Tuesday, April 13, 2010

Rationing of care by Duke University Medical caused my dad to die

I am sitting in a hotel room in Chicago to see my knee and ankle orthopedic surgeons.

As I am in the hotel room waiting for my appointment with my Chicago orthopedic surgeon, I watch television and am painfully aware that every other advertisement is for the humane society. The ad is very successful. But it is much too horrifying for me to watch.

The animals in the ad are suffering, abused, injured, abandoned. Those pitiful animals in the humane society ads are no different than my dad at Duke Medical. Ironic. Dad always told me that he felt "pitiful."

I grab for the remote as quickly as I can. Too slow. Tears roll down my face.

The treatment of the abused, neglected and abandoned animals was functionally the same as my dad received by Duke University Hospital and orthopedic residents and fellows at Duke University Hospital. I wish that I could have simply donated $19 a month for someone to rescue my dad - just like the abused animals.

I certainly wish I could trust Duke University Medical (Durham NC) and specifically the Duke University Medical orthopedics. It would save the trips to Chicago.

But Duke University orthopedics let me down. They promised they would take care of my dad. They did not.
The mission of the Duke Orthopaedic Surgery Residency Training Program is to provide the trainee with the knowledge, clinical and surgical skills in all areas of orthopaedic surgery necessary to ethically practice either academic or community practice at the highest possible level of competence by the completion of the training program.

With respect to my dad, the Duke Orthopedic Residency Training Program failed miserably. The Orthopaedic Foot and Ankle Surgery Fellowship failed my father even worse.

My dad was diagnosed with Stage 3 colon cancer in Spring 2007. Dad's oncology surgical care at Duke was first rate. Shortly thereafter, dad's prostate began causing him difficulty and he needed prostate reduction surgery. Dad's urological surgical care at Duke was first rate.

It seems that Duke Medical had already adopted Barack Obama's mentality that rationing of care to the elderly was acceptable and necessary.

Beginning at dad's August 2007 DUH hospitalization for UTI (related to the then recent urological surgery) there was not one single medical service, not one single hospitalization, not one single medical procedure where my dad was treated appropriately by Duke Medical.

The poor care at DUH culminated in November 2008 with Duke Orthopaedic surgery "student" Dr. Bret Peterson (then in either a fellowship or residency) whose:
(1) disrespect for my family, my dad and even his supervising surgeon (Dr. Mark Easley) and

(2) lack of basic knowledge relating to infectious disease was frightening.

Dr. Bret Peterson told me that he did not have to comply with Duke Orthopedic Clinic surgeon Mark Easley's orders that my dad have "urine cultures" tested because "my [Dr. Bret Peterson] job at Duke University Hospital is to save the hospital money."

Congrats on that Dr. Bret Peterson. You saved DUH the cost of a complete urinalysis because you were ignorant of the symptoms of a UTI in an elderly patient. Not every elderly patient is demented, Dr. Bret Peterson. But confusion is a standard symptom of a UTI in the elderly. Infectious Disease 101.

Dr. Bret Peterson, you subjected my frail dad to additional trips to his once current but now former Duke urological surgeon. Dr. Bret Peterson. Why? Because the urologist told me to bring dad directly from hospital to his (non Duke) office. My dad indeed had a UTI infection high into the urinary track when you ignored him.

Kudos to you, Dr. Bret Peterson, for saving money for your hospital. Is that why doctors go to medical school?

You were wrong, Dr. Bret Peterson. But, sure, you saved a few pennies for DUH. That, my dear Dr. Bret Peterson and DUH, is called rationing of care. It is inexcusable. It is contrary to your oath to do no harm.

Of course dad was only subjected to the improper care at DUH and arrogance of Dr. Bret Peterson (during a November 2008 DUH hospitalization) because of the arrogance of his colleague, Duke hospitalist Dr. Veshana Ramiah (during a August 2008 DUH hospitalization).

