Florida Doctor Thinks He's Above the Law (IMO)

It started with itching. The itching went on for several months, got worse and turned into a rash. A rash on my neck. Unprecedented. Drove me nuts. I resisted the urge to scratch it, knowing that would only make it worse. I tried cortisone cream from Walgreen's, then chlortrimazole --something from WalMart, then Noxzema, zinc oxide, aloe vera gel...The rash--on my neck-- was spreading. I didn't know if it was contagious.

On the Medicare website I found a dermatologist that accepted medicare and made an appointment. March 17,  2011 the day of the appointment there was long wait in the doctor's waiting room. Then a door opened and I was whisked into a back room, where a nurse rapidly recited a list of don'ts: don't use washcloths, don't take long showers, don't take hot showers. I later heard the nurse recite the same litany to another patient-- like it was scripted. Before any diagnosis, two prescriptions were handed to me: one for an antibiotic cream, the other an anti fungal. "Put both of them on at the same time," instructed the nurse; mix them together. Also: the nurse said buy Hibaclens liquid soap over the counter and wash the rash with it first, as she scribbled a name on another piece of paper.

The doctor showed up, looked at my afflicted neck, swiped at it twice with cotton tipped swab, left the room. Total face time: less than 5 minutes.

Looking back, I would've been better off going to a Saint Patrick's Day parade and getting drunk. But you know what they say about hindsight...

On my way out, as always I halted at the nurses station. I know the drill. "How much do I owe?" I asked the nurse/staff member. "Nothing," was her answer.

A paper was pressed into my hand, and I was urged to come back for another appointment in a week to "find out the lab results."

Why, I wanted to know. "I can't afford to come back for multiple appointments," I told her. Just tell me when to pick up my lab results.

"Two weeks," she said.

Two weeks passed and I called the doctor's office and was told: lab results were not in yet. 'kay. Bye.

Three weeks. The staffer by the name of "Kat" said come in and get the lab results on Thursday. April 7.

On Thursday, I drove to the dermatologist's office with a signed HIPAA form in hand, (downloaded from a legal website) to pick up my lab results. Again, the office gatekeeper told me the labs weren't back yet. I handed her the HIPAA form and asked for what medical records they did have, waited while they were copied, and left saying mail the lab results to me.

The rash was a little better by this time--or at least not any worse, but not because of anything the doctor had prescribed. His prescription potions made the rash worse and I discontinued use.

When I got home I looked at the "medical records" the doctor's office staffer ( nurse? office manager, billing diva? ) had given me. The print was so light it was practically invisible. I couldn't even determine what lab tests the doctor had ordered. I didn't find out what lab tests were done on the skin swab from my neck until I got a copy of my Medicare Summary Notice (MSN) that listed the lab tests done and the amount charged and paid for them. I had to request this information several times before Medicare released it. The skin cultures were done 3/17/11 and I received the MSN in May, 2011

Still, I wanted to know what had caused this rash in the first place. More importantly, I wanted to know if it is/was contagious.

I had made a decision not to mix both prescription medicated creams together, because how would I know which one worked, if I used them both at the same time? Instead I tried first one, (mupirocin) then the other (triamcinolone). The first one made the rash look like raw hamburger and feel like freshly ground meat.  I washed it off, let the skin calm down, and tried the cream again. Same result.

I tried the second prescription cream, after thoroughly washing  my neck. It did not go well. Skin stayed irritated and got more irritated the longer the stuff (which contained steroids) stayed on my skin. I tried more of the same later. No improvement. Using this cream was like throwing grease on a campfire. It flared. I gave up after three tries.

It took at least a month of trial and error self treatment, using non prescription common remedies, doing my own research, protecting my neck from sun light, wearing scarves and hoodies in the summer time, switching to non-perfumed no dye laundry detergent, unscented Dove soap, taking Vitamin E, and gradually my skin returned to normal. What helped a lot: a $1 bottle of calamine lotion.

Soon after I dropped off the HIPAA request ( 4/7/11) for my medical records, the doctor's office sent me a bill for $59. It said: if payment is not made within 20 days, a ten dollar late fee will be added to this amount.  I shot off the following letter:


June 5, 2011

John Cottam, MD
Tampa, FL
June 5, 2011
Re: Billing Statement

Dear Sir/Madam:
First, on my appointment date, March 17, 2011, I asked your office staff if I owed a co pay or any other payment at that time. She answered no. Therefore, I won’t pay a “late fee,” as referenced on your statement which I received June 4, 2011. If you expected to be paid at the time of service, you/your support staff should have asked for payment at that time. I did not ask you to extend credit to me.
Second, you took a skin culture. Medicare’s records indicate that the following tests were paid by Medicare on my behalf:
1. 87070 Culture, bacterial aerobic with isolation A.
2. 87102 Culture, fungi (mold or yeast) Isolation with presumptive identification of isolates; other.
3. 87026 Smear, primary source with interpretation: fluorescent and/or acid fast stain for bacteria.
On 4/07/2011 I hand delivered a HIPPA authorization form to your office staff for release of my lab results/records to me. I’m still waiting.
When I receive the lab results for the skin cultures listed above, I’ll send payment for your bill.
Mail the lab results to me at the address above.

