Finding the Suster case (Wisconsin DRL v. Suster) was like finding gold. For in it, are all the elements wherein health insurance companies are involved in the suppression of new things in health care. Below is a “Narrative” recently filed in that DRL v. Suster case. It says a lot about the corruption in our Administrative Law system.
Opinion by Consumer Advocate Tim Bolen
The “Narrative” also points out how sleazy health insurance companies really are, and how far they’ll go to NOT pay claims.
I’ve always said that those people who have to rely on Medicare suffer, because they are restricted, due to an antiquated approval process, to health offerings that are, at their newest, fifteen (15) years old. Health insurance companies, in my opinion, are not much better in their offerings for similar reasons – and offer nothing newer than seven (7) to ten (10) years old.
In response to this vacuum in health care offerings, what’s known as “Alternative Medicine” has taken over 50% of the total US health care dollar away from the medical complex – and Americans are paying for these services out-of-pocket. Health Insurance companies are slow to wake up to reality, and instead of embracing health paradigms Americans are buying, they pull stunts like the one described in the “Narrative.”
Stuart Suster MD is a man, who at great risk to himself (he is now getting DEATH THREATS), tried to get health insurance companies to recognize the benefits of, and pay for, new health paradigms. Look what’s happened – so far…
I doubt we’ll see any change, in the near future, in the way health insurance companies operate.
The Suster case is, in my opinion, a landmark. It brings up legal issues, involving the Administrative Law process itself, rules regarding the conduct of prosecutors, and it spotlights health insurance companies’ improper use of the Administrative licensing hearing to simply NOT PAY CLAIMS by threatening the health professional’s very existence. If you are interested in reading these legal issues, read the “RESPONDENT’S POST-HEARING CLOSING ARGUMENT BRIEF FOR PROPOSED DECISION BY ALJ.”
Here is the “Narrative…”
STUART M. SUSTER, M.D., Respondent
Case No.: 00MED272, LS-0210291-MED
NARRATIVE ATTACHED TO RESPONDENT’S POST- HEARING CLOSING ARGUMENT BRIEF FOR PROPOSED DECISION BY ALJ
I am Stuart Suster MD, a pain management expert practicing in the greater Milwaukee, WI area. My advertisements state “When you’ve been everywhere else and nothing worked – come here…” I offer newer, and comprehensive, methods towards pain management. I have significant training in this area (see exhibit A – Curriculum Vitae Stuart Suster MD), have completed significant research in this area, and follow the best of Federal and the University of Wisconsin Guidelines (see exhibit B – UW Pain Management Guidelines) in pain management.
I, Stuart Suster MD, operate on the “cutting edge” of pain management – and that is the problem. As a colleague of mine once said “It’s bloody on the cutting edge…”
I am under assault because I exercised my legal rights, insisting that health insurance companies pay, and pay reasonable amounts, for my services to my patients. Indeed I hired the best experts I could find to assist me in properly billing for my services. I followed their advice, and the guidelines of the American Medical Association, in all of my billing practices. One of my experts has since been appointed by Wisconsin Governor James Doyle as the Insurance Commissioner for the State of Wisconsin. He was not allowed to testify at my hearing – since I was allowed NO DEFENSE witnesses.
I am under assault by an unscrupulous employee of the Wisconsin Department of Regulation & Licensing (DRL), one Arthur Thexton, who, within that department, holds the position of Prosecutor in the Health section of the Division of Enforcement. Thexton is well known for his attacks on Wisconsin “cutting edge” practitioners – and has been recently disciplined, and reined-in for this activity, openly, and very publicly, by new DRL management, Secretary DonsiaStrong Hill for his activities in other cases. Indeed, Thexton has been ordered by his department “not to talk to the media about his cases.”
Donsia Strong Hill, said of Thexton in an earlier case (DRL v. Kadile) “What I inherited were a group of prosecutors who basically had functioned in the past with very little supervision over them or direction or even the establishment of priorities,” Strong Hill said. “We certainly have changed that.”
