Personal Statement
November 2006
By Kirkland White
Date of Birth: September 3, 1950
Case #CR06-0172-BES-RAM

When the people fear the government: that is tyranny. When the government fears the people: that is liberty- Thomas Jefferson

They can’t jail all of us! Or can they? -Kirkland White

CITIZENS!
I am a family physician, who was arrested and charged with 98 counts of Medicare Fraud on Nov, 7 2006. They think a 480 year prison sentence is appropriate. I do not. Here is my story.

All facts in this statement are a matter of public record.

I knew from the beginning of my training that there was something very wrong with health care delivery in the USA. For this reason I found little satisfaction in any job venue. Demands were always placed to see more patients and spend less time with them. I concluded that judicious time spent with people could actually solve their problems, but that this was immaterial and even counterproductive to the economics of medical practice in the USA. In 1997 I started developing a unique practice plan: that of delivering medical care to the homebound disabled. I soon came to realize that I had absolutely no preparation for what I was to encounter in this endeavor. I discovered that the days of the county doctor visiting the sick and infirm in the comfort of their homes is not accommodated not by our existing system. The doctor now needs the accompaniment of lawyers, accountants, experts in insurance billing, business, computing and communications consultants, banks and money lenders, skilled interpreters of cryptic government documents and, unfortunately, finely honed political talents. Since I am none of these things and cannot afford to buy the services of such, I embarked on a monumental self education path that continues to this day. This will be a recurring theme in my story.
To my utter amazement, I was exposed to a patient population I had never encountered in my twenty years of medical practice; the homebound disabled. They were of all ages and had unique personal and medical histories. Most had slowly deteriorating, agonizing and untreated conditions. Most could leave their home only with heroic and dangerous effort by them or their caretakers. Most had fallen into despair. All were impoverished. Many of these patients refused to leave their homes due to pain, discomfort, embarrassment, fear of the loss of what remained of their dignity and their previous rough and impersonal handling by the medical establishment. Physicians did not visit them in their homes for various reasons, including loss of revenue, the extensive time expenditures and massive paperwork involved in their care, and fear that their clinical judgment and decisions made with traditional physician skills (listening, touching, using the stethoscope, etc.) were not up to the task, exposing them to excessive liability. Most of my patients were referred to me because NO OTHER PHYSICIAN WOULD HELP THEM. I accepted these challenges and the risks involved. I was able to spend three to four hours on an initial visit with another equal amount of time spent in formulating treatment plans, arranging in-home services and documentation. Not including travel time, a physician in conventional practice could see thirty to forty patients and receive twenty times the revenue for the same amount of work. I persevered in this practice out of financial naiveté and the fact that, for the first time, I could see dramatic improvement in my patient’s physical, mental and spiritual lives. The patients were the sickest, most decrepit and deprived I have ever encountered. They and their caretakers waited silently for death in extreme suffering. Most had over 10 severe, interacting and untreated medical problems.
By the sixth month of practice, I had over 100 patients, mostly referred from state social services. I was working without assistance, seven days a week, 10 hours a day. Although I was making dramatic progress with my patients, I quickly became chronically fatigued and depressed. There seemed to be no end to the homebound disabled. According to the year 2000 US Statistical Abstracts, there were an estimated 30.000 people in Western Nevada who had difficulty leaving their homes to receive medical care, enough to require 60 physicians in their care. I offered my services to any needful person in Nevada and east of the Sierra front in California. I have traveled up to 500 miles round trip to visit a patient in rural Nevada. The paper work required in my patient’s care was massive, requiring over half my time, and increasing on a daily basis. Adding to my growing distress was that Medicare had not paid me for services until almost a year after I started my practice. This was for reasons I have yet to ascertain. The California Medicare intermediary delayed over 3 years in payment. (Claims over two years old are not paid.) I tried to recruit physician colleagues to help me, but they universally thought the work far too difficult. After a year had passed I was deeply in debt and barely making enough to meet expenses. Then came a brief time when Medicare increased their reimbursement to the point that I could operate my practice with minimal losses. From my recollection, my taxable income during these years peaked at $43,000. This represents an hourly wage of $11.268. More typically my income ranged between $6,000 and $20,000 a year. Then Nevada Medicaid lowered their payments to 1/30th the level of previous. This is when they paid anything at all. In my 25 years of medical practice, I have yet to see a single dollar for services rendered from California Medicaid. My medical liability prememiums skyrocketed (representing a 30 fold increase from the time I started practice in 1984). Then the insurance companies refused coverage. Fortunately, the Nevada State legislature mandated insurance companies to provide coverage, which they did at double the rates. I have not carried insurance since 2003. The company demanded payment of $50,000 to cover “past claims”. Of course I did not pay this. All these things exposed me to extreme risk of litigation. Medicare payment cutbacks continued at about %5 a year. Any state programs providing the homebound disabled with help in home repair, maintenance and safety issues were terminated. Those of my patients who were not eligible for state pharmacy benefits went without. During this time I spent thousands of dollars buying them pharmaceuticals, durable medical equipment, making home repairs, etc. Those with State pharmacy benefits added to my paperwork burdon by at least %25.
On a bright note, I finally was able to recruit 2 physician assistants and a nurse who were among the finest people and most gifted practitioners I have ever known. I was able to regain my lost energy and my depression lifted. I realized that we were fighting a losing battle and decided to form a non-profit corporation, achieve 501(c)3 status and apply for grants for continued operations. I had to do this without any professional advice because I could not afford it. Patient referrals were increasing steadily. I made two presentations regarding the deficiencies in health care delivery for the homebound disabled to the Nevada State Legislature during this time and was met with absolute indifference. I could summarize their response to me as :
“This is all very interesting, Dr White, but what does it have to do with us?”
I contacted every Nevada State official regarding my plight, about forty in number, including the Governor, Senators and Congress folk. I had two replies: one from a assemblyperson who stated he understood my problem but had just been elected and had not the slightest idea what to do about it. The other was a seasoned assemblyperson who generally misdirected me or gave me information that was totally erroneous. Even though I had little experience in grant writing, I applied for a $200,000 grant to the Nevada State fund that was created from the tobacco industry lawsuit settlement. I was not awarded this grant even though %95 of my patients had major medical diagnosis related to tobacco use. I was told by the grant committee that my grant was “…just another grant to supply elder medical care.” I found this quite puzzling.
Everyone, including my patients, staff, and State Social Services wanted me to persevere and continue to apply for grants. I determined that the nearest grant I could achieve was at least two years away, and then there was no guarantee of an award. I was already over $200,000 in debt, had mortgaged my home and did not desire a debt increase of over $100,000 a year. I stopped accepting new patients and discharged my employees. During the ensuing months many of my patients mercifully died. There were several suicides and a murder/suicide. I achieved transfer of care for some but was left with twenty-five people who came to me because NO OTHER PHYSICIAN WOULD HELP THEM. Since I have never been a wealthy man, and it costs me $100 a day to practice medicine even at the most simplified level, I was faced with a severe ethical an moral decision. I made a decision and this is where my history will end.
Feel free to ask for elaboration or verification of any of these statements.