A picture is worth a thousand words. Todd Davis, did you let Hendersonville Health and Rehab kill my Mom?

This is what Mom's head looked like seven weeks prior to her fall at Hendersonville Health and Rehabilitation. Not only is there staples on the outside, but the skull itself is stitched inside. It takes up to one year for the skull to heal.
If I were a nurse or doctor, I would examine a patient with this type of wound if she fell, no matter what the circumstance. In the NCDHSR investigation notes, Todd Davis states that the nurse on duty( Lara Mooney ) an LPN, evaluated Mom after the fall, and decided she needed no further care. According to Mr. Davis, Dr Russell agreed with Lara Mooney LPN, and felt that in his "professional" opinion the nurse was correct in her decision.
Then on the next page, Mr Davis states that Dr. Larry Joe Russell saw her after the fall as he would any patient if he was on the property. I'm not sure what actually happened after the fall. I am sure that Dr. Larry J. Russell did not see her after the fall.
Did Mr. Davis forget that he wrote the first statement ? Did Dr. Russell forget which patient he was talking about , and answer two different times? Do that many patients at Hendersonville Health and Rehabilitation  fall on any given day that neither Dr. Russell or Todd davis could get the facts straight? Did Todd Davis actually approach Dr. Larry J. Russell two different times concerning the fall and get two different answers. The whole thing doesn't make sense.
This is just one of the discrepencies in the NCDHSR investigation. I have contacted Mr. Davis, now the Western regional director of the NCDHSR to get his story, and was denied. I then contacted Beverley Speroff, the NCDHSR section chief, and again was denied. The next step was Dr. Aldona Wos, the Secretary of The NCDHHS in Raleigh and was also denied.
If there is a flaw in the investigation process, shouldn't they want to know. How many other investigations are flawed as a result of Mr. Davis' incompetence? Are there people dying in nursing homes and the NCDHSR covering for the influential home owners?
As I have said in the past, I believe that the documents in my possession are extremely incriminating to the NCDHSR and therefore the NCDHHS. I have evidence that the nurses "late entry" by Lara Mooney, concerning the fall Mom sustained was created to prevent the NC State Medical Examiner from ordering an autopsy. The "late entry" was dated the day after the State Medical Examiners office was supposed to request Mom's records from Hendersonville Health and Rehabilitation. They were faxed from Hendersonville Health an Rehabilitation to someone on the next day and the day after that I was notified by the Medical examiner that they were not going to order an autopsy. The "late entry" states that Lara Mooney LPN witnessed Mom sliding out of bed, and that she specifically did not hit her head. The roommate's statement is that she woke up to Mom lying in the floor face down calling for help. She also states that she pulled the call light and no one came, then she had to call out to two CNA's passing the room to get help.
If the NC State Medical Examiner had received the roommate's statement they would have had a reason to order an autopsy. Was Lara Mooney's statement created to prevent an autopsy that could have proved the cause of  Mom's death? All I know is that it sure looks that way to me, and the documents support that theory. Why would the roommate fabricate a story in such detail?
Why would the NCDHSR be so opposed to looking at what I have found in their own documents. Is it because they are used to covering up for the mistakes made by the nursing homes. Is it because they are in the pockets of the wealthy nursing home owners and shareholders who also happen to be politicians in many cases. Could that explain the reason not one official I have spoken with is willing to even consider the evidence I have collected? Believe me I have spoken to anyone who would give me the courtesy of listening, and some that had to be coerced.
Who do you go to when you know something is wrong? The agency that has kept me from getting anywhere is the NCDHHS. If they would review their own findings and admit they made a few mistakes it would open many doors for other actions. If you consider that their " findings " prevented us from taking any other actions, you would realize the importance of my persistence.
When you look at the picture above, would you have had a doctor examine her. Consider that the picture is the actual picture taken after the surgery. How much healing can take place in seven weeks? Everything I found says it takes a full year for the skull to heal. Did Lara Mooney make the proper decision the night of the fall? All they did was take Mom's vitals and put her back in bed. All it takes to determine if there was damage to the brain is to check the pupils, they didn't even do that. Unless Dr. Russell actually saw her after the fall as Mr. Davis stated in one of his stories. However there were no notes anywhere in Mom's medical records that indicate that Dr. Russell ever even saw her. None of the family, that was there all the time ever saw Dr. Russell.
In my next post I will show the copies of the conflicting reports written by Todd Davis, and examples of the sloppy record keeping at Hendersonville Health and Rehabilitation.

NCDHSR , Comitted to serving the people of our State, or puppets of the big medical machine. Violating civil rights on a daily basis!

The following was copied and pasted from the NCDHHS website. The  comments in bold are my experiences in dealing with them.
The mission of the N.C. Department of Health and Human Services is, in collaboration with our partners, to protect the health and safety of all North Carolinians and provide essential human services.
The mission of the Division of Health Service Regulation is to provide for the health, safety and well-being of individuals through effective regulatory and remedial activities including appropriate consultation and training opportunities and by improving access to health care delivery systems through the rational allocation of needed facilities and services.
We will focus on: customer; employees and work teams; managed care and traditional providers; and outcomes and continued improvement. We will carry out our activities by being: responsive; respectful of others; collaborative; and communicative and committed to serving the people of our state.
First of all the NCDHSR is not looking out for the " health, safety, and wellbeing of individuals. This is obvious in the fact that they will not even discuss, let alone explain the discrepancies and false statements in their investigation reports. I have asked specific questions related to the complaint investigation regarding my Mother's situation.
I started with the Western Regional Director, Todd Davis, no response. Then I went to Beverly Speroff, the division chief of the NCDHSR , she basically dismissed my questions and told me I could file another complaint.
Next step was Dr. Aldona Wos, the secretary of the NCDHHS, appointed by Governor Pat McCrory. Her response was the same as the others, they were not willing to comment on why their report was full of false information and incomplete records. I challenge the legality of their refusal to "collaborate, and communicate with the people of the State of NC.

The North Carolina Medical Care Commission was established in 1945.  In 1946, the commission was designated as the agency empowered to administer the Hill-Burton program within the state.  Pursuant to the Executive Organization Act of 1973, the 17-member Commission was incorporated into the Department of Health and Human Services.
The commission has the duty and power to promulgate, adopt, amend and rescind rules in accordance with the laws of the state regarding the regulation and licensing or certification, as applicable, of hospitals, hospices, free standing outpatient surgical facilities, nursing homes, adult care homes, home care agencies, nursing pools, facilities providing mammography/pap smear services, free standing abortion clinics, ambulances and emergency medical services personnel.
In 1975, the North Carolina General Assembly enacted the Health Care Facilities Finance Act, which enables the commission to issue tax-exempt revenue bonds to finance construction and equipment projects for non-profit and public hospitals, nursing homes, continuing care facilities for the elderly and facilities related to the foregoing.
When all of this began, one of the members of this commission, Gerald P. Cox, was directly connected to the owners of Hendersonville Health and Rehabilitation. Mr Cox was also the owner of Autumn Care Nursing Homes in North Carolina and Virginia. This commission has the authority to promulgate, adopt , amend and rescind the rules governing nursing homes. Is it not a conflict of intrest for an owner of nursing homes is on the commission that regulates them? I for one question the integrity of Mr. Cox and the other members of the commission. Is anyone naïve to believe they are not serving themselves and their friends rather than the public interest?

The Nursing Home Licensure and Certification Section   regulates nursing homes by conducting routine   surveys and complaint investigations. It provides licensing services such as changes in beds and ownership. It provides regulatory education to promote compliance with Federal regulations for   Medicare/Medicaid certification.
If this is the case, Medicare and Medicaid are in serious trouble. Is it just a coincidence that Governor McCrory refused all that Medicaid money? Is it possible that he didn't want the Feds looking at what the money was spent on and who benefitted from it?
He does appoint the Secretary of the NCDHHS and the members of the Medical Care Commission. Why let the Feds in on your private little party of friends.

To sum it all up, if you have a problem with any branch of the NCDHHS you are simply out of luck. Even if you can prove that mistakes were made, and they did not do their jobs, who is going to listen? I've been trying for three years and believe my Civil Rights have been violated by several agencies including the NCDHHS, Office of the Inspector General, and even the FBI. What do you do about it, I haven't got a clue but I will continue to demand that my rights are no longer violated. This is a prime example of how private corporations are in charge of our Government. This has to be stopped before it is too late, if it is not already! 

Todd Davis, Western Regional Director of the NCDHSR. Promoted because of incopetence or doing someone a favor?

