Interpersonal Neurobiology, a compelling framework for trauma and stress recovery

Interpersonal Neurobiology (IPNB) is a compelling framework for trauma and chronic stress recovery due to its emphasis on:

  1. Integration of Brain, Mind, and Relationships: IPNB recognizes the interconnectedness of brain, mind, and relationships, promoting a holistic approach to healing by addressing cognitive, emotional, neurophysiological, and relational aspects of trauma.

  2. Neuroplasticity: The framework acknowledges the brain’s capacity to change and adapt, offering hope for recovery through interventions that foster positive neural patterning and the formation of new, healthier pathways.

  3. Social Connection: IPNB underscores the importance of relationships in healing, highlighting the impact of positive social interactions on brain functioning. Building supportive connections can contribute significantly to recovery.

  4. Mindfulness and Presence: The emphasis on mindfulness practices within IPNB encourages individuals to stay present in the moment, fostering self-awareness and helping to regulate the nervous system, a crucial aspect of trauma recovery.

  5. Attachment Theory: IPNB incorporates insights from attachment theory, recognizing the significance of secure attachments in early life and their ongoing impact on emotional regulation and resilience throughout one’s lifespan.

  6. Emotional Regulation: The framework provides tools for understanding and regulating emotions through regulation of the internal state, empowering individuals to develop healthy coping mechanisms and responses to stressors.

  7. Narrative Integration: IPNB incorporates the power of storytelling and narrative in the healing process, allowing individuals to make sense of their experiences and reshape their personal narratives in a more empowering way.

  8. Cultural Sensitivity: IPNB acknowledges the cultural context of an individual’s experiences, providing a flexible and inclusive framework that can be adapted to various cultural backgrounds and belief systems.

The interdisciplinary nature of Interpersonal Neurobiology, combining neuroscience, psychology, and social sciences, makes it a comprehensive and effective framework for navigating the complexities of trauma and chronic stress recovery.

Posted in Education, Healthcare, Interpersonal Neurobiology, Mental Health, Nervous System, Neuroscience, Thriving | Tagged , , , , , , , , , , , | Leave a comment

Review of Howard B. Goldstein, DO, MPH

goldstein photo cchs website screenshotIn February 2019 ChristianaCare urogynecologist, Howard B. Goldstein, DO, MPH performed two procedures on me without consent after he withheld vital information I needed to make an informed decision. I had twice consented to a “single minorly-invasive procedure with no external incisions and no tissue removal… [with] 6 weeks recovery, then back to a normal life forever,” a sacrospinous ligament suspension with a possible cystoscopy (viewing of the interior of the bladder). I consented to no other treatment.

While I was still doped up, the urogynecologist told me he’d “had to” perform two other procedures. The nurse, on hearing about this from another nurse, exclaimed, “Oh, the Dr. Goldstein Speical!'” According to numerous healthcare providers, this means he’s done it to many. It seems like Informed Consent is no more than a nice concept.

After I got home I looked up the 2 unauthorized procedures and found he had done exactly what he had promised he would not do! Goldstein cut pieces of healthy tissue–including muscle!–off my genitals without consent! Instead of the promised 6 weeks of recovery for the consensual surgery, he said, “You’re going to be in pain for at least 6 months.” He tried to shame me when I said he should have informed me first. His betrayal caused me serious Medical PTSD which I have yet to recover from in the 5+ years since.

What Howard B. Goldstein DO, MPH did to me is Female Genital Mutilation (FGM). He was a known problem and ChristianaCare still let him operate on me, enabling his abuse of my body and person. I would not let anyone I care about go anywhere near that man or the hospital that employs and protects him at the expense of his unnumbered victims. If they protect this level of evil, it’s likely that they would also protect countless lesser evils, none of which I would wish to encounter.

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“What do I do with my anger and rage?”

In our culture, we’re taught to not be angry, to calm down, and to “overcome” our anger, the emotion that alerts us to violations. Cruelty and contempt from caregivers is a serious violation. It’s no wonder survivors of severe abuse often ask “What do I do with my anger and rage?” They are barraged by the false assertion that is that anger is bad for us, we shouldn’t express it, and we should try to make it go away, especially by repression. That can put us on a hamster wheel of helpless rage and outrage. This is why it is important to bring anger and rage into the physical realm through meaningful action. There are infinite ways to express them that aren’t harmful to anybody and that an abuser doesn’t even have to know about. 

Rituals and ceremonies can be powerfully transformative. I buried “the father of my dreams” in a mock funeral in the rain. It wasn’t so much an expression of rage but the hurt and the disappointment. The effect was profound. 

