Fugitive Busted By His Pacemaker (And His Doctor)

DrRich | January 3rd, 2011 - 6:35 am

Podcast:

In Durango, Florida the week before Christmas, the FBI arrested fugitives Roger Gamlin, 62, and his wife Peggy, 54, at Mercy Regional Medical Center after a doctor determined their real identities through Roger’s pacemaker.

Wanted by the feds for 2 1/2 years on suspicion of embezzling millions of dollars from their south Florida title company, Roger and Peggy had been living quiet and unassuming lives as Ron and Nancy Jenner in Durango.

Then Peggy brought Roger to Mercy Medical Center after he developed a nose bleed that would not stop. The hospital (in accordance with the sage advice of its attorneys) is not saying exactly what happened next. But we know that Roger’s true identity was determined through his pacemaker, and the FBI quickly showed up to arrest him and his wife. Roger and Peggy waived their rights to an identification and detention hearing, were placed into custody, and will be transported to south Florida to face embezzlement charges.

The reason this story made the newswires, of course, is because the fugitives were identified through a pacemaker. Pacemakers can be electronically scanned to reveal information about the patient’s cardiac condition. Every implanted pacemaker also stores information that identifies the patient. That’s apparently what did Roger and Peggy in.

The “angle” that has made this a news story is the pacemaker angle. And yes, it’s true that when you receive a pacemaker or an implantable defibrillator, it’s like receiving a subcutaneous electronic identity chip, like the one you have in your dog. Anyone with the right scanner can find out who you are. So if you plan to become a fugitive from the law, it is best not to have one of these. (Alternately, get your pacemaker AFTER you change your identity, so that it matches with your alias.)

But really, you don’t need to have an implanted medical device in order for a hospital to learn your true identity. A medical facility could find out who you are any time they wanted, by surreptitiously obtaining DNA samples, for instance, or – for extremely rapid identification – dusting your drinking cup for fingerprints and doing a computer match. DrRich doubts whether such things are occurring today. His point is that it could happen whenever somebody wanted it to happen, whether you have a pacemaker or not.

To DrRich, the interesting part of the storyline only peripherally involves the pacemaker. The real story is this:

  • A patient goes to a hospital for medical help.
  • A medical procedure is done which generates certain data for the medical record.
  • The data in the medical record is immediately cross-referenced with data from a federal database that lists persons of interest.
  • The FBI shows up at the bedside in less time than it takes to raise a nurse with a bedpan.

Now, that’s actually a pretty interesting story.

(And people wonder why the Central Authority is so hot to have electronic medical records.)

But even that is not the most interesting angle. What DrRich wants to know – the angle he would explore if he were writing this up for the Sunday Times – is: What was the doctor thinking?

You’re an ER doc. A guy comes in with a bad nosebleed. You stabilize the bleeding, but the guy looks pretty pasty and you’re worried about his heart, so you interrogate his pacemaker. (Here’s the first red flag. For an ER doc, interrogating a pacemaker – not a routine procedure in most emergency rooms, and one which yields only sparse information about the status of a patient’s heart – is generally pretty far down the list of things to do. Could it be that Roger is acting suspiciously, and you want to find out whether he is who he says he is? If so, you are no longer acting as a doctor, but as an agent of the government.) In any case, whether intentionally or not, you learn that the patient has checked in under an alias.

So now what do you do?

There are some things you need to consider as you decide what to do. First, you have established a doctor-patient relationship with Roger, which binds you to confidentiality – unless you believe Roger is an imminent threat to himself or others. But simply using an alias does not constitute an imminent threat to anyone. Besides, using an alias is not necessarily illegal. Samuel Clements used one, and so do most people who work in Hollywood. And how many times has Barack Obama changed the name he answers to?

Second, you yourself might get into trouble if you look into the matter. For instance, if Roger were an illegal alien and you took it upon yourself to escalate the matter of false identity, you could get into serious trouble. After all, the U.S. Attorney General has determined that an Arizona law is unconstitutional which would permit police officers to investigate the actual identities of suspected illegals who are detained for other offenses. And you are not even a police officer, and Roger is not being detained for an offense, but has come in to seek medical assistance. Furthermore you are well aware that if a suspected illegal alien shows up in your ER, you are supposed to treat him/her without asking any questions about identity or legal status.

But you determine that Roger does not look Hispanic (or Arabic) – a determination that by any reasonable definition would constitute racial profiling – and so is not likely to be a member of a protected group.

DrRich thinks you are thinking like this: “This man is obviously using an alias – so what is my obligation here? In the old days my obligation would be to honor the confidentiality of my patient, who, for possibly very legitimate reasons, has altered his identity. But it’s not the old days. Now, I’m obligated to do what’s best for the collective, and only secondarily what’s best for this patient. I suspect the collective would like to know about this guy, to check him out. It’s a little risky – what if he turns out to be an illegal from, say, Argentina? A lot of people from Argentina look European. But that risk seems small, and if he is some kind of fugitive from the law I would be doing a great service to my overlords.”

So you rat him out.

