Monday, June 7, 2010

Dr. Robert W. Handy Memorial "Check out your doctor day"

I am starting a new tradition in honor of my dad, Robert Wesley Handy, PhD. We will continue this educational segment on the first Monday of each month.

Do you really know your physician or surgeon. You or a loved one may be in a hospital and the care may be provided by a "hospitalist" or "stranger doctor."

1. How much do you know about this doctor?
2. Is he or she licensed to practice medicine?
3. Does he or she have board certification?
4. Did he or she graduate from a medical school in a foreign country? Ask whether the foreign medical school is rated. That is important.
5. Was the physician raised in a foreign country?

Do not be shy about asking the physician questions about his or her background. It may mean the difference between life or death.

Check the license through your state's medical board.

Check the board certifications through the American Board of Medical Specialties


My dad was treated in August 2008 at Duke University Hospital by a physician who was a foreign medical graduate (FMG). She went to a medical school in South Africa. As a caregiver, you should understand the basic human values of the country where your physician grew up or studied medicine.

What basic values could exist in South Africa that would affect the physician's judgment and care for my elderly dad? Those from South Africa can no more put aside the values of their society than a United States resident could.

The elderly are not valued in South Africa. If your physician is a FMG from South Africa and/or raised in South Africa, you should be aware of that unfortunate fact.

Article titled "Times Have Changed for Elderly People in South Africa and so have the rules."

WE WERE shocked to read in the press of the fire that broke out at the Rusthof old-age home in Paarl on May 1, and of the three frail residents who lost their lives. In November 2007, 16 elderly residents of Kwabadala Home in Nkandla, Kwa-Zulu-Natal, were burned to death.
The Paarl fire is being investigated and no report on the Nkandla fire is available but both tragedies point to the importance of proper safeguards for the elderly.
Coincidentaily, the Regulations of the Older Persons Act of 2006 were published in the Government Gazette on April 1. Once implemented, this act wiil dramatically improve the care of older people.
However, the lack of media interest in the bill, the act and the finalisation of the regulations is of great concern, as public awareness is crucial. Few in our mostly youthful society give a thought to how old peopie are faring, except in their immediate families, whom they try to provide for
Perhaps this is not surprising, since so many old people are hidden from view in rural areas, backyards, retirement villages or homes for the aged not necessarily from choice. This lack of interest reflects the fact that the old are still seen as unproductive and a burden, even though many are care-givers of grandchildren, and volunteers.
The gestation period of some eight years between the first Older Persons Biil and the promulgation of the act must account for some of the inattention of the media. But the delay reflects the considerable consultation to ensure the fmal act met the needs of the old. This included public hearings in all provinces by the SA Human Rights Commission and a national convention in 2005 at which an interim committee was set up to form the SA Older Persons Forum, a voice for older persons to interact with the government and monitor the implementation of the act. The forum is a registered NPO and Section 21 company and provincial forums are in most provinces, including the Western Cape.
Priority must be given to preventing the sorts of disaster that occurred at Kwabadala and Rusthof Residential facilities must be required to have emergency exits and disaster plans, fire protection certificates in terms of the Occupation, Health and Safety Act 85 of 1993 and smoke detectors. And these requirements must be regularly monitored.
For many years the care of older people was regulated by the Aged Persons Act of 1967, mainly concerned with old-age homes. The 2006 Older Persons Act reflected international thinking, which has moved from institutional care towards community care. This is due to the realisation that the world's elderly population is increasing at an unprecedented rate and institutional care will soon become unaffordable even to the wealthiest nations. In South Africa, with its high Aids-related death rate, the estimated population of over-60s was 5.3 mfflion in 2009, nearly 11 percent of the total population.
The approach of the Older Persons Act goes beyond providing alternatives for the care of older people. Recognising that societies can no longer afford to see older people as a growing burden requiring more and more help, the act emphasises their participation and involvement.
This wifi require that their rights are respected, that they have better health, education, adequate income and suitable housing, so the ageing population can become a valuable and important component of society's resources. (Vienna International Plan of Action on Ageing).
While compulsory retirement is not yet seriously questioned in South Africa, the act goes a long way towards making the constitution a reality in the lives of older people.
Instead of looking upon them as recipients of grants or objects for welfare, it aims to ensure their rights are respected and protected. It also aims to facilitate accessible, equitable and affordable services.
Older persons rights are now laid down in law and all government departments and organisations will be obliged to respect such rights.
Many challenges face us in ensuring the implementation of the Older Persons Act. Despite severe budgetary constraints, service providets and operators of old-age homes, assisted living accommodation and retirement vifiages must be alerted to the norms and standards which will soon apply.
Government departments such as hea1th and the police must ensure they no longer discriminate unfairly against older people. The community too, has a responsibility: any person who suspects an older person has been abused or suffers an abuserelated injury must immediately notify the police. Failure to do so wifi be an offence. Furthermore, compudsory admission to a home against the wishes of an older person wifi now require a medical practitioner to certify that any delay in admission might result in their death or irreversible damage to their health.
Provincial budgets for services for older people and their care and protection are modest and, in the poorest provinces, paltry. The bulk of this money is stifi spent on subsidies to homes, even though these subsidies have long been frozen and are no longer are enough to cover the cost of even the most basic care.
Finally, the engagement of the press and media is crucial if the rights and welfare of older people are to be kept in the public eye.
This extract from the Vienna International Plan of Action on Ageing (August 1982), is highly pertinent to South Africa: The human race is charactensed by a long childhood and by a long old age. Throughout history this has enabled older persons to educate the younger and pass on values to them... The presence of the elderly in the family home, the neighbourhood and in all forms of social life stifi teaches an irreplaceable lesson to humanity.
Not only by his life but indeed by his death, the older person teaches us all a lesson. Turok is chairwoman of the Western Cape Older Persons Forum.