I also duplicated a photo of my father that showed his meanness. I printed out 15 copies on one piece of paper in black and white. I cut them out and tossed one image into the toilet before each use. There’s something satisfying about pissing on your abusive dad and flushing him. It didn’t truly dispose of him or make him stop being a Dark Tetrad, but it helped solidify in me a change in the field between us because it changed my affect toward him. And so in that way, it was effective. 

One year, I sent out a crappy birthday card to him and another to my abductor. I found my abductor’s father’s address and mailed it to him there. The cards for my perps were similar. Each said, “On your birthday…” on the front with a cartoon dog with balloons and other festive elements. Inside it said, “I hope you remember all the horrible abuse you perpetrated against me and take all the responsibility. I hope you have a crappy birthday!” 

I printed the words shame, blame, and responsibility on a piece of paper, cut them out individually, and put them inside the cards. I intended them to fall out like confetti when they opened the card. I imagined my father getting his and opening it in his kitchen, where the floor was cheap vinyl that had super static cling. A tiny piece of paper would be hard to pick up. I imagined him having to pick them up and being pissed off that he had to clean up the mess. I even had a friend mail it from another state with the address in her handwriting so he’d have no clue who sent it or what might be inside.

A few years ago I tied a string around my wrist twice with two knots, one for each of my dark personality parents. I held a little ceremony in which I cut the strings off and burned them as I spoke about my parents and the relationships. It was empowering.

My childhood was a boot camp run by monsters, so for me, fighting back as a Trauma Awareness Activist-Artist and Relational Neuroscience educator is part of healing. I strive to transmute the rage of generations of abused children into a force for positive change. Pow! 

I highly recommend having a temper tantrum and tearing up phone books that someone else has agreed to clean up. Other ways to express anger and rage: art, poetry, satire, comics, dance, drumming, music, and other physical acts speak to us at the somatic level. You might have a naked dance in the moonlight and burn something to free yourself or express your rage and he’s not gonna know about it, but it’s gonna feel mighty good to you. 

If you’re repeatedly unheard, that’s a kind of shaming and a kind of denial of your lived experience. You need to find an appropriate way to “protest,” or speak your truth. If your protest is heard and responded to you don’t continue to feel angry and that rage is like the fermented anger that it’s been bubbling in. Expressing it through mindful acts can be a way to be heard, especially if you invite trusted individuals to participate.

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Physician reviews as justice

sex misconduct by ob gyn physiciansPosting a review of a bad healthcare experience is one of the very few options for neglected and abused service users to create accountability.

The healthcare system is woefully lacking in safety and accountability mechanisms to the extent it offers layers of protection to heinous abusers like Earl Bradley and Larry Nassar, so they can continue to harm innocent and vulnerable people for years or decades despite ongoing complaints.

By suppressing vital information about abusers and allowing them to continue their abuses, hospitals essentially feed victims to perpetrators. They are aided by the tendency of licensing boards to also do nothing.

This is “healthcare” in America and the “justice” system doesn’t care. We shouldn’t have to “hope the next one is better,” as Delaware DAG Zoe Plerhoples advised as the best way to “protect” myself from potential harm from other malignants in white coats, safeguarded by silence and backed by huge corporate resources.

But this is what corporatized America gives us, which is one of the reasons that telling the truth of my lived experience is the only justice I have known.

A provider might be able to have the negative review removed, as I’ve seen with reviews of the GYN who performs “The Dr. Goldstein Special.” But before they do, they will certainly see it, and perhaps others will, too–and be steered away from bad players.

I did what I could do, and it feels empowering to put the truth out there, where at least someone might find it. I will not be complicit through silence and I will not be silenced.

#TraumaAwareAmerica #patientreviews #accountability #justice #zoeplerhoples #DAG #Delaware #DOJ #newarkde #thedrgoldsteinspecial #badmedicine #PatientSafety #harmreduction #truth #onlinereviews #

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Physician empathy is a powerful healthcare intervention

Empathy not optionalAs a trauma survivor who has studied Interpersonal Neurobiology (IPNB) for five years, I have learned that empathy is vital to human well-being, especially after trauma, and that, neurophysiologically, I need empathy. It helps integrate the brain, which helps the brain and nervous system to function better, which reduces chronic symptoms.

Four days ago I gave my pain specialist the gist of what I wrote below. He listened attentively, and immediately created an opportunity for me to share a little about the FGM betrayal trauma, which so deeply affects every aspect of my life.

My doctor, who naturally expresses empathy, came through. His face and eyes softened as he reflected on what it must be like for me and how challenging it is to deal with unauthorized permanent changes to my body. It was such a relatively big dose of empathy that I could not take it all in at once. I needed to titrate it over days. My system is unused to such empathy from anyone, especially doctors. Yet, their empathy is potentiated by their status, which, to our nervous systems, makes them alloparents, substitute parents.

