Mr. Christopher LaBonte
I, Christopher Kevin LaBonte, had Orthognathic Surgery at the Atlanta Veteran Affairs Medical Center (August 16, 2013) to correct a moderate bite problem that resulted from a lower left mandible fracture that occurred in 2005 while serving in the United States Army. My bite started worsening over time. It became difficult to chew without TMJ pain, and my jaw started to develop limited opening. I was referred to VA Oral Surgeons to correct these problems. The resident medical students with little experience and theoretical knowledge recommended Upper and Lower Orthognathic Surgery as the only course of corrective action. This surgery is the most dangerous and difficult oral surgery performed in the United States. It entails peeling back the face, severing the upper jaw from your nasal cavities, chiseling the lower jaw from the skull, breaking them into pieces, moving the pieces to the desired location then screwing the upper and lower jaw back in with bone plates and screws. The resident students did not describe the surgery in this manner; however, described it as a minimally invasive procedure. One resident stated, "We will make a few breaks and tweak your bite so that it lines up properly. The only risks to this surgery is some minor numbness to your lip and chin area, and infection which is a risk of any surgery."
Considering all of the horror stories about VA surgeries, I requested outside private care to perform surgery with an oral surgeon whom I had an established medical relationship. My Fee Basis (outside care) requests were denied twice. The reasoning stated for denial was my requested surgeon was "too costly, and the VA could perform the surgery at the Atlanta VA Medical Center." I was assured a "world renowned surgeon that has performed this type of surgery hundreds of times" would be conducting the surgery. I would later discover this was an intentionally misleading and untrue statement. The primary surgeon for the surgery was to be an experienced surgeon named Dr. Martin B. Steed, D.D.S. (Doctorate in Dental Surgery). This too was later discovered as misleading and untrue statement made by the VA. The VA resident students stated that if the surgery was not performed my bite would continue to worsen and the jaw opening would diminish to the point where I would not be able to open my mouth. I was informed that I needed to have the surgery now at a young age (age 28 in 2013) so that I would heal properly. The pre-op for the surgery was conducted in July of 2013 by Emory residents, Ibrahim Mohamed Haron (B.D.M.) and Michael Rosenthal (D.M.D.). Rosenthal and Haron were the only residents at my pre-op appointment which concerned me. The VA took special care not to mention Ibrahim Mohamed Haron in the medical notes at this time as he was not licensed at all. Dr. Steed was not involved in the pre-op appointment which worried me. I was assured by the residents that he was going to review my pre-op appointments notes prior to surgery.
On August 16, 2013, approximately a month and a half after my pre-op appointment, the surgery was performed. I arrived early, as I always do, but was tremendously nervous. I was given medications from the doctors to help relax. I had only seen and talked to residents, so I specifically requested to see Dr. Steed. After about 30 minutes he made an appearance. This reassured me that he was present and would be conducting the surgery. I was then checked into holding where the anesthesiologist administered further medication to relax me.
That is the last thing I remember until waking up in ridiculous unbearable pain and numbness. I, immediately, knew something was very wrong. The surgery lasted longer than anticipated due to complications. I could not speak and was barely able to move my jaw. I was repeatedly told to speak over a period of hours by the resident Ibrahim Mohamed Haron and other medical students that I did not recognize.
I could not speak!
My tongue was numb and my jaw was not moving properly. My nose and mouth was bleeding profusely. The residents were demanding me to speak in an aggressive tone and physically manipulating my jaw while asking me to speak causing extreme pain. I was able to painfully mutter the words "F-ck You" although they could not fully understand what was said. I requested a pen and paper with the best improvised sign language gestures I could muster. I wrote "F-ck You" and underlined it. Then continued to explain that I could not speak and to please stop pulling and pushing on my jaw due to the severe pain it was inflicting. I requested to see my wife multiple times in writing. They denied her access for hours while they forced me to speak.
