Doctors, Patients, Answer the Call!

My first paycheck as a fresh out of medical school M.D. came from the VA. I performed my first “solo flight” cataract operation on a trusting veteran at the Audie Murphy VA Hospital- talk about a brave soldier. He and I developed a patient-physician relationship over a year, and by the time he was in need of vision restoring surgery, he wanted only me to do it, and I didn’t want anyone else to operate on my beloved patient. I had been training for this rite of passage since I could pray. I was ready. He was proud and honored to volunteer to be my first complete operation-at least that’s what he told me, and that’s what I believed. He had been a pilot and told me about his first solo flight as well as many other stories of his experiences in World War II. He instilled confidence in me, and we shared an unspoken trust and sacred bond like no other. That’s what the Hippocratic patient-physician relationship is. I prayed harder, humbled and aware of my own frailty. The surgery went flawlessly, and I was off on my medical journey, a surgical career now spanning twenty years, 10,000 cases, and tens of thousands of patients.

My father overcame poverty through hard work and education to become a pioneering neurosurgeon and the first chairman of neurosurgery at the University of Texas Medical School at San Antonio. He operated at the VA hospital for 30 years, devoting his life to giving veterans state-of-the art, highest quality, compassionate, dignified, individualized neurosurgical care while training some of the finest neurosurgeons in the United States. His brothers were both WWII veterans, and both were lifelong patients of the Audie Murphy VA Hospital. These three brothers provided and received the best of the best there, in the fashion of WWII hero, Audie Murphy himself.

After five years in academic medicine and 9 years on the VA/UT payroll, I set off into private practice. I continue to care for veterans. I am blessed and honored to care for Generals, Colonels, Sergeants, and Seals each day. One of my patients was even a Tuskegee Airman. If you stop, listen, and examine each individual patient, you will learn so much. You will also find the diagnosis and treatment they seek. Such a process does not come from administrators, computers, or a 2700 page law; it comes from hands-on, secure, heartfelt personal interaction between the highly-trusting patient and the highly-trained Hippocratic physician.

Enter government medicine with its perverse incentives, impersonal bureaucratic waste, and anti-Hippocratic, pro-statist mentality- this is where we are. Is this what we trust?

A few weeks ago, a friend called me, worried sick about his father, a veteran, who had left the Audie Murphy AMA (against medical advice) the day before. I said “bring him to my office now”. The patient-veteran reported he had been admitted for stroke symptoms to an under-renovation room of six men, where he sat for three days with little to no evaluation or interaction with medical personnel, waiting for promised tests and treatment. He walked out.

That same day, a patient-VA nurse related concerns about current attitudes and conditions at the VA and that she was retiring. She said the Audie Murphy museum had been disassembled, his revered belongings offered back to his family, in the name of renovation. This memorial, which had graced the entrance to the hospital, inspiring thousands for years, a hallowed reminder of sacrifice, heroism, courage, and exceptionalism, is now being transformed into administrative offices. How symbolic. How fundamentally frightening.

Then a few days later, news of the institutional, inhumane VA crisis breaks. We discover that our precious, courageous veterans are not only being denied access to the VA, but that across the nation thousands are being placed on dead-end waiting lists to potentially die at the hand of government employed administrators seeking bonuses at the expense of saving lives. These government employees, who have never taken the Hippocratic Oath, are paid by the same hand that dismantles the memorial to self-sacrificing Audie Murphy to erect offices for self-serving government bureaucracy. We say “No More”!

Who assigned our veterans to the Real vs. the Secret list? Were there established criteria like age, union membership, or certain diagnoses from top down? Were there payoffs? Was it reward vs. penalization? Or was it just luck of the draw and mood of the scheduler that day? Whatever it was, we need to know. Bonuses based on waiting list times instead of number of patients served are perverse. Perverse leaders/bosses believe “ends justify the means” and tend to recruit like-minded followers/employees, who, lock in step, shorten the waiting list to get the bonus. What is the goal- incentivizing employees to ration scarce medical resources by any means or actually caring for patients by allocating scarce resources to patient-care instead of bonuses?

