UPDATE: Defendant Dennis Laurion wins Internet defamation case in Minnesota Supreme Court.
David McKee v. Dennis Laurion
"When a doctor hires a private detective to find out which one of the 4,400 nurses in St. Louis County, MN may have called him a “tool” you know the man is serious about defending his reputation. That is just what Dr. David McKee of Northland Neurology and Myology is doing in preparation for the next leg of his defamation lawsuit against the son of a former patient, Dennis Laurion.
"When neurologist Dr. David McKee treated World War II veteran Kenneth Laurion his reportedly insensitive remarks and dreadful bedside manner had the vet’s son, Dennis Laurion, up in arms. The younger Laurion took his wrath to the web and posted unfavorable reviews about Dr. McKee on several rate-your-physician websites. Dennis Laurion contended that Dr. McKee failed to treat the elder Laurion with concern and respect.
According to Laurion, Dr. McKee “seemed upset” that Kenneth McKee was moved to a ward after a stint in the intensive care unit and said to his patient, “When you weren’t in ICU, I had to spend time finding out if you transferred or died.”
Laurion also reported that the doctor dismissed the stroke patient’s need for therapy before pulling Kenneth Laurion up to his feet and forcing him to walk without any regard for whether the patient’s hospital gown was tied at the back. Dennis Laurion even went so far as to write that when he “mentioned Dr. McKee’s name to a friend who is a nurse, she said, ‘Dr. McKee is a real tool!’”
"Angered by Laurion’s Internet critique, Dr. McKee filed a defamation suit against Dennis Laurion for $50,000. In his case Dr. McKee alleged that after treating Kenneth Laurion for his stroke, Dennis Laurion made “false and malicious statements” about the doctor to “nineteen different professional and medical organizations, regulatory agencies, and websites.”
"Upon hearing the case, Sixth Judicial District Judge Eric Hylden dismissed Dr. McKee’s lawsuit because he found Dennis Laurion’s comments to be a matter of opinion and thereby protected by the First Amendment. But in January of 2012 the Minnesota Court of Appeals reversed Judge Hylden’s decision and ruled that a jury should evaluate that certain statements made by Dennis Laurion for their truthfulness and defamatory potential and returned the case to the lower court for further consideration.
"McKee v. Laurion is now scheduled to go to trail in January of 2013. But the Laurions are not backing down. They are already busy filing petitions with the Minnesota Supreme Court. The Laurions contend that the Minnesota Court of Appeals made an error in their determination that Dennis Laurion made false statements about his father’s allegedly “not-so-nice” neurologist. It appears that the only evidence the appeals court had to support their decision was Dr. McKee’s assertion that Dennis Laurion lied. And when you consider that a stroke sufferer will be dragged into court to give testimony on this issue just after his 88th birthday, it seems that Dr. McKee’s private investigator might have an easy time finding that nurse."
---DefamationLaw.net
Doctor's suit tests limits of online criticism
McClatchy Tribune News Service
March 30, 2012
MINNEAPOLIS — Two years ago, Dennis Laurion logged on to a rate-your-doctor website to vent about a Duluth neurologist, Dr. David McKee.
McKee had examined Laurion's father, Kenneth, when he was hospitalized after a stroke. The family, Laurion wrote, wasn't happy with his bedside manner. "When I mentioned Dr. McKee's name to a friend who is a nurse, she said, 'Dr. McKee is a real tool!' " he wrote.
McKee wasn't amused. He sued Laurion for defamation, and now the case is pending before the Minnesota Supreme Court.
McKee, 50, is one of a small number of doctors who have gone to court to fight online critics, in cases that are testing the limits of free speech on the Internet. "Doctors are not used to public criticism," said Eric Goldman, an associate professor at the Santa Clara University School of Law in California, who tracks such lawsuits. "So it's a new phenomenon for them."
While such cases are rare, Goldman said, they've been popping up around the country as patient review sites such as vitals.com and rateyourdoctor.com have flourished. Defamation suits are "kind of the nuclear option," Goldman said. "It's the thing that you go to when everything else has failed."
McKee's lawyer, Marshall Tanick, said the doctor felt he had no choice but to sue to protect his reputation and his medical practice.
"It's like removing graffiti from a wall," Tanick said. He said Laurion distorted the facts — not only on the Internet, but in more than a dozen complaint letters to various medical groups. "He put words in the doctor's mouth," making McKee "sound uncaring, unsympathetic or just stupid."
[Maura Larkins comment: Wait a minute. Dr. McKee is complaining that someone filed a complaint about a doctor??? Patients are just supposed to silently accept whatever a doctor dishes out?]
McKee calls Laurion "a liar and a bully," and says he has spent more than $7,000 to "scrub" the Internet of more than 100 vitriolic comments, many traced to a single computer (IP address) in Duluth.
"Somebody who holds a grudge against you can very maliciously go on the Internet, post anything they want, and ... basically redefine who you are," he said.
Laurion, 65, a retired Coast Guard chief petty officer, says he deleted the Internet comments shortly after the lawsuit was filed and "never rewrote them."
At the same time, his lawyer, John D. Kelly, defends the postings. He says it was Laurion's perception that "the doctor's speech and conduct were tactless and inconsiderate." And that, he argued, is "constitutionally protected."
So far, Minnesota courts have had mixed reactions. A district court in Duluth dismissed McKee's lawsuit last year, but the state Appeals Court reinstated it in January. Laurion has appealed to the Minnesota Supreme Court.
The dispute isn't about McKee's medical decisions, but about something less tangible: his body language and comments when he walked into Kenneth Laurion's room at St. Luke's Hospital in Duluth on April 20, 2010.
In his online postings, Dennis Laurion wrote that McKee "seemed upset" because he thought his father, then 84, was still in intensive care.
"Never having met my father or his family, Dr. McKee said, 'When you weren't in the ICU, I had to spend time finding out if you transferred or died,' " according to Laurion's account. "When we gaped at him, he said, 'Well, 44 percent of hemorrhagic strokes die within 30 days. I guess this is the better option.' "
Laurion, who was visiting with his wife and mother, wrote that McKee was brusque and dismissive during the exam, especially when his father raised concerns that his hospital gown was hanging open at the back. "Dr. McKee said, 'That doesn't matter,' " according to Laurion's account. "My wife said, 'It matters to us,' " and they left the room.
McKee discovered the online comments when a patient brought them to his attention. He filed suit, seeking more than $50,000 in damages. "The way he quoted me was completely inaccurate," McKee said in an interview. At the time, he said, nobody in the room "appeared to me to be the slightest bit upset."
[Maura Larkins comment: Figure it out, Dr. McKee. Their husband and father was in your care. They couldn't afford to make you angry. You were in a position of power.]
According to court documents, McKee admitted making a "jocular comment" about only two ways to leave the intensive care unit, but said he only meant that he was relieved to find Laurion in his hospital bed. He denied citing any statistic about stroke deaths and said the entire story was distorted beyond recognition.
"Every physician gets an occasional complaint from a patient, or even a patient's family member, but this was so ridiculous," he said. "This just seemed so extremely over the top, and really meant to be harmful."
In the first legal battle, district Judge Eric Hylden in Duluth sided with Laurion. "The statements in this case appear to be nothing more or less than one man's description of shock at the way he and in particular his father were treated by a physician," he wrote in dismissing the suit in April 2011.
The appeals court disagreed, ruling in January that some of the statements were fair game for a defamation suit and sending the dispute back for trial.
Tanick, McKee's lawyer, said the case isn't just about someone voicing an opinion. He said Laurion defamed the doctor by accusing him of things "that never happened."
Laurion's lawyer, however, says it's a matter of perception. "Something happened in that room that disturbed the four members of the family significantly," he said.
More than a dozen defamation suits have been filed since 2004 by doctors or dentists over online reviews; most have been dismissed or settled, according to Goldman.
Some medical practices have even tried to silence critics by requiring patients to sign a form forbidding them from posting comments on the Internet.
But Dr. Jeffrey Segal, a North Carolina neurosurgeon who promoted the controversial forms, says he's since had a change of heart; he "retired" them last year in the face of widespread criticism...
Here's a similar case from California.
Monday, August 27, 2012
Friday, August 24, 2012
California labor board files complaint against SEIU in Fresno election for voter intimidation
See all posts re SEIU.
Judge rules against SEIU in California fight
By Alec MacGillis
Washington Post
July 21, 2011
A judge ruled this week that the Service Employees International Union improperly coerced workers caught in the middle of SEIU’s high-stakes turf battle with a breakaway union in California, potentially invalidating a 2010 election involving 43,500 employees.
SEIU, the nation’s most politically influential union, has been engaged in a costly fight with the former leaders of a 150,000-worker California chapter that formed a breakaway union in 2009. The split followed clashes with then-SEIU President Andy Stern over his emphasis on growing membership even if it meant giving concessions to employers.
Last fall, SEIU won the biggest standoff, an election to represent 43,500 Kaiser Permanente workers in Northern California.
The vote was a big setback for the breakaway union, the National Union of Healthcare Workers, leaving it with fewer than 10,000 members.
But this week, Administrative Law Judge Lana Parke ruled that Kaiser had improperly withheld pay raises from workers in Southern California who had switched to the new union and that SEIU had then improperly threatened the workers voting in the Northern California election that they, too, could have raises denied if they made the switch. It is now up to the National Labor Relations Board to decide whether to call a second election, as the judge recommends.
