Hospital just keeps on producing.

NVMC is keeping its head above water.

Southwest (odd how a corporation with a Texas presence names a hospital in PA "Southwest") has their own problems. The blog didn't seem to really catch on out there, but there are several loyal followers. They just needed a cash infusion for an update. Essent was part of the baggage.

Paris. Paris had its own problems. How Christus was bamboozled into buying Big Mac is beyond me. Maybe the bean counters really believed that two hospitals that were losing money combined would lose it half as fast rather than twice as fast????

The 'due diligence' conducted by Essent missed an awful lot, and Monty was burying as much as he could at that juncture. On paper, the facility looked good (doubling the corporate beds!)...and yes, there were savings areas that were obvious. But, the duplication of services, the number of properties, and the mind-set were essent-ially ignored. When they looked at it rationally, the building of a new facility at the North Campus might well be a fantasy--unless a non-competitive buyer (like the VA) could be found for the South, or a re-designated use (rehab, LTAC) that could stabilize costs could be found.

The cuts were to be expected. The problem is, few realized that. The community was used to a not-for-profit environment, that could deficit spend. The attitude was it doesn't matter what we lose, we'll still have jobs. Essent didn't dissuade that notion during the courtship, but then there is hammer time.

Possibly the way to have gone, was to have involved the community more. But they are in a fix. The heart hospital sounds good "on paper" (again), but the proximity of Dallas, with cheaper pricing and newer facilities, puts a hole in that. Advanced Heart has been directing patients that way for years.

What will play out? Who knows. The lawsuit that Essent is pursuing (you thought it was over????) has to show two things: One, my posts were false. Second, by circulating said falsehoods, enough credence was given that financial losses were incurred. They are hindered by a several things, history, common knowledge, and their own policies.

Monday, December 17, 2007

Another Does Case....12/29

There is another aspect to the lawsuit. Essent does want to know who contacted me with 'tips'. Another 'Doe' case was in the media and finalized last year. That was the Apple vs Does, based on another blog and its sources.

May 26th, 2006

Huge Win for Online
Journalists' Source Protection

EFF Arguments Secure Reporters' Privilege for Internet News Gatherers

San Jose - A California state appeals court ruled in favor of the Electronic Frontier Foundation's (EFF's) petition on behalf of three online journalists Friday, holding that the online journalists have the same right to protect the confidentiality of their sources as offline reporters do.

"Today's decision is a victory for the rights of journalists, whether online or offline, and for the public at large," said EFF Staff Attorney Kurt Opsahl, who argued the case before the appeals court last month. "The court has upheld the strong protections for the free flow of information to the press, and from the press to the public."

In their decision, the judges wrote: "We can think of no workable test or principle that would distinguish 'legitimate' from 'illegitimate' news. Any attempt by courts to draw such a distinction would imperil a fundamental purpose of the First Amendment, which is to identify the best, most important, and most valuable ideas not by any sociological or economic formula, rule of law, or process of government, but through the rough and tumble competition of the memetic marketplace."

The case began when Apple Computer sued several unnamed individuals, called "Does," who allegedly leaked information about an upcoming product to online news sites PowerPage and AppleInsider. As part of its investigation, Apple subpoenaed Nfox -- PowerPage's email service provider -- for communications and unpublished materials obtained by PowerPage publisher Jason O'Grady. A trial court upheld the subpoena.

But Friday, the court said that O'Grady is protected by California's reporter's shield law, as well as the constitutional privilege against disclosure of confidential sources. The court also agreed with EFF that Apple's subpoena to email service provider Nfox was unenforceable because it violated the federal Stored Communications Act, which requires direct subpoenas of account holders.

"In addition to being a free speech victory for every citizen reporter who uses the Internet to distribute news, today's decision is a profound electronic privacy victory for everyone who uses email," said EFF Staff Attorney Kevin Bankston. "The court correctly found that under federal law, civil litigants can't subpoena your stored email from your service provider."

EFF worked with co-counsel Thomas Moore III and Richard Wiebe in this case.

For the full decision in the case.

For more on Apple v. Does:

While this is a California case, if you will note, the our appeals court utilized the Cahill decision in their call.

Friday, December 14, 2007

My Rights??....12/21

Had a comment tossed my way that set me a bit on edge:

That's all you have to say about the appeals court decision? How bout a shout-out and a way-to-go for the 6th court of appeals making a stand for your first amendment rights?