In August 2008 my dad was hospitalized. He had a horrible chemotherapy related infection. Dr. Veshana Ramiah explicitly refused to communicate with my dad's Duke Clinic physicians and surgeons.

Dr. Veshana Ramiah told me that contacting the Duke Clinic physicians would "muddy the waters." She refused to follow through with initial orders that dad be seen by an oral surgeon (the chemotherapy caused horrible sores in dad's mouth).

Dr. Veshana Ramiah told me that *she* was the physician in charge and made all of the decisions. Dr. Ramiah "un-ordered" tests that the Internal Medicine fellow ordered. In particular, Dr. Veshana Ramiah "un-ordered" the fellow's order that dad been seen by a Duke oral surgeon to evaluate the chemotherapy sores in his mouth.

Why did Dr. Veshana Ramiah "un-order" the Internal Medicine fellow's order for a specialist to examine dad's mouth (so that he could eat and speak)? Apparently Dr. Veshana Ramiah wanted to punish my dad.

Dr. Veshana Ramiah told me that my dad (who was seen his entire adult life every six months by a terrific dentist and former professor at UNC School of Dentistry) "had years of dental neglect." As such, the pompous Dr. Veshana Ramiah would not permit dad to be seen by an oral surgeon. Rather, she actually mocked my dad's inability to speak as she stood in front of him. Based on his inability to speak, Dr. Ramiah classified my dad as "demented." That's rationing of care.

Dad was never demented. He knew everything that was going on. Dad knew Duke Medical. He knew, Dr. Mark Easley, Dr. Michael Morse, Dr. Veshana Ramiah, Dr. Hope Uronis.

My dad knew until the moment of his death that the place he always admired throughout his career (as a medicinal research scientist) and considered "premier" was in fact ignoring him.

I ache and my family aches for this man that suffered as I was literally begging Dr. Easley (or anyone at Duke) to see him and care for him.

Dr. Veshana Ramiah and DUH discharged my dad via ambulance because he could not walk. He had a horrible sore at the site of his orthopedic surgery at DUH four months earlier. Again, rationing of care.

Dr. Mark Easley told me that DUH ignored the foot infection. Dr. Easley told me that DUH should have properly treated my dad's foot.

How can you protect these doctors, Dr. Easley? You asked me to trust you and I did.

How can you protect the DUH doctors (including Dr. Bret Peterson) that mistreated your own patient during the November 2008 hospitalization?

In part, my dad died because of bone infection. Dr. Anna Person (Duke Infectious Disease) was caring for my dad after the November 2008 hospitalization. But in January 2009 Dr. Anna Person left Duke Infectious Disease. After that date, no one cared enough to make sure dad's foot was not still infected.

When Dr. Anna Person left, the treatment for dad's bone infection ceased. Why Dr. Easley? Why Duke Infectious Disease? Why did you ignore my dad?

Dr. Easley, you were concerned that the bone was not healing. Why didn't you consider that Duke Infectious Disease stopped treating him without any medical evidence that the infection was gone. Could the bone have failed to heal because dad was still suffering from an infection?

Did it just not matter because dad was over age 70?

I trusted Duke Orthopedics to make sure that the infection initially ignored by Dr. Veshana Ramiah's ignorance was properly treated. Okay, I will not focus on Dr. Ramiah. Dr. Easley, I don't understand how you can tell me Dr. Ramiah treated dad contrary to standard of care and not protect your patients. The patients trust you, Dr. Easley, and the patients are the vulnerable people in this scenario.

I trusted/expected that the infection would be treated you, Dr. Easley. Although you described the failure by Dr. Veshana Ramiah to have created an "unfortunate situation," I trusted you would help dad. You certainly would make sure the infection was gone. But you did not.

How many times do I have to look the other way for DUH hospitalists and physicians, Dr. Easley? Even though dad is dead, there are other patients (and I am sorry but some are old and may seem to be a drain on our economy).

Your elderly orthopedic patients rely on you, Dr. Easley.

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