Shots fired

[rev ronin]

A couple weeks shy of 11 years in PA practice, and I filed my first board complaint against a physician. IME physician repeatedly misconstrued PTSD criterion A, and thus denying diagnosis and hence preventing care (well, preventing workers' comp form paying for it... same thing in practice) to at least two injured workers, and probably more. We'll see what happens.

Not something I wanted on my "PA career" bingo card, but there appears to be no other way to protect my patients.

[ventana]

oh man

good luck

that would cause me a lot of consternation 

[SedRate]

Is this the same physician that was the topic of one of your other posts?

[sas5814]

Misdiagnosis is a real issue. There seems to be a (mis) belief that negative misdiagnosis on mental health isn't the same thing.

 

Harm is harm. If they were missing MIs and strokes the medical board would care.

[rev ronin]

2 hours ago, SedRate said:

Is this the same physician that was the topic of one of your other posts?

Probably. I try and avoid escalation when there's another option, and will kvetch in the mean time. Seeing the same exact thing done to a second patient... Yeah, no choice.

[rev ronin]

1 hour ago, Hemmingway said:

Misdiagnosis is a real issue. There seems to be a (mis) belief that negative misdiagnosis on mental health isn't the same thing.

 

Harm is harm. If they were missing MIs and strokes the medical board would care.

In this case, if it's not misdiagnosis, it's fraud, because the instructions are to use the DSM to evaluate a diagnosis, and nowhere in the report does it say--nor would it be accepted if it did--"I'm substituting my own judgment for the DSM criteria."

[ohiovolffemtp]

I'm sure you're doing the right thing, but I wouldn't be too hopeful that the board will do any official action.  From what I've seen quality of care issues fall low on medical board's concerns unless they involve excessive prescribing of controlled substances.  Provider substance abuse issues, not completing required CME, Medicare fraud, etc. all rank much higher.

I've only made 1 board complaint in my career: about an orthopedic surgeon who refused to respond to a consult on one of his post-op patients.  The surgery was done at the VA and the only response I got through the house supervisor at the VA was that he would consult if the patient was transferred to the ED at the VA.  The state medical board took no action.

[rev ronin]

10 minutes ago, ohiovolffemtp said:

I'm sure you're doing the right thing, but I wouldn't be too hopeful that the board will do any official action.  From what I've seen quality of care issues fall low on medical board's concerns unless they involve excessive prescribing of controlled substances.  Provider substance abuse issues, not completing required CME, Medicare fraud, etc. all rank much higher.

All that, and in Washington State, the chiropractic board seems to be spending all of its time on DC's who didn't like mask mandates.

I can't control what the medical board does. All I can do is report unprofessional conduct as such and trust that they will do their job. My litmus test isn't whether it irks me--many IMEs do--or whether it hurts my patient--again, many do. It's when there's an objective standard, that standard isn't followed, and that that standard wasn't followed hurts my patients. THEN it's time to act.

[TWR]

Rev, just wondering whether prior to filing your complaint, did you attempt to reach out to this doc and ask him why he made the decision he did, or did you just file the complaint?

[iconic]

Good luck proving misdiagnosis in psychiatry. It's so common there is a lot of research written on the topic. Almost everyone referred by PCPs is misdiagnosed. 

Edited August 26, 2023 by iconic

[rev ronin]

15 hours ago, TWR said:

Rev, just wondering whether prior to filing your complaint, did you attempt to reach out to this doc and ask him why he made the decision he did, or did you just file the complaint?

Absolutely. I was told by the company that hired the psychiatrist that my complaints or contact information would not be forwarded.

ETA: Oh, and I emailed them after filing it letting them know what I'd done and that their refusal to address the issue resulted in the board filing.

Edited August 27, 2023 by rev ronin
add aftermath

[rev ronin]

14 hours ago, iconic said:

Good luck proving misdiagnosis in psychiatry. It's so common there is a lot of research written on the topic. Almost everyone referred by PCPs is misdiagnosed. 

So, the issue here is one of negative misdiagnosis. Check all the criteria for PTSD, you get a PTSD diagnosis and thus, in the workers' comp realm of things, mental health treatment for PTSD. In this case, the psychiatrist in question stated that not experiencing a life-threatening injury meant the workers did not meet PTSD criterion A and therefore did not have PTSD. As you can see here, "experiencing a life-threatening injury" is not part of PTSD criterion A: merely witnessing threatened serious injury to someone else is enough. I went used book shopping, and none of DSM-III, III-R, IV, IV-TR, 5, and 5-TR ever required "experiencing a life-threatening injury" as part of PTSD criterion A. In each case, the worker received what cannot reasonably not be construed as serious injury.

Negative misdiagnosis means less liability for the state, which pays for the IMEs.

[rev ronin]

As an update, the medical commission has initiated an investigation. That means my complaint passed the first hurdle. I think three factors contributed:

1) It alleges actual harm to multiple patients by the same behavior, and unknown others who may have been harmed.
2) There's an objective standard (DSM-5)
3) All the conduct in question is in writing.