Obamacare architects and the healthcare advisors our Commander-in-Chief has chosen to surround himself with do not like the Hippocratic Oath. They believe it is too costly, outdated, and that the government needs to intervene between the patient and physician. They believe in the collectivist philosophy of Plato, where the individual’s duty is to the state. At some point you’ve used up enough resources; at some point you’ve lived enough life. They seek socialized medicine. They revere Saul Alinsky, his relative truth, and his “ends justify the means” tactics. See for yourself. Read Rules for Radicals. Read the writings of Ezekiel Emanuel, MD, Obamacare architect, Presidential advisor, member of The Federal Coordinating Council of Comparative Effectiveness Research (“The Council”, established 2009 in the Stimulus Bill, Obamacare phase one), and creator of The Complete Lives System as described in his article “Principles for allocation of scarce medical interventions”, (www.thelancet.com Vol 373 January 31, 2009) . Healthcare law crafted by those who espouse such perverse ideology, enforced by a system of perverse incentives, results in perverse outcome and loss of human dignity and life. This is not what our veterans fought for. This is not what we can stand blindly by and accept.

One by one, we must each individually do what big government can’t and won’t. Whatever you can do, do it now. Our veterans laid their lives on the line for us; now we must lay our lives on the line for them. This is our “red line”. The American people value life and human dignity. We are a loving, brave, virtuous, ethical people. We value the Hippocratic Oath. We are not like Emanuel, and we do not believe in his statist medicine where at some point it is our civic duty to die. We are a government of, by, and for the people, whose miraculous Constitution created the free-est people in the history of the world, and whose free-minded people created the most amazing, life-extending, life-saving, medical advances in the world. We believe in absolute Truth. Our Constitution empowers us and calls for us to secure the Blessings of Liberty to ourselves and our posterity. Answer the call.

Get Informed or Get in Line

The Veterans Administration Hospitals’ horrific reality is considered unethical and inhumane by most of us Americans, who honor the Hippocratic Oath and value life. Shockingly, the current political reality is that the ruling elites, led by figure-head Obama, are far leftist, Utopian, progressive statists with Communist roots, who do not value individual life but, in fact, believe the world’s problems stem from over-population. Sorry, but I believe our rulers are “sad” about the VA situation, but they think that it is just the way it should be, tough luck, and in the words of Obama appointee HHS Secretary Kathleen Sebilius, “I would suggest, sir, that , again, this is an incredibly agonizing situation where someone lives and someone dies.”

President Obama surrounds himself with advisors the likes of Sebilius, Obamacare architect Ezekiel Emmanuel, and his first appointee as CMS director Donald Berwick- fellow travelers who idolize socialized medicine and will do absolutely anything to achieve it in the United States of America- the country they despise, the country whose Constitution they defile, the country they seek to fundamentally transform.

  1. They believe, in the fashion of Josef Stalin, that socialized medicine is the keystone in the arch or socialism.
  2. They believe, in the fashion of Saul Alinsky, that the ends justify the means, including lying and dying.
  3. They believe that we, the people, are stupid and that they, the central planners, know best and will tell us what to do.

Ezekiel Emanuel’s “Principles for allocation of scarce medical intervention”, published in Lancet 2009, is telling and sets forth his alternative new rationing system- the complete lives system- “which prioritizes younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.” Ezekiel Emanuel, who believes government needs to intervene in the patient –doctor relationship and deconstruct the Hippocratic Oath, advises Obama on healthcare. Accordingly, the “incredibly agonizing situation” at the VA would not only be sanctioned by Obama and his operatives, but it could very well have been implemented (or endorsed by casting the blind eye) by Obama and his operatives from top down, by design- because, as espoused by Sebilius, “someone lives and someone dies”.

Let’s face it; it’s not called the YRADA (young recruits/ active duty administration) hospital, for patients who would qualify for care based on Emanuel’s complete lives system “which prioritizes care to young people who have not yet lived a complete life”. And, as far as “instrumental value principles” go, our veterans are not high enough on Obama and his fellow anti-imperialist pals’ lists to warrant actual medical care. In reality, patients at the VA don’t make the cut under Obama’s signature legislation. They are too old, and they are not valued. They are waiting in long lines…dying. Tough luck.

I wish this were not the case, but it is. If you don’t believe it, you are not informed with facts, those stubborn things that coexist with absolute truth.

Make no mistake: this IS government-run medicine. They master-minded this “incredibly agonizing system”, and they will stop at nothing to achieve this for all.

Do something. In the fashion of our forefathers, we must stand up and strong against all odds. Stand for prolonging life not ending it. Stand for our elderly, sick, weak, and disabled. Stand for our heroes, our veterans. Fight courageously for the lives of those who courageously fought for our lives. Or get in line.

 

 

 

Letter to my Aetna Patients- Enabling is Easy; Taking a Stand is Hard

May 12, 2014

 

Dear Cherished Patient,

I regret to inform you that I am no longer ethically able to continue my agreement with Aetna to serve as an in network provider.

However, I am pleased to inform you that I am committed to our mutual patient-physician relationship, which, in medical reality, supersedes any impersonal, one-sided relationship between you and an insurance company.

