"If You Cannot Go Home Again, There's Really Nowhere Else To Go"

As the Asheboro alcohol brouhaha rages, and my story/blog is enjoying a higher profile than it's ever had, I'm getting more e-mails . . . from old patients/parents . . . from other doctors similarly burned in public service . . . from nurses who've waged some of the battles at my side that just wanted to say, "Hi!/Glad you're still "raising Hell!".

The patients express a kind of knowing incredulity . . . along the vein of, "what else can you expect from Randolph Hospital and/or the mill-town kings of Asheboro?".

The doctors express empathy/sympathy - and curiosity as to how/why I've continued to fight for as long as I have. All of them have hit substantial road-blocks in the reporting, legal and/or regulatory processes. They want to know if I'm working . . . what kind of support systems I have . . . and (the best one), how to get started blogging. Because rest assured folks, there are many more doctors just like me out there . . . their lives destroyed/irrevocably for not playing the game.

I recommend blogging to them very cautiously (albeit optimistically) - it is not a genre for the thin-skinned or faint of heart. Some of these doctors have already been through the kind of hell that would make you want to put a gun into your mouth. They really don't need to hear that they're "attention-seeking/lonely hags" or "nut-jobs" from the clueless scum that swim at the bottom of blogging's barrel.

The nurses are, well, nurses. They've seen it all, and they know a lot more than they're ever given credit for - by the boy-doctors or the suits. They love it when a doctor (especially a lady doctor) has "the balls" to fight the good fight. And I love them right back for taking my back.

I got this one from a parent last week (as a comment - it was not posted secondary to privacy concerns -it's been modified slightly to post):

Gosh! I have been waiting for 10 years to find out about my long lost pediatrician. Back in 1995, Dr. J, you were my children's doc and when it seemed you disappeared it hurt me.

You detected hernia in my son and referred me to a specialist. He did have surgery, and now Tuesday he will be 15 - he is doing great.

We were told you started your own practice and they couldn't tell me where. That made me feel hurt and upset that you would leave your patients without notice.

It has bothered me for this long - and now I am doing an on-line class on Interpersonal Communication. An assignment we have this week is about conflict in the workplace. (I've been looking for) a case study to go by in our field of interest. Mine is the psychology/medical field. And wow, I found this case study, and my heart is overwhelmed but not surprised about the whole ordeal.

Dr. J, I am so sorry for the trouble you have encountered by careless people. But I am glad that you have been the person you are, and I KNOW God will soon work for you. I am glad also that I know where you are, and still carry the status of MD. I looked you up on the Net. I want to keep in touch and see how things are. With God on our side and citizens like me, we can do something.

I think the comment speaks for itself. As long as they could hold onto "the business", Randolph Hospital executives (or their deliberately clueless Board Members) did not care what their actions did to anyone else. And please note, lying wasn't something they fell into. They were lying to patients (to my detriment) from day one.

Yesterday, I was contacted by another physician who had an unpleasant experience with the National Health Service Corps - aka NHSC (hers was 20 years ago). She was referred to me by an old friend with ties to the Semmelweis Society (one of several grass-roots organizations that is trying to shine light on the horrific abuses of medical peer reveiw in this country). I am no longer a member of Semmelweis (leadership changes a few years ago caused the organization to take some very ugly/self-interested turns that I wanted no part of), but I do keep in touch with several of the old guard (mostly doctors in the military and public service).

Until fairly recently, one of the best-kept secrets in medicine was the total hose-job young physicians can get in some of these state & federal loan repayment programs. Indeed, if you want to talk about "our liberal media", a few years back, 60 Minutes did a puff piece on the NHSC - clearly designed to sucker more naive newbies into the program. Leslie Stahl ooo'd and ahh'd over a few of the program's success stories, but did nothing to expose its deep, dark flaws . . . mainly due to non-existent oversight.

The doctors that consider/enter these kinds of programs are generally young, idealistic types - often "first generation" doctors (i.e. not descended from doctors) un-nerved by the massive debt they incurred in medical school . . . or foreign-born physicians trying to secure permanent status (since just hopping over the fence and dropping a baby doesn't work for doctors). It is basically an arrangement of glorified indentured servitude - i.e. time in a medically "under-served"or rural area for money - the doctor is a warm body and not much more. And take it from me, the NHSC demonstrates our federal bureaucracy at it's warped/decrepit worst - there are no checks, no balances and no protections for the doctors who sign away chunks of their lives to get out from under debt. And the last thing this program gives a rat's tail about is patients! The penalties and fiscal consequences (more debt) for a doctor who breeches or "defaults" on an NHSC agreement are often severe (designed to prevent default), but the reverse is not true for an assignment or practice.

