If you've
been blackballed by the medical community, what
can you do? It is evil what is happening to
patients. Hospitals arrogantly think they can do
as they please, forcing people to receive rectal
exams, taking blood samples for government
databases without the patient's knowledge,
denying medical treatment unless you sign a
financial commitment, et cetera.
When Doctors Shun
Difficult Patients
By ROBERT
REINHOLD, Special to the New York Times
Published: November 14, 1988
OJAI,
Calif., Nov. 10— Even Jeanie
Joshua agrees she is a troublesome
patient. But, she asks, is that good
enough reason for all the kidney doctors
and dialysis centers in two counties to
deny her the blood-cleansing treatments
without which she will quickly die?
By her own
account, the 38-year-old Ms. Joshua
challenges doctors about her treatment
and does not always follow orders. She
is suing one of her former doctors for
malpractice, and another doctor told her
he could no longer abide ''your
insistence in directing your medical
treatment to such an extreme degree.''
Now, none
of the kidney specialists and none of
the six kidney centers in Santa Barbara
and Ventura Counties will accept Ms.
Joshua for dialysis.
Three times
a week her husband must drive her to Los
Angeles, a round trip of nearly 150
miles to and from this remote town.
Her
situation tests the limits of a doctor's
legal right to refuse unwanted or
obstreperous patients when medical
resources are scarce. And Ms. Joshua's
assertion that she is the victim of a
doctors' ''conspiracy'' to blackball her
for suing a colleague also raises the
ethical issue of whether professional
people are justified in shunning
litigious clients.
Nothing in
law obliges a physician to take a
patient, said Alexander Morgan Capron,
professor of law, medicine and public
policy at the University of Southern
California. But he said Ms. Joshua's
assertion about blackballing a litigious
patient, if true, raised the possibility
of a ''severe chilling'' of the right to
sue for malpractice.
''A doctor
does not have to take a patient just as
a patient does not have to take a
doctor,'' agreed Ms. Joshua's lawyer,
Marie Rodarte Tobyansen of Carpinteria.
''But you cannot just let somebody die.
A lot of doctors do not want to treat
patients with AIDS. Does that mean they
are not entitled to treatment?'' Doctor
Had to Stay in Town
On Oct. 7,
Ms. Joshua's latest nephrologist, or
kidney specialist, Dr. David W. Doner
Jr. of Santa Barbara, wrote her that he
would drop her by Nov. 4. He said her
insistence on directing her course of
treatment had ''strained'' their
relationship and added that serving as
her doctor has harmed ''both my
professional education and family
life.'' He could not go out of town, he
told her, because no other doctor would
serve as his backup for her.
Dr. Doner
offered a number of alternatives,
including home dialysis, all of which
the frail, 92-pound woman says are
unacceptable or medically impossible.
Stroking
her black Persian kitten, Yoda, Ms.
Joshua discussed her case in the redwood
house she and her husband, Sholom, built
on a hill with a sweeping view of the
Ojai Valley. Mr. Joshua is a child-abuse
investigator for Ventura County. They
recounted the events this way:
Ms. Joshua,
a former teacher, lost kidney function
five and a half years ago as a result of
lupus, a chronic skin disease that often
impairs the kidneys. She tried dialysis
at home, under the supervision of Dr.
Michael Fisher of Santa Barbara. The
filters on the machine malfunctioned,
allowing nitrates into her body. Red
blood cells were destroyed, transfusions
were needed and her health worsened.
In 1986,
she sued Dr. Fisher, her home nurse, the
maker of the machinery, various
laboratories and others. The suit is
pending. Then she switched to another
kind of home dialysis. But an infection
forced the removal of the catheter and
Ms. Joshua was forced again to seek
conventional dialysis away from her
home. This precipitated the latest
crisis.
Dr. Doner,
she says, made up various excuses for
not having her treated at the Santa
Barbara Artificial Kidney Dialysis
Center, 35 miles away. The nearest
available centers for regular dialysis
are in Los Angeles. 'My Total
Preoccupation'
''The
tragedy is that I am forced to make this
my total preoccupation,'' she said.
''When you are left without life support
in the area where you live, it takes
over your whole life. So granted I'm a
big pain in the butt. What's that got to
do with denying me life support?'' She
charged that the doctors who would back
up Dr. Doner were partners of Dr.
Fisher, whom she is suing, and therefore
will not treat her.
An attorney
for Dr. Fisher, Marvin A. Bauer, denied
the charge. ''Everybody in a humane way
feels sorry for her plight,'' he said,
''but she has brought much of this on
herself. She is noncompliant, she has
her own ideas about her medical care. It
is her approach to doctors that makes
them say, 'Wait a minute.' ''
The lawyer
for Dr. Doner, Ms. Joshua's latest
physician, said his client originally
accepted Ms. Joshua knowing about the
litigation but had ultimately grown
exasperated. ''The issue is solely that
she is difficult,'' said the lawyer,
Harold M. Haider, adding that she had
refused certain tests and had improperly
taken a medication bought in Mexico that
was not approved by the Food and Drug
Administration. Ms. Joshua concedes that
taking the drug was ''a mistake.''
Precedent on Doctors' Side
Ultimately,
Mr. Haider said, any doctor has a right
to withdraw after giving sufficient
notice and providing suggestions for
alternative treatment. Otherwise, he
continued, the doctor would be subjected
to ''involuntary servitude.''
Legal
precedent seems to support his view. In
1979 a doctor in Oakland refused further
dialysis to a 35-year-old heroin addict
because of disruptive and uncooperative
behavior.
The addict
sued the doctor and his hospital but
lost at trial. On appeal, the judge in
the Court of Appeal, Joseph Grodin, now
on the California Supreme Court, upheld
the doctor but was troubled.
''Occasionally,'' he wrote, ''a case
will challenge the ability of the law
and society to cope effectively and
sensitively with fundamental problems of
existence. This is such a case.''
END
The
following article is just one of
tens-of-thousands of abuse cases in the U.S.
where doctors blackball patients for filing
complaints, filing a lawsuit against a doctor or
just being annoying or uncooperative. Once they
give you the boot, you are doomed to suffer.