Thursday, January 31, 2013

The Final Week

     The last week of any job is ethereal.  If it weren't, it would hurt too much.  The future beckons with such magnetism that it's hard to keep remembering that the present isn't over yet.
     Separating from the smooth regularity of clinic operations and my excellent, reliable staff is not going to be easy.   If it weren't for my patients, and how some of them need help with the transition to a new medical clinic, I might have called in sick this week.  But I don't recall ever having called in sick, or rescheduling patients because I didn't feel like working.  That sort of thing just isn't done in the medical profession.
     Therefore, here I am, all week, as usual, moving up and down the clinic halls to pick up one chart after another, and see patients in their turn.  It's almost like every other week.
     I am holding people's hands and escorting them across what feels like a swinging rope bridge, over what must seem to them to be the jagged canyon of their health and well-being.  They need help getting to the other side, where another doctor can be found.  
     They speak to me along the way.
     "Where will I go?"
     "What will I do?"
     "This place is like family."
     "I'll never be the same."
     "Your staff--they're my friends."
     "You saw me through the worst period in my life."
     "I'm afraid."
     "I can't possibly change doctors."
     "What about my medicines?"
     "No one else knows the things I told you."
     "I can't believe you're leaving."
     "Do you think I'll be all right?"
     "You helped me when no one else could."
     I think all doctors have patients whose connection to them runs very deep.  Rupturing this connection can have dire consequences.  Most of the time, however, people find their bearings again with a new doctor.
     My answers to their questions sound lame.  I give them names of other doctors, choosing the ones whose personalities seem like good matches.  I tell them that they'll be all right.  I write their prescriptions and make eleventh-hour referrals.
     Meanwhile, what I want to say to them is this:  I care about you, but everything else in doctoring is gadgets and props.  The real medicine is inside you.   All you need is someone who can help you turn it on.
     Although this has been my guiding principle for twenty-five years, in this last week I'm not so sure any more.   So I say thank you back to them, when they thank me, and I summarize their health status in a final chart note, and hand them the entire chart to take to their next clinic.  Then I work on closing the clinic, as patients' voices echo in my thoughts, late into the night. 


Wednesday, January 30, 2013

The Roach Motel

     The Office of Professional Responsibility (OPR) is a department that is part of the Department of Justice (DOJ), and has the purpose of investigating and ousting federal prosecutors who do a bad job.  It was created in the wake of Watergate, when Americans were forced to admit that their leaders could be corrupt and the justice department might even participate in the corruption.  The OPR is a branch of the DOJ commissioned with policing itself.  Some people think it's doing a terrible job.
     Fordham University law professor Bruce A. Green used to be a federal prosecutor and has c-chaired the American Business Association's ethics commitee.
     "I used to call [the OPR] the roach motel of the justice department," he said.  "Cases check in but they never check out."
     The OPR is, in theory, a place where people like you and me might register complaints such as breaches of ethics, misconduct, or criminal acts by federal attorneys.  (The Office of Inspector General is a parallel bureau where complaints about non-attorney breaches are supposed to be investigated.)  If I believed, for instance, that I had been mistreated by the federal prosecutors in my so-called case, I could file a complaint with the OPR.
     Some portion of OPR complaints are registered by defendants like me, although most come from judges, state agencies, private attorneys, government officials, media reports and congressional representatives.  The usual procedure is for the OPR to notify the federal attorney who has been reported about the complaint, and request a response in writing.  After an investigation, the OPR is supposed to give both the complainant and the attorney a decision.  
     But it seems that OPR investigations may take even longer than investigations like the one of my medical clinic.  OPR cases sit in limbo for years.  Therefore, even if I thought I had a case to report (for example, that federal prosecutors raided and wrecked my clinic without making sure they had sufficient cause), it might take forever to get a response from the OPR.  And disciplinary action against the prosecutors, if deserved, would be unlikely to happen, ever.
     I'm thinking about filing a complaint with the OPR, and seeing which "case" moves faster:  the prosecutors' case against me, or my complaint against them?  It would be like two gopher tortoises in my back meadow:  how fast can they rest?  Tortoises like to sit around.  So, apparently, do federal prosecutors and OPR investigators.
     Sometimes I wonder what actually happens in the office of the OPR?  Or in the that of my prosecutors?  Do they have bricks-and-mortar buildings?  Do they dress up in semi-formal attire every day, and drive to work?  Do they walk into their offices and say, "I don't feel like doing anything today.  Let's order out for pizza--"?  Or are there phone calls and lots of paper shuffling, and secretaries who give the impression of being busy, a la that series, "The Office"?  Do they put in nine-to-five days, and give all the taxpayers a day's work for a day's pay?  Is anybody supervising them?
     I think you and I are supposed to be supervising them.  Right?  After all, we pay their salaries.
     It's not clear whether the OPR is even required to tell the public about cases it's investigating.  Investigations of federal prosecutors by the OPR may not have to comply with the Freedom of Information Act, not even when those prosecutors are found guilty of unethical, wasteful, or criminal behavior, at taxpayers' expense.
    So, apparently it's okay for the federal government's prosecutors and agents to notify the media in advance of a raid on my clinic, in order to publicize it to the world--without having to reveal one speck of evidence to support their actions...but it's not okay for the justice department to reveal its findings, even after federal prosecutors may have been found guilty of misconduct or blatant crimes.   During the Bush era a decision was made that such information shouldn't be made public because it might cause "embarrassment" to Department of Justice attorneys.  As far as I can tell, this decision still stands. 
     It's been more than six years since the OPR  reported how many complaints it receives (there were 869 in 2006) and how many were deemed worthy of follow-up (230 in 2006).   Federal lawyers are rarely disciplined for misconduct--which means, their very misconduct is, in effect, sanctioned.
     Why shouldn't federal prosecutors do whatever they want--running over citizens, hiding evidence, fabricating stories, pretending to be busy with ongoing investigations (for example, of me), while important and sometimes life-saving records (for example, the medical charts belonging my 3,000 patients) taken long ago (June 16, 2011) lie around gathering dust in back rooms (like the one in the FBI's Tallahassee office, where two of my employees were permitted to go, only once, to copy a few records, and told me it looked as though the charts hadn't been touched, a year after the raid)--why shouldn't federal prosecutors act, or not act, willy-nilly, like this?  One study on cheating showed that 80% of people will cheat, at least a little, if they know they can get away with it.  And every business owner understands that when the cat's away, the mice play.
     According to a report, "The Roach Motel," (ABA Journal, July 1, 2009) from which some of this post's information was taken, federal prosecutors in high-profile cases have gotten away with hiding key evidence, altering reports, failing to disclose exculpatory facts, and intentionally misconstruing evidence in order to put behind bars people who don't belong behind bars.  If this is what they can do when everyone is watching, imagine what goes on in low-profile cases?
     With Eric Holder at the helm, what else could we expect?
     I don't think I'll file that OPR complaint just yet.  It's likely to be a waste of everyone's time. 

Tuesday, January 29, 2013

What Makes a Good Family Doctor?

     1.  A good doctor has the ability to go to where a patient is, find the place of suffering, and open it, gently.
          a)  The true place of suffering may be very different from the place the patient points to.
          b)  The route is indirect.
          c)  The doctor must approach with caution and sensitivity, as though the patient were a rabbit or mouse, so as not to cause him or her to run away.
     2.  A good doctor understands that medicines are tools, but not treatment.  Without treatment, a patient will get sick in the same way over and over, no matter how modern or powerful the medicine, or how quick the apparent, initial recovery.
          a)  Real treatment requires a relationship between two people.
          b)  A transformation in a patient's physical state requires that the relationship between two people--doctor and patient--be mirrored internally as a relationship between the patient's deep and superficial aspects.
          c)  The relationship must be caring.
          d)  None of this can be spoken about in a direct way.
          e)  Stories, symbols, myths, religious accounts, dreams, local lore, humor, references to one's personal life, or to other people's maladies and cures may present themselves as material for finding the right path to a healing center, in the same way that birds, tracks, other spoor, or totem animals may show up to guide a person through the woods to the deep interior, where there is water.
          f)  The trip through the woods is one way a person can get to know himself.  It applies to the doctor and the patient, since knowledge moves in both directions.
          g)  Water is healing.
     3.  Possessing many manual skills, and having expertise with a wide range of simple, modern methods for looking at the bodies of patients and conducting treatments is a good thing.  It inspires confidence, and fulfills the expectation of patients in every age that the doctor be well-trained and capable.  This was as true in medieval times as it is now, although the nature of "modern" methods is always changing.
     4.  The longer a doctor and patient know one another, the better.  A relationship over years and decades makes for much more efficient treatment.
          a) After awhile, a simple word or the doctor placing a hand on the spot that is sick can adjust the patient's broken place--the brokenness is making him sick--so that it is set right, and the patient gets well.
          b)  Trust, and a history of getting well many times in the past, make it easier to get well again, if the surroundings and doctor are the same.
          c)  Having to find a new doctor is jarring to a patient, and can bring on new problems.  The next doctor is unlikely to have the same kind of mirror, which therefore may take years to get used to.  Sometimes, however, it's the only option.
     5.  You can tell whether you have a good family doctor if, when the doctor comes in the room and sits down, and looks at you, and asks you questions, and you answer them, and more things are said, or there is a thoughtful silence, you notice your lungs filling up.  Then, the air comes out as though of its own accord in the form of a deep, restful sigh, and your posture relaxes, and you have the feeling that you want to smile.  

