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Friday, August 8, 2008

Responding to Mr. Merian: BCBS Vs. Private Family Physicians the Follow Up

Introduction: A couple of months ago, I wrote this piece. The piece focused on the story of Dr. Shirley Pigott. Dr. Pigott is a private family physician in Victoria, Texas and has been for more than two decades. She has also been active within the Texas Academy of Family Physicians. In 2002, she had a billing dispute with her biggest insurance provider BCBS of Texas. Blue Cross Blue Shield of Texas is not only the biggest insurer of the patients of Dr. Pigott, but they insure about one third of the folks in Texas altogether. In other words, it is difficult to be a physician in Texas unless you are a part of their network.

At roughly the same time that this billing dispute began, Dr. Pigott and her colleagues also began complaining to each other about how difficult the insurance companies were making it on them. Keep in mind that private family physicians have no salary. Everything they make comes from whatever they charge their patients. Since one third of patients in Texas can be expected to be covered by BCBS, BCBS is in a position to make things very difficult for family physicians if they so choose.

In about 2004, Dr. Pigott formed a group called the group of 35, of family physicians around the country, that decided that enough was enough. They decided that it was time for the American Academy of Family Physicians to fight harder for private family physicians. Initially, this group took three demands, or mandates as they are called, to the state levels of the AAFP. Dr. Pigott was given the responsibility of presenting these mandates to the Texas Academy of Family Physicians. The mandates essentially simply asked the TAFP to recognize the struggles that family physicians go through and fight harder for them.

Dr. Pigott presented the mandates to the proper committee within the TAFP. It was completely well received except for one doctor. That doctor's name is Dr. Doug Curran. Dr. Curran was then the President Elect of the TAFP. He wasn't even on the committee and was merely visiting the committee that day. Despite his objections, the three mandates passed the committee, the full TAFP, and eventually the AAFP.

At about this same time, Dr. Pigott received a complaint from the Texas Medical Board Disciplinary Committee. At the time, this committee was headed by Dr. Keith Miller. (as you can see if you go to most previous link Dr. Miller has been the subject of controversy and eventually resigned from the committee) In fact, this particular link minced no words in describing Dr. Keith Miller.

Notorious Texas Medical Board (TMB) henchman, Dr. Keith Miller, abruptly resigned his position on the TMB on Friday, September 7, 2007. Miller’s resignation was due to the intense scrutiny of his abusive and tyrannical actions against physicians while on the TMB.

(This will become important because my accuser will also go on to defend Dr. Miller)

The dispute involved a patient that demanded their medical records. Dr. Pigott customarily reviewed the medical records at a follow up appointment. This patient didn't make a follow up appointment and rather demanded the records be sent to their home. Since this broke protocol, Dr. Pigott didn't mail out the records for significantly longer than the law required which is 15 days. While this is a technical violation of the rules of medicine, it is a very mild one and should be the subject of a very mild punishment, if any at all.

Instead, because these records weren't mailed out on time, Dr. Pigott began a nearly four year battle against the TMB disciplinary committee. At one point, the board threatened all sorts of draconian punishments: one year probation during which she would be monitored by another physician, provide the board with random patient records upon request, a $500 fine and force Dr. Pigott to pay for the doctor that would monitor her, and this is among a whole host of punishments numerated 1-10 with several subsets for most. Again, these draconian punishments were in response to Dr. Pigott sending out medical records in an untimely manner. Furthermore, Dr. Keith Miller was later the subject of investigation of much corruption, including another story by me, and his nurse practioner Bridget Hughes was found by the Texas Nursing Board (must then click link download attachment) to have doctored 50 prescriptions of drugs like methadone. Furthermore, it was Dr. Craig McMullen, the doctor that employed Hughes prior to Miller, that discovered this. In other words, Dr. Miller hired Hughes despite knowing full well that she had committed a serious breach medical ethics.

Now, while her proceedings against the TMB disciplinary committee were going on, Dr. Pigott was continuing in a leadership role within the group of 35. She continued presenting mandates and continued fighting on behalf of private family physicians. At one such meeting, she came up against Dr. Doug Curran again. He was now the President of the TAFP and he visiting the committee she was presenting to, again, even though he wasn't a member of the committee. Once again, he confronted and objected to everything Dr. Pigott presented only this time most of the committee objected with him. Dr. Pigott told me that not only were her mandates rejected but she felt humiliated to the point of tears.

