Disability Discrimintation? My Assertive Tongue Causes Re-evaluation

pcgumshoe · 05-30-2007, 03:33 AM

I've been terribly upset since last week and have chatted with my therapist, but I want to throw this out to the lapbandtalk community.

I fall into the upper >20% on the intelligence scale (IQ: 126). I know this because April 30th, I had a nueropsychological exam that re-confirmed all my diagnoses up to this point and confirmed that E.C.T. had taken its toll on me.

My mental diagnoses are Bipolar I with PTSD. Where the PTSD comes from is a mystery, I wasn't in the military, but rumor has it that it comes from my continued social isolation due to the Bipolar.

No matter how intelligent I am, my mental disabilities wipe out most of that when people are involved-- I have no tolerance for stupidity and knowing that there are 80 (or more) out of every 100 people less intelligent than myself doesn't help.

When I considered WLS, I did my homework and decided I wanted the Lap Band. It was covered by my insurance (Medicare) and I contacted the local center approved to do the surgery. When I talked to them, I received this laundry list of requirements that I couldn't fulfill in 6 months, but maybe one or two years. The local doctors in my state want 5 years showing obesity with my Primary Care Doctor (I've only had a PCD since 12/04 -- 2.5 years). I can prove obesity for 10 years, but can't prove my attempts at weight loss.

With my brains in hand, I attacked the requirements as excessive in comparison to the Medicare National Guidelines. During my battle I learned that if I drove or flew to another state, I'd have less stress and requirements. I picked California where I have family.

In April, I flew out to L.A. and was seen by a Dr., Nurse, Dietitian, Social Worker AND, because I'm bipolar, a psychiatrist. The results were promising except they tried to steer me towards bypass, but said I'd be a good candidate for either.

Instructions in hand, I returned to Florida and began scheduling appointments with the proper people to get the additional tests I needed so that once I cleared the multi-disciplinary panel (all those people I met with in L.A. meeting and discussing my case) I would be ready to schedule my surgery. From those meetings to surgery, said the Dr., would be between 5-6 weeks especially since I had Medicare.

I received notice about three weeks ago that I passed the multi-disciplinary panel. I had already had an endoscopy (it coincided with my colonoscopy previously scheduled) and I had an ultra-sound.

While waiting for the results, I had some difficulty with my local doctor coordinating the three test results and was on the phone with his office six times during 2 weeks. First they had this report, then they didn't. They didn't have that report, then I got it for them. In the end, I was told they were "faxing" the results to my Center in California.

After I was told they faxed the reports, I called my care coordinator and left a message saying that she should receive them by today and to call or email that she had received them. That night, I got an email saying that they ONLY got the ultra-sound (my local doctor's fault) and that they were waiting for a letter from my psychiatrist who performed the E.C.T. and my therapist.

Now, up to this point, I'd been gritting my teeth trying to make people do their job in a timely fashion. When somebody promises to fax something, or talk to somebody, I take their word for it, only to be let down later. I requested that ALL communications with my mental health workers go through ONE person at the Center and I picked the psychiatrist. My therapist confirmed that she had spoken with the psychiatrist, but that no request for a letter was every made.

In a hasty response to my care coordinator, I explained that there was NO request for communication with my psychiatrist (who would have been useless since he ONLY treated me with E.C.T. because nothing else worked, neither did the E.C.T., and we had no history outside of this setting). Additionally, I pointed out that someone had spoken with my therapist AND that I had already cleared multi-disciplinary panel.

Now, I know that my subsequent voice-mail to the social worker and my email to the care coordinator where fueled by my frustration with my local doctors, but there wasn't anything in them except my being assertive. And, yes, people have said that when I'm being assertive, it scares people. However, having reviewed the emails and voice-mail (I record all outgoing interstate calls on my PC) there was nothing in them threatening.

My hospital knows that I'm mentally disabled. They've talked to my therapist who stated bluntly that A) the surgery would not worsen my condition, but in fact may alleviate some of my depression, and B) that I would be able and willing to follow post-operative instructions.

Last week, the social worker and the psychiatrist requested to have my case brought back before the multi-disciplinary panel because of my email and phone calls. Now, nobody will return my call and I was told that I will be receiving a letter. The inferences I got from staff was that my email and voice-mail caused this potential negative decision in treatment.

I've brushed up on ADA law and I reviewed my psychological examination. Here's what the psychologist said about me: "In these individuals' cases, the detachment from others is accompanied by conflicts that they experience in social situations. These MCMI scale scores indicate that they feel somewhat inadequate and often wish that someone would provide nurturance, shelter and guidance. They fear, however, that when others get to know them, they will reject them. As a result, they often seem nervous and tend to be somewhat moody and resentful. At times, they may be friendly and cooperative, but anger and dissatisfaction soon color most of their relationships."

