Caveat: I am a lawyer, and a PhD in medical biochem, which makes me a PATENT attorney, not an insurance attorney. Larra and I help people with appeals, so I know a good deal about that area of law, but not enough to make me qualified to practice in that area, much less in medical malpractice - but I know enough to make suggestions, which is what I will contribute. But nothing I say is to be construed as legal (or medical) advice.
Having said that, I saw Cottam's "informed consent" agreement (see this thread:
http://bariatricfacts.org/threads/crap-band-removal-approved-but-ds-denied-help.3175/), which I assume is substantially identical to the one he had you sign, and I think it is highly misleading. The title of the document is "Certification of Consent to Loop Duodenal Switch" (which is interesting in itself, since that is not what Cottam calls it - he has joined up with Roslin to call the procedure which they slightly tweaked the limb lengths from what is known internationally as the SADI, and they gave it their own name, SIPS - so why does he not use SIPS as the title of this paper? I submit because he's trying to deceive you with the use of the term Loop DS in the title), while the rest of the document just uses "duodenal switch" to refer to the procedure. There is NO attempt made to explain it is not a standard DS, or to specify what is being done
- in fact, it appears to me that it is describing a STANDARD DS:
* The Malabsorptive Component
The malabsorptive component of the DS procedure rearranges the small intestine to separate the
flow of food from the flow of bile and pancreatic juices. This inhibits the absorption of calories
and some nutrients. Further down the digestive tract, these divided intestinal paths are rejoined;
food and digestive juices begin to mix, and limited fat absorption occurs in the common tract as
the food continues on its path toward the large intestine.
The loopDS doesn't separate food from the flow of bile and pancreatic juices - the food leaves the stomach and IMMEDIATELY contacts bile and pancreatic juices - but in a shortened alimentary tract. The loopDS doesn't have two "
divided intestinal paths" - it has one path.
If I were your attorney, I would argue that duodenal switch has a specific meaning in the art - it means a pylorus-preserving sleeve gastrectomy, with intestinal reconstruction to provide an alimentary tract of about 250 cm or 40% of the small intestine starting around the jejuno-ileal junction, with a SEPARATE (i.e., DIVIDED) biliopancreatic limb comprising the distal duodenum starting just above the insertion points of the bile and pancreatic ducts, and ending with an RNY anastomosis about 100-125 cm from the ileocecal valve, or a number that approximates 10% of the small intestine, and wherein the proximal end of the ileum is anastomosed to the proximal duodenal stump.
The "good news" is that your procedure can (I believe) rather easily be revised to something close to a standard DS (but with a somewhat longer - 300 cm - alimentary tract) by severing the small intestine just upstream of where Cottam anastomosed it to the proximal duodenal stump, sealing the side that stays attached to the stump, and moving the open end down to the place where it should be anastomosed to the ileum about 100-125 cm from the ileocecal valve.
I'D WANT THAT DONE SOONER RATHER THAN LATER. However, I'm not sure I'd want Cottam to do it, because of the lack of trust I'd have in his ethics (rather than surgical skills).
I hope you can get an attorney to represent you and the other people DECEIVED by Cottam into being part of his study (with Roslin) on his "SIPS" procedure. I hope you can get your insurance company to revoke (or stop) their payment to him for fraudulently giving you a procedure other than what you consented to, and one which is EXPERIMENTAL and they would not have covered had they known exactly what he was going to do, since he used CPT code 43845, which refers to a STANDARD DS, and to warn him not to attempt to collect the denied payments from you.
The definition of battery under most versions of state law includes the concept of an unauthorized touching. I would argue that his misleading and unethical (in my opinion) practice, including information communicated (or NOT communicated) in his in-person consult and the inconsistent misleading consent form, followed by doing a procedure on you that is NOT what you (and others) understood you had given consent for, constitutes an actionable battery. He failed to obtain fully informed consent before doing surgery on you because he intentionally obfuscated the fact that he was doing his OWN procedure, which substantially and materially differs from the standard of care duodenal switch in the field, his motive being to get as many subjects as possible for his study (with Roslin) and to publish the results of this procedure that they named as being distinct even from the SADI that is being investigated in Europe, in order to make a name for himself in the field.
Moreover, since he is associated with a university, I would also file a complaint with the university, stating that you not only did not give informed consent to the procedure he did on you, you most certainly did not give informed consent to be part of a medical EXPERIMENT. This is a HUGELY serious charge, by the way.
Please (to the extent that your lawyer says is OK, of course) keep us informed of how this progresses. To the extent you can, it is important that you let us know WHILE it is going on, because the likely outcome is going to be a settlement with a gag order that you don't talk about the terms of the settlement or publicly disclose anything about the lawsuit - until you sign it, you should be free (within the confines of your legal advice) to post updates, so we can get the gist of things, including the accusations made in the legal filings. These could be useful for others who are similarly situated, either as Cottam patients, or patients of other surgeons who are also following this unethical (in my opinion) practice, and their attorneys.