I stayed overnight for observation in the VA Surgical Intensive Care Unit (SICU). This was a place from a nightmare. I specifically remember another veteran in the room across from me screaming for help in a very desperate voice. His alarm on his machine was going off repeatedly for over an hour. A nurse told him to "hush" or "shut up" multiple times. The SICU was mostly staffed with residents, like most of the Atlanta VA, were laughing, joking, watching movies, taking tests, and completely ignoring this veteran next to me pleading for his life. My wife asked a nurse why this veteran was not being helped and was told to "mind her own business." My own night in the SICU was a long and agonizing night. The nurse set up a morphine drip with the push button release. The pain was so intense that the morphine was having no affect. The nurse with doctor authorization switched to a diluadid IV pump which had little affect on the pain. The diluadid was able to relax my anxiety, but my pain level was still a 10+. I was released from the SICU the following day, once I was able to urinate on my own.
The VA allowed me to go home. I was ecstatic to get out of the SICU and the VA. I had a white cast material splint around my upper teeth which made it impossible to tell what my upper teeth and jaw looked like. I was given no post-op instructions. Once at home, my nasal cavities began to fill with puss and blood. I attempted to relieve the pressure this caused by blowing my nose. Unfortunately, this ruptured my nasal cavity causing blood and pus to pour out of a hole from stitches that had ripped between my upper gum line and sinuses. My wife called the on-call resident who stated this "was normal and nothing to worry about." Due to the seriousness of the situation, we went to the Atlanta VA Emergency Room which is over 60 miles away from our home. We waited, in the ER, for an on-call oral surgeon to come to the VA. The on-call resident failed to show and we were forced to stay up all night parked in our car in the parking deck for the dental clinic to open in the morning. We saw the resident that we spoke to on the phone the previous day. I did not consider my nasal cavity rupturing normal. My wife and I decided to file a complaint with Elizabeth Cox, a Patient Advocate in the Director's Office. This complaint was not documented in the complaint system as we requested.
I was given elastics to wear by the residents. There were hooks placed on the inside of the splint and hooks on my lower braces brackets for the elastics. My lower jaw was canted at an unnatural angle which was physically and mentally agonizing. The residents told me not to worry that my muscles would adjust with the help of elastics to fix the cant. I could not chew or eat solid food during this period of time. My gums were purple, extremely inflamed, and infected. My face was bruised and enormously swollen. The splint cast came off 6 weeks later. I was alarmed because none of my teeth touched. Again, the residents reassured me that this was normal and the elastics would bring my teeth together.
Three of my incisions were still open and bleeding months after the surgery. My face was still extremely swollen 6 months after the surgery. My lower right side gum line deteriorate due to necrosis from bone shards which were left inside during surgery. Around December of 2013, I could pull back my right cheek and see a large area of bone along with one of the titanium plates. As soon as I noticed the bone and plated exposure, I went to the Atlanta VA and waited all day to see a resident. They said they could "get in there and see what is going on." Another surgery was then schedule for a month later.
The infection, bone and plate exposure was left unattended and untreated for 4 weeks!
The lower plates and bone shards were finally removed in February of 2014. Once again, my wife and I filed a complaint with Elizabeth Cox regarding having to wait a month to get care for an obvious dental emergency. This complaint was also never put into the complaint system or was deleted at a later time. We also made a complaint to the Assistant Medical Director Robert Evans around the same time. I, unintentionally, bled on Elizabeth Cox's notepad due to uncontrollable bleeding from my nose and mouth. She had to tear off that page and begin her notes again. It was a memorable experience for everyone in the Director's Office, even to this day. My wife also had to speak for me during these complaints because I could not speak clearly.
I had to have all of the plates in my Upper Maxilla removed due to improper placement and infections also in 2014. The plates and screws had been placed on major nerve branches, as well as through my eye sockets. I have lost the majority of supporting bone to my Upper Maxilla due to surgical manipulation, misplacement of surgical hardware, and infections. The Upper Maxilla hardware was removed by an outsourced private practice oral surgeon in back-to-back surgeries starting in October of 2014. This private practice oral surgeon stated that "the way the hardware was installed makes no sense to me."
I did not see Dr. Martin Steed again after I left the SICU on August 17, 2013. He left the State of Georgia a month after my surgery. The new residents that were constantly rotating in and out had no knowledge of the details of my surgery or my care. They had no knowledge of how the elastics were suppose to be worn, why my bite alignment was still not correct, or why my pain had not diminished. There was an all around serious lack of communication. I paged Ibrahim Mohamed Haron at Emory, and expressed my concerns over the phone. He told me, "Your bite should be aligned and you should feel no pain because it has been 4 weeks since your surgery." He then ended the phone conversation. He never made any follow up inquiries into my care or attempted to see how I was doing directly after the surgery.
