Thursday, February 28, 2013


     It is four weeks since my clinic closed.  It is one week since the last vestiges of clinic activity were swept from the 810 NW 16th Avenue building, which now stands hollow and forlorn.
     I should feel forlorn, too.  But instead, I am lighter than air.  I am floating, weightless, relieved, imperturbable, and strangely elated.  I have not felt like this since before I began taking care of patients, twenty-five years ago.  I had forgotten what life without responsibility for the welfare, health and survival of other people feels like. 
     I don't think most people appreciate how weighty the mantle of physicianhood is.
     At all times of the day and night, sometimes waking me from sleep, the collosus of responsibility for what was happening to my patients, whether they got better or not, whether I had diagnosed them correctly, chosen a good treatment, acted in their best interests, avoided dire consequences which could cost them their lives, or spoke the right language to their deepest psyches, pressed in on me.   It was pressure which, like the atmosphere pushing against our physical bodies (14.7 pounds per square inch, or one ton per square foot!) becomes the norm, not registering as "pressure," until at last it's lifted and the person, or doctor--for instance, me--is released like an astronaut on a long tether into outer space.   
     Now, I see, this is life.  This is how other people live.
     Weightlessness is an extraordinary phenomenon.  Perhaps it's what we experience at death, our spirits wafting into a great beyond where we float like dirigibles and wave to one another, grinning and holding up two fingers signifying, "Peace."
     Perhaps what I'm experiencing, the death of myself as a doctor, isn't so bad.  Perhaps I should be grateful to the FBI agents and prosecutors who made my clinic an impossibility.  Thanks!
     I am imagining long kayak trips on the Santa Fe river, and hikes through the woods, and sprawling days in my garden in the sun.  I will actually get to see the sun, because I won't be burrowed in the clinic from early morning to long past dusk using every erg of my imagination and ambition to figure out what might be wrong with people who have come to me for help--or what might go wrong, and how I should intercept, or heal them, or lift their weight of worry, sidestepping disaster, making the treatment look like nothing, nothing at all.
     Add to the weight of responsibility for thousands of people's health the fifty insurance companies whose clerks refuse to pay for the work a doctor does, and the barrage of requests for copies of office notes as "proof" the patient was seen;  add to it a subset of patients who have been propagandized, in recent years, to doubt the medical profession and therefore threaten to sue;  add, also, the government's "crackdown on doctors" (one in four doctors will be audited by Medicare this year, and many of those will be targets of investigations, required to defend themselves against accusations of "fraud," a poorly defined federal crime, allowing many entryways for prosecutors, who know little or nothing about medical billing, to accuse, steal, demoralize, and attack);  add to that hundreds of faxed notices that pharmacies won't fill your patients' prescriptions unless the doctor prescribes what they say the patient needs;  add to that the 90,000 new ICD-10 codes that have to be learned by October this year, and the penalties for not installing electronic records;  add to that an FBI raid--without cause!--and its incalculable harm to a doctor's reputation, and the dozen or so lawyers, after the raid, whose fear-ridden warnings, projections of future disaster, and perpetual invoices are like an army that turns war machinery against its own country... add all that up, and you get what we refer to in medicine as "multi-organ collapse."
     I was on the brink of multi-organ collapse.  I was irritable, sleep-deprived, depressed, unbalanced, betrayed, infuriated, confused--and most of all, worried about whether I could continue making sound decisions about patients, whether I would be able to make them better, or at least try.  The raid, a public phenomenon, has cast my reputation into question--and a doctor's reputation is everything.
     The dozen lawyers are still in the wings of my life, and so is the "investigation," if that's what you call it, and I am still stuck with my calumny--courtesy of the FBI raid.
     I'm still avid about medicine, with its many twists and turns, and the thousands of research studies that inform it, and how they ought to be applied, when it comes right down to it, to the patient sitting in front of a doctor, two people in relationship, a sometimes sacred thing.
     But nothing, not even being relegated to government-attack-limbo, not even being in the throes of consolidating a class-action lawsuit, not even dealing with clownish Fallgatter--whose ego makes him a contestant for the circus, as the man with the biggest-head-in-the-world, and who represents one side of America, a shameful side, the one that sacrifices ethics for money, and will kill for money, deserved or not,  Even these hefty circumstances can't match the pressures inherent in practicing medicine every day, and caring deeply and without reservation about patients, their suffering, their outcomes. 
     None of my other difficulties matter, the ones having to do with fallible people like FBI agents and lawyers, or misguided aims like those of the DOJ.  Those things are like pieces of matter following their elliptical orbits, way far away, and I am at the center, released, floating, euphoric.
     I am raising my hand, and giving all of you the peace sign.

Wednesday, February 27, 2013

Government Extortion

     Government intimidation and extortion is happening all over America.  Businesses and individuals who have been raided by the feds are "settling" and signing gag orders, agreeing not to talk, in exchange for getting the government to go away..  They settle before a case has been delineated, before due process, before a trial--sometimes even before charges have been entered.  They don't settle because they're guilty and want to hide their crimes:  they settle because it costs hundreds of thousands of dollars, or millions, to defend oneself against the government, whose prosecutors have turned into bulldogs out to "get" citizens who are successful, and collect money for a bloodthirsty administration.  These guys have an unlimited budget, funded by taxpayers, and unlimited time to allow cases to drag on and on.
     Here's a case in which a thoracic surgeon who miscoded a difficult aortic procedure was arrested and put in a federal penitentiary, and is still there--for a clerical error, very easy to commit given Medicare's obtuse "coding" system for billing:
     And here's Mike Huckabee, former governor of Arkansas, interviewing Henry Jusckiewicz, owner of Gibson Guitar, about the extortionist raids on his factories.  Jusckiewicz says, "The current administration doesn't like successful businesses."
     When business owners and professionals are attacked in this way, or raided, they are rendered helpless.  They can't move to the government's time zone, where uncovering facts and charges can take seven years.  Anyone who has ever run a successful business knows that resolving problems quickly is the key to the solvency and stability of an enterprise.  With statutes of limitations that can extend for five or ten years, business owners like me can sit in limbo after raids and intimations of misconduct without hearing a word from the government.
     "What did I do?"
     "Why did you take my money and supplies?"
     "Why did you take my patients' medical records?"
     "Why won't you give back my patients' medical records?"
     "What was the purpose of the raid?"
     "Did you need all those guns?  Isn't that dangerous?"
     We're the government.  We can do what we want, when we want, and you can't do anything about it.
     "Right, I forgot.  I thought I was a contributing citizen of this country.  I thought I had rights."
     If I had said that, I might be in the slammer or, worse, dead....  Consider this story:
     Sal Culosi, a 38-year-old optometrist in Fairfax County, Virginia, was killed by a SWAT team during a raid on his home for betting $50 on a Virginia Tech football game.  While betting on football may be a crime, how can government officials justify the use of FBI agents armed with automatic weapons to bring the optometrist to justice?  Culosi was barefoot and wearing a t-shirt and jeans when a sleep-deprived agent who had been pretending to be his friend, to encourage him to increase his bets, shot him dead.
     "Dude, what are you doing?" were Culosi's last words.  The police officer named Bullock, who killed Culosi at close range (probably when Culosi reached for his cell phone in his pocket) was suspended for three weeks without pay--then, back to work!  During the family's lawsuit against government officials for violating Culosi's rights, the court asked why an unarmed optometrist with no criminal record should have required a SWAT team to arrest him for betting on football.  The case--centered around violation of Culosi's constitutional rights--was settled for $2 million, but the government spent an estimated $20 million (unlimited resources--even though our country is $19 trillion in debt) on its defense, and the country has lost a valuable professional.  See for more details on this case. 
     When government agents storm a peaceful place of business, brandishing automatic weapons and locking doors, telling employees they can't leave, and questioning them without reading their Miranda rights, giving them the right to call an attorney, or detaining them for many hours past when the officers' safety is secured, they are using maximum intimidation.  When they take supplies (totaling over $100,000 in my clinic; $500,000 at Gibson Guitar);  communicate with other government agencies (like Medicare, in my case, which withheld more than $1 million in payments over two years, without which my multi-service clinic couldn't function as it had in the past--all without explanation) to harrass a business owner and his or her relatives (Mountain Pure's owner reports that three of his relatives were audited by the IRS around the time of his company's raid--this is common practice, my lawyers tell me); and require companies or individuals to spend millions in legal defense costs over many years, before reaching a "settlement," without a trial or conviction--this is extortion.

     Extortion is defined as "the crime of obtaining money or property by threat to a victim's property or loved ones, intimidation, or false claim of a right" by Nolo's Plain-English Law Dictionary. Title 18 of the U.S. Code (Crimes and Criminal Procedure).

     The purpose of extortion on the part of government officials is simple:  to take back money for the government.  Our Department of Justice has made accumulation of assets through extortion--rather than enforcement of laws for the protection of citizens--its primary aim.  Stealing goods, robbing bank accounts, threatening harm, and overlooking the constitutional rights of Americans in the process is business as usual for the DOJ and its worker bees, who include my prosecutors and their FBI underlings who, if they hadn't gotten enough sleep the night before, in the motel rooms where our tax dollars put them up, far from home, before raiding my clinic at gunpoint, I might have suffered the same fate as the optometrist, Culosi.
     It's a crap shoot.  Yesterday, Culosi.  Today, me.  Tomorrow, you. 