At around this time, Dr. Pigott discovered that Dr. Curran was the subject a full spread photo advertisement for Blue Cross Blue Shield, and then within weeks, she discovered this puff piece about Dr. Curran in which members of BCBS are quoted in glowing praise of him. Dr. Pigott began complaining to members of the TAFP as well as other medical authorities that she believed that Dr. Curran had a conflict of interest between his representation of doctors and his close alliance with BCBS.

Her complaints became so noisy that Dr. Curran confronted her and in the middle of their conversation Dr. Pigott says that he told her this...

Do you know that I am a member of the Blue Cross Blue Shield Texas Medical Advisory Board with Dr. Keith Miller, and Dr. Fred Merian.

Now, Dr. Keith Miller I have already touched on but Dr. Fred Merian is also the former President of the Texas Medical Association. Throughout my original piece, I refer to the BCBS Texas Medical Advisory Board as super secret. Of course, this is a bit provocative. It isn't hidden like secret parts of the CIA, however, you will find scant little information about it on the internet. You will certainly not be able to confirm on the internet who serves on this board. Most importantly, why are three doctors also working for the insurance company. This is of course an inherent conflict of interest.

Ultimately, Dr. Pigott discovered enough about what happened and then hired a legendary attorney and she wound up being given a slap on the wrist.

Several months later though, Dr. Merian's son found my article and found plenty to object to. Here is his first comment.

You have a lot of nerve maligning my father like that. I am Dr. Merian's son. My father is the most ethical and caring doctor there is. And your labeling him as some corporate shill is downright libeleous. And since when is it wrong to go after doctors who are overcharging their patients?Do you even attempt to contact the three Doctors whom you labeled with this article? I know all three, and they have impeccable reputations with both their patients and their fellow Doctors.All of these Doctors earned their positions, is being from a small town mean you are not qualified to make policy in this state? Do you have to be from Houston or Austin in order to be qualified to hold a position of leadership?

Now, on one hand, I can understand and admire Mr. Merian's instinct to furiously defend his father's reputation. On the other hand, I found it rather peculiar that Mr. Merian was the one up in arms. After all, his dad was mentioned in passing and only because Dr. Curran identified him as one of three on this BCBS Medical Advisory Board. Furthermore, at this point, there is a mountain of evidence that Dr. Keith Miller is NOT a doctor of "impeccable reputation". I, myself, have presented several cases of corruption he was involved with. The Texas Medical Board's Disciplinary Committee was the suject of an investigation by the Texas legislature.

Furthermore, the reputation of the three is beside the point, the story that is the subject of the original piece speaks for itself. You either believe it and draw appropriate conclusions or you don't. That said, Mr. Merian wrote this response in which he attempted to take me to task for my reporting. Let's take things one by one. Here is how he concludes.

My father practiced medicine in Yoakum, Texas (pop 6000) before moving to Victoria, Texas (pop 45,000). Your implication here, of course is that individuals from small towns are inherently unqualified to serve in high profile positions, and therefore can only reach those positions through corruption and collusion. Again, you make this statement with no proof to back it up. In order for your allegation (that my father was put in the Presidency of the TMA by BCBS) to be true, you need to be able to back it up. My father (and Dr. Curran) were elected to their positions by the membership of their organizations. You are accusing thousands of Doctors of selling out to BCBS, all the while offering no proof at all. But challenging me to refute it. This is a logical fallacy known as "Shifting the burden of Proof" The burden is on you to prove your allegations, otherwise they are invalid and not credible.

This statement is absurd on its face. The original story is split into three parts because it is so long. Even the introduction to this piece is probably too long and yet that is the only way I can present all of the relevant information of the story. Furthermore, this is not the only piece I have done about corruption within the Texas Medical Board. You either believe the story or you don't. I believe I have given plenty of supporting evidence to make my reporting solid. The audience can judge.

That said, if you believe this story, and furthermore, if you believe my other stories about the corruption at the TMB, it absolutely leads to troubling conclusions? I never said that doctors from small towns can't be in positions of power. I said that given the evidence I presented, we should all ask how these three got where they got. I find it very troubling that three doctors are in positions of power within the medical community all the while they are also working for the biggest insurance company in a position for which you can find scant information about.

We don't allow lawyers to represent both the plaintiff and the defendant. A lobbyist that concurrently represented a pro family group while they represented Planned Parenthood would be the subject of serious questions. Mortgage brokers can't also work for banks. By the same token, there is a serious conflict of interest if a doctor represents other doctors while they are also representing the interests of the insurance companies. That's exactly what is happening when Dr. Merian is President of the Texas Medical Association while working for the BCBS Medical Advisory Board.

