posted
I can't stop thinking about 3 things from the hearing and I hope someone here can answer them for me.
1. The Board painstakingly went over each point/change that the Dept. of Health wanted to make regarding the panel's recommendations. When it was time to review the changes Dr. Jones' lawyer wanted to make, Dr. O'Neill said that there was a long list of points; however, only 2 or 3 were brought up. Did I miss something or did they completely gloss over the remaining points when they went straight to vote? Or is that OK?
2. Did the changes proposed by the CT Dept. of Health like adding that "Dr. Jones did not adhere to the standard of care" prove that the Dept. of Health is siding with the IDSA guidelines (and the contentious Feder NEJM article)?
3. Did the fact that the panel basically admitted that they diagnosed the children to be "lyme-negative" mean that they, too, are siding with the IDSA guidelines (and NEJM article)?
Are these important pieces for the appeal or atty. general Blumenthal's review?
The CDC/IDSA keep saying that these are "guidelines" and that they should not come before physician judgment and experience, but that does not seem to be happening.
Thanks for the helping me sort this out...
Confused in RI, Allie
Posts: 300 | From Northeast | Registered: Dec 2006
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Especially the first question???
Posts: 300 | From Northeast | Registered: Dec 2006
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shazdancer
Frequent Contributor (1K+ posts)
Member # 1436
posted
I was not there, though I was able to go over the video of the session. In my opinion, there was a difference between what Attorney Tillis (sp) was going after and what the panel was comfortable going after.
It appears to me that Tillis wanted to find Dr. J guilty of not adhering to the IDSA standard. (Which is why he called on Shapiro to testify.)
The panel, however, was trying to look at the overarching standard of good, general medical care -- a prompt and thorough medical exam, elimination of other possible causes, diagnostic and follow-up tests, monitoring of treatment.
I think sometimes the panelists got bogged down in understanding the problems that come up in treating Lyme -- bad blood tests, local docs who won't cooperate or monitor, long distances/cost making it hard to schedule regular follow-up exams. These kinds of things are commonplace to those of us who have dealt with Lyme, but do not come up when dealing with a child's broken broken leg or strep throat.
So when the panel says "standard of care," I think they are talking about good medical care in general -- not a standard of care specific to Lyme. They just don't understand that getting ANY care for Lyme can be a hardship at best.
Posts: 1558 | From the Berkshires | Registered: Jul 2001
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posted
Well, why do we have to put up with the ID ducks anymore? If we don't like the position of the ID doc, then can't we say so, and ask for what we want?
It just may mean going to an LLMD and forgetting about them, but at least I think we should verbally refuse requests for us to go to ducks and tell them why and also tell them what we want -- ie, fair and honest treatment for a real disease, to be treated considerately and compassionately as the ill people we are. That we are deserving of the same patient rights as any who are ill, and to stop treating us badly.
I stood up to the rheumatologist who sent out for an ELISA after I had a positive Western blot. It came back negative. I told him I knew what was going on. He walked out saying he was going to write a letter to my doctor. I said, so am I, and I was in the next day with my letter to explain the situation.
When reps from that hospital were out on the street later on, asking for our support, I said I had no problem with the hospital, but I could not sign a statement of support because three docs there are anti-Lyme, and I named them: David Curtis, rheumatologist; Lory Wiviott, ID doc; Shelly Gordon, ID doc.
I say enough is enough. They're bullying us and I don't wish to accept their authority anymore since it's based on standing down from respecting the seriousness of the illnesses we've got. It's time to tell these folks that we are not in agreement with ID doc recommendations and will not follow them, and what's more, this is what we want, and spell it out.
I do one more thing these days: after a bad encounter with the doctor, I then tell the staff what's going on with Lyme disease. I educate that doctor's staff. I hand them my Lyme brochures. I tell them it's spreading here and they need to take precautions or they could get it too. And to protect their pets too. In other words, make it real and personalize it.
I've had it in doctors' offices. I don't think we should take it lying down anymore. I'm not a mean person; I mean well, and I have to remember that as I'm duking it out there, that this is for people's health and safety. To insist on the positive goal, even as I fight the cruelty being shown us.
[ 21. December 2007, 12:45 AM: Message edited by: Robin123 ]
Posts: 13116 | From San Francisco | Registered: May 2006
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So, it looks like it is "legal/ethical" for the board to ignore some of the changes in the MOD (or whatever the panel put forth) that the Jones side requested.
I thought maybe they made a big BOO BOO. But from your experience, Finette, it is common to ignore these requests in some circumstances. Makes no sense.
I think that NEJM article is really showing it's power now. The one that basically ignored "science" and told everyday docs how to deal with patients that have been misinformed as they searched the internet for answers.
But how can it be ok for the board to ignore all the requests of one side?
Did the DPH win? NO. They wanted far broader and harsher wording in the charges...
Who won? Dr. Jones keeps his license, but has to pay $$ and be monitored for 2 years. (except that monitoring process could be horrible). but in some ways, he won.
the problem was that his "win" was nested in all this talk about "standard of care" and that is where he "lost".
The board definitely contradicted itself when it said that it wasn't taking sides regarding treatment guidelines, but then obviously did.
This should be grounds for countersuit... etc.
Confused as always, Allie
Posts: 300 | From Northeast | Registered: Dec 2006
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Areneli
Frequent Contributor (1K+ posts)
Member # 6740
posted
I will add just 4 of my questions or opinions:
1. Why Dr Jones's lawyer sounded impatient and angry? I suspect that no anger would be better for the case.
2. Prescribing over the phone was clearly an offense, even for me - a Lymie. It is a common offense among doctors but he was caught and has to suffer consequences.