By the time I saw my pain specialist, I had been in bad condition for 5 days. My symptoms were up, I was sleeping poorly, had little energy, and just wanted to quit life. But his dose of empathy was even more potent than I expected. Since that appointment on Tuesday afternoon, my pain levels have been lower, I’ve slept better, and my mood has lifted. I feel able to engage more with life and have hope for improvement once again.

My doctor’s empathy is a powerful intervention. I intend to keep asking for it, and help all my healthcare practitioners to grow their understanding of the great importance of empathy as an intervention that improves patient outcomes and reduces physician burnout, while also positively affecting the bottom line. Win-win-win! It seems like magic, but it’s Interpersonal Neurobiology (IPNB). We are the healing wave.

“Need Your Help with Brain Integration- Trauma damages the nervous system and disrupts brain integration. Safety serves as therapy, but finding it in a culture where the powerful exploit the vulnerable for dominance and acquisition is daunting. Safety, necessitating both the absence of threat and the presence of connection, is greatly absent in my life due to medical and psychiatric abuse following my plea for help with severe complex PTSD from extreme developmental trauma.

“Lacking essential connections for basic functioning, a harmonized brain, and a regulated nervous system, all disrupted by medical abuses, I rely on my physicians to aid in brain integration for a chance at achieving homeostasis before it’s too late.

“Safety is the therapy. Connection is safety, and empathy is the safest connection. I need a lot of kindness, compassion, understanding, and empathy from everyone. Especially empathy. Especially from my doctors. Especially from my male doctors. This is what my nervous system tells me in multiple ways.

“I need 40 seconds of compassion and 10 seconds of empathy in every appointment with any healthcare practitioner, along with the Patel Pause during consultations and twice during procedures. Seeking approximately a million instances of this support.

“This ‘Treat Me Well’ intervention is integral to my neuroscience-based, somatically-oriented dynamic healing framework, particularly within the Exposure Therapy aspect of the Medical PTSD (MPTSD) treatment plan. This approach replaces old, negative memories of negligent, abusive, and malicious healthcare encounters with new positive experiences, fostering healing one compassionate and empathetic visit at a time.

“Resolving Medical PTSD Requres Making a Safe Space in Medicine- Studying interpersonal neurobiology has underscored the crucial role all my providers play in addressing Medical PTSD. The focus is on altering my brain’s predictive coding, a task lacking established protocols in a system overlooking MPTSD. Safety in the medical environment is the only remedy, achieved by enhancing my ability to communicate needs, set boundaries, and secure the necessary Empathy Level care for my nervous system. Building relationships and trust become pivotal for healing, requiring providers who understand and connect. These connections aim to support my nervous system in reclaiming the safety and agency stolen by psychiatric and surgical abuses.”

#TraumaAwareAmerica #doctors #HealthcareExcellence #healthcare #medicine #physicianempathy #interpersonalneurobiology #Empathy #ptsdrecovery #brainhealth

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ChristianaCare Patient and Family Relations’ Disregard for Patient Needs and Safety

I wanted to pursue a serious grievance regarding a ChristianaCare medical experience that caused me significant and lasting harm. I received communiques that are unhelpful, and mostly gobbledygook. I only received the vaguest assurance of any resolution of the harmful systemic and provider issues because I kept pushing for six months.  

The grievance process was extremely frustrating and slightly more than useless. I only obtained the slim satisfaction of a meeting with leadership after months of persistence and luck that I pushed the right buttons in the right order. I was not granted the meeting with the provider for which I made multiple requests. As one repeatedly harmed by abusive and neglectful men throughout my life, I need to speak my piece to Dr. Schwartz. I’m not sure if it is him, leadership, high mucky-mucks, or the attorneys who are afraid of my words, but I guess maybe all four. 

The Patient Relations office demonstrated great disregard for the needs of the patient, as you can see by the contact log below. I didn’t realize at first that I would deal with a stonewalling obfuscator so I didn’t log the first 2-3 calls, but the pattern is clear. Kellie McQueen often neglected to return a call until I resorted to the use of some sharp words. Then she would move a fraction of an inch.  If she’s not supposed to be a stonewaller then she needs to go back to the factory to overwrite the program because she is not a good person for an aggrieved patient to deal with on any level. I declined to try to work with her because she has repeatedly shown great reluctance to work with me. In addition, Ms. McQueen showed not even a speck of empathy. The best she and the entire system could offer was, “I was disappointed to hear you did not feel supported,” which is two middle fingers up!

Nobody should have to work that hard to get a feel-good meeting, one that should have been offered by the system a year ago. They should have asked me for a debriefing that would help them do better in the future. Not put it on me, and put it on me to be doggedly determined to get a freaking decent response from this person who is supposed to be in patient relations. Most aggrieved people aren’t going to go through that; it’s too much for them. They’re busy trying to recover from whatever harm was done to them and maybe get back to work so they can earn money to pay their rent or mortgage and pay their medical bills. From what I can tell, this is what The System wants. 

