Archive for the ‘Nephrectomy’ Category

CITRON RESEARCH – Intuitive Surgical: Angel with Broken Wings, or the Devil in Disguise? Part 2

January 17, 2013
Citron Reports on Intuitive Surgical (NASDAQ:ISRG) : Part II
Intuitive Surgical: Angel with Broken Wings,
or the Devil in Disguise?

Our first report on Intuitive Surgical surveyed some of the major litigation problems the
company is facing, and we reviewed some of the academic and peer comparisons of da Vinci
surgeries to other treatment approaches.
Part 2 of the investigation focuses on five more key issues that will negatively impact earnings
in the near future and put Intuitive’s stock at $300 per share in 2013.
As Wall St. awaits ISRG earnings next week, which are at risk of tipping weakness in its total
procedures growth, the real story is the macro picture, which portends enormous headwinds in
2013 for the one-time Wall Street darling. Procedure counts will dramatically soften and new
machines sales will flatline, due to:
heightened awareness of treatment cost differentials to be leveled under Obamacare,
the consequences of looming litigation, which will
force hospitals to disclose more completely and accurately the risks of complications in
robotic surgeries, including :
o the specific risks of being exposed to the movements of the robot’s instruments
o the electricity conducted within and through them, and
o the surgeon’s level of skill and training in manipulating the device.
But $300 is just the first stop. What happens when it becomes clear that insurance companies
will no longer pay huge reimbursement premiums for robotic surgeries? Or the FDA initiates an
inquest into the patient burns and perforations unique to robotic surgeries, as yet undisclosed
in Intuitive’s one-sided marketing blitz? Or the litigation against the company from injured and
deceased patients gains class action status? It is Citron’s belief that none of these risks are
currently priced into the stock, and they are all very real risks indeed.
In this report Citron has taken source-document research to the next level, and has actually
databased every MAUDE (FDA) report on Intuitive, so any investor, doctor, or law firm can
search by keyword (i.e. “malfunction”, “death”, “burn”, “laceration”, etc.) In this report we
also present a roadmap that shows the forces weighing on Intuitive over the next 12 to 18
months, and the challenges they face on the way down.

Complete story:  http://www.citronresearch.com/wp-content/uploads/2013/01/Intuitive-Surgical-part-two-final.pdf

CITRON RESEARCH – Intuitive Surgical — Angel with Broken Wings? Part 1

Posted in Citron Reports by Stocklemon on the January 17th, 2013

In the most comprehensive piece ever written on Intuitive Surgical (NASDAQ:ISRG), in this second part of its investigation, Citron Research examines both clinical research and current healthcare policy, showing how and why it will directly impact the company’s earnings negatively over the next 12 months as the stock heads through $300.

This is an important piece of research.  It fully describes the corner ISRG has painted itself into — its outrageous marketing claims and its highly emotional online advertising campaign, including patient testimonials and surgeon referrals, that will expose it to fierce legal challenge.

It details how the company has pitted its own interests in opposition to its primary customers — the major hospitals of the US — when the above legal challenges forces it to fully disclose the numerous  fatalities and injuries that have arisen from da Vinci procedures, and the actual reasons for such adverse outcomes.

Meanwhile, Obamacare will put an end to the medical arms race. Will you be left owning this high- multiple name?

Intuitive Surgical Part 2:  The story that HAS to be told.

http://www.citronresearch.com/intuitive-surgical-angel-with-broken-wings/

 

Evidence from Registry Aids Management of Kidney Masses

JUST FOUND THIS RESEARCH ARTICLE:

LOOKS LIKE THIS IS WHAT MY DOCTORS AND HOSPITAL NEW BEFORE THEY REMOVED MY LEFT KIDNEY, URETER AND LYMPH NODES FOR NO CONFIRMED CANCER BEFORE OR DURING SURGERY, AND MY MEDICAL RECORDS SHOW ONLY RENAL MASS  –  WHEN THEY VERBALLY TOLD US KIDNEY CANCER  —

HOW CAN THIS BE ACCEPTABLE?  Society should DEMAND answers and accountability.   I NOW LIVE WITH THE HORRORS OF SURVIVING SEPTIC SHOCK (from intestinal puncture during surgery), MULTIPLE ABDOMINAL HERNIAS AND CKD-STAGE 3.