Leaders of the breakaway union noted that the ruling came at the same time as SEIU and other unions are arguing in favor of new rules proposed by the labor relations board to reduce employer coercion against workers before union elections.
“SEIU has been promoting itself an as advocate for labor law reform and workers, and against coercion and intimidation, but no institution has done more to coerce and thwart workers about which union they want to join,” said John Borsos, vice president of the breakaway union...
California labor board files complaint against SEIU in Fresno election for voter intimidation
NUHW.org
AUGUST 22, 2012
The California Public Employment Relations Board has filed an official complaint against SEIU-UHW West for its conduct in the 2009 Fresno homecare election.
Citing SEIU’s “physical and verbal threats,” “menacing and abusive behavior,” “unlawful destruction and removal” of property and a campaign of lies intended to mislead 10,000 Fresno homecare workers into voting to stay in SEIU, the board has affirmed the serious charges brought by homecare workers against SEIU.
NUHW President Sal Rosselli spoke out in support of the board’s decision,
“Today’s complaint validates entirely what Fresno homecare workers have said about what they experienced from SEIU. Threats, destruction of property, mail tampering, abusive behavior and violations of workers’ rights, all waged in a deliberate campaign of intimidation by SEIU following the direct instructions of Dave Regan, an ethically bankrupt leader who sits atop SEIU-UHW and serves on the SEIU International Executive Board to this day.”
Judge rules against SEIU in California fight
By Alec MacGillis
Washington Post
July 21, 2011
A judge ruled this week that the Service Employees International Union improperly coerced workers caught in the middle of SEIU’s high-stakes turf battle with a breakaway union in California, potentially invalidating a 2010 election involving 43,500 employees.
SEIU, the nation’s most politically influential union, has been engaged in a costly fight with the former leaders of a 150,000-worker California chapter that formed a breakaway union in 2009. The split followed clashes with then-SEIU President Andy Stern over his emphasis on growing membership even if it meant giving concessions to employers.
Last fall, SEIU won the biggest standoff, an election to represent 43,500 Kaiser Permanente workers in Northern California.
The vote was a big setback for the breakaway union, the National Union of Healthcare Workers, leaving it with fewer than 10,000 members.
But this week, Administrative Law Judge Lana Parke ruled that Kaiser had improperly withheld pay raises from workers in Southern California who had switched to the new union and that SEIU had then improperly threatened the workers voting in the Northern California election that they, too, could have raises denied if they made the switch. It is now up to the National Labor Relations Board to decide whether to call a second election, as the judge recommends.
Leaders of the breakaway union noted that the ruling came at the same time as SEIU and other unions are arguing in favor of new rules proposed by the labor relations board to reduce employer coercion against workers before union elections.
“SEIU has been promoting itself an as advocate for labor law reform and workers, and against coercion and intimidation, but no institution has done more to coerce and thwart workers about which union they want to join,” said John Borsos, vice president of the breakaway union...
California labor board files complaint against SEIU in Fresno election for voter intimidation
NUHW.org
AUGUST 22, 2012
The California Public Employment Relations Board has filed an official complaint against SEIU-UHW West for its conduct in the 2009 Fresno homecare election.
Citing SEIU’s “physical and verbal threats,” “menacing and abusive behavior,” “unlawful destruction and removal” of property and a campaign of lies intended to mislead 10,000 Fresno homecare workers into voting to stay in SEIU, the board has affirmed the serious charges brought by homecare workers against SEIU.
NUHW President Sal Rosselli spoke out in support of the board’s decision,
“Today’s complaint validates entirely what Fresno homecare workers have said about what they experienced from SEIU. Threats, destruction of property, mail tampering, abusive behavior and violations of workers’ rights, all waged in a deliberate campaign of intimidation by SEIU following the direct instructions of Dave Regan, an ethically bankrupt leader who sits atop SEIU-UHW and serves on the SEIU International Executive Board to this day.”
Monday, August 20, 2012
Almost Half of Doctors Burned Out by Rising Workload
Almost Half of Doctors Burned Out by Rising Workload
By Shannon Pettypiece
Bloomberg Businessweek
August 20, 2012
About 1 in 2 doctors are burned out, showing signs of emotional exhaustion and little interest in work as patient loads increase, U.S. researchers found.
Doctors working in emergency, family and internal medicine were the most likely to feel drained, according to the study released today in the Archives of Internal Medicine. Researchers said burnout also was tied to long hours, with 37 percent of physicians working more than 60 hours a week.
The number of doctors reporting feeling burned out is surprising and troubling, said Tait Shanafelt, a professor of medicine at the Mayo Clinic and lead study author. He said the trend may cause physicians to quit or reduce their workload just as demand for doctors is increasing with the aging population. The issue may get worse as 32 million Americans are expected to get health insurance by 2014 under a new U.S. law, increasing the number of people seeking medical care, he said.
“Right at a time when we are trying to provide care to people who are uninsured and projecting workforce shortages we are seeing this burnout rate creep in, which may cause physicians to reduce workloads and consider early retirement,” Shanafelt said.
He added that burnout has also been linked to medical errors and worse patient care in previous studies.
The study found that 46 percent of doctors show at least one sign of being worn out. Shanafelt said the burnout was about 10 percent higher than in the population as a whole. Unlike with other professions, more education isn’t linked to a lower risk of feeling drained among doctors, the study found.
Across Specialties
Researchers collected responses from 7,288 doctors across all practice areas to measure levels of emotional exhaustion, depersonalization and sense of professional accomplishment. The data was compared with surveys of the general population.
There was no increased rate of depression or suicide among doctors compared with the general population, a sign that the burnout is specific to the work environment, Shanafelt said. He said more research is needed to determine proper treatment.
Doctors have been increasing the number of patients they see to make up for reduced reimbursement from health insurers and the government, Shanafelt said. Physicians in private practice are also dealing with more bureaucracy, such as a push by the government to implement electronic medical records.
“If this were only 5 percent, we could say that these are just people who don’t manage their stress well or need additional training,” Shanafelt said. “But with almost one out of every two physicians, we have to say there must be something about their environment contributing to this.”
By Shannon Pettypiece
Bloomberg Businessweek
August 20, 2012
About 1 in 2 doctors are burned out, showing signs of emotional exhaustion and little interest in work as patient loads increase, U.S. researchers found.
Doctors working in emergency, family and internal medicine were the most likely to feel drained, according to the study released today in the Archives of Internal Medicine. Researchers said burnout also was tied to long hours, with 37 percent of physicians working more than 60 hours a week.
The number of doctors reporting feeling burned out is surprising and troubling, said Tait Shanafelt, a professor of medicine at the Mayo Clinic and lead study author. He said the trend may cause physicians to quit or reduce their workload just as demand for doctors is increasing with the aging population. The issue may get worse as 32 million Americans are expected to get health insurance by 2014 under a new U.S. law, increasing the number of people seeking medical care, he said.
“Right at a time when we are trying to provide care to people who are uninsured and projecting workforce shortages we are seeing this burnout rate creep in, which may cause physicians to reduce workloads and consider early retirement,” Shanafelt said.
He added that burnout has also been linked to medical errors and worse patient care in previous studies.
The study found that 46 percent of doctors show at least one sign of being worn out. Shanafelt said the burnout was about 10 percent higher than in the population as a whole. Unlike with other professions, more education isn’t linked to a lower risk of feeling drained among doctors, the study found.
Across Specialties
Researchers collected responses from 7,288 doctors across all practice areas to measure levels of emotional exhaustion, depersonalization and sense of professional accomplishment. The data was compared with surveys of the general population.
There was no increased rate of depression or suicide among doctors compared with the general population, a sign that the burnout is specific to the work environment, Shanafelt said. He said more research is needed to determine proper treatment.
Doctors have been increasing the number of patients they see to make up for reduced reimbursement from health insurers and the government, Shanafelt said. Physicians in private practice are also dealing with more bureaucracy, such as a push by the government to implement electronic medical records.
“If this were only 5 percent, we could say that these are just people who don’t manage their stress well or need additional training,” Shanafelt said. “But with almost one out of every two physicians, we have to say there must be something about their environment contributing to this.”
Sunday, August 12, 2012
Did the FDA go rogue to protect X-ray equipment sales? FDA created enemies list and spied on scientists
In Vast Effort, F.D.A. Spied on E-Mails of Its Own Scientists
By ERIC LICHTBLAU and SCOTT SHANE
July 14, 2012
A wide-ranging surveillance operation by the Food and Drug Administration against a group of its own scientists used an enemies list of sorts as it secretly captured thousands of e-mails that the disgruntled scientists sent privately to members of Congress, lawyers, labor officials, journalists and even President Obama, previously undisclosed records show.
A list names three of the 21 people said to be collaborating in criticism of the F.D.A., including employees and outside contacts.
A memo reports that monitoring software had been placed on the laptop of an agency medical officer.
What began as a narrow investigation into the possible leaking of confidential agency information by five scientists quickly grew in mid-2010 into a much broader campaign to counter outside critics of the agency’s medical review process, according to the cache of more than 80,000 pages of computer documents generated by the surveillance effort.
Moving to quell what one memorandum called the “collaboration” of the F.D.A.’s opponents, the surveillance operation identified 21 agency employees, Congressional officials, outside medical researchers and journalists thought to be working together to put out negative and “defamatory” information about the agency.
F.D.A. officials defended the surveillance operation, saying that the computer monitoring was limited to the five scientists suspected of leaking confidential information about the safety and design of medical devices.