In my last post I spoke of the need for reform in regards to the way the nursing homes operate. This post I will provide some of my own ideas on what I feel is needed.
First I will start with the North Carolina Department of Health Service Regulation NCDHSR. This is a branch of the North Carolina Department of Health and Human Services, which is the State level branch of Health and Human Services, a Federal agency.
The NCDHSR is responsible for the enforcement of nursing home regulations. They are the ones who are actually doing the inspections allowing the nursing homes to maintain their licenses. They are also the ones that conduct any complaint investigations against nursing homes. The investigations, or "surveys" are conducted by personnel hired from the nursing industry. They conduct their investigations in teams. They supposedly review medical records, interview residents and staff, and conduct walkthrough inspections.
When they are conducting an inspection they first report to the Director of Nursing to announce their arrival. The Director of Nursing then announces over the intercom that there are State inspectors on site. They also post a sign on all entry doors alerting anyone entering the building that they are being inspected. In my opinion, this is the first thing that needs to change. How do you expect to properly inspect a facility when the staff has an advance warning. The inspectors are usually the same people as well. The first thing the staff does is hurry from room to room to correct anything that was cited in previous inspections, or that is obviously a violation of the rules.
I would propose that inspections be conducted without warning or announcement. Do they really expect the staff to go about business as usual, knowing someone is watching? What would happen if the inspectors walked in the door just as visitors do? I am guessing that they would find more violations than they could write down. The way they carry out these inspections, it appears they don't want to find violations.
 I realize that some of their rules are not as important as others, however they are still rules. As an example, they are supposed to post the staff levels and resident population daily in a conspicuous place. I was in Hendersonville Health and Rehabilitation during an investigation and the information posted was a week old. I reviewed the results of that investigation, and there were no violations found. Were they really looking or are these investigations simply a formality.
I also propose that someone who is not a former nursing home employee be on the team. I understand that there are HIPPA concerns, but these people would be no different than a receptionist in a doctors office. I believe that when you work in the business, you are used to working under staffed and out of empathy, ignore violations.
Then there are the interviews with residents. I am sure that most residents are afraid to tell the truth. They are already getting substandard care, and experience a great deal of intimidation. Knowing the workings of Hendersonville Health and Rehabilitation, the residents interviewed are probably chosen by the Director of Nursing. The ones that I've read do not reflect the overall treatment of patients.
There are also surveyors notes sheets. In Mom's case the surveyors notes contained two statements concerning a fall, each one said the opposite of the other. I was told that they were just a statement made by the Doctor. That is evidently enough for the NCDHSR, even though they are contradictory. I even went so far as to send them a copy of the notes, and asked for an explanation. They replied that the investigation was done in the past and that I could file another complaint if that wasn't good enough. Coincidentally the lead investigator Todd Davis, the same person that wrote the conflicting statements was promoted to regional director. Obviously incompetence is rewarded within the NCDHSR.
Reform would have start by dealing with the incompetence of the NCDHSR. Which would then lead to the NCDHHS. When I contacted  Aldona Wos the Secretary of the NCDHHS, I was basically told that they would not even answer the question of why there were two different accounts of one incident.
More to come, this is just the beginning of what needs to be reformed!

With the politicians owning and financially benefitting, where will the reform come from? Certainly not the NCDHHS, they work for the politicians!

I am sitting here this morning thinking about what has happened in the last three years. My brother and I have reached out to countless people in order to determine if Hendersonville Health and Rehabilitation and Dr. Larry Joe Russell, violated any laws or regulations. We have found that they continue to operate with no fear from anyone.
I have been inside Hendersonville Health and Rehabilitation this year over a one month period visiting a friend. In that time I personally witnessed many violations of NCDHSR regulations. There was even a NCDHSR complaint investigation conducted during that time. Even with the sign on the front door stating that there was a NCDHSR investigation going on, I still witnessed violations.
The problem is that the DHHS refuses to listen to the public. They will side with the nursing home every time. Try to dispute any of the DHHS findings and see how far you get. I have in my possession documents that are full of inaccuracies and sometimes even contradict themselves. When I contacted Beverley Speroff, the chief of the nursing home licensure division of the NCDHSR, I was told they were not willing to look at the documents. I even went so far as to ask for clarification of the documents, again refused. I sent a list of specific questions pertaining to the investigation they supposedly conducted on my complaint. They refused to even answer any of the questions.
I then took it to the next level, I contacted Aldona Wos, the Secretary of the NCDHHS. I simply explained my situation and asked for her to intervene. The first letter I sent was ignored, the second was sent registered mail and I did get a response. The letter made no reference to the first letter and was from Secretary Wos's chief of staff. Again they refused to even look at the report. It seems that they have no concern for the public safety. They also could care less about the concerns of a voting citizen of the United States and North Carolina. The reason is they are not elected, they are appointed by the Governor.
As I have stated in the past I am receiving help from a United States Congressman. It took several emails to get through to him, I finally went to his office and met with a staff member. I have requested a meeting with the Congressman himself, and have never been granted that meeting. The same Congressman was here to participate in a local parade before the elections, but no time to meet with me. I feel that he is trying to help, but either he has too many friends connected to the nursing home business, or he just doesn't want to get into something so big.
In my last post I wrote of politicians benefitting from " Obama Care ", specifically the Frist family. This morning on Meet the Press, they were discussing Congressmen and Senators and their rise in economic status in recent years. What a surprise that was right? Then while speaking about income amounts, they stated that Congressmen and Senators do not have to list in their income ownership interests in properties in their reports. Is it any wonder that there are many members of the Senate and Congress that own nursing home properties. I am not implying that the Congressman that I'm dealing with is one of them. I would be willing to guess that he has a few friends that are profiting from ownership in these homes.
It is truly a disgrace that with all the money they are making, they still cant ensure the residents needs are satisfied. I'm not talking about facials and massages, I'm talking about basic care. Things like showers, help eating, assistance with toileting, and even making sure they get the right medication at the right time. A resident in a nursing is simply a source of income for people that are already wealthy. This industry cries for reform, from the NCDHSR down to the ownership and operations. However with so many politicians involved in the ownership of these places, I don't know how there will ever be reform. Why would they do something that would take money from their own pockets. Especially if the only people benefitting would be the elderly residents who probably don't even vote. Why would they give up the $5.00 or so it would cost to get a shower, if they could put that $5.00 in their pockets.

This morning I woke up with tears in my eyes, I had been dreaming about my Mother.

This morning I woke up with tears in my eyes, I had been dreaming about my Mother. It has been a while since I had felt that aching pain of loss. I think about my Mom and Dad often and the memories are not the painful kind. I am not sure what brought this dream on, but I imagine it is the approaching holiday season.
It is important to explain that I am a Christian, I believe in heaven and know Mom is on that list. I also believe we are supposed to forgive those that hurt us. I have forgiven those who I believe to be responsible for Mom's death.
So why do I continue to write about things that led to Moms death ? As a Christian am I not supposed to forget what happened. After all, people say that whatever happens " it is God's will ". Although this is supposed to be comforting, in some instances it is ridiculous. God gave people free will, that doesn't mean that whatever people do is God's will.
I believe that God needs soldiers who are willing to fight the evil that exists in todays society. I do not think we are supposed to let others treat people as they wish. To accept the mistreatment of elderly helpless patients in nursing homes is apprehensible. The willingness of the governing authorities to turn their heads and let this happen is infuriating. It is also obviously accepted by politicians, because they refuse to get involved in reform or enforcement of the laws.
I kept asking myself what reason would a politician have to ignore a situation that cries for reform. Why wont anyone listen to my concerns and act on the proof I have of wrongdoing, Medicare fraud, antitrust laws, and numerous DHSR regulations being violated regularly with no fear of repercussion. Isn't healthcare reform a major topic of both political parties at election time? Well this election cycle is over and nothing has changed.
I keep reading about how terrible the affordable care act is for our country, and how the Republicans want to repeal it. Yesterday I came across several articles that would make the following statement false. Here is a portion of one of the articles;  Bill Frist is the former U.S. Senate Republican Majority Leader from Tennessee. During the heat of the health care reform debate, he sang the praises of President Obama's health care reform. His stance raises the question, "Why"? Then I found another article that answered the question. Here is the beginning of that article; One of the nation's biggest beneficiaries of the Affordable Care Act, Thomas Frist has seen his fortune rise by $1.5 billion, along with shares of his hospital conglomerate, HCA Holding. Is it a coincidence that they share the same last name, no it is father and son. What a gift to give your dad $1.5 billion dollars.
There is the problem, politicians owning the businesses that are benefitting from a lack of reform, and the lack of regulations being enforced. The Frist family doesn't care how many others woke up with tears this morning or any other morning. They care that their family is getting so rich they couldn't possibly spend all the money they are making. Here is a quote that explains it all, I'm not sure of the origin of the quote but I got it from my preachers Facebook post.
"But to demand justice where there is no righteousness, no interest in righteousness, no willingness to be righteous, is to demand to breath air under water. It cannot be." Does the Frist family have a willingness  to be righteous? Is there any politician that has the willingness to be righteous, even at the cost of their political office? We can only hope so, but I am not very optimistic!
My mom died at Hendersonville Health and Rehabilitation a SanStone property. SanStone does not own it, but the owners of SanStone own most of the company that does. They also own Beystone in Fletcher, which is going to close when they finish construction of The Lodge in Mills River. Other SanStone properties include Stonecreek H&R, Madison H&R, Oak Forest H&R, Sanford H&R. According to the NC Secretary of State's office , this year they also registered properties in Anson County NC, Rutherford County NC and Wake County NC. Although this took place in April of 2014, I can only find record of one of them on the Medicare.gov nursing home compare website.
I have read articles about SanStone buying other homes, and actually had workers from these places contact me about their concerns. They were lied to about what was taking place and the next thing they were owned by SanStone.
I have found many reasons to believe that SanStone is politically connected to the same lawmakers as the Frist family. They are directly connected to Gerald P. Cox who is on the NC Medical Care Commission appointed by the Governor to administer the appropriations of government funds for building and improving nursing homes. I am sensing another lack of willingness to be righteous.
I forgive them for letting my Mother die without respect and dignity. However I will do everything I can to stop them from exploiting any other helpless elderly person. I could sure use all the help I can get, I am not wealthy enough to be heard nor do I have the support of the others in similar situations. Is this really going to be written off as " it's God's will " or are there other soldiers willing to fight? Are there people willing to be righteous?

Hendersonville Health and Rehabilitation and Sanstone, do your job, and earn all that Medicare money you're taking!

