In response to the complaint about our business with ID # [redacted] below will hopefully provide the information requested including all facts and documentation performed by witnesses and all involved. Bedford Family Urgent Care, Inc. was founded and opened to the community on March 15, 2005,...
over 10 years ago (just to clarify that we have not been open for 15 years). The claimant, the former patient who initiated this complaint, has been a patient at this facility since April 2005 (10 years and 8 months). Our office policies and procedures have not changed over the years regarding our prescribing procedures which are dictated to us by our governmental bodies, such as the Drug Enforcement Administration (D.E.A.) and the state of Virginia Board of Medicine. As dictated by Code of Virginia 54.1-3303, as healthcare providers and prescribers, we must document a history and physical to accompany any prescriptions we provide to our patients. This is also for the safety of our patients so we do not inadequately treat our patients or cause harm to our patient. In addition, if a provider is found to have done harm in a negligent manner due to providing suboptimal health care, our D.E.A. licenses and state licenses may be under disciplinary action including revocation of our license. On Tuesday, December 8, 2015, patient called a total of four times requesting flagyl which is an antimicrobial (antibiotic type medication) to be called in to her pharmacy. With the first phone call, as was documented, staff member # 1 advised the patient that it is a medication that will require an office visit. The patient did not want to be seen and insisted that the physician told her that “she could just call the office for a prescription if she needed it”(as stated per documentations from staff member #2). The patient was put on hold and the staff member # 2 advised me of the situation and I advised,per office policy, our office cannot just call in an antimicrobial without having a documented visit. Staff member # 2 then advised the patient an office visit was required to have the documentation in an office visit and “that we just cannot call in an antibiotic” per staff member # 2. The patient advised staff member # 2 that “she has 3 appointments scheduled and she cannot afford to miss anymore work” and then the patient was advised it is office policy that she will need to be seen to receive this medication. She was advised that she can be a walk-in for her acute condition. She then asked for the physician to call her back but was advised she can leave a message if she would like but it is not guaranteed there will be a return phone call and the patient hung up on staff member # 2. Second phone call: The patient then called back stating she wanted a refill on her Flagyl, the antimicrobial/antibiotic. Staff member # 2 picked up the phone and advised the patient that she can review this medication with the physician on her upcoming appointment on 12/18/15 or she can do a walk-in office visit today. The patient began raising her voice at staff member # 2 stating that she is having problems with colitis and she could end up in the hospital. I had talked with the physician by this time, in between her scheduled appointments, and the physician confirmed that, due to Virginia regulations, the patient will need to be seen in an office visit to receive that medication and she had not advised the patient she could call it in for her without an office visit. I relayed this information to staff member # 2. Staff member # 2 then picked up the phone and informed the patient again of the office policy and what I had informed her. Then, verbatim from staff member # 2 documentation, the patient “interrupted me and stated she doesn’t care who I discussed this with”. The patient was, once again,informed that she can walk in to be seen if she is having issues. She began asking about the physician’s schedule for Wednesday, December 9th, which was completely booked, and we, again, advised the patient if she was sick or injured, she could walk-in. I am typically the main healthcare provider for the majority of walk-in and urgent care patients while the physician sees all the routine checks and primary care patients with fewer urgent care patients. If the urgent care patient is one of the physician’s regular patients and may need a continuance of care, I may either evaluate the patient first and confer with the physician, or I will advise staff to prepare the walk-in patient to see the physician. This depends on the circumstances and the schedule. The patient wanted a guarantee to see the physician on 12/9/15 which could not be guaranteed as a walk-in. At this point, staff member # 2 reported that the patient began yelling again and demanded that she will be guaranteed to see the physician. The patient became very belligerent on the phone so the staff member # 2 ended the phone call. Approximately 10 minutes later, the patient called back and requested for 2 different staff members and staff member # 2 put the patient on hold to seek out recommendations. I advised staff member # 2 again that I already checked with the physician and she recommends an office visit and the patient can walk in today if she would like to be seen today (or tomorrow if she prefers). I advised staff member # 2 that if she does not accept this option, there are no other options since an office visit for documentation to prescribe a medication is required by Virginia State regulations. I also advised staff member # 2 that, due to the belligerence, the returning phone calls by the patient, the disruption and disregard to office policy by the patient, this is considered harassment and non-compliance. If she continues to call and harass the office, we may need to advise the patient that this indeed is considered harassment and we may need to contact the police for further assistance. Apparently, before staff member # 2 could return to the phone, the patient had hung up. The patient then called back 2-3 minutes later accusing staff member # 2 of leaving her on hold and would not pick up the phone. Staff member # 1 who picked up the phone on this 4th phone call, then advised the patient that someone would return her phone call.A short time later approximately 2:40 pm, the patient showed up in the office demanding to speak with the physician and declined to be seen as a walk-in at that time. She advised the front desk staff that she wasn’t leaving until she talked with the physician but still denied to be a walk-in. The patient was advised to take a seat and staff member # 1 would relay the message. The patient then stated she would wait “as long as it takes – if it takes all day” per documentation of staff member # 1. I was advised of the situation and as we