[TWR]

On 9/19/2023 at 5:48 PM, rev ronin said:

As an update, the medical commission has initiated an investigation. That means my complaint passed the first hurdle. I think three factors contributed:

1) It alleges actual harm to multiple patients by the same behavior, and unknown others who may have been harmed.
2) There's an objective standard (DSM-5)
3) All the conduct in question is in writing.

Does this psychiatrist know who filed a complaint against him/her?

[rev ronin]

10 hours ago, TWR said:

Does this psychiatrist know who filed a complaint against him/her?

Complaints are public record. Did a phone interview with the investigator today, where she (a Psych NP), confirmed this. Patients' names are redacted, of course.

[rev ronin]

... and now for the rest of the story. After the investigation grew--tell a few people who are also hacked off about the low quality of psych IMEs, and they tell a few people, and so on--six victims were identified, not just the two I initially complained about.

Psychiatrist Christine Lloyd is now no longer licensed in Washington State after the voluntary/agreed surrender of her license pursuant to an informal disposition by the Washington Medical Commission:

"1.2 Respondent performed independent medical examinations (IME) of Patients A through F for the Washington State Department of Labor and Industries (L&I).
"1.3 Respondent conducted examinations that did not meet the standard of care for the purpose of the exam.
"1.4 Respondent's IME examinations and reports did not meet the standard of care regarding documentation of objective, sound, and sufficient medical information, documentation of the worker's history and clinical findings, and documentation of objective conclusions and recommendations supported by underlying rationale linked to the patient's medical history and clinical findings.
"1.5 Because Respondent incorrectly believed that a patient must suffer a life threatening injury in order to be diagnosed with posttraumatic stress disorder (PTSD), Respondent's reports for Patients A through E did not include a diagnosis of PTSD. Suffering a life threatening injury is not one of the diagnostic criteria for PTSD in the Diagnostic and Statistics Manual of Mental Disorders, fifth edition (DSM-5).
"1.6 For Patients A, C, D, and F Respondent did not meet the standard of care for evaluation and documentation of whether the patients posed an imminent risk to themselves or others.
"1.7 For Patients A through F, the diagnostic skill and reasoning that Respondent documented in the reports did not meet the standard of care."

I can't link to this document directly, but you can search by here name at

https://fortress.wa.gov/doh/providercredentialsearch/Default.aspx

Lessons:

1. These things take forever, with little communication after the initial investigation. This is 15 months for what I thought was a pretty obvious case of "that's not what the DSM-5 says."
2. If you notice a pattern of poor behavior from one clinician, it's highly likely that their conduct extends beyond what you can see.
3. Real people are affected by clinicians who don't practice at the standard of care. One of my two patients died after the complaint was filed, but that was apparently of a heart attack. No way to really tell if the ignominy of having your PTSD dismissed by a physician not following appropriate standards of care contributed (No, I'm not worried about defamation: the case is public, and Dr. Lloyd's signature is attached, indicating her public concurrence with the investigation findings)

Now the next time a lawyer asks me if I've ever filed a board complaint against a physician, I can not only say yes, but say I'm 1 for 1 in the complaints being investigated, sustained, and acted upon. Much rather not have to do this again, though.

[CAAdmission]

Well done. You did the right thing, and the system arrived at the most likely best outcome. 

[ventana]

Wow, strong work.  

[ohiovolffemtp]

Will be interesting to see if South Carolina, where she is also licensed, takes any action.

[rev ronin]

On 11/22/2024 at 1:32 PM, ohiovolffemtp said:

Will be interesting to see if South Carolina, where she is also licensed, takes any action.

Washington (I read all our health professional license disciplinary actions out of morbid curiosity) usually takes a few months to a couple of years depending on the severity of the behavior reported, but they do yank licenses based on FSMB reporting.

[rev ronin]

The rest of the rest of the story: Even though it was based on an IME adjudicated to be deficient, my one surviving patient is unable to pursue that diagnosis ever again, because when his claim closed with a permanent partial disability award he gave up all appeal rights on previously contended diagnoses. So, he's permanently screwed out of the diagnosis. Or, more properly, can never have care for that diagnosis paid for by state Labor and Industries insurance.

[sas5814]

3 hours ago, rev ronin said:

The rest of the rest of the story: Even though it was based on an IME adjudicated to be deficient, my one surviving patient is unable to pursue that diagnosis ever again, because when his claim closed with a permanent partial disability award he gave up all appeal rights on previously contended diagnoses. So, he's permanently screwed out of the diagnosis. Or, more properly, can never have care for that diagnosis paid for by state Labor and Industries insurance.

That is sad. He/she should pursue legal action against the physician to compensate for what the costs of treatment would be and would have been covered.

I'm not a "sue the bastards" kinda guy but this one seems to call out for it.

[rev ronin]

2 hours ago, sas5814 said:

That is sad. He/she should pursue legal action against the physician to compensate for what the costs of treatment would be and would have been covered.

I'm not a "sue the bastards" kinda guy but this one seems to call out for it.

The system relies on a lot of lawyers NOT wanting to take fee contingency on iffy cases like this, unfortunately. Which is stupid, anyways: $<5k of therapy would do my patient a lot of good, even though he's back to work.