If Kellie McQueen’s job is to wear out “complainers” with gobbledygook, silent treatment, and inaction she deserves a raise. If her job is to help people who have encountered problems in the system then she needs to be moved to a new position in the back of the file room ASAP. Stonewalling and silent treatment are highly dysfunctional and a kind of abuse. They seem to be built into the patient relations system. That’s jacked up!

I did not log the first few calls between Kellie and myself, but soon it became apparent that I needed to. Here is the contact log to date. 

2019-04-16 – I left a voicemail about going forward with the grievance.

2019-04-23 – I left a voicemail about going forward with the grievance.

2019-04-30 – I left a voicemail, “As I said in my last message, I wish to take the Dr. Schwartz matter to the grievance level. Dr. Schwartz’s behavior was inappropriate and he should experience the consequences that inform him so he can avoid causing similar harm to other patients in the future.  If you are unable to help in a timely manner I will find the go-around. I’m going to give it another 24 hours, and then…I’ll see you on the other side.”

2019-05-03 –  Received letter dated April 30 stating “these concerns have been forwarded to our leadership within the Department of Psychiatry.” [Psychiatry and Behavioral Health leadership

2019-07-24 – Received letter from Kellie McQueen dated April 30 re Dr. Schwartz grievance with handwritten note about excuses, letter says need time to talk to “entire staff involved in your concern.” Who are those staff? 

2019-07-31- Received letter from McQueen dated July 25 and postmarked July 29 stating she had “immediately forwarded your concerns to the leadership for the Department of Family & Community Medicine” which contradicts her first letter. 

2019-08-26 – Visited Kellie McQueen in her office. She told me they weren’t going to share the report or tell me the outcome. I requested a meeting with Dr. Schwartz. She said leadership might decide it better for them to meet with me. Fine. 

2019-09-15 – Left Kellie a VM to touch base about my request to have a meeting with Dr. Schwartz. 

2019-09-18 – 2105. Left Kellie a VM:  I came by to see you today around 2:30 but you were out of the office. I wanted to tell you that I don’t just want to see Dr. Schwartz, I want an apology from him. From his mouth to my ear. That shouldn’t be too hard to arrange. I expect you could work that out within a couple weeks, max. And I really hope so because I don’t want to trouble you. I know your job is a lot about smoke, mirrors, glitter, and hoping people will eventually go away. Unfortunately, I’m not that type. I want some satisfaction. It’s been almost 5 months and I have no satisfaction at all. Just these three letters that are pretty much gobbledygook. You told me there was an investigation and it was completed on a particular date. You can’t tell me who was involved, what process was used, and whether there was any change in anything. For all I know Dr. Schwartz could be neglecting his duty every day. and if this is how Christiana care treats patient relations and grievances then how can I have confidence that I won’t encounter another Doctor who puts his or her patients at unnecessary risk?  like I said I’m not going away. I want satisfaction. I hope you can work with me on this because if you can’t I will have to figure out my own way to get satisfaction. It will be legal and it will be civil but it won’t be pretty. I look forward to hearing from you soon about when I can get my apology from dr. Schwartz. Thanks and have a great day.

2019-09-19 – Kellie left a VM: Hi Shay, it’s Kellie from patient relations at Wilmington Hospital. I did receive your message from last night at 9:12. I am working directly with the leadership in order to set up a meeting, and as we discussed in my office, I don’t necessarily think that Dr. Schwartz would be at that meeting. I think it will be leadership. But I do ask them to kind of guide me on when we could meet and who will be at the meeting. I’m sorry that you feel that maybe my job is made of smoke and mirrors and twinkle dust and all this, but it really isn’t. I take my job very seriously, and I take your grievance very seriously so long. I am working towards getting this thing scheduled and I will be back in touch once I have a couple of days for you to choose from. All right. Thank you very much, bye-bye.

2019-10-08 Left VM for Kellie at 1505 – Hi, Kellie, It’s been 6 weeks since I visited your office with my request for a meeting with Dr. Schwartz. As you recall, at that time you let me know it would likely be with “leadership” rather than the psychologist whose willful neglect put me in the hospital for a week. You also let me know that ChristianaCare won’t share the grievance report or tell me the outcome. In other words, no satisfaction at all. 

From this patient’s standpoint, it is clear that neither Christiana Care, its “leadership,” or its patient relations department cares about patients who are harmed by its providers. Otherwise, I would have received a swift and genuine apology from *somebody*. 

