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Re: Ethics/Improper Treatment - Patient Oppression

PC Service Line Chief
Shirley Madden
Beckley VA Medical Center
Beckley, WV

RE: 2/25/11 - Improper Accusation/Medical Advice

Ms. Madden:
I have been very stressed after our meeting on 2/25/11 for many reasons and can not take a passive role under these extreme circumstances. I am ashamed of me getting so upset but in no way deserved to be humiliated in the manner you chose to treat me and then proceeded by your influence to change my plan of treatment.
I did not request that you be contacted and my concerns were primarily based on the lack of proper communication between medical providers concerning my treatment and medications. When I was sent to your office, I fully believed that we would at a minimum have a brief discussion so that I could identify my concerns. Instead I was just told to follow you and sit outside Dr. Patel’s office like a 2 year old child being taken to the principles office.
Once in Dr. Patel’s office, your insinuation that I was an ADDICT was both false and extremely humiliating i.e ...”we are willing to treat your ADDICTION Mr. DXXXXX...”. Then you went on to influence the type and amount of medication provided which is especially alarming to me. Also, for you to suggest Suboxone at this point is totally unwarranted since this medication is highly addictive and extremely difficult and painful to quit. I was not aware that you were a medical practitioner with complete understanding of my medical issues in which you made such decisions.
Since you are apparently the primary influence for my medical care, you should also be aware of the following issues:
1. Medications are usually based on science and an average body weight of 70 kg (154 pounds). I am currently 6'2" - 280 lbs.
2. My surgical records will show that I had a very high tolerance to opiates even prior to being on the medications for a long period of time (it took approx.. 4 hours to reduce pain below a level of 8-9 after my last surgery which required morphine IV and percocet orally simultaneously).
3. I had identified the tolerance increase to medical providers for quiet some time which went ignored. I previously did not pursue the issue vigorously because of the “stigma” that the necessity to take pain medication carries.
4. I am not a “pill hunter” nor have I abused my pain medications. If anything, I have ignored the issue far too long at considerable expense to myself.

5. It took considerable efforts for my issues to be recognized and I was extremely grateful and hopeful (to tears) when I learned of the “group” discussion of my treatment program (although it is now apparent that the plan is falling apart at the seams).
6. During this “group” meeting, it was decided to try an extended release morphine along with one immediate release morphine tablet. Although it was quickly apparent that the medication did not relief the pain effectively, it did prevent the physical discomfort of withdrawal symptoms and I committed myself to completing to 15 trial period so that I could truly evaluate the effect.
7. During my follow up appointment (15 days), I was in extreme discomfort and advised Dr. Patel and/or his assistants of the following problems:
A. The morphine did little to assist in pain relief during periods of significant pain and the immediate release tablet seemed not to be effective.
B. I also experienced very high anxiety with constant pain/pressure in my chest with occasional nausea.( It also caused my depression to deepen greatly in which I have not had the opportunity to discuss.)
8. Dr. Patel initially recommended 15mg of oxycodone - 3 times daily. Upon me questioning the effective time of relief (to offset withdrawal symptoms), Dr. Patel recommended and prescribed 5mg oxycodone - as needed - 8 daily. I was in agreement with this since it would allow 10-15mg during periods of significant pain and 5mg during periods of lower level pain.
9 I was very hopeful and looking forward to adequate relief so that I could place my energy into other important issues of my life and finally put this issue to rest for awhile.
10. To my extreme disappointment, the pharmacy advised me that the prescription could not be filled until a prescription for hydrocodone had expired. Since this medication had been opened and was prescribed from a different clinic, I fully believed that disposal of the discontinued medication was the prudent thing to do for many reasons. I absolutely would not of allowed myself to experience these 15+ days of discomfort if I had realized the retribution the VA would inflect because of this action.
11. On 2/25/11, I had appointment at the VA in which I was instructed to see you about my concerns (not at my request). My concerns were based on the lack of communication which at no time were addressed by you.
12. On 2/25/11 Dr. Patel suggested prescribing a supplement of hydrocodone to last until the oxycodone medications be processed in which we were both in agreement to.
13. Through further influence from you, my prescription was yet changed again to morphine with no further discussion with me.
14. Since I had already identified some of the problems I have with morphine, I am totally confused on your insistence that this be the prescribed medication. Besides morphine being much more physically addictive, it is a very poor oral pain medication since the majority of the pain relieving qualities are destroyed in the liver. As I identified earlier, it does little more than prevent severe withdrawal symptoms while quickly increasing tolerance for opiates.