Mr. Merian claims his dad is a pillar of the community and has dedicated his life to doing good. I don't doubt that however so are tens of thousands of doctors in Texas, and yet, it is his dad that concurrently was President of the TMA and part served on a board for the biggest insurance company in Texas. Given what happened to Dr. Pigott, and the role BCBS Texas Medical Advisory Board played, this should be troubling to everyone.

Then, Mr. Merian says this about the BCBS Medical Advisory Board.

A simple Google Search of the site pulled up quite a bit of information on it. Including this description:

The Texas Medical Advisory Committee and the Texas PeerReview
Committee serve in an advisory capacity to the Medical Director and HMO Blue Texas regarding health care delivery issues that affect members and participating network Physicians and other Professional Providers. The Committees participate in the development, implementation, and evaluation of required peer review activities

That's not quite a bit of information. In fact, this is a snippet as part of a web page related to something totally different within BCBS of Texas. This medical advisory board doesn't have its own web page. BCBS doesn't disclose who is on it and how they got there. They don't publish the minutes of the meetings. All that BCBS does is define what it is as part of a totally different web page. Again, given the role that BCBS Medical Advisory Board played within this story I find this lack of disclosure very troubling.

Then, Mr. Merian says this.

Now, it is obvious this board is not "super secret" so we will move on to
some of your other allegations against my father.You also alleged:

Three doctors, Dr. Doug Curran, Dr. Keith Miller, and Dr. Fred Merian, were simultaneously in significant positions of power in the Texas medical community. Dr. Curran was the head of the Texas Academy of Family Physicians. Dr. Miller was head of the Texas Medical Board's Disciplinary Committee. Dr. Merian was head of the Texas Medical Association. At the same time, these three were also members of the super secret BCBS Texas Medical Advisory Board. In other words, they were playing both sides of the fence. They represented the interests of doctors, and at the same time represented the interests of BCBS against doctors.Dr. Curran was not sworn in as President of the TAFP until 2006, and he served 1 year (not several years as you claimed), Dr. Miller was not appointed to the Board of Medical Examiners until 2003. And my father took his office as President of the TMA in 2002, and he also only served one year. So, you are wrong in alleging that these three men held their offices simultaneously. Also, the President of the TMA while being the visible face of Doctors in Texas, holds NO power outside the TMA. The TMA is not involved in the certification, regulation or discipline of Doctors in Texas. It is also not involved in negotiating with insurance companies for doctors, nor in
the distribution of benefits. Therefore, there is no conflict of interest. Besides, that is a determination for the TMA Board of Directors, the ethics committee and house of Delegates. Both of which were aware of my fathers position, neither of which objected.

This may technically be true, however all of this folks were in positions of power within each of organization long before they became head of each of their organizations. Again, it is just absurd to say that being President of the Texas Medical Association, which he himself says is the face of Doctors, doesn't represent doctors. Furthermore, the fact that no one objected to Dr. Merian simultaneously serving on the BCBS Medical Advisory Board should be troubling not some validation. Furthermore, while the TMA may not have been involved in discipline and certification, the TMB Disciplinary Board was, and Dr. Keith Miller was head of that for several years, while he was part of this group.

Then, Mr. Merian said this.

Physicians advisory boards advocate FOR doctors. You asked how I knew such
boards existed? Simple internet search. (and, I have worked in or around the insurance industry for over 10 years, there are all kinds of advisory boards) Here is the information for the board at Aetna Insurance. The kicker? 19 state Medical
Associations asked for such a board to be created. If such boards were so Anti-doctor, why would 700,000 Doctors demand such a board be created? They wouldn't.

This so called internet search is a google search of the words "physicians advisory board insurance". Of course, some combination of those words will come up a lot. That's how a google search works. Furthermore, if BCBS uses it in a nefarious manner it is reasonable to believe other corrupt insurance companies might want to create one as well. What's more, one paragraph after Mr. Merian painstakingly tried to convince the audience that the TMA doesn't represent doctors, he proclaims that 19 Medical Associations asked for such a board to be created. Who exactly were they representing when they asked for this?