Fortunately, the word on the NHSC is getting out - and the newer generation of medical residents is just a tad more business-savvy than mine was. In fact, I had a conversation with a recent grad just last week who told me that "everybody knew" an NHSC assignment could be a black hole from which one might not emerge - and that doctors who found themselves in trouble in some of these boon-dock situations would get no help from the government. Many new doctors are steering clear. I was delighted to hear it.

I've digressed. As I said, yesterday, I was contacted by another NHSC alumna. Her woes began 20 years ago, she joked, before the modern conveniences of word processors and blogs . . . she typed out her first, "Dr. XYZ vs. NHSC" on an old IBM type-writer.

Her problems began, when working under a protracted NHSC service obligation (a whole nuther story), and ironically in a "private practice"/"for-profit" ER, she resisted writing narcotic prescriptions for frequent flyers & known addicts in the ED - to keep them "happy" (you know that "the customer is always right"/"team-player" stuff so common in the corporate medical setting). The doctor who "supervised" her was, simply put, a crook who wanted her to move to a clinic situation in which he had ownership - and finish her obligation there (working for him) without telling the NHSC. Our then-young, idealistic, law-abiding heroine refused to defraud the government, and shortly thereafter was fired. The NHSC could've cared less about her ethics or her loyalty. All they cared about was that she had "defaulted" on a service agreement. So the bullying began - to place her in another location - or saddle her with more debt.

It's a long/complicated/hard-to-follow story (as all of these stories are) . . . ten single-spaced pages on Adobe. At one point, the NHSC wanted her delivering babies when she had no residency training to do so!?! She wound up making her own way - eventually serving four years in various HMSA's (Health Manpower Shortage Areas) to fulfill an obligation of two - and the government continued to harass her.

Of course, her story certainly does not fit the sound bit mind-set or attention-span of most journalists/bloggers - or an increasingly entitled public that thinks all doctors are rich & greedy. Exposing the fiasco certainly does not jive with the government's/medical societies' grand plans to snooker more young/naive/financially desperate doctors into these indentured servitude programs . . . and it blows all that hospital spin about "care you can trust" out of the water.

Her story involves lawsuits and government ineptitude (a Congressman had to intervene for her too) and the total de-railing good/honest physician's career . . . just another physician who was trying to do the right thing, and for her trouble was treated like a criminal.

In short, she was me. And she eventually gave up at getting any kind of re-dress/restitution after the NHSC put her through hell.

I referred this doctor to my blog (specifically, the "We Are Above The Law" post), and told her that a more description of my ordeal was on my sidebar under my profile (which was designed for the Ed Cone & JR types). I told her I was considering legal action against the state & federal programs/oversight agencies that had hosed me.

An hour or so after responding to the first e-mail, I got a reply. She had looked at the site and was impressed (unlike GSO blogger-that-be Roch Smith, Jr., who looked at it for two hours, fancied himself an expert, and dismissed me as a disgruntled employee). She spoke of starting her own blog. Then she had this to say:

One thing I can say to you is that when injustices happen they tend to destroy the people that were targeted not only because of the direct damage done by the actions of the perpetrators, but by the reactions made by the victim. These horrible things "tie up" good peoples' time and money when their "life force" could have been used to make a difference elsewhere. I made up my mind a long time ago not to fall into this trap. I used my efforts to mount a defense from the evil that had been hurled at me and tried to stay out of the revenge game. I never got a dime for all of my "mental anguish" and I know I'm probably on a "black list" somewhere. There are days I wonder just how much money and time has been spent in investigating me for the lies (the NHSC) lodged against me. It must be a dollar amount in the 100's of thousands by now. I find it best to leave a situation and have nothing to do with the abusive people and criminals out there. I refuse to be fodder for them.