In 2015, I discovered that while under anesthesia the residents had me sign a digital consent pad authorizing Ibrahim Mohamed Haron to be the Primary Surgeon and authorizing procedures not discussed in my pre-op appointment. I do not remember or have any knowledge of signing or reading these documents, especially since I was under anesthesia. I believe I was coerced into the surgery so that the residents could gain surgical experience on a "real" patient with this specific procedures.
The resident that was the primary surgeon that performed the surgery only had obtained a Bachelors Degree in Dental Medicine from the University of Kuwait. He graduated in 2009. He misrepresented himself as a doctor with a medical background. This is a felony in the State of Georgia. He has practiced Dentistry without a license in the State of Georgia, which is also a felony. He obtained his first Dentistry License a week before my surgery from the State of Virginia. Virginia License #0401414186; Date Acquired: 08/09/2013; Expires: 03/31/2016. Later he obtained a License from Illinois by referencing his Virginia License as proof a background. Illinois License #019030033, Date Acquired: 08/28/2014; Expires: 09/30/2015. Ibrahim Mohamed Haron could not prescribe my medication, yet alone Motrin since he has no Doctorate Medical Graduating Degree. He had the technical skills of any Bachelor Degree student; not a Doctorate Degree. I am one of the first people he operated on and the legality of is still in question.
One question to the VA would be why was such an inexperienced surgeon allowed to operate on me? Upper and Lower Orthognathic Jaw Surgery is a very complex and dangerous surgery. Not to be taken lightly. Oral Surgeons with years and years of experience have difficulty with this surgery, but have the experience and knowledge to overcome most of these complications.
Why was my informed consent changed and obtained in an unethical and sneaky way? My informed consent was not obtained as some of the procedures conducted were never discussed or their side effects. If the residents would have mentioned the side effects of worsening of bite, bone death, jaw loss, tooth loss, death from stroke, permanent nerve damage, or Trigeminal Neuralgia during my pre-op appointment; I would not have even considered the surgery to be an option because of these dangerous side effects.
All of these procedures were performed on my upper and lower jaw at one time. As stated before the surgery lasted longer than anticipated. I was in surgery beyond the "normal" timeframe for this surgery. I have been told that I am lucky to have made it through the surgery by several private care doctors. These procedures are incredibly dangerous. I believe my health and well being was not taken into account at all. I honestly believe the primary goal of the VA residents and doctors was to provide a surgery where the residents could gain surgical experience. I did not knowingly consent to under go surgery with the primary surgeon being Ibrahim Mohamed Haron who was vastly under qualified to perform such an involved procedure on my person.
According to Ibrahim Mohamed Haron's social media pages, he has devote Islamic views. I was an Army combat veteran that was deployed to both Kuwait and Iraq. I was deployed to Kuwait at the same time that Ibrahim Mohamed Haron was attending the University of Kuwait. It is no secret that many people from this region and religion want to harm US Soldiers.
Why was Ibrahim Mohamed Haron allowed to operate on Combat Vets whom he very likely would have had difficultly treating objectively or even had ill intentions towards?
The Department of Veteran Affairs Medical Centers should be sensitive to the need for veterans to feel comfortable and safe with their doctors. The VA Medical Centers, in fact, should be more sensitive to this issue than any other facility in the country. As a combat veteran; I should have been given the choice to have Ibrahim Mohamed Haron involved with my care, on any level, especially performing a highly dangerous surgical procedure that would render me unconscious.
Who investigates these residents’ credentials? According to Emory University OMFS Residency program's website, "An applicant must have a D.M.D. or D.D.S. from an American Dental Association (A.D.A.) approved dentistry program/school and licensed in the United States." Ibrahim Mohamed Haron did not meet any of these requirements when he was accepted into the program in July of 2011. Out of thousands of applicants, why was this man chosen if he did not meet the basic requirements of the Emory OMFS residency program? Why did the VA not properly vet his credential either? Ibrahim Mohamed Haron joined the Emory University OMFS program in July 2011 and was acting in an official dental capacity without a license from any state until he obtained his Virginia License in 2013. He did not only practice dentistry illegally at the Atlanta VA, but at Grady Memorial and other local Atlanta hospitals. There is a photo of him, from one of his social media pages, proudly standing on the Grady Memorial Trauma Helipad in scrubs before his Virginia License was granted. He has still not been granted a License from the Georgia Board of Dentistry to practice in Georgia. How is Ibrahim Mohamed Haron, one of Emory's Chief Residents of 2015, not behind bars or deported for committing multiple felonies?
