Are Clinician Manuals Illegal

[carbonman]

As a matter of fact I find it offensive that you would say that an RT can't be trusted.
I know its fashionable to beat up on RT's and DMEs but please consider that some of us try to do it right...

I am amazed at how many times you come here,
telling us that it's illegal and RT's have it all right.

I'm going to, once again, beat the dead and rotting horse....
I was lied to by the DME RT's I had to deal with.
They pulled every cheap used car trick in the book
to deny me a data capable machine.
They were incompetent in setting the machine,
except to make sure I did not have access to anything.
I listened to the director of the sleep ctr. passout
information that was a smoke screen to patients about
the availability of data capable machines.
As far as RT's knowing "rules and statutes", it's on
a case by case basis.
As Paul points out, they probably work by the golden rule....
"the guy w/the gold makes the rules."

You may not be in that catagory......BUT, it's your house.
If you have not received the message yet.....your house is a mess.

[JohnBFisher]

To be perfectly honest its not clear if its illegal.

Either there's a law against it or there's not. Perhaps it's not clear to YOU. And it isn't to me, either. But neither of us are lawyers...
That's why I wouldn't trust EITHER of us on that.

... You may not be in that catagory......BUT, it's your house.
If you have not received the message yet.....your house is a mess. ...

It's not just about a law. We also have contractural obligations involved in the situation.

The obligation does not need to be explicitly written. The fact that the provider / clinician manual states that the manual should not be provided ... and there is a contract between the DME and the equipment manufacturer that (almost certainly) includes text that the DME will only provide equipment in accordance with the contracted terms ... (those contracted terms may in fact be goverened by an agreement between governmental regulatory agencies such as the FDA and the manufacturer ... but this is regulation, not law) ... and any agent of the DME is obligated to follow the contractural term and conditions. Thus the note in the manual would be construed by a court as part of the contract. It is a clear instruction that the manual should NOT be provided by he DME or any agent of the DME to the patient.

So what's this all mean. Well let's take the example of someone using the manual (provided by an RT, unbeknownst to the DME) to change their settings. That patient then gets into an accident. Someone then sues the equipment manufacturer. Through discovery, they find the DME provided the manual. The manufacturer can then (justifiably) argue that they are innocent in the situation. This would greatly increase the blame on the DME. The DME could fire the RT (who would probably have a hard time finding any further work as an RT). But the DME would still be in a bad position.

So, to avoid such a mess, the DME insists the manuals be removed. The RT (as an agent of the DME) must adhere to those policies.

The RTs and DMEs are not villians in this situation. Due to the situation they must follow the rules of the game.

However, is it illegal for the patient to have a manual? Nope. It's just the RT / DME can not provide it by the terms of the contract they have with the equipment manufacturer.

So, why do RT/DMEs often say "It is illegal". Some may not know or understand the contractural situation. Some may just say that because it is easier to explain than going through the above explanation.

PS - I am definitely not a lawyer. However, I often deal with situations where contractural obligations are involved (failure to meet them) and we have lawyers from both parties involved. I've had the chance to hear this lecture often ... and I often try to help others understand that it is important to live upto the terms of the agreement.

[jnk]

I suggest that the following procedure be followed, then:

Patient: "May I have the clinician's manual?"

DME employee: "Unfortunately, the RT and my employers won't let me give this manual here in my hands to you, so I am now going to throw it into this empty wastebasket and then leave for 30 seconds to go wash my hands. You know, I often find that the cleaning guy happens to come by to empty this wastebasket by the time I get back."

[Slinky]

Ah, jnk, why bother? The Clinicians Manuals are easy enough to find online. I'd really rather that the DME provider's RT keep AND ACTUALLY READ the damn Clinicians Manual. Of course, they would hopefully also understand what they were reading! But that's another issue entirely.

It just would be nice if the RTs understood the various features of the xPAPs they provide, at least enough to utilize those features to help the patients acclimate to SUCCESSFUL xPAP therapy. *sigh* But that is asking too much of far too many DME provider RTs.