I hope and pray you will continue to seek your care from me. My pledge is to provide state-of-the-art, personalized medical and surgical care to you with privacy, dignity, and compassion. I honor the Hippocratic Oath. My fees are reasonable and transparent.

I will provide you with billing codes for my services should you choose to file with Aetna as you would for any out of network provider.

I have attached my letters to Aetna should you be interested in why I have terminated my agreement with them. Perhaps, you will reflect upon your relationship with Aetna as well.

Make no mistake; this is a direct result of Obamacare. Aetna could have honored their mission statement and chosen to stand for the best interest of the patient, but instead Aetna colluded with the federal government and its lawless, discriminatory “Affordable Care Act”, selling the false promise of my services on the federal Obamacare exchange without discussion, permission, or notification. I will not enable or facilitate such deceptive, manipulative, and discriminatory behavior. America’s patients and physicians deserve better. Without us, what do they sell?

Please, address your concerns with Aetna.

Respectfully,

Kristin S. Held, MD

Patient-Surgeon, Rebel-Doctor

As a surgeon, I am 100% responsible for my patients. As a patient, I learned the hard way that absurd bureaucratic, governmental interference in the patient-physician relationship is lethal. I learned that as a patient-surgeon, I must actively protect my patients from the insanity of government-run medicine.

When I arrived for my mastectomy, an arm band was placed on my wrist. The arm band had a bar code. I don’t read bar code, do you? Everything that happened to me from that point on involved swiping my barcode. I awoke from surgery to my surgeon assuring me that everything had gone flawlessly. I thanked him and God. The hospital was full, so I was stuck in Recovery for hours. When I finally settled into my hospital room, I was startled by a warm, wet sensation- that of bright red blood flooding from my bandages and drains through my gown and into the sheets. My pulse quickened, and I grew faint. My surgeon returned emergently and adeptly stopped the hemorrhaging. He was superb. We were perplexed.

Flashback: As a young medical school faculty member in the early 1990’s, I felt honored to serve on our county hospital’s “Quality Assurance” committee. The University and County Hospital district had discovered they could get easy money from Medicare and Medicaid to supplement what they got from the State and County if only they did a “few little extra things” in return and complied willingly. Federal Government (CMS) required that we create “indicators” which could be monitored, as if to prove or judge that we were doing something worthy of getting paid, with their money, to treat our patients (as if they actually knew anything about medicine). In reality, they were trying to justify their existence and gain control over us.

I naively helped produce indicators and unquestioningly followed subsequent orders from the “powers that be”- being that I was a type A, pleaser, rule-following, too-trusting-in-government, doctor. The ensuing years beheld a massive transfer of power from physicians and patients to bureaucratic government entities and their pals, the hospitals. Government held the medical purse, and now government holds the power over our lives. I am partly to blame for the sophomoric laminated “5 moments of hand washing” and “fire triangle” signs posted in my OR as lame responses to lame indicators.

Flash Forward: As a seasoned surgeon in private practice, amidst the storm of my battle against Obamacare, I was diagnosed with breast cancer.  Untested rules and regulations (new indicators which now came from top down) were set in place. These had never been tested on patients but were established by government fiat as “the new way of doing things”, and money would go to only those who complied. The perfect storm for medical disasters was brewing.

Obamacare operates through a series of perverse incentives and a few carrots which are ultimately traded for many sticks each passing year. For example, CMS will penalize hospitals that have readmissions. Likewise, CMS will not pay surgeons for their services if patients develop post op problems (even if the problems are acknowledged consequences of life-saving surgery). These are the new top down indicators. Combine Obamacare’s “pay for performance”, with HIPAA, and the requirement for “meaningful use” electronic medical records, and it is medical tsunami time.

To prevent monetary penalization for readmissions from postop DVT’s, many hospitals opted to require that orthopedic patients receive post-operative anticoagulation as a standing order. To avoid not getting paid for surgery if a patient gets a post op DVT, the surgeons agreed. To comply with HIPAA, hospitals came up with absurd ways to identify patients without calling them by name, and out of fear of hefty fines, again, doctors went along. Electronic medical records (EMR) were “deemed” excellent and not only mandated for physicians, but government actually bribed physicians with $44,000 per doctor to adopt EMR. The safety and truth of any of this was never tested. It is all just false speculation from medical Utopia.

