Need advice...botched surgery

Ok, so it's been awhile since I've been here because I don't fit in.  For those of you that I've never met, I had a sleeve done on 4-6-11.  I lost 10lbs pre-op and have lost 8lbs since surgery.  Completely wasted surgery.  Anyways, I have been looking into DS because the sleeve is doing nothing for me, obviously.  I submitted for insurance and was denied because they say that now that I lost the 18lbs my BMI is too low to qualify for DS.  My new surgeon wanted to do an endoscopy to find out what is going on and why I'm not losing.  This was done yesterday and here is what it found.  My sleeve is VERY large.  If the endoscopy doc couldn't have seent he staples, he would've never known I had surgery at all.  My stomach measures 44mm and aparently a 32f bougie is 11mm, which is supposedly what was used.  The fundus (which is SUPPOSEDLY removed with a sleeve, getting rid of stretching and the grehlin) is "completely intact and has no areas of narrowing". GRRRR
I'm so pissed off I could kill someone.  So now, my new surgeon is resubmitting everything, including the endoscopy to insurance again to appeal.  I have a question for you all....would you sue?  I am so angry that I went through all this, all the recovery, not holding my babies, frusteration of not losing anything, and now finding out that I did that all for NOTHING because my surgeon is a ******g idiot.  Now, to top it all off, the 18lbs total that I lost put my BMI just under what it needs to be in order to get DS.  I do NOT want rny, and Dr. Buchwald highly recommends a DS for me.  He sees no reason in waiting because he says I will just gain more weight than I already have since surgery.  What do you guys think?  Thank you in advance for your thoughts.

I think I would wait to see what the insurance says with the resubmittal information from the new surgeon.  If it's approved, then you're good to go.  If not, I'd go through whatever appeal process is available to you.  Are they saying that they'd approve you if you gained the 18 pounds back?  I suppose that's an option also--as well as weights in your pockets. ;-)

My personal opinion is that you will need to spend money on a decent attorney, and you might lose.  If you have that kind of money around, I think I'd be likely to put it towards the DS if you can't get it covered, or save it for plastics if you do get it covered.

So sorry this happened. I cannot even understand what toll this has taken on you.

One thought, if you gain the 18 lbs back will you then be eligible for insurance approval?

Do you have any documentation from your surgery of the surgeons notes or anything? Something to say that it was to be a 32fr (or 34, 36, etch)? If not, can you obtain a copy of these from that surgeons office? If you have (or can get) any info like this I would take it to a lawyer (specializing in medical malpractice). I'm not sure the scope from the new surgeon is enough because sleeve size is not a standard thing.

Best of luck!

I have all of my records from surgery.  No, the size is not standardized...however, it is suppose to remove 85% or so of your stomach....which wasn't even CLOSE to being done.  My entire fundus is there.  I can eat almost the same amount I could eat before surgery.  Have been able to since shortly after my swelling went down.   That is not standard.  GRRR

So sorry to hear of your troubles and the botched surgery.

I would definitely find a malpractice attorney (not sure exactly how you find a good one though, maybe someone else knows this) and tell them your story and see what they say.  Probably get opinions from two different lawyers.

To me, it seems the surgeon did not perform the surgery in the way he said he would, and there doesn't seem to be a reason for that, so I would look into what recourse you have.

Sue, sue, sue, or at least threaten to sue. Why are you not telling who this surgeon was. Do you want others to go to him/her? These forums sometimes, often in fact slide into some kind of self-congratulatory rah, rah fan club. But it is the stories like yours that are the valuable ones. Share your information, save someone else from going through the misery you have to go through. That said, all the best in getting out of the mess that that surgeon put you in.

Oh it's no secret who it was.  It was on my profile, but I took it off when I started seeing Buchwald as my new surgeon going for the DS.  The one who did my sleeve is Brandon Helbling at St. Alexuis in Bismarck, ND.  He is the same that did Kelby's surgery...but aparently did hers correctly.

To answers other questions, my insurance requires a BMI of 50 for DS, but 45 for others.  Because of the 18 I lost, i am now at a 41.  They also stated in the denial that not enough time had passed.  Hopefully with this new info fromt he endoscopy maybe insurance will do something as well.  He should have to pay out of pocket for me to get the DS now since I am stuck STILL morbidly obese and can now not get approved for a revision. 

 
Ya know.... I ain't gonna lie.....

When I first read your story.....I thought you were a Kook.....

How could someone give up on a sleeve 4 weeks out????

But than I thought..... she musta got a ****** up sleeve.... cause at 6 weeks out all I could eat was a half a scrambled egg.

Your scope totally backs up your story!

As far as legal action..... I dunno....the VSG is not standardized....leaves him a bunch of outs.....

Hope it works out....

frisco

Haha I could tall a lot of ppl on here thought I was a nutjob.  I KNEW that something was wrong tho because I could eat damn near what I could eat before surgery, and I KNEW that wasn't right.  Everyone would rather critique me for what I was doing instead of helping me search for reasons.  I'm so glad I was referred by people on OH to Buchwald.  He knows his stuff...the man is 80 years old and has been doing bariatric surgeries since 1973.  Of anyone knows, he does.  The last pound I've lost was at 12 days out from surgery...I suppose about the time the swelling went down and I was able to STILL eat way too much.  Since then I have gained 2lbs back.  Super frusterated and not sure whwat the next step is.  Do I call my old surgeons office and threaten to sue?  Do I contact an attorney to do that?  So irritated that I did all this for nothing.

You were definitely wronged. 

You said: "Everyone would rather critique me for what I was doing instead of helping me search for reasons."  It is not that they "would rather".  This forum is not full of surgeons with endoscopes in their back pocket. Those that responded to you knew less than you, and you didn't know for sure until you had the endoscopy. Your case seems extremely rare. So no one could speak from experience.

Your story sucks and is a reminder that people should seek second medical opinions, and this forum is not the best for medical advice.

As for suing. It's an expensive and stressful process. I hope you figure it out. I think that a complaint should definitely be filed against the doctor. I also think that you deserve compensation.  Good luck.