The third anniversary of Mom's death has come and gone and the memories of her last days are still haunting me. The fact is that Hendersonville Health and Rehabilitation and SanStone are still being allowed to ignore NCDHSR regulations.
After Mom died I had to visit Hendersonville Health and Rehabilitation several times to obtain records and such. After that I had no intention of ever going back there again. Then earlier this year, a member of my church family was admitted to Hendersonville Health and Rehabilitation. He was nearing the end of his life due to cancer. I'm not sure how I got the courage to go through those doors again, but I went to visit him there.
I drove up to the building that was so full of bad memories, parked my car and took a deep breath. Walking up to the door was one of the most difficult things I have ever had to do. Then when I stopped at the desk I was directed to his room. He was in room 101 A, it must have been a test or something. The same room and bed that Mom spent her last night in. I had not been in that room since November 2, 2011, the day before Mom died.
I walked down the main hallway feeling like the walls were closing in on me. I looked at every nurse and wondered if they had known my Mom. I actually walked by Tammy Mace, the nurse that found Mom the morning she died. I turned the corner and there was the desk where I was told Mom was not responding and had been sent to Pardee hospital. And then I turned the corner and there was the room, I hesitated for a moment then went into the room. There was my friend lying in the bed my Mother had died in.
That's when things changed, all I could think about was the man lying there knowing he was near the end of his life. I visited him regularly, and the other stuff seemed to go away. At first he was pretty much in bed every day when I arrived. I would sit on the edge of the bed and listen to his stories and tell him mine. As the days went on he was able to participate in some physical therapy. I would sit with him as he did as much therapy as he could. One day when I got there he actually took a short walk with a walker. He would ask about my day and I would ask about his.
As the days went on I started seeing the same things that I had seen in Mom's records. The nurse would come in and tell him they didn't have time for his shower that day. His oxygen mask didn't fit right and was cutting into his face .After  several days they finally got one that fit him. His clothes were not always clean and he needed help reaching his water.
Then he started losing his strength and would be less able to participate in therapy. I asked if I could take him outside for a while. We sat in the sun and talked till he started getting cold. Then back inside for therapy, which didn't last very long. He was wheeled back to his room, and the nurse asked me to try to keep him in his wheelchair for another twenty minutes. While we were sitting there talking, he stopped talking momentarily. I asked what was wrong and he looked down to the floor where there was a puddle of urine. I asked if he wanted me to get him someone to help, he said he would just wait till they put him to bed. After ten minutes or so he asked me if I could get someone to change him. I went to the nurses desk and asked for help in getting him cleaned, the nurse told me to push the call light and someone would be in. It took at least another fifteen minutes till the nurse showed up. Then they just changed him and put him in bed.
He maintained his positive attitude but felt like he was a bother to his caregivers. More and more I realized that things were actually worse than we thought with Mom. They didn't even seem to care whether anyone saw how they treated their patients. They were always short of staff and the quality of care suffered. I would visit on weekends and there was hardly any staff at all.
My friend made it through his twenty one days that Medicare approves and he had to be moved. It was decided he would be moved to an assisted living facility. I visited him at Hendersonville Health and Rehabilitation the day before he was to be moved. The next day my family and I  went out of town for spring break. He died the day I came back from my trip. The last time I got to visit him was in Hendersonville Health and Rehabilitation.
I am thankful for our time together, I'm not sure who was actually helping who. Scott helped me get past many things and I hope I helped him in the end of his life. As Christians we talked about religion and our beliefs, but we also talked about food, driving and Family. I miss my friend but I know we will talk again some day.
Hendersonville Health and Rehabilitation has no regards for the NCDHSR regulations. They have no fear of being cited or fined for their actions. The point of this story is that they were not providing adequate care in 2011, and they are not providing adequate care in 2014. The NCDHSR has no interest in finding violations or enforcing their own regulations now, and they had no interest in 2011 either. Based on the actions of the NCDHSR, elderly people have no right to be treated with dignity or respect while in a nursing home. Shame on them for what they allowed to happen to my Mother and my Friend.

Three long years and still no answers.

On this day three years ago, mom was getting ready to go home. The staff at Hendersonville Health and Rehabilitation had determined that she had "reached her goals". In other words her Medicare would no longer cover her stay. She died early that morning.
It had been decided that she would stay at my sisters house for a while till she was strong enough to return home. The decision was ultimately Mom's to make and most of the family supported her. There were things to do and everyone was making sure Mom would have everything she needed when she was discharged.
During her stay at Hendersonville Health and Rehabilitation, Mom had been participating in physical therapy and gaining strength every day. This would not have been necessary had she not been forced out of Memorial Mission Hospital before she was ready. Care Partners was a waste of valuable Medicare dollars, with no benefit to Mom's health from her stay there.
In the afternoon on November, 2 2011, my wife and son picked Mom up at Hendersonville Health and Rehabilitation. The afternoon was spent going to the bank and then to Wal Mart, for a new pair of jeans to wear home. After shopping, Mom returned to Hendersonville Health and Rehabilitation for her final night. Everything was going according to schedule.
Thursday November 3, 2011, at 5:07 am my cell phone rang. I was up and getting ready for work. I answered the phone and the voice on the other end told me that my Mother was not breathing and they were trying to resuscitate her, that's all she knew. I told my wife what was going on and drove over to Hendersonville Health and Rehabilitation. When I arrived I had to ring the bell to get in the door, it was like a ghost town, there was one girl that let me in and then I found Tammy Mace RN behind the desk on Mom's hall. She had no more information and told me they had taken Mom to Pardee Hospital by ambulance.
I drove straight to Pardee and pulled up just as they were wheeling a patient in from the ambulance, I'm sure it was Mom. I went into the emergency room and was told to wait out front. After five minutes or so they came and took me to the family room, where I waited for the Dr. to come. Another five minutes and DR. Boleman, and a nurse came in to tell me Mom never recovered consciousness and had died. Everything just stopped and I couldn't say anything. My wife and younger son arrived soon after and we all cried together. That was the beginning of this story, since that day I have been searching for the truth.
After all the documents and records I have been through and all the people I've spoken to, I still cant say for sure what actually happened. I believe that the fall Mom had sustained in the early morning hours of  October 30 was the cause of her death. I have many reasons for my suspicions. I have documents that conflict witness statements, a " late entry " in the nurses notes concerning the fall. The same " late entry " on a separate page from all the other nurses notes was faxed somewhere the day before the NC State Medical examiners office refused to authorize an autopsy. Their decision was based on the review of Moms medical records they had obtained from Hendersonville Health and Rehabilitation.
I believe that if Dr. Larry Joe Russell had examined her after the fall, she would still be alive. Lara Mooney Rn is the one who wrote the late entry concerning the fall. It was apparently her that decided Mom did not need to see a doctor. Hendersonville Health and Rehabilitation is guilty of lying to protect their reputation. And the NCDHSR has allowed them to do so and refused to even look at the proof that I have. Three years and still no answers.

"SanStone our passion makes the difference" Really !!!!

October 19, 2011, that was the day they moved mom from Memorial Mission Hospital to Hendersonville Health and Rehabilitation. It finally looked as if she was headed down the road to recovery. This time she was strong enough to actually benefit from the rehabilitation and physical therapy sessions.

It was later in the afternoon on that Monday when she arrived at Hendersonville Health and Rehabilitation. I remember my sister and I were there when the cna came in to get her personal information. Everyone felt that Mom was going to overcome the effects of the surgery and return home. It was apparent that it would still be a while, but she was expected to make a full recovery!
I will never forget the first night, sitting there and hearing the woman across the hall screaming. I am sure Mom was probably scared to death. Her fear was that she would die in a nursing home. We were all convinced that was not going to happen. I would guess that she did not sleep much that first night due to the screaming and howling across the hall.

The next day Mom got a roommate, she was very nice and a visit to Mom included a visit to her as well. She was in Hendersonville Health and Rehabilitation just for iv medication, I would guess her age somewhere in the late 30's to early 40's. She was a blessing, she would always try to help Mom when she was able.

The first week was an educational experience for all of us. After Care Partners and Mission Hospital, someone from the family would be there most of the day. My sister spent the night in a chair for the first couple of days. Someone would stay and help Mom with dinner, and stay till nine or so.  As Mom gained her strength back we started to feel more comfortable leaving her alone at night.
The roommate would fill us in the next day about how the night went. Everything seemed to be going well.

Mom was participating in the therapy and doing great. When I would visit in the afternoon, she would be in therapy. Mom was doing everything she could to get out of there. She was still needing help toileting as she could not see very well. Then one during my morning visit, I was going to help her to the restroom and when she pulled back the covers she was naked from the waist down. I got one of the cna's to assist her and dress her.

 I went to the director of nursing, Susan Habel, and was told that sometimes they have to let them "air dry ". This was when we started to notice certain things were not right. One afternoon, Mom  asked my brother to see if she could get a shower, said she was getting "fragrant ". He spoke to the cna on that hall and she said she had three or four others waiting but she would make sure Mom got a shower. Mom had a voice recorder and one of her recordings stated that it was three o'clock in the morning and she had not had her shower yet.

We complained and a meeting was scheduled with the social director and Susan Habel RN the Director of Nursing. I was not able to attend the meeting, but my sister and brothert did. There was no mention of the problems we had discussed, they just started talking about Moms discharg.
Thats when things got serious, Mom fell on the 29th of October, 2011. Hendersonville Health and Rehabilitation called my sister and informed her of the fall and supposedly informed Dr. Larry Joe Russell. According to which one of Dr. Russell's statements you read. One says he saw her as he would any patient who fell while he was on site, the other says he did not see her and that he agreed with the nurses evaluation that she didn't need to be seen. Both these statements are in the NCDHSR investigation of our complaint. I tried to get them to explain how DR. Russell did both see her and not see her in the same day? I was totally blown off by the NCDHSR. Their report is full of lies and falce statements. From their own documents I believe it is obvious that the "investigation" wasn't taken very seriously by the NCDHSR. I'm sure they see this kind of stuff regularly, and just turn their heads. I dont know how Todd Davis, Kim Britt and Paul Yockey of the NCDHSR can sleep at night.

I bet none of them could sleep at Hendersonville Health and Rehabilitation. I gurantee you their parents will never end up in Hendersonville Health and Rehabilitation either. My Mother died three years ago in Hendersonville Health and rehabilitation. Her greatest fear became a reality. The cause of death had nothing to do with what she had been admitted for. The real cause of death is the low staff levels at Hendersonville Health and Rehabilitation.