Why Dr Jones didn't admit plainly ``I prescribed abx inappropriately. Sorry! It will never happen again''? I am sure the board would be happy with it. Was it a problem with excessive pride of being above the little things?
If he would admit and apologize, the other issue with standard of care would be nicely separated and not like it is right now, confused with practicing telemedicine all in one bag. The message almost seems that the ILADS standard of Lyme care is prescribing abx over the phone. This is not OK for ILADS or us.
3. Why the reasons about prescribing over the phone haven't been explained CLEARLY (problems with finding local doctor who would accept ILADS point of view) by the lawyer to the board? As far as a I can see it, it was a central part of this accusation. Seems like a lost opportunity to me.
4. I know, there was a standing ovation but I still think that many people from this board could write similar quality defense speeches at no charge, so I would like to know what is included in this $1000/day legal cost for the last 1 1/2 years as I was not too impressed this time.
[ 20. December 2007, 11:10 PM: Message edited by: Areneli ]
Posts: 1538 | From Planet Earth | Registered: Jan 2005
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Areneli
Frequent Contributor (1K+ posts)
Member # 6740
posted
Fin, You wrote: "as for the telemedicine...I disagree. The first case was simply a renewal of meds from prior Dr. so that they werent discontinued pending an appt. VERY common in chronic illness ( i.e. thyroid,potassium for cardiac, diabetes meds etc) IF you assume or accept a person having a chronic condition, its MORE ethical to continue meds already on than to discontinue prior to re-evaluating them"
Maybe it is ethical but it is still against the law. You cannot write a script for anybody without seeing the person. Law is not always ethical.
A charge sometimes may be dismissed if there is a very good reason for breaking the law. I know a case of a doctor who caused a serious traffic accident while driving after a drink or two. The charges were dropped (or reduced - don't remember well) because of circumstances. He was having some alcohol at his free time but received an emergency phone call about railway accident. He took the risk to save lives since no other doctors were available at the time.
Was Dr Jones compelled by some higher reason to break the law? If so, why wasn't it brought up?
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sometimesdilly
Frequent Contributor (1K+ posts)
Member # 9982
posted
" (it may be) ethical but still against the law to prescribe to a person without seeing them..:
i know i cannot possibly be the exception- and i have had multiple doctors in good standing with excellent professional credentials and reputations do exactly that for me over the years for at least 3 different conditions that they explicitly diagnosed over the phone and for which they prescribed everything between antibiotics and steroids.
Just how many doctors who have done that, especially when they helped and not harmed their patients get hauled before a medical board?
and "was dr. Jones compelled for some higher reason?"
YES- to help 2 children in crisis when no other medical professional would. that is what he does for a living.
and "why wasn't that brought up to the board?"
it was, repeatedly. as bizarre as it may seem to you and in fact be, the Board is quite hostile to the fact that Dr. Jones consistently honors the Hippocratic oath and put his patients's well being first.
dilly
[ 21. December 2007, 12:47 AM: Message edited by: sometimesdilly ]
Posts: 2507 | From lost in the maze | Registered: Aug 2006
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Areneli
Frequent Contributor (1K+ posts)
Member # 6740
posted
...many people speed, but only some got caught.
Perhaps they catch you easier if you drive a big red vehicle.
What I am saying is, that if you as a doctor get involved with LD don't forget that people watch you closer than other doctors ... because you are different from majority.
Posts: 1538 | From Planet Earth | Registered: Jan 2005
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posted
To continue this very interesting conversation, I just looked again at what Pineapple posted in the "What happened to Dr J?" post.
Pineapple listed the rules of states' medical boards for doctors prescribing to patients they have not seen yet.
Here is Alabama's: "Prescribing for a patient who the physician has not personally examined may be acceptable under certain circumstances. These may include...continuing medication on a short-term basis for a new patient prior to the patient's first appointment."
I scrolled through the states and found that Colorado, Nebraska, N Carolina and S Carolina have the same language.
I did not see Connecticut in this states' list. So I'm assuming that Connecticut does not include this language.
Some had statements about a physician covering in the absence of another. So I don't know if this rule would apply to what happened with Dr J -- ie, an "absent" doctor.
Many had statements about physicians prescribing medications in emergencies.
So you can't say there are no legal precedents for what Dr J did -- ie, extending a prescription until he saw the patient.
Comments?
Posts: 13116 | From San Francisco | Registered: May 2006
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posted
Getting back to my first diatribe here, I say get creative! You can do a lot to alert the public if you just think about how you'd like to go about doing it. Have some fun with it.
I now flyer with info about the general and local danger, about the politics, and I pass out wallet-sized Plague Alert! slips with important websites on the back.
I educate all the taxi cab drivers in SF, as I have paratransit for my unstable bod. "No, I haven't had a hip operation. I have Lyme." Very few know what I'm talking about.
Now I'm starting to hear back reports of "I told the couple I just drove to GG Park about what you said."(We have a GG Park Lyme infection report, with a bull's eye rash and bartonella thrown in. Ugh and more ugh.) Thank you, Mr taxi cab driver. I want to hear it coming back to me, what others are now doing to tell others. Yes!
Posts: 13116 | From San Francisco | Registered: May 2006
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bettyg
Unregistered
posted
interesting thread, comments, legalities, and suggestions from robin!
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