To me, it seems that SHOULD the Center deny to treat me, that denial will be because of my "detachment from others" accompanied by "conflicts that [i] experience in social situations" as well as "anger and dissatisfaction." As all of this is a result of a disability, to deny me a treatment that 1) could potential improve my situation, 2) I had already been cleared pending the Endoscopy and Ultra-Sound, would be a discrimination based on associative nuances of my mental health disability that would otherwise have no bearing on my successful outcome post-operatively.

Anybody have any thoughts? I've tried talking to the lawyer from obesityhelp.com and he said, "We need to talk." However, like ALL my other social situations, his office is never "in" and his last email said, "I'll call you." Maybe I'm just unlucky and there's some sort of divine design to make my life miserable.

:faint: :help:

pcgumshoe · 05-30-2007, 05:23 PM

I guess I was to verbose for a reply.

Lynette617 · 05-30-2007, 06:08 PM

I'm so sorry that you've had to go thru all of that, and still haven't got any closer to a surgery date. That is unreal. I'm sure you thought about self pay, but I'd be upset to pay for something that should be covered by insurance.
Hopefully the lawyer will get back to you and be able to help.

I wish you best of luck in your pursuit of surgery. Don't give up.

annieM · 05-31-2007, 09:19 AM

I agree, don't give up. It is beyond frustrating and I wish you good luck in dealing with all this. I was self - pay because of various reasons but I know how hard it is to get insurance companies to cough up cash.
What is E.C.T?

kacee · 05-31-2007, 09:36 AM

I too am self-pay because I did not want to go through the hoops for the insurance company. I know my body, I know my history, I know my prognosis. I don't want some paper pusher who has never met me to decide my fate. Because you have a many-dimensional medical history you are most likely going to be buffeted through the system, and very likely denied (first time around). I know a lot of people are not in position to self-pay...I looked at mine as "Okay, this is just a "used car loan" I would take out...." and it hasn't bothered me one whit to make that sacrifice. Good luck with your endeavors and hang in there.

musicalmomma · 05-31-2007, 10:07 AM

Quote:

Originally Posted by pcgumshoe

....Anybody have any thoughts? I've tried talking to the lawyer from obesityhelp.com and he said, "We need to talk." However, like ALL my other social situations, his office is never "in" and his last email said, "I'll call you." Maybe I'm just unlucky and there's some sort of divine design to make my life miserable.

:faint: :help:

WOW...I'm going to try to stay as neutral as possible here. I know it's VERY frustrating when you want and need something so desperately and you keep hitting road blocks. It's even more frustrating when medical professionals don't follow through as promised, thereby delaying you process. However, people do not like nor appreciate being talked down to and being bullied into doing what you want them to do. Most people respond to polite, courteous requests. Others do require a little firmer approach, but remaining professional and courteous, even complimentary, gets you MUCH further and faster than berating, insulting, and bullying. Again, I do sympathize with feeling like "your just another number" and the attitude you probably face from uncaring 'professionals'. I sympathize with your frustration with the hoops you have to jump through. Many of us had to jump through just as many hoops...some even more. So, most of us feel your pain. I'm not criticizing, just offering the help you asked for. Try saying something like "I totally understand that your job is stressful and that you're terribly busy. I REALLY appreciate you taking time to take care of this for me. It means a lot!" Making people feel appreciated for their efforts gets you MUCH further than telling them how inept they are. I'd even go as far as apologizing to the doctor that re-submitted you to the multi-disciplinary committee, "if I came across wrong, please forgive me, I was acting out of my frustration..."

Now, as far as the above quote. Obesity Law is currently handling my husband's appeal for Lap Band. They're website CLEARLY states under the FAQ section:

"I'VE HEARD YOUR OFFICE IS HARD TO GET A HOLD OF....WHAT'S THE DEAL?

As you can imagine, there are many people we work with and many who seek our help. Low overhead means limited staffing . . . when you call us, you DON't get a "call center," you get us! So, when we're talking to someone, the phone still rings with your call and the voicemail picks up....it's simply a numbers game. So, even though we try very, very hard to get back to folks promptly, sometimes it takes a day or two for us to catch up....so we always thank you in advance for your patience."

pcgumshoe · 05-31-2007, 12:00 PM

Thanks all for the replies.