were discussing the situation in the front desk area with windows and doors closed, the patient came to the front desk window knocking on it and noting she wanted to be included in the conversation. At that point, I went to the front desk window and advised the patient that to receive the requested medication, it will require a documented office visit and she can be a walk-in for it. She told me that she comes here once a month and that the physician told her, on a previous visit, just to call her when she needs something. I informed her that is not how it works and that I had already discussed this situation with the physician and she said the patient was advised to come in to be seen if there were any problems. The patient disagreed with this and went on to note that no other doctors office does this the way we do, so I advised her she is welcome to go to one of those other doctors’ offices but an office visit is required to document the reason we are prescribing the medication along with a history and physical. The patient stated she will find another doctor at that point. I advised staff member # 3 to provide the patient with a medical records release form. She continued to say she was not going to leave until she speaks with the physician. I advised that she can wait but the physician had to leave in 15 minutes due to a prior commitment. The patient stated she will wait by her car then. With this stalking-like behavior, I advised at that time, that I will need to call the police and I asked her to leave the premises, but then parked in a parking lot in the back of the office near where the physician parks.I contacted the police who responded in a timely manner to the back of the building where the physician parks. One officer came in to speak with the staff and to get our statements and the other officer went to the patient’s car, where she was sitting watching for the physician to walk out, to get the patient’s statement. We provided our statement of the events that took place as noted above. I advised the officer that, on the basis of harassment of the office staff and stalking of the physician, the patient will be banned from the premises to eliminate any further issues. The physician did leave to her prior commitment while both officers were talking to the patient in the parking lot. She stopped by their location while in her car and spoke with the patient and officers for approximately 10 minutes. The physician informed me that she had advised the patient that a documented office visit was required to receive that medication. The physician called me while she was with the officers and the patient. She asked if we should see her tomorrow 12/9/15 for that medication. I advised her we should not as I had already advised the officer that the patient is banned from the premises due to harassment and stalking. I also I advised we already offered her a walk-in visit with every phone call she made as well as when she arrived to the office, and she refused every time. The physician did not realize that the patient was being banned from the office premises for her previous behavior and agreed that she should not be seen. The physician left to go to her prior commitment. The physician called me after she had left the parking lot and advised me of what was discussed. The patient noted staff member # 2 was rude and that staff member # 3 “threw” a medical records release form at her. Due to the position of my desk, I could hear each time staff member # 2 talked to the patient during all phone calls, and did not pick up on any “rude” misconduct by staff member # 2. I did hear staff member # 2 repeatedly tell the patient she would need to be seen to receive an antibiotic. Staff member # 2 kept me updated as well after each phone conversation (and during each phone call as she had to put her on hold a couple of times to let me know what was going on and to find out recommendations). I did not witness the transfer of the medical records release form from staff member # 3 to the patient, but there were two or three other staff members, including staff member # 1 and staff member # 2, noting that staff member # 3 did not “throw” the form at the patient. I asked if the patient received it with any poor attitude on the patient’s part, and all staff members present for the exchange stated the patient did not receive it poorly (e.g. jerking the paper out of staff member # 3’s hands). They stated the patient received the form well and staff member # 1 noted she received the paper from staff member # 3 and folded it. One of the officers returned to the office to receive a 2nd medical records release form. It was provided to the officer to give to the patient. In the next couple of days, the former patient was “friend requesting” staff members repeatedly on Facebook. One staff member, after so many friend requests from the former patient finally approved it. Apparently, the former patient must have wanted us to see a slanderous review on the office Facebook review section. Her review left out key points such as her stalking behavior before I stated I would call the police. She put remarks on the review making the officers she dealt with appear biased in the situation. Therefore, I went to the police station to consult with an officer regarding this review. The officer noted there is nothing needing to be done in regards to the slanderous remarks, but I did advise that she put statements by the officers who were present for the encounter that may show those officers being bias in the community in case he wanted to look at it. The officer also advised not to worry about what she had put on Facebook because we have a great reputation in the community. I reviewed the Facebook accounts for the office, which I didn’t realize we had 4 of them. I wasn’t sure how we had Facebook pages for the office and one of them had about 8-10 reviews on it, another had 1 review on it, and the other two did not have any reviews on them. Since we did not initiate the Facebook pages and since we do not need the Facebook pages, I deleted them. I personally do not use social media and I do not believe we need social media for advertising in this small community. We receive new patients frequently due to either word-of-mouth or their excellent experience here. We are a private practice without the need for time limits on our office visits with our patients. We provide quality care without the corporate demands; therefore we do not have limitations of time to spend with our patients as other providers may have while working at a major corporation. As far as the patient’s statement, her facts are quite askew. As I have already noted, we have been in business for 10 years, 10 months now. The patient has been a patient here since 