REFERENCE ARTICLE FROM MAYO CLINIC WEBSITE>

see link below for complete article.

http://www.mayoclinic.org/medicalprofs/kidney-masses.html

 

Evidence from Registry Aids Management of Kidney Masses

Centers of excellence for renal surgery obtain optimal outcomes treating renal masses using a rapidly expanding suite of evidence-based therapies. The desired outcome is preserving as much renal function as possible while returning the patient to the highest quality of life. At Mayo Clinic, the Mayo Clinic Renal Nephrectomy Registry is a key resource for achieving this objective. It includes more than 30 years of renal cancer surgery outcome data that are used to identify successful techniques and guide therapeutic innovation. Begun in 1970, the Mayo Clinic Renal Nephrectomy Registry tracks every patient who undergoes kidney surgery at Mayo Clinic in Minnesota — more than 7,000 patients to date, with only 3 percent lost to follow-up. Clinical annotation from patients’ medical records is linked to the natural history of disease, including histologic, pathologic, and molecular presentations. A single urologic pathologist reviews tissue specimens, and a single statistician analyzes the data. Because first-line therapy for all renal masses is open or minimally invasive surgery, referral to an advanced multidisciplinary surgical center offers patients the expertise and options needed to achieve best outcomes. Small renal masses Increasingly, small renal masses (SRMs) (ie, <7 cm) are found incidentally during abdominal computed tomography (CT) scans. In the past, radical nephrectomy has been the treatment of choice for SRMs. This practice is changing because of potential disadvantages of removal of the entire kidney to treat SRMs. Mayo Clinic urologists who helped develop the technique of partial nephrectomy, or nephron-sparing surgery (NSS), have been instrumental in demonstrating the effectiveness of NSS as a treatment option. Nephron-sparing surgery Data show that 20 percent to 25 percent of all SRMs are benign. As many as 66 percent are low-grade, or indolent, tumors, according to a 2003 Mayo Clinic study. In 2008, Mayo published data demonstrating that the NSS survival rate is superior to that of radical nephrectomy, and in patients younger than 65 years, radical nephrectomy is strongly associated with decreased overall survival. The greater survival rate for NSS is generally attributed to benefits of preserved kidney function. Appropriate selection of patients for NSS focuses on size, location, and tumor growth pattern, with exophytic tumors generally suited to NSS and infiltrative tumors suited to radical nephrectomy. Size, location, and tumor growth pattern important in selection of patients Enlarge Mayo Clinic urologic surgeons reported on NSS in 798 patients by an open or a laparoscopic approach, with a cure rate of 98.3 percent. Key elements of Mayo Clinic’s success with NSS are surgical technique and collaboration. Mayo urologic surgeons have developed multiple ways to minimize potential ischemic damage to the kidney during resection while facilitating complete tumor removal. Close collaboration with pathologists in the operative suite benefits patients by ensuring complete tumor resection with negative margins at the time of surgery. Minimally invasive interventions Minimally invasive approaches include laparoscopic robotic surgery and percutaneous thermally based treatments such as radiofrequency ablation and cryoablation surgery. These approaches are indicated in patients who are poor surgical candidates and in those with peripheral tumor, usually measuring less than 3 cm, remote from the ureter. Mayo Clinic is at the forefront of developing both radiofrequency and cryoablation percutaneous therapies for SRMs. The largest studies of both have been reported by Mayo Clinic interventional radiologists, who continue to refine these techniques. Results show radiofrequency ablation provides 89 percent to 97 percent local tumor control. Cryoablation provides success rates from 88 percent to 99 percent, with the caveat that the follow-up periods of the studies are short. Late-stage, aggressive, node-positive cancers These tumors require complex surgical procedures that impact multiple organ systems. Patients with these tumors benefit from a multidisciplinary surgical team’s expertise. At many centers, the surgery is considered over once the kidney is resected. Data from Mayo Clinic’s Renal Nephrectomy Registry, however, argue against this practice. Data show that when patients are selected for lymph node dissection, based on Mayo’s algorithm for high-risk cases, node-positive disease is found at the time of dissection in 31 percent of cases. Mayo surgeons completely clear all regional lymph nodes when performing radical nephrectomy to improve detection of metastasis and continue to study the effects. Chart tracking 10-year survival for radical and partial nephrectomy Enlarge Metastatic disease Since December 2005, multiple new drugs have been approved to treat metastatic renal cell carcinomas. Most inhibit angiogenesis to interrupt tumor blood supply and shrink growth. Patients tolerate them well. Even so, for select patients Mayo Clinic researchers have consistently demonstrated the advantage of aggressive surgical resection of metastatic disease. Mayo’s metastatic renal cell carcinoma patients receive the benefits of multidisciplinary care as needed from specialists in medical oncology, radiation oncology, and all fields of surgery. http://www.mayoclinic.org/medicalprofs/kidney-masses.html

ccRcc diagnosed 08/03/2012

Hello. I have been reading the posts here for a few weeks as I try to get a handle on this whole Renal Cell Carcinoma thing.

