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>SAMPLE: LETTER OF TERMINATION<
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>Dear PATIENT NAME:<
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>The purpose of this letter is to terminate the physician-patient relationship between us and to inform you that you will no longer be able to receive hemodialysis services at the DIALYSIS FACILITY NAME, effective DATE OF LAST TREATMENT.<
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>This letter is the last step of a process which began on DATE. Over the past SPECIFY TIME PERIOD IN QUESTION you have repeatedly LIST NEGATIVE BEHAVIORS & ACTIONS. I have met with you on at least HOW MANY occasions to discuss the consequences of your behavior. As your physician, it is not possible for me to assume responsibility for your care under such circumstances.<
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>Other patients feel their own safety is at risk. Our social worker has met with you and your family on several occasions to try to come to some agreement as to the conditions under which you would continue to receive treatment and the DIALYSIS FACILITY NAME. A psychiatric or psychological consultation was also recommended, but you refused.<
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>Therefore, I feel I have no choice but to withdraw as your physician, and recommend that you seek medical management elsewhere. I am attaching to this letter a list of nephrologists in the area, and a list of dialysis clinics were you might seek treatment. Our SOCIAL WORKER/HEAD NURSE/OTHER STAFF MEMBER will assist you.<
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>You should understand that when I withdraw from this relationship, the DIALYSIS FACILITY NAME will no longer be legally able to provide dialysis services to you.<
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>I cannot stress enough the importance of your making energetic attempts to find another physician and facility. Your records will be transferred promptly.<
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>Sincerely,<
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>PHYSICIAN SIGNATURE<
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>FACILITY ADMINISTRATOR SIGNATURE<
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>MODEL<
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>AGREEMENT OF EXPECTATIONS/TREATMENT AGREEMENT<
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>PATIENT NAME agrees and understands the following aspects of his/her dialysis treatment at DIALYSIS FACILITY NAME.<
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>1.) Your physician will review your dialysis progress each month. He or she will be available for appointments for other medical problems. If not, staff will explain why he/she is unavailable, and tell you when you can expect to see the physician. If you choose to see your physician in his/her office, it is your responsibility to arrange the appointment.<
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>2.) A dietitian will be available to you every month. If you need to see a dietitian, you may schedule an appointment or talk by telephone.<
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>3.) A social worker will be available to you and your family monthly. If you or your family need your social worker, you may schedule an appointment or consult by telephone.<
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>4.) Facility staff will teach you about your disease and treatment, tests, equipment, medical risks involved with non-compliance with physician orders, risks of infections, and other treatment options.<
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>5.) Facility staff will tell you about changes in your treatment before they are implemented and tell you the reason for the change. You will be informed of your medical condition and response to treatment, as indicated.<
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>6.) Facility staff will provide competent, high quality health care. Staff will treat you with respect and dignity. Staff will not threaten or abuse you with language or actions.<
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>7.) Facility staff will tell you of any procedural changes when you arrive for treatment. Facility staff will provide you with an explanation whenever a change in a procedure is made. You will be informed of possible treatment options and allowed to participate in the decision as to the type of treatment selected for you.<
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>8.) Your facility staff will inform you of the benefits and risks of transplantation. You will be informed of your suitability for a kidney transplant. If you are an interested candidate, you will be further evaluated at the transplant center of your choice.<
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>9.) Your medical records will be treated as confidential and private. Except as required by law and obligations imposed by governmental regulation, permission must be given to you prior to release of your medical information. In the presence of a professional staff, you have access to review or request interpretation of your medical record.<
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>10.) Your dialysis treatment team will create a dialysis care plan for you and update it every 12 months. You will be notified when your care plan is being reviewed. You and/or your family will be offered an opportunity to attend the meeting. This plan will be reviewed with you annually.<
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>11.) You have the right to refuse treatment to the extent permitted by law, and to be fully informed of the consequences of this action. In addition, you will be asked to sign an informed consent or a refusal of treatment forms prior to administration or withdrawal of treatment.<
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>12.) You will be provided with an interpreter or advocate as indicated for language, visual or hearing problems.<
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>13.) Facility staff will not discriminated against you based on age, sex, race, or medical disease.<
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>14.) You will receive regular statements from the business office. You are encouraged to telephone or make appointments with representatives of the business office to answer any questions you may have about dialysis related charges.<
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>15.) You can ask questions or file a grievance without fear of retaliation from facility staff.<
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>16.) You may be offered the opportunity to participate in experimental research, however, your participation should be strictly on a volunteer basis.<