While they acknowledged that the surveillance tracked the communications that the scientists had with Congressional officials, journalists and others, they said it was never intended to impede those communications, but only to determine whether information was being improperly shared.
The agency, using so-called spy software designed to help employers monitor workers, captured screen images from the government laptops of the five scientists as they were being used at work or at home. The software tracked their keystrokes, intercepted their personal e-mails, copied the documents on their personal thumb drives and even followed their messages line by line as they were being drafted, the documents show.
The extraordinary surveillance effort grew out of a bitter dispute lasting years between the scientists and their bosses at the F.D.A. over the scientists’ claims that faulty review procedures at the agency had led to the approval of medical imaging devices for mammograms and colonoscopies that exposed patients to dangerous levels of radiation.
By ERIC LICHTBLAU and SCOTT SHANE
July 14, 2012
A wide-ranging surveillance operation by the Food and Drug Administration against a group of its own scientists used an enemies list of sorts as it secretly captured thousands of e-mails that the disgruntled scientists sent privately to members of Congress, lawyers, labor officials, journalists and even President Obama, previously undisclosed records show.
A list names three of the 21 people said to be collaborating in criticism of the F.D.A., including employees and outside contacts.
A memo reports that monitoring software had been placed on the laptop of an agency medical officer.
What began as a narrow investigation into the possible leaking of confidential agency information by five scientists quickly grew in mid-2010 into a much broader campaign to counter outside critics of the agency’s medical review process, according to the cache of more than 80,000 pages of computer documents generated by the surveillance effort.
Moving to quell what one memorandum called the “collaboration” of the F.D.A.’s opponents, the surveillance operation identified 21 agency employees, Congressional officials, outside medical researchers and journalists thought to be working together to put out negative and “defamatory” information about the agency.
F.D.A. officials defended the surveillance operation, saying that the computer monitoring was limited to the five scientists suspected of leaking confidential information about the safety and design of medical devices.
While they acknowledged that the surveillance tracked the communications that the scientists had with Congressional officials, journalists and others, they said it was never intended to impede those communications, but only to determine whether information was being improperly shared.
The agency, using so-called spy software designed to help employers monitor workers, captured screen images from the government laptops of the five scientists as they were being used at work or at home. The software tracked their keystrokes, intercepted their personal e-mails, copied the documents on their personal thumb drives and even followed their messages line by line as they were being drafted, the documents show.
The extraordinary surveillance effort grew out of a bitter dispute lasting years between the scientists and their bosses at the F.D.A. over the scientists’ claims that faulty review procedures at the agency had led to the approval of medical imaging devices for mammograms and colonoscopies that exposed patients to dangerous levels of radiation.
Needless tragedy of boy, 12, who died just three days after doctors missed raging infection
Needless tragedy of boy, 12, who died just three days after doctors missed raging infection from cut to arm he got playing basketball
By DAILY MAIL REPORTER
12 July 2012
A 12-year-old boy died three days after cutting his arm playing basketball because doctors failed to spot deadly bacteria ravaging his body and sent him home with painkillers, his parents claim.
Rory Staunton, from Queens, New York, suffered a soaring temperature, vomiting and excruciating pain in his leg just hours after falling over and grazing his arm at school in April.
Although septic shock is a leading cause of death in hospitals and campaigns were underway to raise awareness of the horrific illness, physicians did not recognise Rory had the condition.
Rory's parents took the boy to their family doctor, Dr Susan Levitzky, who did not express concern at his high temperature, leg pain, vomiting or blotchy skin, but said it was best to visit a nearby hospital.
At the emergency room at NYU Langone Medical Center, doctors said he was suffering a stomach upset and dehydration. Dr Camille Scribner gave him fluids and sent him home with Tylenol.
Just three days later, he died in intensive care. Hospital records note the cause as severe septic shock brought on by the infection.
Doctors now believe he was gripped by an infection after a bacteria, streptococcus pyogenes, got through his cut.
The bacteria dwells naturally in the skin, but if it gets into the blood, it can move extremely quickly and the likelihood of stopping it are low. It is often hard to detect in the early stages.
DEADLY ILLNESS: STREPTOCOCCUS PYOGENES AND SEPTIC SHOCK
Rory was killed by septic shock after a bacteria named streptococcus pyogenes got through the cut on his arm and into his blood.
The bacteria lives naturally in the skin and the throat - areas of the body that have good defenses. It is the cause of strep throat and impetigo, but when it gets into the blood or soft tissue and is not treated, it can be deadly.
Rory's body went into sepsis - when the body's blood pressure drops in a response to spreading bacteria. Fast breathing, like Rory's, is an early sign of sepsis.
If it is not caught, it can result in shock, where the vital organs fail to function properly due to poor blood flow.
Sufferers will be admitted to the ICU and given large quantities of fluids and antibiotics intravenously.
Of the severest cases - around 650,000 a year - there is a 25 per cent chance of death. After blood pressure is noted as low, the chance of survival decreases by 7.6 per cent an hour.
Rory's parents said they were never told about blood tests indicating he was producing a startling number of white blood cells, which would suggest the bacterial infection.
'Nobody said anything that night,' his mother told the paper. 'None of you followed up the next day on that kid, and he's at home, dying on the couch?'...
By DAILY MAIL REPORTER
12 July 2012
A 12-year-old boy died three days after cutting his arm playing basketball because doctors failed to spot deadly bacteria ravaging his body and sent him home with painkillers, his parents claim.
Rory Staunton, from Queens, New York, suffered a soaring temperature, vomiting and excruciating pain in his leg just hours after falling over and grazing his arm at school in April.
Although septic shock is a leading cause of death in hospitals and campaigns were underway to raise awareness of the horrific illness, physicians did not recognise Rory had the condition.
Rory's parents took the boy to their family doctor, Dr Susan Levitzky, who did not express concern at his high temperature, leg pain, vomiting or blotchy skin, but said it was best to visit a nearby hospital.
At the emergency room at NYU Langone Medical Center, doctors said he was suffering a stomach upset and dehydration. Dr Camille Scribner gave him fluids and sent him home with Tylenol.
Just three days later, he died in intensive care. Hospital records note the cause as severe septic shock brought on by the infection.
Doctors now believe he was gripped by an infection after a bacteria, streptococcus pyogenes, got through his cut.
The bacteria dwells naturally in the skin, but if it gets into the blood, it can move extremely quickly and the likelihood of stopping it are low. It is often hard to detect in the early stages.
DEADLY ILLNESS: STREPTOCOCCUS PYOGENES AND SEPTIC SHOCK
Rory was killed by septic shock after a bacteria named streptococcus pyogenes got through the cut on his arm and into his blood.
The bacteria lives naturally in the skin and the throat - areas of the body that have good defenses. It is the cause of strep throat and impetigo, but when it gets into the blood or soft tissue and is not treated, it can be deadly.
Rory's body went into sepsis - when the body's blood pressure drops in a response to spreading bacteria. Fast breathing, like Rory's, is an early sign of sepsis.
If it is not caught, it can result in shock, where the vital organs fail to function properly due to poor blood flow.
Sufferers will be admitted to the ICU and given large quantities of fluids and antibiotics intravenously.
Of the severest cases - around 650,000 a year - there is a 25 per cent chance of death. After blood pressure is noted as low, the chance of survival decreases by 7.6 per cent an hour.
Rory's parents said they were never told about blood tests indicating he was producing a startling number of white blood cells, which would suggest the bacterial infection.
'Nobody said anything that night,' his mother told the paper. 'None of you followed up the next day on that kid, and he's at home, dying on the couch?'...
This San Diego doctor accepts checks from drug company representatives
I had an interesting experience on July 24, 2012 when I drove a friend to the doctor.
The receptionist said the doctor doesn't accept checks, so my friend paid with a credit card.
Then I saw one of those drug company representatives walk through the door. If you don't know what I mean, then you might have a particularly ethical doctor. The representatives are young and good-looking. This one was a man in a suit with the posture as straight as a marine's. He strode in pulling his black case on wheels, and was immediately ushered inside.
In my experience, the representatives are more often very attractive young women.
As I was leaving, I noticed a check lying on the receptionist's desk. I saw it was for $30.00. Apparently the doctor does accept checks--from drug representatives. I assume he was being paid to listen to the agent.
The receptionist saw me looking at the check, and she grabbed it quickly, then she couldn't seem to think of any good place to hide it, so she set it back down.
Years ago I had a neighbor who was prescribed an off-label drug (meaning used for a condition for which it was not approved by the FDA) she didn't need. That doctor's office was crawling with representatives almost all the time. Both the drug company and the doctor got in trouble with the law.
I wonder if my friend's doctor will prescribe unnecessary drugs after his discussion with the drug company agent.
The receptionist said the doctor doesn't accept checks, so my friend paid with a credit card.
Then I saw one of those drug company representatives walk through the door. If you don't know what I mean, then you might have a particularly ethical doctor. The representatives are young and good-looking. This one was a man in a suit with the posture as straight as a marine's. He strode in pulling his black case on wheels, and was immediately ushered inside.
In my experience, the representatives are more often very attractive young women.
As I was leaving, I noticed a check lying on the receptionist's desk. I saw it was for $30.00. Apparently the doctor does accept checks--from drug representatives. I assume he was being paid to listen to the agent.
The receptionist saw me looking at the check, and she grabbed it quickly, then she couldn't seem to think of any good place to hide it, so she set it back down.