I was diagnosed August 3rd with a large mass on my left Kidney 10cm, and ever since then it’s been a confusing ride of tests, guesses, and assumptions. I have been trying to learn everything I can about this disease. It’s not looking pretty from the Internet reads.

It appears that the cancer is restricted to the renal area. The PET Scan came back only showing that left kidney. The Doctor “seemed” to be happy with that scan result, but to be honest, he does not say much.

They determined they need to get that sucker out of there, and I am scheduled for a radical kidney removal tomorrow morning 11:00 AM. As I understand it, the game plan is to do it with laproscopic surgery, unless a condition on the fly mandates open surgery.

Frankly I am terrified, but put on the “no problem face” in front of the kids. Being a single Dad is hard enough without this complication. Not sure if I am more worried for me or for them. Probably both.

Since Dads are not suppose to whine in front of their kids, I guess I am doing my whining on here.

http://csn.cancer.org/node/245786

Simple Nephrectomy not so simple

You may remeber me from posts over the year over my problems after surgery; maybe not, but the update on me is that my problems are most likely due to the metal left inside me during surgery. My advice: if you think something is wrong do not stop until someone finds it. I have been in a special kind of hell for a year and today learned why.

From the beginning I had complications after surgery. Non specific pain swelling and a constant feeling that something was pushing from my insides. After many complaints to and dismisals from my surgeon I was steered to my G.P. by someone on this site. He explained that I may have sympathetic nerve syndrom and put me on Gabapentin which helped a bit. I began having unexplained spasms which felt like a hernia so I went to see my G.P. today and he sent me for an x-ray. It was there that I found out my surgeon left an unknown metal fragment inside me. It is about half an inch long as best as they can tell.It has been a long painfull year and I may need surgery to remove it. I am unsure how much of my pain is related to a foriegn object left in my body but as far as I am concerned it is the cause of my pain untill I can say otherwise. I must say again : if you feel something isn’t right don’t go peacefully into this good night….

New

Finally found another surgeon who will meet with me,,seems knowing you have a foreign metalic thing in you scares some of them off. I go Friday for consultation..Very nervous about another surgery. I pray this will be the end of my constant pain I am so tired of feeling this way. I have tried to stay clear of strong medicine only taking it when the pain is unbearable (like today) good luck to all of you who are moving forward in your treatments. Keep positive and know your body

 

http://csn.cancer.org/node/251389

 

 

Cyst or Cancer

Dad dying of Stage IV Renal Cancer.  During MY vist to ER today for Kidney Stone they told me a cyst I had 5 years earlier doubled in size from 0.6 cm to 1.3 cm.

Not sure if this is a simple cyst or the complex type the report did not say. Anyone else see this before?

New

They did CT Scan for kidney stone and reports that the cyst doubled in size and that I need to see a urologist.  They note nothing on if its complex or simple.  Said not to worry but the CT report says something different.

New

Urologist was concerned by growth rate.  Told me to do CT with/without contrast.  Not able to do inside three days so he flipped to MRI.

Guess I am concerned by the reaction of the urologist. I thought cysts were no big deal and could grow.

My question Is a MRI just as good as a CT scan for Kidney?