It isn't just my rights, it's everyone's. The court's decision was in line with what I had been saying, and the opinion was well within my comfort zone: That I had an expectation of privacy, that if sufficient proof was rendered, the privacy would be set aside, however, prior to that I would have a chance to refute the presented matters.

Maybe it is because I take it for granted that the opposite had me so riled. However, the ruling set things right and all's well with my personal corner of the judicial system.

Should Essent pursue the case? It's their right. But, with the legal commentary that I've received, and my lawyer's counsel, I really don't feel that the facts support an adverse judgment.

But that isn't Essent's goal. Their goal, through the whole matter, is disclosure of my identity and what recourse they might have outside the legal proceedings. Kind of who-are-you-and-how-can-we-make-your-life-miserable.

I'm criticized for bringing up Holly as an example, but she is a PRIME example of what Essent has done and is capable of. And, for merely being suspected of being me, several employees have been fired, or was that just used as a public excuse? IT functions have decreased with the centralized data management, so somewhat less experienced and knowledgeable staffing is required.

Contemplate this: What kind of a split can the Paris medical community sustain now? In their current state, what kind of fence-mending can Essent provide, or would they even try? Is this whole thing merely to cow possible dissidents?

So much for a corporate showplace.

Wednesday, December 12, 2007

Warming Up??....12/18

Well, Essent's boardroom is probably seeing a bit more reds in their color schemes, considering the ruling handed down on the appeal. For one of the more confusing documents (not that I disagree, of course), follow the link. The ruling isn't confusing (pretty much what I indicated, a Cahill based decision), the formatting is. Don't know what the problem with my browser is.

While there's not singing yet, she's warming up in the wings.

Monday, December 10, 2007

Burning Rubber....12/12

For those who are wondering why the appeals court is taking their time, let's run through some statistics:

62% of cases are disposed of with in 6 months.
25% in 6-12
13% in 12-24
0% longer than 24.
Realize these are last year's statistics, but will probably hold. What complicates this case are the issues involved. A 'constitutional' issue, a somewhat obtuse decision, and statutes that support neither.

So while we're spinning our wheels, they are turning and just need a little traction. What might render the case moot is if it outlasts Essent, and it would seem that that might be the case. Some in corporate are wondering if it will last a year.

Saturday, December 08, 2007

Ever Wonder??....12/13

Do we wonder about the Essent Board of Directors? Who they are, what other companies they're involved with? It does become interesting. I was perusing the Business Week description of the Essent corporate structure (which is way out of date) and found the board members.

David Mayer -Jazz Pharmaceuticals
Ron Wolford -ForHealth Technologies
James Elrod Jr. -Vestar Capital
Bryan Cressey -Thoma Cressey
Steven Silver -GoldToeMoretz
Jeff Goldsmith -Cerner
Bryan Marsal -GoldToeMoretz

One tidbit noticed about Cerner--The CEO and the Board vice-Chairman have sold a net of 55,000 shares within the last three months. How much confidence do they have?

As for Essent--Connery has decided not to pursue the lawsuit against Essent for an early release of the money for his shares.

Friday, December 07, 2007

Who's Resumes are in Play?....12/9

You have to wonder...since Essent was Hud's baby, how many executives with the company had personal commitments from Hud, promises if you will, that were keeping them in place? Is Essent due for an outflow of 'talent'?

While Essent is shopping for a new CEO, they might peruse the other aisles as well.

Buying companies is like buying stocks: Some people buy on momentum, some buy when they figure a stock is at its lowest point. There was consideration a while back--when Essent was in its game. Now, however: How low can you go???

Monday, December 03, 2007

Pakistan Repercussions?....12/17

With all the turmoil in Pakistan, the question becomes: How will this affect local healthcare if the political climate changes for the worse? We have several Pakistani physicians in our community, prime example is Doctor Hashmi.

The New England Journal of Medicine indicates: "Pakistan has contributed approximately 10,000 international medical graduates (IMGs) to the United States...." Only 300 have returned to the medically underserved country. Should there be changes in the relationship between the US and Pakistan, how will that affect those physicians currently in the country on resident alien or dual citizenship status? With those with a large portion of their wealth, or the majority of their family in Pakistan.

The new heart hospital, comes to mind. Speculation is all anyone can do without the facts, but that's probably what Essent is having to do as well. Assurances can only be based on the current situation, rather than a future one.

I would imagine that there will be no great changes, but one can never tell....