[rjjayrt]

That may apply to your DME/RT if it does then report them. Its easy to come to this forum to rant against DMEs and RTs but actually doing something about the substandard care you received is appearently too difficult. Again I agree there are DME's and RT's who phone it in and they should be called on it because its not the standard of care that patients deserve. But to come to this forum where new users read the posts, where new users may come to the conclusion that based on what they'd read here that theres no use in working with there RT/DME or worse yet may decide to take there prescription and order online and try to self treat without the requsite information required to do so is dangerous. The problem of "bad" DME's and RT's needs to be corrected and quickly but to lump all DME's and RT's in one group is wrong. There are many DME's and RT's who take pride in doing there job and doing it right. There are thousands of DME companies in this country, and the only ones you know of who are doing a bad job is the one you've had contact with. Voice your complaints loudly and clearly but please realize that there are many who try to do it right, its a shame and I mean it that you've not had the opportunity to interact with one.

[Wulfman]

It should be pointed out that when purchasing these machines online, ALL of the manuals come with them.
This was yet another reason (of many) I chose to bypass the brick & mortar establishments and purchase my equipment from CPAP.COM.
I had been reading this forum for awhile (at that time) and knew that the manuals could be purchased off of Ebay and the basic instructions were starting to be listed here, too. But, in my mind, if I was purchasing the machine, I should be getting all of the (original) documentation that goes with them. I wanted to be in charge of my therapy even before I started.


Den

[jnk]

. . . I'd really rather that the DME provider's RT keep AND ACTUALLY READ the damn Clinicians Manual. Of course, they would hopefully also understand what they were reading! But that's another issue entirely . . .

Its easy to come to this forum to rant against DMEs and RTs but actually doing something about the substandard care you received is appearently too difficult.

OK. On that point you and I differ. It is not the patients' job to clean up your profession. When will your industry start policing itself? Because if it doesn't, trust me, you will all go down. And go down hard. And there will be very little mourning.

Pawning off the responsibility on the helpless patients who wander into the shark-infested waters of the larger DME companies is not a fair thing to do. And you know that.

I understand your not liking the "bashing" that goes on here. You take it personally. That should give you some insight into how personally those of us take it who have been lied to. Repeatedly. The RT/DME has the power. It is not a rare occurance for patients to get abused by those wielding that power. Blaming the victim is not the solution. Just read the stories in the forums. Then, if you don't like what you read, why don't YOU do something about it instead of asking us to fix it? And simply doing a good job yourself with your patients isn't enough. What are you doing to support efforts to make sure the rest of the RTs are being policed in such a manner that keeps them from withholding information from patients and causing serious health problems?

Why is the compliance rate for CPAP so low in this country? I'll tell you why. DMEs. That's why. And the RTs who aren't doing something to fix that are part of the problem.

The RT at my DME was a liar, a cheat, and a scoundrel. What did I do about it? I found helpful people online and now buy all my PAP products from cpap.com. That's what I did. And now I encourage all I meet to do the same. What are you doing to fix the problem? How many have you helped online?

If you are trying to make the point that there is no problem in your industry, you will find few people in your own industry to agree with you on that. The worst bad-mouthing of DMEs and RTs I've ever heard has been from the mouths of respected sleep doctors. And they are scratching their heads on how to fix the problem. Now THAT should tell you something. Eventually the sleep docs will figure it out. Some now send their patients online, from what I hear. I applaud them.

jeff

ps- This message has not yet been approved by carbonman.

[ozij]

Well said, jeff!

[rjjayrt]

Again you've not taken the time or you just choose to ignore what I've posted. I AGREED that there are substandard DME/RT's out there. I dislike them as much as you do. How is the problem supposed to be addressed without those affected complaining to the PROPER agencies. You seem to ignore the fact that there are 45,000 members on this forum, and millions of people on CPAP. Regretfully, just because its posted on here doesn't make it an industry wide problem. I also respectfully suggest that you don't have any idea what the compliance rate among CPAP users is any more than I do. Besides complaining when I go to statewide RT meetings theres not much more I can do other than make sure my house is in order. I can tell you that the standard of care has been addressed by AARC (american association of respiratory care) and it emcompasses what we as users would like to see DME/RT's do. But alas not all DME's and RT's follow the prescribed standards of care and unless someone whos been affected complains about it nothing will be done. I regret that this has become heated between you and I.