Years ago I had a neighbor who was prescribed an off-label drug (meaning used for a condition for which it was not approved by the FDA) she didn't need. That doctor's office was crawling with representatives almost all the time. Both the drug company and the doctor got in trouble with the law.
I wonder if my friend's doctor will prescribe unnecessary drugs after his discussion with the drug company agent.
Inquiry into the spectacularly profitable HCA Hospital Chain cites unnecessary cardiac work
Hospital Chain Inquiry Cited Unnecessary Cardiac Work
By REED ABELSON and JULIE CRESWELL
New York Times
August 6, 2012
GRAPHIC: HCA’s Growing Profit
In the summer of 2010, a troubling letter reached the chief ethics officer of the hospital giant HCA, written by a former nurse at one of the company’s hospitals in Florida.
In a follow-up interview, the nurse said a doctor at the Lawnwood Regional Medical Center, in the small coastal city of Fort Pierce, had been performing heart procedures on patients who did not need them, putting their lives at risk.
“It bothered me,” the nurse, C. T. Tomlinson, said in a telephone interview. “I’m a registered nurse. I care about my patients.”
In less than two months, an internal investigation by HCA concluded the nurse was right.
“The allegations related to unnecessary procedures being performed in the cath lab are substantiated,” according to a confidential memo written by a company ethics officer, Stephen Johnson, and reviewed by The New York Times.
Mr. Tomlinson’s contract was not renewed, a move that Mr. Johnson said in the memo was in retaliation for his complaints.
But the nurse’s complaint was far from the only evidence that unnecessary — even dangerous — procedures were taking place at some HCA hospitals, driving up costs and increasing profits.
HCA, the largest for-profit hospital chain in the United States with 163 facilities, had uncovered evidence as far back as 2002 and as recently as late 2010 showing that some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures they were performing. Those hospitals included the Cedars Medical Center in Miami, which the company no longer owns, and the Regional Medical Center Bayonet Point. In some cases, the doctors made misleading statements in medical records that made it appear the procedures were necessary, according to internal reports.
Questions about the necessity of medical procedures — especially in the realm of cardiology — are not uncommon. None of the internal documents reviewed calculate just how many such procedures there were or how many patients might have died or been injured as a result. But the documents suggest that the problems at HCA went beyond a rogue doctor or two.
At Lawnwood, where an invasive diagnostic test known as a cardiac catheterization is performed, about half the procedures, or 1,200, were determined to have been done on patients without significant heart disease, according to a confidential 2010 review. HCA countered recently with a different analysis, saying the percentage of patients without disease was much lower and in keeping with national averages.
At Bayonet Point, a 44-year-old man who arrived at the emergency room complaining of chest pain suffered a punctured blood vessel and a near-fatal irregular heartbeat after a doctor performed a procedure that an outside expert later suggested might have been unnecessary, documents show. The man had to be revived. “They shocked him twice and got him back,” according to the testimony of Dr. Aaron Kugelmass in a medical hearing on the case.
In another incident, an outside expert described how a woman with no significant heart disease went into cardiac arrest after a vessel was cut when a Bayonet Point cardiologist inserted a stent, a meshlike device that opens coronary arteries. She remained hospitalized for several days, according to a person who has reviewed internal reports...
In a recent statement, HCA declined to provide evidence that it had alerted Medicare, state Medicaid or private insurers of its findings, or reimbursed them for any of the procedures that the company later deemed unnecessary, as required by law...
Some doctors accused in the reviews of performing unnecessary procedures are still practicing at HCA hospitals...
A Giant Hospital Chain Is Blazing a Profit Trail
By JULIE CRESWELL and REED ABELSON
August 14, 2012
During the Great Recession, when many hospitals across the country were nearly brought to their knees by growing numbers of uninsured patients, one hospital system not only survived — it thrived.
In fact, profits at the health care industry giant HCA, which controls 163 hospitals from New Hampshire to California, have soared, far outpacing those of most of its competitors.
The big winners have been three private equity firms — including Bain Capital, co-founded by Mitt Romney, the Republican presidential candidate — that bought HCA in late 2006.
HCA’s robust profit growth has raised the value of the firms’ holdings to nearly three and a half times their initial investment in the $33 billion deal.
The financial performance has been so impressive that HCA has become a model for the industry. Its success inspired 35 buyouts of hospitals or chains of facilities in the last two and a half years by private equity firms eager to repeat that windfall.
HCA’s emergence as a powerful leader in the hospital industry is all the more remarkable because only a decade ago the company was badly shaken by a wide-ranging Medicare fraud investigation that it eventually settled for more than $1.7 billion.
Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the cost of its medical staff, a move that sometimes led to conflicts with doctors and nurses over concerns about patient care.
In late 2008, for instance, HCA changed the billing codes it assigned to sick and injured patients who came into the emergency rooms. Almost overnight, the numbers of patients who HCA said needed more care, which would be paid for at significantly higher levels by Medicare, surged.
HCA, which had lagged the industry for those high-paying categories, jumped ahead of its competitors and was reimbursed accordingly. The change, which HCA’s executives said better reflected the service being provided, increased operating earnings by nearly $100 million in the first quarter of 2009.
To some, HCA successfully pushed the envelope in its interpretation of existing Medicare rules. “If HCA can do it, why can’t we?” asked a hospital consulting firm, the Advisory Board Company, in a presentation to its clients.
In one instance, HCA executives said a private insurer, which it declined to name, questioned the new billing system, forcing it to return some of the money it had collected.
The hospital giant also adopted a policy meant to address an issue that bedevils hospitals nationwide — reducing costs and overcrowding in its emergency rooms. For years, the hospital emergency room has been used by the uninsured as a de facto doctor’s office — a place for even the most minor of ailments. But emergency care is expensive and has become increasingly burdensome to hospitals in the last decade because of the rising number of uninsured patients.
HCA decided not to treat patients who came in with nonurgent conditions, like a cold or the flu or even a sprained wrist, unless those patients paid in advance. In a recent statement, HCA said that of the six million patients treated in its emergency rooms last year, 80,000, or about 1.3 percent, “ chose to seek alternative care options.”
“Many E.R.’s in America, particularly in densely populated urban areas where most HCA-affiliated facilities are located, have adopted a variety of systems to determine whether a patient in fact needs emergency care,” the statement said. “About half our hospitals have done so. Typically, our affiliated hospitals have two caregivers — usually a triage nurse and a physician — make that determination. It should be noted that other non-HCA affiliated hospitals are using similar processes to address E.R. issues.”
As HCA’s profits and influence grew, strains arose with doctors and nurses over whether the chain’s pursuit of profit may have, at times, come at the expense of patient care.
HCA had put in place a flexible staffing system that allowed it to estimate the number of patients it would have each day in its hospitals and alter the number of nurses it needed accordingly.
Several nurses interviewed said they were concerned that the system sometimes had led to inadequate staffing in important areas like critical care. In one measure of adequate staffing — the prevalence of bedsores in patients bedridden for long periods of time — HCA clearly struggled. Some of its hospitals fended off lawsuits over the problem in recent years, and were admonished by regulators over staffing issues more than once.
‘Through the Roof’
Many doctors interviewed at various HCA facilities said they had felt increased pressure to focus on profits under the private equity ownership. “Their profits are going through the roof, but, unfortunately, it’s occurring at the expense of patients,” said Dr. Abraham Awwad, a kidney specialist in St. Petersburg, Fla., whose complaints over the safety of the dialysis programs at two HCA-owned hospitals prompted state investigations.
One facility was fined $8,000 in 2008 and $14,000 last year for delaying the start of dialysis in patients, not administering physician-prescribed drugs and not documenting whether ordered tests had been performed.
Claiming he provided poor care, the other hospital did not renew Dr. Awwad’s privileges. Dr. Awwad is suing to have them reinstated. HCA declined to comment. HCA says it stands by its procedures, billing practices and level of care...
By REED ABELSON and JULIE CRESWELL
New York Times
August 6, 2012
GRAPHIC: HCA’s Growing Profit
In the summer of 2010, a troubling letter reached the chief ethics officer of the hospital giant HCA, written by a former nurse at one of the company’s hospitals in Florida.
In a follow-up interview, the nurse said a doctor at the Lawnwood Regional Medical Center, in the small coastal city of Fort Pierce, had been performing heart procedures on patients who did not need them, putting their lives at risk.
“It bothered me,” the nurse, C. T. Tomlinson, said in a telephone interview. “I’m a registered nurse. I care about my patients.”
In less than two months, an internal investigation by HCA concluded the nurse was right.
“The allegations related to unnecessary procedures being performed in the cath lab are substantiated,” according to a confidential memo written by a company ethics officer, Stephen Johnson, and reviewed by The New York Times.
Mr. Tomlinson’s contract was not renewed, a move that Mr. Johnson said in the memo was in retaliation for his complaints.
But the nurse’s complaint was far from the only evidence that unnecessary — even dangerous — procedures were taking place at some HCA hospitals, driving up costs and increasing profits.
HCA, the largest for-profit hospital chain in the United States with 163 facilities, had uncovered evidence as far back as 2002 and as recently as late 2010 showing that some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures they were performing. Those hospitals included the Cedars Medical Center in Miami, which the company no longer owns, and the Regional Medical Center Bayonet Point. In some cases, the doctors made misleading statements in medical records that made it appear the procedures were necessary, according to internal reports.
Questions about the necessity of medical procedures — especially in the realm of cardiology — are not uncommon. None of the internal documents reviewed calculate just how many such procedures there were or how many patients might have died or been injured as a result. But the documents suggest that the problems at HCA went beyond a rogue doctor or two.
