Dr. Amaka Nwubah
2020 21st Avenue S
Nashville, TN 37212
Friday, August 7, 2020
Dear Dr. Amaka,
I am writing you today to express several significant concerns that have grown during my past few interactions with your office and medical staff concerning my wife, Alyssa Carter, and her bilateral mastectomy and reconstruction. Before I go any further, I want to stress that we have been remarkably pleased with your attention, the skill you present, and your demeanor. We feel like yours are the right hands for her to be in. However, the same cannot be said for the experience we’ve had thus far with Maxwell Aesthetics staff.
First, there is the matter of medicines that were prescribed for her. While I did not complete her patient intake forms, we routinely list “hydrocodone, oxycodone, and opiates” on her list of known allergies. I cannot imagine she would have excluded hydrocodone from the list of allergies during the initial paperwork prior to our first visit with you, though she may have assumed (as would I) that “opiates” include hydrocodone. Moreover, this allergy was most definitely transmitted to the nurse/technician during the prescreening interview prior to our initial visit with you. That this slipped through is an understandable error, and mistakes do happen. However, what transpired after our pharmacist (thankfully) caught the error is what gives me great pause.
Upon notifying Kandice of Alyssa’s allergy to hydrocodone, Kandice became somewhat defensive. She challenged me when I informed her of the allergy, saying, “Well that’s not in her chart! Her chart says Oxycodone.” I attempted to politely correct the information she had, but she persisted. “It’s not in her chart,” she repeated. I felt it best to stress that I both understood it was not in my wife’s chart and that it was, in point of fact, the case nevertheless. I noted Alyssa is allergic to all opioids/opiates. “Hydrocodone is not an opiate,” Kandice then insisted. This is the most dangerous (and deadly) portion of the exchange. In that moment, I came exceedingly close to terminating the call and cancelling the procedure. I again, as calmly as I could muster, pointed out, regardless of hydrocodone’s opioid status (it is, as you are aware, a Class 2 narcotic specifically because it is an opioid), my wife is still deathly allergic to it. At that point, Kandice opted to consult with you about alternative pain management drugs.
This was not the only significantly difficult part of dealing with the office and clinical staff at Maxwell Aesthetics, unfortunately. In addition to this potentially life-threatening lapse, we experienced other challenges.
One particular challenge hinges on the manner with which the Maxwell Aesthetics office and clerical staff handled our request for processing Alyssa’s FMLA/disability request. Because Alyssa has been at work during this time, and due to my availability during business hours because I work from home, I have been shepherding her leave request through the Restoration Hardware process—which involves not only RH personnel, but also a third-party benefits management company (The Larkin Group) and Prudential Insurance.
Beginning on the morning of Monday, August 3, I phoned the office to request to whom I could forward the necessary paperwork. The receptionist forwarded my call to a voicemail box for the nurses. I left a message, and I anticipated hearing back the following morning. However, by 2 p.m. Tuesday, I decided to phone again. At that point, the receptionist informed me they would not provide contact information or the paperwork until we had paid the $35 processing and filing fee. In a follow-up call, I paid the fee and received Kandice’s email address, at which point I emailed her the paperwork with a request to phone me prior to completing it, as we had questions. She returned that call Wednesday morning, and we visited about the various leave options and concerns. All seemed well at that time.
However, a half-hour after speaking to Kandice, I received a phone call from Prudential. They had an additional form that needed to be attached to the packet I had sent to Kandice. The gentleman, Andre, asked for the clinic’s contact information, which I provided. Again, I assumed all was well and would be handled. After all, Kandice was aware of the need to process the paperwork. (A quick reminder, we were originally anticipating this to be a much longer process, but because of scheduling with school and the shared availability you and Dr. Hargreaves, we were able to “rush” the first procedure a bit, which created the time crunch for Prudential.)
Today, as we were coming into the office for our pre-operation visit, I receive a second phone call from Prudential. The exasperated agent informed me Prudential was “having trouble with the doctor’s office,” because the doctor’s office was “refusing to provide a fax number” until we had paid the $35 filing fee for the paperwork to be completed. I obtained the fax number and provided it to Prudential myself. According to Prudential, that form should have been delivered momentarily. As you are aware, I mentioned it several times during our office visit. This was not an accident, as I wanted you to be aware in as gentle a manner as possible that we were having issues getting vitally important paperwork processed. As of end-of-business today, I still have not received the completed FMLA/Disability packet I delivered on Tuesday, and I do not know if the packet has been processed or if Prudential has succeeded in delivering the additional form. Consequently, Alyssa’s leave request will not be processed until sometime next week, during a period of time where we are managing her surgery and her recovery while simultaneously trying to file the required paperwork.
Finally, throughout the process, we have expressed concerns that the procedures Alyssa is about to undergo are, indeed, pre-certified from our insurance provider. Tuesday afternoon, I emailed Denise in order to discuss this matter with her, as in the past we have had confusion from Blue Cross about procedures. Denise had not phoned me back as of Wednesday afternoon, and I followed up again, at which point I was able to speak to her directly. (The pattern of leaving messages, sending emails, and requesting a call back, only to have to phone again, seems to be the norm with the support staff.)
I want to stress, again, that we have been more than pleased with your service and we have complete confidence in your abilities and skills as a physician and surgeon. However, these emotions have been repeatedly undermined by interactions with your staff. This was a feeling that was reinforced today in our final interaction, and it is one that both has nothing to do with Alyssa’s treatment and confirms for me that the issues we have experienced are hardly isolated to Alyssa’s care.
After our arrival in the clinic and prior to being shown to the examination room, the receptionist received a phone call from a patient. From what we could gather from the receptionist’s single-sided conversation, the patient was exasperated with an insurance question. The receptionist addressed the patient by his last name, and she then proceeded to say, “You need to be speaking to Denise about this. However, I think Denise has more than addressed your concerns. You just don’t like the outcome of that conversation.” Before the end of the conversation, we were able to ascertain the patient’s name, that there were insurance problems, and his concerns weren’t being addressed. If anything sums up the brusk nature with which our concerns have been addressed repeatedly, the manner with which the receptionist addressed the gentleman on the other end of that call is the ideal case study. Overhearing his experience hit just a little too close to home.
While I trust you will address these matters promptly and professionally, Alyssa requests that you maintain confidentiality on these matters until after she has completed her treatment, as she does not want to strain her relationship with office personnel. I have assured her such would not be the case.
Again, I thank you for your professionalism and skill. Granted, aside from the incident concerning Alyssa’s hydrocodone allergy, these matters are mostly trivial. I only wanted to bring these matters to your attention from the perspective of a patient and her family. Should you wish to follow up with me concerning these matters, I am happy to speak to you at your convenience. My contact information is included below.