Sunday, November 8, 2015

A Decent Society

     "What is a decent society?  A decent society is one whose institutions do not humiliate people.  A civilized society is one whose members do not humiliate one another."
                                                                      Avishai Margalit, A Decent Society

     As self-appointed exemplars of civilization at its best, we in the United States, though there are many nations worse than ours,  have a long way to go before we can declare with honest self-awareness that we are a decent and civilized people.

Friday, October 30, 2015

Another Witness for the Feds: Ms. Barker

     I saw a retail place for rent in Hawthorne, next to the post office.
     Four or five hundred square feet:  big enough for medical consultations, an EKG machine, minor surgery equipment, the usual apparatus for small-time doctoring.
     Maybe I ought to hang out a shingle again, I thought.
     There are no days when I'm not practicing medicine, off-label, so to speak.  Wherever I go. someone catches me by the sleeve and asks for advice, or a prescription.  People call me at home for "second opinions."  
     You don't stop being a doctor just because the feds indict you, it seems.  My license is intact, though this probably irks the bejeezus out of the prosecutor.  
     And the indictment is a joke, whatever happens, whatever story the prosecutor tells at my trial, fanning a spark she caught from the FBI agent's flint into a blaze.  The indictment simply has no basis in fact.  And if facts can be twisted like fencing wire to rein in a different story, a story completely opposite to the truth, a story that sends me to jail, then we don't live in a country of educated, honorable, truth-seeking, self-questioning people.
     "Do you think I ought to go back into medical practice?" I asked my sister, a nurse, who lives in my home state of Pennsylvania.  She's someone who relies on intuition and spiritual guidance to make decisions, and these count for as much as anything, in my book.  
     "You need a diversion from the mess they've put you in," she said.  "And you're so good at medicine.  You should be helping people."
     I miss patients and medicine, the magnificence of the human body healing itself, the riddle of symptoms, figuring out how they add up to diagnoses, turning those diagnoses into cure, kneading the cures into a prolongation of life.
     "Why don't you look for a space to set up practice?" my sister suggested.  "And pay attention to signs along the way, from the universe."  
     This is pretty much what I expected her to say.  (We ask people for the advice we want to get.  We prompt them to offer exactly that.)
     I called the phone number on the sign for the space next to the post office.  Myra Jill Barker (352) 481-2376.  There it is, in case the prosecutor wants it.
     "Ms. Barker, hello."
     "Who's this?"
     "I'm calling about the property owned by Mr. Lewis, next to the Hawthorne Post Office."
     "What do you want?" she demanded.
     "Are you a realtor?  Or are you selling that property privately?"
     "I'm a realtor," she said, and there was pride in her tone.
     "Is Mr. Lewis willing to rent the space?"
     "Yes, he is."
     "Can I look at it?"
     "I just showed it this morning to someone who wants to rent it."
     "All right, then.  Perhaps I could call you back in a week, in case that person doesn't go forward with the rental."
     "No," Ms. Barker said firmly.  "That's not going to happen."
     "What do you mean?" I asked.
     "Because that person is not someone I want to rent it to."
     "Okay," I said, mystified.  "Do you want to show it to me?"
     "I would, but first tell me what you plan to do with it."
     "I'm Dr. Colasante, and I'm thinking about opening a small office there.  A consulting clinic."
     Then the phone connection was lost.  Click-click, dial tone.
     Probably my AT&T connection, which drops calls every day.
     I called back.  
     "I'm sorry for the dropped call," I said.  "I wanted to--"
     Ms. Barker burst into my sentence.  "I've cleaned up all your dead bodies!"
     "I've cleaned up all your dead bodies, and I'm sick of it!"
     (Was she delusional?  I couldn't tell, not over the phone.)
     "I don't understand, Ms. Barker.  What do you mean?"
     "I used to work for the fire department.  I hauled away all your dead bodies!"
     "Would you like to talk about this?"  I asked.  "I'm confused by what you're saying."  Was she calling me a murderer?  
     "No I would not like to talk.  And I will not rent to you."
     "You're saying you won't rent to me?"
     "That's right, I won't."
     "But isn't your client, Mr. Lewis, the one who would make that decision, rather than you, the realtor?"
     With that, she hung up.  Which made me think the call hadn't been dropped a few minutes ago.  She'd hung up on me then, too, but answered my call-back to drive in a sword.  
     Experiences like this send a jolt through my nervous system.  What's going on?  
     Apparently there are people who think I am scum of the earth, and Ms. Barker is one of them.  How many more are there?  Dozens?  Hundreds?  If I open a clinic, will people throw rocks through the windows?  Will they trail me with Tazers or, worse, shotguns?  
     I know there isn't cause for this, so they must be piggybacking on the government's attack, a government that is piggybacking on Pat McCullough's lawyer's--Mr. Cohen's--attack, a lawyer who hopes to profit big-time from a whistleblower commission (he's already borrowed against multiple future expected whistleblower payoffs, to the tune of $30 million)--money that would go to Pat, whose attack served her purposes, and hers alone, at great cost to everyone, taxpayers included, except her.
     When someone powerful like the government makes an accusation, does everyone else follow suit, like the Pied Piper's retinue, blowing horns, shouting curses, waving swords, adding their own anger to the mess of inchoate anger rising up out of their unsatisfying lives, sullying the small possibility of any truth coming out?  
     What if the truth is complicated and time-consuming to unravel?  It's much easier to jump to firm, pat conclusions.  "She's a liar, she's a thief, she's a fraud!"  Those are simple, satisfying things to say about me, to take in and vomit out like a good, fat, five-course meal.   They take a load of guilt off the accusers, who feel pure and clean in their hearts, afterward.
     "Was Ms. Barker's refusal to talk to me a sign?" I asked my sister.
     "I don't know," she said.  "But it gives you another taste of what it's like to live in that part of Florida."
     "What do you mean?"
     "It's different down there.  People are different."
     "Right," I said.  But really, I was thinking about Mr. Ivey, from yesterday, and all the patients here in Florida whom, different or not, I had come to love.  People I wanted to help live a long time, because they had big hearts, and things to teach me.
     "Maybe you should come home," my sister said.  "People need you here, too.  Come back up north.  You're a bird who's lost your migratory path.  Maybe Florida isn't the place for you."


