Wisconsin’s ‘chronic Lyme’ patients embrace alternative treatments, rack up big bills

By Zhen Wang, Wisconsin Watch

 

Crystal Pauley, a former physician assistant, didn’t believe in so-called chronic Lyme disease — until she became sick.

Many health care providers reject chronic Lyme disease as a diagnosis. One 2010 survey found that just six out of 285 primary care doctors surveyed in Connecticut — an epicenter for the tick-borne infection — believed that symptoms of Lyme disease persist after treatment or in the absence of a positive Lyme test.

When Pauley worked for the La Crosse-based Gundersen Health System, she remembered hearing about a friend from high school battling chronic Lyme in Australia. But she had her doubts. “I’m working in the medical field,” she said. “We’ve never learned about that.”

Years later, Pauley has changed her mind. Pauley tested positive for Lyme in 2020. She suffers from unrelenting fatigue, joint pain and brain fog. She walks up stairs sideways because of the unbearable knee pain. Pauley said she has become “pseudo-Lyme literate” because of her own personal journey.

Pauley belongs to a cohort of patients with Lyme-like symptoms but negative test results or patients with positive test results who suffer from lingering symptoms long after treatment. They call it chronic Lyme disease, while the Centers for Disease Control and Prevention labels it as Post-Treatment Lyme Disease Syndrome (PTLDS). The CDC says there is no known treatment for the condition.

“Their symptoms are always real. They’re experiencing them,” said Dr. Joyce Sanchez, an infectious-disease associate professor at the Medical College of Wisconsin who treats Lyme patients with persistent symptoms.

“If someone is having physical symptoms and isn’t feeling listened to, then they’ll have mental health repercussions and then that will impact their physical well-being,” she said. “And then it’s a spiral that if you don’t address both components of health, you’re not going to make much progress on either side. And they will continue to feel sick.”

Wisconsin Watch talked with five Wisconsin patients, all women, who have been searching for validation and experimenting with personalized treatments as part of a long and sometimes grueling battle with the illness. The infection comes from tiny ticks primarily found in the northeastern United States, including in Wisconsin — which is a hot spot for Lyme, ranking No. 5 among states for Lyme cases in 2019.

One of the five tested positive for Lyme using a two-step testing recommended by the U.S. Centers for Disease Control and Prevention. Three others tested positive using a test not recommended by the CDC. The fifth woman was diagnosed as possibly suffering from the disease by a “Lyme-literate” practitioner.

Wide-ranging symptoms

All of the five patients share commonalities. They’ve never noticed the signature “bull’s eye” rash around the tick bite, the hallmark of Lyme disease, which is seen in 70% to 80% of patients. But relentless waves of rheumatologic, cardiac and neurological symptoms have flattened their lives. Some of them were previously fit and healthy.

Pauley, 37, who as a student cranked through medical textbooks, began having trouble remembering

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Special needs patients who need a dentist have few options

In summary

Tens of thousands of Californians with disabilities require special accommodations for dental care, but only 14 centers in the state can treat them.



Lea este artículo en español.

Update: This story was updated May 17, 2022 to reflect the most recent percentage of dentists in the state who accept Medi-Cal.

The first time Namirah Jones visited the dentist at age 5, her meltdown brought the office to a halt. Her mother, Mia Costley, her grandmother and a dental assistant held her down while she screamed. The dentist couldn’t even get a mirror in her mouth.

“That’s when it was determined that no dentist could ever work on her; she would have to be put to sleep,” Costley said from their apartment in Corona.

Jones, now 19, has severe autism and an intellectual disability. She’s among tens of thousands of patients across the state whose disabilities — ranging from cognitive and physical disabilities like autism and cerebral palsy to complex health conditions like Alzheimer’s and Parkinson’s — require sedation during dental procedures, making basic dental care largely inaccessible.

A typical dental office cannot perform general anesthesia nor can it accommodate other disabilities requiring wheelchair lifts or other specialized equipment.

Instead, disabled patients languish on waiting lists for years at the few places that can see them — usually dental schools. When they get an appointment, it’s frequently a financial hardship requiring time off of work for caregivers, long drives from remote areas of the state, overnight hotel stays and out-of-pocket surgical fees.