In the 6+ months I have interacted with you you have shown me your capability within the dictates of your job. I understand systems are inherently slow and cranky. I also know the difference between that and obfuscation. I see no sign that anyone took it seriously, nor do I see any potential satisfaction through your system. Such a well-established pattern says I can count on it being the same in the future so it’s time to move along. I’ve lost my desire to *try* to work with you so I have turned my attention toward a different direction. Thanks for your time and have a good day. 

2019-10-09, at 1346 Kellie left VM – Hi Shay, it’s Kellie from patient relations. I did get your message, and I’m reaching out to you to schedule a time. I’m not sure if you have any restrictions in the day or time. We have some parking things going on here at Wilmington, but I can schedule it either location Wilmington or Christiana Thursday. If you have any dates that you absolutely cannot make if you could leave me a voicemail, and I will have someone in my office that helps scheduling make sure that we honor those dates and times that you’re not able to meet if there is some days and times that are better if you can share that that would be helpful as well. So, feel free to leave me a message at 320-4608. Thank you.

2019-10-19 I left a vm for Kellie – I got your message and initially was not inclined to respond because it is regurgitative. This is what we spoke of when I visited your office 8 weeks ago. No progress in 2 months.  However, on further consideration I decided if you can get back to me in a week with a date 2-4 weeks out, without further prompting, then that would indicate a significant improvement in your pattern. So I will give it one last try. In that 2-4 week window my only unavailability is Thursday mornings and 10-1 on Tuesday November 12th. I could meet at Wilmington hospital or Foulk road family Medicine. Given that exceptional flexibility I’m sure the scheduler will be pleased to easily find something available. I look forward to hearing about the meeting with leadership in the next week or so. Have a nice day.

2019-10-21 VM from Kellie McQueen at 1525 – Shay hi. It’s Kellie from patient relations. I got your message. And I know that you had stated some difficulties with Thursday’s I do want to just check because we’re having difficulty getting people together at the same time. Could you please call and leave a message on my voicemail if 10/31 at 11:00 is something that you’re able to do and I could actually have that right in my office so that we don’t have to get any conference space. Its conference space has been very tight for scheduling meetings. So if that is a date that you are available, then I can secure that with the Physicians, the leadership. So what’s the date would be October 31st at 11:00.  [Short notice, and on the day of the week and time I specifically said I could not generally make!] If you could just confirm that and leave me a message. That would be great. Thank you. You can reach me at 320-4608.

2019-10-22 at 0730, I called, spoke to Kellie – Said I appreciate your proposal for meeting with leadership at 11 a.m. on Thursday, October 31st in your office. It turns out that it can work.  

Kellie said she’ll send a letter by mail to confirm the meeting and who I’m meeting with. Also offered to cover valet parking if I like. Finally, some actual movement here! 

2019-10-29 Kellie left this VM at 0849 – Shay hi. It’s Kellie from patient relations at Wilmington Hospital. Just wanted to reach out to you. I we are scheduled for Thursday to meet with the two providers that I have scheduled. I unfortunately have a family emergency and I have something that I have to attend on Thursday at the same time. I can have my colleague actually come to my office and have the meeting in my office so that we don’t prolong this any longer and you know, you’re able to meet with the providers off. My preference is that I I would like to see this followed through myself, but I understand it’s just, you know, been long-time scheduling and and getting everybody together. So I’m going to ask if you could leave me a message on my voicemail today. I’ll be picking up my messages and I can certainly have one of my colleagues, you know, come to my office job. You know facilitate the meeting, so that’s not a problem. But if it’s something that you prefer me to facilitate or be there with you, I would certainly try to have this may be rescheduled for next week, and I would ask the providers to make adjustments in their schedule to do so, it’s just I apologize. It was a very unexpected situation we have so I have to be out on Thursday. So just let me know whatever works for you. I am happy to have my colleague fill in for me, or I’m happy to try to have this thing rescheduled for the following week when I’ll be here. All right. I’ll wait to hear from you. If you wouldn’t mind. Just leaving me a message. So I know if I need to schedule one of my partners. My number is 320-430-6085.

My return message:
I got your message and I agree that keeping the meeting as scheduled is best. I’m sorry you have a family emergency and I hope all is soon well again. I’ll look forward to meeting with your colleague at the meeting we scheduled on Thursday at 11. Thanks, take care, bye-bye. 

2019-10-31 – Meeting with Leadership – The culmination of 6 months of effort. 

This was the feel good meeting we should have had soon after I got out of the hospital last July, 16 months prior.  At last, I finally got someone in the system to listen!  Drs. Kavanaugh and Rapacciuolo understood what I said and were empathetic and apologetic. They took my criticism and suggestions well. They informed me that my case had resulted in identification of some holes to plug and that “a curriculum” was in process, “but these things take time,” so, every day the system continues to unnecessarily re-traumatize people. Based on treatment from providers and patient relations, I’ll never learn what was and will be implemented, so there is no assurance for me. 