1 month after we opened and had continued coming here without complaint. She had even seen me on multiple occasions and I treat patients well. Yes, I have had to dismiss patients for prescription drug misuse or illicit drug use. I have had to dismiss patients for harassment, frequent non-compliance, or threatening to get a gun and shoot us after his non-compliance with blood pressure medication. However, these are legitimate reasons for dismissing patients from the practice. Stalking and harassment was the reason for this patient. We never had any problems out of the patient in the 10 years, 8 months that she was a patient at our facility, so I am not sure why she was so unreasonable and irrational on that day of 12/8/15.The “rude” claim may be her opinion but, from what I observed, staff member # 2 kept informing her that she will need to be seen and that she could walk in that day if she wanted to so we can have documentation and the patient, apparently, did not like that answer, but staff member # 2 continued to advise her of this procedure and staff member # 2 remained consistent. The claim that we were “laughing and making fun of the fact I was there” is false as we were trying to figure out how else to tell her that she will need to be seen to receive the medication. This was absolutely no fun matter and, frankly, was very frustrating to all of us that she would not agree to be seen to get the medication and that she was harassing the office staff. Otherwise, if we were truly “laughing and making fun” of her in the front desk area, she would have posted it in her Facebook review and all over her personal Facebook prior to this claim dated 12/22/15(I did keep her slanderous Facebook reviews and documentation if you need further documentation). She also never told us that if we “were going to act unprofessional and childish leave the window open so I can defend myself.” What really happened was that she knocked on the window and said she wanted to be included in the conversation. Regarding the form being “thrown” at her, as I mentioned before, there were 2 or 3 witnesses to the fact that staff member # 4 did not throw the form at her. She also stated in her claim that I “yelled” and I never yell during incidents such as this. I may have talked firmly, but again, maybe that was in her opinion. As far as her “desired settlement”, she can continue to slander the office, but the office runs smoother without non-compliant patients. We cannot bend the rules for anyone or it is our license on the line as well as the patient’s life, which is most important. Her illness was not “life threatening” or we would have sent her to the Emergency Department for immediate care. If she thought it was “life threatening”, she should have gone to the Emergency Department anyways. She never stated that she was under distress and she would have wanted to be seen if she was under any kind of distress. She did not appear under any distress at all, just angry and demanding during my encounter with her at the front desk window. All “life threatening” illnesses always need to be evaluated in the Emergency Department and not in a primary care/urgent care facility, which is our specialty. We offered to see her that day as a walk-in, and if it was “life threatening,” we could have initiated the evaluation and called the ambulance for her. That is what we do for all possible “life threatening” conditions. Again, the patient refused to be seen multiple times during repeated phone calls and when she walked in the office. As far as her statement regarding her ras “complacent,” I am not sure what she means with “complacent” in her complaint as I cannot find a fit with her other context, so I do not have a response to that statement. However, I believe her perception may be off kilter and I am not sure why, but I hope she can find her sense of peace and balance again. Since I wrote the above Revdex.com response to the complaint, I have received a complaint against me with Department of Health Professions (DHP) by this same claimant/patient which was dated 12/8/15, same date of the event. She embellished and altered the story compared to other reports from her own words. The patient reported to the state board the following:She stated that I “became irate” with her when she “was trying to get a ‘refill’ on a prescription for Flagyll [sic].” She notes that she has been given “Flagyll [sic] twice one time being a few weeks ago.” She noted to the board of medicine that she “called the office and” staff member # 2 noted above “was rude on the phone so I hung [sic] and called back and asked for someone else.” Staff member # 2 “took the phone back and started in on me again and hung up on me.” The patient goes on noting she “called a third time and talked to” staff member # 1 “who said the office manager…would call back in a ‘few minutes’. I went to a training for work and hadn’t heard back so I went there at 230 when my training was over. I asked to speak to” the physician “and was told she was leaving at 300. I said fine I can wait.” The patient then noted that I “busted through the door yelling at me about policy/ [sic] I told her that other doctors office didn’t have that policy and she told me maybe I should find another office and one of her staff threw a paper at me to move my records. I said I am talking to your mother if I have to wait by her car. She then told me to leave the premises because she was calling the cops. She did in fact call the cops and lied telling them there was a fight/disturbance. I left the building went to my car and sat in the bank parking lot. There were 3 officers that showed up.” She claimed that I “told the officers” the physician “was not in the office she had gone to the ER to work. When in fact she was still there.” The physician “stopped to talk to me, and they asked her if she could see [sic] the next day. She said yes. She called the office from her cell phone to make me an appointment and” the patient stated that I “told her no. Enough is enough and said I am no longer allowed on the premises.” The patient then notes “not only that my meds are running out and I had the 3 appointments back to back to back. One was for my physical and to refill meds. I am now forced to find another proider [sic] after 15 years with this one and no warning. Just a rude arrogant PA stomping her feet like a 2 yr old.” For one, as mentioned above, Flagyl is not meant to a medication to be “refilled”, especially without an office visit or a reason for the medication since it is an antimicrobial/antibiotic. For tick-borne diseases such as Lyme and Rocky Mountain Spotted Fever (RMSF), what Flagyl is used for is to break up resistance barriers called biofilm that the bacteria form to defend itself from