I now suffer many permanent side effects due to the negligence of the Atlanta VAMC, Ibrahim Mohamed Haron, and the doctors assigned to oversee him. I currently have to see many doctors. The periodontist I see every 3 months due to the soft tissue and gum damage sustained from the surgery has stated that my case is the "worst Orthognathic Surgery she has seen." Her sentiments are echoed by my new team of orthodontist who state this is one of the worse cases they have ever seen, and is extremely complicated. A TMJ specialist, who is trying to help me reduce my pain the best way he can, admits my case is very rare and complicated also. I suffer constant chronic muscle spasms from the structural imbalance the surgery created in my facial bones. I have a medical condition called Trigeminal Neuralgia from damage to multiple branches of my Trigeminal Cranial Nerve. Trigeminal Neuralgia, known as Suicide Disease, is described as "one of the most painful medical conditions known to man." It is one of the most sensitive nerves in your body. Your Trigeminal Nerve is how you can tell there is a grain of sand between your teeth. The Trigeminal Nerve is hardwired directly into the pain center of your brain. Having this nerve exposed to open air can cause permanent damage to the nerve. The VA Surgical Report admits to damaging a portion of this nerve (cutting it) during the surgery on August 16, 2013 by Ibrahim Mohamed Haron. I struggle with facial deformity due to the extreme cant of my lower jaw. The pain I experience is a daily constant battle. After over a year of wearing elastics, the doctors have been able to only get one tooth to make contact with my lower teeth. Making one tooth touch at an awkward angle and that is it! All of my bite force is focused on this one tooth and is extremely painful when used to chew. I have to wear an orthodontic splint that allows my upper and lower jaws to make contact artificially. This does help to relieve some of the muscle spasms and strain in my tongue, jaw, and TMJ joints. It also helps me speak properly. According to my doctors, I will have to depend on the use of these and other types of prosthetics for the rest of my life to maintain this small level of functionality. I will have chronic pain, and nerve pain for the rest of my life as well.
There is a surgical option that can try and correct what was done wrong, but due to the many unknowns; such not having full knowledge of what was previously done surgically or the extent of the surgical nerve damage already done; it should be a last resort. As it should have been in the first place. I was told by the residents in October of 2013 that "In a year everything should settle and be mostly healed and the jaws aligned from elastic wear." Well, I waited a year in agony with no improvements, but the opposite. My condition continued to worsen. A recent Cone Beam CT Scan showed that my Inferior Alveolar Nerve (part of the Trigeminal Branch which the VA admitted to damaging) is exposed. There is a large portion of bone missing in my mandible that usually protects this nerve from external forces and pressure. Every time Masseter and Local Associated Muscles which are used for speaking, eating, drinking, etc., contract and expand in that area of my jaw the nerve is being compressed. This causes intense intractable pain. Multiple portions of my Trigeminal Nerve Branches are also being compressed by hard scar tissue that lines the inside of my cheeks and mouth.
In September of 2014, I decided to file a TORT Claim as I believed gross negligence had been conducted by my "Doctors" at the VA. At this point all of my VA Specialty Care was then outsourced. It has been difficult finding providers that will accept VA Fee Basis payment as it pays lower than Medicare and the payments are never received in a timely manner, if at all. I attempted to get answers from my Local VA Leadership, the Atlanta VAMC Director, and her staff. I was stonewalled and treated like "the enemy" for filing a TORT Claim. My VA doctors were instructed not to speak to me regarding issues or items that had to do with my TORT Claim, which is ridiculous because I still need ongoing medical treatment regarding my jaw. I had to physically point out issues on imaging such as bone loss, nerve exposure, jaw misalignment, etc., to the Clinical Chief of the Dental Department for him to address these issues and record them in the medical records. I was told by the Privacy Officer at the Atlanta VAMC (Paula Marti) that she was not allowed to give out Ibrahim Mohamed Haron's licensing or credential information even by FOIA request which was an overt lie. My wife and I have been banned from the 3rd Floor of the Atlanta VAMC, which is where the Director’s Office and the Administration Offices are located, for asking questions regarding my healthcare. I have audio recordings of this incident. I spoke directly to Elizabeth Cox about why she had not documented my complaints. Only to be told she "Would need to check her notes and get back to me." It has been 3 months since I have last spoken to her and made this request, and no follow up from her to me has been made. I also can no longer get her on the phone with me.