Monday, January 28, 2013

"Why Are You Writing That Blog, Anyway?"

     This is a question I was asked, today, by a person who is very practical.
     My blog has no practical purpose.   It isn't even a rational response to what has happened to me.
     So why am I wasting my time writing it?
     It's very hard, to have been cast in a negative light in the public eye.  It takes stamina for me to get up every morning.  Since the raid on my clinic, I have headaches, backaches, joint aches--the usual physical manifestations of stress.
     We are social creatures, even the most introverted among us.  We want to be liked.  We need respect and approval.  I am no different.  It helps me move through the day and take care of patients to have the respect of those around me.  After an attack by a behemoth like the federal government, it feels as though that quantum of respect has dwindled.
     I haven't lost the respect of everyone.  There are my patients, and staff, and family, who seem to care--and this is lifesaving.  But I have the nagging feeling that every person, however loyal, however old a friend, now harbors niggling doubts about me.  Is she a criminal?  Did she do something ugly, and shameful, and against the law?  Maybe she did.
     My blog is a way of having a conversation with myself about this discomfiting situation, and about who I am, really.  How much has the fact of being a doctor added to a belief in my intrinsic worth?  How much does a government raid, and its associated stigma, subtract from that?   Could I survive even worse opprobrium?  How can I walk around in public with the scarlet letter, shame, attached to my coat, deserved or not?  Do I deserve it?  Am I getting confused, because I don't know where the next attack might come from?
     The blog is my psychological support, like the trusses underneath a bridge that steers me from one way of being to another.  I write posts to remind myself that I'm the same person today as I was yesterday, and will be tomorrow.  I write to remind myself of my integrity.  Writing connects my outer self to my inner.  Without such a connection, every one of us would falter in times of great distress.  I will write in this blog until my story is finished being told, and I'm grateful for every person who reads it.  I realize that it isn't great entertainment, in a country that prizes entertainment.
     The people who read my blog are another reason I write.  They act as a bulwark against the government.  As long as I have witnesses, I feel I can endure whatever happens.  As long as the government knows I have witnesses, it must be accountable for what it inflicts.   We are all watching.  I will not allow for there to be secrets.  I will not settle with the prosecutor, or sign gag orders, or plea bargain.  This is America, after all, and I am exercising freedom of speech.  I thank my readers for helping to bulk up the walls of my defense.
     I am like a medieval city,  protected by the ramparts of my blog, its readers, and my two lawyers.  The prosecutors and FBI agents are on the other side, along with the judge, the Patriot Act, the innumerable statutes that give prosecutors immunity from the Bill of Rights, and the many silent individuals who prefer in times of conflict not to take sides, or else to side with the favored team-- Goliath, the government, which must be appeased, because it has a lot of ammo.
     My blog is my defense.  I am not guilty.  I have done nothing wrong.  My life is being altered forever, by people who want to cash in on whistleblower fees, or who hope to advance their careers, or who think they can run over solo doctors and ruin them because it looks like easy pickins. 
     Well, it won't be easy--not if I can help it.      

Sunday, January 27, 2013

What Happens When You Die?

     Doctors listen to all kinds of stories from patients, adding them to the compendium of anecdotal knowledge from which we draw strength for making diagnostic leaps.  One of the most intimate is the return-from-death-and-lived-to-talk-about-it stories.  There aren't many:  in twenty years, I've been graced with ten.
     What happens when you die?  It's hard to believe that people aren't thinking about this all the time.  I know I am:  What happens at the moment of death?  Is it a "moment"?  After that, then what? Why do we die?  Why are we here?  What's the point?
     The "why?" questions are philosophical, and of course they're interesting, more or less.  But what's more compelling, for flesh-and-bones people, is Who-Am-I, after I take my last breath?  What will I feel?  Should I be scared?  Will it hurt?
     I'm sure that last question, Will it hurt? is a big one for people.  After all, it's exactly what they want to know when I load a 3-cc syringe with lidocaine and a tiny, 30-gauge needle to numb a sphere of skin around an area I'm about to biopsy.  It's even the main thing on their minds when I flick off a few skin tags--again, using a local anesthetic--a procedure that takes a matter of seconds.
     "Hey, Doc, is this gonna hurt?" they ask, with false bravado.  If removing a skin tag triggers the question about pain, shouldn't the fear of one's own death be practically unspeakable?
     So, when I probe this topic, death--which doctors are supposed to do with everyone--I like to do more than fill out the absurdly simplistic form called the "Living Will," especially as patients get close to the end.  "Are you worried?"  I ask.  "What do you think happens when you die?"  and "Are you wondering how it feels?"
     Most people don't want to talk about death, so I let it go.
     Some have fixed notions about what will happen, and I don't mess with them, either.
     "I know what's going to happen:  I'm going to meet my maker in heaven," they tell me.   Perhaps they have the trip planned, and the scenery is already familiar, having been mapped out in advance through a version of guided imagery, reinforced in church each week.  They know, in a way that is the essence of faith, and don't need or want interference.  The subject has to do with God, not men.
     But this is such a secular age that many of us become disoriented around the topic of death, mainly our own deaths, which makes that "last great adventure" (as some patients refer to it) a terrifying prospect.  Hence, the escape into worldly things:  food, drink, drugs, adventure, obsession, drama, Fox News, and tabloids about other people's deaths, or near-deaths.  As long as we're busy, we don't have to think about our personal deaths.  And why bother?  Life is for living, they say.
     But when they die--and come back--it becomes a pressing, intimate topic.  They do want to talk about it--but only in respectful company.  It's not parlor chatter.  It's not fishing-boat, golf course, or dinner table material.  It's too personal.  It's too real.
     Here's the story of one man, my patient, who "died" after cardiac surgery, and had to be resuscitated three times.

     First, I was moving fast through space, and it was dark except for where I was headed.  I wasn't scared.  Instead, I felt weightless, and in a state of bliss.  I didn't want to go back to the world, which seemed to me, in those moments, to be a vessel of pain. 
     Then, I was taken to a room lined with purple velvet.  The ceiling, floor and walls were cushioned with it, and the velvet was very soft, and glowed.  I didn't question anything.  There was no need for questions.  I was at peace.  I've never felt such peace in my life.  I knew that everything was going to be fine.  I knew that all the things that had happened to me in my past were as they should be, and that the world was part of something big, like universal love.  It was all right and good.
     The purple room was a holding-place.  I was kept there because decisions were being made, but there was no urgency or sense of doom.  After awhile, I was transported along a long corridor, at the far end of which was a bright light.  I was being guided by a presence--it could have been an angel, whom I felt but could not see.  I was surrounded by great love-- filled to the brim with it.  It was the most wonderful experience imaginable--and now I know that there is nothing to fear, ever.  
     Whatever happens to me in life, I can't be harmed--not really.  Nothing can touch what is truly me, because it's being kept safe in that place, by that love, which is all there is.

     Having to return to the earthly world, he said, wasn't the aversive jolt some return-to-lifers describe, because he understood it was part of the "great plan."
    I couldn't deny that the irascible, impatient man I had known before his near-death experience had undergone a dramatic personality change.  He no longer complained.  He was serene.  He smiled continuously.  His face seemed to contain light. 
     The patients who shared their death experiences with me have given me permission to repeat them to others, which is sometimes a comfort to those who are fearful, at the end.  I have accompanied many patients along the last stretch of their lives--and some to the very brink--but then they let go, and are carried far away.
     I think of them in that purple room, cushioned by love, watched over by angels, dissolving into the light of oneness, and I, too, am comforted. 