“For more serious procedures people can be waiting for a year, which if you think about it, living with dental pain for a year is like torture,” said Tony Anderson, executive director of Valley Mountain Regional Center in Stockton. Regional centers oversee the coordination and delivery of services for Californians with disabilities. 

The situation is untenable, said California Dental Association president Ariane Terlet. The association is asking the Legislature to include $50 million in the budget to build special needs clinics and surgery centers across the state.

“The state is responsible for ensuring access to dental care for patients with special health care needs,” Terlet said. “If California is serious about its commitment to health equity, people with special health care needs must be provided timely access to dental care.”

“For more serious procedures people can be waiting for a year, which if you think about it, living with dental pain for a year is like torture.”

Tony Anderson, executive director of Valley Mountain Regional Center in Stockton

Jones is non-verbal and, like many people with autism spectrum disorder, is hypersensitive to certain sights, sounds and sensations, making the dentist’s office a nightmare.

In 2019, she began touching her mouth repeatedly. Her mother worried she was in pain and called Loma Linda University School of Dentistry, where she had previously been able to get her teeth cleaned under sedation. This time, they said her weight gain made the procedure too risky. 

UC San Diego said Jones,

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Heartbeat-Tracking Know-how Raises Patients’ and Doctors’ Anxieties

If someone’s heart skips a beat, tech companies want to let them know about it.

Gadget companies — beginning with Apple and now Fitbit, which is owned by Google — are advertising wearable equipment that check heartbeat rhythms and alert customers when something is out of sync.

These goods contain some feats of technological know-how. Quite a few use advanced optical sensors that peer beneath the pores and skin to keep track of how blood volume alterations — just about like monitoring the tides — and thus tally heartbeats. Other units have a miniature electrocardiogram — which data the heart’s electrical action — embedded. Both strategy can detect irregular heartbeats — and probably atrial fibrillation, a problem that impacts an estimated 2.7 million Us residents and drives up the possibility of stroke and coronary heart failure. When a particular person has it, the beating in the heart’s upper chambers is erratic, and blood does not flow as nicely as it ought to to the heart’s lessen chambers.

Even now, although the gadgets are a technological accomplishment, some cardiologists say the information the equipment produce is not constantly helpful. Notifications from the products aren’t definitive diagnoses.

It’s a conundrum, and a consequential one, for the health care program. Tens of millions of persons are armed with these devices, and if even a small fraction of those people get a ping, it could suggest substantially extra treatment and expenses for the process.

“The engineering has outpaced us,” mentioned Rod Passman, a cardiologist at Northwestern University who’s helping with a examine examining the Apple Watch’s means to monitor for the heart rhythm ailment. “Industry came out with these items simply because they could. Now we’re enjoying catch-up and seeking to figure out what to do with this data.”

Coronary heart rhythm sensors are among the a lot of resources packed into these wearables. End users can have their techniques counted, their slumber tracked, and their gaits analyzed. Some goods will simply call 911 if the wearer has been in a auto crash or experienced a terrible tumble.

People capabilities are meant to make people the protagonists in protecting their health. Through an function touting Fitbit’s atrial fibrillation function, organization co-founder James Park explained it was a single of numerous options of the brand’s health and fitness-monitoring bands that are “making users simply in management of health and fitness and wellness.”

The wearable’s atrial fibrillation ping — a “test [doctors] didn’t order,” Passman mentioned — tells people there’s a thing probably irregular. Eventually, although, any procedure is still left to the health care provider.

The original visits never normally deliver swift answers. To corroborate a notification, a cardiologist outfits individuals with professional medical-quality diagnostics — a patch or cumbersome observe — that are more precise than wearables. (The Apple Enjoy, for illustration, is cleared by the Fda for “informational use only.”) That fancier gadget may have to operate for a although to catch a momentary missed beat. That ready indicates a

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Wisconsin dentist convicted of fraud following breaking patients’ enamel

A Wisconsin dentist has been convicted of health treatment fraud right after he purposely weakened his patients’ enamel so he could bill coverage businesses for crown techniques.

Scott Charmoli, 61, was also convicted of generating false statements relevant to wellbeing treatment issues in the plan from 2015 to 2019, according to the US Attorney’s Business office for the Japanese District of Wisconsin.