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>For In-Center Hemodialysis Patients<
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>17.) The dialysis facility staff will assign your days and time for treatment, LIST TREATMENTS DAYS AND TIME. On occasion, an unforeseeable event might prevent a machine from being available at the time of your appointment. In which case, you will be given an explanation. A hemodialysis machine will be made available to you as soon as possible.<
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>18.) The NAME OF DIALYSIS FACILITY employs reuse of dialyzers. You will be informed of the reuse process used at the facility and asked to sign an informed consent.<
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>19.) You agree to arrive on time for dialysis treatments and all appointments scheduled with dialysis staff, such as social worker or dietitian, business office, etc. If, on occasion, unforeseeable events prevent you from arriving at your scheduled time for treatment, (or scheduled appointment) you should give a two hour notice to your facility. Your dialysis time or schedule may be changed because of tardiness to avoid interfering with other patients' schedules.<
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>20.) You agree to treat all members of the health care team and other patients with respect and dignity and to refrain from threatening others with your language or actions.<
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>21.) You agree to take responsibility for your illness by following your physician's orders, taking medications as prescribed, and complying with the renal diet.<
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>22.) You agree to ask questions about any part of your illness or treatment that you do not clearly understand.<
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>23.) You agree to participate in the annual review of your treatment with facility staff.<
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> The Renal Network - 911 E. 86th Street, Suite 202, Indianapolis IN 46240<
>For more information call 317-257-8265 (phone) or 317-257-8291 (fax) or <
>Email to: info@nw9.esrd.net and info@nw10.esrd.net <
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>This website adheres to the CMS Privacy Policy for all
owsers <
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Bitch 2
Joined: 19 Jul 2003
Posts: 7
Posted: Sat Jul 19, 2003 5:48 am Post subject: think I will send
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this to the unit in Texarcana for the hell of it.
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We have a firm commitment
Joined: 19 Jul 2003
Posts: 1
Posted: Sat Jul 19, 2003 11:13 am Post subject: National Action Network
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Many of us have been meeting and realize that we had better realize that the dialogue has not worked. When CMS stated that the patients are not protected,
as they dont tell the physicians how to operate their business.<
>That is rubbish and if that is the governments excuse to inaction than that tells us one thing. Five years we have begged,pleaded,sent documents to the Senate Hearing, have had the Senate hearing staff aware of the other patient that were being violated, and guess what, they dont even return your phone call. I really trusted that this clinic would realize that this patient did nothing wrong. The staff in the clinic can sign away and make up so called evidence against this patient, but they should realize that this will be going to a higher level. All those in the clinic that are staff and have signed against the patient, realize that you can contact us and we will keep you anonymous. To purger one self is against the law and possible loss of licensure.<
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>The timing is perfect, all the threads are now being connected. If this clinic Collom and Carney Clinic Association, threatened me at the CEO level, then think of what they are capable to doing to the patients. Your right Mr. TOm Simmons I dont know who I am screwing with, but I will tell you this, all you needed was to do what is right. You have no idea who you have been screwing with. This I promise you will be the biggest NATIONAL nightmare this company will ever have to deal with. You threatened you want to sue me personally, go for it,but the coward that you people are use a helpless patient to pay back. You want a bite of me,,,do it like a man and go after me. This is what it is all about isnt it?<
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>You have called the game, we were hoping that you would have a shred of decency, but if you wanted a power play you will have one now. We have decided that you have had a chance to do what is right, but you still continue to do as you please. Shame on the physician Dr. Myrick who signed her dismissal. Shame on the social worker, who sold out. <
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>We are moving forward and we realize that the government is allowing you to be sold ,wont protect you,could care less what the physicians do to you,have allowed this industry to self police,have allowed your rights under the Constitution to be violated, then have 2 more patients dumped that have to go into heart failure in order to receive treatment in an Emergency room, knowing that these patients die. It is go to the streets and march,,. we will have 100"s that have been promised<
>This is going to hit many states and then the Expose is ready to come out..The government can force this clinic to take back this patient, and they are accesories to murder, the law can be changed tomorrow, the government needs to do what is right with our patient population and take away the Medicare if they can pick and choose and violate the law. Lets see if our government will side with the patients. We have appealed to the NETWORK, the decision...lets see the folley and another the physician did right. We have a STRONG legal case,,,what will the physicians do when they are in front of a camera.<
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>Mr. Simmons, you have my address, take it out on someone with their health you coward. I thought you would be smarter than to do it this way. Want a piece of my arse,,,,the address to sue me is on the website. Be man enough to file the suit that you have threatened me with, and leave the patients alone...!<
>Arlene
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rugrat
Joined: 19 Jul 2003
Posts: 1
Posted: Sat Jul 19, 2003 4:59 pm Post subject: appears that they will regret this
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agree that this will blow up in thier faces. Talk about a public relations nightmare. All they half to do is put the patient back in. then they have nothing to worry about. Are they crazy? Lost thier minds or temporarily insane?<
>I do not get what they are thinking.