The company who operates Hendersonville Health and rehabilitation is SanStone Health and Rehabilitation. Their telivision and print ads state " Sanstone, our passion makes the difference ". I guess their passion is to run substandard homes with low staff levels and get rich. My Mom is gone and I am at peace with that.  It's just that people need to open their eyes and see who these people really are. Thats what drives me to continue on my quest for the truth, I welcome any help!

NCDHSR and Hendersonville Health and Rehabilitation, Volentary Manslaughter ?

Three years ago, I would never have imagined I'd be writing about these issues. Like most people I assumed that the people watching out for the elderly were actually doing their jobs. That is the furthest thing from the truth. As I learned how slack the NCDHHS regulations were on nursing homes, and how they were not even enforcing them, the journy began.
I never would have dreamed I'd have any reason to call the the State Bureau of Investigation, the
NCDHHS, two different Congressmen, the NC State Medical Examiner, Centers for Medicade and Medicaid Services, The Office of the Inspector General, NC State Medical Board and NC Board of Nursing. And if you told me I would have two meetings in the office of the F.B.I., I would have told you you were crazy.
But that was three years ago. And believe it or not, the above is just a partial list of people I have spoken to. Anyone heard of the office Ombudsman, Carolinas Center for Medical Excellence, NCI Advancemed, North Carolina Department of Medical Assistance,
My Mother died in the hands of greedy nursing home owners and theives at Hendersonville Health and Rehabilitation. In the days following Mom's death, I started to see many reasons for concern. Questions were only fueled by the number of people who had died in that same facility in just a few months time. I origionally counted eighteen in a little over two months. That seemed to be a lot of deaths for a "Health and Rehabilitation" facility. Maybe they should change the name to "Hendersonville if you're lucky you get out alive and Rehabilitation".
As time went on, I was more and more convinced that something had gone wrong and Mom did not die a natural death. Immediatly I questioned why the death certificate was signed by Dr. Larry Joe Russell instead of the Emergency room doctor. I was told Dr. Russell was Mom's doctor at Hendersonville Health and Rehabilitation which was a surprise because no one in the family had ever met him or heard his name.
While picking up the death certificate for the estate paperwork, I looked through the books at the courthouse. Dr. Larry Joe Russell has signed a whole bunch of death certificates. Over two thirds of them, the cause of death is listed as "failure to thrive". Most of them died in one of Henderson County's many nursing homes. Dr. Russell is the Doctor of record at all the local homes and the medical director at the Laurels of Hendersonville.
I cant prove what happened to Mom was not due to natural causes. What I can prove is that the medical records from Hendersonville Health and Rehabilitation are incomplete, inacurate and sometimes just false. I can also prove that Dr. Russell never saw her.
Mom's medical records prove that they are playing games with medications, and committing Medicare fraud. I can also prove that the North Carolina Department of Health Service Regulation, a division of NCDHHS, is allowing this to happen. I have documents that indicate that the NCDHSR is committing Medicare fraud by allowing them to operate without true regulations.
With all that said, I have been unable to get any response from any of the agencies listed above. Not the NCDMA, CMS, OIG, CCME, OIG, NCBON, NCME, FBI or the NC Medical Board. The one thing that keeps holding me back is the ficticious report by the NCDHSR and subsequent " medical review. The NCDHSR should be charged with volentary manslaughter and the investigators prosecuted.
I currently have a request with the Freedom of Information Act for a complaint inspection of Hendersonville Health and Rethabilitation that was completed the day before Mom died. The status of that request is pending since March of this year. My brother has a Freedom of Information Act request for documents from NCI Advancemed that has been pending since September 2013. They are all trying to keep us from finding out the truth.


According to one publication Dr Russell had seen over 4000 patients in the year 2012. That doesn't account for his stable of FNP's and PA's. According toa study from The Annals of Family Medicine, one doctor can reasonably help 983 patients in a year working solo. As part of a team, delegating tasks properly, the same doctor could reach 1,947 patients.
Even if you include his "team" thats more than twice what the Annals of Family Medicine says they reasonably see in a year. Maybe thats why so many of Doctor Russell's patients die.

SanStone, Care Partners, Hendersonville Health and Rehabilitation, licensed to kill by the NCDHHS ????

After twenty one days at Care Partners, they decided that Mom was ready to go home. She was still not eating well and was barely able to walk. Again, if someone in the family had medical power of attorney we could have disputed the release.
Care Partners did little to rehabilitate Mom, they simply put her in a room and kept her from falling out of bed. They did not help her eat and the rehab was a joke. The simple truth is Mom was not ready to be released. She was forced out of Mission hospital before she was ready and now Care Partners was doing the same thing. If someone had medical power of attorney we could have
protested her release. They would have had to reevaluate and Medicare would have had to pay for her care during the process. But twenty one days is twenty one days, and Mom wanted to go home.
Care Partners did help with obtaining all the necessary home medical supplies, from their recommended providers. I would not be surprised to learn that the providers were owned by the same people as Care Partners.
Mom was released from Care Partners and sent home. She was still unable to care for herself and the family tried to take over where Care Partners left off. My sister spent the night sleeping in a chair at the foot of Mom's bed, and each of us helped when we were able. Mom was able to stay in her house for a whole week before she was readmitted to Memorial Mission Hospital. Proof that her initial release was premature. This time they kept her for about two weeks and then they sent her to Hendersonville Health and Rehabilitation.
Mom was admitted to Hendersonville Health and Rehabilitation on October 19, 2011. Her doctor, according to the records was Dr. Larry Joe Russell. I have obtained a copy of Mom's records and there is no indication that Dr. Russell Ever laid eyes on my Mother. There are no notes from Dr. Russell in all of her records. Anything that had to be signed by her doctor has Dr. Russells initials on it, usually three to ten days after it's origional date.
Hendersonville Health and Rehabilitation is operated by SanStone Health and Rehabilitation. SanStone Health and Rehabilitation is owned by Christopher Sprenger and Michael Deloach. The Sprenger family owns numerous nursing and rehabilitation facilities, starting in Ohio. Sanstone is spending lots of money advertising, their slogan is " Our passion makes the difference". I would have to agree with that statement, their passion (for making money) is why the care is substandard in their homes. Can you say understaffed? Go into Hendersonville Health and Rehabilitation on the weekend, early in the morning, or after seven at night. Try to find a nurse or cna when you need one. It really doesn't matter when you go, there is never enough staff.
According to the North Carolina Division of Health Service Regulation, they are required to post the staffing details in a public place. I was never able to find where they posted it, and when I did it was out of date. I requested a copy of the staffing reports for the dates Mom was in Hendersonville Health and rehabiloitation. They sent me the information, twenty one days of a form that was filled out in the same handwriting every day. I doesnt break down the times or anything, just the total number of hours worked in a day. What they do is put the majority of staff on in the daytime when people are most likely to be visiting.
It is important that anyone reading this understands that this has been going on for three years. My brother and I have spent countless hours going through the medical records. We could also write a book on what we know about the way nursing home ownership works. We have made numerous attempts to get the NCDHSR to hear our case, to no avail. I have gone so far as to send a certified letter to Aldona Vos, the secretary of the NCDHHS. I received a letter from her chief of staff stating that the matter was closed.
Lets just say that there were things in the records that were not accurate, or even incriminating, wouldn't they want to know. Keep in mind, they are responsible for licensing and inspecting these homes. Who am I supposed to go to if there is something the NCDHHS did, that needs to be explained? There is not one governing authority that will allow me to show them the information I have. So much for representation! 



Footnote:
Thomas Franke, Chairman of the board of Care Partners is also on the board of Omega Health Care Investors. Omega is a major player in the healthcare business as is Mr.Franke.
There was a time when the governing authorities would take a look at Mr. Franke and all of his business relationships. That was before corporate contributions took over our government. It would take an act of congress to get anyone to question Mr. Franke's  financial relationships. The irony is that Congress is basically in the pockets of Mr. Franke and people like him so that will never happen. God help us all!

Memorial Mission Hospital, and Care Partners, shame on you !

This time three years ago was probably one of the worst times in my life. Mom had surgery on the 7th of September 2011. The surgery, a craniotomy was scheduled due to her worsening eyesight. Dr. Harold Picus was the surgeon who performed the surgery at Memorial Mission Hospital in Asheville NC.
According to Dr. Picus, Mom was expected to make a complete recovery. The surgery involved opening the side of her skull to access the pituitary gland where the tumor was located. Needless to say when the family was allowed in to see Mom after the surgery it was quite a shock to see all those staples in the side of her head. The recovery was taking longer than expected and Mission was in a hurry to get her out of there.
Mom was in ICU for the first five days or so, and then she was moved to a private room. She was not able to eat for another couple of days. After several more days she was able to eat a small portion of her dinner. Mom's appetite was nowhere close to what it was before the surgery, but it was enough to get Memorial Mission Hospital to force her release. Not one of us knew enough to get medical power of attorney, or how to protest her release. She was obviously not ready to go anywhere, but the doctors convinced us that she had a small window of opportunity to get into Care Partners. One of the doctors at Mission told my brother Medicare would refuse to pay if they waited too long.
My brother spoke to the nurse at Mission Hospital who was preparing the papers for Mom's discharge. He pointed out the fact that Mom was not ready to be moved, she left the room and returned a little while later. She was crying and told my brother that she had postponed the release but she could only do so much. She was moved by ambulance two days later to Care Partners in Asheville.
Things were starting to get really complicated. Medicare will pay for twenty one days of rehabilitation. Mom was put in a room and pretty much just left there. The family took turns feeding her and taking care of what we could. We were even bringing food from home and restaurants . The staff would wheel in the meal cart and just leave it. Mom could not see well enough to eat on her own. Care Partners answer was to keep giving her Ensure instead of feeding her. The only thing Care Partners did do, was make damn sure Mom did not fall. If she moved wrong and set off the bed alarm they were in there really quick. Tension was getting bad within the family, each of us had our own idea of what was best for her. Still, no one could bear the thought of having Mom declared incompetent.
Believe me, looking back now someone should have had medical power of attorney before the surgery even took place. Mom had downplayed the whole thing, probably in an attempt to keep peace in the family. Mom could have disputed her release, but she did what the doctors told her to do. They even asked her if she was ready to go to Care Partners, her answer was " if you say I am ".
Anyone having any surgery should have a medical power of attorney. If you do not you are totally at the mercy of the medical community. They will keep you as long as they are getting those Medicare dollars, then you're on your own. It's amazing that after twenty one days at Care Partners, it was decided that Mom was ready to go home. She was still not able to walk without assistance and was barely eating. Twenty one days is twenty one days. More to come

Aldona Wos, Mark Payne, Todd Davis, Beverly Speroff, what are you afraid of ? Who are you protecting ???