 

http://csn.cancer.org/node/252586

Still confused about Creatinine and GFR

My urologist had told me that the time would come when I would need a CT scan with contrast but I wasn’t expecting that time for another six months. My GP is suggesting a CT scan with contrast for an issue not necessarily related to my kidney cancer. He has advised me of the risks to my remaining kidney, risks I was already aware of. He tells me that he spoke with a radiologist who said that contrast is not dangerous to the kidney if the kidney is “normal.” Normal being defined as a GFR over 60. He wants me to have another blood test to see if, hopefully, the GFR has gone up since my last one just a few weeks ago. I don’t have a lot of hope for that since my last reading was 56 and prior to that it had fluctuated for the last 19 months between 47 and 56. He will be consulting with my urologist and nephrologist next week and is expecting a decision from me. I think I have no choice but to do it, but there are a few things I need to have straight in my mind before I make that decision.
1. Has anyone who has had a radical nephrectomy had his/her GFR readings return to what they were before surgery? I am thinking that generally speaking the younger folks might say yes to this and the older folks might say no. It would be very helpful to know that an older person had his/her readings go back to normal.
2. If your GFR readings declined after a radical nephrectomy and did NOT go back to normal, how big of a drop was there in the readings? Mine started out over 90 and is now 56. Anybody have similar results?
3. Has anyone who has had a CT with contrast since their radical nephrectomy noticed that their GFR readings went down temporarily or permanently and can attribute that drop to the contrast?
Thanks for any info you can provide.
Mike

 http://csn.cancer.org/node/237367

Still confused about Creatinine andGFR

This is a quote from the National Kidney Foundation website in answer to a question from somebody whose creatinine level was 1.58:

“A creatinine level of 1.58 may be normal after removal of one kidney, especially if you are over 50 years of age. Removing one kidney always results in a decrease in total kidney function and an elevation in the creatinine test.” Notice the “always.”

From MedicineNet.com:
“A person with only one kidney may have a normal level of about 1.8 or 1.9.” Notice the “normal.”

My levels were normal before my radical nephrectomy and went bad immediately afterwards. The above statements pretty much jibe with what my urologist told me — that my creatinine readings (currently 1.5) and GFR readings (currently 47) are normal for somebody with one kidney. Yet my nephrologist tells me I have chronic kidney disease (CKD), Stage 3. He is not “alarmed” but of course I am. I told the nephrologist what my urologist said and what I had read online and he said, “oh yes, that’s true.” But he still diagnosed me as having CKD and has ordered more blood tests at the end of July, which I don’t have a problem with. As a matter of fact, I like being monitored this closely. But of course, I am confused. I plan to discuss this with my urologist in my second followup visit in August.

Thank you, Iceman, for sharing your results in my previous posting but I’d like to know how others’ blood tests have gone since their surgeries. If you don’t mind, may I ask who else has had high creatinine/low GFR readings? And if so, have you been told you have “chronickidney disease?” Or have you been told that this is normal for your situation and nothing really to worry about?

Thanks.
Mike

http://csn.cancer.org/node/251421#comment-1315279

Complex kidney cyst

I recently was diagnosed with a complex renal cyst and the doctor told me 90% that it was cancer. Scheduled for ultrasound (found cyst during a belly pain MRI). What to expect as I have been told that a partial nephrectomy will be done soon. Pain out of surgery? Fill me in. I can take it! I am new to this discussion board. I welcome any suggestions or comments as I suffer from anxiety disorder so I worry all the time.  Anyone that can comment if you been there… Help!

 

 http://csn.cancer.org/node/253240

Georjean Parrish’s story of Patient Harm & Abuse

Will be also adding scanned medical records and ALL 6 discs of radiology, CT, MRI, Ultra sound, etc. Directly to this page.

http://www.sepsisalliance.org/faces/georjean_parrish/

——————————————————————————————————————————————

Dr. Erik Castle & Dr. Shane Daley REMOVED A KIDNEY & other things with NO Confirmed TCC KIDNEY CANCER Diagnosis Prior to or during surgery, punctured my intestine and allowed me to lay in terrible pain, untreated for 2 days until I went into SEPTIC SHOCK and they have remained UNACCOUNTABLE – Dr Erik P Castle & Dr. Shane Daley – Mayo Clinic AZ

Dr. Erik Castle & Dr. Shane Daley REMOVED A KIDNEY & other things with NO Confirmed TCC KIDNEY CANCER Diagnosis Prior to or during surgery, punctured my intestine and allowed me to lay in terrible pain, untreated for 2 days until I went into SEPTIC SHOCK and they have remained UNACCOUNTABLE – Dr Erik P Castle & Dr. Shane Daley – Mayo Clinic AZ

——————————————————————————————————————————————

The only Dr we have ever been allowed to talk to and we had never met him before.

http://ireport.cnn.com/people/Grjnparrish

——————————————————————————————————————————————

IMPORTANT INFO: I really need to share my experience so your are NOT THE NEXT VICTIM