Tuesday, February 26, 2013

Fish Oil

     If you think that taking a capsule or two filled (you think) with fish oil is going to extend your life or keep you from getting some awful health problem, you're crazy.
     First of all, none of us even knows what's really in those capsules (artifical fish-flavored palm tree oil?), because no one is regulating their production.  Second, it may be true that there are "studies" showing that fish oil reduces inflammation in the blood vessels or plays a role in preventing heart disease (does it?) but who believes those studies, anyway?  They're full of bias, and sometimes based on outright lies, and their research is funded by companies who stand to gain from the results.   Third, what difference does it make if a capsule or two extends your allotted days of life by five or ten minutes, if in the meantime your life is totally messed up?
     And the lives of most people in America are totally messed up.
     We haven't got a clue how to live.  We keep buying products and going to shamans and complaining about things we could do something about but are too chicken to do something about, and in the evenings we while away our time watching CNN and hoping someone will show up who will actually do those things, or save us in some other grandiose way.  Then, we have trouble falling asleep.
     Why is it that we are living in hundreds of thousands of towns that have no public transportation to other towns?   Why are we holed up in our cars, or at shopping malls, or at home enduring our private versions of grief, instead of out there on dirt and cobblestone roads like our forebears, talking to one another on the streets before dusk, sharing watermelons from local fields, drinking sangria over games of bocce ball with friends, or scrubbing clothes down at the stream while processing the latest village gossip?  Where are the regular intervals of public festivity, where everyone shows up and people accept the strange variety of our species, thereby helping, as a community, to contain oddities that might otherwise, without public nudging and support, turn into pathology that threatens us all?
     Who ever convinced us that St. John's wort or fish oil or Metamucil would save us from the despair that was announced by Albert Camus and has increased exponentially ever since?  What's the deal with gurus and yoga sessions, tai chi, Reiki, cardiologists, feng shui, and handfuls of supplements?  As a country, our lives are terrible, full of anxiety and wishfulness, lost, sad, solitary, and empty of content.
     We need community to contain us.  We all need to know that there is a human safety net that will catch and hold us if some devastation should befall one of us or our loved ones.  Maybe it's not a national health insurance plan, or unemployment compensation, or a stronger military, or more mindless jobs, or more or less government that will improve our national well-being, but being surrounded by groups of people we can trust, people who know how to have fun together, fun that doesn't exclude large populations for being different.  Living lives that are cut off from one another is destroying us as a nation. 
     When was the last time you witnessed someone experiencing joy?  When did you last feel joy?  Do you even know what joy feels like, these days?  Is it joy, to watch your favorite team win a football game?  Is it joy to eat a 7-piece fried chicken meal from a drive-thru?  Is surfing the net joy?  Is Facebook?  I don't even know.
     We are a stressed, sleep-deprived,  bamboozled, half-educated, dream-starved, cell-phone babbling society caught like insects in the sticky net of corporate promotions--and fish oil is just another one of those absurd promotions.  It's not our fault--not really-- that we don't know what to do with ourselves.  We live in a country that devalues community, promotes awful, corporate solutions to loneliness, and keeps holding onto the illusion that the next new thing will make us give up our addictions and feel better.   We are several generations removed from people who knew, instinctively, how to get along with one another and allay, in the process, deep anxieties.  
     Even if we wanted to step out into the street and share life with a community of like-minded others, we couldn't   Our towns aren't set up this way, not any more.  Even if we knew that raising a barn or two together with our neighbors would be the best thing for our health, how might we find a way to do it?  So, we take fish oil, and we guilt-trip ourselves into going to the gym.  We pay for pomegranates and blueberries, pump up our nervous systems with caffeine, take testosterone, jump out of airplanes for adrenalin rushes we hope will reboot our psyches, buy self-help books, and obsess over whether we might have failed our parents or our children or ourselves.  We follow one after another silly prescriptive--whatever is written up in the latest grocery-store magazine, or has been advised by our harried, heavily propagandized doctors--not admitting that products or habits that are supposed to prolong life and improve well-being will never be a substitute for lives that are meant, biologically speaking, to be communally lived.
     Forget about fish oil.  Forget about all those supplements, superfoods, faddish exercise regimens and oriental interventions you hear about, and find ways to reconstruct community life, for the sake of yourself and everyone around you.  Give up all those fatuous, quasi-spiritual beliefs in purist substances and paths that masquerade as miracles--because they won't save you from anything.
     Instead, join a community garden, or start a weekly poker group, quilting club, or hiking association.  Have some parties, arrange a family reunion, form a carpool or children's play group, cook with your friends, complain and cry on one another's shoulders, share your life with lots of other people, do your part to interact with others, and love them in all the strange ways people show love to one another, on a regular basis.  Be politically active, fight for public transportation and city inter-connectiveness, promote the use of tax dollars to foster a return to village life.  Do anything that increases your network of close contacts, nurtures community and reinforces the stress-relieving, life-sustaining connections we need, as a species, to survive.  This will save you, more than anything.  This will save us all, maybe, as Americans.

Monday, February 25, 2013

All about Class-Action Lawsuits

     Class-action lawsuits are mostly an American phenomenon, having originated in the United States.  They seek redress, mostly, for civil rights violations.  Very often it is consumer rights organizations which instigate lawsuits against a large company, or group of companies, to obtain compensation for damages that have resulted from false advertising or deliberate withholding of vital information.
     One example is the 2006 landmark lawsuit in which big tobacco companies were convicted, on charges of fraud and racketeering, for misleading Americans about the health risks of smoking, and for marketing cigarettes to children.  An appeals court unanimously upheld the lower court's decision, in which Judge Kessler argued in a 1,683-page opinion that tobacco companies had been deceiving the public for fifty years, to maximize corporate profits.  This case had been filed by the Department of Justice against tobacco companies, but six public health organizations became parties in the suit.  In 1998, a Master Settlement Agreement, required tobacco companies to pay $206 billion over 25 years to compensate states for costs of tobacco-related illnesses.  In 2006, additional remedies were imposed on the tobacco companies, including restrictions on advertising, mandates for labeling, and requirements that the companies report marketing data to the government.  This case went all the way to the Supreme Court, and was upheld. 
     What about class-action lawsuits against the federal government?  Such cases are possible, if they can override sovereign immunity protection, and if there is enough commonality among the plaintiffs, across state lines, for the suit to be potent.  Many class action suits are sought within a single state, as state courts are considered to be more sympathetic toward plaintiffs, compared with federal courts.
     Our lawyers tell us that we don't have enough commonality to file a class-action suit against the government, unless the facts can be contained within one state.  In three of the raids, the FBI agents haled from Texas.  If all five raids were overseen by agents in Texas, we might have grounds for a class-action suit in Texas.
     But,, as I research the requirements for class-action lawsuits, it seems to me that we do have enough commonality to consolidate a group case, although whether it's advisable to file a class-action suit is debatable.  Here's what Wikipedia's experts say:

The procedure for filing a class action is to file suit with one or several named plaintiffs on behalf of a proposed class. The proposed class must consist of a group of individuals or business entities that have suffered a common injury or injuries. Typically these cases result from an action on the part of a business or a particular product defect or policy that applied to all proposed class members in a typical manner. After the complaint is filed, the plaintiff must file a motion to have the class certified. In some cases class certification may require discovery in order to determine its size and if the proposed class meets the standard for class certification.
Upon the motion to certify the class, the defendants may object to whether the issues are appropriately handled as a class action, to whether the named plaintiffs are sufficiently representative of the class, and to their relationship with the law firm or firms handling the case. The court will also examine the ability of the firm to prosecute the claim for the plaintiffs, and their resources for dealing with class actions.