The Grafton resident attached extra than 1,600 crowns about a 20-thirty day period period of time, the Milwaukee Journal Sentinel described.

On average, Wisconsin dentists mounted much less than six crowns for each 100 clients, but in 2019, Charmoli’s level exceeded 32 per 100 people, an insurance plan business govt testified, in accordance to the outlet.

The plan was uncovered right after Scott Charmoli sold his exercise in 2019.
Fb / Jackson Family members Dentistry

The scheme was uncovered immediately after Charmoli marketed his exercise in 2019, and the new proprietors recognized soon after examining information that the crown numbers were out of whack.

His sentencing is scheduled for June 17 and he faces up to 20 a long time in the slammer.

Charmoli also faces healthcare malpractice lawsuits in Washington County, introduced by virtually 100 previous patients whose scenarios have been stayed pending the end result of the federal case, the news outlet claimed.

Scott Charmoli
Charmoli hooked up much more than 1,600 crowns above a 20-month period of time.
Facebook / Jackson Loved ones Dentistry

His license to apply dentistry in Wisconsin has been suspended since February 2021 pending a probe by the state’s Dentistry Analyzing Board.  

Charmoli would exhibit a individual an X-ray of a nutritious tooth, but position to a line or a location he reported indicated a fracture or decay – and then would say a crown was needed, in accordance to the indictment.

“Patients, who considered Charmoli was the specialist, acknowledged his phony representations and agreed to the crown technique,” the indictment said.

Jackson Family Dentistry
Charmoli fully commited the fraud whilst functioning at Jackson Relatives Dentistry.
Fb / Jackson Spouse and children Dentistry

Following breaking the tooth, he took X-rays that accompanied a claim submitted to insurance policy.

Crown techniques are usually not entirely covered by coverage, so the dentist did not acquire comprehensive reimbursement for the claims and his sufferers experienced to make sizable co-payments, according to the Journal Sentinel.

Charmoli obtained $318,600 out of $745,570 in statements submitted to Delta Dental amongst Jan. 1, 2016, and June 28, 2018, the indictment explained.

He also obtained one more $114,294 on promises during the initial 6 months of 2019, the document states.

Scott Charmoli
His license to follow dentistry in Wisconsin has been suspended considering that February 2021.
Fb / Jackson Loved ones Dentistry

Previous patient Todd Tedeschi testified that Charmoli informed him he should get two crowns at the exact time to avoid having to repeat anesthesia, even although his enamel weren’t bothering him.

“It seemed extreme, but I didn’t know any improved,” Tedeschi claimed, in accordance to the outlet. “He was the experienced. I just

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Wisconsin dentist Scott Charmoli convicted of overall health-treatment fraud for intentionally breaking patients’ enamel

On Thursday, adhering to a four-working day demo, Charmoli, 61, was convicted of 5 counts of wellness-care fraud and two counts of earning fake statements about his patients’ treatment. He’s scheduled for sentencing in June, when he’ll encounter up to 10 years for each of the well being-care-fraud counts and a optimum of 5 many years on the other two convictions.

Charmoli’s lawyers did not right away reply to a ask for for comment from The Washington Write-up on Tuesday evening. But when the dentist pleaded not responsible at his arraignment in December 2020, his lawyer at the time reported the only point her client was responsible of was hard perform.

“He definitely denies that his difficult-gained prosperity of numerous, lots of several years of dental follow at the 40 to 60 hour for every 7 days selection are the solution of anything at all other than his very own diligence, tricky work and superior business acumen,” protection legal professional Nila Robinson mentioned.

Charmoli experienced belongings value much more than $6.8 million at the end of 2020 and owned holiday vacation properties in Wisconsin and Arizona, according to prosecutors, who allege he billed much more than $4.2 million for crowns in between 2016 and 2019.

Setting up in 2015, Charmoli badgered his sufferers into receiving crowns they didn’t require, federal prosecutors alleged. After intentionally harmful their teeth, he submitted pictures and X-rays to coverage companies as “before” pics to justify the treatment method required to resolve the damage he’d just done.

“It appeared too much, but I did not know any far better,” Tedeschi stated. “He was the professional. I just reliable him.”