antibiotic. We usually provide a course of Flagyl for 1 week prior to a stronger or different antibiotic if we are still battling the infection. It could have waited until her 12/18/15 appointment in that case. If she was having acute symptoms (such as an acute flare of “colitis”), she would have to be seen to obtain a history and examination according to Virginia Law 54.1-3303. For other offices, I hope they are abiding by Virginia state law as well. If not, their license may be in question. As far as the “rude” claims, I did not observe any from any staff member, but, as I said before, it may just be how she perceived the events that unfolded and, she obviously embellishes stories and fabricates or alters events as time has elapsed since 12/8/15. As far as “yelling”, I do not yell. I do not stomp my feet like a 2 year old. I am a 38 year old, 10+ year practicing Physician Assistant (P.A.) that is soft-spoken and does not like vulgar language (it makes me uncomfortable). All who know me have,most likely, never heard me yell. I do have to talk firmly in order to appear confident practicing as a Physician Assistant and to operate as an effective Office Manager. I try and treat employees well and maintain a balance of not letting them walk all over the physician and me. So “yelling” is quite exaggerated by the patient. And yes, I did call the police. The patient was already harassing the office and I have had to call the police on maybe 1 or 2 patients in the past 10+ years due to harassment of the office. The last straw, per se, was when the patient was stalking the physician and stated she was going to wait by the physician’s car which is parked in the back of the building and to continue to be non-compliant with office policies that are the same for all of our patients. The stalking definitely went above my comfort level on 12/8/15. So yes, I called the police. Two officers arrived (not 3, but a 3rd showed a while later after the physician already had left to go to her prior commitment), and as I stated before, one came into the office to speak to us, and the other went to the parking lot to speak to the patient. The patient was never in the office when the officer was speaking with us, and the physician was present while the officer was speaking with us, so I am not sure how she came up with the idea that I told the police that the physician was not present. Regarding the physician asking me about seeing the patient the next day on 12/9/15, the physician did not realize that the patient was being banned from the premises due to her harassment of office staff and stalking the physician. When I advised her of this when the physician called me, she agreed and she noted she did not realize that the patient was being banned. The patient then answered a question on the DHP complaint form: Did the patient/client sustain any injury or harm as a result of the licensee’s actions? If yes, please explain. The patient noted that she still has “no medications to help me with my stomach” and that she is “left to find another provider after seeing my doctor for almost 15 years. I love the doctor.” The office has only been open for business since March 15, 2005. As far as finding a new physician, according to her Facebook postings, patient saw her “new physician” on 12/9/15, so she does have a new physician now (we received a medical records release form dated on 12/14/15), and I hope her behavior stays in check with the new physician. Health care workers do not deserve the stress and frustration with harassment and stalking.She also noted in the DHP complaint that her “daughter in law listened to the phone call that was on speaker phone when” staff member # 2 “was rude and hung on me.” See below for the discrepancy regarding this comment.The patient’s husband also is still a patient here and has not switched his medical records to a new healthcare provider. He is a very pleasant gentleman and has a future appointment March 25th which was scheduled when he was here 12/18/15. When he was last seen here 12/18/15, he brought in a letter addressed to the physician from the patient, his wife. In her letter she stated “your staff have always been rude”. However, she had never complained before and had seen me many, many times and had continued coming here for the 10 years and 8 months (4/2005 – 12/2015) that she has been a patient here. She also stated in this letter that staff member # 2 “was rude and yelling so I hung up on her. Little does she know she was on speaker phone and half my office heard her and encouraged me to call back to talk to someone else.” As noted in the DHP complaint, the patient stated on 12/8 that it was her “daughter-in-law” that was on speaker phone and “listened to the phone call.” She had also noted on the DHP complaint, that she had training at work and when the training was over, she came to this office at 230. There is quite a bit of inconsistency with her stories. She did note in the end of the letter that she has a new provider now and that she is being referred to a specialist for her RMSF. That is a good end result for her if she is happy with her new provider and receives the care that she needs. That is what matters most. Regarding this entire situation, it has caused a lot of distress to staff, my mother - the physician, and myself. I think the patient is vindictive in nature and we believe some other issue in her personal life has made her project her anger onto us when we were following the laws and regulations of the state and federal governing bodies. I would ask and will pursue some means of ending her acts of vengeance against our office as we have endured her slandering, defamation of character, fabrications and exaggerations, harassment, and stalking behaviors long enough. All she had to do was walk-in to be evaluated for her symptoms so we may prescribe Flagyl, if it was appropriate, or other treatments to treat her condition.I have kept all documentation and evidence if you would require any articles for further investigation. Please feel free to call me if you have any further questions or concerns [redacted]Sincerely,[redacted], PA-COFFICE MANAGER
I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
Wow. Obviously this is a she said, she said kind of problem. I know the facts. Ms [redacted] knows the facts. As well as her staff. I will allow the Virginia Department of Health Professionals to do their job. I will relay any further outcomes as they happen. [redacted]
In response to the complaint about our business with ID # [redacted] below will hopefully provide the information requested including all facts and documentation performed by witnesses and all involved. Bedford Family Urgent Care, Inc. was founded and opened to the community on March 15, 2005,...