Ace Hardware, 10/28/15

     I was at Ace Hardware buying a few ounces of seeds for fall collards and mustard greens when the man behind me tapped my shoulder.  "You'ze Dr. Colasante?"
     "You'ze the doctor who used to see people down there yonder?"  He pointed in the direction of Hawthorne Medical Center, now weed-strangled, vermin-infested, defunct.
     I noticed his custodian's button-down shirt with the name embroidered over his breast pocket:  "IVEY."
     "Yes, I'm Dr. C.," I answered.
     "I know you!" he smiled broadly.
     "Really?"  I asked.  "But I don't recognize you,  Mr. Ivey.  I'm sorry."
     I was trying to place him, but we'd had eight thousand patients back then,  a lot.
     "I did take care of some Iveys," I recalled, ticking off a few of names for him.
     "I wasn't never one of your patients," he explained, "but a lotta my kinfolk was."
     In truth, I'd seen enough Iveys, and Williamses, and Manns, and Rutledges, and Gordons to fill a telephone book.
     Each family practically had its own shelf of medical charts.  They were good, cheerful, hard-working, belly-laughing, church-going, soulful, thoroughly respectable people, who made my job a lot of fun.  I did what I could to get them well and keep them going, but clinic visits with them were never only about health.
     We talked about politics, family gatherings, kids, school, the upcoming church picnic, fishing, shrimping, God's will, the weather at the lake, and how to cook collards.  We talked about justice and injustice, race, prejudice, hate, love, the Bible, and forgiveness.
     I was an extension of the community--honored to be so!--and office visits were one more way of "communing."  
     "So that's why you don't look familiar," I said, relieved.  "I'm sure I would have remembered you."
     We paid for our purchases and went out to the street together.  I covered my brow with my seed bags to cut out the glare of the morning sun ricocheting off the hood of my Prius.
     "You was a good doctor!" he exclaimed.  "Everybody says so."
     "Maybe I ought to go back into practice," I mused.  "I've been thinking about it."
     "You ought to!" he practically shouted.
     "Who's your doctor?"  I wanted to know.
     "Tell you the truth," he said, shaking his head, "I don't got no doctor."
     "Don't you have insurance?"
     "I have insurance, but no doctor.  Don't know where to go.  There is no place."
     In fact, there are two separate medical facilities in Hawthorne, each no more than a few blocks from where we were standing.   I said so, tipping my head in both directions.
     "Naw," he said without elaborating.  "No place to go, not really."  
     So we had an office visit right there in the street.  I parried him with questions, made some guesses based on his physical appearance, found out what his blood pressure was, and wrote him a slip for lab work.  He seemed grateful.
     "Hey, 'fore you go," he whispered hoarsely, pulling my shirtsleeve.
     I leaned in to hear, feeling conspiratorial.
     "How you gonna cook them mustards?"
     And before I could answer he was telling me to put a little sugar in the greens after draining the pot liquor, along with salt and onions, and maybe some pork, if I liked it.  "Sugar's the secret to taking out some of that bitter."
     "Thanks for the tip!" I said.
      "Sure thing."
      I was getting in the car, starting up the engine.
      "We can meet, or talk on the phone, once your test results are in," I suggested.  I'd taken down his phone number.  "But really, Mr. Ivey, you need a doctor."
     "Yeah, I know, Doc! " he called out jocularly, walking away.  "And you know what?" he looked back. " I'm waitin' for you!"