     The stumbling block for us as plaintiffs is that we might not qualify to be certified as a class.   "A class-action by a group of people who have suffered similar harm from similar actions of a particular defendant," says the website of Heygood, Orr & Pearson.  Our problem may be that the "particular defendant" happens to be the government, and we can't sue the government because it has sovereign immunity.  The FBI agents are all different people, and therefore wouldn't fit the criterion of "a particular defendant."  And they come from different states, confounding a claim within a state.
      In a class-action lawsuit one or more representatives stands in for the entire group.  "The claims of the class representative must arise from facts or law common to all class members," the Heywood lawyers go on to explain.  Class certification requires that plaintiffs persuade the court that a class action is warranted, and to define the scope of the class.
     Our "class" would be all individuals and companies who have been raided by the FBI and believe that in the execution of the raid their constitutional rights were breached.  The "representatives" would be the five of us, as company owners and plaintiffs against the government.
     Our lawyers don't think we'd be granted certification for class status;  moreover, it may actually weaken our case to attempt to represent the thousands of individuals whose rights were violated in raids similar to ours, especially if those individuals didn't want to press charges against the government, for fear of retaliation.
     (One employee told me, "I don't want to participate in a class-action suit, because it will trigger an IRS audit, or invite government harassment...."  Such fear  is common, and serves as a barometer for the trust Americans feel toward our government.  A January, 2013 national survey by the Pew Research Center showed that 73% of Americans said they don't trust the government, while only 11% said they do.  When I gave this statistic to my mother, who has great faith in authority, she interjected with uncharacteristic vehemence, "I don't trust our government at all!  Not one bit!" and told me that corruption at the local level has reached new highs.  But Congress has also lost favor with the public, whose confidence in lawmakers dropped from 67% in 1985 to 23% in 2013.)
     What might we five plaintiffs expect as a class, a group, or as individuals, if we file a lawsuit against the government or its officials?
     First, the government is likely to file a motion right away to have the case dismissed, saying we plaintiffs don't have a legitimate case, or haven't named the crime.  Then, our lawyers will give the facts supporting our lawsuit and show why it's justified.
     Second, if we file a class-action lawsuit, we'll be subject to the criteria imposed for class designation.  Heygood lists these as follows:
  1. Numerosity: the plaintiffs must show that “the class is so numerous that joinder of all members is impracticable.” While there is no set minimum number of class members, typically courts will require at least 100 members in order to satisfy the numerosity requirement. The plaintiffs must also show that class members must be identifiable through the use of specific criteria or information.
  2. Commonality: the plaintiffs must show that there are questions of law and fact that are common to the claims of each class member. The commonality requirement is satisfied where the party opposing the class has engaged in some course of conduct that affects a group of persons and gives rise to a cause of action.
  3. Typicality: the class representatives must show that their individual claims are “typical” of the claims of the various class members. Typicality exists where the representatives’ claims arise from the same event or course of conduct that gives rise to the claims of other class members and the claims are based on the same legal theory.
  4. Adequacy: the plaintiffs must show that they will fairly and adequately protect the interests of the class. To make such a showing, they must typically demonstrate that they have the willingness and ability to take an active role in and control the litigation in order to protect the interest of the absentee class members and that their attorneys will act with the necessary zeal and competence.
          Next, if we get class status, the government's lawyers will appeal the decision, taking it to a higher court, thereby stalling the case.  If class status is upheld, we can move on with discovery, taking depositions, getting access to affidavits, and deposing experts.  At this point the government is likely to object again, alleging that we don't have the facts right, or have overlooked a detail in the law that protects its agents from being sued.  This is called a "summary judgment motion," a common method to delay or obliterate a case.  A judge must decide, based on the documents, whether the government's motion to drop the case has merit.  If not, the case proceeds.
     If the case goes to trial and wins, the government's defense lawyers would appeal the decision, taking it to a higher court.  Or, if the court rules against us, we have the option of requesting appellate review, too.
     Finally, the case is settled at a higher court--maybe the Supreme Court, if the merits of the case remain in dispute, and the issues are important enough.
     Class-action suits are useful because they consolidate hundreds or thousands of similar cases into one, saving court time, and allowing for conformity of decisions.  But since the defendant in our case is the government, specifically the Department of Justice and Eric Holder, we may be blocked from pursuing class-action status because of inherent obstacles to suing the government.
     Class-action lawsuits are usually cases about pharmaceuticals (Vioxx, Phen-Fen), oil spills (BP Gulf, Exxon Valdez),  product liability (tobacco, silicone breast implants), financial products (Enron, DeBeers diamonds), or natural disasters (Hurricane Katrina).  But the Class Action Fairness Act passed in 2005 (via heavy lobbying by corporations) makes it less likely that plaintiffs like us will win cases, because it forces cases to be transferred to federal courts, where the corporations being sued tend to be favored by judges, as opposed to state courts, which are known to rule in favor of plaintiffs.
     Litigation of class-action suits is expensive for big companies, so they're likely to settle cases before they go to trial.  But a case against the government is a different animal:  the government has deep pockets, and doesn't have to worry about the costs of litigation.  Its agents and prosecutors can delay and deny charges indefinitely, if there are mechanisms for doing so.  What the government does have to worry about, given its bad public ratings, is publicity that casts it in an even worse light.
     Therefore, it may behoove us as plaintiffs to notify all major media organizations about our claim, if we move forward with a lawsuit, class-action or otherwise.  Getting The Wall Street Journal or The New York Times to write a story about invidious government raids when a business doesn't pose a real threat to national security, or about the use of Gestapo techniques to obtain paperwork from solo family doctors' offices, or the extravagant waste of taxpayers' money to attack hapless civilians, for the purpose of getting paperwork from them...that's a story Americans need to hear, and one that might change how the FBI and its DOJ parents run their show.

Sunday, February 24, 2013

The Plaintiffs Meet in Nashville

     "I probably shouldn't talk about the details of our decision on my blog--right?" I asked the two lawyers who were driving me to the Nashville airport after our meeting.
     "No, it's probably not a good idea," Mike Easely said, and Tim Dudley concurred.
     "Why not?"
     "It'll probably piss a few people off."
     "They could try to stand in our way."
     "Can they do that?"
     "No, not ultimately.  You have rights, too."
     "Don't all lawyers tell their clients not to talk--ever?  Don't you wish defendants were mute?"
     "Yeah, I guess so," they laughed.
     But I think I'll take their advice this time.  The case is too important.
     Our meeting was attended by four plaintiffs and four lawyers, all of us sitting around a big table in a conference room belonging to Gibson Guitar.  On the wall were framed charcoal drawings of guitar players whose leathery hands were strumming, affectionately, their instruments.  (Is there any instrument that says "Made in America" more than the guitar?)  Gibson is one of the most respected guitar makers in the world, but the company also owns Baldwin pianos, and Wurlitzer jukeboxes and vending machines--so it's a big protagonist in the American economy, considering it's a privately held company.
     The owner, Henry Juszkiewicz, had just come in from a trip to Japan.  Midamor's owner was still attending a trade show in Dubai and couldn't be present, but had been at an initial meeting weeks earlier (which I couldn't attend, since I was shutting down my clinic) and had had a lot to say.  Every one of us nursed a sense of personal outrage over the turmoil, mostly unnecessary, created in our businesses by government agents.  John Stacks, whose standing in his community has plummeted since the raid on his water-bottling plant ("the banks don't want anything to do with me") said he wanted the lawyers to take action immediately.  Henry settled his six-year case with the government last August, but didn't sign a gag order and therefore preserved his right seek redress of damages.  We were all in agreement that we should move forward immediately with a class-action suit, but the methodology of action against the government is stymied by a small detail called sovereign immunity.
     Sovereign immunity is a condition which holds that the government can do no wrong, and is therefore immune from civil lawsuits or prosecution of any kind.   It makes it next to impossible to sue the feds for anything.
     No wonder FBI agents said, at a number of our raids, "We're the government!  We can do what we want, when we want, and there's nothing you can do about it!"  They were right...almost.
     The use of cannons when a pea-shooter will do is extravagant, ludicrous and wasteful, and reveals, in ways we'd like to make public, the private insecurities of government agents and prosecutors, who conceal their smallish self-esteem behind a barrage of weapons, shouting, and general bullying.  Sometimes their tactics go awry, and a person or two get killed.  Oh well, seems to be their thinking.  If you don't want to risk your life, do as you're told and stay out of our clumsy way.
     One of my clinic employees described the way FBI agents treated her, when they stampeded our clinic on June 16, 2011,
     "I was in a room drawing blood on Mrs. K.," she said.  "The agent swung open the door, sending a shock wave through the room, and shouted at me to 'get that needle out, now.'"
     The medical assistant looked down at the blood coursing into the tube, which she was holding steady, despite the disturbance created by the supercilious, uniformed agent, who was so close she could feel the heat emanating from his torso.
     "No, I can't," she told the agent, glancing at him from behind, as he hovered over her.  She tried to show him that the needle was attached to a vacuum device, and might tear the patient's vein if she yanked it out suddenly.
     "'Get it out now, I said!" the FBI agent commanded, with a tone indicating that his patience was being taxed.  That's when the medical assistant turned around and saw a gun aimed at her head.
     Mrs. K. asked, "What's going on?".
     "Go home," the agent told her.  "Find another doctor."
     Why are military tactics being used in small business settings, where the workers are earnest people, unlikely to be armed and, in any case, disinclined to use weapons?  Did the agents think of the medical assistant's phlebotomy needle as a weapon?  What procedural manuals instruct government agents to storm a building like our medical clinic--a place of healing, and, like a chapel or psychological support group, a sanctuary, a pacifist enterprise--and terrify everyone, including patients whose health status might be precarious?  What threat made it necessary, that day, to haul in from long distances dozens of armed agents--four or five for every clinic employee present that day--to "contain" the situation?
     We shared with one another details about the raids on our businesses, including our back-stories, and identified similarities.
     Gibson was accused of importing unfinished ebony and rosewood from Madagascar, in defiance of the Lacey Act (which states that the U.S. government can prosecute Americans for breaking the laws of other countries)--but the imported wood was, in fact, finished fingerboards (made of wood which is unavailable in America).  Madagascar's government issued affidavits confirming the wood was not unfinished, and saying Gibson hadn't broken any of its laws. ("We don't even recognize your country," the prosecutor in the case said, in a last-ditch effort to be right, "so it doesn't matter if you say the wood was finished.  We'll make that decision.")  The government's case was weak--in fact, nonexistent.  Nevertheless, its agents demanded, over the years, millions of pages of documents and spent huge sums (of taxpayers' money) "investigating," i.e., trying to foist a conviction on, the company.
     Duncan Outdoor Sports was accused of accepting a cash payment that wasn't deposited into the bank immediately (an undercover agent paid for an item in cash and said the deposit didn't show up in the bank)--but government agents never checked to see if the deposit had been recorded as taxable income in the bookkeeping records.  It's fine to "take money from the till," as long as that revenue is reported on the bank register, and included as taxable income .
     Mountain Pure Water was accused of not producing documents on a FEMA loan it had been granted in 2008 following tornado damage.  But, in fact, the requested documents had been copied and sent twice, in response to the government's request for records.  The company had been making monthly payments on the loan without a break.  "I'm 110% sure I'm innocent," said Stacks, who resents having to pay lawyers to prove the government is wrong, especially after its agents terrorized his employees and damaged his standing in the community where he was born and raised.
     Midamor was accused of selling meat that didn't meet the standard of for halal, or wasn't labeled properly.  "Halal" indicates that:  a) Allah's name was pronounced during slaughter;  b) the animal's throat is slit with a very sharp knife;  c) the animal was conscious prior to slaughter;  d) the blood was drained by hanging the carcass upside down;  d) the slaughter was performed by a practicing Muslim, Christian or Jew;  e) the animal was not given feed that contained animal byproducts.  Since Midamor's owner wasn't at the meeting, I am not certain how the government's claims were worded, or whether the company has been indicted, or settled.
     The justifications for the raid on Colasante Clinic are "sealed," supposedly to protect witnesses who are already identified on Google--especially Pat McCullough, whose whistleblower claim is public knowledge.  Nevertheless, the prosecutors in my case say they need to hold back information in affidavits supporting their raid, including the 3,000 patient charts they continue to keep under lock in Tallahassee, because "the investigation is still ongoing."  An odd development has occurred, however:  the documents referable to a public hearing that was held, in September 2011, for the purposes of reclaiming patients' medical charts and working capital, are now sealed, including my lawyers' pleadings.  The courthouse has told my attorneys that they can't get access to their own motions any more.
      It's experiences like these that have brought the five of us plaintiffs together, some accompanied by our personal lawyers, to meet with our two Arkansas lawyers, Mike Easley and Tim Dudley, who say they can make a strong case for us against the government. Many of our employees wish to join the lawsuit, too, because they feel they were wronged during the raids.
      Whether or not any of the government's claims have merit, as small or large criminal offenses (and all of us believe the government doesn't have a case) the raid/threat/attack methodology, reminiscent of the Gestapo (an abbreviation for "secret state police," from Nazi days) which was implemented by FBI agents in every single one of our raids--and hundreds or thousands more, across the country, is what we question and oppose.
     "I'm pumped," said Mr. Easley.  "You guys have a lot to be angry about."
     "We have a strong case," said Mr. Dudley.  "Let's iron out the details and get going.  We can have your lawsuit filed within two weeks."
     In summary, yesterday we had a meeting that galvanized the group and underlined our shared purposeto push back on ever-increasing government encroachment of our rights, and to question the necessity of armed intimidation and dangerous (an optometrist was killed by an FBI agent in a Virginia raid) SWAT-team tactics, used for the simple purpose of recovering paper documents or computer hard drives that might have been obtained without raid at all.
     The meeting turned my lonely, two-dimensional grievance into a three-dimensional platform.  We five plaintiffs want to do something for ourselves, it's true, but we want to do something important for America, and for you, too.
     If it weren't for America--we're all together in this!--we could forget about the raids and attacks, and our anger, and our fractured reputations, and we might be able to act as though those agents' reprehensible actions were nothing but a bunch of bad dreams.