Wednesday, June 2, 2010

Making sure NCMB sees trend of poor care at Duke

When I was a cancer patient at Duke, I was also treated terribly. I know cancer makes money. I know Duke gets tons of research money but . . .

In addition to informing Duke, Joint Commission and NCMB about dad's physicians that neglected him and, frankly, rationed his care, I also filed a NCMB complaint against my oncologist (for reasons I will delineate later), Dr. Gretchen Kimmick.

In addition, I filed a NCMB complaint against (I cannot believe she is) female athletic team surgeon at Duke, Dr. Alison Toth. Again, I will give readers more detail later. Suffice it to say, Dr. Alison Toth refuses to communicate with patients and will abandon you as a patient (by having her officer manager call you)!

Toth told me she would surgically repair my knee in 2008 (actually Dr. Mark Easley also promised in 2007). Now it is 2010. My knee is worse and now my ankle is severely damaged because (as both Toth and Easley knew), I was trying to maneuver my failing left knee/leg to care for a very sick dad.

My knee and ankle surgeries are scheduled in Chicago in July 2010! In the meantime, I have developed after a car accident severe back pain and further damaged ankle and knee - no doubt the cause of the impact of my/the driver's side of the car.

If Dr. Toth had treated me in 2008 (as she promised she would because she was my treating physician/surgeon), I could have cared for my dad better and I would not be disabled today.

Thanks again, Duke Medical - and especially the (IMHO) arrogant Dr. Alison Toth who unethically ignored and then, contrary to the medical regulations in NC, abandoned me as a patient.

Tuesday, June 1, 2010

Duke's poor treatment of my dad in the hands of the NC Medical Board

The months since my dad's death while a patient at Duke Medical have put me in a position of hearing other, equally disturbing stories about poor medical care and continuity of care at Duke Medical. Some of the most disturbing stories come from Duke Medical employees (esp nurses).

I am leaving the long story of dad's repeated poor care and treatment at Duke Medical in the hands of the North Carolina Medical Board. I also pray that the Joint Commission will adopt procedures that will require hospitals to communicate, coordinate and cooperate with Clinic staff, physicians and surgeons. I am particularly concerned and suspicious about the need for hospitalists in a teaching facility such as Duke.