over 10 years ago (just to clarify that we have not been open for 15 years). The claimant, the former patient who initiated this complaint, has been a patient at this facility since April 2005 (10 years and 8 months). Our office policies and procedures have not changed over the years regarding our prescribing procedures which are dictated to us by our governmental bodies, such as the Drug Enforcement Administration (D.E.A.) and the state of Virginia Board of Medicine. As dictated by Code of Virginia 54.1-3303, as healthcare providers and prescribers, we must document a history and physical to accompany any prescriptions we provide to our patients. This is also for the safety of our patients so we do not inadequately treat our patients or cause harm to our patient. In addition, if a provider is found to have done harm in a negligent manner due to providing suboptimal health care, our D.E.A. licenses and state licenses may be under disciplinary action including revocation of our license. On Tuesday, December 8, 2015, patient called a total of four times requesting flagyl which is an antimicrobial (antibiotic type medication) to be called in to her pharmacy. With the first phone call, as was documented, staff member # 1 advised the patient that it is a medication that will require an office visit. The patient did not want to be seen and insisted that the physician told her that “she could just call the office for a prescription if she needed it”(as stated per documentations from staff member #2). The patient was put on hold and the staff member # 2 advised me of the situation and I advised,per office policy, our office cannot just call in an antimicrobial without having a documented visit. Staff member # 2 then advised the patient an office visit was required to have the documentation in an office visit and “that we just cannot call in an antibiotic” per staff member # 2. The patient advised staff member # 2 that “she has 3 appointments scheduled and she cannot afford to miss anymore work” and then the patient was advised it is office policy that she will need to be seen to receive this medication. She was advised that she can be a walk-in for her acute condition. She then asked for the physician to call her back but was advised she can leave a message if she would like but it is not guaranteed there will be a return phone call and the patient hung up on staff member # 2. Second phone call: The patient then called back stating she wanted a refill on her Flagyl, the antimicrobial/antibiotic. Staff member # 2 picked up the phone and advised the patient that she can review this medication with the physician on her upcoming appointment on 12/18/15 or she can do a walk-in office visit today. The patient began raising her voice at staff member # 2 stating that she is having problems with colitis and she could end up in the hospital. I had talked with the physician by this time, in between her scheduled appointments, and the physician confirmed that, due to Virginia regulations, the patient will need to be seen in an office visit to receive that medication and she had not advised the patient she could call it in for her without an office visit. I relayed this information to staff member # 2. Staff member # 2 then picked up the phone and informed the patient again of the office policy and what I had informed her. Then, verbatim from staff member # 2 documentation, the patient “interrupted me and stated she doesn’t care who I discussed this with”. The patient was, once again,informed that she can walk in to be seen if she is having issues. She began asking about the physician’s schedule for Wednesday, December 9th, which was completely booked, and we, again, advised the patient if she was sick or injured, she could walk-in. I am typically the main healthcare provider for the majority of walk-in and urgent care patients while the physician sees all the routine checks and primary care patients with fewer urgent care patients. If the urgent care patient is one of the physician’s regular patients and may need a continuance of care, I may either evaluate the patient first and confer with the physician, or I will advise staff to prepare the walk-in patient to see the physician. This depends on the circumstances and the schedule. The patient wanted a guarantee to see the physician on 12/9/15 which could not be guaranteed as a walk-in. At this point, staff member # 2 reported that the patient began yelling again and demanded that she will be guaranteed to see the physician. The patient became very belligerent on the phone so the staff member # 2 ended the phone call. Approximately 10 minutes later, the patient called back and requested for 2 different staff members and staff member # 2 put the patient on hold to seek out recommendations. I advised staff member # 2 again that I already checked with the physician and she recommends an office visit and the patient can walk in today if she would like to be seen today (or tomorrow if she prefers). I advised staff member # 2 that if she does not accept this option, there are no other options since an office visit for documentation to prescribe a medication is required by Virginia State regulations. I also advised staff member # 2 that, due to the belligerence, the returning phone calls by the patient, the disruption and disregard to office policy by the patient, this is considered harassment and non-compliance. If she continues to call and harass the office, we may need to advise the patient that this indeed is considered harassment and we may need to contact the police for further assistance. Apparently, before staff member # 2 could return to the phone, the patient had hung up. The patient then called back 2-3 minutes later accusing staff member # 2 of leaving her on hold and would not pick up the phone. Staff member # 1 who picked up the phone on this 4th phone call, then advised the patient that someone would return her phone call.A short time later approximately 2:40 pm, the patient showed up in the office demanding to speak with the physician and declined to be seen as a walk-in at that time. She advised the front desk staff that she wasn’t leaving until she talked with the physician but still denied to be a walk-in. The patient was advised to take a seat and staff member # 1 would relay the message. The patient then stated she would wait “as long as it takes – if it takes all day” per documentation of staff member # 1. I was advised of the situation and as we were discussing the situation in the front desk area with windows and doors closed, the patient came to the front desk window knocking on it and noting