2019-11-13 VM from Kellie – Hi Shay, this is Kellie McQueen calling from patient relations at the Wilmington Hospital. I’m just following up. I apologize that I was not able to attend your meeting that Charlie filled in for me, but he did fill me in on your meeting, and I hope that that was helpful. I think he felt that it was so if you would like to give me a call back. I just wanted to um discuss I guess maybe scheduling in the office and just I guess who the contact would be. I guess who would see you for Continued Care. I’m not sure. I think that was discussed at the meeting, but I just want to make sure that I’m clear and and you’re clear, and we probably have to discussion. So I’m in the office all day tomorrow. Please feel free to give me a call at any time. My number again is 302-320-4608. And this is Kellie from patient relations Thank you. Bye.

2019-11-15 – My Email to Kellie, re her VM of 13 NOV – Hi, Kellie, I received your voice message and am not at all clear what it is about. It would help if you could clarify the subject for me. Thank you, and have a great day!

No reply to date. Maybe the email address was wrong, but given Kellie’s pattern of unresponsiveness, I have to presume she is just doing her job: give me the silent treatment and hope it makes me go away. But I am done dealing with her. She is bad for my mirror neurons and I’ll not have that in my life.

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Grievance for Highmark re “The Dr. Goldstein Special”

Text of my 2022-06-25 grievance for insurer Highmark Health Options (part of Blue Cross/Blue Shield), re “The Dr. Goldstein Special.” This is a follow-up to the gaslighting, cherry-picked facts, and twisted reality in prior Highmark responses.

Explain the Details of Your Grievance: 

Apparently, Highmark Health Options’ grievance team can’t understand the concept of non-consent. Or, they are paid to dance around the truth and avoid actually doing anything to support patient safety and agency. So, I’m laying it out super clear and super simple here. 

In sum: 

This was non-consensual surgery. 

Non-consensual surgery is highly unethical. 

This perpetrator caused great harm to me. 

The surgeon has done this to unknown numbers of other victims.

I remain a high utilizer because I’m trying to recover from Goldstein’s heinous act. 

Although he promised no tissue would be removed and there would be no external incisions, on 2019-01-03 Howard B. Goldstein DO cut approx 2 square inches of healthy tissue from my genitals without consent. This was for a condition about which I had no complaint, did not consult with him about, for which he did not explain the procedure, benefits and risks, or recovery, nor did he obtain consent. Goldstein Dx the rectocele on 2018-06-12 but we never discussed, as it was not a problem. I consulted with Goldstein only for treatment of the cystocele. 

I had no complaint about a rectal prolapse. Goldstein offered me three options for correction of bladder prolapse. A cystocele is a prolapse of the bladder, while a rectocele is a prolapse of the rectum. These are separate complaints with individual codes and very different treatments. I consented to treatment for the cystocele but not the rectocele. That was never discussed and I sought no treatment for a prolapsed rectum.

I chose to move forward with the surgery to correct my prolapsed bladder, not rectum. A rectocele is not a bladder condition or uterine prolapse, and is not associated with urinary incontinence. The rectum is posterior to the vagina, while the bladder is anterior. Very different parts of the body. Surgical corrections for prolapse of these organs involve very different procedures. The cystocele repair Goldstein and I discussed involved a simple suspension of the uterus from the sacrospinus ligaments: no external incisions, no tissue removed, as Goldstein promised. Rectocele repair requires external incisions and removal of healthy tissue, both of which Goldstein specifically promised would not occur. 

As Goldstein noted in the record, I consented to the sacrospinus ligament suspension for uterine prolapse (twice). The rectocele was not a complaint, not discussed at any time, and no recommended repair was proposed or agreed to. Aside from the possible cytoscopy, no other surgical procedures were discussed, mentioned, or consented. Goldstein treated the rectocele without discussion, proposed treatment plan, explanation of risks and recovery, or consent.

During the period between his decision and the surgery, Goldstein unethically withheld that he had decided in advance of my hospital admission to perform the two non-consensual procedures. Goldstein thereby willfully and premeditatively denied my agency. I did not agree to treatment of the rectocele; the genital cutting was forced upon me through medicalized sexual violence.

Goldstein did not correct my problems, he greatly exacerbated them. My overarching problem is PTSD due to too many men in positions of power who incapacitated me and did what they wanted to my genitals without consent and got away with it every time. As you might be able to imagine, this causes tremendous distress in a person. It’s especially distressful when the perpetrator actually cuts a chunk off the junk! The Dr. Goldstein Special gave me far more and bigger problems than it corrected, which will affect my quality of life to the end. 