The Department of Veteran Affairs' investigative process into medical malpractice is corrupt. The Veteran is required to fill out a form SF-95; Claim for damage, injury, or death. The Veteran's case is assigned to one of the Department of Veteran Affairs' many attorneys. This attorney doubles as the investigator into the Veteran's medical malpractice/negligence case. The investigative attorney is legally immune to all criminal actions that they discover during the course of their investigation. All aspects of the findings of the investigation are attorney client privilege between the Investigating Attorney and the Department of Veteran Affairs. The Veteran is not allowed to file for damages in federal court until the Department of Veteran Affairs' attorney conducts their "investigation". The Department of Veteran Affairs is given six months for this investigation. Even if the veteran files in Federal Court, after the six month wait period, he/she is not allowed access to the Department Of Veteran Affairs' Investigative Report due to Federal Law. From my personal experience, I feel this six month "investigative" period is used to coach witnesses, manipulate evidence, misplace evidence, take subtle retaliatory measures toward the veteran whom filed legal action against the V.A., and to basically conduct all around damage control before the veteran files for damages or injury in Federal Court. Only the Department of Veteran Affairs has investigative jurisdiction over themselves. If you ask a criminal to investigate themselves, they are most likely in the interest of self preservation going to find themselves innocent of all charges. The Department Of Veteran Affairs also enjoys the protection and representation of the Department of Justice's Attorney General if the veteran's claim reaches federal court. While the veteran is forced to find an attorney that is willing to take on a corrupt Governmental Agency, Hospital, and in many cases a University whom have had six months to coach their doctors and other witnesses before the Federal Court Case. The veteran's attorney, in most cases, is tasked with finding an expert medical witness in a narrow medical specialty field. This witness must also be willing to take on the Department Veteran Affairs Medical System and all expert witnesses the Department of Veteran Affairs Medical System has on their payroll. Furthermore, the veteran's attorney has no access through the process of discovery to the "investigation" the Department of Veteran Affairs' Attorney/Investigator conducted. The Attorney representing the veteran is only entitled to 20% of total damages awarded if settled before federal court. If the veteran's case goes to federal court, the Veteran's Attorney is entitled to 25% of the total damages awarded. All of these legal advantages granted to the Department of Veteran Affairs creates Veteran Affairs Medical Malpractice cases (Commonly referred to as TORT Claims) extremely undesirable for an attorneys tasked with representing the veteran. All cards - monetary, legal, and technical are stacked against the already injured veteran who finds himself in the unfortunate situation of taking on an extremely corrupt system by him/herself.
I brought many of the medical and ethical issues described in the above testimony to the attention of senior management at the Atlanta Veteran Affairs Medical Center. After many attempts and frustration of trying to settle these serious medical quality of care issues locally with management at the Atlanta Veteran Affairs Medical Center, I contacted Secretary McDonald's staff which motivated the local Atlanta Veteran Affairs Medical center to start improving my quality of care. Secretary McDonald contacted me directly and gave instructions to contact him or his staff if I had any other quality of care issues regarding the local Atlanta Veteran Affairs Medical Center. I specifically requested a meeting with the local Atlanta Veteran Affairs Medical Center Director, Leslie Wiggins. An appointment was scheduled, but then canceled repeatedly both before and after I filed my Form SF95. I requested to speak with Leslie Wiggins over the phone, which was denied multiple times. I would get transferred to one of her many staff members who would either be unhelpful or not answer their phones. One of Mrs. Wiggin’s staff members, the Risk Management Officer Sonja Reid has repeatedly presented an aggressive attitude toward me over the phone and has been very uncooperative in answering any of my questions regarding quality of care issues that directly impact not only my own healthcare but other veterans as well. Sonja Reid instructed local Atlanta Veteran Affairs Medical Center employees and doctors that they were not allowed to speak to me about anything that could be related or associated with my TORT claim. The issues outlined in my TORT claim tie directly into my current medical care. She was essentially denying me care when ordering my doctors not to speak to me which is illegal. Citing the TORT claim as reasoning for these actions against me. My claim status is currently administrative. It is not yet a federal lawsuit and I have no attorney representing me in this early phase of my TORT claim process. There is no legal or ethical obstacle preventing any Veteran Affairs Employee from speaking with me. I believe employees were instructed not to speak to me to avoid self incrimination for being complicit in criminal activity or to prevent any additional damage to their hospital's reputation by preventing me from gaining any further knowledge into just how horrible their quality of care and lack of oversight truly is.
