Topic: Patient's right to have an amputation (medical, legal and ethical question)
Boon
unregistered
posted
My dad was in an accident in October of 2000. He had no insurance, and the accident wouldn't have been covered anyway. He was working under the hood of a van when it slipped out of gear and started rolling. He made a dive for the brake and his leg got caught between the door of the van and a tree.
My sister drove him to the hospital while he held a loose tourniquet (sp?) on his upper thigh. The rural hospital had an orthopedic surgeon on staff, and he happened to be there when Dad came in.
There were 14 pieces of bone that were large enough for the surgeon to piece back together. Since the accident, Dad has had 2 6 month rounds of IV antibiotics and 5 more surgeries due to infection. When he's not in the hospital or on IVs, he's on expensive oral antibiotics, and the infection is still bad enough to cause pus to leak through ulcers in his shin.
The surgeon who first treated him refused to administer strong antibiotics while Dad was first in the hospital, instead giving him one of the -cillin drugs, even though he was told that Daddy was suseptible to infection since his spleen and tonsils had been removed many years ago.
This surgeon performed all further surgeries, including one to put an antibiotic fluid next to the bone, and left a hole for it to drain back out of. One was to remove dead bone tissue and replace it with antibiotic-impregnated cement beads. One was to put in steel (?) rods to help stabilize the bone, and another to remove it because Daddy go so sick.
If these infections don't kill him, we're afraid the antibiotics will.
He finally, after months of trying, found another orthopedic surgeon to see him for a consultation. See, the original surgeon is apparently on the "blacklist" as far as malpractice insurance companies are concerned. MY doctor told me that if her insurance company found out that she saw Daddy as a patient, her insurance would be dropped.
Well, the new doctor won't treat him. Won't prescribe more antibiotics. Won't prescribe pain medication. Won't amputate (which is what Daddy wants and has wanted all along). He's too afraid of his insurance company.
So what do we do? At this point, Daddy says he's ready to run a chainsaw through it so they'll HAVE to treat him. This is so upsetting.
At what point can the patient declare that enough is enough, take it off? At what point will his leg be "sick enough" for them to take action? Will he have to be on the brink of death again before they'll medicate him? Are they trying to kill my father?
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Had you know about the surgeon from the get-go, it wouldn't be an issue.
Unfortunately, I'm not sure what you can do beyond contacting the insurance company directly and perhaps filing a petition with the State medical board.
If a doctor has been blacklisted from medical insurance, there should be some warning to prospective patients so they don't get caught in this bind.
-Trevor
Edit: I'm sorry Boon - I wish I knew how to better help. I hope everything works out for you and your father.
Edit 2: You might also consider filing a complaint with the local hospital for keeping someone on staff who has been "blacklisted". Also, it's your civic duty to write to the local newspaper and inform them of this.
posted
Wow, this totally sucks. When the malpractic insurance sets up these systems, it leaves patients no choice but to bring more lawsuits in order to get anything accomplished. Call a lawyer?
Posts: 11017 | Registered: Apr 2003
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Boon
unregistered
posted
The way the law reads, you have to file suit within 2 years of the ORIGINAL INCIDENT. The first doc kept Dad as his patient for 2 years and 2 days.
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posted
I don't quite understand the issue here with insurance. Is the problem that once a patient sees the original surgeon, any doctor who sees that patient will not be covered by their malpractice insurance?
quote:The way the law reads, you have to file suit within 2 years of the ORIGINAL INCIDENT. The first doc kept Dad as his patient for 2 years and 2 days.
You need to see a lawyer. Maybe a good lawyer could make a case for the incident of malpractice being sometime later than the original accident.
posted
Yep, that's exactly it. No doctor in the area will see ANY patient that this original doctor has treated, because he leaves them is such poor shape that it's too much liability for them.
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Boon
unregistered
posted
And the folks have tried the lawyer route too. Nobody will take the case. Not easy enough, I guess.
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posted
It's an effort to cut down on medical malpractice and insurance fraud, I think.
Because Doc A has been blacklisted, any patient coming from him is automatically suspect. Any doctor treating suspect patient will fall under suspicion himself. The theory is, this practice will stem the tide of insurance fraud by cutting down on fraudulent referrrals. Unfortunately, this kind of blanket policy scoops up legitimate patients and doctors along with the crooked ones.