[Patrick A]

Jeff
My new sleep doctor really did bad mouth the large nation wide DME here in San Diego, Mexifornia....well said about the low compliance rates also.

[jnk]

Again you've not taken the time or you just choose to ignore what I've posted. I AGREED that there are substandard DME/RT's out there. I dislike them as much as you do. How is the problem supposed to be addressed without those affected complaining to the PROPER agencies. You seem to ignore the fact that there are 45,000 members on this forum, and millions of people on CPAP. Regretfully, just because its posted on here doesn't make it an industry wide problem. I also respectfully suggest that you don't have any idea what the compliance rate among CPAP users is any more than I do. Besides complaining when I go to statewide RT meetings theres not much more I can do other than make sure my house is in order. I can tell you that the standard of care has been addressed by AARC (american association of respiratory care) and it emcompasses what we as users would like to see DME/RT's do. But alas not all DME's and RT's follow the prescribed standards of care and unless someone whos been affected complains about it nothing will be done. I regret that this has become heated between you and I.

I have no problem with you. You have good posts. Your point of view is needed. I only take issue with the characterization of the larger issues.

As I see it, on the one hand, we have to weigh some "bashing" of some medical people who might get their feelings hurt. I am not condoning that. I am just saying that on the other hand we have to weigh the many thousands of patients coming online at a number of forums because of less than helpful medical people. When I take those two related situations and weigh them, I am much less worried about some RTs getting their feelings hurt and MUCH MORE concerned about the patients not getting the help they need. And my primary point is that this situation has become a call to arms not because of a few posters at this forum but because of an industry-wide problem that is openly acknowledged by many respected people in sleep medicine.

Of course, that is only my point of view. My voicing it to you was meant to get you fired up to take a more active role, not to offend you. I am not directing heat at you. I am asking you to become just as heated as we are and to join in the online efforts to help people. That's all.

[Hand extended.]

jeff

[carbonman]

....etc....etc...etc

jeff

ps- This message has not yet been approved by carbonman.

Posted 2/2/09 Attn: newbies, your brain may be fried....

...and you don't know it.

OSA does come on gradually and we become accustomed to it as being 'normal' for us. If you read much here you will see the very same pattern over and over and over again when the new folks come here GumbyCT

......holy Ambien, Batman, I need some sleep,
diagnosed w/OSA,
given an inadequate, barebones cpap,
need to get a data capable cpap.

We all feel tired and fatigued....but it is the gradual destruction that happens so slowly
that we don't realize how much damage is done. It clouds our cognitive abilities and
and dulls our decision making abilities.
There is so much information and so much to learn when we walk out of the sleep study.
There are so many decisions that need to be made, and we are at a disadvantage.
No wonder it's like shooting ducks in a barrel for the DME to fleece us.
I know, I was a duck in the barrel once.

Be aware that you are working w/a disability, admitted or not.
Read, read and re-read the advise you receive here.
Be kind to yourself as you begin your cpap journey.
Take it as you can, you can't learn it all over night.
Be patient in learning to deal w/your mask and learning a new way to sleep.
Check, check and triple check if you're not sure about a decision.

Your brain will come back to life and it will eventually thank you.

The last thing a brain dead newbie needs is to have to fight w/the
DME to get equipment.....but that is the case over and over.

[Slinky]

rjjayrt, you are right. There ARE some good provider RRTs out there and even some good DME providers. I did walk away from the first DME provider I encountered, their RRT was a sheister, at the very least, less than truthful. My second DME provider has been good to me.

