Re: Educating Physicians about PA

January 5, 2007

You need to report these problems to your State Medical Board. They have the duty to review the problem and admonish or punish the physicians. Not the HMO.

Did you not miss work for some time etc due to missed Dx and were treated with incorrect drugs for some time. You may need to see a different lawyer.

I dont recall your story in detail.

May your pressure be low!

Clarence E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

January 5, 2007

Guess we need to be looking for PA patients with strokes, etc.

Still going to the Med Lic Board is a start.

May your pressure be low!

Clarence E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

January 5, 2007

I certainly agree that this should be reported to the State Medical

Board, but don't get your hopes up on a malpractice action.

First keep in mind that I'm not an attorney, but am familiar with this

in general. You should seek real professional advice.

Here's my dose of reality for the day. If anyone has better news,

frankly I'd love to hear it. Any successful hyperaldo cases out there

in recent years??

From a legal point of view, these cases seem very hard to pursue. In

many states, including mine, the statute of limitations begins at the

time the initial malpractice took place or initial injury resulting

from malpractice.

So, for example, with a 2yr statute as it is in my state, the initial

malpractice in my case took place 4yrs ago. Even though I continued

to see the same doc until 1Q-2006 and there was in essence continued

malpractice, it doesn't matter because the courts (at least in GA)

consider the first failure to diagnose irrespective of whether there

are subsequent failures to Dx the same thing.

Secondly, if we look at time point of injury, with HTN related injury,

unless there is a specific event such as stroke, heart attack, death,

etc, with tort reform as it is, there is great difficulty in defining

initial injury time. A specific and really ugly example was a woman

suffering from neuropathy as a result of a physician missing an

obvious B-12 deficiency in her blood work. Subsequently, the

physician Dx drugs and procedures that were inappropriate for the

actual problem and provided no help to the patient (sound

familiar???). 4 years after the initial malpractice while seeing the

same physician, the patient becomes paraplegic due to B-12 deficiency

with no hope of recovery. Even though action was filed less than one

year after onset of paraplegia, the court rules that the malpractice

and injury began 4 years ago, so that's when the clock starts running.

Even though there is a clear correlation between the B-12 deficiency

and the end-state injury, it is irrelevant. That's the real world in

many states...most particularly those in which tort reform has occurred.

In all jurisdictions, unless you can get a very " special " jury, the

more troubling issue for those of us with PA and SA related injuries

due to misdiagnoses is that there is often not a clear causation

between injury suffered and the misdiagnosis. Let's take my white

matter lesions, for instance. I'm pretty confident, and my medical

team is as well, that they were a results of poorly managed HTN and

elevated aldo. However, there is no clear causation. In general,

these can be caused by HTN related vascular events (silent

mini-stroke), vasculitis, demylenating disease such as MS, traumatic

injury, or even viral injury. It is easy to eliminate MS and trauma,

but how do you eliminate viral injury?

Worse yet, how do you eliminate injury from vasculitis...the

-potential- biggie in many of the non-HTN impacts of aldosterone?

Although there is substantive evidence in animal models, with the lack

of human studies of aldo related vasculitis, the plaintiff can't say

the vasculitis was caused by aldo. Legally, vasculitis could have

been caused by any number of things, and aldo, for now, is not one of

them. Even if it were, you have to disprove a bunch of negatives

here. Yes, the doctor was an idiot and misdiagnosed, but it may be

very difficult to prove causation of injury.

With many injuries you can't demonstrate a loss. Say I -can-

correlate the wml's and vascular damage from aldo with the malpractice

(not likely). If they are not making me obviously ill right now, how

do I prove that the vascular and brain injuries these will diminish my

quality or length of life and to what extent? While it is more likely

that I will have dementia and/or a shortening of life, it certainly is

not a sure thing, and there are many things that I can do to mitigate

future consequences...at least in theory. In any case, I'm sure as

heck not drooling on myself at this point...might be later, but then

it is too late to file a case.

That does leave an obvious cause of damages, loss of work time and

perhaps loss of career. Loss of work itself is not nearly enough

money to make it worth pursuing such a complicated case (unless the

attorney is bored and has nothing better to do...you don't want that

attorney). Depending on what the career and income was, if the

malpractice caused you permanent loss of livelihood, maybe you've got

something there. Again, an attorney would spend the huge amount of

resources to pursue the case unless the monetary loss is substantial.

With hyperaldo being such a " rare " disorder, there are few

malpractice teams that even know what it is and even fewer clinicians

that would be available as expert witness (and they will be needed).

As such the costs of litigating will be increased.

Here's the best part, if you win, not only do you have to pay off your

attorney's cut, but g-d help you if your insurer(s) gets wind of the

case. They will want their cut of your winnings for unneeded

proceedures, hospital stays, etc. So you win $500K. Of that $200K

goes to the attorneys and the insurer get $150K or whatever. You get

the $150K that is left...less federal and state taxes. So you are

left with maybe $90K. Is it really worth it???