And in the world of insurance, suspicion is more damning than fact. And by threatening to drop a doctor, an insurance company exerts a measure of control over it's clients (the doctors).
Although it makes me wonder how Doc A can still be employed at a hospital when he has been blacklisted by various insurance providers.
-Trevor
Edit: I still suggest filing a complaint with the hospital for negligence in retaining this moron on staff and contact a local news agency.
Most news channels have some sort of investigative reporter who loves this sort of thing.
posted
Seems like there would be several "incidents" involved.
Posts: 14745 | Registered: Dec 1999
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Boon
unregistered
posted
I guess the whole point of the story is this: how can we convince a surgeon to just cut his leg off?
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Boon
unregistered
posted
quote: Sounds like what your Dad needs even more than a good lawyer is a good general practitioner to advise, interpret, and coordinate care. Does he have one? If not, can he switch?
Doesn't have one, and can't get one thanks to this quack.
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posted
If you've already seen a lawyer, I've got nothing to suggest other go out of state where he's not known. Not very helpful, I guess, but it's a crappy situation all around.
Unless he went to a hospital when a particular incident got bad. Don't they have to treat him then?
quote: Actually, nafcillin is a much much stronger antibiotic than, e.g., vancomycin, which is the last-line drug in many cases (last-line not because it's strongest, BTW).
No, that's not what it was. I can't remember which one, but Jen got the same drug when she had an ear infection about a year ago.
Edit: Vancomycin is what they give him through IV. Ciprofloxacin is what he was on most recently.
posted
My parents have not had medical insurance for many years. Fortunately, neither got sick, so they had no PCP.
The surgeon was on staff at the hospital where Dad was brought in to the ER. He followed up treatment in his clinic.
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Boon
unregistered
posted
Okay, I just talked to my mom. The ER doctor originally referred him to Surgeon. Also, he does see an internist. That's where he's been getting the antibiotics and pain pills for the last year. He's also the one who finally found the surgeon Daddy saw last week.
Unfortunately, this new surgeon won't treat Dad, like I said. And this was the ONLY one in the Tulsa area that would agree to even look at it.
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posted
So, he goes into the hospital and the ER Doctor refers him to Surgeon 1 (Quack).
Quack is the one blacklisted on insurance carriers. The internist is still seeing your father, even though he's associated with the Quack and referred him to another surgeon, Surgeon 2 who refuses to treat the injury.
It sounds like you may have to make some phone calls yourself to find out the particulars.
posted
Well, I suppose it could be that the doctor doesn't want to cut off a semi-functioning leg BUT...
Daddy's been using a cane. His leg "healed" crooked. It's always been very weak. It's now deteriorating, to the point that he can actually FEEL and SEE the bone bend when any pressure at all is put on it.
It's also costing about $150 a month for pain pills and antibiotics, money my parents just don't have to spare. Daddy hasn't been able to work since the accident, first because of the injury, and now because he can't drive on the pills he has to take. He's been depressed because he can't support his wife anymore.
So, "medically necessary" or not, it IS necessary as far as my parents' finances, as well as Daddy's mental health is concerned. At what point can they say, "Look, we know it looks somewhat okay, but it's painful and we can't afford this anymore, so just take it off"? Or can they? If the patient has "autonomy" as suggested in another thread, why can't Daddy demand to have this festering, money-sucking, painful appendage "aborted"?
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quote: If your parents' budget is too tight to cover medications, are they involved with a social worker? If not, why not? Are they aware of the assistance programs offered by the various pharmaceutical companies?
CT, I suspect, given the situation Boon describes, that they are proud stubborn Oklahomans with the red dirt flowing in their veins like blood. My first thought was "only in Oklahoma". The true grit of these people who are the salt of the earth, and would choose to have a leg amputated to "get on with life" rather than save it and remain "whole" at all costs is amazing. I have been privledged to know a few of these people and they are precious and rare like a unique wine. Even if you might want to kick them for not taking assistance I think you would be proud to know them too. I suspect you are not unlike them yourself.
posted
CT, do you have a way that I can ask you a medical question that isn't displayed all over this board?
Posts: 6367 | Registered: Aug 2003
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