Saturday, January 26, 2013

Racism and Governmentism

     Harper Lee's To Kill a Mockingbird is a book about good and evil.  It has sold over 30 million copies because people are preoccupied with this subject:  sooner or later, we all confront evil--first,  from outside ourselves, and later, from within.
     It is an unfortunate fact--because it has terrible implications for everyone--that some people, no matter how old, never acquire the depth or courage to acknowledge the existence of evil within themselves.  Such individuals persist in the comforting childhood conviction that evil is "out there," and we must attack it as though it's a hoard of dragons and we are the mythical heroes poised to rescue the human race from annihilation.
     It may be true that humans need to be rescued, and it really is from reptilian monsters and aliens and devils--but they reside within us, and unite us as carriers of an evil force so insistent on making itself known that if we don't admit its reality it seeps out of us and casts an aura around everything we do and touch.  Then, if we still don't perceive ourselves as its true source it begins to emanate, like fog, into the world.  By this point we don't see our own evil.  We assume instead that we're good, and that evil is a threat from without, like burglers, and terrorists, and Nazis, and frauds.
     The evil in Harper Lee's book is racism, and more specifically, prejudice--which comes from a deliberate refusal to know.  We don't want to know ourselves, or others, not really.  We want others to be like us, on the surface, and when they're not we either envy them or hate them.  The more different they are, the less we want to know them.
     Not that any of us admits this.  Perhaps we don't recognize the process, insofar as our less noble attributes squat below consciousness.  And not that there aren't gradations of envy and hatred which seem less harsh and therefore more normal--since other people have them, too, and prove it via snide remarks, jokes, charitable works, moralizing and gossip--but none of that subtracts from the irrational wish we harbor that people should conform to our standards, and be like us.  When they aren't, and when we don't own our fear, envy, and hatred, these feelings reposition themselves outside us, as objects in our world, seemingly unrelated to us, except that we hate them, and consider them not us.
      One of the more cogent summaries of To Kill a Mockingbird is that it it is an indictment of racism, but not racists.  This is worth thinking about.  Most of us blame the human beings who carry, say, racist beliefs, and who act on them, rather than the set of assumptions and habits of unconsciousness from which racism springs.  It seems to me that our attack should be on the idea of racism, not racists.   Maybe human beings--racists or not--are okay.  They're simply human.  They follow the crowd, they get caught up in what Levy-Bruhl called a participation mystique, wherein they are unable to distinguish their own feelings as separate from the those of the times.  Maybe it's not the racists we should oppose, but the field effect of racism, which is hard for any individual to override.
      I hate the fact of racism, but I don't hate racists.  Racists are people who happen to be unsophisticated mouthpieces for a system of beliefs that attains power because so many of us fail to recognize it as a system that it might as well be one of those dragons I mentioned above.  When something like racism gains supremacy, it's because some of the monster of evil has gotten out of each of us, and gathered force.  Then it traps the majority under its spell, and exhales from its fiery gullet a form of hatred that becomes endemic.  The result is evil:  outside us, all around us, snatching more and more of us into its realm like that legendary dragon who ate maidens one by one until a single brave soul, St. George, stood up to it, wielding a sword.
     Racism is an example of the composite manifestation of all our little unrecognized internal prejudices having seeped into the world--because we haven't owned them as ours, our personal quota of evil, like original sin--and coalesced into a monstrous force with the capacity to infect masses of people.  If we each dealt with the evil within us, as our personal, heroic task, we wouldn't have gigantic evils like racism, outside us, to slay.
     Which brings me to the prosecutors and FBI agents who have made my life a kind of misery.  I don't mention them as individuals very often, because as far as I'm concerned they are products of a system that is not so different from racism.  I call the system "the government" because I don't know how else to refer to it, but that catch-all, "the government," doesn't connote the negativity I intend.  Maybe I should say "governmentism," because it's more of an "ism" that has taken hold of that entire cohort of human beings--those given the task of protecting us, but who instead have had their brains reprogrammed, and are caught up in a weird, destructive, propagandist mania not unlike that of cults, like scientology or the Ku Klux Klan. That's how I see government agents, and it's scary.
     When federal agents stormed my office, and when the prosecutors and their back-up crew--who happened to be more FBI agents--showed up in court for my emergency hearing last year, there wasn't an ounce of doubt on their mask-like faces.  They were all badges, certainty, and shared superego.  They were infected by "governmentism" as surely as people can be infected by the pandemic of racism.  They were caught up in the police process as though on a military mission:  a matter of life and death.  But a raid on a solo medical clinic is not a dangerous assignment.  ("We have hypodermic needles, but we don't use them as weapons," I told them during the raid, questioning the need for all those semiautomatic pistol.)
     The agents needed the kind of exponential power you find in masses.  Therefore, dozens of them stormed my office--having traveled from all over the state--tripping over themselves.  Otherwise, they wouldn't have the power they needed to make me feel small.  Real power comes from knowledge, or the facts--that's what they didn't have. They were caught up in the group excitement of governmentism, which is highly irrational;  without that, they would have had before them the hard task of questioning their motives.
     I don't hate the prosecutors, FBI agents, judges, or lawmakers who seem to be responsible for the raid and wreckage of my business.  Nor do I hate all the Americans who believe in these authority figures without giving it a second thought.  They don't recognize the participation mystique within which they are being held, like a school of fish or a herd of zebras, feeling what all their companions are feeling--and cut off from their individual hearts and minds, which might, if permitted, tell them there is something terribly wrong--maybe even something evil, worse than racism, if that's possible--about the governmentism that has them in its clutches. 

Friday, January 25, 2013

Was Pat McCullough Set Up by the Government?

     Someone suggested to me that the purchase of Hawthorne Medical Center might not have been  "on the level"--that the federal government staged the whole thing as a way of getting inside my business and confiscating all my earnings, past and present.
     In this scenario, Pat McCullough would have been a fake, an envoy for the feds, slated with the task of looking for ambiguities in my clinic's billing-coding-documentation process, so the government could steal money under the guise of cleaning up what has been portrayed in recent years as the awful, messy, fraudulent world of doctoring.  Government agents--who are people, after all, with salaries to earn and political aspirations to nurture--would collect revenues for our flagging economy, feather their beds (the FBI takes a percentage of money from plea-bargaining to fund its coffers), and represent themselves to the TV-sedated people of our country as good policemen who are making the world a better place.
     Those of us who question government raids, and who claim that our national liberties are being threatened, look as much like "radicals" to the indifferent masses as did the few brave town criers in the 1930's when Hitler and his men sang lullabies to their people, getting them to sleep through the decimation of millions of its country's most creative and contributory human beings.
     It's a fact that Pat did "due diligence" for eighteen months prior to the transfer of my Hawthorne business into her name, and that she had access to all the clinic's billing records, including the Medicare insurance numbers for patients, physician licenses, and all manner of data that could make for a real heist.  I have no idea if she was behind a big scam, supported by the government or outside the law.  I hadn't considered the possibility that she might have been an actor in a Dragnet drama--a government agent masquerading as a do-gooder with a Kentucky twang, out to get the bad doctor.
     Pat signed a confidentiality agreement with me, and our lawyers exchanged the usual overwrought dispatches, and c.c.'ed  them to everyone, so it seemed natural to assume that my clinic information, including patient charts and insurance numbers, was safe.
     (But government agents aren't bound by confidentiality agreements, are they?  It seems to me that they can do whatever they like with people's private medical records, and with their bank accounts.) 
     I suppose governments everywhere engage, at times, in slick set-ups, based on the need to find guilty parties, and justified, at least outwardly, by a mission to protect their citizens.  And I expect that too often the cocksure ship of their assumptions founders on the shores of the facts.  Even worse, most victims of their misguided attacks never get compensated, and are left like people on small desert islands to their own devices.  The number of death-row inmates who have been exonerated by DNA evidence, and sent back out into the world after lifetimes of mistreatment, attests to this.
     But it's hard to believe that anyone--even our immoderate government police--would resort to such exreme methods--buying an entire business?--to investigate a rural doctor's business, when it could obtain every document it needed to indict and destroy that doctor with the wave of a subpoena, or steal every asset in the books by assuming ownership of bank accounts and titles..
     And Pat...well, she was slick.  And she might have been of the right caliber for bureaucratic work.  But I like to think the government would have been a little less sordid, if all it wanted was my money and my life.  Why put the health and well-being of thousands of patients at risk, depriving them of access to medical care at their local medical facility, and why add so many productive employees to the unemployment rolls?  Our elected officials and their minions don't waste resources like that, do they?  