My insurance is pretty much a slam dunk in 80% of the states - I'm disabled and have Medicare so there isn't a prior-authorization required. If I meet the criteria, I get the procedure, so my first foray into dealing with difficult doctors was in my home state, and believe me I was very nice.

The other issue that upsets me is that they know that I'm disabled and prone to appear nervous, moody and resentful. So, what I don't understand (and I believe qualifies as discrimination) is why they would say, "Okay, you pass!" then when I get upset because three people didn't do their jobs right (after 30-45 days in their hands) they are "shocked" and "surprised" that I would act this way?

Imagine if I went to a psychologists office and said, "I've been diagnosed bipolar, PTSD, and I tend to exhibit frustration, anxiety, and irritability." Then, a few weeks later, after I had been nice for the first couple of sessions, I "show" my bad side. Then that doctor is shocked, surprised and scared. Isn't that dumb?!

You know the catch 22 here? If I were six inches shorter and about 130 LBs smaller, it would be like a Chihuahua instead of a Saint Bernard!

I can also appreciate about the Lawyer, but it is frustrating, I just wish I could handle it here, legal and otherwise. I guess I'm a bit of a control freak.

lefty · 05-31-2007, 06:08 PM

You are between a rock and a hard place.

I just talked with an older woman at my support group meeting last Tuesday who ended up being self-pay rather than using her medicare benefit because the waiting was too long with medicare. She said that they only do so many medicare patients per month because the actual payment from medicare is quite a bit less than other sources and doesn't have as big of a profit margin.

I also do not tolerate ineptness very well. However, I try to believe that the people I am counting on to help me on my way are very busy with workload. Therefore, they are doing the best that they can under the circumstances.

I think Musicalmomma hit the nail on the head in her response. My first thought after reading your post was; "that you attract more bears with honey", and that your outspokenness could very well be contributing to the cause of any delays. Getting the psych evaluation is pretty much par for the course for most WLS candidates. It is to determine if you (we) have any unaddressed mental issues. You sound as though you are receiving treatment for your issues, but now there is a question as to whether or not your treatment is adequate because of your impatience and aggressiveness. They have an obligation to make sure that you are competent enough to make the decision to have WLS and be able to handle the stressors involved with the lifetime commitment.

I don't know about you, but I prefer to work with pleasant people. Maybe they are taking that into consideration, too.

Outside of displaying patience and understanding, the only other suggestion I have is to gather the various reports required and send them in yourself. Try to remember that you are a passenger, not the driver. NO ONE likes a backseat driver.

Best wishes to you.

pcgumshoe · 05-31-2007, 08:22 PM

Thank you lefty, you brought my attention to something I knew, but failed to mention.

You said, "It is to determine if you (we) have any unaddressed mental issues. You sound as though you are receiving treatment for your issues, but now there is a question as to whether or not your treatment is adequate because of your impatience and aggressiveness."

I completely agree with you. And to be honest, and I told them this, my mental health treatment is NOT adequate. This will also answer a question I failed to answer earlier, "What is E.C.T." by annieM.
I am drug resistant. In the past thirteen years, I've been on over 30 different types of psychotropic medications to treat my various conditions. At present, I only take Valium as needed. That usually means when I'm about to leave the house and go out among other people (but obviously, I should take it both when I leave physically and vocally!). The Valium is to calm me down and allow me to be slightly desensitized to my surroundings, however, if I'm going to be somewhere that alcohol is available, that works just as well.

I've complied with the requests of my doctors to reduce the amount of Valium, and I've cut caffeine and sugar. I'm also trying to excercise more. I'm truly committed to this.

Now, E.C.T. was my last attempt to abate my condition. E.C.T. stands for Electro-Convulsive Therapy (often called Shock Therapy, Kitty Dukakis just did a book about it called SHOCK). It is the last defense against depression and severe mania (I have the former with bouts of hypo-mania or not full blown mania in mixed episodes). I endured 46 E.C.T. treatments. What they did is four times a week, I reported to a hospital, they put me under general anesthesia and they pumped enough electricity to power a 60 watt light bulb through my brain to cause a seizure (convulsion) that is controlled with muscle relaxers. The goal is to kill the depression.

The E.C.T. is the last treatment available to me in the U.S.A. (there's one in Spain, but it isn't here yet and it uses magnets). When I was done, I was more depressed than when I started, why? Because I had failed at everything and thought I would never get better.

About a week after my last treatment (January 07) I conducted a personal inventory. I said, "What is otherwise wrong with me that could ALSO cause depression?" I came up with this list: 1) Bipolar, 2) Poor Self-Esteem, 3) Obese, 4) Sleep Apnea, and 5) Poor sleep when I do sleep. All of these things cause or contribute to depression.