I would also be in favor of such a medical advisory board. Only, if this board actually represented doctors, they wouldn't be a part of the insurance company. A board that looks to try to hash out the differences between doctors and insurance companies in a manner that is beneficial to both wouldn't be a part of the insurance company. Such a board would have representatives of doctors and representatives of the insurance companies working independently of either. Furthermore, their actions would be out in the open. They would have a web site. They would publish their minutes. They would publish their conclusions. This particular board does none of those things. It is very easy to take a well meaning concept and corrupt it. I never said that medical advisory boards are necessarily a bad idea. I said this one is corrupt and I proved it by several stories all split into three parts.

Furthermore, as it applies here, the board was used as a tool of intimidation. If you believe Dr. Pigott, then clearly Dr. Curran wanted her to believe that being a part of this board meant that he could damage her.

Which brings me back to the beginning. In his defense of his father, Mr. Merian never challenged any of the contents of the story. Dr. Pigott did become a leader within the community of private family physicians. She did work painstakingly to make the TAFP and the AAFP work more on behalf of private family physicians. While she was doing this, she was simultaneously brought in front of the TMB disciplinary committee because she didn't send out medical records in a timely manner. They did attempt to punish her in a draconian manner, and it was only after she identified this group within the BCBS that the TMB backed down. Those are the facts. I have backed up each of those facts.

My favorite latin phrase is Res Ipsa Loquitor, the facts speak for themselves. I believe the facts of this story speak for themselves.


kmerian said...

Mr. Volpe, I spoke with my father this weekend.

You claimed the only thing you accused my father of was serving on a board with BCBS at the same time he was president of the TMA.

Turns out that is not true. At no time during my fathers presidency with the TMA did he serve on any board with BCBS of Texas. As a matter of fact, that board did not even exist at that time.

Also, my father wanted me to tell you that he has never advocated FOR BCBS against a physician. And if BCBS ever attempted to make him do that, he would quit in a moment. The excellent relationship between the physicians of Texas and BCBS is evidence of the advisory boards fairness and strength in presenting physicians issues to BCBS.

I only know Dr. Miller and Dr. Curran in a professional capacity. I vouch for what I know. If the allegations of Dr. Pigott are correct, then I was mistaken.

But the fact remains, you included my father in this sorry debacle when in fact he had nothing to do with any of it. I don't know why Dr. Curran brought him up, or the context in which he did.

But, I hope you will update your piece to reflect that my father had no relationship with BCBS AT ALL while he was president of the TMA. And as a matter of fact did not begin serving on that board until he retired.

mike volpe said...

I'll update my piece when BCBS updates their web site and makes this group transparent. Until then, I will simply allow your father's comments, through you, to stand as they are. Again, I didn't say anything about your father that you don't readily admit yourself. I will not change anything. I don't know when your father began working for BCBS because such things can't be confirmed because the group isn't transparent.

Your father may not have advocated against doctors, and we will just have to take his word for it, but the other two members of this group clearly did. Where was your father while Dr. Pigott, along with thousands of othr Texas doctors, being sham peer reviewed?

Again, your father is such a minor and inconsequential side issue to this piece that it is amazing you continue with this. Given that Dr. Curran identified him as one of the three members of this group, how exactly do I do this piece without mentioning him. In fact, given the consequences of Dr. Curran bringing up this group like he did, I frankly mentioned your father very little.

What I would hope is that folks like you look at the big picture. Your father doesn't have it so bad. The same can't be said for Dr. Pigott and thousands of other doctors targeted by the likes of Dr. Keith Miller, the same Dr. Keith Miller that you vouched for.

kmerian said...

Mr. Volpe, that is a shame. You alleged my father served as President of TMA at the same time he was on a board advising BCBS. That has been shown not to be true, but you refuse to correct it.

You claimed my father was placed in the Presidency of the TMA by BCBS, yet you offered no proof.

You claimed my father was in a position of "power" at BCBS. But, even you admit that you don't know what authority (if any) this board has. (According to my father they have none, because they are an ADVISORY board) BCBS is under no obligation to follow any of the boards advice.

You claimed BCBS employs my father to "punishes doctors that powerful forces deem a threat". You then go on to detail Dr. Pigotts issues before the TMB. With no evidence BCBS was involved except that ONE of the TWENTY or so doctors has a passing connection to BCBS.

You also claim my father has "gotten into bed with BCBS in order to help BCBS root out those of (his) colleagues that they determine too expensive to keep around." Again though, you admit that you have no idea what this advisory board does, so how can you possibly make this statement. Especially when you admit that you made absolutely no attempt to contact BCBS?

