Page 4

November 4, 2003: Some of the documents shown in the links have had non-essential
material deleted for this report for brevity and space.


FINAL FAILURE TO TREAT BY MISDIAGNOSING

Usually the contention of a section is placed at the end of the section. However this section begins with the summation so the reader can determine if the documents support the final contention.

There have been and are now lawsuits and complaints against Health Insurance Companies claiming the Companies were not paying doctors for needed services to patients and/or refusing to pay for medical procedures recommended by the doctors.

This section results in a uniquely opposite outcome. The doctors were informed verbally and by letter on several occasions, being unable to work full time, I could not afford to pay them and the cost of the medical tests especially the CT Scan. I needed the doctors to furnish to my health care insurance company, Anthem (BCBS) the necessary coding information so that the services were approved for payment prior to the services. I was referred by my primary care doctor based on prior records of sinus fistula problems. The specialist ordered the CT Scan for the sinus evaluation on which he wrote, "?oro-antral fistula". The Mass General/specialist knew that Anthem would not cover dental treatment as they had denied it as such in the very beginning. The specialist and Mass General continued to code it solely as dental. There was a prolonged delay by Mass General/specialist in furnishing medical records to Anthem even though Mass General/specialist knew that I was appealing the denial so that their bills would be paid by Anthem. Upon review of the records and present CT Scan by its doctor, Anthem determined contrary to the specialist that it was a medical condition. If I had not appealed, it would have been the specialist/Mass General, not Anthem preventing payment for recommended medical services.

When the new infection continued, I called the office of my primary care physician, Kevin Connolly, and was seen by his assistant who prescribed Augmentin. When this did not stop the infection I was seen by my primary care physician who prescribed another regimen of antibiotics for the infection. (KC5-5-03) When it still did not clear up the infection, based on my past history of a sinus oral antral fistula and several surgeries and past infections, he became concerned that there may need to be surgery to stop the underlying problem of leakage of sinus fluid down into the jaw and around one of my remaining teeth. He indicated there was a need for referral to a specialist and diagnostic tests such as a CT scan to determine the present condition of my sinus and jaw. We began an extended and futile search for a specialist who would take me as a patient.(KC5-7-03, KC5-13-03, KC5-20-03) From May 5, 2003 we both tried to get an appointment until I had my first appointment with an oral surgeon, a specialist, Dr. Dodson, as a referral out of the area at the Oral Maxillofacial Surgery Department at Massachusetts General Hospital on May 27, 2003. From the time of the first visit to Copley Hospital, I spent most of my time lying on my back with my head back to keep the sinus fluid away from the bottom of my sinus and on a regimen of various antibiotics to keep it under control. My office was basically closed.

There was a concern during this period of time, that if it got worse and I needed to go to an hospital emergency room, I could get the same treatment as occurred at Copley Hospital. Upon my request and after our discussion of the dangers of the continual infection, my doctor gave me a letter on May 23, 2003 to carry with me in the event I had to go to an hospital emergency room. (KC5-23-03) He indicated that I could not go on indefinitely under this condition and if I could not get a referral soon, he would recommend that I go to an emergency room at a large hospital and refuse to be released so they would be forced to treat me. He was very concerned that this infection could lead to serious complications.

I had an appointment with the specialist, at Mass. General Hospital on May 27, 2003 at which time there was a panoramic x-ray taken and he scheduled a second appointment for June 5, 2003 with a CT scan to be done at the same time. At the same appointment he also wanted to remove a tooth which had become loose next to the site of infection from severe bone loss from the infection. He also indicated he wanted to do a biopsy of the gum in the infection site as he wanted to rule out a tumor, etc. (TD6-5-03A, TD6-5-03B)

He also wanted me stop taking antibiotics for up to 7 days prior to removal of the tooth even though I had an ongoing infection.

During this time, I was in contact many times with my primary care physician, Mass General and the specialist to be sure that my health insurance provider, Anthem BCBS was properly notified and the necessary approvals were obtained for the out of network appointments, tests, etc. were properly processed and approved prior to the services. Anthem upon repeated contacts indicated they had not received any information from the healthcare providers. Finally there was communication with Anthem but the information was solely referring to dental procedures which are not covered under medical. Not able to earn a living, I was concerned with receiving medical bills especially for the CT scan tests. (KC5-22-03, KC6-2-03A, KC6-2-03B, TD6-4-03)

I indicated my concern to both the specialist and primary doctor of stopping medication and pulling a tooth while there was still an infection. I did not receive any response from the specialist. My primary doctor told me to continue with the antibiotics and he would make the necessary referral in network at the Cottage Hospital and get it approved by Anthem. On that understanding I had the CT scan tests performed on June 9, 2003 at Cottage Hospital. There are selected images of the results as links on the first page of the index of this report. The films and reading were sent to the specialist on June 11, 2003. You will note the report on the CT scan which indicates a surgical defect in the floor of the sinus with apparent soft tissue closure, although a soft tissue opening cannot be excluded by this examination. (CH6-9-03) Although requested on several occasions for the final evaluation of the tests and report, the specialist did not send an evaluation to me.

