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Personal Kaiser Lyme Disease Denials

Failure to diagnose my Lyme disease by three Kaiser Permanente doctors was the
inspiration to create the Kaiser Papers Lyme disease page. This section gives these
doctors, Steven Spindel MD, Joseph Kane MD, and Jerry Slepack MD, the recognition
they deserve.

The realization that refusal to diagnose Lyme disease appears to be common in the
Kaiser system gave me the incentive to provide information and assistance to Kaiser
members. The protocols used by Kaiser virtually insure that Lyme disease will not be
diagnosed, particularly late-stage and chronic Lyme disease. Members should also be
aware that Kaiser doctors do not have the specialized knowledge and expertise required
to competently diagnose and treat Lyme disease and other tick borne diseases. The
complexities and myriad presentations of these diseases do not lend themselves to a
fifteen minute “cookbook medicine” approach.

The information in this section is constructed from my medical records at Kaiser pertaining
to Lyme disease. Some information is provided from the data I saved since documents
relating to my Lyme disease are either missing from my medical record or of such poor
copy quality, they are illegible.

Dr. Steven Spindel is an infectious diseases specialist at Kaiser NW.

Dr. Joseph Kane is now head of infectious diseases at Kaiser NW. There does not
appear to be a record that he is board certified in infectious diseases.

Dr. Jerry Slepack was the head of infectious diseases at Kaiser NW at the time. He has
since changed employment to another regional HMO.

In issuing their “second opinion” denials, Dr. Kane and Dr. Slepack never even saw me
or communicated with me in any way.

Materials provided to Kaiser;

- Chronology of Symptoms


- Summary of Symptoms

   (Note – I was very sick when I wrote this. It is not complete. Looking back, the likely
    place of exposure was at a highway rest area in Hood River, OR in May, 1994 when I 
    stopped to take my dog, Bo, for a walk. We were both infected. Omitted in this
    summary is that Bo’s veterinarian observed heart rhythm irregularities similar to mine.)

    I was given a cortisone injection and an aerosol steroid in 1999. Steroids should never
    be given with Lyme disease because they suppress the immune system. Use of steroids
    may explain my chronic Lyme disease.  Use of steroids  may have contributed to my
    chronic Lyme disease. My right shoulder, where the steroid injections were given, is
    permanently damaged.     

- ELISA test ordered by Kaiser – May 19, 2000 (negative)

- ELISA test ordered by Kaiser – March 21, 2001 (negative)
   (Note – the ELISA is a cheap and inaccurate test based on a single East Coast strain.             
   There are 15 known West Coast strains. Positive results are unlikely with the
   strain differences.)

- IGeneX Western Blot Lyme IgG test ordered March 21, 2001 by a Kaiser doctor
   who tried to be helpful. I had to pay for the test.
   (Note that the test showed four positive bands and one band of equivocal intensity.   
   This test is highly specific to Lyme disease. The CDC requires five positive bands
    for their highly restrictive surveillance reporting criteria that few can meet.
    Subsequent Lyme Western Blot tests IgG and IgM after I left Kaiser met the
    CDC surveillance criteria.)

First Western Blot tests after leaving Kaiser;

These Western Blot tests below, IgG and IgM, were ordered by a tick-borne
disease specialist one year after the Western Blot IgG test ordered by a Kaiser
doctor was done.

The Lyme IgM Western Blot result was positive, surpassing the requirements
for the CDC surveillance criteria.

The Lyme IgG Western Blot was one band short of meeting the CDC surveillance
criteria. But the four resulting bands were unequivocally positive.

In subsequent tests both Lyme IgG and IgM showed an expansion in the number
of reactive positive bands. This was likely due to a reinforced immune system
resulting from treatment that allowed the antibody response to be strengthened.
The number of bands ultimately lessened as the Lyme disease receded.
This occurred after several years of treatment.

Copies of the first two Lyme Western Blot tests after leaving Kaiser are shown below;





The Three Denials

Dr. Spindels medical report
http://lyme.kaiserpapers.org/pdfs/Kaiser Spindel 1.pdf
http://lyme.kaiserpapers.org/pdfs/Kaiser Spindel 2.pdf

This is my first Lyme disease denial by Kaiser. I was referred to Dr. Spindel in
infectious diseases for a Lyme disease evaluation. His behavior during the
appointment was so abusive it made my adult daughter cry while we were there.
His report is so filled with fabrications and distortions that it is still upsetting to read.

The appointment was on June 5, 2000 and the report shows it was not printed
until August 8, 2000. It appeared in my medical record sometime after that. I do
not believe this was a casual dictation. I believe this “medical report” was also a
deliberate attempt to undermine my character and credibility.

A copy of my chronology of symptoms and accompanying description of symptoms
was provided and my IGeneX Lyme IgG test showing one band specific to the
Lyme bacterium and four other bands as required by the CDC for serodiagnosis
of Lyme disease.

Dr. Kane’s medical report
http://lyme.kaiserpapers.org/pdfs/Kaiser Kane.pdf
The one sentence “second opinion” denial was based exclusively on Dr. Spindel’s denial.

Dr. Slepack’s letter of denial

Below are some observations.

Dr. Slepack states that I may have been infected in Northern California. I never said
that I went to Northern California or claimed I was infected there.

Another item of note is that my Western Blot test ordered by a Kaiser doctor was not in
my medical record as of the date that Dr. Slepack reviewed my medical record. I am
told that missing medical record information is not uncommon at Kaiser. Particularly
when it is detrimental to Kaiser.

Dr. Slepack appears to be incredibly or purposely misinformed about Lyme disease.
This biased and incomplete information on the symptoms of Lyme disease is part of
Kaiser’s protocol to avoid diagnosis. Dr. Slepack implies that my symptoms were
due to anything but Lyme disease.

Dr. Slepack states I may have had Lyme disease but despite ongoing symptoms
and continuing to be very sick, the disease was “self-limiting” and antibiotic treatment
would not have helped and could result in “potential harm.” His claims are
unsubstantiated and false.

A few weeks of “potentially harmful” antibiotic treatment resolved most of my life-
threatening cardiac arrhythmia irregularities that involved numerous trips to emergency
rooms over a number of years.

It is a shame that unknowing Lyme disease victims rely on the opinions of doctors such
as these for what they believe to be honest and competent help.

Complaint filed against Dr. Steven Spindel
 
This complaint was submitted to Kaiser Permanente Northwest and also personally
given to medical records for inclusion in my medical record. Rather than using the high
quality document I gave them, Kaiser copied the complaint before including it in my
medical record. The copy quality of the complaint used in my medical record is so
poor it is illegible.

Complaint may be read at:
http://lyme.kaiserpapers.org/complaint-filed-against-dr-steven-spindel.html
In pdf form at:

Rebuttals to Dr. Joseph Kane and Dr. Jerry Slepack

I requested that these rebuttals be included in my medical record. I do not know if
they were.

A copy was also submitted to the CEO of Kaiser at the time, David M. Lawrence, MD.
There was no response.

http://lyme.kaiserpapers.org/pdfs/Kaiser-Lyme-Kane-rebuttal-final.pdf
and in html at:
http://lyme.kaiserpapers.org/Kaiser-Lyme-Kane-rebuttal-final.html

http://lyme.kaiserpapers.org/pdfs/Kaiser-Lyme-Slepack-rebuttal-2002.pdf
and in html at:
http://lyme.kaiserpapers.org/Kaiser-Lyme-Slepack-rebuttal-2002.html

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