Thank you for your anticipated cooperation.

There was no cooperation from the doctor or his staff. The doctor and/or his staff preferred verbal communication--as in no paper trail. One of his staff left a message on my machine saying I could get my lab records when I came in and paid the money she said I didn't owe on 3/17/11 when I asked how much I owed. 

After driving to this doctor's office when his staff  told me I could pick up my lab report and being told they didn't have them, I was not about to waste any more of my time (or gas money--almost $4 a gallon).

I sent off this letter.

July 1, 2011

John Cottam, M.D.
Tampa, FL

Dear Dr. Cottam:
This is my third request for my skin culture lab results.
Medicare’s records indicate the following tests were paid by Medicare on my behalf
Date of service was 3/17/2011. Payment was made to Quest.
1.87070 Culture, bacterial aerobic with isolation A.
2. 87102 Culture, fungi (mold or yeast) Isolation with presumptive identification of isolates; other.
3. 87026 Smear, primary source with interpretation: fluorescent and/or acid fast stain for bacteria.
I hand delivered a HIPPA authorization form for release of my lab results (to me) to your office staff on 4/07/11. I sent you a letter on June 5, 2011.
I need the lab results to be mailed to me at my home address. No phone calls. Please send legible clear copies.

Thank you for your cooperation.


The doctor didn't cooperate by sending my lab report, but he did send another bill--with a $10 late fee added on.

I looked up HIPAA law and found this:

FL statutes Title XXXII Chapter 456,
 "Any health care practitioner licensed by the department or a board within the department who makes a physical or mental examination of, or administers treatment or dispenses legend drugs to, any person shall, upon request of such person or the person’s legal representative, furnish, in a timely manner, without delays for legal review, copies of all reports and records relating to such examination or treatment, including X rays and insurance information. (However, when a patient’s psychiatric, chapter 490 psychological, or chapter 491 psychotherapeutic records are requested by the patient or the patient’s legal representative, the health care practitioner may provide a report of examination and treatment in lieu of copies of records. Upon a patient’s written request, complete copies of the patient’s psychiatric records shall be provided directly to a subsequent treating psychiatrist.) The furnishing of such report or copies shall not be conditioned upon payment of a fee for services rendered."

On July 5th, 2011 I sent the doctor another HIPAA compliant Authorization For Release of Information. I enclosed a copy of my driver's license and a self addressed stamped envelope.

On 7/12/11 I downloaded a Health Information Privacy Complaint form here: http://www.hhs.gov/ocr/privacy/  I filled it out and mailed it.

August 25, 2011 I got this letter in reply:

In September 2011, I got the exact same letter. It was undated, so I kept the envelope.

Department of Health and Human Services, Office for Civil Rights did not provide an email address so I could communicate with them. I don't have long distance on my phone. The toll free number at OCS refers you to download and print out a complaint form, which I already had done.

It was becoming clear that the Dept of Health and Human Services was going to provide NO services to this human. And the Office of Civil Rights didn't give a damn about mine.

I found this on wikipedia:
"According to the Wall Street Journal, the DHHS takes no action on complaints under HIPAA..." No surprise there. Maybe.

So I took my request directly to Quest, the lab that processed my tests.
On 8/22/11 I sent Quest Diagnostics a HIPAA form with a copy of my driver's license and requested my lab reports from 3/17/11.
On 10/10/11 Quest Diagnostics sent me a reply. It said:

Thank you for your recent communication to Quest Diagnostics. We received your request for your laboratory test results. In order to maintain privacy,  the billing department does not have access to patients' laboratory test results.

So that results are properly interpreted and explained, we encourage patients to request this information from the ordering physician (so the doctor can charge for another office visit?)  However, if you wish to request a copy of your laboratory test results directly from Quest Diagnostics, please contact our client services department, located at the laboratory where your tests were performed, by calling 1-800-282-6613 EXT 4000. Our client services department will release this information directly to you if state law permits. ( Hmmm I thought HIPAA was a federal law)

Thank you for using Quest Diagnostics. We look forward to serving you in the future. #Fail

So I called their 800 number and was told that my state's law does not permit a patient's  lab records to be released to the patient--only to the doctor. In the matter of access to our own health records, it seems state law overrules federal law. This medical-legal-government gridlock was running over me.
Let me tell you, I was running OUT of patience.