Unfortunately it's gotten harder and harder to "stay away" from such situations. Such a waste! Kids go without adequate medical care in this country and all that money is being used for what? Revenge against me because I told the truth? STUPID! Use your life for something better than going after the stupid bastards that wronged you. Your best revenge is to warn others against them--so it is good that you have a website.

The only way the legal system will pay any attention is if SEVERAL people have the same compliant against your adversary. "Class action" lawsuits are paid attention to.

Her well-meaning advice echoed sentiment I've gotten from others in the blogopshere (ala, "get over it" and "Move on"), and I felt the need to respond:

Yeah, I wish blogs had been around when my troubles first got started.

We're all put on the planet for a reason. When I find something else more worthwhile, I will do it. In the meantime, these greedy, lying bastards will squirm. I can tell you that in my case, virtually no money has been spent on an investigation - because I have been blown off as a disgruntled "whack-job".

You remember the story of the Exodus? "And Pharaoh's heart was hardened." I get the Pharaoh, I really do.

And my heart, once open and free, is harder than stone.

They don't get a free pass for that.

Thanks for reading. I put something up nearly every day.

She wrote back:

Are you still practicing Pediatrics? Doing what you love?

I responded. There were tears in my eyes as I typed.

Yes, I am practicing Pediatrics. I am quite good at it. But I do not love it anymore. The light has gone out - in fact, it was snuffed out when I lost everything for doing what I loved the right way. It's just a job now. And you have no idea how horrible it is for me to say that.

I lost myself - I lost what what was important to me - what made me me - in the practice of medicine.

And I am seriously considering leaving the profession.

This is not a conversation I want to engage in right now.

She responded:

I understand. I have the exact same feelings about emergency medicine at times. All of my friends who I went to medical school with left the field of medicine long before I did! Sometimes I feel stupid for hanging in there. I only asked the questions to see if you still have a stable life, a support system. I gave up a lot to fight my enemies. If you are truly committed to getting after the people who wronged you, it is only prudent to know what you have and what you stand to lose.

The people I was protecting myself from thought nothing of ruining my life at every opportunity, on many levels. I was naive. I had no idea how evil people in the medical business could be.

And I responded thusly:

I have the best family and friends in the world - we are the YaYas - a group of high-school/church chums that have been together through thick and thin. I am their Queen. Everyone perceives me to be so strong. Sometimes it's hard to keep up the facade of a happy face. But I'm good at it.

At this point, the people who wronged me have much more to lose. They made sure I had next to nothing and that fuels the fire. An oversight on their part.

Evil is the right word. In my younger days, I never would have imagined.

If you cannot go home again, there's really nowhere else to go.

So there you have it: (1) A communique from a former patient who had the wrong perception of me because of the self-serving lies she was told by others (and the basis for one of my claims for damages against RMA). And (2) a conversation between two doctors burned ten years apart by the same broken, warped, corrupt system. We did everything we were supposed to do for these people. We were supposed to have bright futures.

There's actually a part (3) to this story. While I was composing this post this morning, I took a call from a physician recruiter.

The background to this phone call starts ten years ago - as I, and later my former partner, scrambled to find jobs/our footing in the wake of what RMA did to me. We were both told (independently, by multiple/different recruiters) that we would find it "impossible" to find jobs within driving distance of Asheboro. We had been black-balled. I did some sniffing around and traced it back to Randolph Hospital's then-recruiter. But Randolph Hospital executives denied having anything to do with it.

Of course, as we have seen, lying is old-hat to them.

Laurie and her husband wanted to stay in North Carolina, but they had a young family to support and saw the writing on the wall - they now live in Arkansas (Laurie's home state) and are very happy. They left a baby son in the graveyard here (he died from a congenital heart defect at two days of age). I know that tore them up.

But my family and my roots are here. I don't want to move. I continue to maintain my home here (even if I don't sleep there much) - one of the YaYas lives there full-time (upstairs in her own "princess suite") and house-sits while I am gone. And I've continued to work as a Locums - because it pays the mortgage and allows me to come home on a regular basis. The closest I've gotten to Asheboro in ten years were two extended stints in Albermarle/Troy (via Stanly Regional), and an absolutely miserable one-month assignment in Greensboro - in a clinic one block from Moses Cone with cockroaches on the walls. I actually thought about chatting up the Medical Board about that one - but what is the point?