Anthem was also indicating that all they had received was material solely classifying the services as dental in nature which they do not insure under a medical service. Although there had been repeated requests for such information be sent to Anthem, it was not sent to Anthem which had no choice but to deny any services, tests etc. (A6-12-03, A6-22-03) Anthem indicated I could request copies of the records from the healthcare providers to be sent to Anthem which would have their physician review them. If they made a determination that it was medical and that the services were not accurately reported, Anthem would pay the costs as medical services. (KC8-8-03)

On June 20, 2003 I made a written request to the specialist and the hospital for copies of all my medical records but Mass General refused requiring their own form be completed. On June 30, 2003 I sent a second request for my records which was not fully complied with. On July 25, 2003 upon my inquiry by telephone, and they indicated they did not receive my request so I sent a third request that same day. You will note that I had similar difficulty obtaining my records from Copley Hospital. Upon my call to Copley hospital on July 25, 2003, they informed me that they had sent the copies of my records which I never received.

On August 11, 2003 I sent a fourth written request for copies of all my records to be sent to me and Anthem for the appeal. Mass General was made aware of the appeal and was sent $25.00 to cover any costs to avoid delay.

When neither I nor Anthem received the records on September 3, 2003 I called the Oral Maxillofacial Surgery Dept to find out why I had not received the records and was informed that the specialist had not put my records into the system but that they would send them out. That day I sent a fifth written request for my records and enclosed another $25.00 for costs so there would be no delay.

< p>The records (not all) were finally sent to me and Anthem so they could finally make a determination of the appeal. (TD6-20-03, TD6-30-03, TDM7-25-03, CopH7-25-03, TD8-11-03, TD9-3-03, TDRe9-3-03)

Shortly after the appeals department called to indicate my appeal was granted and all the bills were paid as their physician approved it as clearly medical in nature. The prior records, the new CT scan and the records from Mass General Hospital clearly indicated it was primarily a problem involving the sinus. (A8-25-03, A9-17-03)

I had made an appointment with a local dentist in St. Johnsbury, VT, Katherine Silloway, to have my teeth cleaned, etc. as discussed with the primary care doctor. It was rescheduled to July 1, 2003 because of the sinus problem. The tooth that was near the infected area had lost so much bone supporting it, it was very loose and needed to be removed. I was also going to have the dentist look at it, to remove it, do a general checkup, make arrangements to get a partial plate for the missing teeth, a cleaning and set up a regular schedule for maintenance. She agreed that the tooth needed to be removed, that my gums were in good shape (including the area which Dr. Dodson wanted to perform an biopsy for possible tumor). About July 3, 2003, I received a report she prepared on July 1, 2003 in which she tried to cover everything from the past problems including the sinus fistula but she did not list my gums for any cause for concern. However she refused to accept me as a patient.

On August 28, 2003 I went to a dentist in Littleton, NH, Michael Morley and he removed the loose tooth. On my next appointment on September 17, 2003 to discuss obtaining a partial plate, he gave me a list of oral surgeons to go to for an evaluation. The list was mainly those whom I had already unsuccessfully tried for the earlier referral.

Shortly thereafter when trying to return to a normal schedule, the area of the damage again became sensitive. On the weekend of October 25, 2003 we went to visit my daughter in Maine at which time I was on my feet or sitting driving. On Tuesday night the area of the old surgery was sore and by Wednesday forenoon it appeared to have become re-infected. On Thursday, October 30, 2003, it had become very sore with discharges from the sinus with increasing discomfort. I went to the walk-in clinic at Cottage Hospital and since have been back on the antibiotic of Augmentin/AmoxTR-K which will be for a period of ten days.

It appears the damage to the bottom of the sinus may be too extensive to be successfully corrected by just lying on my back and using antibiotics as this has happened on several occasions over an extended period of time.

When this first began with the large oral antral fistula, one of the surgeons who did an evaluation indicated that often in the case of a large fistula with an older person, it requires that an artificial membrane be placed between the sinus and underlying tissue to keep the sinus fluid from re-infecting long enough for the sinus membrane to close and the damaged tissue to heal properly and this was especially so when there had been past unsuccessful attempts to close the fistula. However none of the surgeries performed to date ever used a membrane or any other barrier as the injured area was re-opened, dressed, cleaned out and sewn back together.


FAILURE TO RECEIVE ANY POSITIVE RESPONSE

A review of the prior material indicates that I have presented this material to many agencies, professions, professional boards and as yet, U.S. Representative Charles Bass is the only one to respond.

I delivered the first edition of the CD to the office of Judd Gregg and the campaign office of John Kerry in Concord in July, 2003 without response. I will be delivering this last edition of the CD to many more.