But, rjjayrt, MOST of the apneans who search for and find these forums do so BECAUSE of the local DME provider and provider's RT that they encountered. They HAD to in self-defense because of the local DME provider(s) they encountered.

What percentage of local DME providers do you estimate inform a NEW xPAP patient of the choices of brands and models of CPAPs available? What percentage of local DME providers do you estimate offer NEW xPAP patients a fully data capable CPAP? What percentage of local DME providers do you estimate offer a lenient mask exchange policy (keeping in mind the Respironics, Resmed and F&P free replacment policies for most of their masks for local DME suppliers)? What percentage of local DME suppliers do you estimate provide adequate facilities for proper mask fittings (a place to lay down and a CPAP machine to provide pressure during the fitting)?

Its WRONG that the responsibility for educating and supporting new xPAP users falls on the local DME providers. That responsiblity belongs squarely on the shoulders of the sleep specialist doctors. I realize that that is not cost effective for the sleep specialist doctor to do so personally - but - that does NOT absolve the sleep DOCTOR from employing an xPAP savy RPSGT, RRT, or RN to provide that education and support. If the sleep specialist doctor is just an employee or contracted w/a sleep lab, its still the sleep specialist doctor's responsibility to refuse to work w/or for a sleep lab that doesn't have such an experienced, savvy person on staff and available to their patients. At least that is the way "I" see it.

It appears that far too many local DME providers employ an RRT to handle both their respiratory business AND their xPAP business but hire on the basis of the respiratory business, which is the more in demand, w/little to no concern for that RRT's knowledge of apnea and CPAP therapy.

You know, tho, you are right in respect to our filing complaints. I didn't take my complaint any further than the district manager of that first shesister DME provider I encountered. I thought of complaining to my insurance, but my primary is Medicare. I'd already had experience w/trying to lodge a complaint against a medical professional w/Medicare. And never really thought of complaining to my secondary insurance that picks up my Medicare copay.

A full YEAR after an eye exam that I paid for out of pocket because they didn't accept Medicare (glaucoma is considered a medical condition by Medicare) the eye clinic billed Medicare and Medicare paid them. Sometime later I got my EOB from Medicare and saw that. I called Medicare about it and was told that it was a Medicare covered benefit so Medicare paid their 80% of the allowed and it was up to me to contact the provider and try to get my money back. I did and it took about 3 months and some constant contact w/the provider before they admitted their mistake and refunded my money.

[Patrick A]

I suggest that the following procedure be followed, then:

Patient: "May I have the clinician's manual?"

DME employee: "Unfortunately, the RT and my employers won't let me give this manual here in my hands to you, so I am now going to throw it into this empty wastebasket and then leave for 30 seconds to go wash my hands. You know, I often find that the cleaning guy happens to come by to empty this wastebasket by the time I get back."

Good point.

Don't squash or wrinkle my aluminum hat, it keeps "them" from knowing what I'm thinking. Pass the crayons please.

[Kiralynx]

How is the problem supposed to be addressed without those affected complaining to the PROPER agencies.

Just curious as to how patients are supposed to police the health care industry?

Who ARE the proper agencies?

You could be a big help if you would create a post which tells people how to handle the liars, the cheaters, the wretched jerks who are too lazy to do their jobs.

As it happens, I like the RT at my local Apria.

I loathe Apria. I end up tearing my hair out every time I have to order supplies. In fact, unless I can afford it out of pocket, I put off ordering supplies because dealing with Apria is so stressful.

viewtopic.php?f=1&t=47581&st=0&sk=t&sd=a is only one of several exchanges with Apria.

I have reported Apria to my insurance, Aetna. I have told them I intend to change DMEs and that I need information on reimbursement for out of pocket expenses. This has resulted in a fruitless and frustrating line of garbage that I must have a referral from my PCP in order to change DMEs.

viewtopic.php?f=1&t=47653&p=431347#p431347

Now, I'm asking: how would you procede to resolve these issues?

I have no clue. I just know that if I can afford it, I'll order from someone who fills my orders promptly and without giving me a run-around.