On April 2 I saw Dr. Myles Howard at Syracuse Community Health Center (SCHC). (I had previously seen him once about three years ago.) He told me that SCHC did not do catheter changes and referred me to Upstate Medical Center’s nephrology clinic. It took three weeks for the referral to leave his office.
I need catheter supplies, which includes two catheter bags a month, so I called Byram Healthcare and placed my monthly order, giving Byram the name of my new primary care physician. When the order was not forthcoming then I called them again. This time they told me that they had faxed a request for a prescription twice to Dr. Howard.
So I called SCHC and the physician’s nurse told me that there were a pile of faxes next to the fax machine, and another pile of faxes in the doctor’s mailbox. I really needed a script for my catheter supplies. You know what they tell you do it if your cath bag starts to leak, e.g., spout urine all over your living room rug?
They tell you to call an ambulance and go to the hospital. That costs you, the citizen/taxpayer, about $1500—about a thousand for the ambulance and about $500 for the Emergency Room. I don’t need the grief and you don’t need the bill. All that is needed is for the doctor to fax a prescription to the supply company then I will get two cath bags, each costing about $45, and I can change them at home in my bathroom.
So I ask the nurse if she will pull my fax out of the pile and put it in front of the doctor for his signature. She snaps, “I don’t have time for that!”
So my Power of Attorney (POA) figures that the Syracuse Community Health Center has screwed up somewhere along the line while I posit the possibility that Byram has screwed up. POA goes to visit SCHC and talk to the nurse. I call Byram.
This time I talk to an unusually competent young woman who investigates my order and tells me that the two faxes were sent but not to any phone number.
“Say what?” I ask. “You mean they were just faxed out into the ether? Sent to the universe without any specific address?”
“Yeah,” she says, “something like that.” Then she gets busy and finds the correct fax number for the doctor at the SCHC. The doctor, the nurse, the POA, me and Byram all agree that Byram will sent it right away to SCHC and the nurse will be watching for it and the doctor will send the prescription right away and then I will get the supplies within five business days. It only took five people, one personal visit and about three hours but, by God, we’ve got it licked.
Except that UPS doesn’t deliver any supplies.
The great day that we all focused our attention on solving this problem was June 10. On or about June 23, I call Byram again. They tell me that they faxed the request for a prescription to SCHC and Dr. Howard on June 10 and again on June 18. And Dr. Howard still hasn’t sent a script.
I’m not sure what happened next. Maybe I called the nurse. Maybe the POA did. Maybe I called SCHC administration. My chronic hyperglycemia, acute urinary tract infection and worsening chronic kidney disease—not to mention the summer’s high humidity—are all sucking the life out of me and my memory is getting squishy.
And then, on Wednesday, June 25, I get a call from the nurse. She says the doctor has just signed the prescription, and he will no longer be my doctor.
When a physician kicks a patient out of his practice, he has to do it with a certified letter that states he only will provide emergency care for one month. When physicians write this letter, they do not have to give a reason and 90% of them don’t. This is not about two mature adults having a reasonable conversation about their working relationship. This is one autocratic doctor yelling, “Off with her head!” And it is particularly problematic because I have an appointment on June 27, two days hence, to get the physical exam that is required by the county in order to maintain my eligibility for home health aides, of which I am in desperate need.
So I talk to the Good Doctor, who looks slightly incredulous that SCHC, which is the bottom of the barrel, has kicked me out, but he volunteers to do the physical. He is a psychiatrist but says he thinks he can still do this.
Then I talk to my friendly local chiropractor who apparently never has kicked a patient out of his practice. In fact, he continues to treat a thoroughly disagreeable fellow who also was kicked out of SCHC.
I talk to my-friend-the-physician (MFTP) and ask him why they send this certified letter. He doesn’t really know why. He’s done it, but says it’s only because that’s the way it’s done. Custom and habit. MFTP suggests that maybe the NYS Dept. of Health (DOH), which licenses physicians, requires it. Or maybe the DOH Office of Professional Conduct does. Or maybe it’s the American Medical Association.
I say, bitterly, “Or maybe the letter is just sent to cover your ass so you don’t get sued.” No, he says, it’s not that. He will ask some questions, try to figure out why, and get back to me.
What I have learned in my years as an activist is that when somebody screws with you then you go over that person’s head to get un-screwed—and nobody knows who has effective authority over physicians. They, like God, cannot be held accountable for their actions.
Then my psychologist comes to see me. She is also a doctor, although not a physician, and she declares that she, too, has written the certified letter kicking people out of her practice. She says she’s only done it to patients who have stopped keeping their appointments, and it’s done to prevent the provider from getting charged with abandonment—abandoning a patient being considered a very seriously bad thing in the medical and psychological professions.
So I’ve been abandoned by “my” doctor and nobody knows why or what to do about it. I haven’t seen or spoken to Dr. Howard in nearly three months, so what is his problem?