At Lawnwood, where an invasive diagnostic test known as a cardiac catheterization is performed, about half the procedures, or 1,200, were determined to have been done on patients without significant heart disease, according to a confidential 2010 review. HCA countered recently with a different analysis, saying the percentage of patients without disease was much lower and in keeping with national averages.
At Bayonet Point, a 44-year-old man who arrived at the emergency room complaining of chest pain suffered a punctured blood vessel and a near-fatal irregular heartbeat after a doctor performed a procedure that an outside expert later suggested might have been unnecessary, documents show. The man had to be revived. “They shocked him twice and got him back,” according to the testimony of Dr. Aaron Kugelmass in a medical hearing on the case.
In another incident, an outside expert described how a woman with no significant heart disease went into cardiac arrest after a vessel was cut when a Bayonet Point cardiologist inserted a stent, a meshlike device that opens coronary arteries. She remained hospitalized for several days, according to a person who has reviewed internal reports...
In a recent statement, HCA declined to provide evidence that it had alerted Medicare, state Medicaid or private insurers of its findings, or reimbursed them for any of the procedures that the company later deemed unnecessary, as required by law...
Some doctors accused in the reviews of performing unnecessary procedures are still practicing at HCA hospitals...
A Giant Hospital Chain Is Blazing a Profit Trail
By JULIE CRESWELL and REED ABELSON
August 14, 2012
During the Great Recession, when many hospitals across the country were nearly brought to their knees by growing numbers of uninsured patients, one hospital system not only survived — it thrived.
In fact, profits at the health care industry giant HCA, which controls 163 hospitals from New Hampshire to California, have soared, far outpacing those of most of its competitors.
The big winners have been three private equity firms — including Bain Capital, co-founded by Mitt Romney, the Republican presidential candidate — that bought HCA in late 2006.
HCA’s robust profit growth has raised the value of the firms’ holdings to nearly three and a half times their initial investment in the $33 billion deal.
The financial performance has been so impressive that HCA has become a model for the industry. Its success inspired 35 buyouts of hospitals or chains of facilities in the last two and a half years by private equity firms eager to repeat that windfall.
HCA’s emergence as a powerful leader in the hospital industry is all the more remarkable because only a decade ago the company was badly shaken by a wide-ranging Medicare fraud investigation that it eventually settled for more than $1.7 billion.
Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the cost of its medical staff, a move that sometimes led to conflicts with doctors and nurses over concerns about patient care.
In late 2008, for instance, HCA changed the billing codes it assigned to sick and injured patients who came into the emergency rooms. Almost overnight, the numbers of patients who HCA said needed more care, which would be paid for at significantly higher levels by Medicare, surged.
HCA, which had lagged the industry for those high-paying categories, jumped ahead of its competitors and was reimbursed accordingly. The change, which HCA’s executives said better reflected the service being provided, increased operating earnings by nearly $100 million in the first quarter of 2009.
To some, HCA successfully pushed the envelope in its interpretation of existing Medicare rules. “If HCA can do it, why can’t we?” asked a hospital consulting firm, the Advisory Board Company, in a presentation to its clients.
In one instance, HCA executives said a private insurer, which it declined to name, questioned the new billing system, forcing it to return some of the money it had collected.
The hospital giant also adopted a policy meant to address an issue that bedevils hospitals nationwide — reducing costs and overcrowding in its emergency rooms. For years, the hospital emergency room has been used by the uninsured as a de facto doctor’s office — a place for even the most minor of ailments. But emergency care is expensive and has become increasingly burdensome to hospitals in the last decade because of the rising number of uninsured patients.
HCA decided not to treat patients who came in with nonurgent conditions, like a cold or the flu or even a sprained wrist, unless those patients paid in advance. In a recent statement, HCA said that of the six million patients treated in its emergency rooms last year, 80,000, or about 1.3 percent, “ chose to seek alternative care options.”
“Many E.R.’s in America, particularly in densely populated urban areas where most HCA-affiliated facilities are located, have adopted a variety of systems to determine whether a patient in fact needs emergency care,” the statement said. “About half our hospitals have done so. Typically, our affiliated hospitals have two caregivers — usually a triage nurse and a physician — make that determination. It should be noted that other non-HCA affiliated hospitals are using similar processes to address E.R. issues.”
As HCA’s profits and influence grew, strains arose with doctors and nurses over whether the chain’s pursuit of profit may have, at times, come at the expense of patient care.
HCA had put in place a flexible staffing system that allowed it to estimate the number of patients it would have each day in its hospitals and alter the number of nurses it needed accordingly.
Several nurses interviewed said they were concerned that the system sometimes had led to inadequate staffing in important areas like critical care. In one measure of adequate staffing — the prevalence of bedsores in patients bedridden for long periods of time — HCA clearly struggled. Some of its hospitals fended off lawsuits over the problem in recent years, and were admonished by regulators over staffing issues more than once.
‘Through the Roof’
Many doctors interviewed at various HCA facilities said they had felt increased pressure to focus on profits under the private equity ownership. “Their profits are going through the roof, but, unfortunately, it’s occurring at the expense of patients,” said Dr. Abraham Awwad, a kidney specialist in St. Petersburg, Fla., whose complaints over the safety of the dialysis programs at two HCA-owned hospitals prompted state investigations.
One facility was fined $8,000 in 2008 and $14,000 last year for delaying the start of dialysis in patients, not administering physician-prescribed drugs and not documenting whether ordered tests had been performed.
Claiming he provided poor care, the other hospital did not renew Dr. Awwad’s privileges. Dr. Awwad is suing to have them reinstated. HCA declined to comment. HCA says it stands by its procedures, billing practices and level of care...
Kaiser gave patient incorrect instructions, costing patient over $1,000
Kaiser Permanente
scambook
Complaint 139447
Date Occurred:03/01/2012
Reported Damages: $1,474.00
I was sent to RAI by Kaiser Permanente 12/12011 to initial renal dialysis. I was approached there by Peter Carrion, a representative from Kaiser, to enroll me in a Kaiser supplemental plan to start when Medicare became effective. I advised Mr Carrion I would be a home hemodialysis patient.
He instructed me to send my enrollment forms for the supplemental Kaiser plan 2 weeks before starting home hemodialysis. I started home hemodialysis classes 1-23-12, and began dialysis at home 2-16-12. I received a Medicare card with an effective date 3-1-12. I called Mr. Carrion and asked him if the effective date was correct as I understood Medicare became effective upon starting home hemodialysis.
He stated Medicare became effective 90 days after the onset of dialysis. I questioned him further but he insisted this was the case. I then accessed a web site for Medicare recepients which states that Medicare is effective the 1st day of the month that home hemodialysis classes are initiated.
I called and fax'd this information to Mr Carrion on numerous occasions without response. I then contacted his supervisor, Norma.
Norma states it was not their responsibility to know when Medicare became effective, that was up to the Social Security office. She was not interested in connecting the timing of the enrollment forms being sent to when the Medicare was made effective. I called the Social Security office who requested documentation from the Kaiser Permanente approved provider who initiated my home hemodialysis classes. This was done, I was advised it would take 6-8 weeks for my card to be corrected. I received my new Medicare card with efffective date 1-1-12 in April. Kaiser has since billed Medicare and received payment for services provided after 1-1-12.
Kaiser will not, however, refund premiums of $747/month for January and February of 2012 as my enrollment forms were not submitted until 2-1-12 as instructed by Mr. Carrion, their representative, and my Medicare was not started due to inaccurate information received from RAI, the Kaiser approved dialysis provider. It wasn't until I intervened that this was corrected. I believe Kaiser should be responsible for the instructions given to applicants and the Social Security office.
Respectfully submitted,
Anonymous SBID #8cab002602
Posted 07/26/2012
scambook
Complaint 139447
Date Occurred:03/01/2012
Reported Damages: $1,474.00
I was sent to RAI by Kaiser Permanente 12/12011 to initial renal dialysis. I was approached there by Peter Carrion, a representative from Kaiser, to enroll me in a Kaiser supplemental plan to start when Medicare became effective. I advised Mr Carrion I would be a home hemodialysis patient.
He instructed me to send my enrollment forms for the supplemental Kaiser plan 2 weeks before starting home hemodialysis. I started home hemodialysis classes 1-23-12, and began dialysis at home 2-16-12. I received a Medicare card with an effective date 3-1-12. I called Mr. Carrion and asked him if the effective date was correct as I understood Medicare became effective upon starting home hemodialysis.
He stated Medicare became effective 90 days after the onset of dialysis. I questioned him further but he insisted this was the case. I then accessed a web site for Medicare recepients which states that Medicare is effective the 1st day of the month that home hemodialysis classes are initiated.
I called and fax'd this information to Mr Carrion on numerous occasions without response. I then contacted his supervisor, Norma.
Norma states it was not their responsibility to know when Medicare became effective, that was up to the Social Security office. She was not interested in connecting the timing of the enrollment forms being sent to when the Medicare was made effective. I called the Social Security office who requested documentation from the Kaiser Permanente approved provider who initiated my home hemodialysis classes. This was done, I was advised it would take 6-8 weeks for my card to be corrected. I received my new Medicare card with efffective date 1-1-12 in April. Kaiser has since billed Medicare and received payment for services provided after 1-1-12.
