Sunday, July 29, 2012

An Open Invitation to the FBI

Dear FBI:
     You are the guardians and protectors of America.  You are seekers after truth.  I don't believe the things other people tell me about your agents, because everything they say is bad, and that simply can't be true.
     I know that your boss, the head of the Department of Justice, is under the gun and this may make all of you feel uneasy and defensive.  My office staff and I understand what you're going through because we, too, are upset about being under the gun by you.  Your raid and forfeitures, and your continuing investigation, are disturbing to all of us at Colasante Clinic and make it difficult for us to focus on patients, who need our full attention.
     Therefore I would like to provide answers to all your questions.  You no longer need to circle the office like wild animals stalking prey, scheduling clandestine meetings with my staff, questioning my patients over the fences of their yards, calling the homes of my employees and ex-employees to glean information that might, if cut and spliced, be used against me.
     You do not need a subpoena:  I will accompany you without resistance and give you whatever information you need.  Please present your questions and accusations, and give me the opportunity to respond to your confusion.  You will see that there has never been any wrongdoing in my medical practice, and certainly no attempt to defraud insurance companies--in fact, my efforts have been focused doggedly on representing what we do for patients with accuracy.  My knowledge of billing and coding surpasses that of most physicians--as it must for solo doctors--and my intent to help patients by clarifying their symptoms with the safest available technology is sincere and based on science.
     Several of my staff have disclosed that your questioning of them has focused on tests and procedures performed on my patients within the confines of my office.  The tests that seem to bother you most are ultrasound studies.
     Have you ever seen ultrasound images?  Have you noticed how informative they are?  Do you know that ultrasound is a technology that is safe, non-invasive, and free of radiation?  It is my opinion that every physician's office should own an ultrasound unit, and it should be used every day as an extension of our eyes and ears. Ultrasound is like a stethoscope with eyes:  it sees into the body, and its shadowy images identify pathology that other more dangerous, high-tech equipment (like CT scans) cannot.
     You must realize that patients who schedule appointments with us have symptoms.  They don't visit the doctor when they feel well or are pain-free.  A great number of patients describe abdominal, pelvic and chest pain. They come to my office, in particular, because we have a reputation for doing diagnostic studies on site, circumventing the need to refer them to multiple other physicians.  They come to my office instead of going to the emergency room.
     The ultrasound is a superb tool for identifying those who might have a gallstone blocking the common bile duct, a coronary artery that weakens movement of the heart's powerful left ventricle, or an ovarian cyst which, if oversized, can cause disabling pain.  We have found small thyroid cancers, large liver hemangiomas, uterine masses, and prostate nodules.  Putting a patient with chest pain on the treadmill and performing an echocardiogram (a type of ultrasound) right after exercise is a good technique for determining whether that patient really needs to see a cardiologist.  We have been able to save patients the time and expense of specialist visits by using this technology.
     Perhaps the problem, from your standpoint, is that Medicare pays us too much for ultrasound studies.  Even if I agreed, I couldn't change Medicare's fee schedule.  Medicare sets its fees, and other insurance companies copy the government.  Remember, it takes specialized training and a lot of experience to read ultrasound studies with accuracy.  It's important to look at the cost-benefit ratio.
     Yes, our total charges to Medicare add up to more than the average family physician's office because we do diagnostic work-ups on patients in the office, we follow up on all their symptoms, and we require specialized staff.  Consider, however, the money we save Medicare on CT scans, specialist visits, emergency room doctors in the middle of the night, and MRI's?   Think of what we save society by offering patients the reassurance of a normal test, followed by personalized counseling that inspires them to change their lifestyles.  Then think of how much is saved--somewhere down the road--when these same patients don't have heart attacks, gall bladder infections, kidney stones, or hepatitis from fatty liver infiltration.  Would you like a list of the cancers we have detected--using ultrasound--at such an early stage that patients were cured with minimal treatment, never needing expensive chemotherapy or radiation?
     Furthermore, you must not underrate the diagnostic value of a normal ultrasound test.  One of the basic tenets of melanoma diagnosis, for instance, is that for every melanoma a doctor identifies through biopsy of a skin lesion, he should have done twenty biopsies that come back normal.  Otherwise, he's not doing enough biopsies, and he's likely to miss a cancer by making assumptions that turn out wrong. This precept extends to ultrasound studies, too.  When patients have pain, it's invaluable to be able to do an ultrasound study--on the spot--which shows whether that pain (as patients fear) represents cancer or not.  Can you imagine the relief a patient feels, knowing I actually looked at the place that hurts?
     If you had abdominal pain, wouldn't you want to know it wasn't something serious or life-threatening?  When you have chest pain--as you may, some day, given the statistics in this country--do you want your doctor to shuffle you around from hospital to specialists over a period of weeks, or will you want a study now, to find out what you really need?
     The problem, as I see it, is that most doctors are not using ultrasound units in their offices--not that I am using it.  Perhaps their reasons for eschewing such a valuable tool has something to do with the problems I'm having with you:  your attack on my judgment, your raid on my office, the allegations implied by FBI agents calling my patients and staff, the sick feeling created by your unwillingness to speak up, ask your questions, and get intelligent answers from me.
     Therefore I am offering you, again, the opportunity to meet with me--the target of your research--to talk about whatever lacunae may be left in your investigation.  I can give you some background on Pat McCullough, who so deftly pointed your suspicions in my direction and thereby succeeded in escaping scrutiny of her deplorable behavior.  I can explain the basic philosophy of my medical practice, which is based on science and has saved much pain and suffering for patients--isn't that the point of doctoring, after all?
     And perhaps I can provide you with whatever information you need to release me from the state of siege you have imposed, so that my staff and I may return our attention to the peaceful practice of medicine.  Then I might even be able to work on my other mission:  a farm residential community for adults with autism on property I purchased for this purpose in 2009.  "Carmine's Farm" now has official non-profit (501c3) status, but its development is paralyzed as long as you hold me hostage, psychologically and financially, with this investigation.
     Please contact me as soon as possible.  I will give you a tour of the clinic.  I can show you the magic of ultrasound technology.  Perhaps we can talk over lunch.

                                                                                                  Ona Colasante MD


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