she wanted to be included in the conversation. At that point, I went to the front desk window and advised the patient that to receive the requested medication, it will require a documented office visit and she can be a walk-in for it. She told me that she comes here once a month and that the physician told her, on a previous visit, just to call her when she needs something. I informed her that is not how it works and that I had already discussed this situation with the physician and she said the patient was advised to come in to be seen if there were any problems. The patient disagreed with this and went on to note that no other doctors office does this the way we do, so I advised her she is welcome to go to one of those other doctors’ offices but an office visit is required to document the reason we are prescribing the medication along with a history and physical. The patient stated she will find another doctor at that point. I advised staff member # 3 to provide the patient with a medical records release form. She continued to say she was not going to leave until she speaks with the physician. I advised that she can wait but the physician had to leave in 15 minutes due to a prior commitment. The patient stated she will wait by her car then. With this stalking-like behavior, I advised at that time, that I will need to call the police and I asked her to leave the premises, but then parked in a parking lot in the back of the office near where the physician parks.I contacted the police who responded in a timely manner to the back of the building where the physician parks. One officer came in to speak with the staff and to get our statements and the other officer went to the patient’s car, where she was sitting watching for the physician to walk out, to get the patient’s statement. We provided our statement of the events that took place as noted above. I advised the officer that, on the basis of harassment of the office staff and stalking of the physician, the patient will be banned from the premises to eliminate any further issues. The physician did leave to her prior commitment while both officers were talking to the patient in the parking lot. She stopped by their location while in her car and spoke with the patient and officers for approximately 10 minutes. The physician informed me that she had advised the patient that a documented office visit was required to receive that medication. The physician called me while she was with the officers and the patient. She asked if we should see her tomorrow 12/9/15 for that medication. I advised her we should not as I had already advised the officer that the patient is banned from the premises due to harassment and stalking. I also I advised we already offered her a walk-in visit with every phone call she made as well as when she arrived to the office, and she refused every time. The physician did not realize that the patient was being banned from the office premises for her previous behavior and agreed that she should not be seen. The physician left to go to her prior commitment. The physician called me after she had left the parking lot and advised me of what was discussed. The patient noted staff member # 2 was rude and that staff member # 3 “threw” a medical records release form at her. Due to the position of my desk, I could hear each time staff member # 2 talked to the patient during all phone calls, and did not pick up on any “rude” misconduct by staff member # 2. I did hear staff member # 2 repeatedly tell the patient she would need to be seen to receive an antibiotic. Staff member # 2 kept me updated as well after each phone conversation (and during each phone call as she had to put her on hold a couple of times to let me know what was going on and to find out recommendations). I did not witness the transfer of the medical records release form from staff member # 3 to the patient, but there were two or three other staff members, including staff member # 1 and staff member # 2, noting that staff member # 3 did not “throw” the form at the patient. I asked if the patient received it with any poor attitude on the patient’s part, and all staff members present for the exchange stated the patient did not receive it poorly (e.g. jerking the paper out of staff member # 3’s hands). They stated the patient received the form well and staff member # 1 noted she received the paper from staff member # 3 and folded it. One of the officers returned to the office to receive a 2nd medical records release form. It was provided to the officer to give to the patient. In the next couple of days, the former patient was “friend requesting” staff members repeatedly on Facebook. One staff member, after so many friend requests from the former patient finally approved it. Apparently, the former patient must have wanted us to see a slanderous review on the office Facebook review section. Her review left out key points such as her stalking behavior before I stated I would call the police. She put remarks on the review making the officers she dealt with appear biased in the situation. Therefore, I went to the police station to consult with an officer regarding this review. The officer noted there is nothing needing to be done in regards to the slanderous remarks, but I did advise that she put statements by the officers who were present for the encounter that may show those officers being bias in the community in case he wanted to look at it. The officer also advised not to worry about what she had put on Facebook because we have a great reputation in the community. I reviewed the Facebook accounts for the office, which I didn’t realize we had 4 of them. I wasn’t sure how we had Facebook pages for the office and one of them had about 8-10 reviews on it, another had 1 review on it, and the other two did not have any reviews on them. Since we did not initiate the Facebook pages and since we do not need the Facebook pages, I deleted them. I personally do not use social media and I do not believe we need social media for advertising in this small community. We receive new patients frequently due to either word-of-mouth or their excellent experience here. We are a private practice without the need for time limits on our office visits with our patients. We provide quality care without the corporate demands; therefore we do not have limitations of time to spend with our patients as other providers may have while working at a major corporation. As far as the patient’s statement, her facts are quite askew. As I have already noted, we have been in business for 10 years, 10 months now. The patient has been a patient here since 