Kaiser will not, however, refund premiums of $747/month for January and February of 2012 as my enrollment forms were not submitted until 2-1-12 as instructed by Mr. Carrion, their representative, and my Medicare was not started due to inaccurate information received from RAI, the Kaiser approved dialysis provider. It wasn't until I intervened that this was corrected. I believe Kaiser should be responsible for the instructions given to applicants and the Social Security office.
Respectfully submitted,
Anonymous SBID #8cab002602
Posted 07/26/2012
La Verne teacher claims Kaiser Permanente nurse violated her privacy
Teacher claims Kaiser nurse violated her privacy
allnurses.com
Jun 9, '09
When stories about hospital privacy breaches turn into lawsuits, there's usually a celebrity name attached.
Britney Spears, Farrah Fawcett and Nadya Suleman have all claimed medical staffs snooped through their confidential records.
But celebrities aren't the only ones alleging violation of their privacy. A second- grade teacher in La Verne says she is the latest victim of a medical confidentiality breach.
Louise Steele, 56, claims a Kaiser Permanente nurse pried into her medical file and reported the findings to her employer, Bonita Unified School District, according to a lawsuit filed May 29 in Los Angeles Superior Court.
Steele accuses Kaiser Permanente and nurse Lisa Martinez of conspiracy, negligence, invasion of privacy and emotional distress, according to the complaint.
Martinez, who had a child in Steele's class at Roynon Elementary School, did not return calls Tuesday....
In January, Lisa Martinez accused Steele of making a derogatory comment to her son. Her son was removed from Steele's Roynon Elementary class.
Shortly after, Martinez was filling in at the San Dimas office of Steele's physician when Steele came in for an appointment.
Martinez accessed Steele's medical records and reported the content, which included mental- and emotional- health information about Steele, to her ex-husband. Alex Martinez then submitted a letter dated May 18 to the school district stating Steele "is not fit to continue being an elementary school teacher" and asked the district to investigate. Soon after, Steele received an anonymous letter saying Martinez pried into Steele's medical file.
allnurses.com
Jun 9, '09
When stories about hospital privacy breaches turn into lawsuits, there's usually a celebrity name attached.
Britney Spears, Farrah Fawcett and Nadya Suleman have all claimed medical staffs snooped through their confidential records.
But celebrities aren't the only ones alleging violation of their privacy. A second- grade teacher in La Verne says she is the latest victim of a medical confidentiality breach.
Louise Steele, 56, claims a Kaiser Permanente nurse pried into her medical file and reported the findings to her employer, Bonita Unified School District, according to a lawsuit filed May 29 in Los Angeles Superior Court.
Steele accuses Kaiser Permanente and nurse Lisa Martinez of conspiracy, negligence, invasion of privacy and emotional distress, according to the complaint.
Martinez, who had a child in Steele's class at Roynon Elementary School, did not return calls Tuesday....
In January, Lisa Martinez accused Steele of making a derogatory comment to her son. Her son was removed from Steele's Roynon Elementary class.
Shortly after, Martinez was filling in at the San Dimas office of Steele's physician when Steele came in for an appointment.
Martinez accessed Steele's medical records and reported the content, which included mental- and emotional- health information about Steele, to her ex-husband. Alex Martinez then submitted a letter dated May 18 to the school district stating Steele "is not fit to continue being an elementary school teacher" and asked the district to investigate. Soon after, Steele received an anonymous letter saying Martinez pried into Steele's medical file.
In Ill Doctor, a Surprise Reflection of Who Picks Assisted Suicide
In Ill Doctor, a Surprise Reflection of Who Picks Assisted Suicide
By KATIE HAFNER
New York Times
August 11, 2012
Dr. Richard Wesley has amyotrophic lateral sclerosis, the incurable disease that lays waste to muscles while leaving the mind intact. He lives with the knowledge that an untimely death is chasing him down, but takes solace in knowing that he can decide exactly when, where and how he will die.
Under Washington State’s Death With Dignity Act, his physician has given him a prescription for a lethal dose of barbiturates. He would prefer to die naturally, but if dying becomes protracted and difficult, he plans to take the drugs and die peacefully within minutes.
“It’s like the definition of pornography,” Dr. Wesley, 67, said at his home here in Seattle, with Mount Rainier in the distance. “I’ll know it’s time to go when I see it.”
Washington followed Oregon in allowing terminally ill patients to get a prescription for drugs that will hasten death. Critics of such laws feared that poor people would be pressured to kill themselves because they or their families could not afford end-of-life care. But the demographics of patients who have gotten the prescriptions are surprisingly different than expected, according to data collected by Oregon and Washington through 2011.
Dr. Wesley is emblematic of those who have taken advantage of the law. They are overwhelmingly white, well educated and financially comfortable...
By KATIE HAFNER
New York Times
August 11, 2012
Dr. Richard Wesley has amyotrophic lateral sclerosis, the incurable disease that lays waste to muscles while leaving the mind intact. He lives with the knowledge that an untimely death is chasing him down, but takes solace in knowing that he can decide exactly when, where and how he will die.
Under Washington State’s Death With Dignity Act, his physician has given him a prescription for a lethal dose of barbiturates. He would prefer to die naturally, but if dying becomes protracted and difficult, he plans to take the drugs and die peacefully within minutes.
“It’s like the definition of pornography,” Dr. Wesley, 67, said at his home here in Seattle, with Mount Rainier in the distance. “I’ll know it’s time to go when I see it.”
Washington followed Oregon in allowing terminally ill patients to get a prescription for drugs that will hasten death. Critics of such laws feared that poor people would be pressured to kill themselves because they or their families could not afford end-of-life care. But the demographics of patients who have gotten the prescriptions are surprisingly different than expected, according to data collected by Oregon and Washington through 2011.
Dr. Wesley is emblematic of those who have taken advantage of the law. They are overwhelmingly white, well educated and financially comfortable...
Wednesday, August 8, 2012
Melvin Morse, Delaware Pediatrician, Accused Of Waterboarding Daughter
Melvin Morse, Delaware Pediatrician, Accused Of Waterboarding Daughter (VIDEO)
Huffington Post
By David Moye
08/08/2012
Melvin Morse, a pediatrician specializing in near-death experiences, is accused of "waterboarding" his daughter, 11. His wife, Pauline, allegedly witnessed the act but did not stop it.
A Delaware pediatrician who is a recognized researcher in near-death experiences in children has been accused of holding his young daughter's face under a faucet -- an act he called waterboarding, according to officials -- while the girl's mother allegedly watched.
Officials in Georgetown, Del., arrested Dr. Melvin Morse and his wife Pauline at their home on Monday and charged them with reckless endangerment, conspiracy and endangering the welfare of a child.
The charges stem from a July 12 domestic assault incident in which Morse was accused of grabbing his 11-year-old daughter by the ankles and dragging her across the driveway into the house, where he then spanked her, according to WCAU-TV.
Officials arrested Morse a few days later and charged him with endangering the welfare of a child, as well as assault. After posting $750 secured bail, he was released.
Investigators said that the 11-year-old was brought to the Child Advocacy Center and interviewed on Aug. 6.
Police told WBOC-TV that during the questioning, the girl claimed that for two years beginning in May 2009, on at least four occasions, her father disciplined her in a manner he called "waterboarding," where he held her face under a running faucet, "causing the water to go up her nose and all over her face."
Although the victim's mother, Pauline, reportedly saw at least some of these alleged incidents, officials tell WPVI-TV that she failed to stop her husband from performing the act.
They were both arraigned and Melvin was committed to the Sussex Correctional Institution on a $14,500 secured bond. Pauline was released on a $14,500 unsecured bond.
Both the victim and her 5-year-old sister are now in the care of Division of Family Services, police told WTXF-TV.
Morse runs an organization called the Institute for the Scientific Study of Consciousness and has been interviewed on the subject of children's near-death experiences.
Huffington Post
By David Moye
08/08/2012
Melvin Morse, a pediatrician specializing in near-death experiences, is accused of "waterboarding" his daughter, 11. His wife, Pauline, allegedly witnessed the act but did not stop it.
A Delaware pediatrician who is a recognized researcher in near-death experiences in children has been accused of holding his young daughter's face under a faucet -- an act he called waterboarding, according to officials -- while the girl's mother allegedly watched.
Officials in Georgetown, Del., arrested Dr. Melvin Morse and his wife Pauline at their home on Monday and charged them with reckless endangerment, conspiracy and endangering the welfare of a child.
The charges stem from a July 12 domestic assault incident in which Morse was accused of grabbing his 11-year-old daughter by the ankles and dragging her across the driveway into the house, where he then spanked her, according to WCAU-TV.
Officials arrested Morse a few days later and charged him with endangering the welfare of a child, as well as assault. After posting $750 secured bail, he was released.
Investigators said that the 11-year-old was brought to the Child Advocacy Center and interviewed on Aug. 6.
Police told WBOC-TV that during the questioning, the girl claimed that for two years beginning in May 2009, on at least four occasions, her father disciplined her in a manner he called "waterboarding," where he held her face under a running faucet, "causing the water to go up her nose and all over her face."
Although the victim's mother, Pauline, reportedly saw at least some of these alleged incidents, officials tell WPVI-TV that she failed to stop her husband from performing the act.
They were both arraigned and Melvin was committed to the Sussex Correctional Institution on a $14,500 secured bond. Pauline was released on a $14,500 unsecured bond.
Both the victim and her 5-year-old sister are now in the care of Division of Family Services, police told WTXF-TV.
Morse runs an organization called the Institute for the Scientific Study of Consciousness and has been interviewed on the subject of children's near-death experiences.