Saturday, February 23, 2013

Dinner with John Stacks

     We stood on the corner of the crowded intersection of Broadway and 2nd Avenue North in Nashville, where storefront windows arrayed with cowboy boots, some studded with rhinestones and others dripping with suede fringe, compete with music venues, their doors wide open for business until four in the morning.  Street lights twinkle as far as the eye can see, until they stop in the mirror-like waters of the Tennessee River, which makes the whole rowdy scene seem to float downstream.
     It wasn't a get-me-out-of-here experience, like Times Square, which hems people in with narrow thoroughfares, claustrophobic skyscrapers and blazing corporate logos, because people who come to Nashville are really, really serious about music, and are the substance of the roiling, molten center of the town's economy.  Propped-open saloon doors beckoned us into raucous karaoke performances where the singers, who happen to be ordinary people who've practiced, prepped and gussied up like real entertainers, step onstage, one after the other, to unleash their heartfelt versions of country tunes.
     I wouldn't have entered any of these clubs, preferring not to commit myself and instead gawking like a tourist from the sidewalks at groups of mostly young people swinging their hips, stamping their boots, singing along with the current star because they know all the songs word for word.
     "Hey you!" one of the karaoke singers shouted, pointing at me.  "You, with the white hat!  Where you from?"
     "Florida," John Stacks shouted back, pointing at me.
     "I knew you was from a long ways off!" the singer said with a regional drawl, "'cuz I can tell by the way you look."
     Everyone laughed, looking at me.  I don't suppose people wear white ski caps and Gap t-shirts in this part of the country.
     "Come on up here and sing us a l'il tune!" he went on, holding out the microphone.  "Come on!  Come on up!  I'll help y'all along!"
     Shyness is not a concept they understand in Nashville--especially not justifiable shyness.  The idea that someone might not be able to sing doesn't make sense within a hundred-mile radius of Graceland.
     Everyone around us wanted to sing, and everyone had plenty of songs by heart, complete with dance steps, hand motions, and a country twang like a creaking door-hinges at the end of every stanza.  The audience members were ready to hop onstage and pour out their souls--they were just waiting for an invitation.  Everyone, it seemed, but me.  I know Gloria Gaynor's, "I Will Survive"-- like every woman who grew up in the seventies--but I wasn't about to subject anyone else to my version of it, not at two hundred decibels.
     Therefore, I demurred, and was replaced by a Johnny Cash look-alike.  His name was Roger, and he told us later that he lives and works in Tulsa, but drives to Nashville every few weeks because he loves to perform.  If only we all had an opportunity to live out our alter-egos any day of the week, not just in Nashville. 
     I was thinking about how FBI agents are paid to act out their alter-egos every day, like six-year-old boys who get giddy at the chance to ride in the front of a police car, or start up a fire engine, or hold a real gun.
     In fact, FBI agents and federal prosecutors play cops-and-robbers so much they seem to forget who they really are--namely, human beings.  It doesn't feel so great, I suppose, being ordinary, like the rest of us, when you've had the chance to brandish guns, and feel the thrill, every day, of driving fast cars, arresting people, exercising power
     "The FBI agents in my factory's raid were power-tripping big time," John told me over dinner at the River View Restaurant.  He had a sizable sirloin steak on his plate, festooned with giant prawns, all of it grilled like everything else in the noisy downtown eatery and microbrewery, and he kept asking me if I wanted to try some.  But my plate was loaded with food, too--mahi, shipped from the coast--was I a traitor, eating seafood in the beef belt of America?
     John said he'd had nightmares for months after the raid, many of them featuring him as a superhero who was getting back at the FBI bullies.
     "It has really done a number on me," he said, "as it has for the other plaintiffs in this lawsuit."  We talked about the raids on Gibson, Midamor, and Duncan, and the parallels to our own company raids.  John told me about the numbers of employees at his company, as well as Midamor and Duncan, who have suffered health problems related to the trauma of the raids.
     "The government's tactics have been escalating over the past five years.  There are more guns, lots more intimidation, and many more FBI agents," he noted.
     "There were at four or five law enforcement officials for each one of my employees, at my office," I told him.  "Why should the government need so much reinforcement?  What danger did we pose?"
     "It's getting out of hand," he said.
      Everyone in our class-action group has been indicted so far, except John Stacks and me.
     But this week John learned that he, too, is about to be "tried"--by a Grand Jury, if such a thing could be considered real trial.  He will probably be indicted.
     "I thought Grand Juries were held in secret," I said.
     "Most of the time, they are.  But sometimes they send the defendant a 'target letter'--an invitation to the Grand Jury hearing.  That's what they did with me."
     "Will you attend the hearing?"
     "I want to, because I'd like to say a thing or two," he answered, without disguising his resentment. "But my lawyer says I should't go.  In fact, he says I absolutely should not go."
     "Can't he go with you?"
     "No," he said.  "Defendants' lawyers are not permitted at Grand Jury hearings."
     "So, you'd have to wing it?"
     "That's right.  And my lawyer says it's too dangerous."
     "Because I'd only be allowed to give one-word answers, and the prosecutor's intent would be to entrap me, and to strengthen the government's case by twisting my words."
     "Are you likely to be indicted?"
     "My lawyer says it's  99.9% certain."
     "Do you think they have a case against you?"
     "No.  It's a travesty.  The whole thing is crazy."
     Once indicted, a defendant has to give up his guns and can't travel outside a narrow range.  John has water-bottling plants in Texas, Arkansas and Mississippi, and owns a bank in Little Rock.  He lives on a ranch which used to be the family homestead--the dairy farm where he grew up, and his father grew up, and their parents, and so on.  His roots go deep, but his work requires that he travel a lot.
     Midwesterners like John Stacks and the other plaintiffs in our upcoming lawsuit really are the heart of America.  They grow or manufacture most of what the rest of us eat, drink, buy and walk on every day.  Arresting them is no small thing, as it threatens America's bread and butter.  Even if some of them are guilty, the transgressions are likely to be minor.
     I say this because I am remembering a TED talk about crime and punishment.  In it, the speaker--an expert in the motives behind criminal acts--reports results from a study showing that 80% of people anywhere will lie or cheat a little bit, if they think they can get away with it.  It's built into the human psyche--maybe we're like foxes.  People won't cheat a lot--even if they can get away with a lot--but they'll cheat a little.  They aren't sociopaths, and they aren't a major threat to society, and we can't lock them all up, or we won't have society.
     Therefore, if government agents want to raid, indict, and incarcerate 80% of Americans, they probably can.  Where do they draw the line?
     Which lying, cheating human beings present an imminent danger to society, and which ones simply require a fine, a warning, or restrictions on their business enterprises?  Here is where our country's judicial system has gone wrong.  We can't indict all the tax-paying business owners in this country, not without bankrupting the DOJ.  The owner of Gibson Guitar, Henry Juszkiewicz, says government agents spent $20 million investigating him over a period of six years.  He settled with the government last August for a few hundred thousand dollars.  If this is how well the DOJ is doing on its profit-and-loss tallies with "take-backs," it's deepening our national debt without offering much in the way of improving citizens' safety and welfare.
     After dinner, John and I walked up and down the sidewalks of downtown Nashville, bumping into plaster effigies of Elvis, listening to Loretta Lynn and Randy Travis songs screaming out of the music halls, and ducking into souvenir shops.
     I suggested a visit to a nostalgic candy store, where I bought a bag of flying saucer candies filled with sugar beads.  They're called "satellite wafers," and the label on the package says:  "This candy has enjoyed a great reputation, particularly in the northeast, where people love these candies so much they will do anything to get their hands on them."  I think it's the communion-wafer texture of the candy that accounts for its popularity, because it suggests something like absolution.  I ate the whole bagful.
     There was a weatherworn tin sign on the wall of the store, and it was for sale, too.  It portrayed a white chicken who looked for all the world like my indefatigable hen, Mabel.  The chicken was about to cross the road.
    "I dream of a world in which the motives of chickens will no longer be questioned," the sign said.
    "Amen," I thought.  

