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I am trying to publicize to the American people what a dangerous place
the state of FLORIDA has become for the developmentally disabled.

In 1992, we joined a class-action suit against the State of Florida and
Governor Lawton Chiles for REFUSING to comply with Federal laws
requiring the state to provide placement facilities for ALL
developmentally disabled persons who apply and qualify.  Two of the
plaintiffs have died awaiting care while Florida stalls and Governor
Chiles plays the violin.  Finally, the Federal judge has told Florida
that no person should have to wait more than 90 days for placement and
gave Florida 60 days to explain to the Federal court how it plans to
comply.  The judge also blocked Florida's attempt to REMOVE $30 million
in funding for placements by simply renaming some contract facilities. 
They would no longer be called "Intermediate Care Facilities" and would
therefore no longer be required to meet Federal standards of care.  This
was to be done without any change in the patients residing in those
facilities.  Florida was given until January 26, 1997 to comply or be
found in "contempt of court."

Since no state placement facility was available for our son, we were
forced to care for him at home.  My first attempt to cover him under my
employers' traditional insurance was refused.   They would not cover
him.  We had to wait a year and then enroll him in an HMO.  Today,
traditional insurance is no longer an option at my employer, Florida
Power & Light Company.

That is when our NIGHTMARE began:

I have started my own web page:
http://pw1.netcom.com/~sambrola/noHMO/mypages.html
It has links to my other pages.

There you can see my Summary of our 6 year Nightmare with AvMed HMO in 
three parts at: http://pw1.netcom.com/~sambrola/noHMO/summary1.html 
                http://pw1.netcom.com/~sambrola/noHMO/summary2.html
                http://pw1.netcom.com/~sambrola/noHMO/summary3.html

Four of the more than twenty letters I sent to the Dade State Attorney,
Katherine Rundle are at: 
http://pw1.netcom.com/~sambrola/noHMO/ltr16.html
                http://pw1.netcom.com/~sambrola/noHMO/ltr18.html
                http://pw1.netcom.com/~sambrola/noHMO/ltr19.html
                http://pw1.netcom.com/~sambrola/noHMO/ltr20.html

Katherine Rundle REFUSED to prosecute AvMed HMO & Roger Strube, AvMed's
former
Medical Director over 110,000 members in Dade County.  These letters
will demonstrate that he WOULD have been convicted if the case had went
to trial.  AvMed asks the question: "What line did Roger Strube cross
with actions that are not being done every day by dozens of others,
including doctors, nurses, & case managers?"  The GUILT or innocence of
an accused MUST be determined by comparing the accused's actions with
the LAW, not with the behavior of others; and that comparison MUST be
done by a judge and jury.

*********Roger H. Strube, M.D. was NOT acquitted.*******************

Katherine Rundle dropped the only charge against Roger H. Strube in
August, right after
she was notified that not only would she run unopposed in the November
election, she would not even appear on the ballot. Therefore, I had no
way to get the case publicized.

I have attached a copy of the UPDATE of our experiences since then.  It
is also available at: http://pw1.netcom.com/~sambrola/noHMO/DOCS1.html. 
I also posted it to the Miami Channel 7 WSVN Message Board @
http://www.wsvn.com/extra/bbs/messages/697.html

*****************THANK YOU, KATHERINE RUNDLE!!!!!*********************

I also have tried to obtain a copy of the printed record of the House
Ways & Means Committee, Subcommittee on Health hearing on H.R. 2976,
Patients Right to Know Act, that was held on JULY 30, 1996. I submitted
our Summary and a copy of the AvMed Bonus Plan signed by Roger H. Strube
to that hearing. U.S. Rep. Carrie Meek just advised me that the printed
record of that hearing has not been published YET. Six months later.

Did you know that as an American citizen and a taxpayer, I am not
allowed to obtain a copy of the contract between AvMed HMO and the U. S.
Health Care Financing Administration for MEDICARE coverage, that spells
out what care MUST be provided? That information is considered
"proprietary" and not public record. I pay for it, my father-in-law
depends on it, and I'm not allowed to READ it. How absurd. Is this still
the USA? Its not the same USA I thought I was defending during my 20
years of military service!