Charmoli gave his patients more crowns — a technique in which a dentist replaces a harmed or lacking element of a tooth with a tooth-shaped cap — than 95 p.c of Wisconsin dentists from 2016 to 2019, in accordance to federal prosecutors. At Charmoli’s demo, an insurance plan business govt testified that the normal dentist in the condition performs about six crown treatments per 100 sufferers, whilst Charmoli did extra than 32, according to the Journal Sentinel.

A previous dental assistant for Charmoli testified that traffic at his apply, Jackson Relatives Dentistry, picked up following they moved into a larger place and marketing experts encouraged him to thrust sufferers into having to pay for more companies, the newspaper claimed.

The assistant, Baily Bayer, claimed the shift in tactic created her uncomfortable and pressured she finished up leaving the observe, according to the newspaper. Dentistry, she instructed jurors, “shouldn’t be a income pitch. It should be you both have to have it or you do not.”

Following Charmoli was indicted in December 2020, far more than 60 patients attained out to prosecutors to report that they “strongly believe” he experienced purposely ruined their teeth, necessitating them to cobble together “significant co-pays” for the repairs.

“Some of

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Dentist identified guilty of detrimental patients’ teeth to raise profits | Wisconsin

A Wisconsin dentist was discovered responsible of healthcare fraud and other costs after he deliberately harmed his patients’ teeth to enhance gains, raking in tens of millions from his scheme.

Scott Charmoli, 61, was convicted of 5 counts of health care fraud and two counts of making phony statements about his clients’ procedure last Thursday, in accordance to the Milwaukee Journal Sentinel.

With his sentencing scheduled for June, Charmoli faces up to 10 yrs for every healthcare fraud charge and a greatest of five yrs for just about every of the two other prices.

Prosecutors say that Charmoli experienced routinely drilled or broken his clients’ teeth on intent, charging them for additional treatment solutions to repair the destruction he experienced just performed. As a final result, Charmoli’s gains ballooned, with the dentist likely from generating $1.4m and installing 434 crowns in 2014 to $2.5m in 2015, putting in over 1,000 crowns, reported the Washington Submit.

In accordance to prosecutors, in 2015, Charmoli started pressuring his shoppers into receiving pointless crowns, a dental procedure exactly where a tooth-formed cap is positioned on a weakened tooth. Charmoli would drill or split his client’s teeth and mail X-rays of the intentional destruction to insurance plan as “before” photos to justify the crown processes.

One shopper, Todd Tedeschi, testified that Charmoli pressured him into obtaining two crowns in 1 appointment, inspite of Tedeschi believing that his enamel were good.

“It appeared excessive, but I did not know any far better,” explained Tedeschi. “He was the skilled. I just dependable him.”

Some of the sufferers that Charmoli badgered into avoidable treatments have been also susceptible, said prosecutors.

“Some of these patients ended up very susceptible persons in abusive interactions, lately widowed, survivors of cancer and dwelling paycheck to paycheck scrounging to pay for the co-pays required for the needless methods he was billing,” stated prosecutor Julie Stewart in 2020.

Between 2016 to 2019, Charmoli billed much more than $4.2m for crowns, performing additional crowns than 95% of dentists in Wisconsin for the duration of that time. According to testimony from an insurance corporation govt, although an ordinary Wisconsin dentist performs fewer than six crowns for each and every 100 individuals, Charmoli’s price exceeded more than 32 crowns per 100 shoppers.

By the close of 2020, Charmoli had in excess of $6.8m value of assets, with holiday vacation residences in Wisconsin and Arizona.

Nearly 100 of Charmoli’s previous sufferers have sued him for health care malpractice, with all those situations established to begin after Charmoli’s federal criminal proceedings are over. While Charmoli’s legal professionals did not deliver remark to the Post adhering to Charmoli’s conviction, his lawyers commented all through Charmoli’s December 2020 arraignment, where the dentist pleaded not guilty, expressing Charmoli was only responsible of “hard work”.

“He unquestionably denies that his challenging-acquired prosperity of numerous, several decades of dental follow at the 40 to 60 hour per 7 days array are the solution of everything other than his individual diligence, hard get

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