Now I know that when I lose weight, I feel better about myself. From January 2004 to December 2004, I lost 60 LBs on a low carb diet. It was great, my self-esteem shot through the roof and I felt great. Then something happened at a retail store where I was traumatized, I then regained all the weight and then some. I got down to 235 LBs on Low Carb and although I was still obese, it helped me.

When I opted to challenge those PHYSICAL things that contribute to my depression which exhibits itself as aggression and impatience, I was seeking more "adequate treatment" of my mental health condition.

What does this all mean? Lap Band is part of the treatment I need to better my disabling mental health condition. With Lap Band I will be able to knock out some of my sleep problems, most of the sleep apnea, a majority of the low self-esteem, and maybe get back to that 235 or lower. ALL that would give me a better chance of challenging the ONLY remaining cause of my depression, bipolar. Then, and only then, might the medications and/or other treatments work.

I'm not looking at this as an elective surgery, this is a necessary step to better and adequate treatment. You'd be surprised how poorly us mentally disabled people have it in comparison to us obese people! Trust me! I fought for that too, and have partially won!

Lastly, with regards to the woman who is on hold because of the number of Medicare patients, tell her she can go ANYWHERE that Medicare is accepted. She might want to check another Center of Excellence near by and confirm ahead of time whether they have a LIMIT on Medicare patients... my understanding is they are discouraged from doing that, but I know how Medicare works too. I had a $16,000 surgery (unnecessarily) to fix my deviated septum to help me stop snoring (my sleep doctor said it was a waste!). When the bill got paid by Medicare, it was about $1,600. So I know!

barbara465 · 05-31-2007, 09:03 PM

I've read your trials with much interest and really feel for your plight. I want to add something that you might not like. I want you to know that the Lap Band journey is not a cake walk. This is not easy. There are many, many frustrating moments along the way. Support, people interaction, is critical to some of your success. Even being a good bandster means that you won't be problem free. I wanted to point this out because Lap Band surgery is not the entire solution. There are many components that go into successful results. even then, the results may be slower or more complicated than you imagined. Please think of all the ramifications of the surgery with a clear head and as unemotionally as possible.

I wish you luck on whatever you decide. Insurance companies make it very difficult for all of us. Mine paid, but I did have to endure some very frustrating moments. :)

green · 06-01-2007, 02:36 PM

It is a pity that you are drug resistant because it sounds as though you have caused some of the additional delays through your own aggressive attitude. I am sympathetic to your situation of course; incompetence is annoying and you are understandably anxious to get your life on track. The problem is that you have been dealing with and must continue to deal with a number of beaurocracies, and this includes busy and, generally speaking, underpaid and overworked office clerical staff. These are the people who do the paper work and answer the phones in all offices, including those of your doctors. These are also the people who can screw you if you don't make nice with them. It sounds to me that it might be the right time to take a bunch of anti-anxietants, let 'em take effect, and then get on the phone and do some major grovelling to the folks who answer the phones and handle the paperwork. Explain to them that you have a psychiatric condition which causes you to behave badly and that you are very, very sorry to have exposed them to your rage.
By the way, I truly am sympathetic. I have anger issues, too. Fortunately I respond well to pharmaceuticals.
In the meantime, eat lots of protein and stay away from the sugars. Sugars are not only bad for the figure, they are also bad for the brains of cranky folk.;)

GayleTX · 06-01-2007, 07:48 PM

There are many kinds of intelligences.....the current thinking puts them in seven basic categories. Very few of us have all seven. The kind that has been most highly regarded over the years is, of course, the kind that the psychologists can measure.....the verbal kind. Those people have a tendency to give others the impression they are superior to others and often have poor social skills. They then react by thinking their problems are because of other people's stupidity. Too bad that their strength is often downfall and is the very thing that makes life difficult for them in spite of their IQ.

Here are the Seven Multiple Intelligences

Verbal -the ability to use words
Visual -the ability to see things in your mind
Physical -the ability to use your body well
Musical -the ability to understand and use music
Mathematical & logical -the ability to apply logic to systems and numbers
Introspective -the ability to understand thoughts and feelings in yourself
Interpersonal -the ability to relate well to others, people smarts.