Your behavior and attitude was extremely insulting and humiliating in which I did not deserve nor does any patient deserve similar treatment. My medical records will illustrate that I have shown no indication that I am an “abuser” or “pill hunter” and I will not further tolerate being treated with such regard. This is especially insulting to be subjected to this humiliation while patients who are actually abusing the system are given the highest respect and assistance to continue their unethical and illegal behaviors.
Although I sympathize with the problems of abuse and the extreme work load of VA medical providers, I can not be made to suffer any longer because of this. After being subjected to many painful/destructive surgeries in Richmond which led to my current pain, I surely would not be pursuing additional surgery unless I was hopeful of someday eliminating the need for such medications. If your concerns are that I may actually feel comfortable enough to function and be somewhat productive, I rarely do and have little expectations for change considering the approach you have taken and “label” you have elected to put on me.
I became passive and complacent previously when I was having the surgeries performed in Richmond which only allowed for more destruction of both my mental and physical health. I am painfully aware that my medical treatment has been used as a means of recourse towards me for expressing my concerns but I will no longer allow this to suppress me. I am not the only patient that this type of behavior effects and have also been advised by VA medical providers concerning their own frustrations to administration dictating medical treatment to be rendered.
I have to also express my disappointment that you elected to immediately place Dr. Patel and myself in a confrontational situation without taking even 5 minutes to discuss my concerns. This now puts me in the undesirable position of my medical treatment being altered because of personal conflict whether from Dr. Patel or the “overflow” from my addressing these concerns.
The VA administration has carefully “stacked the deck” to suppress valid complaints, protect themselves from civil remedies while acting as “puppet masters” for medical providers all at the expense of the patients. Although this may be true, I am sure that there must be a “chain of command” present in order to expose these concerns. At the top of this “chain” must be the American people in which I am 100% positive would not endorse Veterans being unjustly humiliated and healthcare actually being determined by administrative personnel.
As stated previously, I fully expect retaliation for my expression of concerns (a freedom worth dying for) but I will not remain passive under these insulting circumstances. I (as many others) have far often been improperly treated largely because VA personnel and medical providers act as though they are beyond reproach and totally protected from repercussions for their actions. Medical treatment should not be a “conflict” between patients and medical providers with the patient left with no means of resolution.