Back in the real world, after significant blood loss and sensing something not right, I determined to stay alert. In the middle of the night, the nurse came in, opened her med cart, scanned my arm band and then the electronic chart, and told me to take the meds. I asked what they were and determined they were not indicated for me. To her dismay, I refused. I left the hospital as soon as I could, in less than 24 hours, fearing further problems. We ultimately discovered that in the recovery room, my barcode had been inadvertently scanned to a different patient’s chart-that of an elderly man having orthopedic surgery- a patient for whom the hospital required anticoagulation for DVT prevention because of Obamacare style medicine.

Once my wristband was on, no one asked my name again. The electronic record, the impersonal HIPAA-born barcode, and the mandated DVT prophylaxis to prevent not getting paid, all culminated in an event that almost killed me. Had I not been a physician, who knows what else might have happened had I stayed in the hospital and continued to get someone else’s meds.

At my last two operations, instead of being assigned a barcode, I was given a sticky note labeled “A” for one and “B” for the other. When the nurse came out and called “Patient A” or “Patient B” , at least one or two elderly, hearing impaired or nervous, patients stood up with me to head back to the OR. Let’s restore sanity. I have a name. I am not a barcode, an A, or a B. I am a unique patient.

It is our duty as physicians to stand for tested, proven, individualized medicine and against the false assertions of untested government group medicine. It is time to say “No, We Won’t” to those who defile the practice of Hippocratic medicine. If we won’t stand up for our patients and profession, who will?

I am no longer naively trusting of the government and its deadly false assertions and mandates. I will not do those “few little things” just to get paid. I will not comply with the insanity and inhumanity of Obamacare. And now, more than ever, I am 100% empowered to fight for the safety of my patients and the sanctity of the patient-physician relationship. I am now a rebel doctor. What are you?

Healers and Heroes, Pawns and Pillagers

Are you a healer, a mover, an innovator? Do you really want to reform healthcare and provide real care to real patients? Or are you a brainless pawn, guilted and exploited, enabling a Government-Lobbyist-Insurance Company-Hospital (GLICH) syndicate to lie, cheat, and steal from our patients and profession? Are you the cure, or are you cancer?

My quest for answers and solutions led me to the Surgery Center of Oklahoma, where I had the great privilege of meeting modern day heroes, G. Keith Smith, MD and Steven Lantier, MD. These highly educated, brilliant physician colleagues have mixed maximal amounts of hard work, front-line experience, and common sense with free-market principles, ethos, and courage to develop a model for true cost-saving, patient-centered medical care.

Dr. Keith Smith, Medical Director at the Surgery Center of Oklahoma, says their prices are anywhere from a sixth to a tenth of what a patient would typically pay at a so-called ‘not-for-profit’ hospital. The reason the prices are so low is that the surgery center is completely physician owned. Because the center deals directly with patients and physicians, without the greedy tentacles of third party intervention, money is spent on care for patients in lieu of cash for politicians, lobbyists, insurance executives, hospital administrators, and bureaucratic waste. Prices are transparent and posted on the center’s website. Patients can call and speak to physicians directly. The facility is beautiful, state-of-the-art, and efficient. Outcomes are superb and complication rates are extraordinarily low. Privacy and dignity are inviolable. Everyone is smiling and happy.

Recently, employees of Oklahoma County were given the option of having their surgery at the Surgery Center of Oklahoma. Within three weeks, the county saved $140,000. In two months, the county has saved $400,000, for a potential savings of $2.4M annually. Policy analysts believe that if the state of Oklahoma would offer state employees access to such a center, state taxpayers could see savings of up to $20 million dollars a year. The model works.

Ironically and despicably, lobbyists spend billions of dollars a year influencing politicians to perpetuate the “GLICH” scam, so lawmakers in both parties roadblock even such impressive free market models. Why? Hospitals and insurance companies profit immensely on the backs of patients, doctors, and employers by artificially increasing hospital prices (the bill) relative to insurance “allowables” (the payment), so that hospitals can receive big money government subsidies for fabricated losses attributed to “uncompensated care”, and so that insurance companies can receive big money kickbacks from employers for phantom savings they “brokered” for employers. Thus far, state employees have not been granted access to the Surgery Center of OK and must seek care at hospitals whose prices are 0% transparent and %80 to %90 higher. Big government is literally colluding to deny patients access to excellent care at massive savings. Billions of tax dollars are squandered laundering money and power to politicians, insurance companies, and hospitals under the guise of providing care for patients. The “GLICH” syndicate deals our services like drugs. Without our services, the deal’s off.

Will physicians act boldly in step with Doctors Smith and Lantier, two pillars of medicine, or will we passively sanction the victimization and demise of American medicine at the hand of Government colluders, the pillagers of medicine? What is it you really want? What will you really do to get it?