1 month after we opened and had continued coming here without complaint. She had even seen me on multiple occasions and I treat patients well. Yes, I have had to dismiss patients for prescription drug misuse or illicit drug use. I have had to dismiss patients for harassment, frequent non-compliance, or threatening to get a gun and shoot us after his non-compliance with blood pressure medication. However, these are legitimate reasons for dismissing patients from the practice. Stalking and harassment was the reason for this patient. We never had any problems out of the patient in the 10 years, 8 months that she was a patient at our facility, so I am not sure why she was so unreasonable and irrational on that day of 12/8/15.The “rude” claim may be her opinion but, from what I observed, staff member # 2 kept informing her that she will need to be seen and that she could walk in that day if she wanted to so we can have documentation and the patient, apparently, did not like that answer, but staff member # 2 continued to advise her of this procedure and staff member # 2 remained consistent. The claim that we were “laughing and making fun of the fact I was there” is false as we were trying to figure out how else to tell her that she will need to be seen to receive the medication. This was absolutely no fun matter and, frankly, was very frustrating to all of us that she would not agree to be seen to get the medication and that she was harassing the office staff. Otherwise, if we were truly “laughing and making fun” of her in the front desk area, she would have posted it in her Facebook review and all over her personal Facebook prior to this claim dated 12/22/15(I did keep her slanderous Facebook reviews and documentation if you need further documentation). She also never told us that if we “were going to act unprofessional and childish leave the window open so I can defend myself.” What really happened was that she knocked on the window and said she wanted to be included in the conversation. Regarding the form being “thrown” at her, as I mentioned before, there were 2 or 3 witnesses to the fact that staff member # 4 did not throw the form at her. She also stated in her claim that I “yelled” and I never yell during incidents such as this. I may have talked firmly, but again, maybe that was in her opinion. As far as her “desired settlement”, she can continue to slander the office, but the office runs smoother without non-compliant patients. We cannot bend the rules for anyone or it is our license on the line as well as the patient’s life, which is most important. Her illness was not “life threatening” or we would have sent her to the Emergency Department for immediate care. If she thought it was “life threatening”, she should have gone to the Emergency Department anyways. She never stated that she was under distress and she would have wanted to be seen if she was under any kind of distress. She did not appear under any distress at all, just angry and demanding during my encounter with her at the front desk window. All “life threatening” illnesses always need to be evaluated in the Emergency Department and not in a primary care/urgent care facility, which is our specialty. We offered to see her that day as a walk-in, and if it was “life threatening,” we could have initiated the evaluation and called the ambulance for her. That is what we do for all possible “life threatening” conditions. Again, the patient refused to be seen multiple times during repeated phone calls and when she walked in the office. As far as her statement regarding her ras “complacent,” I am not sure what she means with “complacent” in her complaint as I cannot find a fit with her other context, so I do not have a response to that statement. However, I believe her perception may be off kilter and I am not sure why, but I hope she can find her sense of peace and balance again. Since I wrote the above Revdex.com response to the complaint, I have received a complaint against me with Department of Health Professions (DHP) by this same claimant/patient which was dated 12/8/15, same date of the event. She embellished and altered the story compared to other reports from her own words. The patient reported to the state board the following:She stated that I “became irate” with her when she “was trying to get a ‘refill’ on a prescription for Flagyll [sic].” She notes that she has been given “Flagyll [sic] twice one time being a few weeks ago.” She noted to the board of medicine that she “called the office and” staff member # 2 noted above “was rude on the phone so I hung [sic] and called back and asked for someone else.” Staff member # 2 “took the phone back and started in on me again and hung up on me.” The patient goes on noting she “called a third time and talked to” staff member # 1 “who said the office manager…would call back in a ‘few minutes’. I went to a training for work and hadn’t heard back so I went there at 230 when my training was over. I asked to speak to” the physician “and was told she was leaving at 300. I said fine I can wait.” The patient then noted that I “busted through the door yelling at me about policy/ [sic] I told her that other doctors office didn’t have that policy and she told me maybe I should find another office and one of her staff threw a paper at me to move my records. I said I am talking to your mother if I have to wait by her car. She then told me to leave the premises because she was calling the cops. She did in fact call the cops and lied telling them there was a fight/disturbance. I left the building went to my car and sat in the bank parking lot. There were 3 officers that showed up.” She claimed that I “told the officers” the physician “was not in the office she had gone to the ER to work. When in fact she was still there.” The physician “stopped to talk to me, and they asked her if she could see [sic] the next day. She said yes. She called the office from her cell phone to make me an appointment and” the patient stated that I “told her no. Enough is enough and said I am no longer allowed on the premises.” The patient then notes “not only that my meds are running out and I had the 3 appointments back to back to back. One was for my physical and to refill meds. I am now forced to find another proider [sic] after 15 years with this one and no warning. Just a rude arrogant PA stomping her feet like a 2 yr old.” For one, as mentioned above, Flagyl is not meant to a medication to be “refilled”, especially without an office visit or a reason for the medication since it is an antimicrobial/antibiotic. For tick-borne diseases such as Lyme and Rocky Mountain