Friday, February 22, 2013

Heading to Nashville

     Nashville is where I am headed to meet, with four other plaintiffs, all of us successful and well-respected business owners, to talk about the class-action lawsuit we are waging against the American government.  At the meeting will be two lawyers who believe our constitutional rights were violated during the harsh raids on our respective businesses.  The lawyers are experienced and well-versed in constitutional law, and have agreed to take on our lawsuit as their primary--or only-- case, however long it should take, which will probably be years and involve the appellate court system.
     Appellate courts are one of the best things about our judicial system.  Knowing that whatever one does, in the name of the country, it will be subject to review by intelligent judges who uphold the Constitution, must be a deterrent to many power-tripping prosecutors and short-sighted federal agents across the land.  Even if such prosecutors prevail in a lower court, the decision may be overturned if an appellate judge decides that procedural errors were committed at any point along the way, or the defendant's constitutional rights were overlooked. 
     I have been told by my own lawyers that eighty percent of appellate courts uphold the decisions made by lower courts, but the one in five where a decision is reversed must have a sobering effect on lawyers, especially federal prosecutors, hoping to railroad citizens.  Appellate courts are also known as "courts of errors" because they correct errors made by lower courts.  Appealing to a higher court is considered a citizen's right, if he or she doesn't like the lower court's decision, but appellate courts have the power of "discretionary review," which means they don't have to review a case if it doesn't seem to carry enough weight of evidence to justify changing a verdict.
     I am about to board my second flight, heading out of Charlotte for Nashville, where I'll meet John Stacks, CEO of Mountain Pure Water, to review our goals for tomorrow's meeting with other plaintiffs and the attorneys.  The plaintiffs in our lawsuit are:  Mountain Pure Water, Gibson Guitar, Midamor Meatpacking, Duncan Outdoor Sports, and Colasante Clinic.  In addition, some of the employees who were present on the day of the raids believe their rights were ignored, and would like to file individual lawsuits against the government.  Therefore, we will also discuss, at our meeting tomorrow, whether having these employees join our class-action lawsuit is a good idea, and how to incorporate their claims.
     This two-day trip seems like a good idea, as it will consolidate my decision to make an impact, however small, on government agents' use of excessive power against American citizens.  Suing the government for the problem--more and more common--of its agents overreaching the statutory limits of their power is the best way--perhaps the only way--to underline the importance of protecting our rights under the Constitution.
     The class action lawsuit is not about whether any of our companies are guilty of a crime or not.  Those questions must be answered in individual cases whenever the government gets around to issuing indictments--if the evidence supporting their actions against us in the raids and in the aftermath of the raids justifies an indictment.  Our lawsuit will be focused on procedural transgressions, and is an attempt to make everyone in the country aware that if we don't stand up and object, loudly, when our rights have been violated, we might as well give up those rights altogether.  If we give up our rights, we might as well be agreeing to living in a totalitarian state.
     My next posts will provide updates on our meeting, our goals, our various experiences as heads of our companies at the times of the raids, and our strategies for getting the rest of the country to pay attention to an alarming and incendiary trend, on the part of our government agents, to attack, arrest, and destroy the reputations of its citizens without evidence, bypassing due process, and in violation of the Constitution.  Goliath has gotten too big, and needs restraints.  The more witnesses we have--even blog readers!-- as we work to clamp down on government power, the better.

Thursday, February 21, 2013

60 Cranes

     Last Tuesday I made one last trek to Colasante Clinic.  Despite the cloud cover that afternoon there was light coming through the slats of the horizontal blinds on the windows in the exam rooms, and I could see as though through twilight.
      I crossed the huge, hollow spaces of my old clinic, peering into rooms that were as forlorn as the galleries in a ramiform cave.  The walls seemed to be weeping, as they do in caves.  I undertook this final foray to make sure the place was presentable:  floors swept, refrigerator clean, cabinets empty.  There were still pushpins in the walls, and cardboard boxes on the waiting room floor, so I cleared them out.
     I made sounds, "Hello!  Anyone here?" which stuck to the plaster and didn't echo.  I looked into rooms, remembering employees at their work stations.  I stayed about as long as I would at a cemetery:  ten minutes.
     Then I drove home and stood in my driveway, looking around.  The sun was halfway to the horizon, the air was quiet, a ladybug landed on my arm and flew off.  The dogwoods were blooming, and and so were the redbuds, and the Japanese magnolias.  They seemed to be having a party. 
     Now what?  I asked.
     That's when I heard the cranes.
     Every year, two sandhill cranes settle onto my property at the end of their fall migration.  They meander around the pond and eat the sunflower seeds I put out for them.  They lay a single egg, which hatches into a small sandhill crane, who grows up and flies away and never returns.
     Five yards from where I stood were "my" cranes, family members who had arrived to winter-over in Florida.  Their languorous backward-knee gait reminded me of slow dancing.  They were intent on something, and "craned" their necks to hear what it was. 
     Seconds after I spotted them, they took some running leaps into the air where they were joined, soaringly, by twenty-six others, their legs straight as arrows behind them, their necks elongated, flying in formation like a fleet of jets.  There followed a second group of eighteen, and a third of sixteen.  Sixty cranes, choreographed into three groups, flying west, probably to Payne's Prairie.
     There are only 5,000 sandhill cranes left in Florida, although there are 600,000 other crane species (greater and lesser sandhill cranes, and Mississippi cranes) in the United States.  Florida sandhill cranes are a protected species, threatened by loss of habitat.  They require grassy places near calm water, like marshy wetland, for nesting, and they lay only one to three eggs per year, incubating them for one month and tending to the hatchlings for ten months, when the brood reaches maturity.  The couple mate for life and tend their eggs and progeny together.
     My cranes have one baby a year, so their other eggs and hatchlings must serve as food for predators like the hawks, foxes, coyotes, raccoons, eagles, owls, bobcats and alligators who live in their midst on my property.
     Cranes, like all birds, represent freedom, flight, and the realm of the spirit.  In the west they are considered a clumsy species, according to The Penguin Dictionary of Symbols, but elsewhere cranes are revered.  In Japan, cranes are associated with a long life and good fortune.  If you receive a thousand origami cranes held together by string, called Senzaburu, legend says you will be granted a wish.  In Ancient China cranes were considered a symbol of immortality.  Certain African myths hold the bird in high esteem because it seems to possess self-knowledge, and knowledge of God is considered possible only for those who have knowledge of themselves.
     When those two sandhill cranes appear each year in my backyard I feel graced.  Their long flight and annual return are signs of regeneration--like daffodils, ladybugs, hummingbirds. clover.  The cranes choose my property, but perhaps they consider it their property--and I am their groundskeeper.
     Sixty cranes!  That's a lot of regeneration.  They called to one another with their low-pitched warbling, and drew my two cranes into their enormous, tripartite flock for an aerial demonstration so deeply instinctual I couldn't guess what it might signify--but it seemed holy. 
     For me, after leaving the empty shell of my clinic one last time, after shedding the cloak of medicine as though it had in the end become a bristling husk that hurt to carry around, after returning home in a state of deep disquiet, seeing those sixty cranes was an affirmation of something primordial.  I may not have known what it was, but it was not nothing.  