Thursday, January 24, 2013

A Nuisance Lawsuit That Won't Go Away

     It's been a while since I wrote about the first lawyer I hired to find out why the federal government raided my clinic. 
     He's a federal defense lawyer in Jacksonville, and his name is Curtis Fallgatter.  I had been given his name by an old college friend, who got the name, in turn, from a D.C. lawyer-friend, whose brother had once worked in Jacksonville and thought Fallgatter might be good.  My friend loaned me the money for a retainer, saying Fallgatter seemed like a good bet.
     It was a flimsy reference, but it was better than jotting down names from magnets stuck to the fronts of telephone books, or searching the web for advertisements posted by law firms.  Besides, time was pressing in on me:  I needed someone to present my clinic's case at the Alachua County Courthouse, to get the government to open its affidavits and tell me what I was doing wrong.  Otherwise, I'd have to close the clinic, reduce staff, reorganize the budget, cave in...or something. 
     Fallgatter was polite and ready to get to work immediately, stating that he had other clients, but no urgent cases on his schedule.  He wanted $20,000 up front, and told me he'd discount his usual hourly fee--$475/hour--to $425/hour just for me. 
     Together, we wrote the "Motion for an Emergency Hearing for the Return of Patient Records, Clinic Working Capital, and Opening of the Affidavits," using emails and telephone calls.  I educated Fallgatter about the business of medicine, and he explained mechanics of the federal court system to me.  One day, Fallgatter drove to Gainesville to see my office and interview some of my employees.  He brought along a colleague from his firm, Mark Barnett, as well as a retired detective.  In two or three weeks the Motion was finished, and ready to be filed with the court.  I hoped for an immediate hearing, since my bank account had no money to pay staff, the lease, the employee insurance plan, or bills for supplies.  The FBI had confiscated all the money in my personal and clinic bank accounts, so that checks were bouncing.
     "I can't file the motion," Fallgatter told me one evening.  I had been pressing him for days to have it delivered to the judge, so we could set a date for a hearing.  It looked fine to me, but he said the motion needed more work.
     "Why can't you file it?"  I asked.
     "You owe me more money."
     "I paid you $20,000."
     "You owe me more," he said.
     "You mean the retainer is depleted, after a couple of weeks?"
     "It's expensive to do this kind of work."
     "But $20,000 was more than enough to write the motion," I said.  "And filing it now is a clerical task."
     "I can't file it without more money," he said.
     "It's just a matter of getting it to the courthouse!"
     "But you have a balance to pay."
     "How much more?"
     "You mean, writing this motion has cost $46,000?"
     "I've worked hard for you.  This is a complicated case."
     "You're not investigating the case," I argued.  "You're filing a motion to find out what the case is about, so I know where to go from here."
     "I expect to handle your case until the very end.  It could be a long time."
     "Why didn't you let me know when the retainer ran out?"
     "My secretary is a little behind in getting statements printed."
     "How could you accumulate charges like this--knowing the government forfeited my bank accounts--and not tell me?"
     "Can't you borrow more money from your friend?"  Fallgatter asked.  "I'm sure you can get it."
     Because he was the attorney of record, and because it is forbidden for an individual to file a motion on behalf of a business, Fallgatter did end up filing the motion for my emergency hearing, but not before arguing with me for a few more days about the money he said he was owed, then asking the judge for a two-week  postponement of the "emergency" hearing, so he could attend his niece's wedding--a commitment he hadn't mentioned when I hired him.  If he had, I would have found another lawyer, because it wasn't a postponement I could afford.  I reduced my staff to half, and closed the clinic for two weeks to make a plan.
     Now, Fallgatter claims his services, which were canceled immediately after the hearing, cost $87,000.  Since I only paid the $20,000 retainer, he is suing me for the remainder. 
     Four other lawyers tell me that his charges are outrageous, and insupportable.  One said it's an embarrassment to the profession.  Another said not to pay him another dime.  Two are acting as fact witnesses, and another is defending me in this new case against Fallgatter.  A fifth is reviewing the invoices in detail, and will act as an expert witness.
     The hearing about Fallgatter's charges is scheduled in Jacksonville for the end of February. 
     I'm sure Fallgatter's intent is to overwhelm me with legal threats, so I'll pay him just to get him out of the way. 
     He's certainly doing his part.  Every day I am bombarded with emails about the Fallgatter case, and notices of depositions, and motions to cancel, and motions to override, and motions to change dates, and motions to call witnesses, and requests for documents and dockets and statements and agreements.  I read them, and try to pretend this is happening to someone else, because I have to keep seeing patients, and figuring out what's wrong with them, and writing prescriptions to last until they find another doctor, and make sure all the coding and documentation is correct. 
     And I have to administer last rites to my dying clinic.

Wednesday, January 23, 2013

What TV-20 Left Out

     Yesterday,TV-20 aired another two-minute news report about my clinic.  Here's the link:

     It takes deftness and a keen appreciation for the attention span of American viewers to put together a semi-coherent story about anything, in a mere two minutes.   The reporter insisted on putting a positive spin on the padlocking of my clinic's doors.  I gave him my side of the story, but it included facts he didn't think would appeal to the public--too negative.
     It's a good thing I have my blog as a way of letting off steam!
     I realize that the reporter has to do a job which is less about news and more about marketing, and I forgive him.  He had to leave room for a murder case in the same ten-minute segment, didn't he?  Moreover, he's straight out of school, and has to make a good impression with the guardians of the TV-20 studio, in these two years neophytes are hired to gain experience in exchange for low wages.  It's a pretty good deal, given the competition for media jobs.  Then, they're shoved out of the hatchery like fattened turkeys to find their own way in the world.
      My story isn't lurid, so it has to be heartfelt for people to watch.  Therefore, the reporter acted as though donating all the clinic's equipment to Guatemala sort of makes it worthwhile to shut the whole place down.  Not exactly tearjerker material, but a hook for viewers' attention.  For my part, giving away the equipment is better than posting it, item by item, on Ebay.  And I liked the people who were running the rural and inner-city clinics when I went to Guatemala seven years ago, after a series of mudslides destroyed whole towns and they really needed doctors.

     Here's what the TV-20 reporter didn't say: 

     1.  I haven't done anything wrong.
     2.  It's the government's fault, at least indirectly, that I'm closing my clinic.
     3.  It's been a walloping two and a half years since the federal government filed a case against me.
     4.  It's been nineteen months since the FBI raided my clinic at gunpoint, taking all the patients' medical records, and lots of other stuff.
     5.  No reason has been given for the raid, not then, and not now.
     6.  At a court hearing (initiated by me, sixteen months ago) a local judge gave the federal prosecutors permission to keep every bit of information about what I might be doing wrong, as a doctor and as a business owner, top secret.  It didn't matter that I might continue to do whatever it is they thought I was doing wrong, thereby harming the American people, if they didn't at least give me a clue.  The judge also said the feds could keep my patients' medical files, all 3,000 of them.
     7.  I don't really want to close my clinic.
     8.  Without the ability to hire another doctor or two, or mid-level providers, I can't run a clinic that I can vouch for, a place with the broad range of services and expanded hours I've always offered, and which meets the needs of patients in eastern Alachua County. 
     9.  Medical professionals, including doctors, are not willing to take a chance working for someone who is under investigation by the federal government (I don't blame them).  Therefore, I can't hire physicians, nurse practitioners, or physician assistants to help me take care of patients--not since the raid.
    10. I feel ashamed, oddly, even though I have nothing to feel ashamed about.  This is something that happens to people who are abused, or whose rights have been violated by over-powerful, overreaching "protectors."  It's a form of Stockholm Syndrome. 
    11. I have two lawyers, but they tell me that federal prosecutors have big vats of protection, in the form of statutes giving them permission to violate our Bill of Rights rights during times of national emergency.  Are we in a "national emergency"?  These prosecutors are unlikely ever to be held accountable for ruining my career, even if their actions were wrongheaded, which they were.
    12. I am told that if federal prosecutors make a mistake, and raid or ruin a citizen in the process, they never apologize.  Instead, they find ways to trump up charges, however ambiguous or vague, and slap huge fines on the people they have attacked, so that those people, their victims, will be amenable to plea bargaining and will consent to gag rules.  That way, federal agents can keep up their shiny images for the rest of us.
    13. Thomas Jefferson said that when the government fears the people, there is liberty; but when the people fear the government, there is tyranny.
    14. I am afraid of the judicial branch of our government, and the overreaching power of its many single-minded, power-bloated, politically-motivated prosecutors and their posses.  You should be, too.

Tuesday, January 22, 2013

7 More Days

     Colasante Clinic will be open for seven more days of business.
     After that, the place will be gutted.
     The hardest part is the feeling I have of abandoning my patients and staff.
     "I just heard the bad news," a couple said today, looking downcast.  "You're closing!  What are we going to do?"
     "I don't have another job," my employees say, one after another.  Perhaps they're hoping for supernatural intervention.  They are very loyal to me, and to our patients.  
     There is sadness all around, and I am giving and accepting hugs morning, afternoon and evening.
     After everyone leaves, I sit on the swivel chair in my back office and stare at the piles of patient charts.
     I still have to document every word and action that passes between me and my patients--as though such a thing is really possible.  It's pitch-black outside when I go home.  I don't know if I'll miss this job or not.
     Every life-change leaves a big hole in the places that are forsaken.  It's as though a meteor has struck, and every single thing is shorn of the meaning it once had.
     "What will you do?"  I am asked, over and over.
     What will I do?
     I don't know what.  Wait, I guess.
    Wait, and see. 

Monday, January 21, 2013

The Petition Clause

     The Petition Clause (also known as the Freedom of Petition Clause) is the last part of the First Amendment, and it guarantees that citizens will always possess the right to petition the government for a redress of grievances.  It does not say that the government has to listen or respond.
     To petition the government, an individuals have to show that they been personally affected by the matter, and that they have a legal right to demand attention, usually because one or more other rights have been breached.  Petitions may be made to local, state or federal governments, or to any branch within those sectors:  legislative, executive or judicial.  The clause allows people to strike, picket, rally, protest, march, write letters, stand on soapboxes, draw up petitions, speak in public forums, publish articles, or blog--whatever it takes to get a message across to the government.
     The Declaration of Independence contains a paragraph explaining why the right to petition was so important to the founding fathers.

In every stage of these Oppressions We have Petitioned for Redress in the most humble terms:  Our repeated Petitions have been answered only by repeated injury.  A Prince whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a free people. 

Congress listed its grievances against England in the Declaration, including the following:

     1.  The king not obeying his own laws;
     2.  Keeping standing armies on American soil;
     3.  Imposing taxes without the people's consent;
     4.  Denying the right to trial by jury in some cases.