I made the following hand deliveries to the New Hampshire Lawyers Committee on Professional Conduct of the New Hampshire Supreme Court:

1. Paper copies of the report on June 13, 2003,
2. Two copies of the CDs on June 29, 2003.

On August 24, 2003 I sent a letter requesting an acknowledgement of receipt of my material. I have not received any response.

I have hand delivered the CD to many attorneys in my area but have not received any response. I have contacted numerous law offices and individual attorneys in New Hampshire, Massachusetts and all over the country for representation to bring action on any of the matters in my report. To date only one attorney brought an action in the Berube matter.

I sent records on Berube to the following agencies/departments in New Hampshire:

1. Office of Attorney General,
2. Board of Dental Examiners.

Both entities refused to do anything.

I also sent the records on Zafiropoulos and Salman to the following agencies/departments in Massachusetts:

1. Office of Attorney General,
2. Board of Registration in Medicine which disciplines doctors, as well as several other agencies which oversaw the Board of Registration.

There were NO responses.

The only acknowledgement of receipt of the CD or website has been that received from Representative Bass.



CONCLUSION

When this first began back in 1969 to 1973, I convinced myself that it was an extremely unusual aberration that was unlikely to occur again. When the harassment began again in 1993, I convinced myself that again this was an extremely unusual occurrence. That there would be individuals in the contacted institutions, professions and agencies who would decide enough was enough and that this sort of activity would not be allowed to continue. When the medical damage began, I believed that if I continued to seek treatment and the damage continued there would eventually be a reaction of those who would know that it was wrong. Finally I believed that when the records were released to the public, there would be a positive reaction to prevent it from continuing and to make sure it would not be repeated against other persons.

I released the CD and placed the information on the website when there had been no reaction, nothing to discourage the continued harassment, improper and/or denial of medical/dental treatment. I had hoped that the medical/dental mistreatment would stop. I have sent copies of the CD and information as to the website to a number of healthcare professionals to be sure they were aware of the publication. However the denial of treatment, delay of receipt of copies of medical records, refusal to send copies of all medical records continued after the CD and Website were released. No profession, agency, or any individuals stepped forward and spoke up, said enough is enough, none functioned properly. No profession, institution, agency in this society functioned properly.

The basic institutions, the underpinnings of this society are dysfunctional and broken. I now realize, what happened is not really an extremely unusual aberration but increasingly the norm.

It is too late for me but maybe what is in this CD and on the website will eventually cause a positive reaction so that this kind of behavior will not continue.


CONTINUED GOVERNMENT SURVEILLANCE & MANIPULATION

When incidents occurred I found it necessary to set up random tests. Any response to my test would be so remote as to rule out any reasonable coincidence. I began random testing in the first episode during the Vietnam period from 1969 to 1973, when I, along with many others, found myself the object of intense interest to the authorities. As a consequence from 1969 to 1973, I set up random instances to determine if I was (and to what degree) still an object of interest.

Starting in 1993 after making informal inquiry of individuals and agencies to obtain information about the events of 1969 to 1973, I discovered that I had again become an object of interest to the authorities. After filing formal inquiries under the Freedom of Information and Privacy Acts, I again became an object of intense interest. As in the past, I set up many random instances (tests) which are still done to determine if and to what degree I am still an object of interest.

The week of November 1, 2004, I used the 'Yahoo' people search engine for a name to obtain the present address and telephone number of a person. I did not attempt to use the information and no one had access to my computer and the information was not removed from the secure location of my office. The person searched on Yahoo never was a friend, school classmate, in the same or a related profession, in any of the same organizations and did not live in the same state. The only contact I had had with the person occurred in 1964 and a one brief inquiry of the person in 1972 when I had indications and reason to believe the person had been contacted by the authorities. Three days after looking up the person on 'Yahoo', the person (FA) appeared at my office and tried to strike up an extended conversation which went on for over 90 minutes until I was able to break off the encounter. The conversation generated by the person was strained and contrived with no apparent objective, although FA did bring up the inquiry in 1972 and tried to elicit current information about further events resulting from any recent government inquiries.

In light of the past events, what are the odds that this appearance by FA at my office was purely by chance? Statistically what would be the probability that this appearance was a chance coincidental occurrence?

It brings to mind what Martin Niemoller, a German Protestant minister and leader of the church's opposition to Hitler who was interned by the Nazis wrote:

"In Germany they first came for the Communists, and I didn't speak up because I wasn't a Communist. Then they came for the Jews, and I didn't speak up because I wasn't a Jew. Then they came for the trade unionists, and I didn't speak up because I wasn't a trade unionist. Then they came for the Catholics, and I didn't speak up because I was a Protestant. Then they came for me, and by that time no one was left to speak up."

-- Bernard J. Wolfe, Jr.