Very Sincerely,

cc: VA Administration
U.S. District Attorney

It is with great frustration and pain that I am contacting your office to encourage appropriate action(s). I have come to believe that the VA policy is to “ignore and discourage” (oppress) rather than provide proper medical treatment based upon science and a patients symptoms.
I have had to take opiate pain medications for over 5 year now due to previous improper treatment at the VA facility in Richmond and their extreme neglect. Although the pain medication has not been effective for quite some time, I did not vigorously pursue proper treatment due to the stigma and shame of requiring pain medications. Due to an significant increase in pain to both my hand/wrist and back, I was forced to pursue adequate relief in lieu of continuing thoughts of suicide.
The nightmare that I have been subjected to during the past 7 months and the mental abuse I have endured without justification is inconceivable:
a) constantly having to contact medical providers concerning chronic pain with no resolution
b) having my prescriptions altered “behind closed doors” by non-prescribing providers and non-medical administration staff (upon contacting the WV Board Of Medicine, I have been advised that these actions are grounds for disciplinary actions and may possibly be criminal)
c) being falsely called an addict by a non-medical administration personnel and being further humiliated in front of my medical providers
d) having my treatment based upon personal mis-assumptions rather than the actual pain and medical history (these numerous mis-assumptions have “assumed” me to a state of constant pain and mental anguish beyond descriptive words)
These lack of ethics and proper treatment coupled with the fact that I am an individual with limited resources attempting to gain resolve from an “administrative machine” has rendered me hopeless. I have went to the extreme of completing a Form 95 in my Mother’s name in case of my demise along with discussing the issue(s) with her. My Mother has witnessed my deterioration and loses due to my treatment in Richmond and current lack of treatment. This stress is difficult for her and damaging to her health. I often have to weigh this fact against what has become very limited options for relief.
From the time that I began pursuing adequate pain relief, I have been confronted with statements such as...”you are welcome to go to another pain clinic”...”when did you quit work”...”we are willing to treat your ADDICTION Mr. Durham”... (all of which were spoken with a large degree of sargassum while minimizing my pain and discomfort).
This unwarranted and absolutely FALSE statement referring that I am an addict is totally unacceptable and could possibly carry a life long “label” in which I do not deserve and will not accept ! This humiliating statement was demeaning to my character and libel.
This long on-going experience has caused me more mental stress and anxiety than anyone should have to endure. Although I felt completely isolated and alone in my efforts, my recent research has shown that I am not alone and that I have been improperly treated and diagnosed due to pseudoaddiction apparently being treated as addiction (very unfairly due to my medical records and me being forthcoming even under such stigma that pain meds have).
My medical providers (especially those in pain management) should be familiar with pseudoaddiction and the significant damage it can cause patients. I have attached some information on pseudoaddiction along with the State of WV’s view on adequate pain relief. It is also alarming that the Pain Clinic Providers have little or no true understanding of addiction and how their minimization and neglect of proper treatment can turn dependance into addiction. If there were any indication that I was an addict, science and research indicates that it would of been evident long ago (prior to now since I was on the same dose and type of meds for over 5 years).
I have currently lost over 8 years of my life due to improper treatment, mis-assumptions and the inability to get the proper authorities to respond. During my visit on 2/25/11, I was hurried out the door with a statement...”what do you want Mr. DXXXXX, I have other patients”... This is especially insulting since I have spent the last 8 years watching everything that I have worked for diminish and my quality of life become non-existent directly due to my treatment in Richmond. I have earned more than 5 minutes of time and a half-hearted attempt to resolve my very real and significant concerns.
I will not further explain that tolerance and dependance is not ADDICTION although medical providers should be aware of these facts. My medical history and current pain should be illustration to scientific facts that physical dependance and tolerance develops over time and failure to treat these problems will often cause pseudoaddiction. Even with all of the scientific evidence and medical facts, medical providers continue to treat me based upon personal “assumption” while taking every opportunity to also insult my integrity.
I have stated many times both verbally and in writing that I can not endure much more of this continued abuse. After being treated so unprofessionally in Richmond, I convinced myself that it was due to a few individuals and was not the intent of the Veteran’s Administrations. Since I felt that the actions were of these individuals, I believed that the individuals should be held accountable (in which the VA protects this type of behavior) and not the American People. I have now come to suspect that the Administration does not only condone improper treatment but may actually direct it at the costs of patients mental and physical health.
I have more than earned my right to have my concerns addressed and investigated thoroughly. My problems are just a “symptom” of the actual problem in which the actual problem must be corrected so that others are not unduly placed in the same position.
I have exhausted myself in my efforts to gain attention to my concerns in which approaching you is my last effort to handle the problem through local means. I have been advised to pursue relief through the U.S. District Attorney’s Office, WV Board of Medicine and Inspector General’s Office if you can not provide the proper attention that these issues require. I am not the only one in this situation but I am one of the few which will pursue the issue to the end.
I would give anything in this world to have some of these medical providers spend 24 hours “in my shoes”. Between the loss of work/financial security and the pain and mental anguish, I sincerely doubt if they would last very long. They don’t seem to care or even realize that I am suppose to endure their treatment (punishment) 24/7 for weeks (until the next appointment) based upon their personally bias treatment. I need to work and I am currently looking at not even being able to pay my minimal mortgage payment due to the time spent on this issue and the inability to function under my current physical and mental conditions. One of the most insulting items in this whole “mess” is how the medical providers are so completely wrong in judging who I truly am. In all of my life I have never had my integrity insulted and my character assassinated as I have by the VA Staff over the course of my treatment and/or non-treatment. I have also been prevented from being a part of my treatment while decisions are made “behind closed doors” while providing no written records of what was discussed and the basis for neglecting and/or changing my treatment. Patient’s Rights are continually neglected and smirked at by medical providers through their condescending remarks when attempting to exercise these rights. This is destructive to many more patients than will ever be recognized. As a businessman with education in both Business Administration and Industrial Engineering, I am confident that this type of treatment is very costly in the end and will eventually be instrumental in bankrupting the system if not addressed properly. “It is less expensive to put out 6 quality products per hour than to put out 10 faulty products per hour in which most will be returned and repaired over and over again”.
Now that this has become a personal issue with many of my providers (along with the inappropriate accusations by the administration), how can I ever expect to develop the trust and open dialog necessary to obtain proper treatment?
I sincerely hope that this is concerning to you and continue to wish to believe that this is NOT the policies endorsed by you. I look forward to your reply.