IndioGirl55 · 06-01-2007, 10:13 PM

Quote:

Originally Posted by GayleTX

There are many kinds of intelligences.....the current thinking puts them in seven basic categories. Very few of us have all seven. The kind that has been most highly regarded over the years is, of course, the kind that the psychologists can measure.....the verbal kind. Those people have a tendency to give others the impression they are superior to others and often have poor social skills. They then react by thinking their problems are because of other people's stupidity. Too bad that their strength is often downfall and is the very thing that makes life difficult for them in spite of their IQ.

Here are the Seven Multiple Intelligences

Verbal -the ability to use words
Visual -the ability to see things in your mind
Physical -the ability to use your body well
Musical -the ability to understand and use music
Mathematical & logical -the ability to apply logic to systems and numbers
Introspective -the ability to understand thoughts and feelings in yourself
Interpersonal -the ability to relate well to others, people smarts.

NOW YOU ARE ONE INTELLIGENT WOMEN - SO VERY WELL SAID :clap2:

pcgumshoe · 06-01-2007, 11:15 PM

GayleTX wrote: "There are many kinds of intelligences.....the current thinking puts them in seven basic categories."

Sorry, you are incorrect, it is not the "current thinking" but it is another form of thought on the subject, although it is not as widely accepted as you may have been led to believe.

Although you are correct with regards to multiple intelligence scales, when a group considers a person's "I.Q." They are referring, generally, to Full Scale I.Q.

My psychologist refers to three scales: Verbal, Performance and Full Scale.

My quoted I.Q. was the full scale: 126
My verbal was 122 and my performance was 129.

These scores are determined accordingly:
Verbal Scales are based on:
Vocabulary
Similarities
Arithmetic
Digit Span
Information
Comprehension

Performance Scales are based on:
Picture Completion
Digit Symbol-Coding
Block Design
Matrix Reasoning
Picture Arrangement

The test was the Wechsler Adult Intelligence Scale III. During the course of my exam, however, I noted that the test seemed to be "old." To which the doctor said, "No, it's relatively new." After a few more questions, I indicated that the test was at least 10 years old. He turned to the copyright section that indicated 1997.

The I.Q. that GayleTX is referring to is Gardner's opposing view to traditional I.Q. Additionally, Gardner has still failed to "define" intelligence.

These are Gardner's actual seven plus three others:
Linguistic: Has to do with words, spoken or written
Logic-Mathematical: Logic, abstractions, inductive and deductive reasoning
Spatial: Vision and spatial judgment
Bodily-kinesthetic: Movement and doing
Musical: Rhythm, music, and hearing
Naturalistic: Nature, nurturing, and classification
Interpersonal: interactions with others
Intrapersonal: having to do with oneself

And Gardner studied spiritual, existential and moral.

Had I been evaluated under this lessor respected I.Q. system, clearly I would have scored poorly in the interpersonal area. I wouldn't doubt that for a heartbeat.

My I.Q, I'll be the first to say, does cause me problems. It is my understanding that some have tried to categorize Einstein under these 7 areas and he was found to be retarded in many of them, social being one of them!

I guess Gayle was just trying to point out that I am at fault for this. That's partially true, however, the A.D.A. says that people must make accommodations for persons with disabilities, even hidden ones, that are reasonable. If they knew I was prone to becoming frustrated, irritable, and anxious, AND they accepted it, then they were required to accommodate me. It should be stressed that before I struggled with the ineptness that caused this friction between me and the doctors, I had passed the multi-disciplinary review committee. In other words, I was okay to have the surgery.

One other thing, the use of this word "anger" is misplaced. "Anger" is the appearance of a conglomeration of emotions. For example, what might make people think that I "appear angry" verses another person may be different. Depression, irritability, frustration and anxiety may be inside me and give the appearance of "anger." In another person, "anger" might be disgust, repulsion and bitterness. This might not be important to you, but I like to be specific so that I can identify the problem. We all walk around with the stigma of being overweight. People look at us and say, "Gee, you're fat, you should exercise more and eat less." And it isn't always that simple, is it? Neither are my emotional issues that are involuntary and innate (That means I was born with it - since birth I've had this).

pcgumshoe · 06-01-2007, 11:23 PM

Oh, and Gayle, just to support what you said, my signature on my personal email account says, "I see stupid people..." My play off the 1999 movie The Sixth Sense.

I guess now I just need to add, "...and they don't know they are stupid." However, if I did that, I'd be bowing to your belief.

I don't know where you fit in the intelligence spectrum, but if you are in the upper levels and THINK that you are average, it is very hard to understand why so many people do such stupid things.

I am sure that you can't understand why I would do something as stupid as described above, but that's because you'd have to assume that I'm on the same interpersonal level as you. I guess I'm not...