Last month, one of the Locums companies contacted me and wanted to float my CV (doctor talk for "resume") locally. So I did it. I did not have a lot of hope.

It's not just about the black-ball.

It's about the profile I now have because I fought back.

Now my CV is impressive/extensive - a work of art actually. I'm good at what I do, I'm adaptable and I'm very conscientious (even if there's not a lot of real joy in it anymore). I honor obligations even when it hurts. I've been everywhere and done everything and my CV reflects that. I've been up front with all of my assignments about the situation in Asheboro - and in fact, list the interviews I've done with various journals on bad-faith peer review/my experience as a Locums on my CV. I don't blog about current assisgnments (except in very vague/bland terms). I've been offered a permanent position at nearly all of the assignments where I've worked (but those assignments are not home). So generally when my CV is plopped on someone's desk outside of the immediate area, it gets a quick bite.

But not this time. Cornerstone refused to even interview me. A practice in Winston never called back. The only bite I got was in Burlington - and it was not a good fit. I passed.

The recruiter called this morning just to check and see if I had gotten any calls/follow-up. I told her no, but comforted her not to trouble herself. I knew I was locally "radioactive" and had just wanted to see if anything had changed.

It hasn't.

All of this is a big reason that all of the flag-waving and self-righteous moral oneupmanship behind Schmidly & "the who's" big push for alcohol in Asheboro makes me sick.

You wanna talk about "morals" and "democracy" and "rights" and "free speech"? Talk to someone who has walked the walk.

And when you do, show some respect.

And if you call me a "whack-job" after what I have overcome/survived, (as Ray Criscoe says) you'd better have something better to parrot than a bunch of gutless, mealy-mouthed, back-stabbing liars in order to back it up.

And OBTW, do not ask me to feel sorry for Steve Schmidly - the lawyer who put Mock Trials above the real thing . . . OR or the lying/cheating/greedy/overpaid/sexist/scumbags who run Randolph Hospital.

It's my opinion. I've more than earned it.

Unlike Dr. Rogers, I have no qualms about "going negative" on people who have behaved so negatively (while the "pro" crowd is roaring in faux outrage over city ordinance violations, they're planting their own handiwork in rights-of-way and still stealing yard signs). Sometimes you have to roll up your sleeves on a battlefield:

I keep going back to the way this nation (greatly blessed) was founded. It wasn't because our Founding Fathers turned the other cheek. Tea in the harbor and all that. Lincoln's generals trounced the enemies of the union at Gettysburg . . . and drove a stake through the heart of the Confederacy during Sherman's march. They weren't "nice" about it. Hitler's ovens were not shut down by Churchill sitting down and shutting up . . . or the Allies staying "positive". I think God expects good men and women (as individuals and collectively) speak and to act when faced with great injustice.

So I'm standing and speaking, and if it's ugly/blunt so be it. We don't live in a pretty world.

This is a hospital administration that would now have us all believe that economic development trumps the huge human toll that increased access to alcohol will take on our community - in the form of increased DWI's (do you really think that if someone is stupid enough to drive drunk after buying their booze in Randleman, they won't drink and drive if they buy it in Asheboro?), the decline of neighborhoods, more vagrancy, more assaults, more crime, more domestic & child abuse and more disease.

That's not about fear. It's common sense - the plain and simple truth. It's a truth I have seen - over and over again - all over this state and four others - with my own physician's eyes. How any self-respecting physician who has lived/practiced in Asheboro for any length of time . . . any doctor who respects the values and traditions this town has long held dear . . . can support this measure is beyond me.

Of course, the people behind this referendum do not have a lot of use for the truth . . . except that in this case, it will amount to increased local heathcare expenditures (expenditures that will be glossed over in the fine print of whatever scheme the high-dollar consultants come up with next). That means bigger bonuses for the stand-up guys who fired a home-grown Pediatrician after she saved a baby's life . . . the very-important-people who lied to countless Mothers & children about what had happened to their Pediatrician . . . the Teflon-coated community leaders who defrauded state and federal governments programs of the hundreds of thousands of dollars spent to bring doctors here and keep them here . . . the prominent, law-abiding citizens who put their hands on a Bible and lied repeatedly on their Oath in order to save some money.

Because it's all and only about money.

But hey, enjoy that glass of wine with diner.

We're getting to the point that I really am wondering why I fought so hard to come home.