     These breaches remind me of my own case.  The government is not following its own laws, in denying me information as to why my clinic was raided or why my bank accounts were robbed.  The forfeiture of my clinic's working capital and my personal assets represents a kind of tax against me, for something invisible.  The government seems to be making up its own laws as it goes along, and they are laws that behoove the government in its goal to become more powerful, rather than the people and their interests.  FBI agents and federal prosecutors are a police force akin to an army, because they carry semiautomatic weapons which they don't hesitate to use to harass and subjugate the rest of us, when it serves their purposes.  After two and a half years, I have yet to learn the nature of the charges the government is entertaining against me, nor have I been given the right to a trial. 
     Whenever the colonists petitioned the British monarchy for an answer to their complaints, they were met with more taxes, more unfairness, more restrictions on their freedom, and more military presence.  In 1215 the Magna Carta limited the power of the monarchy, in an attempt to keep it from becoming despotic.  But time seems to erode such limits, and those in power tend to grab more power, and more.
     The framers of our Constitution added the Bill of Rights as a way of limiting the powers of the government's representatives.  But time has eroded these limitations, and the federal government has more power than ever.  If the Petition Clause were effective, I should be able to ask my state representatives to appeal on my behalf to the federal government for a review of my case, and for justice.  But the states have rescinded so many of their powers to the feds that they don't protect their people against federal tyranny. 
     Here are my complaints, analogous to those of the colonists:
     1.  The federal government is not obeying its own laws:  it should make its investigation of me transparent, it should announce its charges, and it should justify its terrible actions against me, or else remove itself with a broad apology.
     2.  The federal government has an army of agents ready to pull guns on citizens for apparent offenses, and minor offenses that don't threaten our social order.  These armies are in place for the purpose of intimidating everyone, and are analagous to a military state.  They need to be removed.
     3.  The forfeitures of my bank accounts amounts to a tax.  The government walked into my banks, signed checks for the full amounts in the accounts, and walked out with the cash.  No warning, no consent on my part, no explanation.  If this isn't the worst kind of taxation, I don't know what is.
     4.  Two and a half years after the federal government's investigation of my clinic and my physicianhood, I have not been granted the right to a trial, nor have I been given an enumeration of the charges against me.  I have been denied due process.  Our government has become as obscene and despotic as King Edward's reign at the time of the Revolutionary War.
     We need a new Declaration of Independence.  We need to reinstate the Bill of Rights.  We may need another revolution in this country, if we have any hope of our children calling themselves "free."

Sunday, January 20, 2013

Do We Have Freedom of Speech?

     Freedom of speech...we think of this as the epitome of American rights.
     But--can we really say whatever we want?
     If you happen to work for one of our government's many agencies, you may not be able to speak freely about your job unless you say how good it is.  And if federal prosecutors charge you with one or a whole slew of crimes, upon which hang huge penalties, such as jail time, and then the government says it will drop those charges prior to trial if you pay a financial sum and sign a gag order...doesn't the gag order override your First Amendment rights?  Why should it be the case that government agents can make deals with you to "sell" your right to freedom of speech.
     Isn't that something like making a deal to buy one of your kidneys, or a lung?  Should it be allowed?
     I don't think so...not in this country.  But it is.
     Would you sell a kidney for $20,000?   People do it--in other parts of the world, in inferior countries.  Would you sell your freedom of speech for, say, $100,000?  It happens, when governments become corrupt.  
     Not only are you allowed to sell your right to speak about certain experiences, but you can be  strong-armed, by our government, into selling off your First amendment rights.  For a thousand dollars?  For a hundred thousand, or a million?  For a Get-Out-of-Jail-Free card?
     As I mull over the pros and cons of participating, as a lead plaintiff, in a group lawsuit against the government, petitioning for change in the way federal prosecutors go about investigating whistleblower reports, petitioning against the harm they do (because politics, not ethics is their first priority), I wonder why so many people are cowed into settling cases with government agents rather than fighting for their rights.
     John Stacks, owner of Mountain Pure Water, tells me that since his youtube video, "Rampant InJustice," he has spoken with a hundred-fifty or so people who have been victims, like him--like me--of "prosecutorial overreach."  Their businesses have been raided, their Miranda rights ignored, their reputations ruined, their emotions thrown into the flux of post-traumatic stress, and their solvency threatened.  Nevertheless, John says, he isn't able to persuade the majority to do anything besides complain.  He can't get them to join us, repositioning themselves as plaintiffs--not defendants!--against the government.  They feel wronged--nevertheless, they're scared.
     Whatever the nature of the charges the prosecutors think they can drum up in our cases, including mine, their methods are wrong, unconstitutional, and need to be made right.  There's a mechanism for doing this, "The Petition Clause," a scion of the First Amendment, and we must rally together behind it, when the government steps out of line.  Otherwise, we're sliding into a world where our civil rights are nothing but ink marks on paper.  We have to defend what's ours, or we lose it. 
     Here's the text of the First Amendment:

     Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof;  or abridging the freedom of speech, or of the press;  or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

     In 1791, the Bill of Rights was passed because the Constitution, without it, didn't guarantee American citizens their civil liberties.  But the Bill of Rights means nothing unless people react when the rights they're guaranteed are breached.  If we settle with the government, sealing our mouths forevermore about the wrongdoing committed against us, we cave into fear and allow for the slow, inevitable erosion of all these rights we consider central to our way of life.   
     Why do government officials insist on gag orders?  Why not let citizens speak freely about their experiences at the hands of our justice system?  It has to be because the government has something to hide, in every one of these cases.  If its agents did their jobs faultlessly, they would have no reason to gag their victims.  If they followed the law, and didn't misuse their powers as a matter of course, and if they were driven by principles rather than self-aggrandizement, they could stand up to anything the rest of us have to say about them.   
     In the 1990's the federal government became aware that the media happens to be a powerful tool, and should be "managed."  Since that time, if you work for a government agency, like OSHA, or the FBI, or the CIA, it could cost you your job to voice criticism about the policies in your workplace, or the manner in which officials hush misguided decisions and corruption.
     It seems the government has an image to keep up, just like any big business.  And it has the power to airbrush its exterior, and it has a big police force to punish those who dare to mar the image.  Government officials seem incapable, themselves, of admitting wrong--and just when victims of governmental intemperance are about to go public about those wrongs, they're offered a payoff.
     At least, that's how I understand a decision by so many people--whose businesses, like mine, were raided, whose employees were terrorized, and whose lives have been damaged, irreparably--not to rebel against an overreaching government, using the platform of their First Amendment rights.  Instead, frightened and hoping to put the experience behind them, they settle.  Settling with the government doesn't do the rest of us any good.  It's a form of treason against our country.
     If this is how Americans respond to government abuse, we might as well be in the Soviet Union.  Who will reinstate our Bill of Rights?
     It should be all of us, but courage tends to be in short supply under authoritarian governments, when one party is really all there is, and it's armed, and it knows how to manage populations with propaganda and fear. 

Saturday, January 19, 2013

Patients, #14: "You''re Gonna Pay for This"

     Mervin has a three-year-old child and a fiance.   He can't afford to be in pain.
     This is his second appointment with me.  At the first one, I had told him I wouldn't prescribe narcotic pain medicines.  Now he wants me to say it again.
     He doesn't have a job.
     "There aren't any jobs," he tells me.
     It's true, the nation's unemployment rate is high.  Such statistics sometimes serve as an excuse for people like Mervin, who don't court employers, groom themselves for interviews, apprentice themselves to a trade, or even place more than one or two on-line applications for job-openings before giving up.
     "My neck is killing me," Mervin says.  "So is my back."
     "What about your arms and legs?"
     "They hurt, too."
     "What about your head?"
     "Real bad.  My neck is messed up."
     "Your stomach?"
     "Yeah, it all hurts."
     He doesn't beat around the bush.  He wants pain pills, and this time he's brought proof that he needs it--proof in the form of a two-year-old MRI report, copies of another doctor's office notes showing he has been prescribed oxycodone in the past, and letterhead from a pain management clinic in St. Petersburg.
     When patients bring their own records, sometimes they have edited out the incriminating parts.
     "Why aren't you still seeing this pain doctor?"  I ask.
     "He's no good.  He gives me a hard time.  I need someone who cares."
     The MRI describes two small disc herniations.
     One-third of people walking down the street have disc herniations, and most have no pain.   That means disc herniations, while not normal, are common, and not a reason for prescribing pain medicine.  I tell Mervin this.
     I say, "Your MRI isn't proof that you need Dilaudid, Lortab, or Valium."
     "But that's what my last doctor gave me.
     "So?" I asked.
     "So you can see I need them."
     "You're an addict, Mervin."
     "No, I'm not.  Where'd you get that idea."
     "I don't want you to tell someone, years from now, that no doctor ever said you're an addict.  So, I'm telling you, now.  I can send you to detox today, if you agree."
     "I don't need detox," he shouted.
     "Okay," I said.
     "So you're not going to help me with my pain?"
     "I want to help you quit drugs, and get a job, and have a life."
     "Go F* yourself!" he said.
     "When you want my help, please come back."
     "You're gonna pay for this," he warned me.  "Just wait and see."
     He yelled at the staff on the way out.  The receptionist stood up, her hand on the secret 911 button, when he stopped at the check-out counter.  He wanted his $2 co-pay back.  
     It's not as though we aren't used to people like Mervin.  This is Florida, after all, the land of citrus and Lortab.  People travel from all over the country to visit our pain clinics.  Mervin wasn't from Gainesville, but he had a Florida Medicaid card, and knew that with a valid prescription he could get pills for just about nothing.
     Was I safe, later that night, all by myself, leaving the clinic?
     Should I carry a gun?
     Should I carry a semiautomatic pistol, like the police, in case my first shots miss their mark?
     Walking across the parking lot to my car,  a black cat crossed my path.  It belongs to the people who live behind the privacy fence, and who wouldn't see a killing, or an abduction, if Mervin happened to show up and act crazy.  "You're gonna pay for this," his voice echoed in my memory.
     I will miss practicing medicine, but I won't miss Mervin or any of his clones.
    True, these people are also my patients, and they need help.  But they need divine help, which I don't have.
     I don't even know where to tell them to get it, these days.
     I said a prayer for Mervin, before turning on the ignition, and then I said one for myself.