When Madison CBS News 3 asked Strong Hill, “You’re supervising them more closely?” She responded, “They are definitely being supervised more closely.”
Those earlier cases, three of them, all of which Thexton lost, pointed out that Thexton has connections to, and adheres to the policies of, a national organization known as the “quackbusters.” The “quackbusters” rail against anything new in health care. Their “bible,” a website called “quackwatch.com,” is operated out of a basement in Allentown, Pennsylvania by one Stephen Barrett MD, a man who hasn’t been licensed to practice medicine in any State, since 1993. Their“flagship,” the so-called National Council Against Health Fraud (NCAHF) is operated out of the current NCAHF president’s business, a hair removal and ear piercing salon in Braintree, Massachusetts.
I need relief.
Thexton, a well known power abuser, has recently, because of other cases involving other cutting-edge practitioners, been reined in, but that is no help to me in my current situation. I may be the last case where he is allowed to abuse someone, using his power, but it is unfair to me that I have to continue this process, at my own emotional and financial expense, after, so-to-speak, “the barn door has been shut.”
I am not being prosecuted, as it were, in a justified administrative hearing. I am being persecuted by a known abuser, an unethical, unscrupulous member of a national crackpot organization (the quackbusters) dedicated to stamping out new things in health care – Arthur Thexton.
Arthur Thexton has used extraordinary means to stop me in my attempt to be properly paid for my services by health insurance companies. On this, world-renowned Consumer Advocate Tim Bolen wrote, in his Millions of Health Freedom Fighters – Newsletter, that:
I see cases against practitioners all over North America, and the Wisconsin DRL v. Suster case is, by far, the worst thing I’ve ever seen anywhere. Thexton, for this case alone, should lose his job at DRL, and his license to practice law, for what he’s done to Stuart and Mary Suster. Ruby Jefferson Moore, the so-called Administrative Law Judge (ALJ), in the case, deserves some serious review…, if not legal disbarment, herself.
Thexton, a well known ABUSER, in the Suster case, pulled out all the stops. Thexton used his position at DRL to act on behalf of a group of health insurance companies involved in a billing dispute with Stuart Suster MD. When Suster failed to heed Thexton’s warnings to “back off” on his attempts to collect money owed him, Thexton began a series of events, using his position at DRL, to destroy Stuart Suster. Thexton’s actions were so blatant on behalf of health insurance providers that DRL, and police agencies, would do well to examine Thexton’s finances.
Thexton’s actions smell of “payoff.” In summary:
(1) First, Thexton accused Suster of being mentally unstable, and “using drugs,” forcing Suster to undergo Psychiatric and Drug evaluation. While Suster was undergoing this humiliation, Thexton called the evaluator, attempting to influence the outcome. Suster easily passed the evaluation. When that attempt failed, Thexton moved to step
(2) Thexton went to the media to ruin Suster’s practice, and then
(3) went to police agencies trying to get Suster arrested. When that didn’t work, and police agencies rebuffed Thexton, Thexton
(4) in a “secret hearing” filed eleven counts against Suster with the Wisconsin medical board. The eleven “counts” include over 50 accusations of criminal activity which had been rejected for prosecution by the appropriate police agencies. The new accusations included eleven separate “suddenly found” accusations of sexual misconduct. Thexton then
(5) went back to the media with the new accusations, asking the people of Milwaukee to “call the TV Station, the DRL, the FBI, the DEA, or the local police if they knew anything about Suster.”
(6) Then, when Suster complained about Thexton’s manipulations, Thexton ordered so-called witnesses “not to talk to Suster – although they were talking to the media.” Then
(7) Thexton, with Ruby Jefferson Moore, conspired to eliminate “due process” from the so-called Administrative Hearing, going so far as to not allow Suster to cross-examine witnesses against him, nor call any witnesses in his own defense. All the while, Thexton had the TV station broadcast Thexton’s commentary about the hearing on a daily basis.
(8) Thexton, working in conjunction with Stephen Barrett of quackwatch.com, broadcast the whole bogus accusation/hearing situation worldwide.
And, the Susters are trying to recover from this.
