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BiPolar Discriminated when seeking LapBand

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pcgumshoe

Member
What is the name of your state? Florida

I'm bipolar, disabled. I receive Medicare. I've battled my condition since 1990. I've been on over 30 different types of medication with little to no help. Recently, I had E.C.T. (46 treatments) and that didn't work. When I was done with E.C.T., I looked at what physical conditions could I tackle that would alleviate my worsening mental health condition.

I determined to have a Sleep Study and look at weight loss surgery. My state, Florida, does not comply with the National Medicare Guidelines concerning weight loss surgery. As a result, I flew to California to be evaluated for treatment.

I explained before I flew, after I got there, and when I returned, that I was disabled and that my condition wasn't fully manageable because of my resistance to medication and these other contributors to my depression.

Initially, I was approved to have the procedure, but after 45 days of lack of communication from the Center, losing or missing important paperwork prior to scheduling, I got frustrated and sent three emails and one voice mail where I exhibited my Frustration, Irritability, and Anxiety. These are ALL part of my condition and covered under the ADA.

Based on these exhibitions (and there was no name calling, no yelling and no abusive language, just the appearance of me gritting my teeth in frustration), I was denied treatment.

In its pertinent parts, my denial stated, "Our initial review of your medical information and psychological history brought up serious concerns regarding your ability to have a successful surgical outcome. However, the team had wanted to give you the opportunity to work closely with us to determine if your risk factors could be contained well enough to proceed. Unfortunately, interactions between you and our staff have made it so that this close relationship cannot be developed and the multidisciplinary team has determined that you are not a candidate for this procedure at this institution."

My April 30th Psychological Exam states the following: "In these individuals' cases, the detachment from others is accompanied by conflicts that they experience in social situations. These MCMI scale scores indicate that they feel somewhat inadequate and often wish that someone would provide nurturance, shelter and guidance. They fear, however, that when others get to know them, they will reject them. As a result, they often seem nervous and tend to be somewhat moody and resentful. At times, they may be friendly and cooperative, but anger and dissatisfaction soon color most of their relationships."

Isn't this discrimination? "Interactions between you and our staff have made it so that this close relationship cannot be developed," vs "they may be friendly and cooperative, but anger and dissatisfaction soon color most of their relationships."
 


pcgumshoe

Member
Nobody questioned the legality of it :)

I guess then, the follow-up question: If it IS discrimination, don't I have an A.D.A. or other type of actionable case?

I've spent $2,500 flying round trip, hotels, car rental, all so that I could get this near my family. Then there's the stress of having to start again, the frustration and of course the perpetuation of that "conflicts that they experience in social situations."
 

JETX

Senior Member
I guess then, the follow-up question: If it IS discrimination, don't I have an A.D.A. or other type of actionable case?
No.
The problem is that you clearly have other medical issues that they could reasonably show prevent a safe surgery.
 

pcgumshoe

Member
Actually, I don't.

Depression causes obesity
Obesity causes depression

I've had 46 E.C.T. treatments under general anesthesia
A septoplasty under general anesthesia
Colo-rectal surgery under general anesthesia

I'm cleared by my mental health professionals who agree that this surgery would be a BENEFIT not a detriment!

There's nothing in the "SURGERY" itself, this is a matter of personality conflict, my 126 IQ vs their 80-95, and I get frustrated not knowing why there are so many stupid people around.
 

pcgumshoe

Member
If not discrimination, what about abandonment?

I was a patient, and was progressing towards having an important surgery. Up and until the time that I was told I had been brought before the multidisciplinary panel again, I was concluding the necessary tests to have the procedure scheduled. Nobody told me anything about being "tested" then, isn't that intentional infliction of emotional distress?

Dr. says, "We'll treat you, go have these tests."

Doesn't mention that he has "serious concerns regarding your ability to have a successful surgical outcome"

Also, Dr. does not disclose that he and his staff are attempting to "determine if your risk factors could be contained" let alone describe any "risk factors."

Patient has tests, the tests and other results get lost and Dr. says, "Your interactions with us" cannot negate the "risk factors" that we didn't tell you about.

He's abandoned me AND discriminated against me.
 

CourtClerk

Senior Member
You know, I used to be obese and I wasn't depressed. I just liked the taste of good food, so that whole:
Depression causes obesity
Obesity causes depression

May be true in some circumstances, but I believe (and this is just my belief) that in most, it's just pure laziness. There are other methods to lose weight. Weight watchers is much cheaper than surgery and when you reach your goal weight, you can attend their meetings for FREE. Surgery is not guaranteed. Better for you to learn to control your weight in another manner.
 

cbg

I'm a Northern Girl
My husband was diagnosed with depression almost twenty years ago.