Did you know that the Boards of Medicine in Indiana & Wisconsin RENEWED
Roger Strube's license to practice medicine in those states WHILE Roger
Strube was still facing trial for "practicing medicine without a
license" in Florida.  Wisconsin renewed his license in spite of the fact
that Roger H. Strube, M.D., had already been disciplined in Wisconsin
for "improperly prescribing amphetamines". This is on his record with
his acknowledgement, his attorney's acknowledgement, and WITHOUT the
cooperation of the patients involved.  I had also informed them of his
actions in Florida.  Indiana renewed his license despite my notifying
them of Strube's record in Wisconsin and his actions here in Florida.  I
hope he leaves Florida and sets up practice in one of those states.

I have written to the American Medical Association and requested their
opinion of this licensing fiasco.  I have received no response and
expect none.

I am sending E-mail to as many people as I can to request they ask their
Congressional Representatives to seek publication of that hearing and to
vote for passage of that legislation.  

Not just patients, AMERICANS HAVE A RIGHT TO KNOW!!!

Sam Brola 
"REFUSE TO LOSE"

UPDATE follows: also at http://pw1.netcom.com/~sambrola/noHMO/DOCS1.html

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                              Samuel Brola
                             Monika D. Brola
                         17400 S. W. 113th Court
                          Miami, Florida  33157
                        Telephone: (305) 254-9608
                        Facsimile: (305) 256-0841
                 Internet Email: sambrola@ix.netcom.com
         Web page URL:  http://pw1.netcom.com/~sambrola/noHMO/mypages.html

January 20, 1997

To Whom It May Concern:

You may have seen the Web page summary of our long fight with AvMed over our 
son's medical care.  The following is the sequence of events since Katherine
Rundle, the Dade State Attorney REFUSED to prosecute AvMed HMO and its former
Medical Director of the Miami Plan.

1) In October, David was admitted to Baptist Hospital with a respiratory 
infection.  He responded well & was shortly discharged to his home care with 
IV antibiotics.

2) November 7, 1996, my wife, Monika, was admitted to Deering Hospital for 
surgery to be performed by Mohamad Shahmohamady, M.D.  The surgery was to 
correct years long gynecological problems, mainly pertaining to cysts on the 
left ovary.  A D & C had not been much help.  Dr. Shahmohamady recommended and 
my wife agreed to a full hysterectomy.  According to hospital records a "Total 
Abdominal Hysterectomy with Bilateral Salpingo-oophorectomy" was performed.  
On November 8, 1996, I questioned Dr. Shahmohamady about the surgery.  I asked 
if there had been any difficulties, problems, surprises, or incidents.  He 
reported not.  He stated everything went perfectly fine.  Monika was 
discharged from Deering on November 9.

2) On November 14, 1996, David's condition worsened slightly with lethargic 
response and a fever.  Instead of changing antibiotics, AvMed's physician 
ordered him re-admitted to Baptist Hospital.

3) A change in antibiotics lowered his fever and returned his energy in just 
three days, however, David's physicians kept him in the hospital longer.  His 
CAT scan had shown an abscess in the right lower lobe of his right lung.  
Pulmonologist, Dr. Reed, performed a bronchoscopy and confirmed the abscess 
was NOT walled off and was draining, although slowly.

4) Dr. Reed called for a Surgical consult, and the AvMed surgeon recommended  
a partial lobectomy as the "best option".  When I spoke to the surgeon, he 
told me David had a 99% chance of surviving surgery, 50% chance of remaining 
on a ventilator, and a 25% chance of needing a tracheostomy.  Further 
discussion revealed that the surgeon was NOT aware of David's other conditions 
except for the CD rods on his spine from scoliosis surgery.  He had only seen 
two CAT scans 6 weeks apart and not examined David.  He did NOT know that 
David had cerebral palsy, mental retardation, and seizure disorder.  Any of 
these would make the surgical rehabilitation extremely difficult since rehab 
from massive chest surgery requires complete cooperation & participation of 
the patient.  He also did NOT know that David's right lung had been diagnosed 
as 95% necrotic 5 years ago.  His response to that news was, "Well, of course, 
if we get in there and find that to be the case, we will simply remove the 
entire lung."  Not so simple.  

None of David's physicians could show us even one example of a successful 
surgery of this type on a patient with compromising conditions similar to 
David's.  How can you call something the "best option" when you can't even 
show one survivor?  We are aware of two cases of cerebral palsy patients 
having similar surgery.  The young female patient went in for a "partial 
lobectomy".  She did not survive.  A young male patient, who was very 
responsive and aware went in for a lobectomy.  He "survives" on a ventilator 
but is no longer responsive or aware.  

My personal research reveals that surgery is rare for lung abscesses.  David's 
primary care doctor admitted that a patient of his had taken 6 months of 
intense antibiotic therapy to clear an abscess.  Still, the physicians 
pressured us to allow the surgery.  We refused, since the antibiotic therapy 
seemed to be working.