Wednesday, February 20, 2013

Angry Patients and Office Fees

     Every now and then patients complain bitterly about how much they "got charged" for a doctor visit or a hospital stay.  Ever since the raid on my clinic, certain angry patients--egged on like the Pied Piper's followers by the government--accuse me of fraud, as though they had thought of it themselves.  
     One patient complained, recently and vociferously, on my blog, that I should not have charged her for an office visit when she stopped in to pick up her chart, even though she did not simply pick it up, but insisted on having a personal visit with me on the spot, and made a scene in the waiting room.  "Fraud!  Fraud!  Fraud!" she wrote afterward on my blog, followed by "Shame!  Shame!  Shame!"--because I had the nerve to charge her insurance for the visit.
     I remember the incident.  My receptionist had to call me out of a room, where I was attending to someone else, because this particular patient was so angry she raised the fear-level in the clinic.  The front office staff said they "couldn't take it any more," meaning they were feeling threatened by this patient's escalating temper (in the wake of the Newtown incident).  They alerted me to defuse the situation:  "Either calm the patient down or make a decision to call law enforcement," was the message.
     I was able to neutralize the situation, but it took time and required skill.  We didn't need police back-up, everyone remained safe, the patient's dignity was preserved in front of everyone in the waiting room, and I urged her to visit with me alone in an exam room.  Afterward, I returned to the patient I had abandoned on account of this emergency, but the encounter had been exhausting.
     That was an emergency office visit, whether the patient appreciated it or not.  A person who becomes violently angry in public is likely to have a personality disorder.  Our social norms are so powerful, that overriding them to give vent to internal rage in a very public place, means that an individual has lost the ability to censor primitive feelings, and therefore can appear (and become?) dangerous to others.   Perhaps the patient didn't realize it, but my intervention was an "office visit."  True, I hadn't discussed her blood pressure or headaches, but handling a personality disorder is an "office visit," too.  It required documentation in her chart, it took time, it was a "face-to-face encounter," and it was billable.
     Of the nearly 1,500 patients who "picked up" their medical records in the weeks prior to closing Colasante Clinic, only a handful required an office visit, and were billed as such.  Most patients signed a release, got answers to questions about where they might transfer their medical care, expressed sadness and gratitude, and left.  
     People who express violent anger in a public place like the doctor's waiting room often feel completely justified in doing so, in the throes of their outbursts, no matter who else might be in the vicinity or how those people might feel.  Afterward, those same angry individuals may need to ward off feelings of shame by insisting on their righteousness.  Or, shame doesn't even come close to the surface of consciousness, they are so caught up in their rage.
     The point is, office visits come in many different configurations.  But whenever a doctor has an encounter with a patient, it's likely to meet criteria for an "office visit," and is, therefore, a billable service.  An office visit is defined as a "face-to-face encounter," requiring
     Doctors don't have the luxury of deciding how much they should get paid for their services, however.  It has come to my attention that most people don't understand this.  When it comes to almost anything else you might wish to "purchase," the seller sets the price, and the customer either pays it or not.  But when doctors see patients who have insurance, the fee-for-a-product-or-service system is thrown out the window.  Almost all doctors see patients who have insurance.
     Doctors don't sent fees;  insurance companies do.  Insurance companies decide whether a doctor should be paid, how much, how often, and for what services--and they decide this after the patients have been seen and treated.  Insurance companies publish long (tens of thousands of pages, in some instances) "explanations" for what they pay and what they don't, but more often than not these explanations are obtuse, difficult to navigate, and self-contradictory.  Moreover, they don't follow standard guidelines for good medical care, leaving doctors to tell patients they should get a treatment that "isn't covered."  It's a rare patient who will pay for a service out-of-pocket when it isn't covered by an insurance plan.  Instead, the patient is likely to insist that a doctor call the insurance company and petition, plead, or file a request for an "override" for the service.  A great deal of time in a doctor's office is spent behind the scenes advocating for patients in this way, often to no avail.
  Nevertheless, if a doctor agrees to "take assignment" with an insurance company, he or she has to comply with the insurance company's rules and guidelines, even if they are not in a patient's best interests.  There is almost no room for negotiation.  This is something that aggravates doctors more than anything, and accounts for the fact that many doctors want to leave medicine, or at least stop signing contracts with insurance companies.
   Insurance companies have interpolated themselves between the doctor and the patient.  They decide what a patient "needs," not doctors--even though insurance companies aren't doctors, don't know the patients, and aren't equipped to practice medicine.  They're practicing it, anyway--and very badly, because their primary concern is profits, not people.  Hence, for decades Blue Cross refused to cover a screening colonoscopy in patients over age fifty, despite every medical guideline supporting the need for this preventive test.  Medicaid doesn't cover flu shots.  Medicare doesn't cover dietary counseling for diabetes.  Choices won't cover a range of birth control options.  Most insurances won't cover the shingles vaccine.  Medicare doesn't pay for the pertussis vaccine.  The list goes on and on, and physicians are left to guess about which guidelines for good medical care will be covered by a particular insurance carrier, and which won't.  If I give a pertussis vaccine or insert an IUD for a patient, because a representative at a patient's insurance company said the service would be covered, but then it's denied, I have to consider it a loss for my clinic.  Fighting with insurance companies over nonpayments costs more than absorbing the loss.  It's one of the ways insurance companies maximize profits:  don't pay for services, and make it very difficult for physicians to figure out why standard services aren't covered.  A long telephone wait time, and a barricade of poorly-informed telephone clerks at the front lines of insurance companies guarantee that doctors' offices will give up the fight for payment, especially since every insurance carrier plays the same game.  
     Doctors must send insurance companies a "charge," when they send a claim (claim=invoice for services) but the charge is irrelevant, having no bearing on payment.  When patients get EOB's ("explanation of benefits," a fancy name for how much was paid to the doctor and for what) they see a column for "charge," and think the doctor is actually "charging" a fee for a service.  In fact, it makes no difference what number the doctor puts in the column for "charge."  It's necessary for the claim to be processed, but it isn't used by the insurance.  (My "charges" were all set at twice the "Medicare allowable," and this is how many doctors create a number for the "charge" column on a claim form.
     Doctors also list the diagnoses and services provided to patient (in alphanumeric language).  These are listed on the EOB too, but are translated back into English in language that makes it difficult for patients to know what service was supposed to have been provided.  Sometimes the language is not even recognizable as a service, which raises a red flag for patients who then may suspect doctors of fraud.
     EOB's have columns for DOS (date of service), Service, Diagnosis (sometimes), Charge, Allowable, Deductible, Payment to Provider, and Copay.
     The "Allowable" is the fee the insurance company has set for the service provided.  Every fee has an "allowable."  This is what the insurance company has decided it will pay.  If the doctor happens to "charge" less than that amount, the insurance company will pay less.  But if the doctor charges more, the insurance company has put a ceiling on the payment, and won't pay more than the allowable.
     In general, insurance companies only pay a portion of the allowable, leaving the rest for the patient to pay as a copay or deductible.
     Far too often, an insurance company decides to pay nothing--at least not until the doctor gives more information or copies records.  This is a standard stalling technique used by insurance companies all the time, and it pays off.  Sixty percent of nonpayments by insurance companies in Florida are never contested by the doctor's office--usually because the doctor doesn't even know the claim wasn't paid, and the billing employees ignore the extra work required to collect a claim.  Then, the patient saw the doctor for free.  Most of the time, even patients don't know this is happening.
     If you want to know how much your doctor is "charging" for your office visits or other services, you must refer to the "Allowable" line on the EOB you receive, and then look at the amount actually paid.  Doctors who accept insurance know they have to accept the insurance company's fee schedule.  So their "charge" is, in fact, the allowable.
     You might be surprised to find out how often the payments to your doctor for taking care of you are zero.  By working without pay, in this way, doctors have become unintentional givers of charity, as they have been for thousands of years.  But these days, the charity is forced on them by insurance companies, who claim all the nonpayments to doctors as profits.  In this way, insurance companies have outwitted--or defrauded--us all.

Tuesday, February 19, 2013


     For something "top-secret" they sure are talked about enough.  As part of its new America-as-sniper role, drone-attacks are the self-justification of a military that doesn't know what to do with itself.  Without a war, without real enemies, without public backing, the enormous, adrenalin-pumped, attention-starved, American combat apparatus needs somewhere to go with its overfunded budget and superfluous power.
     Thus far, estimates have it that "only" forty-five civilians have been killed by drones, and this proclivity for destroying targets without loss of American lives or extensive collateral damage is the big claim to fame of drone technology.  But that figure has to be conditioned by our military definition of "civilian," which counts "all military-age males in a strike zone as combatants...unless there is explicit intelligence posthumously proving them innocent" (The New York Times, May 2012).  By this definition, if my son, Carmine, who is twenty-five and severely autistic--unable to step out of the way of an oncoming car, let alone defend himself against intentional, sadistic harm--were Iraqi or Pakistani and got killed by a drone, he would not be likely to be counted as a civilian.
     Why are targeted killings now considered acceptable?  Why has the Obama administration ordered such killings?  What can the rest of the world possibly think about such attacks, which don't even follow our own rules and procedures (e.g., the CIA is exempted from following rules for "fair killing" in Pakistan)?
    To whatever extent international resentment toward America after Bush's incendiary reign was calmed by Hilary Clinton's four hardworking years as Secretary of State, things surely must be moving backward again, since John O. Brennan's nomination as head of the CIA.  Brennan has a terrible track record (or a brilliant one, depending on how you view his counterterrorism strategies) as someone who tolerated, perhaps even encouraged, the imprisonment and torture (including waterboarding and the mysterious "disappearances" of terror suspects, who bypassed all manner of due process and were sent directly to chambers of unthinkable abuse, violating any definition of human rights) in the early 2000's, when he was deputy director of the CIA, and he is the progenitor of our current targeted killing policy.  The UN Convention against Torture requires that anyone suspected of authorizing or carrying out waterboarding should be prosecuted.  Why is Brennan being nominated for one of the highest military posts in the country, instead of being investigated for his authorization and overt advocacy of torture during the Bush campaign?
     The rest of the civilized world must be looking on in awe and dread as Americans continue to step outside the bounds of human decency and fairness in our international policy.  These countries are like villagers watching a band of tigers tear into adjoining settlements and maul and destroy inhabitants.  When will other countries be able to counter the use of such violence and force?  Who do we think we are, with all our military might, in the world?
     A parallel to drone attacks, inside the United States, is the government's rampant use of violence against American citizens and their businesses--like me, and Gibson Guitar, and Mountain Pure Water, and Midamor, and Duncan Outdoor Company, plaintiffs in an upcoming lawsuit against government officials, who have been overstepping the parameters of their jobs for years.  Are we not the victims of "targeted killings," too?  Is the stratagem so different from the one underlying drone attacks?  The "government"--whoever that is, these days--"suspects" one of us, you or me, of "something," and attacks, punishes, and depotentiates us, leaving collateral damage, which gets left out in the final calculations of loss.
     Where is the government's accountability?  Where is John Brennan's?  Where is Obama's?  Has our country gone completely mad?  When will the villagers of the world put their heads together, and throw nets over these lions who have crossed the line and are causing mayhem, ruining civilized landscapes, killing innocent people?  When will someone put a stop to our violence?  Because we can't expect lions to engage in self-reflection, or withhold primitive, bloodthirsty impulses, and say, "We're better than this," can we?
     For another take on this subject, check out the [funny] video from Mother Jones, by clicking below:
Drones and the American government's right to kill American citizens