Friday, January 18, 2013


     I got to wondering why I like spending time with my twelve chickens.  And why medical studies show that people who have dogs live longer, and "therapeutic pets" in nursing homes enliven the residents, and pigs and cows are treated as members of the family in some Asian cultures.
     People have cohabitated with animals as far back as recorded history goes.
     Theories about the "beneficial effects" of pets range from the mundane--having a dog means you  get exercise walking the dog, to the spiritual--animals carry mystical energy which keeps us in touch with the invisible ground of our being.
     But I prefer a more psychological explanation.
     Whenever I watch my chickens, and feed them, and delight in them, I am nurturing an aspect of myself which otherwise might disappear into the far reaches of my psyche, and go dormant.  Because chickens are so vulnerable, and need protection from nearly every creature bigger than them, they represent aspects of my soul which, too, are vulnerable, and need protection.  If I lose touch with these very real elements within me, I may languish and die.  Or, worse, I will be left with a shell of a life, like that of a molted crab--strong, glassy, pretty, rigidified, but empty of the warmth and wild, enigmatic, pulsating fervency that constitutes the life-force of the world.
     It's easy to ignore what seem like our soft, fragile, nugatory qualities, because in no way are they celebrated by the institutions we patronize in America.   You can be aggressive and cruel and acquisitive, and have kudos bestowed on you for all that.  But try expressing doubt, or feeling sad, or asking for help, and you're persona non grata.  It's impossible to become the president, for instance, if you admit to not knowing something, or feeling ambiguous--you're a "flip-flopper."
     Chickens are erratic, poorly armed, easily spooked, anxious, and hungry.   They don't meet our current standards for beautiful, they aren't cuddly, and they're constantly getting eaten.   When I spend time with my chickens, and even when I think about them while I'm away, I am giving attention to the fragile, unpretty, frightened, needy, defenseless aspects of my soul.  Like the insides of seeds, these feeling-states represent all of my potentiality.  They may look like weakness, within the context of our masculine value-system, but they are no weaker than the egg, or the uterus, or the embryo-- they represent the font of being, the place where new life begins, aspects of hope, resurrection.*
     Having chickens, and dogs, and cats, and horses--any pets--allows us to connect to deeper aspects of ourselves.  Every time we interact with our pets we are relating, as well, to ourselves--to less familiar, less urbane, and less prized parts of who we are.  That connection is vital.  It confers health, creativity, spontaneity and the capacity for love.  Our pets are beloved because our inner natures are calling on us for love and realization.  They are the places that are instinctual, bad-mannered, smelly, clamoring, and beggarly.  Nevertheless, they ask for the right to be.

    *God chose what is weak in the world to shame the strong (I Corinthians 1:27)
    *So the last shall be first and the first shall be last (Matthew 20:16).    

Thursday, January 17, 2013

Empty Life Syndrome

     There are two kinds of people.
     The ones who are always up to something, and therefore run into conflicts and problems.  And the ones who contemplate being up to something, but mostly do the same thing day after day, so that their lives are not really about anything, or at least not about anything new, or expressive of them.
     The first group is composed of people who give America its renegade reputation:  creative individuals who ask, "What's next?" and "What if?"  They're not all admirable or good, like Ben Franklin, Bill Gates or Stephen Hawking, nor are they all wild and zanily successful, like Donald Trump, Alan Greenspan, or Madonna.  Some are thieves and bamboozlers, or small-time artists and craftsmen, and some are colorful people who zigzag through the world without definite goals or a desire to achieve.
     Educated American parents like to think they're raising kids whose creative instincts are being fulfilled.  They're short on discipline and long on praise with their progeny, and select schools that will foster our outlier ideology, which is epitomized by the cowboy, inventor, protester, orator, poet, painter, mountain climber, firefighter, mystic, insurrectionist, heretic, iconoclast and unrestrained defender of the self.
     These kids end up being homogenized, for the most part, by the corporate-induced culture of sameness in which they live with their peers, despite being raised American and having parents who indulge them.  Conformism, built into our genes, is used by marketing geniuses to manipulate us into acting according to some fabricated ideal so that we purchase all the accoutrements of that ideal.
     Some kid-products of creative parenting become self-referential, and think they should have their way no matter what; some retain a smidgen of self-love but learn to consider their effect on others and therefore become reliable citizens, and a few could care less about anything, they're so driven by inner imperatives that nothing matters except answering their compulsion, sometimes for the good of mankind, as in the case of Mozart.
     One good thing about parenting the American way is that it produces, often, people who are brave, and decide to take on new projects or change their lives in dramatic ways even if it means they might lose everything.  Entrepreneurs are an example:  they win and lose assets as though it were all one big game, from which they can always rebound.  People who have lost everything are sometimes risk-takers, too:  they're not afraid of running aground, because they've been there, and so can act with daring or generosity.  They're not compelled by fear into that grabby possessiveness that typifies those who've played it safe, in case they might get into trouble and lose what they have.
     Most of the world's population is comprised of people who play it safe.  They're the ballast for the high-flying others, and they stabilize the human race.  They provide a safe dropping-place for people who are falling from their dreams.  There's nothing wrong with them, unless their lives start feeling empty.  There's nothing wrong with people in the first group, either, unless they haven't managed to find meaning in what they do.  Meaning comes from referring to an inner directive.  It has to be related to the irrefutable fact of one's death.
     I was talking to my oldest son on the phone, today, listening to his usual diatribe about why I'm in the trouble I'm in, as he puts it.  He has very strong opinions, for a twenty-something.
     He says I never should have owned or sold a business.  Nor should I have built a house or developed a farm or dug a pond or had a chicken coop because, after all, so many problems have arisen along the way.  Contractors take money and don't show up, projects aren't completed according to specifications, people lie and cheat and report you for nothing.  Ponds get alligators, hawks nab chickens, hurricanes fell oaks, roofs leak, businesses run aground, friends betray you, septic systems have to be reconfigured.  Even worse, government agents don't do their homework--preferring, instead, the adrenalin rush and feeling of importance that come from staging a raid.  And then there are lawyers, who are...well, lawyers.
     "You can't tell me I shouldn't have done any of those things."
     "Yes, I can.  If you hadn't had so many ideas, you wouldn't have the government after you now."
     "People can't sit around being passive all their lives.  And neither can you."
     "Why not?"
     "If you don't do something," I said, "you'll end up with Empty Life Syndrome."
     "What's that?"  he asked.  Perhaps he thought I was describing an actual medical condition.
     "It's what happens when you don't put your heart into anything."
     "Yeah.  Like when people think they can keep out of trouble by doing the same old thing every day, and avoiding anything new."
     "Do you think that's what I'm doing?"
     "I don't know.  Are you?"
     "But look at all the trouble you're in," he countered.
     "If I hadn't tried to do anything, I might not be in trouble.  But what kind of life would I have?"
     "You'd have a safe, quiet life."
     "I'd have Empty Life Syndrome."
     "Wouldn't that be better than what's happening to you now?"
     "No, I don't think so.  Empty Life Syndrome is pretty bad.  I'd rather be in trouble--even if it means thrashing around in the slime and muck of humanity--than have that."
     "What can it do to you?" he asked.
     "Turn you into a slug, for one thing."
     "What else?"
     "It can make you afraid to do anything.  The less you do, the less you do."
     "I don't know," he said.
     Despite the liberal, Waldorf upbringing he received, my oldest son is a cautious guy.  He'd probably make a good security guard, or bricklayer, or lawyer.  He's a solid counterweight for those who might otherwise drift into outer space, as has happened with some of his friends.  But he can't bear to see me in trouble.
     "What if you go to jail?" he asked.
     "I'll get to read a whole lot of books."
     "I'm serious," he said.
     "Will you bring me books in jail?"
     "It would still be better than Empty Life Syndrome."
     "Yeah, okay, enough, Mom." he said.