Tuesday, October 27, 2015

Rudeness Is Not a Felony

     Some of my detractors have posted blog comments that amount to hip-hip-hoorays for convicting me.
     Naturally I wondered what that was about.
     If these blog readers--prior patients--claim I should be apprehended, pay a fine,  go to jail, then what for?
     I analyzed the impugning comments and tabulated the following accusations.

          1.  Dr. Colasante made us wait in the waiting room for an hour and a half before being seen.
          2.  Dr. Colasante's staff didn't give us our test results over the phone when we called.
          3.  Dr. Colasante did tests that we didn't think were necessary, and the proof is that the results turned out to be normal.
          4.  Dr. Colasante's staff was rude.
          5.  The reports we got from our insurance companies didn't make sense to us, therefore Dr. Colasante must have billed for services we didn't get.

     Do these complainants know the difference between being unhappy with an experience, and being the victim of a bona fide crime?
     If you're unhappy with how you've been treated at a place of business, it's for one of two reasons.  Either the business has a problem providing satisfactory service, or you have expectations that exceed the stated objectives of the business, or are impossible to meet.
     We all know people who are chronically unhappy with whatever comes their way.   I happen to like most of these crotchety types and enjoy trying to please them, though I usually fail.  They have a world view that places them at the bottom, empty-handed, disappointed by the universe, never valued enough.    Following a predictable formula they turn their unhappiness into blame.  But crime?
     Making a patient wait his or her turn in the waiting room while other same-day patients are being seen in order, is not a crime.
     Not giving patients results of sensitive, HIPAA-regulated tests over the phone is not a crime.
     Rudeness is not nice, but it's not a crime.
     Not understanding an insurance claim submitted by a doctor doesn't mean the doctor committed a crime.
     Not a crime, and certainly not a felony, and not two hundred ten felonies, each of which carries a maximum of ten years in jail.

Monday, October 26, 2015

Haply, I Think on Thee, Ultimate Justice


When, in disgrace with fortune and men's eyes,
I all alone beweep my outcast state, 
And trouble deaf heaven with my bootless cries,
And look upon myself, and curse my fate, 
Wishing me like to one more rich in hope, 
Featur'd like him, like him with friends possess'd,
Desiring this man's art and that man's scope, 
With what I most enjoy contented least; 
Yet in these thoughts myself almost despising,
Haply I think on thee, and then my state, 
Like to the lark at break of day arising 
From sullen earth, sings hymns at heaven's gate;
For thy sweet love remember'd such wealth brings
That then I scorn to change my state with kings.  