Monday, February 18, 2013

Three Hoaxes

1.  Electric and gas clothes dryers--completely unnecessary.
     Clothes dryers use about 12% of a household's energy.  Americans buy 6.5 million dryers per year, at $950 to $2,050 each, and run on average 416 cycles per year.  82% Americans households use dryers--but that means 18% do not!
     The Japanese love modern innovations, but they haven't been bamboozled, like Americans, into buying dryers.  They hang up all their clothes, even in cities.  Many Europeans prefer hanging out clothes too:  even in metropolitan areas there are clotheslines strung from one apartment building to the next, shared by families who live on the same level.
     You can save 12% on your utility bill, or $30 per month by getting rid of your dryer--plus, you'll have space where the dryer used to be.  In Florida, even on rainy days there is often enough dry-time for clothes to air-dry.
     Hanging clothes outside takes advantage of two natural disinfectants:  sunshine and wind.  Clothes smell great, after a few hours in the outdoors, and they last longer, because elastic and fabric aren't worn down by the caustic effects of heat and electrostatic energy.
     Put up a two-line clothesline:  use a post-hole digger to make four holes two feet deep, insert four posts, pour concrete (or use dry concrete, which sets without water), and string up clothesline with four eye-bolts.  Purchase a few packets of clothespins (a very cool invention) and opt out of the corporate hoax of automatic clothes dryers.

2.  Box springs:  ugly, heavy, and dust-attracting.
     The usual reasons given for buying box springs are to keep the mattress from sagging, elevate the bed, and provide extra support.  But a wooden frame bed with a plywood base is more supportive than box springs, and can be built to any height.  Mattresses are more likely to sag when box springs are used, because the springs lose resilience over time.
     Most Asians don't use box springs, but have platform beds.  More and more Americans are switching to platform beds, with foam mattresses, which come in many different densities and may help to reduce back problems resulting from soft mattresses.
     Box springs cost $300 to $1,200, and rack up the cost of buying a new bed.  They aren't necessary!

3.  a)  Fabric softeners: toxic chemicals next to your skin
     b) Commercial laundry detergent:  high-cost toxic waste 
     Here are the active components in fabric softener:

          *dihydrogenated tallow dimethyl ammonium chloride
              (a quarternary ammonium compound)
              (silicone-containing chemicals--wasn't silicone outlawed, for
               breast implants?)
          *dipalmitoylehtyl hydroxyethylmonium methylsulfate

     If you wouldn't eat these substances, you shouldn't put them next to your skin.  Everything you apply to your skin ends up, more or less, in your bloodstream.  One soap company capitalized on this effect several years ago by marketing "caffeine soap."  If you showered with it for ten minutes in the morning, the caffeine absorption into your system was equivalent to two cups of coffee.
     Fabric softeners coat clothing fibers with a layer of chemicals, and make fabric less absorptive, which is not desirable for towels and washcloths.  Fabric softeners reduce the breathability of clothes, and cause people to sweat more.  When people wear clothes after using fabric softeners, it's as though their bodies have been encased in silicone, a chemical that reduces air circulation.
     The usual reason given for using fabric softener is to make fabric soft.  But clothes, and especially towels, naturally become softer with subsequent washings, making fabric softener unnecessary.  If you want to save money and reduce toxicity to your body and the environment, stop falling for the hoax of fabric softeners.  
      The cost of commercial laundry detergent is outrageous, and the chemicals used are unacceptable.  You can make your own safe laundry detergent for pennies a load by following these instructions:

     Cheap and Easy Laundry Detergent (Nontoxic!)
Grate one bar of soap.  Pour two quarts of boiling water over it and stir until dissolved.  Add 2 gallons water, 1/2 cup washing soda, and 1 cup Borax (both available and cheap at the grocery store or hardware store).  Stir and pour into empty plastic or glass gallon or half-gallon containers.  Use 1-2 tablespoons per load.  You may substitute 1 cup Dr. Bronner's liquid soap (at all health food stores) for the bar of soap, and save yourself the grating.  You can also use less water, resulting in a more concentrated detergent, but then you should use much less per load, even as little as one teaspoon.  

Sunday, February 17, 2013

Mabel, a Thought Leader

     Most of us don't think of chickens as having thoughts, let alone the "progressive and innovative" viewpoints associated, by definition, with "thought leaders."  But in her troupe of chickens, Mabel stands out as a hen with tantalizing new ideas.
     Mabel isn't at the top of the pecking order, nor are most thought leaders in the human realm.  Thought leaders are too unusual to be accepted as committee chairs or politicians.  They go their own way, zigzagging from norms, even acting with outright hostility to the status quo--until their ideas become, with insidious regularity, the status quo.  They don't pander to the masses, or garner recognition, or even appreciate fame, if it should fall into their lives, as it does with insufferable frequency.  Fame is an annoyance, because it brings with it a multitude of distractions:  phone calls, mail, TV appearances, speaking engagements, and other time-wasting activities that rob a chicken of the call to creative thinking.
     Mabel--like Einstein, Hawking and Bill Gates, whose strange shocks of hair and rumpled clothing haven't make them paragons of haute couture--doesn't concern herself with appearances.  She is by far the least pretty of the twelve hens in my coop, exhibiting broken feathers, mottled wings, a blunt comb, and a beak that looks like a decayed incisor.  She's too busy exploring the local habitat to squander time grooming.
     "Who cares?" she might answer, with impatience, were a news reporter to question her about her slatternly countenance.  "If they don't like it, they can find someone else to follow around."  As though her very admirers were bothersome, with their clucking and trilling, and their chasing behind her, stepping on her feet, every time she routs out a new thing.
     She's one of the first out of the coop, when I open the gate each afternoon, and she doesn't run along with Crystal to the manure pile, but scratches and kicks up dirt in the most unlikely places.  The other chickens get confused by her frenetic activity, because they're inclined to go in the opposite direction, with the crowd--but then, there's Mabel! and what's she got going?  
     Mabel may rush to the fence line in pursuit of something no one else hears--and what do you know?  It's a katydid, at this time of year!  Tick-tick-tick-tick, she says, as though taunting the others, who haven't tasted a katydid since last spring.  They catch a glimpse of it--just enough to wish it were theirs--but Mabel's got the chomp-gulp-swallow sequence down, and the other poor hens are left wishing they had what she's got:  a knack for ferreting out the new.
     There's a vague suspicion that she creates the things she comes up with, like a sorceress with a bag of spells--but then, chickens aren't superstitious.  So, they rush with scientific zeal to repeat the experiment with the same tools, in the exact location;  they peck in the grass and briars to replicate the results, hoping for the same success, throwing dust on one another in the process.
     Meanwhile, Mabel has moved on, and may be scouting directly under my garden fork, waiting for the guillotine-drop and yank of the prongs to reveal, beneath a knot of sod, a family of squirming beetles.  Quick as an automatic staple-gun she pins them down, eight or ten in succession, using that discolored beak-incisor that is the subject of public ridicule, and dispatches them into her gullet before her panderers arrive.
     Sometimes she travels far afield where predators, hungry for a little chicken fat, could be lurking.  But Mabel isn't afraid.  She isn't appetizing--in fact, she's the last hen you'd cull for the stew-pot, if you were hard-up for dinner, because there'd be nothing but tendon and gristle under her taut skin, yielding a weak broth.  This is a consequence, I believe, of the high levels of cortisol coursing through Mabel's knuckle-sized heart, empowering muscle-fibers that spring to action with split-second, ATP-informed notice.  Cortisol is probably at the heart of creativity, which is a special kind of energy and fearlessness that gives thought-leaders like Mabel their edge.
     What does all of this have to do with me--or, for that matter, you?
     We are symbol-seeking organisms, in the animal-kingdom.  It's what sets us apart from all other living organisms.  Consequently, what we pay attention to, among the myriad stimuli in our surroundings, matters.  What we pay attention to gives us clues about the preoccupations of our psyches.  Our attention wanders to symbols, whether we recognize it or not.
     Most of what happens in our minds is below consciousness--some psychoanalysts estimate that eighty percent of what drives our decisions in waking life arises from the unconscious.  The unconscious, we know, is an objective reality--as real as faraway solar systems, or the deepest reaches of the oceans, which cannot be seen but are measured using indirect means, or by being inferred.  Because it is such a powerful determinant of our lives, it pays to have an amicable connection to one's unconscious, even though much of what it has to say may be unsavory, or unwelcome.
     One has only to rate the enjoyment level of our dreams to appreciate that the unconscious has things to say that we'd rather not hear:  the majority of remembered dreams are unpleasant, if not downright primitive, or nightmarish.  Dreams call our attention to information we want to ignore, but we do so at our own peril.  Unconscious contents that appear repeatedly in dreams, or as symbols in waking life, only to be shrugged off, finally make an appearance in the concrete events of our lives:  illnesses, accidents, ruptures in relationships, job lay-offs, environmental catastrophes, even death.
     Mabel represents symbolic content from my unconscious.  Her thought-leadership role among the chickens is a projection of my psyche onto something in the outer world, and a way of calling attention to the next phase of my life.  Such symbolic content achieves tangible reality by attaching itself to real-life objects or circumstances--this is how the unconscious speaks to us, aside from through dreams.  The unconscious is very old, and uses a language universal to humans:  instead of words, it uses symbols.  Mabel is a symbol of a feminine creative power, innovation, and insouciance.
     Mabel's appearance to my conscious mind, during this period of transition in my life, tells me that it's appropriate to go new places, and to trust a deep instinctual core to guide me.  I am instructed by my unconscious not to be daunted by what is new or perilous, or unconventional, nor should I be concerned with appearances.  I can devote my attention, like Mabel, to an inner world, a font of energy, the source of ideas from which may spring katydids and beetles, symbols--like the Egyptian scarab--of transformation.  (The scarab--or Scarabaeus sacer--is a beetle that emerges from a ball of dung, after it has been inseminated by a male of the species and rolled from west to east, like the sun at night.  It was a powerful symbol of death and rebirth in ancient Egypt, and appeared in New Kingdom royal tombs as the sun, which is swallowed each night and re-emerges the next day as Khepri, a new life.)
     Mabel is a thought leader.  She works alone and is more conscientious of her inner drives than outer expectations.  She represents as aspect of my inner world, which calls for recognition in consciousness. 
     "Thought leaders prove themselves through successful implementation of their ideas," says Wikipedia.  "Through effective communication and clarity of purpose, they effect change."  The change in question, for me, is internal.  I need to alter the conscious relationship I have to my inner world, and give it more credence, now that my role in the outer world, as a physician, has been set aside.
     What are the circumstances, or creatures, or news stories, however trivial by conventional standards, in your life that call to you, and stick in your memory?  These are clues to your inner world, which establishes the itinerary for your life, and deserves attention.    