5) November 26, 1996.  David was discharged from Baptist Hospital on two very 
potent IV antibiotics.  His pulmonologist, Dr. Turpin, also ordered an 
increase to twice a day of Pulmozyme aerosol and aggressive chest physio-
therapy.   It has worked dramatically well.  But AvMed still wants surgery or 
an excuse to disenroll us.

6) December 9, 1996.  David's nurse & I took him to an appointment with his 
primary care physician.  Dr. Sachs said he was now doing great and no other 
treatments needed to be considered for the immediate future.

I returned home in time to witness my wife having a heart attack.  The nurse 
quickly put oxygen on her (we have it available for David) and administered 
chest compressions when she went to full arrest.  When the paramedics arrived, 
Monika went into ventricular tachycardia rhythm three times at home, again in 
the ambulance, and once more at the Deering Hospital Emergency Room.

7) December 11, 1996  Monika was transferred to Baptist Hospital Cardiac ICU 
AFTER having an episode at Deering where her blood pressure dropped to 60 over 
30.

8) December 12, 1996.  A cardiac catheritization was performed at Miami 
Vascular Institute.  The results, per the cardiologist who did the exam, was 
that he could find no blockages, no restrictions, no clots, no lesions.  
Nothing to treat and no visible cause.  He asked if she had been under stress 
(NO KIDDING) and if she smoked.  He stated that the type of heart attacks she 
had (aortic anterior wall myocardial infarctions) were almost exclusively 
caused by stress aggravated by smoking.  He also stated, that it didn't almost
kill her, it did kill her.  If we had arrived 5 minutes later, or not had 
oxygen, or not been able to administer CPR, my wife would be dead. 

I believe that AvMed's pressure to allow dangerous surgery on our son was the 
stress that nearly killed my wife.

9) January 16, 1997.  My wife finally got her surgical follow-up appointment 
with Dr. Shahmohamady.  He did not mention any problems until my wife asked 
about hormone replacement therapy.  Then he told her that she might not need 
it.  They would have to wait until blood test results were in.  She asked why 
tests were needed and then he let her know that HE HAD NOT REMOVED HER LEFT 
OVARY.  He mumbled something to the effect that he couldn't find it.  My wife 
asked for a copy of his surgical notes from which he was reading.  Instead, he 
gave her a copy of the pathology results.  They show only one ovary sent to 
pathology.

Today, we went to Deering Hospital and obtained copies of the Operative Report 
and the Discharge Summary.  They state that a TAH with BSO was scheduled and 
performed.  Then why does my wife still have an ovary?  The left ovary was the 
biggest problem and the deciding factor in having the surgery.

We also obtained copies of the pelvic ultrasound exams that were performed on 
my wife at Baptist Hospital on 05/28/96 and 08/27/96.  Both show that she had 
TWO ovaries and had cysts on the left one both times.

My wife endured a very painful surgical procedure with the hope and promise of 
a future without pain.  Instead, she is AGAIN experiencing some recurrent pain
in the lower left abdomen, and is enduring the stress of probably needing 
further surgery to correct what should have already been done.

We want AvMed's response to this question: "Is the treatment and medical care 
received by Monika Brola representative of what ALL AvMed members can expect, 
or was Monika Brola singled out for the infliction of stress and anxiety which 
caused her heart attacks?  Was she deliberately assaulted because of her fight 
for David's care, or is this the standard of care and treatment one can expect 
from AvMed?

There would seem to be no possible explanation for the surgical malpractice 
performed by Dr. Shahmohamady.  It is clear and obvious that he bungled my 
wife's surgery causing her much pain, suffering, and aggravation.  Until she 
has been examined and evaluated by another gynecologist, we cannot be sure 
what is still there and what still needs to be done.

We are currently seeking a new gynecologist that is not only known and trusted 
by someone we trust, but who can see Monika in a short time.

Sincerely,



Samuel Brola                                                  Monika D. Brola


Attachments sent by fax:

1) 05/28/96 - Pelvic ultrasound report - 2 pages
2) 08/27/96 - Pelvic ultrasound report - 2 pages
3) 11/07/96 - Deering Hospital Admission Form - 1 page
4) 11/07/96 - Deering Hospital Operative Report -  2 pages
5) 11/09/96 - Deering Hospital Discharge Summary - 1 page
6) 11/08/96 - Deering Hospital Pathology Report - 1 page

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