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brenda
Joined: 28 Oct 2002
Posts: 103
Posted: Sun Jul 20, 2003 12:25 am Post subject: hey there older
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sister---you called it right on target. They won't pick on healthy people so go after the others. You have all my info so tell them they have a "healthy" one in the midwest they can go after too. I got your back-
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FYI
Joined: 15 Feb 2003
Posts: 72
Posted: Sun Jul 20, 2003 1:57 pm Post subject: IT APPEARS THAT WE WILL SEE WHAT THEY DO
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I have written my last response to CMS concerning the 3 patients. Lets see if they will stop this insanity. Talk about a perfect example of violating all rights under the Constitution. They have a chance to do the right thing, and the clinic has still an opportunity to do the right thing.<
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>If it is a power play they want, I will oblige them. We have over 300 signed up to March in Good ole Bush land. That doesnt include the National Action Network. <
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>I will be leaving Thursday to hit Las Vegas and California to talk to the National Action Network. We now have 3 that we know of. Two in California and 1 in Texas. I will be speaking and sharing documents, this is to the head officials of Rev. Al Sharptons group. We have been employing the churches who are ready to rock and roll. This clinic feels that they can do as they please, as does the owners Collom and Carney Clinic *badword*. This will hardly be worth dumping a sweet
ave human being. I will vouch for this patient as other patients have spoken to us.<
>I am ready to march and I dont see any other way to have ones rights respected in this field of medicine. The government can support this patient, lets see who they back the ESRD NETWORK and PHYSICIANS or a patient who has done nothing. I am afraid that this case is about as airtight as any case can be. The trial attorney's are in the Bay Area for a convention this last week end, and this is a hot topic. Then off to finish the expose" it couldnt of been better timing. Hopefully DaVita will have a change of heart on their patient in Oakland California.<
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>We are strong and we are right. Patients are citizens and if the government wont do what is right, they have left us little choice. It has been 5 years and they have been fully aware since then.<
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>Arlene
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aprnjam
Joined: 28 Apr 2003
Posts: 85
Posted: Mon Jul 21, 2003 3:17 pm Post subject: Re: IT APPEARS THAT WE WILL SEE WHAT THEY DO
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It seems as though these few "rednecks" think that they control everything and that DEO is a small organization without the power to
ing them or the government down. Boy, are they sadly mistaken! They need to get off their high horses and realize that they have been caught with their pants down around their ankles and they are going to trip all over themselves getting out of this one. They have no way out and they are going to tumble like Humpty Dumpty from the great wall! It never ceases to amaze me to see physician's who think they are God and can line their pockets are the expense of a patient's life. How do they sleep at night? And truly, what goes around, does come around, and they will get theirs. They think they can settle with DEO and that we will back down and they can place a gag order on the settlement. HA! I don't believe that will happen. I don't believe that they have enough money to pay anyone in DEO for a gag order on a settlement. They are about to see the fury of a woman scorned because they refuse to do what is right for their patients. They are violating the 14th Amendment, as well as the Hippocratic Oath they took when they became physicians. May God have mercy on their souls, because their payback is going to a bleep.<
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>We'll
ing them down, one by one if we have to! The ball is rolling and it is growing bigger by the minute and when it hits them, it will knock them down with no effort whatsoever and they will have nowhere to turn. All I can say is, YOU GO GIRL!!! I've got your back in the Midwest, and if you need me, call. :"> We are smoking' now!!
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