The hospitalists at Duke have told me their function is to save Duke University Hospital Money (specifically, Dr. Bret Peterson). DUH has plenty of Fellows and residents that they do not need hospitalists - especially when the hospitalists undermine the opinions and recommendations of Fellows and Residents in front of patients and their families. That would be precisely what Dr. Veshana Ramiah did when she pompously told me that she was canceling all of the orders of the Fellows and Residents because *she* and only *she* was in charge.

My first thought was Dr. Ramiah was not qualified to study and earn post medical school appointments at Duke University. She seemed to have a chip on her shoulder, was (unlike the Duke Fellows and Residents) rude to my elderly dad and did not want to consult with anyone. That attitude is contrary to the DUH that my family has trusted since the early 1980s. but then again, back then, Duke was a premier institution.

And so I breathe a cautious sigh of relief. I have not been interested in suing Duke Medical. I worked for (literally) years with Duke Risk Management and Administration to improve the communication, cooperation and coordination between the Duke Clinic physicians and surgeons and the Duke Hospitals. Both my medical care and my dad's medical care had demonstrated a "power struggle" between the entities.

I hear every week from families whose lives are in turmoil because their loved ones, family members, patients die or are irreversibly ill as a result of that power struggle at Duke Medical.

Since dad's death in January 2010, I am a stronger advocate than ever before. No elderly man should be doomed to endure the mistreatment my dad received at Duke University Medical and their various and sundry entities.

And so, I filed a complaint with the NCMB and the Joint Commission about the poor (abhorrent) care dad received from September 2007 until his death in January 15, 2010. The errors were caused by the failure of Duke University Hospital and Duke Hospital in Raleigh to communicate, cooperate and coordinate with my dad's Duke clinic physicians and surgeons. I will add the highlights of the only other NCMB complaint I filed later. I am tired.

Dr. Mark Easley
(Dad's orthopedic surgeon from early 2005 until January 15, 2010)

(1) According to DUH administration's Ms. Sharon Maddox, Dr. Easley completely agreed with Dr. Ramiah's failure to treat the bone infection in dad's foot during the 08/09 admission and failed to consider/treat bone infection when dad's bones were not healing. Ms. Maddox stated that, according to Dr. Mark Easley, no action could have been taken during the August 2008 which would have changed the course of my dad's orthopedic course.

That was odd. Dr. Easley told me that an orthopedic consult should have been ordered during the August 2008 admission. And, according to what Dr. Easley told me in a face-to-face meeting, dad must be readmitted in October 2008 so that Dr. Easley could clean the foot wound out the way it *should* have been cleaned out during the August 2008 admission.

Dr. Easley told me that because of the failures in the August 2008 care at DUH, dad's foot may have to be amputated.

Dr. Easley and Risk Manager Sharon Maddox have told me two completely accounts. And since Ms. Maddox attributes certain statements to Dr. Easley, I am unfortunately left with the sense that either Mark E Easley, MD or Duke Risk Manager Sharon Maddox is lying.

(2) Dr. Easley expressed concern about dad's bone infection. However, Dr. Easley neither found dad a new Infectious Disease physician when the original physician (Dr. Anna Person) left Duke nor Dr. Easley act in such a manner which would demonstrate that "continued bone infection" was among his differential diagnoses for the failure of my dad's bone to properly heal.

Dr. Michael Morse
(Dad's oncologist from 2007-January 15, 2010)

(1) Dad's oncologist, Dr. Michael Morse, failed to follow his patient, my dad, during the November 2007 admission to DUH. Dr. Morse observed oozing, foul smelling infected skin infections on my dad's body. Dr. Morse wanted my dad to be admitted to DUH and undergo a course of three complete days of IV antibiotics.

The procedure at DUH is for the Duke Clinic physician (i this case, Dr. Michael Morse), to "hand off" his patient to whichever hospitalist happens to be on the floor.