After two weeks, I finally received a response to my letter to Mark Payne the chief of staff of the NCDHHS.
The letter was a request that they review the investigation notes from my complaint against Hendersonville Health and Rehabilitation. I had included three pages of notes from Todd Davis, the lead investigator. Parts of those pages were highlighted to show inconsistencies, and there was also a list of questions. I was simply trying to understand how the report could be so wrong about so many things.
In the report Todd Davis states that Dr. Larry Joe Russell had seen Mom the morning after she fell as he would any patient when he came in that morning at 5:30. On page three of the same report, Mr. Davis states that Dr. Russell did not see her after the fall. He goes on to say that the nurses at Hendersonville Health and Rehabilitation examined her and decided she did not need further care. In Dr. Russell's professional opinion the nurses did what they were supposed to.
Ok I'm a little bit confused as to how this could have happened. According to Mr. Payne, the Surveyor Notes Worksheets are not Mr. Davis'  summary of the investigation .They are simply notes of what Mr. Davis was told by the individuals that he had interviewed during the investigation. Mr. Payne doesn't seem to care that the facts are inaccurate.
Here is the definition of investigation from the dictionary : the act or process of investigating; a careful search or examination in order to discover facts. I'm pretty sure that the Surveyors Notes Worksheets indicate anything but a careful search in order to discover facts. Either that or they just don't care about the accuracy of their facts.
Did Mr. Davis actually interview Dr. Larry Joe Russell twice about the night of the fall. Did Dr. Russell forget what he said in the first interview, or was he confused about which of his "patients" he was talking about . If he actually kept records he would not contradict himself! My question would be who was more confused, Dr. Russell or Todd Davis. If in fact Dr. Russell was actually interviewed twice and told two different stories, would that not be a red flag for an investigator ? Someone "in search or examination to discover facts".
According to Mark Payne, Chief of Staff at the NCDHHS, no further action is warranted. Not one of the questions in my letter was addressed by Mr. Payne. He simply stated that the information contained in the surveyor worksheets were not Todd Davis' summary. As a high ranking official at the NCDHHS, I would question his concern for public safety. Is The NCDHHS protecting the owners of Hendersonville Health and Rehabilitation ? Or do they actually have any authority to enforce violations of their own regulations. Does this have anything to do with the fact that Gerald P. Cox , a member of the NC Medical Commission is connected to the owners of Hendersonville Health and Rehabilitation?
Whatever the answer is, they continually refuse to explain the mistakes that they made in an investigation, that eventually involved the death of a resident of Hendersonville Health and Rehabilitation and a patient of Dr. Larry Joe Russell. If they did nothing wrong then why not just simply answer the questions I ask? There is no legal action I can take if they tell the truth, I am simply trying to make them see the flaws in their own system. Obviously they are protecting someone for some reason.
Again I do not disagree with anything Mr. Payne said in his letter, except for the fact that my complaint was thoroughly investigated. I am working on another letter to Mr. Payne asking for the same answers that he avoided giving me. I'll post when and if I get a Reply.
Keep those letters and calls coming your stories are important. Better yet post a comment on this blog for all to see. Don't be afraid to stand up for those you love!~

Is the NCDHHS so perfect that they dont even want to look?

Back in March, I wrote a letter to Aldona Wos , the North Carolina secretary of DHHS. The letter was a simple explanation of my frustrations with the NCDHSR. I also requested that Secretary Wos would have someone review Mom's file. I sent the letter by regular mail, and never received a response.
In July, I sent the same letter via certified mail. This time I received a response from Mark Payne, the chief of staff of the NCDHHS. The letter is basically a timeline of what was supposedly done following the complaint investigation. There is nothing in the letter that addresses any of the questions I had asked. Typical government response to a question, answer anything except what you are asked.
There are specific things in the report that are not true, or contradict what is said elsewhere in the very same report. This is a symptom of a problem that is system wide in the NCDHHS and CMS. Neither of which will even attempt to explain or even look at what is there. If they were to look they could not ignore us any longer. But how do you get them to look ?
I am not disputing what Mr. Payne says in his letter except the part about a "thorough investigation". I included a list of questions that I would ask Todd Davis, the origional investigators. I also asked for a simple review of the facts. I am working on a list of questions for the investigators. I also requested documentation for some of the facts from the so called review. Now I wait for an answer from Mr. Payne.
I sent him a copy of Todd Davis's summary of the investigation, which is full of mistakes and false statements. Any of which prove that the investigation was not taken serious at all. Hopefully that may matter to someone at the NCDHHS. I have a feeling they will not respond, or that they will tell me the matter is closed as they have up till now. How can you improve on a system if you cant look at mistakes after the fact. Most people just get the response and accept that the NCDHHS has the final say. I believe it is my right if not my responsibility to point out the flaws in the whole nursing home inspection process.
The purpose of what I'm doing is to encourage reform of the nursing home inspection system. I believe that if you have people who worked in that environment, they become blind to the violations. They know that the nursing homes are understaffed and they overlook things because of that. What if they sent someone who was not from a medical background along with the team. Would the results still be the same? What if they were not allowed to announce the arrival of the inspectors over the intercom. If you've ever been in a home when it is being inspected, they put a sign on all entry doors and they announce the arrival of the inspectors.
How do they ever expect to find something wrong if they dont take time to look? They already know what the issues are at the homes, they just dont go beyond that. It's like working in a restaurant and the health inspector comes in. First thing you do is pull the can opener and run it through the dishwasher, if not thats the first thing you get written up for. The main difference is that the mistakes made in nursing homes are sometimes a matter of life and death.
In order for things to cahnge, they are going to have to start looking for real problems, not just the can opener. Staff levels in nursing homes are the main cause of everything else. There are no laws that I've found that say how much staff is required per resident. They break it down by the number of hours worked by the nurses and cna's. There is no specific number required on each shift, regardless of the number of patients. No wonder so many people " fail to thrive " as Dr. Russell puts it on the death certificates.
I saw on the news yesterday where a man got eighteen months in prison for animal abuse. Nursing home residents are being neglected to the point of death, and there are no substantiated complaints. I guess people care more about cute little animals than a helpless elderly person. Things need to change, I can use all the help I can get. Please continue to contact me and share your stories. It will someday make a difference.

Hendersonville Health and Rehabilitation and SanStone must have friends in high places.

I began writing this over two years ago, simply because I couldn't believe what these people are getting away with. I've spent most of my spare time looking into how the nursing home industry works. I've seen the ownership, management, shell companies and all the usual ways that wealthy business owners hide their money. What bothers me the most is that the authorities don't care. They are almost hostile to the person making a complaint or an accusation.
This began when my brother and I filed complaints against Hendersonville Health and Rehabilitation .with the NCDHSR. The complaints were based on the care Mom received there. When we received the copies of her medical records, we were astonished that the NCDHSR could not find any deficiencies.
The records themselves are for the most part handwritten. The majority of the documents have the wrong bed and room number. There is missing medication, no records at all from the shift the night Mom died, no notes from Dr. Larry Joe Russell who was supposed to be her doctor. There is an entry concerning a fall that was written a month after Mom's death. During her entire stay there are only four records of showers. One of the documents indicates that the night of the fall, she took a shower with no assistance. Although it is repeatedly noted that she was a fall risk and required assistance with ambulating.
This is not a complete list of what is wrong with Mom's medical records, but a representation of some of the obvious deficiencies we found. They are some of the violations that were overlooked by the NCDHHS. After the response from the NCDHSR, we requested a meeting with the Western Regional Director of the NCDHSR, Gail Maloney. During the meeting, we were basically told that none of the issues violated  their regulations. Ms. Maloney informed us that she had the final word and that there was nothing else we could do. At the time of our meeting the only thing we had were  Mom's medical records from Hendersonville Health and Rehabilitation. I did not receive the results of the DHSR investigation from the Freedom of Information Act till the following August. I have been through the information and have found too many inconsistencies to list. There are answers to our complaint that have no documentations to support them. This is not the way to investigate, there is proof in the records that is ignored because of the investigators opinion.
Why is the word of someone being investigated given more weight than the accuser? I have nothing to gain from this. Am I not due the same considerations as the very people who have something to lose. How would that work in a court of law. I am innocent simply because I say I am. There would certainly be no problem with the overcrowding of prisons. If someone did something wrong, are they really going to admit it to the authorities.
What do I have to do to get the NCDHSR to respond to my accusations. What rights do I have to make them look at their own mistakes. Lives are being lost due to the fact that the nursing homes are being allowed to violate the NCDHSR regulations. The investigators are looking the other way and allowing the homes to do whatever they want. How much is a life of an elderly patient worth to the NCDHSR. What are they getting in exchange for looking the other way?
All I am asking is for the NCDHSR to do their job, and preform comprehensive investigations. They are getting paid by taxpayers to investigate. Are they also getting paid to ignore their own findings?
That would be illegal and law enforcement would be getting involved. That's what you would think anyway.
 If the NCDHSR is the final word, how will there ever be any sort of reform of the laws concerning nursing homes? Where is the justice for the elderly patients living in substandard conditions? Do they not have rights to be treated with respect ? Is there any dignity in lying in your own waste, or not getting a shower? If you have been in a nursing home, you must have seen things that made you wonder.
If you have someone in a nursing home, especially Hendersonville Health and Rehabilitation, take a look around. There are many warning signs that people ignore. Especially if you are the one who put your loved one in there. Sometimes it is impossible to care for someone at home and there is no choice. If you are in this situation you could help change the laws. Complain if something is wrong, and don't get discouraged when you get ignored by the NCDHSR. It takes more than a couple of people to make a change. I need all the help I can get. Don't let these people keep making millions at the expense of the elderly. Make them provide the care they are getting paid for.

