anything, it always sours my day. This one definitely did.”
“I know from several of my own colleagues who also have got them, though I haven’t got any myself,” said Barbara; “but I hear that each time the state’s OPC contacts a doctor, it is almost always for matters of a new complaint against him and that they nearly always send it ‘certified, with-a-green-band-on-the-top’ and requiring a recipient’s signature, to scare and cow the doctor.”
“Yes. This one had all that,” admitted her friend Nora. ”So, with panic bells going on in my head, I immediately complied and sent them the same day my consultation on the case though I didn’t bother to certify the envelop containing my 2-page report”
“I hear,” Barbara said, “that even if a case does not result in any ill effects to you that the case is not wiped out from your dossier, but that they keep it ‘active,’ so all your cases even when they turn out ‘fine,’ eventually add up to get you in trouble.”
“Yes, that seems the case. I was told that by another friend, also a neurologist, that he has been getting two to three times a year uncomfortable ‘green-banded envelopes’ from the Health Department. Apparently this neurologist also does, like me, for various insurance companies, IMEs that more frequently than not, in contested cases, result in opinions disliked by the claimants. And a neurosurgeon two doors up, just relocated to N. Carolina. Probably for the same. All harassment by the state. These patients with legal demands become very infuriated and want to retaliate against us by reporting us to OPC, the state wolves.”
“That is why,” said Barbara, “I don’t do IMEs though I’m often asked to. Most cases are related to claimed injuries and my group of colleagues, all trauma specialists, providing care, not just one-time opinions, would probably become very upset with me if I did them. These cases of course pin doctor against doctor. The orthopedist, rather than the patient, is often more vocal against the IME report from someone like a neurologist, in this case you.”
“And that is why,” went on Nora, “I want to stop doing IMEs though they add to my income. Plus IMEs on adult patients don’t really fit with my child neurology practice. They are totally a world apart. In court, opposing lawyers, and the care provider, of course try to discredit the value of my opinion precisely because my primary specialty is to treat kids! Yet Insurance companies need them and pay well for them… I already stopped for the same reason 10 years ago doing evaluations for the Department of Veterans’ Affairs on Vets with disputed claims and a couple of months ago I also stopped doing disability evaluations for Social Security. My opinion was often also negative for the claimant, unfortunately for him… and eventually for me now!”
“You mean,” said Barbara, Judge Good’s wife, ”most disability cases of vets you saw for the V.A. were phonies in your opinion?”
“At least the disputed cases. Not the obvious ones. And to my knowledge so is the opinion of other neurologists I know who, like me, do IMEs on vets with questionable claims. And what a racket ‘PTSD’!… But I better leave that issue alone…”
“That opinion of yours would not have set well with either the veterans, their advocates, or with those higher up in the Administration…!”
“The whole thing of veterans compensation and the continued need for VA hospitals, when there so many hospitals half empty and there is easy health for all, is very contentious for budget planners in D.C., very tough for politicians to tackle”…
Both paused. After a few more sips of their coffee refills and a couple of bites on their shared danish, Dr. Phillips went on:
“But now the case of this woman in that car accident, for giving my honest opinion and saying that she had no believable injuries or after-effects, is giving ME a headache and high blood pressure. She has such a weak claim that she probably won’t even sue the insurance company -or me- for damages and go in front of a judge. Instead, easier for her, she is retaliating against me, going after my neck, my license.”
“My husband,” said Barbara, “had to rule recently on a similar case of a trivial road accident where he talked both parties into settling, though he thought the claimant should not have got a penny! He hates these cases. He wishes he didn’t have to see any more…”
4
More Costly Medical Decisions Of Dr. Phillips
But Dr. Phillips was not just a regular neurologist. Yes, she saw some adult patients, some grownups in their 20s and 30s who had been with her since they were kids. She also did occasional IMEs though reluctantly. Her work with IME’s was more medical-detective style than true ‘medicine,’ healing or helping, and she liked to ‘investigate.’ But she considered herself primarily a child neurologist as her official credentials clearly stated. She had had the long training, degrees, certificates and boards to call herself both a neurologist and a child neurologist, but she much preferred the latter. If she could afford it, to see only children, discharging from her practice young adults as they turned 18 or 20, she would have done so long ago as did her colleagues in academia with her same qualifications at the University Hospital.
In private, solo practice, she was not busy enough to see just kids with neurological disorders, so she kept most patients in her practice as they grew older. She had child neurology colleagues in the West Coast who told her they also had a 30 to 40% of their patients above age 20, but like her they were too in solo practice, not in academia. So with reluctance, she still did some IME’s; and often, by necessity, she saw older relatives of her patients-kids when they ask her to take them too as a patient -please, please, please!- and she occasionally took adults with epilepsy or migraines -or MS, Parkinson’s, Wilson’s and Huntington’s- who might have been dissatisfied with some of the other ‘adult neurologists’ present in the area. She stayed away from Stroke and Alzheimer’s.
The good child neurologist Dr. Phillips, as in her daring frankness for IMEs, was also frank in her report on kids, always sending her written note not only to the referring physician but also to the parents. In those she prepared on difficult kids she was perhaps too honest and realistic–especially on sociopaths, autistics, ADHD, slow and underachievers in school: She’d give blunt and pessimistic prognoses without covering everything with honey and outright lies meant only to please parents and educators. But such honesty also got her in trouble with some parents AND educators.
Just before that long conversation with her colleague Barbara, when they talked about the IME on that woman in the trivial accident, Dr. Phillips had seen in her office a 3 year old autistic boy, super hyper and non verbal who was attending a special ‘E.I.’ (Early Intervention) in an elementary school. His mother had told Dr. Phillips of her frustrations in caring for him and of her doubts in the worthiness of what the school was doing for him. She was seeing no signs of improvement in her child’s behavior or any progress in his eye contact or towards language and communication after having attended the program daily for a good year. She thought the program was just ‘baby sitting’ and frequent confinement with a bear hug by his one-to-one aide or in a small safe space, a cubicle, all by himself without interacting with other toddlers.
Autism had been diagnosed in that child by someone else a year earlier, at age 2, though Dr. Phillips would tell her friend Barbara and other colleagues that she normally picked it up much earlier, generally, often with limited eye contact and no laughter, before 12 months. “His pediatrician had just told the mother to have patience. He had not done much for him either; there is not that much that the best hands can do for autistics either but referred him for ‘E.I.,’ Early Intervention. The public sees often on TV the now famous line ’autism speaks,’ that I see as not just misleading, but often as a sad joke in the moderate-to-severe cases” Nora said.
“Most of these,” she went on, “end up in a group home of some sort. In this case, his mom brought the boy to the doctors’ on a leash. After many visits in which she expressed her frustration -while one of the nurses in the office constantly confined the toddler- the pediatrician finally, when the boy had turned two, had told mom that he thought her boy was autistic. At least mom had now a diagnosis. The doctor just referred