Especially for an elderly cancer patient, the "hand off" should not be a cause for Dr. Morse to abandon or renounce all responsibility for his patient. Dr. Morse had an ethical obligation to make sure that the relatively new oncologist/hospitalist Dr. Hope Uronis was following his order of three days of IV antibiotics. Dad's dressings were never changed. They were the same dressings I applied when I brought his to Duke. Dr. Morse had an ethical obligation to make sure that his patients were treated properly, consistent with his orders (since he had a history with my dad) and certainly that my dad/his patient did not leave DUH a sicker man than he entered.

The day after the discharge (a Friday), I took dad back to Dr. Morse's clinic because no one at DUH gave me instructions on the wound care. In addition, my dad was in horrific pain from the untreated, infected sores.

I returned dad to Dr. Morse's clinic three days later (on a Monday). Dad was having difficulty breathing and was admitted through ED for severe pneumonia.

(2) After the discharge for pneumonia, Dr. Michael Morse failed to follow my dad on issues on low oxygen, pulmonary issues. This failure resulted despite the fact that Dr. Morse and his staff were informed by Duke PT Mr. Dana Pierson that dad's oxygen was routinely law. In fact, Dr. Morse's office cancelled the Duke Hospital Raleigh's order of oxygen (post pneumonia) for my dad without any examination or referral to specialist. From November 2007 and until dad's death on January 15, 2010, the pneumonia and issues of pulmonary and oxygen insufficiency were ignored completely by Dr. Morse. They were a non-issue

(3) Dr. Michael Morse failed to chart his April 2008 e-mail conversations with an unknown DUH radiologist regarding ablating a spot on my dad's liver. That failure meant that when dad received an ambiguous letter [that did not explain what part of the part of the body would be ablated, who would perform the procedure and who ordered the procedure].

I contacted Dr. Morse's NP to ask about the procedure since we had never discussed it. NP Cindy Simonsen told me that she saw no notes of a planned ablation or even a request or inquiry by Dr. Michael Morse on the issue. Cindy Simonsen advised me to ignore and just get to clinic at his next regularly scheduled appointment.

By the time I got dad to clinic a few months later, the liver spot had enlarged and was no longer able to be ablated. According to DUH radiology, there were e-mail correspondences between Dr. Morse and Radiologist about the ablation. Dr. Morse's clinic staff workers, including his NP whom his cancer patients rely on significantly, knew zero about the ablation plan.

So when family call, i.e. me, Dr. Morse's staff advised me the ablation procedure is not mentioned in the charting and is therefore an error.

Dad required additional chemo after the ablation was missed. He suffered terribly and was hospitalized in August 2008 under the care of Dr. Veshana Ramiah. (and that takes us full circle back to Dr. Mark Easley and dad's infected foot.)

Dr. Hope Uronis
(Hospitalist at DUH during my dad's November 2007 admission)

(1) Dr. Hope Uonis ignored a much more experienced oncologist Dr. Michael Morse's order that my dad's skin infection (apparently caused by FU-5 chemotherapy) required 3 days of IV antibiotics.

(2) Dr. Hope Uronis never ordered wound management and did not assist the family on discharge how to care for the wounds.

(3) Dr. Hope Uronis arranged for my dad to have a skin culture performed on his back. There were no bandages, oozing or foul smell emanating from dad's back. It would have made more sense to remove a bandaid (that had ooze coming through it) and culture that skin.

(4) Dr. Uronis' failed to consult with Dr. Morse who ordered dad's admission to DUH for 3 days IV antibiotics and that blatant failure to failure to properly care for my dad during the 3 days admission proximately caused dad to be readmitted (4 days post Uronis' discharge) with severe pneumonia.

