DDDS -- Again

When I submitted patient records as described in SS Disability Fail I included an invoice as instructed in the request documents. The check arrived promptly, but I did not receive full payment for one set of records, so I contacted the DDDS office to demand payment in full. In response, Jennifer Elsen, “Medical Relations Manager,” wrote that only 13 pages of the records I sent “fell into the timeframe of 10/1/2012 to present,” and much of what I sent consisted of “general paperwork and not medical records.” She went on to protest publication of the earlier post including “names of the staff who work at the DDDS to respect their privacy.”  

I wrote my congressman to ask for assistance in obtaining full payment, and inquired as to whether government employees enjoy any immunity from public accountability for their work. I just received payment in full. No one has advised me of any prohibition of publication describing the work of government employees, which I would regard as infringement of my First Amendment right to free speech. (Not to mention that I did not print the full last names of the workers as Ms. Elsen implied, only their last names.)

My congressman’s office also informed me, to my surprise, that this matter concerned state -- not federal -- government. In fact the letter from Ms. Elsen displayed State of Washington letterhead. However, when I accessed the Web site for her office I noted that all the workers’ email addresses use the @ssa.gov domain. Furthermore, adding to the confusion, an “Authorization to Disclose Information to the Social Security Administration” accompanied the original request for records. DDDS thus appears to be some kind of state-federal hybrid.

Here, however, I want to demonstrate that, contrary to Ms. Elsen’s claims, the request fails completely to indicate what DDDS will or will not pay for in the way of records. Furthermore, the request documents include vague and cryptic terminology. I hope either DDDS or SSA, or whatever agency of whatever government uses these documents, will benefit from this critique to improve them. But I will not hold my breath.

The original letter indicates “items needed” as: “Hx and physical exam findings, clinic/progress notes, diagnostic studies, neurological and orthopedic findings, response to tx, lab finding, diagnosis, psychological and/or psychiatric reports, consultative exam reports, operative and path reports.” The letter also clearly states, “We will pay $22.00 plus 50 cents per additional page in excess of 20 pages for photocopies of your records.” Nowhere does any document state that DDDS will only pay for records included in these vague categories or within the requested dates.

What is a “Hx?” For that matter, what are “tx,” “findings,” and “path?” Surely our government can afford the extra ink it takes to spell out words like history, treatment and pathology for an endeavour important enough to deserve accurate communication. The authors should avoid vague terms like “findings.” This list also suffer from mixing types of documents, like notes and reports, with types of information, like history and findings. Terms like “studies” and “response” do not fall into either category and thus add to the confusion. If each of us demanded clarification each time we receive a request like this, perhaps a dedicated civil servant would step forward to improve this writing. However, if my experience is any indication, DDDS will likely ignore you until you ask your state or federal representative for assistance. Do not “include assessment of what your patient can still do...” In my opinion providing such an assessment might violate professional ethics and damage your relationship with your patient.

Jennifer, if you want to do your best “for the people” write clearly, respond promptly to requests for clarification, and pay us for what we provide. Then maybe you will not mind when someone like myself publishes your names.

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