A person cannot consent to procedures if they are unaware such procedures even exist.  In advance of the surgery Goldstein added the rectocele and two procedures to the order without patient notification or consent, a tremendous deception that deprived me of agency and perineum. He intentionally withheld that he planned to cut my gentials. This is deception. 

“Deception is the deliberate misrepresentation of facts through words or actions in order to make a person believe that which is not true. The forms deception can take include explicit lying, deception by implication, and deception by omission of information that patients need to make decisions in their own regard. Deception intended to advantage the physician economically or otherwise at the expense of the patient is unethical.” –  Deception, ACOG committee opinion: Committee on ethics number 87 — November 1990 

My medical record, summarized in the attached document, “Cystocele v. Rectocele,” shows Goldstein did premeditatively decide to perform the surgery for the rectocele without prior discussion or consent, so he could deliver “The Dr. Goldstein Special.” Every staffer I asked said it takes a lot to gain such a reputation reputation. This means Goldstein has done the same to unknown numbers of women.

The effects of Goldstein’s betrayal are enormous! This doctor did the same as previous perpetrators; he incapacitated me and did what he wanted to my genitals without regard to the person attached. Only, Goldstein did my prior abusers one better: he didn’t just molest or rape, he took a trophy. This is medicalized Female Genital Mutilation, an outrage!  

With his act of immense betrayal and surgical harm, Goldstein severely damaged my health, heavily reduced my quality of life, and disabled me from even obtaining necessary medical care. Due to his abuse, I suffer from Medical PTSD, an iatrogenic condition initiated by Goldstein’s deceit and mutilation of my body. 

As previously noted, Goldstein is the prime reason I continue to be a high utilizer. I had four or five highly triggering visits with 4 different surgeons for consults about the hernia repair and even went through a special perioperative evaluation for vulnerable patients, but could not go through with the surgery due to the terror caused by Goldstein’s heinous betrayal. HHO paid for those visits despite my inability to follow through due to the Medical PTSD sparked by Goldstein’s non-consensual cutting of my genitals. 

At the current rate of my recovery it will be years of work and expensive specialized therapies before I can regain my sense of trust the medical system, and trust in major surgery in particular. I will need many more visits with providers than usual in order to build a sense of trust. Due to delayed detection and treatment I may unnecessarily develop health problems that need a higher level of care because thanks to Medical PTSD I cannot tolerate routine screening like mammography, Pap smear, bone scan, and colonoscopy.   

Also, I will continue to need special care as I can tolerate it, such as much more therapy and likely specialized pelvic PT. Given insurer costs associated with bad medicine, it behooves HHO to sanction and banish unethical doctors like Howard B. Goldstein, DO.

To reiterate, a bladder and a rectum are two different anatomical parts, a cystocele and a rectocele are separate conditions with differing treatments. I consented to treatment for the cystocele, but not the rectocele, which was never even discussed. The procedures for the rectocele were performed without consent. This is highly unethical according to every reliable source, and should be considered so by anyone involved in healthcare, including insurers who pay for extensive recovery. 

As far as I can tell, Goldstein simultaneously committed Medicaid fraud. He performed surgery on a patient for a condition that was not a complaint. It was medically unnecessary and against the patient’s wishes and best interests. Fraudulent!

What do you want to happen as a result of your grievance?

I want HHO to recognize the truth: this was NON-CONSENSUAL SURGERY, highly unethical. I want my insurance carrier to do everything in its legal power to stop this malignant narcissist in a surgeon’s coat.

I want HHO to take all possible action against this provider and the hospital that not only protects him but fosters his development as a predator. The hospital did not have appropriate patient safety measures in place or this man–whose combination of consensual and non-consensual procedures is so oft performed it’s known as “The Dr. Goldstein Special”–would not have perpetrated his medicalized genital mutilation against me.

HHO has the responsibility to its members to take action against unethical providers like Howard B. Goldstein, DO. I seek accountability for the violation of my agency by declining the consent process for the medically unnecessary removal of healthy tissue from my genitals. I want my health insurer to stand on the side of facts, ethics, and patient safety, and agency. 

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About Medically Unnecessary Non-Voluntary Genital Cutting

“The fact that nonvoluntary genital cutting can sometimes be made less physically, if not emotionally, harmful through medicalization does not necessarily make it any less wrongful. A person can be wronged without being harmed, and vice versa (Archard 2007). In bypassing (or preempting; see Möller 2017) a person’s ability to set and maintain their own bodily or sexual boundaries, nonconsensual genital cutting may wrong the person regardless of the level of harm caused…” 