Dr. Vashana Ramiah
(Hospitalist at DUH during my dad's August 2008 admission)

(1) Dr. Veshana told me without any evidence whatsoever in August 2007 when dad had just undergone 2 major surgeries and an ED visit for a UTI chemo related infection that my dad was demented and had years of dental neglect! The chemo sores were in his mouth. Dad could not talk and Dr. Ramiah literally laughed at dad to his face. Per Cindy Simonsen (NP for oncologist Michael Morse, MD) Dr. Ramiah "snowed my dad on Ativan" and then took an EEG to "prove" his brain was slow. Dr. Ramiah told me she refused to speak with dad's current treating Duke physicians and orthopedic surgeon because that additional information would "muddy the water." That is when I walked to the oncology clinic and found Cindy Simonsen.)

Dr. Gordana Vlahovic
(Hospitalist at DUH during my dad's August 2007 admission)

(1) Dr. Vlahovic failed to order consult for dad's then Duke Clinic urologist as promised. Dad had recently undergone prostate surgery and an ED visit where the bladder would not void. Dad had multiple upper UTIs. I personally contacted the urologist who told me he was never told his patient was in DUH. The urologist reminded me that often the only presenting symptom of an older man with UTI is altered mental state.

(2) Dad lost balance and hit head a week or so before the admit. Brain scan showed admitting subdural hematoma. When I arrived at hospital, the unknown but obnoxious Fellow asked me what I knew about my dad failing and hitting his head early that morning. I said "nothing, but you guys were here." The Fellow said she found dad on floor. Dad was scared and demanded to call my mom at approximately 2:00 am. No nurse mentioned that he fell at that time.

(3) Dad was discharged without a repeat brain scan. That seemed inappropriate since the fall was in his room! I asked the floor nurse if dad would be examined by a neurologist since he presented with subdural and then earlier that morning fell and hit his head in his room. She said that my dad was not a priority and that DUH only had one neurologist! The nurse told me that dad would have an outpatient neurology consult.

(4) While the discharge papers were (I thought) being prepared, I contacted dad's then Duke PCP Dr. Robert Holbrook. It was a Thursday and I wanted to get dad into Dr. Halbrook's office on Friday. I needed to know all to care for dad. Recall at this point, dad had not even started chemotherapy. He was having difficulty with bladder and two falls with head hit.

Dr. Halbrook asked to speak to the Fellow. I gave the phone to the female Fellow. She told Halbrook that Dr. Handy was fine. She lied/claimed that she obtained a urology consult. The Fellow told Halbrook that there was no reason for a PCP visit the next day. The Fellow said (in front of me and on my mobile phone) that "the daughter is a bit over-protective."

(5) No doctor would prepare, much less review with dad and I, a discharge summary. I actually have a blank discharge summary! And, note please this is the cancer floor. I left pushing my dad in a wheelchair and crying. I begged someone to go through a discharge summary with me. No one would. Female, foreign doctors just ignored me. (Just a description - I am not racist.)

(6) Dr. Vlahovic was no where to be found to assist with discharge.

(7) I will always remember her thoughtless advice that spoke volumes about her care of older patients: Dr. Vlahovic told me in September 2007 when dad only had a UTI: "place your dad in a nursing home because you have a life too."

Dr. Yuri A. Fesko
Hospitalist at DUH during my dad's November-December 2007 admission)

(1) Dr. Fesko did not properly prepare a pneumonia follow up or monitoring discharge plan with treating Duke oncologist Michael Morse, MD.

(2) Dr. Fesko signed a fraudulent Letter of Medical Necessity document more than two months after he treated dad (i.e. 2/2008) that purported to partner with April Durable Medical Care Supplier for dad to receive rolled walker.

Dad never received rolled walker because Dr. Fesko's Letter of Medical Necessity was either fraudulent or negligent or both. Dr. Fesko stated that my dad had CHF and needed the rolled walker for general ambulation.

I was concerned that dad might actually need a walker and not get it. I told Medicare in 2008 and I advised DUH Risk Manager Sharon Maddox. Ms. Maddox told me that it was not her problem, it was Duke Raleigh's problem. I called Dr. Fesko's staff and they effectively shrugged their shoulders.

The result was that my dad needed a roller walker in December 2009 and could not obtain one because of Dr. Fesko's actions. Without the benefit of a roller walker, my dad fell on January 02, 2010 and died 13 days later.