Wednesday, January 16, 2013

Medicare Fraud

     Medicare paid out $528 billion for medical services in 2010.  The Office of Management and Budget says that almost $50 billion was for "improper"--i.e., fraudulent--claims.  That's about ten percent, and the government is hell-bent on recuperating it from physicians.
     The biggest Medicare fraud raid in U.S. history involved Florida's current governor, Rick Scott.  He was CEO of Columbia-HCA when the corporation pleaded guilty to many criminal and civil charges and paid out $1.7 billion.  $500 million of this was distributed to whistleblowers, and Rick Scott was fired.  This didn't ruin his career;  in fact, it may have prepped him for politics.  Since the case was settled, it's unclear how much "fraud" really occurred.
     The U.S. government allocates hundreds of millions of dollars a year to fighting Medicare fraud.  It relies on whistleblowers to help rake in money, which funds many more raids and keeps FBI agents employed.  It's hard to know how successful the Medicare Task Force against Fraud really is, because pre-trial settlements like the one at Columbia account for "recuperated" money, and fewer than one-third of arrests for Medicare fraud result in convictions.  Medicare tends to report how many charges it has made against doctors, and how much money it has taken--but not how many cases ended up in trial and were proven to be bona fide fraud. 
     Obama's Affordable Care Act added $350 million more to the coffers of federal agents, whose job is to find and prosecute fraud.  At the same time, it has made it easier for government officials to meet the requirements to indict physicians under Anti-Kickback legislation and the Healthcare Fraud Statute.
      In 2011 the government claims to have collected $4.1 billion in fraudulent payments.  That's the year the FBI raided my clinic and took $400,000 of assets earmarked for clinic functioning.  The prosecutor in my case has yet to divulge the reasons for the forfeiture and, if it's "Medicare fraud," the nature of my fraudulent acts.  Nevertheless, I wouldn't be surprised if the money stolen from my bank accounts has been included in that big anti-fraud figure officials quote as a way of bragging to Americans about what a good job they're doing at the Department of Justice.  It's easy to do a good job collecting money when you're allowed to walk into banks and rob people's accounts, without having to explain a thing, and without fear of repercussions.
     The Physicians Practice web article on April 24, 2012 outlines three ways physicians commit Medicare fraud, by violating one of the following statutes.
     1.  Physician self-referral.  This is when a physician refers patients to a relative who could benefit financially from the referral..  For example, if my brother owned a dialysis center, I couldn't refer my renal patients to him without violating the Stark law and being guilty of a federal crime.
     2.  Anti-kickback.  This law prohibits doctors from paying people, such as my patients, for recruiting other patients into my practice.  The consequences for this are "dire," the article says, and there is "considerable gray area" in its interpretation. 
     3.  Civil false claims.  This covers:  a) sending claims for services that weren't provided.  b) sending claims for patients who weren't seen.   When erroneous claims are sent without the physician's knowledge, the crime is called "reckless disregard."  If I billed Medicare for an EKG but didn't do an EKG, I'd be guilty of breaking this law.  Medicare and law enforcement officials have expanded this violation to include times, for instance, when an EKG was performed,  but "wasn't necessary."  Here's where it behooves the government to pretend it knows how to practice medicine.  While it may be true that a doctor shouldn't be doing an EKG for foot pain, that's not the kind of transgression FBI agents are catching.  Medicare's software is smart enough to reject such claims, because the diagnosis of foot pain doesn't match the list of acceptable diagnoses for doing an EKG, hence no payment would be made.
     One way for government agents to collect money is to interpolate themselves between doctors and patients, without having been in the exam rooms and without knowing anything about patients' medical history, and say that the tests and procedures done weren't necessary.  They can make accusations that doctors have broken the law by billing false claims.  The threat of an indictment, felony, jail time, or ignominy is so terrifying to doctors that they settle out of court, paying big "fines," to make the case go away.  That's how the feds make so much money.
     The fines and penalties for false claims include:  a) refunding the amount the government says it shouldn't have paid;  b) paying three more times that amount in "damages;" c)  paying a fine of between $5,500 and $11,000 per error/false claim.  These fines add up to millions of dollars.  Most doctors work out a "deal" with government officials to pay less and shut up.
    A healthcare attorney on the Physicians Practice site says, "Physicians really can't fly under the radar like they thought they used to be able to, now."   Have physicians been trying to fly under the radar?  That's news to me.
     A podcast on civil false claims violations at Physicians Practice starts with a warning, saying the law is so complicated that physicians can't hope to understand it without the help of a healthcare attorney.  As far as I'm concerned, the law should be as simple as, Thou shalt not lie.  There can only be one reason for it being more complicated:  it makes it easier for government officials to trip doctors up, and collect fines.
     I can't guess how the government might twist and reframe my office visits with patients so they can come up with charges against me in any of the above categories.  I don't accept law enforcement officials telling doctors how to practice medicine.  And, I will not settle, nor will I balk at bringing my case to court for a real jury to hear, if it should come to that.


Tuesday, January 15, 2013

Featherweight Pound Cake

The name is an oxymoron, but this cake really is both light and sturdy.  It's a henkeeper's dream, as it uses plenty of eggs, and stores well.  I serve it with freshly whipped cream sweetened with powdered sugar, and big handfuls of blackberries.  The recipe is adapted from a cookbook I lost or gave away, or I would credit it.  It works well with gluten-free flour, especially Thomas Keller's, "Cup for Cup." Cut the cake into strips, soak with coffee and brandy, add creme fraiche or whipped cream and you have tiramisu.

     11 eggs
     2 cups sugar
     zest of 2 lemons or oranges
     2 1/4 cups flour
     3/4 cups butter, melted and cooled

     Beat the eggs and sugar with an electric hand mixer in a bowl over simmering water for 12 minutes.  They will triple their size.  Take the bowl out of the water, and add the citrus rind.  Sprinkle in the flour, beating as little as possible to incorporate it, then the butter.
     Pour it all into a buttered, floured pan that is 9 inches in diameter and 3 1/2 inches high, or an angel food pan.  (The pan should hold 4 quarts--try filling it with this much water, first, to be sure.)   Bake 50-60 minutes, or until the cake is light brown and a toothpick comes out clean.

Why Are Federal Prosecutors Stealing Our Riches?

     Several days ago 26-year-old Aaron Swartz hanged himself in his New York apartment.  Aaron was a brilliant, innovative computer programmer who was driven to suicide by a federal prosecutor, Stephen Heymann (working under Carmen Ortiz), whose "tough-on-white-collar crime" ethos meant Swartz would face a long prison sentence for tapping into MIT's data base and making millions of academic papers available on-line for free.  No amount of plea-bargaining could sway Heymann from his insistence that Swartz go to jail, and this is more likely to have been because Heymann needed to prove himself to the DOJ (and to his illustrious Watergate-prosecuting father, Deputy Attorney Philip Heymann) than because Swartz represented a danger to society.
     If Swartz committed a crime, it was one from which we could have learned a great deal.  Internet data is highly vulnerable to hacking:  Swartz could have shown us how to seal chinks in the current barricades.  This amazing young man should not have died--and there are many who will say that suicide signifies a deep emotional disturbance.  But any sensitive person subjected to this much public opprobrium with no hope for escape, and facing one of our livid, insensitive, no-holds-barred federal prosecutors bent on climbing the political ladder even if it means abandoning the nuances of the concept of justice, would be driven to the same solution.  I doubt if I could have withstood the pressures Swartz faced--all because he had an innovative mind and a genius for the labyrinthine innards of computer software-- at 26.
     "Aaron's death is not simply a personal tragedy," his family said.  "It is the product of a criminal justice system rife with intimidation and prosecutorial overreach."
     "The government used the same laws designed to go after bank robbers to go after this digital genius," said a spokesman for the American Civil Liberties Union.
     "Unchecked power in the hands of federal prosecutors is a threat to democracy," said the New York Times, in an August 19, 2012 article, "Prosecutors' Overreaching Goes Unchecked."  "We must do a better job of holding prosecutors accountable."
     In 2008 another computer whiz, Jonathan James, committed suicide after being charged by federal officials with breaching retail internet sites.  "I have no faith in the justice system," he said in his suicide note.  "The feds play dirty."
     The true value of America lies in its people.  Geniuses like Swartz and James are this country's riches.  So are physicians who dedicate themselves, like many others, to making America great.  Prosecutors are now investigating and charging 2,400 physicians for fraud, abuse, racketeering, money-laundering and conspiracy.  Can they possible have grounds for such mayhem against professionals who as a group tend to be sensitive, intelligent, and defenseless against such charges, and against power-bloated policemen wielding very big weaponry?
    Why is the federal government stealing and destroying the very minds that demonstrate to the world that the United States is the hub of creativity and innovation?  Does our justice system want to wipe out all the raw materials that serve as the basis of our uniqueness?  Do they think the system will keep on replenishing itself with people like Aaron, or Jonathan, or committed doctors like me, as though such individuals emerge spontaneously, as though they could rise out of an oppressive system that punishes inspiration, originality, and success?  Are prosecutors unbalanced?  Or completely self-serving?  Or just plain dumb?

Monday, January 14, 2013

Basic Spinach

Fresh, local spinach has just appeared at the outdoor markets.  Spinach should be eaten cooked, not raw, because its high oxalic acid content can prevent absorption of calcium in food (and can lead to bone loss, as oxalic acid steals calcium from your bones), and cooking modifies this detrimental effect.  Buy more spinach than you think you need, because it won't last long once you cook it like this.  Use the biggest frying pan you have.  Leftovers make a great sandwich filling, topped with slivers of Parmesan. 

1/2 cup olive oil
8 cloves garlic, chopped
2 lbs fresh spinach
1-2 tsp sea salt

Heat olive oil almost to smoking.  Toss in garlic and stir, add spinach, one handful at a time, stirring and turning until barely wilted, then adding more in this manner until all the spinach is wilted and bright green. Sprinkle with sea salt, toss again, and serve.