FOIA ,Where is the Information????

The Freedom of Information Act (FOIA) is a law that gives you the right to access information from the federal government. It is often described as the law that keeps citizens in the know about their government.
My first experience with the FOIA was when I requested the results of the investigation of my complaint with DHSR. The Complaint was against Dr. Larry Joe Russell and Hendersonville Health and Rehabilitation. A SanStone Property.
 I filled out the form on line and the next day received conformation that they had received my request. Three days later I received the same conformation letter in the mail. It took over one year to actually receive the information I requested that first time!
By the time I received the information, there was nothing I could do about all of the mistakes in the report. When I contacted the NCDHSR to request clarification, they said it had been too long since the complaint was filed. So basically I have no rights because it took them so long to answer my request. The system is set up to prevent the use of any NCDHSR results in a law suit or any other legal action. Basically they make you wait till there is absolutely nothing you can do. If we had the information when we started, we could have gotten quite a bit further with law enforcement. By the time we received the report, nobody wanted to hear it.
I have requested clarification from Todd Davis, the Western Regional Director of the NCDHSR, my request was denied, due to the time since the investigation. I then went the next step and contacted Beverly Speroff, the section chief of the NCDHSR. Again I was refused and informed that the time was the problem, and after subsequent investigations they could not issue a citation.
I wrote Ms. Speroff again and explained that I was not looking for a citation to be written. Again I simply wanted some clarification on parts of their report. The next communication was short and sweet. They refused all requests and informed me if I wanted to make another complaint I could call the hotline.
My brother and I also filed FOIA requests for other information from the CMS (Center for Medicare and Medicaid Services). It has been over a year and we are still being sent back and forth from one FOIA specialist to another. Robin Brooks, Michael S. Marquis, Garfield Daley, Danean Jones, TedDoolittle , Breita Gillard, Sherry Landtroop, Reg 04, Donna Mott, back to Danean Jones and now Edna Brady.
Ms. Brady responded to my email two weeks ago, she said she would call or email me by Friday July 11th. I never received any communication from Ms. Brady. I emailed her again as a reminder, and she responded that she would be in touch by Friday the 18th. It was no surprise that she failed to respond, again. I sent her another email today, and have not yet received any response.
How long does it take to get information from the FOIA? I guess it all depends on who is incriminated by the information you request. What are they trying to keep us from finding out? What right do they have to deny us the information we requested? Is FOIA keeping me "in the know about my government"? I'm more confused now than I was when this whole thing started, is the FOIA based on the discretion of the "information specialist".
Actually as I re read this, I think I may be starting to understand how the system works afterall. It doesn't. Plain and simple this group of people and agencies have no idea who has what. They cant even say they will release any information, or even if there is any thing to be released.
I have asked Ms. Brady twice to expedite the request due to the time since the actual request was made. As of now I have been lead to believe there is some information, but not sure they will release it. I guess this shows that Freedom Of Information is not always a promise, or that they actually have any information at all.
Its a good thing we have this Law like the FOIA, or we would never be able to understand how the government works!

Is the NCDHSR letting Hendersonville Health and Rehabilitation and Dr. Larry Joe Russell Get away with murder?

Is it possible that the NCDHSR is allowing DR. Larry Joe Russell and Hendersonville Health and Rehabilitation to get away with murder? Sounds like I finally lost my mind right? Before you judge my sanity, lets look at the facts.
First you have a patient that is admitted for vocational and physical rehabilitation. The admission form states the diagnosis as rectal pain, constipation and encephalopathy ( disease damage or malfunction of the brain , not necessarily permanent).
The encephalopathy was a result of a craniotomy performed by Dr. Harold Picus. The surgery was to remove a tumor from the pituitary gland. According to Dr. Picus the surgery was successful and a complete recovery was expected.
After spending time at Care Partners in Asheville Mom returned home. She was home for about a week and then readmitted to Mission Hospital for hemorrhoids and stomach pain. After a little over a week she was discharged and sent to Hendersonville Health and Rehabilitation to regain her strength and continue her recovery.
During her stay at Hendersonville Health and Rehabilitation she was actively participating in the therapy, and getting stronger every day. There were several issues with the care she was receiving at Hendersonville Health and Rehabilitation. At the time most of them seemed minor, and Mom was getting stronger. There was a family member with her most of the day .
The problem was Mom was not getting the assistance with toileting or eating. The time it took for them to respond to the call light, forced her to try to go to the bathroom by herself. If one of us was there we would always help, but if we weren't she would try on her own. The response time to the call lights was anywhere from five to thirty minutes .That's a long time to wait if you have to go to the bathroom.
From the roommates description of a fall that occurred days before her death, she was attempting to get to the bathroom. There was another instance that was brought up by a nurse when Mom was found outside her room using her food tray as a walker, looking for the bathroom . Although neither of the two events was correctly documented in her records.
The day of her discharge, Mom was found without a pulse and not breathing. The details of that morning are still a mystery. The owners and administration of Hendersonville Health and Rehabilitation, refuse to provide any details other than the medical records. The records are inaccurate and contain false information. If there is nothing to hide, why are they going to such extremes to hide things.
I'm no doctor, and have no medical training other than what I got in Boy Scouts. I have however done a considerable amount of research, and have come up with a theory. I believe that when Mom fell, she hit her head on the terrazzo floor or her food tray. Being only two months after a craniotomy, this could have been tragic. According to medical journals and articles I have read it takes up to a year for the skull to heal after the surgery.
I believe she suffered a subdural hematoma (bleeding on the brain) that eventually caused her death. According to the records there are facts that indicate she was exhibiting symptoms of the above. There were no tests done after the fall, other than a blood pressure test, oxygen saturation, and pulse. A simple check of her pupils could have indicated further treatment , that was not done. The nurses note describing the fall was dated a month after Mom's death. It was created in an effort to stop the NC State Medical examiners office from doing an autopsy. The nurse Lara Mooney LPN states that she witnessed the fall. According to her statement, Mom actually slid out of bed and did not hit her head. It seems a little hard to believe that a month after a fall, she would remember such details! Not to mention Mom's records say she was to have a personal alarm, and bed and chair alarms at all times.
I have a death certificate of another patient at Hendersonville Health and Rehabilitation , signed by Dr. Larry Joe Russell . I believe the cause of death listed on the original death certificate was failure to thrive. According to the coroner Dr. Huntley, the actual cause of death was a "subdural hematoma as a result of a fall". I was given the name of that patient, by someone who has a relative in Hendersonville Health and Rehabilitation. According to witnesses, the patient was dropped on her head by a nurse, who tried to lift her alone, which is against regulations.
The NCDHSR is conducting bogus investigations which are allowing people to die. In 2011 and 2012, there were nine complaints filed against Hendersonville Health and Rehabilitation. Of those only one was found to be substantiated. In that case the patient was given the wrong medication, and ended up in the hospital. It would have been hard for the NCDHSR to find that one unsubstantiated.
During their yearly inspections they managed to find a total of  forty six pages of deficiencies.
Is the NCDHSR letting nursing homes get away with murder? They certainly don't go out of their way to find deficiencies. I've been trying to get them to look at the report for over two years. I cant even get them to answer my letters.
The definition of murders : the killing of another human being under conditions specifically covered by law. Maybe like dropping an elderly lady on her head and not getting her the proper medical treatment. Murder or not you be the judge, because the NCDHSR will never bring them to a real judge.

It's our money they are stealing!