>

> You need to report these problems to your State Medical Board. They

have the

> duty to review the problem and admonish or punish the physicians.

Not the

> HMO.

>

> Did you not miss work for some time etc due to missed Dx and were

treated

> with incorrect drugs for some time. You may need to see a

different lawyer.

>

> I dont recall your story in detail.

>

> May your pressure be low!

>

> Clarence E. Grim, B.S., M.S., M.D.

> Specializing in Difficult to Control High Blood Pressure

> and the Physiology and History of Survival During

> Hard Times and Heart Disease today.

>

January 6, 2007

>

>>

> Here's my dose of reality for the day. If anyone has better news,

> frankly I'd love to hear it. Any successful hyperaldo cases out

there

> in recent years??

>

>>

What you have written is what I have discovered, without permanent

damage there is no case. It doesn't matter that I was not able to

work for almost two years, it doesn't matter that I was misdiagnosed

for 13 years, and as you said, the physician who first gave me the

essential hypertension diagnosis without ever doing testing and

refused to refer after multiple meds were tried and my BP worsened

AND who ignored the significance of a 3.1 potassium on a

potassium sparing diuretic in Jan 2004...that is over two years ago,

I cannot touch him.

The next PCP had to play " catch-up " as I was 51 and

hadn't even had a routine EKG after 10 years of HTN. My symptoms

were so severe and varied by then that I was sent to referals for

everything BUT Hypertension.

I feel it is time to move on as it only upsets me to see all the

indifference out there. Doctors need to take back their practices,

too many have become complacent, only follow the dictates of the age

specific health practice guidelines given to them by the insurance

companies. Referral seems to be discouraged, when they can't come up

with an answer to a patient's problem they don't seek consult unless

the patient is hospitalized or lab results are significantly off

withthe patient having identifiable symptoms.

Routine diseases, such as diabetes, seem to be handled well but

anything complex never seems to be adequately addressed at an office

visit.

I know, I've seen it , I have worked in healthcare for 33 years.

When managed care took over medicine changed,

and not for the better. It is the most mis-managed system I have

ever seen!

Of course I am not saying ALL docs are like this but, unfortunately,

I have come in contact with my share who were. I was sent for

consults where no info was forwarded as to why I was there, no tests

that had been done were sent. That is when I learned to obtain and

carry my own binder of my records. Docs became impatient with me

when I couldn't answer their rapid fire questions due to the trouble

I had concentrating. Few ever even bothered to listen to the

response, they had already summed me up and decided the treatment

course that would be covered by my insurance plan.

I was diagnosed with Fibromyalgia and Hypermobility Syndrome by a

physician who stood in the doorway after his intern had examined me.

Because I refused to take medications I was dismissed, nothing he

could offer me but come back in a month to see how things are.

I could go on forever, but these are things that are known by the

medical community but ignored. Try to find a local doc who will

speak out about another. It just doesn't happen. I have to live and

work here, at least for now. I need to bury this and go on.

Sorry to sound cynical but that is how it is, at least in my area.

I cannot change it I can only take care of myself, my family and my

friends.

I hope for a physician revolt but don't see that in the future either.

Patients need to be able to take care of themselves or find someone

else to advocate for them.

January 6, 2007

I look at this very simply. If I don't have a personal relationship with the

doc, he won't see me as a person and won't treat me that way. Its as much human

nature as it is managed care. The doc has to manage his time very carefully.

So, if he refuses to talk to me as a colleague, I walk. In fact, I did that

with a guy that is considered to be one of the best endocrine surgeons in the

southeastern US. I thought he was a prick and I was a number, so I walked.

Yes, surgeons don't always have the best personalities, but if he won't listen

to his patients, it is likely he is not listening and learning from his peers as

well. Thank g-d I'm not on an HMO.

Not to say this always works out to the best. I had an excellent relationship

with my former internist. and he really did listen to what I had to say. He

even checked for PA early on...he just screwed up the protocol. These things

can happen and you have to be very educated as a patient to ask the right

questions as well as provide the right info. I was not educated at all at the

time. If I had been, given the nature of our relationship, I would have been

cure of Conns as much as 4 years earlier.

End of the day, though, if your plan gives you the flexibility to be a consumer,

you must be an educated consumer and expect to be treated as an equal.

If you are on an HMO and have the option of fleeing, do so. HMOs are simply not

appropriate for complex care. Just ask my father-in-law...oh right, you can't

because he died from a cancer that shouldn't have killed him but for the

repeated denial of service from his HMO.

-Jeff

January 7, 2007

In a message dated 1/6/07 3:28:21 PM, shotzie@... writes:

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