IMPORTANT INFO: I really need to share my experience so your are NOT THE NEXT VICTIM

——————————————————————————————————————————————

IMPORTANT INFO:Can’t believe this can happen in the USA – Kidney(and other parts) removed NO CANCER confirmed before or during surgery for TCC Kidney Cancer and now suffer from Chronic Kidney Disease – Stage 3

IMPORTANT INFO:Can’t believe this can happen in the USA – Kidney removed NO CANCER confirmed prior to removal

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http://csn.cancer.org/node/227845

——————————————————————————————————————————————

This is how the INJURED PATIENT is treated when they try to get closure and some questions answered. I have NEVER been allowed to talk face to face with any of the surgeons, Dr. Erik P Castle & Dr. Shane Daley, involved in my Kidney Cancer surgery. Since I use Banner Health, I was searching for urology/nephrology to treat my CKD/stage 3 and guess who came highly rated? I never wanted a physician-patient relationship, I just wanted questions answered and closure to move on in 2013. The original appt was 12/17/2012, but when we showed up they told us it was cancelled and then rescheduled for the 1/2/2013 date, then came the HAND delivered letter. AGAIN, where is the HELP/PROTECTION/SUPPORT for the injured patient?

This is how the INJURED PATIENT is treated when they try to get closure and some questions answered. I have NEVER been allowed to talk face to face with any of the surgeons, Dr. Erik P Castle & Dr. Shane Daley, involved in my Kidney Cancer surgery. Since I use Banner Health, I was searching for urology/nephrology to treat my CKD/stage 3 and guess who came highly rated? I never wanted a physician-patient relationship, I just wanted questions answered and closure to move on in 2013. The original appt was 12/17/2012, but when we showed up they told us it was cancelled and then rescheduled for the 1/2/2013 date, then came the HAND delivered letter. AGAIN, where is the HELP/PROTECTION/SUPPORT for the injured patient?
This is how the INJURED PATIENT is treated when they try to get closure and some questions answered. I have NEVER been allowed to talk face to face with any of the surgeons, Dr. Erik P Castle & Dr. Shane Daley, involved in my Kidney Cancer surgery. Since I use Banner Health, I was searching for urology/nephrology to treat my CKD/stage 3 and guess who came highly rated? I never wanted a physician-patient relationship, I just wanted questions answered and closure to move on in 2013. The original appt was 12/17/2012, but when we showed up they told us it was cancelled and then rescheduled for the 1/2/2013 date, then came the HAND delivered letter. AGAIN, where is the HELP/PROTECTION/SUPPORT for the injured patient?
This is how the INJURED PATIENT is treated when they try to get closure and some questions answered. I have NEVER been allowed to talk face to face with any of the surgeons, Dr. Erik P Castle & Dr. Shane Daley, involved in my Kidney Cancer surgery. Since I use Banner Health, I was searching for urology/nephrology to treat my CKD/stage 3 and guess who came highly rated? I never wanted a physician-patient relationship, I just wanted questions answered and closure to move on in 2013. The original appt was 12/17/2012, but when we showed up they told us it was cancelled and then rescheduled for the 1/2/2013 date, then came the HAND delivered letter. AGAIN, where is the HELP/PROTECTION/SUPPORT for the injured patient?
This is how the INJURED PATIENT is treated when they try to get closure and some questions answered. I have NEVER been allowed to talk face to face with any of the surgeons, Dr. Erik P Castle & Dr. Shane Daley, involved in my Kidney Cancer surgery. Since I use Banner Health, I was searching for urology/nephrology to treat my CKD/stage 3 and guess who came highly rated? I never wanted a physician-patient relationship, I just wanted questions answered and closure to move on in 2013. The original appt was 12/17/2012, but when we showed up they told us it was cancelled and then rescheduled for the 1/2/2013 date, then came the HAND delivered letter. AGAIN, where is the HELP/PROTECTION/SUPPORT for the injured patient?
This is how the INJURED PATIENT is treated when they try to get closure and some questions answered. I have NEVER been allowed to talk face to face with any of the surgeons, Dr. Erik P Castle & Dr. Shane Daley, involved in my Kidney Cancer surgery. Since I use Banner Health, I was searching for urology/nephrology to treat my CKD/stage 3 and guess who came highly rated? I never wanted a physician-patient relationship, I just wanted questions answered and closure to move on in 2013. The original appt was 12/17/2012, but when we showed up they told us it was cancelled and then rescheduled for the 1/2/2013 date, then came the HAND delivered letter. AGAIN, where is the HELP/PROTECTION/SUPPORT for the injured patient?
This is how the INJURED PATIENT is treated when they try to get closure and some questions answered. I have NEVER been allowed to talk face to face with any of the surgeons, Dr. Erik P Castle & Dr. Shane Daley, involved in my Kidney Cancer surgery. Since I use Banner Health, I was searching for urology/nephrology to treat my CKD/stage 3 and guess who came highly rated? I never wanted a physician-patient relationship, I just wanted questions answered and closure to move on in 2013. The original appt was 12/17/2012, but when we showed up they told us it was cancelled and then rescheduled for the 1/2/2013 date, then came the HAND delivered letter. AGAIN, where is the HELP/PROTECTION/SUPPORT for the injured patient?
  • Georjean Parrish http://ireport.cnn.com/docs/DOC-474597