Thexton is the one, you will remember, who UNSUCCESSFULLY prosecuted Wisconsin leading-edge practitioner Eleazor Kadile MD using nationally known CRACKPOT Robert S. Baratz as his do-all, be-all “expert witness.” Thexton also tried to prosecute, Eleazar’s wife Genial (a Nutritionist), but an Administrative Law Judge (ALJ) threw out that spurious attack. Thexton also “investigated” Robert Waters MD, for about eight years. Thexton’s superiors at DRL removed Thexton from the Waters case, and the new prosecutor dropped the investigation within a week.
New DRL management has, after examining Thexton’s actions in other cases, made significant policy changes, reining in Thexton. Thexton has a history of abuse.
Bolen has a readership of over 200,000 for his newsletter and his websites. He is a consultant nationwide, and is on a “first-name basis” with DRL management, and Wisconsin legislators. He is considered to be an expert in the politics of health care in the United States. The whole article he sent out, entitled “The Stuart Suster MD Case – the Most Sadistic, Vicious, and Cruel So-Called Prosecution I’ve Ever Seen…” can be read, in its entirety athttp://www.quackpotwatch.org/opinionpieces/Suster2.htm. I have also enclosed a copy of the entire article as (Exhibit C).
A second article, detailing Bolen’s concerns about the health insurance industry’s ability to shortcut the Wisconsin DRL process, and misuse the Licensing Hearing to deny, and discourage, health billings by practitioners, is added as (Exhibit D). It can be found on the internet athttp://www.quackpotwatch.org/opinionpieces/WisconsinTestCase.htm.
There is significant reason, in this case, to suspect, and call for an investigation of, “Foul Play.”
(1) There are, in Wisconsin Regulations for the practice of law, specific rules prohibiting prosecutors from doing exactly what Arthur Thexton did, in my case. Thexton’s relationship with the media RUINED my practice, and my good name, long before I ever had a hearing on the issues.
(2) I am being persecuted BECAUSE I exercised my rights under the law. Not only have I gone out of my way to get expert assistance in my billing issues, but I filed the claims against the health insurance companies following THEIR EXACT procedures, then moved on to using the Employee Retirement Income Security (ERISA) guidelines. I AM STILL IN THAT PROCESS. Thexton, and the insurance companies have conspired to bypass that process, using the DRL licensing hearing to change to a friendlier venue (forum shopping) – one under Thexton’s control. I have over three hundred cases, totaling over a million dollars in billing, going through the ERISA appeals process. Thexton, working on behalf of the health insurance industry, in an improper venue, is attempting to castrate the United States government Department of Labor ERISA claims process.
(3) The Wisconsin Medical Examining Board, for over a year, has been unable to come up with “Pain Management” guidelines. Evidence of this is clear in their meeting minutes. How can I BE PROSECUTED FOR VIOLATING PAIN MANAGEMENT GUIDELINES THAT DO NOT EXIST?
(4) Arthur Thexton brought against me, and used as the official “Case Advisor,” a pain management specialist, and Medical Examining Board member, who is a geographical competitor to me in the greater Milwaukee, Wisconsin area. This is a definite conflict of interest. This case advisor carried the case against me to the board, and also acted as the witness. He has since benefited from my loss of patients, due to the media coverage by Milwaukee Fox 6 TV.
(5) Arthur Thexton took over 100 names of my patients, names he got from several health insurance providers, to Fox 6 TV. The TV station invited them all to a meeting where those that attended, all formerly HAPPY patients of mine, were indoctrinated by Thexton, health insurance so-called “fraud” investigators, and local TV personages to believe that there were significant criminal acts being committed in my practice – including fraud, sexual abuse, and drug abuse. None of these patients, prior to this indoctrination had ever voiced a complaint, except that “my insurance company doesn’t want to pay for my treatment here…” Thexton wrote a “release” to be used by Fox 6 TV, where all of the patients gave Fox TV 6, Thexton, and the insurancecompanies access to their complete medical records, anywhere, and everywhere (Exhibit E). Since that indoctrination meeting, several formally HAPPY patients have come to believe that I am a criminal – and refuse to communicate with me. All of my formerly HAPPY patients showed marked improvement in their pain issues during my treatment of them.