Jeff Durham
cc: Patel/Pain Clinic
Bobbitt/Mental Health

cc/pending: U.S. District Attorney, WV Board of Medicine, VA Inspector General

P.S. It is not just for my benefit that I request intervention, but for many whom are “ignored and discouraged” without resolve. I am extremely ashamed of the Veterans that elect to further complicate the problems with pain management through illegal behavior although this behavior does not warrant the unethical treatment of other Veterans.


  • Jo
    johnb777 Mar 30, 2011

    I hear you. I am being treated very badly and have been for over 2 years. I am not a bad person and certianly not an addict. I don't drink, I don't smoke. I have never been convicted with either alchohol or drugs.
    I have gotten to the point that I do not trust anyone in the VA Health System.
    It seems that nobody in the VA healthcare system cares most of the time. I only hope I can find someone with a little compassion for my situation. I already regret volunteering to attend airborne school. I felt this was the right thing to do at the time to help my unit and my country. I am beginning to regret that I even joined the Army. If it weren’t for my dependency on the pain medication at this time I would stop using the VA Health System and seek help else ware.
    I have found that my medical records are full of lies and twisted words.
    Because of my constant pain I am unable to even try and work for myself anymore to get me thru to social security benefits. I know for a fact I will not be able to hold down a regular job with my status, dependency and constant pain. I feel that the treatment or lack of treatment has put me in a much worse situation than If I didn’t use the VA Health Care System.
    This is all making me paranoid, I believe I may have a PRF Patient Red Flag and they are all collaborating against me. I also have angry thoughts especially when I am on the downward side of my pain meds and watching the clock until I am allowed to take more.
    It’s really getting bad now ever since my last visit on the 25th at the VA Clinic in where the nurse chastised me and the doctor did absolutely nothing. All they said is your
    blood pressure is high. Of course it was high having to deal with people like them. I truly believe that if I stopped being treated by The VA like I am my blood pressure would be down because every time they make me angry my blood pressure goes up and they prescribe me more. I feel like they are thinking, (ok we have been under treating your pain for some time now, but now that your are dependent on them we can treat you like crap and you have to take it or we will take it all away. There are too many evil people in the Va Health Care System.
    I need to stay away from them untill I can get some outside help. I am afraid I am going to loose it and do something bad.
    I am depressed but don't dare tell them because they will just use it against me.
    These evil people need to stop this. It's just not right!

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