One of the medications he takes for the depression has, as a side affect, an appetite suppressant.

He was never obese, but he's losing weight rapidly.

What makes you think you have a RIGHT to the surgery?
 

pcgumshoe

Member
I'm sorry, for a moment I thought I was talking in the LapBand forum... Then I realized you were flaming me... Over there they are far more supportive of my decision.

What gives me the right? I meet the criteria. Medicare's National Coverage Database, specifically, "The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is adequate to conclude that open and laparoscopic Roux-en-Y gastric bypass (RYGBP), laparoscopic adjustable gastric banding (LAGB), and open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS), are reasonable and necessary for Medicare beneficiaries who have a body-mass index (BMI) > 35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity."

I have sleep apnea (That's a co-morbidity caused by my weight). I've been unsuccessful on diets (yes all the major ones!), and I weigh 100 LB over my ideal weight. THAT is what gives me the right!

Yes, there are a lot of prescription medications that curb appetite. You call that a side-effect... is it a negative side-effect? Most medications that doctors have told me are "weight neutral" actually caused weight gain.

If you were obese and it was a matter of "you like food" that's great for you. Let me guess, you weighed 20 or 30 lbs overweight? You can't get this procedure until you are about 100 lbs over weight!

I don't think I need to defend the "yo-yo" diet issue. There's plenty of evidence that diets don't work for the severely obese. Sure, go ahead and say I am lazy, that's B.S. When I am depressed, down, or suffering from my mental health condition, I can't always get out and go jogging, swimming, or do heavy labor in my yard. Why? Well, I guess you don't know anything about clinical depression.
 

seniorjudge

Senior Member
...I'm sorry, for a moment I thought I was talking in the LapBand forum... Then I realized you were flaming me... Over there they are far more supportive of my decision.....
You are not being flamed.

You are being given accurate and correct legal advice.
 

tranquility

Senior Member
A doctor or clinic is not required to perform treatment they feel involves more risk than benefit.

Our initial review of your medical information and psychological history brought up serious concerns regarding your ability to have a successful surgical outcome. However, the team had wanted to give you the opportunity to work closely with us to determine if your risk factors could be contained well enough to proceed. Unfortunately, interactions between you and our staff have made it so that this close relationship cannot be developed and the multidisciplinary team has determined that you are not a candidate for this procedure at this institution.
That is not discrimination, but a medical assessment based on their criteria. Since the criteria is not based on an "illegal" reason, it is not illegal discrimination. Period.

You do not have a "right" to the treatment. From what you've posted (I don't know the details or application and don't express an opinion on you characterization.), you may have a right to medicare compensation if medical professionals determine you meet their criteria for the proceedure. On a side note, I'm not a doctor nor do I play one on TV. I do know many who have had such surgeries and understand the pounds don't melt offf because of the surgery. There is substantial follow-up care where the patient needed close interaction with a number of health professionals to have success with the surgery. All of those I know who have had the weight return or not lost, have had a certain attitude towards treatment. While my experience is not very broad, is clearly anecdotal and not based on studies, certain aspects of your posts demonstrate at least some portions of that attitude. This may be the source of the reticence of the medical team.
 

ellencee

Senior Member
pcgumshoe

Someone should take the time to explain to you why your having the surgery is deemed to be inappropiate. Perhaps your primary physician can do this.

As for your question, physicians and hospitals/surgery centers have the right to refuse to treat patients, provided the patient is not in a life-threatening crisis. Obviously, the physicians chose not to accept you as a patient and made no mention of your disorders in their denial; therefore, no discrimination exists.

The establishment and continuation of a therapeutic relationship is paramount to the success of many surgeries and treatment modalities. Weight loss surgery requires not only a therapeutic relationship but a compliant patient.

The surgery is not a guaranteed "fix" for obesity. It is a difficult surgery from which to recover and if successful, leaves the patient with yards of loose, wrinkled, hanging skin (and boobs). This translates into the patient's needing "plastic surgery" to reshape the skin; it often requires a tummy-tuck and breast reconstruction. It isn't for those who cannot or will not attend to task by eating right and exercising or for those looking for a quick fix. Success in these surgeries is often short-lived and within two years, many patients return to gaining weight and return to their pre-surgery weight in a short period of time.

Should you decide to seek the surgery, again, there is no need to go to California. Florida does have surgeons who perform this surgery; and, Georgia, which is much closer than California, is a pioneer state for the procedure.

I suggest you research the topic further and seek a consultation appointment closer than California.

EC
 

pcgumshoe

Member
You are not being flamed.