Spotted Fever (RMSF), what Flagyl is used for is to break up resistance barriers called biofilm that the bacteria form to defend itself from antibiotic. We usually provide a course of Flagyl for 1 week prior to a stronger or different antibiotic if we are still battling the infection. It could have waited until her 12/18/15 appointment in that case. If she was having acute symptoms (such as an acute flare of “colitis”), she would have to be seen to obtain a history and examination according to Virginia Law 54.1-3303. For other offices, I hope they are abiding by Virginia state law as well. If not, their license may be in question. As far as the “rude” claims, I did not observe any from any staff member, but, as I said before, it may just be how she perceived the events that unfolded and, she obviously embellishes stories and fabricates or alters events as time has elapsed since 12/8/15. As far as “yelling”, I do not yell. I do not stomp my feet like a 2 year old. I am a 38 year old, 10+ year practicing Physician Assistant (P.A.) that is soft-spoken and does not like vulgar language (it makes me uncomfortable). All who know me have,most likely, never heard me yell. I do have to talk firmly in order to appear confident practicing as a Physician Assistant and to operate as an effective Office Manager. I try and treat employees well and maintain a balance of not letting them walk all over the physician and me. So “yelling” is quite exaggerated by the patient. And yes, I did call the police. The patient was already harassing the office and I have had to call the police on maybe 1 or 2 patients in the past 10+ years due to harassment of the office. The last straw, per se, was when the patient was stalking the physician and stated she was going to wait by the physician’s car which is parked in the back of the building and to continue to be non-compliant with office policies that are the same for all of our patients. The stalking definitely went above my comfort level on 12/8/15. So yes, I called the police. Two officers arrived (not 3, but a 3rd showed a while later after the physician already had left to go to her prior commitment), and as I stated before, one came into the office to speak to us, and the other went to the parking lot to speak to the patient. The patient was never in the office when the officer was speaking with us, and the physician was present while the officer was speaking with us, so I am not sure how she came up with the idea that I told the police that the physician was not present. Regarding the physician asking me about seeing the patient the next day on 12/9/15, the physician did not realize that the patient was being banned from the premises due to her harassment of office staff and stalking the physician. When I advised her of this when the physician called me, she agreed and she noted she did not realize that the patient was being banned. The patient then answered a question on the DHP complaint form: Did the patient/client sustain any injury or harm as a result of the licensee’s actions? If yes, please explain. The patient noted that she still has “no medications to help me with my stomach” and that she is “left to find another provider after seeing my doctor for almost 15 years. I love the doctor.” The office has only been open for business since March 15, 2005. As far as finding a new physician, according to her Facebook postings, patient saw her “new physician” on 12/9/15, so she does have a new physician now (we received a medical records release form dated on 12/14/15), and I hope her behavior stays in check with the new physician. Health care workers do not deserve the stress and frustration with harassment and stalking.She also noted in the DHP complaint that her “daughter in law listened to the phone call that was on speaker phone when” staff member # 2 “was rude and hung on me.” See below for the discrepancy regarding this comment.The patient’s husband also is still a patient here and has not switched his medical records to a new healthcare provider. He is a very pleasant gentleman and has a future appointment March 25th which was scheduled when he was here 12/18/15. When he was last seen here 12/18/15, he brought in a letter addressed to the physician from the patient, his wife. In her letter she stated “your staff have always been rude”. However, she had never complained before and had seen me many, many times and had continued coming here for the 10 years and 8 months (4/2005 – 12/2015) that she has been a patient here. She also stated in this letter that staff member # 2 “was rude and yelling so I hung up on her. Little does she know she was on speaker phone and half my office heard her and encouraged me to call back to talk to someone else.” As noted in the DHP complaint, the patient stated on 12/8 that it was her “daughter-in-law” that was on speaker phone and “listened to the phone call.” She had also noted on the DHP complaint, that she had training at work and when the training was over, she came to this office at 230. There is quite a bit of inconsistency with her stories. She did note in the end of the letter that she has a new provider now and that she is being referred to a specialist for her RMSF. That is a good end result for her if she is happy with her new provider and receives the care that she needs. That is what matters most. Regarding this entire situation, it has caused a lot of distress to staff, my mother - the physician, and myself. I think the patient is vindictive in nature and we believe some other issue in her personal life has made her project her anger onto us when we were following the laws and regulations of the state and federal governing bodies. I would ask and will pursue some means of ending her acts of vengeance against our office as we have endured her slandering, defamation of character, fabrications and exaggerations, harassment, and stalking behaviors long enough. All she had to do was walk-in to be evaluated for her symptoms so we may prescribe Flagyl, if it was appropriate, or other treatments to treat her condition.I have kept all documentation and evidence if you would require any articles for further investigation. Please feel free to call me if you have any further questions or concerns [redacted]Sincerely,[redacted], PA-COFFICE MANAGER
I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
Wow. Obviously this is a she said, she said kind of problem. I know the facts. Ms [redacted] knows the facts. As well as her staff. I will allow the Virginia Department of Health Professionals to do their job. I will relay any further outcomes as they happen. [redacted]