Monday, August 6, 2012
Class action suit against Kaiser Permanente regarding overtime pay
Courthouse News
SAN BERNARDINO
Southern California Permanente Medical Group stiffs appointment center supervisors for overtime, a class action claims in Superior Court. Suit filed July 30, 2012.
SAN BERNARDINO
Southern California Permanente Medical Group stiffs appointment center supervisors for overtime, a class action claims in Superior Court. Suit filed July 30, 2012.
Saturday, August 4, 2012
Philanthropist’s death sparks lawsuit against UCLA psychiatrist who was treating her
Philanthropist’s death sparks lawsuit against UCLA psychiatrist who was treating her
By Associated Press
August 4, 2012
Philanthropist's Death Sparks Unusual Lawsuit
By LINDA DEUTSCH
August 4, 2012 (AP)
When former model and philanthropist Phyllis Harvey died last year at the age of 59, little note was taken. Brief paid obituaries appeared in Los Angeles and her hometown paper in North Carolina.
There was no mention of how she died. Nothing was said about her struggle with alcoholism and mental illness. And there was no reference to one of the final projects she helped fund with nearly a half million dollars.
Those details now figure prominently in a medical board complaint and wrongful death lawsuit claiming her psychiatrist coaxed $490,000 in research funding from her while she was under powerful doses of psychotropic drugs that eventually killed her.
The suit filed on behalf of Brian Harvey by attorney Daniel M. Hodes accuses University of California, Los Angeles psychiatrist Dr. Alexander Bystritsky of causing Phyllis Harvey's death with a dangerous combination of drugs that altered her heart rhythm.
Hodes says that Mrs. Harvey was hospitalized several times for heart abnormalities associated with drugs, and that emergency room doctors discontinued her medications only to have Bystritsky resume giving them to her when she was discharged.
Brian Harvey earned a fortune by selling an invention for coating electronic wires with recycled metal from beer cans. Following the sale of his company, he and his wife formed the Brian and Phyllis Harvey foundation to fund scholarships and other donations. The lawsuit claims Bystritsky knew of the couple's wealth and charitable giving and insinuated himself into their lives with house calls, long chats and email with Phyllis Harvey while treating her undiagnosed mental illness. He allegedly touted his own credentials and convinced her to give large donations to research a device that might cure her.
The claim that a physician solicited research funds from a patient provides a new wrinkle in the debate over the relationship between doctors, wealthy patients and the overuse of prescription drugs.
"Was he continuing to treat her with these high-powered drugs to keep her as a patient?" said James J. Walter, a professor at the Center on Bioethics at Loyola Law School. "Every bioethicist would say that practice should be discouraged."
The lawsuit filed in Los Angeles County Superior Court claims wrongful death due to medical negligence, fraud, fraudulent concealment and intentional infliction of emotional distress.
Numerous phone messages left for Bystritsky and his lawyer by The Associated Press were not returned.
The suit also names the UC Board of Regents as defendants, noting that they sent glowing letters of thanks to the Harveys for their donations.
A spokeswoman for UCLA said she could not discuss medical specifics because of privacy concerns but said UCLA will contest the lawsuit.
"The UCLA health care system is committed to the highest standards of patient care and safety," said spokeswoman Roxanne Moster. "This is a regrettable and unfortunate case for everyone involved and we extend our deepest sympathies to members of the Harvey family for their loss."
Bystritsky began treating Harvey in 2004, five years after she was diagnosed as possibly suffering from bipolar disorder, early dementia or schizophrenia, according to documents in the case.
None of those diagnoses was ever fully confirmed by tests and Bystritsky soon had her on a regimen of several psychotropic drugs including Seroquel, a powerful anti-psychotic, said John Harwell, a lawyer who filed a complaint with the Medical Board of California last November on behalf of Brian Harvey.
The lawyers contend that drug, which is known to alter heart rhythm, killed her when she died in her bed April 5, 2011.
"Mrs. Harvey died from sudden cardiac death," Harwell told the medical board, "the very kind of consequence warned against by the FDA in its required Black Box Seroquel warnings, the ones Dr. Bystritsky either ignored or of which he was ignorant."
The medical board declined to comment on whether a complaint is pending before it.
Harvey had overcome alcoholism when she was younger, but she relapsed after her mother's death in 2009, Harwell said. During one of several hospital admissions, she told a doctor she was drinking a bottle of liquor a day along with the sedative Ativan, a potentially lethal combination.
In the two months before her death, the lawyers said she was receiving nine different drugs including benzodiazepine sedatives, Invega, a drug for schizophrenia, and Seroquel which was prescribed by Bystritsky at 180 tablets in 17 days.
Heavy doses of drugs in large volumes led to hospitalizations for overdoses of benzodiazepines, leading to falls, disorientation and intoxication, Harwell said. Emergency room doctors discontinued her medications, but Bystritsky resumed giving them when she was discharged. At times, he said, she became delirious and had hallucinations that bugs were crawling on her skin.
The lawsuit claims that the psychiatrist told Harvey he might be able to cure her with a device he invented, but that he said he needed more money to continue research on the machine.
An Internet search shows that Bysrtritsky, who heads the anxiety disorders program at UCLA, was a partner in a privately held company called Brainsonix which is collaborating with UCLA and Harvard Medical School on an ultrasound device to modulate brain function and treat brain disorders including depression, autism, Parkinson's Disease, epilepsy, obesity and other ailments.
His list of credentials shows that he was trained in neuroscience, psychopharmacology and psychiatry at Pavlov Medical Institute in Russia, New York University and UCLA. He also is a visiting full professor at Harvard University School of Medicine.
Harvey declined to seek criminal charges against Bystritsky because that might have required proving he intended to harm his patient, attorney Hodes said.
Experts said the case would be divided into two issues — the standard of care provided and ethical considerations involved in soliciting donations from a patient.
If true, "It would be a horrible indictment of the fund raising efforts of UCLA," said Donna Darling, a former New York assistant district attorney who now represents plaintiffs in medical malpractice suits. "They should have known she was a patient."
Attorney Harland Braun, who has represented doctors in malpractice cases, said Bystritsky may raise a strong defense that he was trying to help a gravely ill patient and had no intent to harm her. The fact that money was donated to his research, he said, suggests no desire for personal enrichment.
"Jurors have a tendency to trust doctors," said Braun, "and If you can't show the doctor had a motive to do harm, jurors will side with him."
By Associated Press
August 4, 2012
Philanthropist's Death Sparks Unusual Lawsuit
By LINDA DEUTSCH
August 4, 2012 (AP)
When former model and philanthropist Phyllis Harvey died last year at the age of 59, little note was taken. Brief paid obituaries appeared in Los Angeles and her hometown paper in North Carolina.
There was no mention of how she died. Nothing was said about her struggle with alcoholism and mental illness. And there was no reference to one of the final projects she helped fund with nearly a half million dollars.
Those details now figure prominently in a medical board complaint and wrongful death lawsuit claiming her psychiatrist coaxed $490,000 in research funding from her while she was under powerful doses of psychotropic drugs that eventually killed her.
The suit filed on behalf of Brian Harvey by attorney Daniel M. Hodes accuses University of California, Los Angeles psychiatrist Dr. Alexander Bystritsky of causing Phyllis Harvey's death with a dangerous combination of drugs that altered her heart rhythm.
Hodes says that Mrs. Harvey was hospitalized several times for heart abnormalities associated with drugs, and that emergency room doctors discontinued her medications only to have Bystritsky resume giving them to her when she was discharged.
Brian Harvey earned a fortune by selling an invention for coating electronic wires with recycled metal from beer cans. Following the sale of his company, he and his wife formed the Brian and Phyllis Harvey foundation to fund scholarships and other donations. The lawsuit claims Bystritsky knew of the couple's wealth and charitable giving and insinuated himself into their lives with house calls, long chats and email with Phyllis Harvey while treating her undiagnosed mental illness. He allegedly touted his own credentials and convinced her to give large donations to research a device that might cure her.
The claim that a physician solicited research funds from a patient provides a new wrinkle in the debate over the relationship between doctors, wealthy patients and the overuse of prescription drugs.
"Was he continuing to treat her with these high-powered drugs to keep her as a patient?" said James J. Walter, a professor at the Center on Bioethics at Loyola Law School. "Every bioethicist would say that practice should be discouraged."
The lawsuit filed in Los Angeles County Superior Court claims wrongful death due to medical negligence, fraud, fraudulent concealment and intentional infliction of emotional distress.
Numerous phone messages left for Bystritsky and his lawyer by The Associated Press were not returned.
The suit also names the UC Board of Regents as defendants, noting that they sent glowing letters of thanks to the Harveys for their donations.
A spokeswoman for UCLA said she could not discuss medical specifics because of privacy concerns but said UCLA will contest the lawsuit.
"The UCLA health care system is committed to the highest standards of patient care and safety," said spokeswoman Roxanne Moster. "This is a regrettable and unfortunate case for everyone involved and we extend our deepest sympathies to members of the Harvey family for their loss."
Bystritsky began treating Harvey in 2004, five years after she was diagnosed as possibly suffering from bipolar disorder, early dementia or schizophrenia, according to documents in the case.
None of those diagnoses was ever fully confirmed by tests and Bystritsky soon had her on a regimen of several psychotropic drugs including Seroquel, a powerful anti-psychotic, said John Harwell, a lawyer who filed a complaint with the Medical Board of California last November on behalf of Brian Harvey.