(6) Arthur Thexton, working with Fox 6 TV, convinced a formerly HAPPY patient to act in an illegal manner, coming into my office to argue over “her bill.”with a concealed TV camera. The purpose of the visit was to embarrass me on Milwaukee TV, and further Thexton’s previous unfounded assertion that I was “loud and angry.” The TV station played this recording, and interviews gleaned from other indoctrinated formally HAPPY patients, continuously. This severely damaged my business, my personal reputation, and has brought me several DEATH THREATS (Exhibit F).
(7) Arthur Thexton convinced my formally HAPPY patients that my normal practice activities promoted in my office were somehow sexual, and were done for “sexual gratification.” People in constant chronic pain need comforting, and a sense that there is hope ahead for relief. I, and my staff, provide, in every case, that emotional support. “Touching,” sometimes called “Therapeutic Touch,” is one of our techniques. It is our office policy to hug our patients, make eye contact, and to act in a warm, friendly, but firm about following the treatment plan, manner. Thexton’s crackpot “quackbuster” organization rails against “Therapeutic Touch,” although he, Thexton, is well aware that the University of Wisconsin teaches “Therapeutic Touch” on campus. Office policy also dictates that at no time am I ever alone with a female patient. Thexton is also aware that I suffer significant physical limitations, and limited range of motion, in that I am a “Dwarf.” In this light, several of his claims of “sexual misconduct,” are preposterous – and simply NOT POSSIBLE.
(8) Arthur Thexton has intentionally misconstrued, for purposes of unwarranted prosecution, several aspects of my pain management program for my patients. “Pain Management” is not an easy specialty, in that most patients can, and do, become too reliant on, and sometimes addicted to, dangerous drugs – opiates. Care must be taken that the patient follow the EXACT guidelines I set out for them in their personal treatment plan. It is part of my treatment policy to have the patient bring in their medication at each visit, and hand their pills to the office nurse, who will count the pills to insure that the right amount has been taken, and that there are none “missing.” When I change a patient’s medication, for whatever reason, I impound the old medication. These opiates are dangerous by themselves, and worse, when improperly combined by a patient involved in chronic pain, and not thinking clearly. Thexton, without justification, has attempted to suggest about those impounded pills, that I am “either taking the pills myself, or selling them out the back door…”
(9) I was recently invited to, and attended a meeting in the State capitol, where over a dozen “cutting-edge” Wisconsin health practitioners were discussing the proper ways, in the proper venues, to file complaints against Arthur Thexton, and another State DRL prosecutor named James Polewski, both of which were, and are, “quackbusters,” regarding a statewide “pattern of abuse,” Those complaints are forthcoming, and will have a bearing on Thexton’s credibility. There are, I believe, SIX separate complaints being filed against Thexton, each going to three separate agencies. Committee members are meeting with ?Wisconsinlegislators regarding the abuse issues.
(10)Arthur Thexton conspired with Ruby Jefferson Moore, the Wisconsin DRL Administrative Law Judge (ALJ) to deny me any semblance of “due process,” in my administrative case. This case is a “railroad.” As Consumer Advocate Tim Bolen so aptly explains “Thexton, with Ruby Jefferson Moore, conspired to eliminate “due process” from the so-called Administrative Hearing, going so far as to not allow Suster to cross-examine witnesses against him, nor call any witnesses in his own defense. All the while, Thexton had the TV station broadcast Thexton’s commentary about the hearing on a daily basis.” All this is true. But there is more in the complaint – much more.
I am one more victim of Arthur Thexton, in his quest to rid the world of those, who in his crackpot “quackbuster” view of health care, need to be stopped by any means. And, Arthur Thexton is capable of using “any means,” and has done so in my case.
Stuart Suster MD
Sunday, March 21, 2004
Milwaukee, WI
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Stay tuned…
Tim Bolen – Consumer Advocate