Update on Stolen Eggs

     We were cleaning up debris along the west edge of the barn and there it was.
     One of the stolen eggs lay in a pile of dry leaves.  It was soiled and had scratches on its surface, but otherwise appeared intact.
     It made me think of something precious, like an engagement ring, flung in a decisive moment onto the dirt while harsh words pass between two people, words which might tear, bit by bit, at the fabric of the couple's connection until it is rent for good.  The egg, like such a ring, had been forsaken.
     I looked around and soon found bits of eggshell from the other stolen eggs, although I can't vouch that, even if I'd made a painstaking effort with Krazy Glue, I could have reconstructed all three other eggs from that clutch.  Maybe one had been carried off.
     I brought the unbroken egg into the house.  It seemed rather light, but there were no obvious peck-holes or surface cracks.
     If you want to find out whether a stray egg is good to eat or not, put it in a glass of water.  If it sinks, it's fresh.  If it almost sinks, it's not as fresh, but still good to eat.  If it floats, well, unless you're willing to take a big chance--which means you ought to be starving--you'd better throw it on the compost pile. 
     Storey's Guide to Chickens says that an unwashed egg will stay fresh for four months in tropical temperatures.  The eggs in the grocery story refrigerator are usually months old.
     The lost-and-found egg floated.  It may have been a little hollow, owing to micro-cracks in the shell  through which the watery components might have been evaporating  I could imagine a wild creature tapping and scratching at the shell to get inside, causing such tiny fissures.
     "Let's open it!" said Eli, my son, sitting at the kitchen table with the egg in his palm, ready to crack it.
     "No!  Not in the house!" I said, holding up my hand like a traffic guard.  "In fact, not even within a mile of the house."
     Then, Eli told a story from his childhood, about an egg he'd found outside and opened.  It must have been fifteen years ago, when we kept free-roaming chickens--until a hungry fox's blitzkrieg made me swear off chickens for the next decade.
     In those days, the hens laid eggs all over the place:  in tree branches, on the tractor seat, on top of the mulch pile, on the roof of the barn, in the rafters.  One time, my sons were swinging under a huge Live Oak waiting for me to pull cookies out of the oven, and it started raining chicks.  At their feet fell eight hatchlings, who stumbled as they tried to hold themselves up on their new, yellow feet, and whose arrival seemed to presage good things.
     "Mom!  Mom!  It's raining chicks!" they called.  I left the cookies, turning off the oven, and ran outside.  The fluff-ball chicks were wobbling around like seasick passengers on a reeling ship .  We gathered them in a box and nursed them with mash, keeping them safe for weeks, until they wouldn't be harmed by the big hens.
     The stray egg Eli had found back then was no prize.  He hadn't told me about it at the time--it being one of many secrets boys must keep from their mothers for life to be fun.  There were dried bits of yolk inside, he reported now, and a stench that was too much, even for a grubby, tree-climbing, mud-skimming ten-year-old boy.
     I took the egg we'd discovered today to the garden and buried it under a bushel of decomposing manure.
     There were no tracks, anywhere, to identify the marauder.
     But it had to be a raccoon, right?  A hungry raccoon, who took the stash, egg by egg, in its furry, long-nailed, humanoid paws to the back of the barn, and stuffed its gullet on the contents of the first three, sucking them down like a drunk until it fell into a stupor in the shade and slept for, who knows, three days?  Long enough to forget about the last one.
     And that last egg, the one betraying the thief, tells me that I need to tighten the screws on the fence gate, and bury some wooden posts along the edges of the chicken coop, because there's always a chance that someone's looking for a free lunch, scheming to parlay trust into profit, stealing good eggs.

Sunday, January 13, 2013

More on the Class-Action Lawsuit

     John Stacks called, and we had a second conversation.
     He's the guy who commissioned the "Rampant InJustice" youtube (over 300,000 views) after his business, Mountain Pure Water, was raided in nearly the same manner as my clinic.  We spoke for the first time about a month ago, when I had posted a comment to the board on his youtube site.
     He has two lawyers ready to move forward on a class-action case against the government, wherein we would demand a public apology, as well as acknowledgment by government officials that its agents trampled over our First, Fourth, and Sixth Amendment rights, our Miranda rights, and our Article 1, Section 9 rights.
     One of the lawyers, Tim Dudley, is a reserved, cogitative person--like an alligator, perhaps, holding back until the moment of attack, when it swallows its prey without remorse.  The other is a well-known federal defense lawyer named Mike Easley, who has a more voluble, assertive style.  Both are in their mid-fifties, have made the Top 500 Lawyers and Wall Street lists, and have plenty of experience and a reputation for integrity.  Dudley's ex-partner is now a federal judge, which may say something about Dudley himself, or his firm.
     "Why file the case in Arkansas?" I asked Stacks.
     "Because the judges are more conservative here," he said.
     "What's so good about 'conservative' judges?"
     "They care about the Constitution, and they take it seriously when people who have been vested with power ignore the constitutional rights of the people they represent, and attack as though we live in the Dark Ages."
     "How many other people are interested in a class action suit against the government?"
     "Lots of people," he said.  "I've spoken with up to 150 since the video was posted, and most of them were very interested--but they're afraid.  Some prefer to remain anonymous, and some have chosen to 'settle' with the government in exchange for keeping their mouths shut."
     "'Keeping their mouths shut?'" I repeated.  "Why would the government want anyone to keep quiet about what's happened to them?"
     "Maybe, because the government has something to hide.  They don't want the rest of the country to know how they violated constitutional rights."
     "Isn't that exactly why we shouldn't keep our mouths shut?"
     "That's how I feel.  And so do some of the others, who want to collaborate with us.  We need to hold the government accountable."
     "What companies want to join a class action suit?"
     "There's Gibson Guitar, Midamor, Dunkin outdoor Equipment, you, and me.  I think there will be a few others, but it's hard to get them to commit, because it means going public."
     "Who are they?"
     "One is a California company, Rawesome Foods, which has been raided three times, and was even written up in the Huffington Post."
     "What happened to them?"
     "Federal agents conducted sting operations at the store, throwing out loads of milk and cheese, arresting the owner and jailing him on $123,000 bail, and charging him with a number of crimes, including conspiracy."
     The same thing happened this year to Morninglory Dairy in Missouri.  The owner, Joe Dixon, in an appeal to his customers and supporters, quotes Thomas Jefferson on his website:

          The only thing tyranny needs in order to gain a foothold 
          is for people of good conscience to remain silent.

     John Stacks suggested we put together a group lawsuit, rather than a class-action suit.  In a group lawsuit, people with similar cases appeal to the federal government to redress wrongs committed against them, as a way of underlining the need for government agents to respect all of our constitutional rights.  In a class-action suit, defendants have been involved in the very same situation, rather than having had parallel experiences, and want an action, or compensation, to answer their complaint.  My employees and I might file a class-action suit, for instance, whereas a number of different individuals who have experienced the same unfairness might file a group lawsuit.   I agreed with Stacks, that a group lawsuit makes sense for us.
     "What could we hope to gain?"  I asked him.
     "A public admission, by government representatives, that they misused power in a tyrannical way, and in doing so violated the Constitution.  A statement that it will not happen again, and that those judges and agents who are responsible for transgressions should face disciplinary action."
     "Shouldn't we insist that the Patriot Act be retired, so long as the country isn't under imminent threat?"
     "Absolutely," he said.  "The Patriot Act gives government officials license to overlook the rights of citizens.  Then, those same officials make blanket accusations in order to trawl in money, knowing they'll profit somewhere or other, especially if people are scared.  Our country isn't under attack, and we're not in dire circumstances, so we don't need the Patriot Act and all the immunity it confers on federal employees.  Those agents and prosecutors shouldn't be immune to penalties for violating our rights,  The Patriot Act needs to be put to rest."
     Government agents, in their zeal to accumulate money and brownie points with the DOJ, throw a huge net over people and drag them all in, assuming that some of them will end up being big fish, whom they can eat--and not caring whether the others die, like dolphins caught in the enormous, industrial nets of commercial fishermen, or not.
     Stacks asked me whether members of my family had been impacted by the raid.  He said that, of the one-hundred-fifty people with whom he's spoken--people who were victims of similar raids--most reported that their spouses and other family members had become "mentally handicapped" by the experience.
     He meant that they had suffered post-traumatic-stress-disorder symptoms, including nightmares, sweating, palpitations, disturbances in thinking, breathing problems.  Stacks himself can't get the raid at Mountain Pure Water out of his mind, especially the part where federal agents held a gun to his head.
     "They've taken the Patriot Act, and they're using it as a hammer to destroy people," he said.
     It's significant that federal agents are staging raids at companies whose bank accounts offer substantial "compensation" for the government, in the form of forfeitures and fines.
     If I did something equivalent, it would mean I'd be accusing my employees--and even my children--without cause, of theft.  Then I'd be taking money from their wallets, all because my Visa bill is overdue.  Why should my employees and children ever want to associate with me again, let alone work for me, or expose themselves to my tyranny, if I acted toward them the way the government has acted toward me?
     I guess it's one way to address the national debt.