It has been two weeks since my last post. As of today, I still have not received a response to the letter I mailed on April 24, 2014. The letter was sent to Aldona Wos Secretary of the NCDHHS, Governor Pat McCrory, CMS, and several law enforcement agencies. The letter asks for an explanation of why  the investigation of  Hendersonvlle Health and Rehabilitation contained false statements and inaccuracies. Todd Davis, Kim Britt and Paul Yockey did the supposed "investigation".
In the summary there are several statements that contain conflicting information. There are also quite a few times that statements are made that have no supporting facts. The investigation is a joke, and the head of the NCDHHS doesn't seem to be concerned. These investigations allow the nursing homes to remain licensed, even when lives are being lost due to the violations of regulations they are paid to enforce.
If you have read my posts, you are probably familiar with the things I mention above.
I have repeatedly contacted employees of the NCDHHS, CMS, Governor McCrory and members of the Senate and Congress. For two and a half years, I have been pushing them to do their jobs. The responses I have received imply that it is not my right to doubt them. This just proves that if you question anything that is putting money into their pockets, you are the bad guy.
I was recently speaking to a Congressman and he even admitted that these people will ignore you and run you in circles till you go away. That's not going to happen in this case. I will continue to pursue the truth and strive to have the laws changed to stop these people from stealing Medicare dollars. They are stealing money from you and I, and apparently that's acceptable to most people.
I have an acquaintance, that told me their mother was at Hendersonville Health and Rehabilitation and they were double billing Medicare. The mother would call them and they would suggest that they would look into the bills. They were never corrected, and nothing was done about it. Another person called me and told me that DR. Russell was treating her for sleep apnea, and supplying her with a cpap machine. When she changed doctors, they told her she did not have sleep apnea.
There are more stories and I have names and contact information.  That's our money folks, they are stealing our money! I work hard to pay my bills and I personally find it hard to swallow. There are plenty of sick people who need treatment, why does Dr. Russell have to falsely diagnose patients. Cant he simply treat patients and provide the appropriate care, or is it that easy to steal from Medicare and private insurance companies.  
I have seen many stories on the news about how they caught someone fraudulently obtaining benefits from Medicare or the NCDHHS. Believe me that's small potatoes compared to the money that the operators like SanStone and Dr. Larry Joe Russell are stealing. The difference is that the agencies that are supposed to enforce and investigate are controlled by the politicians who owe their positions to these thieves.
The problem is the way businesses contribute to political campaigns. Obviously this is not just an issue with nursing homes, it affects all industries. It is the reason we are eating food contaminated with hazardous chemicals, damaging our ecosystem by allowing fracking, the list goes on and on. The nursing home owners are serious contributors to republicans and democrats alike. The party affiliation is not important, as long as they "earn" there campaign funds after the election.
We are taught from an early age that democracy guarantees that our vote counts. Have you seen the children come home from school with the little  "I voted" stickers. They come home and they are so proud of the fact that they "voted". As a parent it is difficult for me not to explain to them that politicians are not always honest? Should I explain to my son that corporate money is what is controlling the politicians, or do I let him believe his vote will actually make a difference?
We can only hope that there are some politicians that care about more than just money. However in order to get elected, they are relying on corporate campaign contributions. If they get elected and want to stay in office, they have to be careful who's toes they step on. America is being governed by the influence of corporations. I'm sure this is not a surprise to anyone, but why do we allow them to get away with it. How do you stop the cycle if they are the ones making the laws?

Shame on you, Todd Davis, Kim Britt, Paul Yockey, Aldona Wos and Pat McCrory

For the record, I sent a letter to Secretary Aldona Wos of the NCDHHS on April 24, 2014. The letter was pretty simple, it was about the lack of effectiveness of the local DHSR. I offer to share information that would prove that the nursing home inspection process is flawed. I also sent the same letter to Pat McCrory, and others that should be concerned. Still have not received any response. Not even the typical " we appreciate your concern but ... " letter.

What is up with the NCDHHS, are they above making mistakes,or simply not to be held accountable for the ones they do make. One would hope that if there was a private citizen with concerns, they would be taken seriously. Basically from what I've seen , if you disagree with the NCDHHS, that's your problem. Even the State director ( DR. Wos ) doesn't care enough to consider that there may be a problem.
Is there no one watching over this agency at the local level? I thought that by going to the State Secretary of the NCDHHS something would happen. I was definitely wrong about that. What about Governor Pat McCrory, as a citizen of North Carolina am I not entitled to a response? How much do you have to contribute to ones campaign to get an answer to a letter?
Politicians are supposed to be working for the good of the people. If that is the case, how can they ignore their concerns ? I have documentation that shows how little effort is put into the nursing home inspection process. Either someone made a mistake, or simply lied to protect the nursing home operators.
Todd Davis, Kim Britt and Paul Yockey, are the ones who conducted the investigation. I say you should all be ashamed of yourselves. How can you walk by the terrible things happening at Hendersonville Health and Rehabilitation and ignore them. What if your mother or father were residents there. Would you be able to sleep at night, knowing what you know?
I don't see how anyone with a conscience could possibly ignore what happens in these places. I could not imagine how much you would have to be paid to let this happen. There must be a considerable amount of "benefits" to look the other way. What makes it even worse, is that my tax dollars are being used to pay you.
Talk to the nurses at Hendersonville Health and Rehabilitation and they will tell you they are understaffed. Talk to the residents, they will tell you they had to wait three or four days for a shower. Talk to the cna's and they will tell you there is no way they can do everything they are supposed to in one shift. Talk to the administrators, they will tell you how " It's their passion that makes the Difference ". Talk to the NCDHSR, they will tell you there were " no deficiencies found ". Again I say shame on you, Todd Davis, Kim Britt and Paul Yockey.
I say to the NCDHSR, Governor McCrory and Aldona Wos, do your jobs. Protect and serve the citizens of North Carolina, not the wealthy businessmen who own the nursing homes. Go into Hendersonville Health and Rehabilitation and stay for a week. Sleep in one of the urine soaked beds. Wait for them to give you a shower. Eat the same cold food as the rest of the residents. After a week  come out and say you couldn't find any deficiencies!

It all started with SanStone Health and Rehabilitation and Hendersonville Health and Rehabilitation

For the record I have still not received any response to my letter to Secretary Aldona Vos, or Governor Pat McCrory. The letter was mailed on April 24, 2014.

My last few posts were focused on Dr. Larry Joe Russell and his Medicare billing practices. The reason for that is the newly released numbers, posted by the CMS (Centers for Medicare and Medicaid Services). According to CMS the reason they are posting these numbers is so people can find and report Medicare fraud. Seems like a great idea, if they actually intend to take any complaints serious.
My first encounter with CMS was almost two years ago. I was referred to them by then Congressman Heath Shuler's office. The initial reply from CMS starts with how they appreciate concerned citizens who report Medicare fraud. Then it goes on to tell how seriously they take these allegations. When you look at the amount of taxpayer dollars spent on Medicare, they should be taken serious. That letter was from Alfreda Walker out of the Atlanta office of CMS. The letter goes on to say that I will be contacted directly by someone from their office. It also says that I will be contacted by someone from a State agency, concerning Medicaid. Four months went by an I never heard from anyone.
I contacted the Congressman's office and apparently somebody dropped the ball. Turns out it never left Ms. Walkers office. My phone call made something happen, but I'm not sure what. The next communication I received was from NCI Advancemed. The letter I got stated that they had completed their investigation and appropriate action had been taken. I called the number on the letter and spoke to Shannon Stinedurf, the one who had signed the letter. I asked her what action had been taken. Her reply was " there was no action taken, we didn't find anything wrong ". This prompted me to contact Ms. Walker again. She explained that NCI Advancemed was the contractor that handled Medicare fraud investigations. I asked her how they had conducted an investigation without ever contacting me for my information. Ms Walker failed to explain how this was possible. Then she told me that the "quality of care issue was being handled by the Carolina Centers for Medical Excellence, another contractor. She gave me a number to contact them, but it wasn't the right number. After a couple of emails to the CMS, I finally got a number that worked.
I then Called the CCME , and spoke to a representative that listened to my story. The representative seemed to think that there were several issues of concern in what I told her. She said she would pass things on to someone who would conduct a review. It only took a week or so, and I received the letter saying they did not find anything wrong. I tried to contact the first person I had spoken to, and could not get her on the phone. Things were getting more and more confusing.
Both the CCME and NCI Advancemed were government contractors, and both conducted their " investigations " in record time. Neither of them contacted me for any information nor did they seem to be concerned with what I had told them. Being the persistent person that I am, the next step was to call NCI Advancemed and start the move up the chain of command. I finally ended up with Norma Elder, who informed me that they had never been contacted by CMS, Congressman Shulers office or me. They got their information from the NCDMA ( North Carolina Division of Medical Assistance ). The NCDMA got their information from a complaint I had made with the NC Medical Board.
All of these different agencies had done nothing till my call to Congressman Shuler's office. Then they all seemed to find nothing wrong at the same time. I am convinced that someone with serious influence is controlling how this turns out.
If this seems confusing to you, welcome to the club. I have never been politically active, nor have I ever been so disappointed in the United States government. It seems that our government has decided that they are so incompetent they have to use contractors. It would not be surprising to know that the same contractors are owned by politicians and their family members. Probably the same people who own nursing home groups.

Is Dr. Larry Joe Russell stealing from Medicare? You be the judge

In my last post I gave numbers of referrals to and from local Doctors. I have researched the data, and according to the website, the numbers come from the Federal Government. I can not confirm the source, but it appears to be based on Medicare billing.
I have recently been directed by a government official to a Wall Street Journal site that posts the amount doctors billed Medicare for in 2012. According to an official from CMS, it is easier to navigate than the CMS site.  According to the Wall Street Journal website, Dr. Larry Joe Russell billed Medicare for 5000 patient visits. That's ninety six visits a week if he works fifty two weeks a year. Keep in mind that Dr. Russell also accepts Medicaid ,private insurance and cash patients. That's a lot of patients. According to the Wall Street Journal Page, Dr. Russell saw more Medicare patients than all but two other doctors in the county.
According to the NC Medical Board, in 2012 Dr. Russell supervised nine nurse practitioners, and one physicians assistant. Using the information from the Wall Street Journal website together with Dr. Russell this group had 13,575 patient visits. That's 261 patient visits a week, and that's a conservative number based on the information provided. Keep in mind that they also see patients other than Medicare. According to the website that totals around $856,893.04 Medicare dollars. That's $16,478.71 cents a week, not considering any business other than Medicare.
In my opinion, that seems excessive at any level. I understand that doctors, nurses and physicians assistants have a right to make a living. It just stands out that according to the WSJ website, Dr. Russell was the number one Medicare biller under family practice physicians, with over $419,425.00 in 2012. Next look at physicians assistants, Martha K. Hoffman, Dr. Russell's Pa. is second on the list with $60,089.00. Last if you look at nurse practitioners, Denise Hunt was #1 at 138,333.00 , #2 was Linda Brooks at $104,658.00, # 4 was Deborah Whitmire Pittillo at $62,461.00 and at #5 was Alicia K Younger at $45,772.00. Four out of the top five Medicare billers are supervised by Dr. Larry J Russell.
Out of two hundred family practice physicians, Dr. Russell is the thirteenth highest Medicare biller in the State of North Carolina. I realize that this doesn't actually prove anything illegal. I don't know Dr. Russell personally, but I know people who do. Based on what I do know, Dr. Russell is not seeing all these patients as a community service. I also know that he does not actually " see " all of these patients.
Does all of this information prove Dr. Russell is breaking any laws ? I've been told that it does not. Should the authorities be watching him, I would hope so. I would assume that if you were going to audit a certain group, you would look real hard at the number one on the list.
If Dr. Russell is your doctor, you might want to reconsider what you are getting for your money. The numbers above are Medicare only. If you are not one of those 261 Medicare patients, then you are somewhere between 262, and ????
Here is the link to the Wall Street Journal website mentioned above. Just out of curiosity, put your doctor in and see how he ranks next to Dr. Larry Joe Russell.
http://projects.wsj.com/medicarebilling

Also, for the record, I have still not received any response from Aldona Vos, Pat McCrory or anyone else that received my letter. The letter was sent out on April 24, 2014.