You are being given accurate and correct legal advice.
I guess that was what I wanted to say without saying that, "I thought this was a legal forum, not a LapBand discussion forum."

For someone to say that people are fat because they are "lazy" that smells funny to me.

That is not discrimination, but a medical assessment based on their criteria. Since the criteria is not based on an "illegal" reason, it is not illegal discrimination. Period.
Okay, and they can keep that criteria secret? According to the National Coverage Database for Medicare (A Federal Funds Program) I must meet essentially 4 criteria: 1) have a Body Mass Index Greater than or equal to 35 (My BMI is 43), 2) I must have a co-morbidity (I have sleep apnea), 3) I must have been unsuccessful on medically supervised diets (been there, done that), and lastly 4) I must have the procedure at a Center of Excellence (ergo, the one hospital out of less than 200).

Now you're going to argue that they can add their own criteria. Okay, I'm fine with that too. My complaint isn't that they refused to meet with me and assess my situation, my complaint is that they met with me, assessed my situation, tested me with a psychiatrist, a social worker and a dietitian. Those three people, armed with a clearance from my Primary Care Physician, my therapist, and my Sleep Doctor, met 4 weeks ago with the doctor at the center who originally met with me and compared notes.

The following Tuesday, I was told that I was "cleared" by this multiple disciplinary team to move to the next step: Decide which procedure I wanted Bypass or LapBand and based on that have two or three additional tests. Having picked LapBand, I needed two tests. I had an Endoscopy with Biopsy and a total abdominal ultra-sound. The doctor who ordered those tests said that I was "cleared" for the LapBand based on those results.

I requested the Endoscopy Doctor fax the three test results to my LapBand doctors' office. When I called to confirm the three tests, the care coordinator said she got three copies of the ultra-sound and that someone who was explicitly told she could not contact my therapist (because my therapist has been treating me for free via email AND I didn't want to tax her with multiple inquiries from the psychiatrist AND the social worker who were doing the same work) was waiting for a letter from said therapist. Nobody told me about the letter and had they, I would have followed up with my Therapist because I was short on an open window during which I could have this procedure, or risk pushing it 2 or three months later.

Up and until I got the letter, the care-coordinator and the doctor's office, for that matter, were moving forward as if I was going to have the surgery. But because I got short with the lowly employee, she said something to either the social worker or the psychiatrist about how frustrated I was acting and THAT resulted in I was suddenly not a good candidate.

Sadly, my therapist has given me the best advice: Find another hospital closer to where my therapist works (New Jersey - where I lived before Florida), with her help and acting as my advocate, have the procedure, THEN when things are going well, pursue this matter and say, "See, I was a good candidate regardless of my personality flaws!"

I cannot see why you don't consider this either abandonment OR discrimination. I have a personality flaw that is never going to change. I spend most my time at home because I don't want to expose it to the world and ruin people's days. If I were to get better sleep at night (I slept 4 restless nights between 5AM and 9AM this morning) then that would alleviate some of my depression and other associated problems. Were I to lose weight, my sleep apnea would correct itself (I already had the septoplasty that was promised to help this - my sleep doctor still laughs at that waste of time). Were I to lose weight, I'd also have better self-esteem and that would improve my overall mental health.

How do I know these things? Well, I was doing all well and good on a Low Carb diet up and until December 2004 when something else shocking happened to me and my life has gone down hill from there. This isn't really anyone else's fault, it is mine, but I don't choose to be like this, it is innate... I was born this way and I'm just trying to make the best of it.

Follow-up care issue: I'm not going to be their "buddy" or fake "smiles and happiness" I can't do that anymore. This is a case of I have a qualified disability. They knew about it. They accepted it when they accepted me as a patient. Then when my disability reared its ugly face, they opted to abandon me as a patient. Clear cut abandonment and discrimination, sorry please shoot holes in my theory. Or point me to a correlating case, I love reading case law.
 
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pcgumshoe

Member
Oh, one other thing that sucks:

If I had lots of money, these things wouldn't happen to me because I could afford to pay a lawyer to actually represent me on this case AND spend time developing my case, but since I don't have a lot of money (just enough to live comfortably) I won't get equal protection under the law.

I guess I'll keep playing the lottery, then if I win spend it all on the people who have trampled on my rights AND my sub-standard of living.
 

Zigner

Senior Member, Non-Attorney
You OBVIOUSLY have problems "getting along" with people (by your own admission). A doctor (and, by extension, a facility) is allowed to end their non-emergency relationship with you if they feel that they cannot maintain a satisfactory doctor-patient relationship.
You have not been illegally discriminated against and you have not been illegally "abandoned".
 
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