Many veterans are extremely disappointed in both the quality of care and the lack of leadership at the local Atlanta Veteran Affairs Medical Center. I had an appointment to meet with the Atlanta Veteran Affairs Medical Center Director on March 30, 2015. Not surprising to me it was canceled yet again. In sheer frustration, my wife and I decided to visit the Director's Office on March 30, 2015 anyway. I brought an audio recording device in anticipation of a negative experience, as all of my previous experiences have been negative. This office is located on the third floor at the local Atlanta VA. Every employee present on the floor that day were under strict instructions not to speak to me under orders from Sonja Reid, Risk Management Officer, and Robert Evans, Assistant Medical Director, citing my TORT claim as reasoning. I specifically asked to speak to a patient advocate to file a complaint regarding this bizarre treatment. Initially this was denied by the Assistant Director Robert Evans. Within 2 minutes of my wife and my arrival to the Director's Office - five to six Veteran Affairs Federal Police Officers were called up to the third floor to escort my wife and I off the floor, again citing the TORT claim as reasoning. After explaining to the Veteran Affairs Federal Police my situation and physically showing them what the Atlanta Veteran Affairs Medical Resident did to my face, the Veteran Affairs Federal Police advocated for me to speak to a patient advocate. Mr. Forbes, a Patient Advocate, agreed he would speak to me. One of the Veteran Affairs Police Officers then told me he was under orders from Robert Evans, Assistant Medical Director, to stand outside the door, requiring the door to stay open as I filed my complaint and to "make sure proper wording was used" in my complaint. The patient advocate seemed just as alarmed as my wife and I with having a Federal Police Officer dictating what wording we can and can not use in our complaint. Then after my complaint was finished being documented by Mr. Forbes, the Federal Police Officer dictating the language of my complaint then sat down to notify my wife and I were banned from the third floor. The Veteran Affairs Federal Police Officer then asked the patient advocate, my wife, and I for our driver’s licenses for "His report." The patient advocate, Mr. Forbes, seemed alarmed he was being asked for his driver's license information for taking a complaint from a veteran. If my wife and I ever return to the third floor at the Atlanta Veteran Affairs Medical Center, we will be charged with felony federal trespassing. I have this entire strange event that occurred on March 30, 2015 audio recorded. Georgia is a one party consent state when it comes to audio recording, I was well within my rights. Federal Law is also one party consent. I believe this audio recording helps give context to the hostile environment veterans face daily at the Atlanta Veteran Affairs Medical Center.
I wake up everyday in chronic pain. If you can imagine the worst tooth pain you have ever felt; that is how all of the teeth on the right side of my mandible feel constantly and daily. I have to take muscle relaxers 3 times a day for the muscle spasms. I take narcotic pain medication 4 times a day for the chronic pain, muscoskeletal pain, and nerve pain. I take anxiety medication to keep my facial muscles from tensing and compressing my nerves which not only cause sharp facial pain, but also causes severe migraines. These migraines feel like someone is kicking me in the skull. My diet is limited to soft foods that do not require much chewing. According to my current team of Non-VA Doctors, I will not only need continual medical care for my mouth and jaw, but I will have to wear oral prosthetics in my mouth for the rest of my life.
I am extremely disappointed in the VA Healthcare System. The VA's priorities seem to be in the following order: 1) Profit; 2) Hospital Reputation; 3) Protecting High Level Bureaucrats; 4) Protecting Negligent Doctors; 5) Cutting Costs at the Expense of Veteran Healthcare; and finally, 6) Veteran Healthcare. I would refer to it is as death-care, as health is barely taken into account. From my experience the Atlanta VA Medical Center's motto should read, "Delay, Deny, and Hope You Die."
Respectfully,
Christopher K LaBonte
Date: 22 May 2015