The lawyers contend that drug, which is known to alter heart rhythm, killed her when she died in her bed April 5, 2011.
"Mrs. Harvey died from sudden cardiac death," Harwell told the medical board, "the very kind of consequence warned against by the FDA in its required Black Box Seroquel warnings, the ones Dr. Bystritsky either ignored or of which he was ignorant."
The medical board declined to comment on whether a complaint is pending before it.
Harvey had overcome alcoholism when she was younger, but she relapsed after her mother's death in 2009, Harwell said. During one of several hospital admissions, she told a doctor she was drinking a bottle of liquor a day along with the sedative Ativan, a potentially lethal combination.
In the two months before her death, the lawyers said she was receiving nine different drugs including benzodiazepine sedatives, Invega, a drug for schizophrenia, and Seroquel which was prescribed by Bystritsky at 180 tablets in 17 days.
Heavy doses of drugs in large volumes led to hospitalizations for overdoses of benzodiazepines, leading to falls, disorientation and intoxication, Harwell said. Emergency room doctors discontinued her medications, but Bystritsky resumed giving them when she was discharged. At times, he said, she became delirious and had hallucinations that bugs were crawling on her skin.
The lawsuit claims that the psychiatrist told Harvey he might be able to cure her with a device he invented, but that he said he needed more money to continue research on the machine.
An Internet search shows that Bysrtritsky, who heads the anxiety disorders program at UCLA, was a partner in a privately held company called Brainsonix which is collaborating with UCLA and Harvard Medical School on an ultrasound device to modulate brain function and treat brain disorders including depression, autism, Parkinson's Disease, epilepsy, obesity and other ailments.
His list of credentials shows that he was trained in neuroscience, psychopharmacology and psychiatry at Pavlov Medical Institute in Russia, New York University and UCLA. He also is a visiting full professor at Harvard University School of Medicine.
Harvey declined to seek criminal charges against Bystritsky because that might have required proving he intended to harm his patient, attorney Hodes said.
Experts said the case would be divided into two issues — the standard of care provided and ethical considerations involved in soliciting donations from a patient.
If true, "It would be a horrible indictment of the fund raising efforts of UCLA," said Donna Darling, a former New York assistant district attorney who now represents plaintiffs in medical malpractice suits. "They should have known she was a patient."
Attorney Harland Braun, who has represented doctors in malpractice cases, said Bystritsky may raise a strong defense that he was trying to help a gravely ill patient and had no intent to harm her. The fact that money was donated to his research, he said, suggests no desire for personal enrichment.
"Jurors have a tendency to trust doctors," said Braun, "and If you can't show the doctor had a motive to do harm, jurors will side with him."
Thursday, August 2, 2012
Witness tampering in Grotz v. Kaiser Permanente retaliation case?
It appears that there may have been witness tampering by Kaiser Permanente and/or SEIU in the Grotz v. Kaiser Permanente case.
Courthouse News reported on July 11, 2012:
Kristinna Grotz sued Kaiser Foundation Hospitals, the Permanente Medical Group, and SEIU-United Healthcare Workers West, which allegedly failed to stick up for her.
Grotz claims she worked in Kaiser's admitting department from 2002 until she was fired in the summer of 2011.
She says that from early 2008 department manager (nonparty) D. T. used drugs - "in all likelihood methamphetamine" - at work, and that D. T. retaliated against her for reporting it.
This case sounds very familiar.
As a patient of Kaiser Permanente, I was amazed to learn that Kaiser forced its doctors to falsify medical records in my case, apparently to justify denial of care. I have published some of the obviously false documents HERE.
As an employee of a different institution, I experienced a similar problem to that of Grotz. I was a teacher at Chula Vista Elementary School District when my employer retaliated against me for asking for an investigation into abusive, illegal actions by teachers. One of my witnesses told me that Richard Werlin, the Assistant Superintendent for human resources, came to her school and interrogated her about her prospective testimony. It was pure intimidation. The district wasn't interested in the facts; they didn't even interview me! Later, teachers contradicted themselves and each other in their depositions. See Linda Watson deposition HERE.
My union behaved exactly like Grotz' union. California Teachers Association supported teachers who had committed crimes instead of supporting me. My local president,Gina Boyd, said 60 times during her deposition that she didn't know or didn't remember something. See deposition HERE.
Still, I was shocked when one of the witnesses in the Grotz v. Kaiser case contacted me and asked me to remove her name from my post about the case, saying she could lose her license. Apparently she has been threatened, and may be planning to change her story.
I removed the names of both witnesses who were mentioned, but I am concerned that Kaiser and SEIU may be tampering with witnesses in this case, a serious felony.
Courthouse News reported on July 11, 2012:
Kristinna Grotz sued Kaiser Foundation Hospitals, the Permanente Medical Group, and SEIU-United Healthcare Workers West, which allegedly failed to stick up for her.
Grotz claims she worked in Kaiser's admitting department from 2002 until she was fired in the summer of 2011.
She says that from early 2008 department manager (nonparty) D. T. used drugs - "in all likelihood methamphetamine" - at work, and that D. T. retaliated against her for reporting it.
This case sounds very familiar.
As a patient of Kaiser Permanente, I was amazed to learn that Kaiser forced its doctors to falsify medical records in my case, apparently to justify denial of care. I have published some of the obviously false documents HERE.
As an employee of a different institution, I experienced a similar problem to that of Grotz. I was a teacher at Chula Vista Elementary School District when my employer retaliated against me for asking for an investigation into abusive, illegal actions by teachers. One of my witnesses told me that Richard Werlin, the Assistant Superintendent for human resources, came to her school and interrogated her about her prospective testimony. It was pure intimidation. The district wasn't interested in the facts; they didn't even interview me! Later, teachers contradicted themselves and each other in their depositions. See Linda Watson deposition HERE.
My union behaved exactly like Grotz' union. California Teachers Association supported teachers who had committed crimes instead of supporting me. My local president,Gina Boyd, said 60 times during her deposition that she didn't know or didn't remember something. See deposition HERE.
Still, I was shocked when one of the witnesses in the Grotz v. Kaiser case contacted me and asked me to remove her name from my post about the case, saying she could lose her license. Apparently she has been threatened, and may be planning to change her story.
I removed the names of both witnesses who were mentioned, but I am concerned that Kaiser and SEIU may be tampering with witnesses in this case, a serious felony.
Wednesday, August 1, 2012
California patient wins anti-SLAPP motion against doctor she criticized
Also see interesting case in Minnesota, Dr. David McKee v. Dennis Laurion.
Filler v. Walker
Citizen Media Law Project
Dr. Aaron Filler filed a complaint against former patient Susan Walker in Los Angeles Superior Court on May 31, 2011. In his complaint, Filler alleged defamation and interference with prospective economic advantage in response to Walker's review of Dr. Filler on a physician rating site.
On August 24, 2011, Walker filed a motion to strike based on California Code of Civil Procedure §§ 425.16 and 45, California's anti-SLAPP statute. Walker's motion argues that Walker is shielded from liability as the "dissemination of consumer information about medical care is a vital ‘public issue' and the internet is a ‘public forum,' and that Dr. Filler is a public figure subject to the burden of proving actual malice. Filler filed an opposition to this motion on September 16, 2011, also requesting leave to amend the complaint to plead more specific factual allegations to establish actual malice. Walker replied to Filler's opposition on September 22, 2011.
After a hearing on April 19, 2011, Walker's motion to strike was granted. In the order filed on May 8, 2012, Judge Elizabeth White held that Filler's claims arose from Walker's act of free speech in connection with a public issue under CCP § 425.16 and that Filler did not establish a probability of prevailing on these claims. In accordance with this order, Judge White later ordered Filler to pay $50,259.65 to Walker for attorneys' fees and costs.
Party Issuing Legal Threat: Dr. Aaron Filler; Aaron Filler, MD, PHD, APC; Imagebased Sugicenter Corporation; Neurograph Institute Medical Associates
Party Receiving Legal Threat: Susan Walker; Does 1-25
Filler v. Walker
Citizen Media Law Project
Dr. Aaron Filler filed a complaint against former patient Susan Walker in Los Angeles Superior Court on May 31, 2011. In his complaint, Filler alleged defamation and interference with prospective economic advantage in response to Walker's review of Dr. Filler on a physician rating site.
On August 24, 2011, Walker filed a motion to strike based on California Code of Civil Procedure §§ 425.16 and 45, California's anti-SLAPP statute. Walker's motion argues that Walker is shielded from liability as the "dissemination of consumer information about medical care is a vital ‘public issue' and the internet is a ‘public forum,' and that Dr. Filler is a public figure subject to the burden of proving actual malice. Filler filed an opposition to this motion on September 16, 2011, also requesting leave to amend the complaint to plead more specific factual allegations to establish actual malice. Walker replied to Filler's opposition on September 22, 2011.
After a hearing on April 19, 2011, Walker's motion to strike was granted. In the order filed on May 8, 2012, Judge Elizabeth White held that Filler's claims arose from Walker's act of free speech in connection with a public issue under CCP § 425.16 and that Filler did not establish a probability of prevailing on these claims. In accordance with this order, Judge White later ordered Filler to pay $50,259.65 to Walker for attorneys' fees and costs.
Party Issuing Legal Threat: Dr. Aaron Filler; Aaron Filler, MD, PHD, APC; Imagebased Sugicenter Corporation; Neurograph Institute Medical Associates
Party Receiving Legal Threat: Susan Walker; Does 1-25
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