Supplements I Have Recommended

     Over the years I have recommended the following herbs and supplements, based on patients' particular complaints, their other medications, and my understanding of their unique physiology.   
     Herbs are preferable to pharmaceuticals because they are whole products, not "active ingredients" separated from their natural companion molecules.  But herbs and vitamins can be highly suspect, since the FDA declines to oversee their production in the United States.  It's difficult to know whether an herb is ineffective for a patient's condition, or simply a bad product, labeled as containing the herb but in fact containing none of the labeled ingredients.  One study reported that when seventeen different brand-versions of panax ginseng were taken off the shelf at random, and analyzed in a laboratory, not a single one contained any ginseng--yet all were sold as ginseng, accompanied by varying health claims.  Buying products that were made in Germany is one reliable way to get what you pay for, since Germany has an FDA-like organization that regulates the production and quality of herbs and vitamins.

Allergies:             quercetin;  stinging nettles;  butterbur;  hesperidin;  tinospora
Anxiety:               passion flower; 5-HTP;  B6;  Rhodiola rosea; GABA;
Arthritis:              ashwagandha;  boswellia; ginger; curcurmin; MSM; primrose
                             oil; glucosamine; SAM-E;  hyaluronic acid;  cat's claw extract    
Asthma:                n-acetyl-cysteine;  quercetin;  alpha lipoic acid;  ester-C;
                             boswellia; curcurmin
Bipolar:                lithium; B6; magnesium
Bruising:              bromelain; alfalfa
Cholesterol:          green tea extract;  phytosterols;  olive extract;  pomegranate;
                             guggul;  bioflavonoids; niacin (no-flush)
Constipation:        probiotics;  flax seed;  ginger; B6; slippery elm; aloe vera;
                             psyllium;  marshmallow root; licorice root extract (glycyrrhiza);
                             arabinogalactan (larch tree extract)
Depression:          Rhodiola rosea;  passion flower;  GABA;  5-HTP;  L-Tyrosine;
                             pregnenolone (women only)
Diabetes:              chromium picolinate; banaba extract; green tea extract; bitter
                             melon; Gymnema; cinnamon; vanadium
Diarrhea:              cholestyramine; cholestipol; acacia root; boswellia; curcurmin
Fatigue:                alpha lipoic acid;  ashwagandha; malic acid; cordyceps;
                             eleuthera; rhodiola rosea;  L-tyrosine; SAM-E;  panax ginseng
Fibrocystic br:     chaste tree extract; selenium; vitamin E;
Flu:                      oscillococcinum; elderberry extract; DHEA (over 50);
Gallbladder:         digestive enzymes; milk thistle; taurine; curcurmin
Hair loss:              black current seed oil;  primrose oil;  grape seed extract;
                             PABA;  CoQ10;  DHEA (over 50)
Heartburn:            slippery elm;  aloe vera;  curcurmin;  artichoke leaf extract;
                             marshmallow root extract
Heart disease:      coenzyme Q10; homocysteine; nattokinase; resveratrol; krill oil;
                             ubiquinol; garlic
Hepatitis:             schizandra berry;  cordyceps sinensis;  maitake mushroom;
                             selenium;  carnitine;  milk thistle
Herpes:                 L-lysine
Hypertension:       Hawthorn berry; cat's claw extract; pomegranate; cocoa extract;
                              olive leaf extract; grape seed extract; pycnogenol; garlic
Gall bladder:         lipase; protease; amylase; milk thistle; curcurmin
Infections:             maitake mushroom;  astragalus;  lemon balm;  elderberry; aloe
                              vera; eleuthero;  reishi mushroom; cordyceps; shiitake
                              mushroom; green tea extract; alpha lipoic acid; n-acetyl-cysteine;
                              probiotics; ester-C; echinacea; garlic;
Insomnia:              L-tryptophan;  melatonin (over 65);  lemon balm;  GABA;  B6;
                              hops; passion flower;  chamomile;  valerian root
Irritable Bowel:    cholestyramine;  milk thistle;  curcurmin;  acacia
Longevity:            resveratrol;  pregnenolone;  hesperidin;  naringin;  bacopa;
                              pomegranate;  choline;  inositol;  curcurmin;  ginkgo biloba;
                              vanadium;  alpha lipoic acid;  acai berry
Macular degen:     lycopene;  borage oil;  lutein;  grape seed extract;  glutathione;
                              bilberry;  zeaxanthine   
Memory loss:        B12;  butterbur; L-tyrosine; vinpocetine; pycnogenol; krill oil;
                              phosphatidylserine;  ginkgo biloba; lemon balm; Bacopa extract;
                              resveratrol; 5-HTP;  phosphatidylcholine; American ginseng;
                              wild blueberry
Menopause:          black cohosh; pregnenolone; wild yam; soy bioflavanoids: DHEA;
                              dong quai; fig leaf tea 
Migraine:              feverfew;  ginger;  B6;  magnesium 400 mg/d;  riboflavin
                              (400 mg/d);  calcium (1,500 mg/d)
Muscle cramps:    calcium;  potassium;  chamomile;  passion flower;  magnesium;
                              quinine;  lemon balm
Nail brittleness:     black current oil;  primrose oil
Neuropathy:          B-complex;  B6; pycnogenol;  alpha lipoic acid
Overweight:          chromium;  green tea extract;  banaba;  chromium picolinate;
                              taurine;  rhodiola rosea;  magnolia bark;  L-tyrosine;  5-HTP;
Osteoporosis:        calcium citrate;  magnesium;  vitamin D3;  silica;  boron;
Prostate:                green tea extract; saw palmetto; pomegranate; pygeum africanum
                              extract;  milk thistle, turmeric; green tea extract; selenium;
                              pomegranate;  tomatoes;  vitamin E;  pygeum bark;  pumpkin seed oil;
                              stinging nettle root extract
PMS:                     L-theanine (green tea);  L-tryptophan;  GABA;  St. John's wort;
                              primrose oil
Sex drive low:       maca extract;  panax ginseng;  DHEA (over 50), pregnenolone
Stress:                   Eleuthero;  ashwagandha;  5-HTP;  magnolia extract;  GABA;
UTI/kidney:          cranberry;  probiotics;  d-mannose;  astragalus;  cordyceps;
                              quercetin;  dong quai;  curcurmin;  glycine
Varicose veins:      butterbur;  riboflavin;  feverfew;  horse chestnut;  butcher's broom
Yeast infections:    artemisia;  probiotics;  astragalus;  black walnut extract;  olive leaf
                              extract; cloves; grapefruit seed extract extract;