You also claim that during 2002, while my father was President of the TMA, he was also on the BCBS Medical Advisory Board. However, that is not true. But you refuse to remove it solely because it is the only link between Dr. Pigott and BCBS and between her and my father. Is a story more important than facts?

You base your inclusion of my father based on something Dr. Pigott stated that Dr. Curran stated. This is hearsay, and as such, unreliable. And again, you made no attempt to contact my father or BCBS to verify any of this.

You also claimed that Dr.'s Miller, Curran and Merian were on this board with BCBS the same time they were in "positions of power". But, I have illustrated they were not. Your house of cards is collapsing.

In part 3, you claim it is "likely" my father was "helped" into his "position of power by BCBS in order to help execute corruption against doctors like Dr. Pigott" Again, you made this statement knowing nothing about my father. You claim that there are many Doctors with a resume "finer" than my father, yet you admit knowing nothing about him, so your statement is unqualified. Your sole complaint about my father seems to be that he is from a small town so he is inherently unqualified to hold any position of power. (BTW Dr. Pigott is from a small town as well, but you don't doubt her credentials, why?)

Your description of Family Practitioners, while accurate in some areas, shows a level of ignorance about who they are and what they do.

You also claim thousands of Doctors have been "targeted" by the "likes" of Keith Miller. But again, you offer no proof of that allegation either.

You claim the facts speak for themselves. They certainly do.

mike volpe said...

First, it isn't merely hearsay to say that your father was part of this group. His inclusion in the group has been confirmed by third parties on the internet. Second of all, hearsay is a term used in court not in stories on the internet. Third of all, the only proof you offered is your father's word that he didn't serve on both at the same time. Fourth, like I said, when BCBS shows transparency about this group, I will update my story. I will not update it because you claim to have talked to your dad and he claimed that he didn't serve on both at the same tim.

Again, your father is such a tangential part of this story that it is peculiar that you are still consumed by this. You offer no concern for Dr. Pigott, Dr. Kuehne, Dr. Rea, or any of the other doctors targeted by Dr. Miller. Your only concern is that my story implied something nefarious about your father. Of course, in order to imply, you, not me, have to read something in the story that wasn't actually there.

I haven't of course offered stories for all one thousand doctors which is why I said that it was likely that was the number. Though, this is a number I received from more than one doctor targeted. I did, however, do four stories related to the corruption at the TMB and another at the TNB, and now I am working on another at both.

Again, either the stories I have found are all there is or more likely, I have merely scratched the surface.

My connection between Dr. Pigott being targeted is that BCBS insures one third of all patients in Texas are covered by BCBS. Furthermore, again, this is not the only story I have written about doctors in Texas being targeted and others also used BCBS. Finally, my main connection was uttered by Dr. Curran himself. He is the one that made BCBS Medical Advisory Board into a nefarious group, not me. Two of the three people mentioned by him as being part of this group wound up being involved in the targeting of Dr. Pigott. Dr. Miller has been featured in stories by me multiple times, and he has resigned under bad circumstances from his position at the TMB.

You are frankly pretending the facts are on your side. My story takes twenty minutes to read and that is just one. I have written multiple stories about corruption within the Texas Medical apparatus. Either all of them are wrong or I am on to something.

You are attempting to pull a magic trick. You seem to think that a four paragraph response to an article that was five to ten times that is enough.

The original story speaks for itself. The audience can draw their own inferences. That said, that story is full of facts. Dr. Curran's admission is backed up by plenty of evidence that gives my assertions plenty of credibility.

You seem to think that you can attack one small part of my story and maintain credibility. You can't because you already said that my story, in whole, was so full of holes that this is why it wasn't picked up by the MSM.

You have already vouched for the credibility of not only your dad but Dr. Curran and Dr. Miller.

What you have done is attack my story in every which way, and then when those attacks don't gain traction, you settle on the minor point that your dad claims that he wasn't concurrently part of this BCBS group at the same time he was President of the TMA. Well, if this group was transparent, this issue would be settled. They aren't and so I asked lots of questions.

Now, let's look at the big picture. Dr. Pigott has had her life turned upside down for four years and counting. There are many doctors in Texas like her and even more in the rest of the country with similar stories. Yet, you are consumed with your dad's reputation by the implications of this story. Your father has had it pretty good. Dr. Pigott has not. Isn't it time for you to look at the big picture and stand up for what's right? Where is your sympathy for the thousands of doctors touched by the scourge of sham peer review.