Aldona Vos, and the Letter. Unreasonable, you be the judge!

It has been over two weeks since my letter to Dr. Aldona Vos, Secretary of the NCDHHS. I have still not received a reply. The same letter was sent to Governor Pat McCrory, Kathleen Sebelius and members of Congress. I have not received a reply from anyone. As a citizen of the United States and a Taxpayer, I should at least be entitled to a response.
This is routine when dealing with politicians, the first contact you will get a letter thanking you for your concern. Then the letter will tell you about all the fascinating things the politician has done, and how great they are. Then they will close with, " If I can be of any further assistance, please feel free to contact me ". They fail to even specify what you have written about.  I received similar letters from almost everyone that I have reached out to, including the President.
Rather than writing what I asked for in the letter I am going to post it below. Are the requests I make unreasonable, you be the judge.

April 20, 2014
Dr. Aldona Vos
Secretary NCDHHS
2001 Mail Service Center
Raleigh, NC 27699-2001

　
Dear Secretary Vos:
I am writing to ask for your assistance in obtaining information from the NCDHSR. I am trying to get clarification concerning an investigation conducted as a result of a complaint I filed. Twice I have written to Beverly Speroff, Division Chief of the NCDHSR, and been denied.

 Complaints were filed by my brother and I concerning the care our mother received at Hendersonville Health and Rehabilitation. The NCDHSR investigation was conducted on January 18 and 19 of 2011. Results of the investigation found no deficiencies. We had obtained a copy of mom’s medical records and found several issues that should have been addressed. After receiving the results, we met with Gail Maloney, who was then the Western Regional Director of the NCDHSR. Ms. Maloney was presented with a list of concerns we had with the records. The number of inaccuracies contained in the records was overwhelming.

One of the main issues was a nurse’s note concerning a fall; the note was a late entry and was written a month after the fall occurred. We obtained a written notarized statement from the patient that was in the other bed at the time. The roommate’s statement was quite different from one given in the “late entry” nurse’s note. Mom had undergone a craniotomy in September of 2011. She had been admitted to Hendersonville Health October 19, 2011 for physical and occupational rehabilitation. According to the records, she had reached her goals and was ready to be discharged on November 3, 2011. That morning she was found not breathing and without a pulse; she died a little before six am.

At the suggestion of Ms. Maloney, I filed a foia request of the results of the investigation. I did not receive the results from the foia until June 10, 2013. The documents from the investigation and the so called administrative review are full of inaccuracies and false information. The packet contains three different letters written by the doctor that conducted the review. Not one of the letters contains an accurate account of what is contained in the investigation documents. The lead investigator’s summary contains several conflicting statements; one concerning the fall mom sustained.

All I am asking for is clarification of what is contained in the investigation documents. If there are other pages proving what is stated, they are not in the report. As a United States citizen and a tax paying resident of the State of North Carolina, I should be entitled to the information I am requesting. I am not asking for a citation to be written against Hendersonville Health and Rehabilitation but my goal is to call attention to a possible flaw in the investigation process. This is extremely important because these investigations result in the licensing and certification of nursing homes. The results are also posted on Medicare.gov to be used as a tool by citizens trying to choose a nursing home.

Since the beginning of my involvement with the NCDHSR, I have been treated in an adversarial manner. I would question if this is not in some way a violation of Title 18, U.S.C., Section 242. If the report contains false information, I believe that it is a violation of Title 42 U.S. Code § 1320a–7b.

I would ask that Ms. Speroff reconsider my request, however according to her this matter is closed. As the Secretary of the NCDHHS, I would hope you would be concerned if the NCDHSR is denying the public representation. I would also assume that other statutes would be violated if the actions, or lack of action on the part of the NCDHSR, result in the loss of human life.

Thank you for your consideration.

Sincerely,

　
cc:

Beverley Speroff
Kathleen Sebelius
Governor Pat McCrory
Alfreda Walker CMS
Norma Elder NCI Advancemed
Joann Quarles QIO

How many patients can a doctor see in one day? Can you say malpractice!

This is just one of many answers to the question. How many patients can a doctor see in one day. Just to show how outrageous Dr. Larry Joe Russell's referral numbers are! Note the third paragraph!

How many patients can a doctor safely see a day?
   
      Luis Collar, MD Physician
    
      | December 31, 2013
   
   
Today’s question is a simple one. How many patients can a physician see in one day and still be thorough? Don’t get me wrong; I’m all for efficiency. But we need to recognize when efforts at efficiency become “medical sloppiness” or, frankly, malpractice.
With health care policy and insurance reimbursement what they are today, it’s not uncommon to encounter physicians seeing forty, fifty, and even sixty or more patients a day in the outpatient setting. The truth is, though, no matter how experienced the doctor, no matter how technologically streamlined the practice, one physician can’t maintain medical accuracy at that frenetic a pace. Many physicians like to think they can because they manage to see every patient on their schedule and do their thing. But, in most instances, good medicine simply can’t be practiced in five to seven minutes.
Sure, there are cases where that is all that’s required. A young, healthy patient, a simple physical, or a stable patient that just needs a medication refill can usually be handled that quickly. But I often see physicians trying to care for medically complex, older patients on multiple medications in the same fashion. The rationalization is usually that, with enough experience, one can take care of these patients just as quickly. But the issue, then, becomes precisely what constitutes “handling” a patient.
A patient with a complex medical history always requires more time. Trying to argue otherwise is simply intellectually dishonest. You can’t take a history, no matter how focused, reconcile all current medications looking for undesired interactions or required modifications, review labs, monitor patient progress, look for better therapeutic approaches, address new issues, encourage communication, conduct a thorough physical exam, and spend time on health counseling / preventive care in five to seven minutes. It just can’t be done that quickly with these patients.
I’ve worked in offices where this level of “efficiency” is touted as the future, the result of effectively leveraging new technology. But the truth is, as much as it pains me to say it, it’s just bad medicine. And the argument that a particular practice doesn’t have that many complicated patients is, in most cases, yet another fallacy.
Complicated patients are not to be confused with medically interesting patients. Many of the most common chronic illnesses that find their way into physicians’ offices are, in fact, not interesting or exciting for seasoned medical professionals. After all, diabetes isn’t exactly extraskeletal myxoid chondrosarcoma or any of the “sexy” hemorrhagic fevers, but that doesn’t mean it isn’t an exquisitely complex illness requiring a thorough clinical approach.
So the average primary care physician may not have many “medically interesting” patients, but they probably do have many complex patients. I would argue that if any practice has a significant amount of patients over the age of fifty, then seeing more than about twenty-five to thirty patients a day is irresponsible. Seeing three to four patients an hour yields a number somewhere in that range. And while some patients can be “handled” more quickly than others, once you go above that number in one day you’re entering dangerous territory.
If you look at the available data and the current incidence of obesity, heart disease, hypertension, diabetes, and depression to name a few, then any practice serving patients over the age of fifty must, by definition, have a good number of complex patients. Although common, none of these illnesses are “simple.” Quick refills, not listening, not asking probing questions, shoddy physical exams, not looking for all possible signs and symptoms of disease progression, poor or no counseling, and not actively staying ahead of a disease are all poor practice. More importantly, those practices lead to poorer patient outcomes and increased health care costs in the long run. That is particularly true with this patient population.
The challenge, of course, is that our current system still rewards speed and procedures much more richly than patient interaction and thorough analysis. Although not a new concept, as reimbursement continues to decrease necessarily (Medicare’s pockets aren’t as deep as they used to be) and more patients gain access to the system, addressing the question of “medical speed” will become increasingly important.
Admittedly, the thoughts presented here are only based on anectdotal evidence collected over several years of working with numerous physicians, in multiple settings, and at several different hospitals. However, I do believe there is a trend here. The more “evolved” our health care system becomes, the more pressure is placed on physicians to leverage technology and see more patients, the more bad professional habits are being developed. Technology can help increase efficiency, but it can’t yet replace ample time with an interested, compassionate, well-trained physician. Not every patient requires thirty or forty minutes, but if we’re going to be honest, forty or more patients a day is simply ridiculous.
I would challenge all physicians to honestly evaluate how long they spend with complicated patients. More importantly, I’d be interested in knowing how they define a complex patient. And I would question any definition that doesn’t include even the most common chronic illnesses. No matter how “boring” these may be, their intrinsic complexity and impact on public health certainly justify more than a few minutes of diagnostic effort, even with routine follow-up visits.
I would also encourage all patients to expect more from their doctors than a couple of questions and some quick advice in five to seven minutes. If you’re there for a simple cold, then maybe that approach is appropriate. But if you have a chronic illness and are concerned by some new symptoms or recent changes in your overall health, you should expect much more from an office visit.
And finally, I would encourage all policy makers to recognize the valuable role physicians play in our society. We need policies that encourage them to do their jobs properly instead of punishing them for it. Ultimately, though, it’s up to physicians to choose. I hope they are true to their training and show humility in the face of complex, albeit common, diseases. It’s a shame to simply toss all that “medical school stuff” out the window simply because the system is currently what it is.