Medicare hooked me up with this agency whose letterhead says: Quality Improvement Organizations, Sharing Knowledge, Improving Health Care. (aka Quality Assurance). It isn't clear whether this is a state agency or a federal agency. Maybe it's an experimental agency. After many calls, back and forth, I got this letter on or around October 21, 2011:

Despite what the letter says, the Doctor's office did not mail the the lab results to my home address. And no, I haven't moved.

I called Quality Assurance again, got an answering machine. Played phone tag for a couple months. My latest message to Janis Wolf , the letter sender, was returned a month later. She said she would call the doctor again, and then vanished. Ever notice that when people don't want to solve a problem, they prefer verbal communication to written?

(Or when somebody's rights get trashed, the violaters try to block cameras and video recording?)

I called Quality Assurance again, and this time I got someone named "Laura" who said "Janis" worked somewhere else now. 'kay

Laura didn't seem at all surprised that I had been trying to get my records mailed for 9 months. She asked for the doctor's phone number. I gave it to her. She called me back and said the "nurse" said I could have my records if I went there in person and signed "their" form. Been there. Not falling for that again.

Quality? It most assuredly is NOT.
Assurance? I'm assured that my rights are being stomped on...

I asked my Senator for help getting my lab report from doctor. Three months ago. They asked for--and received-- a consent to release information form signed by me. They #failed to do anything. My last two phone calls to my Senator's office were never returned, by Miss Peggy or by anyone else....

It didn't end there.

From my state's attorney general website  I emailed a consumer complaint. Their answer arrived within days. The attorney general doesn't have "jurisdiction" over docotors that violate HIPPA laws. The letter directed me to a website where I could look up information on how to file a complaint.
Public servants, really. I think not.

Finally I called a legal aid office on the advice of somebody else. The woman took all my information over the phone and gave me an appointment. The same day.

If it sounds too good to be true....

After speaking to the young paralegal, for an hour, who then brought my information to the flock of lawyers in the back room, he returned to say they couldn't help me. It wasn't that I didn't "qualify." I'm poor enough to meet their standards...

The intake paper states: "I need help concerning..."
On this line I wrote: "Getting my lab report from skin culture done 3/17/2011."

Before I left the legal clinic, I had to FIGHT for a copy of my intake form.

On Statement of Facts, WHAT CLIENT WANTS, the paralegal wrote: Get lab reports from Dr. Cottam.  
A question occurs to me here and that is: What is so special about my lab results that compels this doctor of dermatology to withold them from me, to lie to Medicare, and to break the law.
By the time the lawyers in the back room were through with it, they produced a paper that concluded the following:

5. Due to the great number of people seeking our services and our limited resources, BAVLP does not have sufficient resources to accept you for representation. We suggest you contact the following: Consumer affairs over the medical bill. 

By the time the lawyers in the back room got through with the paralegal and my documentation, they had turned a blatant violation of my HIPAA mandated legal right to my own medical records into:

Legal problem code 9--"dispute over medical bill."

By now a $59 co-pay had increased to $91 and change...

Heartwarming. Lawyers 'n' doctors watching each other's financial backsides. It's what it's all about.
There are laws in the land. To protect the rich and well connected. But rights? Right.

So I bring it to the Internet. For free. For information. For all.

Here's to our health--- all 99% of us.

Oh hey, doc u superstitious?

Quality Assurance letter
In August 2012, one year after receiving my complaint against Doctor John Cottam, the U.S. Department of Health and Human Services, Office for Civil Rights contacted said doctor regarding a violation of 45 C.F.R. 164.524(a)(1).

The communication from OCR investigator Andrew Mahler nudged the doctor into finally doing the right thing. My lab reports were mailed to me within the week.

So the Wall Street Journal was wrong. (see above)

The lab results were negative for both bacterial and fungal infection, leading me to ask:

Why would the doctor, before sending my skin swab to the testing lab, prescribe both an anti fungal and an antibacterial cream to be applied to my rash at the same time. (which made the rash worse!)

And knowing the lab results came back negative, why wouldn't the doctor contact me and tell me to discontinue use of these medications that I didn't need?

Why in the great state of Florida-- and maybe some others-- is a testing lab allowed by law to withhold a patient's own health information from her?

Why do some doctors use their patients as human lab rats, prescribing potentially harmful drugs and/or surgery before they figure out --if they ever do--what is causing the symptoms,.

So I told you doc, I never give up. And you made the rip off report.


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