The threshold for wronging a nonconsenting person in this context is ‘mere’ medically unnecessary genital touching...More broadly, trust in the medical profession may be damaged when health care providers perform medically unnecessary procedures on the genitals of nonconsenting persons (Barnes 2012)…FGM/C represents a violation of women’s physical intactness. Moreover, it may cause psychological trauma to the point of developing a post-traumatic stress disorder (PTSD) according to the DSM-IV criteria,23 as well as to those of the more recent DSM-5.24 One should also consider that the Istanbul Convention adopted by the Council of Europe Committee of Ministers in 2011 recognized FGM/C as a form of gender-based violence…There is evidence that women with FGM/C are more likely to experience anxiety, somatization, phobia, and low self-esteem than those without genital mutilation.26 In a pilot study on 47 Senegalese women, Behrendt and Moritz22 showed a significantly higher prevalence of PTSD (30.4%, n=7/23) and other psychiatric syndromes (47.9%, n=11/23) in 23 cut women (vs. 24 uncut participants). In addition, PTSD was associated with memory problems.22 The high percentage of PTSD (>30%) in women with FGM/C was comparable with that observed in cases of early childhood abuse (usually between 30% and 50%).22 These results are in line with those found by Chibber et al.27 in a cross-sectional study on 4800 pregnant women; more than half of women with FGM/C showed affective disorders, with PSTD rate up to 30%.” (Buggio L, Facchin F, Chiappa L, Barbara G, Brambilla M, Vercellini P (2019) “Psychosexual consequences of female genital mutilation and the impact of reconstructive surgery: a narrative review,” Health Equity 3:1, 36-46, DOI: 10.1089/heq.2018.0036.)

ChristianaCare allows a gynecologist to serially perform “The Dr. Goldstein Special” on untold numbers of Delaware residents. Deputy Attorney General Zoe Plerhoples, touting her “background in domestic violence,” says it is OK!

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“The Dr. Goldstein Special” violates the Code of Delaware

The Dr. Goldstein Special,” performed on me without consent at ChristianaCare just over 5 years ago, violates the definition of informed consent as written in the Code of Delaware: “‘Informed consent’ means the consent of a patient to the performance of health care services by a health care provider given after the health care provider has informed the patient, to an extent reasonably comprehensible to general lay understanding, of the nature of the proposed procedure or treatment and of the risks and alternatives to treatment or diagnosis which a reasonable patient would consider material to the decision whether or not to undergo the treatment or diagnosis.” – Del. Code tit. 18 § 6801

The perpetrator also violated the state’s definition of medical negligence:
“‘Medical negligence’ means any tort or breach of contract based on health care or professional services rendered, or which should have been rendered, by a health care provider to a patient.” – Del. Code tit. 18 § 6801

However, Deputy Attorney General Zoe Plerhoples gives him a free pass. He can keep on cutting women with impunity.

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“The Dr. Goldstein Special” violates every ethical standard, except in Delaware

In cutting my genitals without my consent, Goldstein violated every ethical standard including: 

The American Medical Association Code of Medical Ethics for Consent, Patient Rights and Withholding Information:

“Informed consent to medical treatment is fundamental in both ethics and law. Patients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care.”

“Truthful and open communication between physician and patient is essential for trust in the relationship and for respect for autonomy. Withholding pertinent medical information from patients…creates a conflict between the physician’s obligations to promote patient welfare and to respect patient autonomy.

Except in emergencies in which a patient is incapable of making an informed decision, withholding information without the patient’s knowledge or consent is ethically unacceptable.” (American Medical Association Code of Medical Ethics Opinion 2.1.3)

“The health and well-being of patients depends on a collaborative effort between patient and physician in a mutually respectful alliance…Physicians can best contribute to a mutually respectful alliance with patients by serving as their patients’ advocates and by respecting patients’ rights. These include the right: To courtesy, respect, dignity, and timely, responsive attention to his or her needs.

The American College of Surgeons Statements on Principles for Informed Consent and Conflict of Interest:

“Informed consent is more than a legal requirement. It is a standard of ethical surgical practice that enhances the surgeon/patient relationship and that may improve the patient’s care and the treatment outcome. Surgeons must fully inform every patient about his or her illness and the proposed treatment.”

“The physician-patient relationship requires that the patient’s interests supersede all other interests, including the personal and financial interests of the surgeon.”

Also, the ETHICAL ISSUES IN OBSTETRICS AND GYNECOLOGY by the FIGO Committee for the Study of Ethical Aspects of Human Reproduction and Women’s Health, OCTOBER 2012, states, “Only the woman patient can decide if the benefits to her of a procedure are worth the risks and discomfort she may undergo.” 

Goldstein’s blatant disregard for this standard of ethical surgical practice shows his contempt for patient safety and autonomy. It also points to the hospital’s neglect to protect patients from predatory operators like him.

However, the state of Delaware, via Deputy Attorney Zoe Plerhoples, gives him a free pass. He can keep on cutting women with impunity.

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