Saturday, October 24, 2015

Facts about Whistleblowing

     Most whistleblower cases take advantage of the False Claims Act, a piece of legislation that is used to accuse and indict doctors who accept Medicare and Medicaid patients.  Any business that bills the government for services is vulnerable to charges under the False Claims Act.  A "false claim" is when an individual knowingly bills the government for services that weren't provided.  In the medical field, the government expands this definition to included services that "weren't necessary," thereby allowing FBI agents and federal prosecutors to step into the physician's role, deciding sans patient, sans symptoms, whether a medical test or treatment was necessary or not.
     In my case, most of the 210 charges in the original indictment are based on the contention that I provided services (hearing tests, counseling about diet, weight loss, addiction) that "weren't necessary."  In some cases, the government claims there isn't enough documentation in the chart to support a claim that services were provided, especially counseling services.  
     Eighty percent of whistleblowers end up with nothing:  their accusations are baseless, the cases have no merit.  Of the whistleblowers who collect a reward for reporting physicians and other government service providers, the average payment is $150,000.  Attorneys take forty percent of whistleblower payments, and taxes take thirty percent or more (see:  Whistleblower Awards).
     If there is justice in our legal system, there will be no whistleblower payment related to my indictment and there will be no case won by the government, because there isn't a legitimate case against me.

Friday, October 23, 2015

My Trial Date

     The trial date in my case was originally set for September 7, 2015.  Now it's January 4, 2016, at 9 AM.  The trial will take place in the federal courthouse in Gainesville, Florida.  Trials are open to the public.  The first day is likely to be taken up with jury selection.  The first month of my trial, I'm told, is likely to be used by the government:  it's typical for a federal prosecutor to take weeks and weeks articulating its accusations, trying to get them to stick like poison darts in the jurors' heads.  Until the prosecutor is finished doing this, the defense is not allowed to talk back.
     The government's investigation of my family practice clinic started mid-year in 2009--that means it will have taken nearly seven years to bring this case to trial.   In that time, no prosecutor or government agent has ever asked me anything about what they presumed was fraud, or about billing and coding in a medical clinic, how my medical practice functioned, why it was different from the average family practice clinic, or who I was.  It was different--and that was enough, apparently, to presume guilt conduct an expensive investigation, raid my new medical clinic two years into the investigation, and indict me five years after the investigation started.
     Pat McCullough, who purchased the clinic after eighteen months of due diligence, called federal authorities in April or May 2009, announced that she had purchased a fraudulent medical clinic and wanted to report the doctor who sold it to her.  In this way she was able to slither out of paying the purchase price (which I financed) while collecting the outstanding receivables and selling everything of value.  She kept running the clinic at half-mast for the remainder of the year, failed to pay many employees, declined to pay monthly bills, was reported to the Labor Board, lost most of the regular patients, closed the doors for good in 2010, and declared bankruptcy later that year.
     By accusing me of being a fraudulent doctor she succeeded in tapping in to Obama's stepped-up plan to "crack down on healthcare fraud" by getting hyped-up FBI agents and federal prosecutors to believe they had an easy win in front of them, "low-hanging fruit" as one defense lawyer said, while not having to pay for the prosecution.  Even better, Ms. McCullough--freed from all debt when her bankruptcy request was granted in 2011--is sitting in the catbird seat, waiting for what she hopes will be the government-sanctioned reward for whistleblowers who catch doctors committing fraud:  around 20% of whatever the government "takes back" from payments made to me (for legitimate services) over as many years as they can convince a jury I was stealing payments, not working for them.
     If I really were a scheming, fraudulent professional, an uncouthAmerican citizen, if I were so clever as to know how to set up a systematic way of tricking the government into paying me what I hadn't earned and didn't deserve, and if that is what I really had in mind to do--wouldn't I have made it easy on myself, and done what Pat did?  Why bother with medical school?  Why train to be a doctor for thirteen years, many sleep-deprived, and study medical journals every evening after office hours for the rest of my life, and lie awake at night wondering if I misdiagnosed someone, or prescribed one medicine when another might have been better, or could have made a patient feel better sooner, or suffer less, or kept him, finally, from dying?
     Whistleblowing is definitely the way to go, not medical school.  There are no penalties for making a mistake--a false accusation--and the rewards are…well, ask Pat.