We indeed have come a long way. Not only have our doctors apparently lost their scruples, but we also appear to have already arrived at a place where medical records can relatively seamlessly interface with other federal databases. Once medical records become fully electronic, patients needing medical aid will have a lot to consider. Are you an embezzler on the lam? Are you behind in paying your income taxes? Are you a parking ticket scofflaw? Do you have erectile dysfunction, or venereal disease? (These latter conditions cannot get you arrested – as of yet – but we know that all databases controlled by the government, no matter how “confidential,” also interface seamlessly with WikiLeaks, and so the publication of lists of patients with embarrassing medical conditions always remains a possibility.)

Once again, DrRich marvels at the fact that, soon, the only safe way to get your healthcare will be through the black market.

8 Responses to “Fugitive Busted By His Pacemaker (And His Doctor)”

  1. Michael A. Smith, M.D. says:

    Why do you discount that the doctor did the “procedure” strictly for remuneration? (I don’t know the reimbursement from MCare, especially in “emergency” situations) I see that as usually one of the two main reasons anything is ordered in an ER anymore.

    Is a short trip down the slope, once you serve Mammon, to becoming a fink.

    No, just as docs are lining up for power in the regime (as you so well have documented), so are they smelling the wind to “get it while they can.”

    Keep fighting the good fight,

    Mike

  2. But Dr. Rich, doctors are already being asked to rat out all kinds of people, why should patients be any different? As I discussed in a post a few months ago (http://roadtohellth.com/2010/10/american-medicines-dont-ask-dont-tell/), doctors are now being formally asked to rat out pharmaceutical representatives who might slip up and answer questions about the off-label use of a drug. Never mind that the vast majority of drug use in specialties like dermatology occurs off-label, and that the treatment of skin diseases would be hopeless without it.

    The benefits to society of turning in these miscreants is obvious, since it helps to reduce the federal deficit. In the last few months of 2010, the FDA secured fines and penalties of billions upon billions of dollars from drug companies for illegally telling physicians that their medications have off-label uses that may be clinically important for their patients. In the case you describe, it may now be possible to secure fines or other financial penalties from the Gamlins. With enough medical policing it might even be possible to pay for a small fraction of the federal bureaucracy that has developed in order to police the clinical, financial and professional behaviors of physicians themselves.

    This type of self-regulating feedback loop is the sort of thing that brings harmony to natural systems, and stability to man-made ones. That stability may be based upon fear, but it is the fear of the few for the benefit of the many. Only someone with criminal intentions would complain. Which makes one wonder why you would make a big deal of this little incident. Are YOU hiding something? Hmmmm?

  3. [...] a lot has happened on the healthcare front over the holidays, even in addition to the Telltale Pacemaker story, and DrRich suspects that more than a few of his readers – busily eating, drinking and being [...]

  4. [...] Fugitive busted by his pacemaker [...]

  5. Dr. Mike says:

    A couple thoughts:

    1. All implanted heart rhythm devices require registration of what goes into the patient, and by whom, and when. Imagine the outrage if it were otherwise.

    2. The most common diagnosis after request for pacemaker interrogation in the ER is “normal functioning pacemaker”-usually triggered by failing to see paceing articlfact on tele, rate faster than lower rate limit, etc. This guy’s device was checked for the same reason most devices are checked in the ED: nobody wants to get sued for missing anything.

    3. I know NO ER docs who interrogate device routinely. If they do, they shouldn’t. It’s way out of the scope of their training and practice. Plus you can’t throw a rock in Fl without hitting a cardiologist.

    4. The remuneration for routine device interrogation is .43 work RVUs, or ~15 bucks. Not exactly a cash cow.

    5. Most off hour device interrogations are done by non-healthcare professionals-industry reps (see point 4 for explanation).

    So I imagine the story more goes like this:

    Guy comes in with a nose bleed. Medical history shows that he has a pacemaker. ECG shows sinus rhythm 75 bpm. “But there no pacing spikes?! Call cardiology!!” Cards calls St Jude rep and states, please go interrogate Mr X’s pacer so the hack in the ER stops paging me. Biff from St. Jude comes in and interrogates device, and notices name on patient’s wrist band is not same as name on device (Step 1: confirm patient identity). Uh-Oh. Rep thinks three things: 1)somebody got the wrong device 2) somebody is using a bogus name 3) the guy sitting in front of me was on the news last night and sold my cousin a bogus home loan.

    And the rest is history. One scumbag and wife go to jail.

  6. [...] See full story here. Every implanted pacemaker stores information that identifies the patient. But hospitals don’t really need your pacemaker. A swab of your DNA or dusting your coffee cup for finger prints could also be used for a computer match against federal data bases. Where this could all lead is explained at The Covert Rationing Blog: [...]

  7. s. twitley says:

    We don’t know that any doc dropped a dime on him. When I was in HHS we found the Justice Department adamant about the language of HIPAA. They insisted on privileging police access to medical record data. They told us it was to investigate health care fraud, and they wouldn’t stand for limiting their access in any way. So electronic medical data may go into the same surveillance system that scans credit card swipes in near-real time to trace persons of interest. Tinfoil hats needed perhaps, but they do catch a lot of fugitives shortly after they use a credit card. Does TIA live on? (Poindexter’s Total Information Awareness, for the un-tinfoiled).

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