    ireport.cnn.com

    We are all TRUSTING people, especially of doctors, and to find DOCUMENTED & FACT…See More

    Letter received after filing complaint with Joint Commision

    • From: Georjean Parrish <grjnbrown@yahoo.com>
      To: complaint@jointcommission.org 
      Cc: Barack obama <info@barackobama.com> 
      Sent: Thursday, August 26, 2010 6:49 PM
      Subject: Re: Correspondence from The Joint Commission Office of Quality Monitoring: 2

      I would think since this is directly related to MY HEALTH & well being,- I should be entitled to an answer as this is part of my medical records, If Mayo has copy I also request copy, or are you just doing the same thing Mayo has done for over a year avoid questions and give NO ANSWERS and deny medical care. This is SOOOOOOO WRONG. You are there to protect us.

      Hope you sleep well at night…..


      Thank You, and have a great day
      Georjean Parrish

      From: “complaint@jointcommission.org” <complaint@jointcommission.org>
      To: grjnbrown@yahoo.com
      Sent: Thu, August 26, 2010 6:37:29 AM
      Subject: Correspondence from The Joint Commission Office of Quality Monitoring: 2

      Thursday, August 26, 2010

      Regarding: Mayo Clinic Hospital
      Incident #41313HHO-81436SXX

      Dear Mrs. Parrish:
      I am writing in response to the issues you communicated to The Joint Commission regarding the above referenced facility.
      We contacted the facility for their written response. Their response has been received, accepted and the incident status is closed.
      Please be aware our current Public Information Policy precludes us from providing you with the specific results of any complaint investigation.
      Per our Public Information Policy, the following information is provided upon written request as it becomes available:
      The number of standards-related written complaints filed against an accredited organization that have met criteria for review
      The applicable standards areas involved in a specific complaint review
      The standards areas in which requirements for improvement were issued as a result of complaint evaluation activities
      When an unannounced or unscheduled survey is based on information derived from a complaint or public sources, the standards areas related to the complaint
      Any determination that the complaint is not related to Joint Commission standards
      In addition, you may also wish to refer to the organization’s Quality Report, which is available at the Joint Commission’s web site (From: “complaint@jointcommission.org” <complaint@jointcommission.org>
      To: grjnbrown@yahoo.com
      Sent: Thu, August 26, 2010 6:37:29 AM
      Subject: Correspondence from The Joint Commission Office of Quality Monitoring: 2
      Commission’s web site (www.jointcommission.org

      , and click Quality Check), to obtain general information about the organization’s performance on key quality measures. To obtain a hard copy of the report, please contact our Customer Service Center at (630)792-5800 or write to the Customer Service Center at:
      Customer Service Center
      The Joint Commission 
      One Renaissance Blvd.
      Oakbrook Terrace , IL 60181
      The Joint Commission stands ready to receive and review issues of concern about accredited organizations at any time and will act in accordance with all the information that is provided to us.

      Sincerely,
      Ms Ally
      Office of Quality Monitoring
      and click Quality Check), to obtain general information about the organization’s performance on key quality measures. To obtain a hard copy of the report, please contact our Customer Service Center at (630)792-5800 or write to the Customer Service Center at:
      Customer Service Center
      The Joint Commission 
      One Renaissance Blvd.
      Oakbrook Terrace , IL 60181
      The Joint Commission stands ready to receive and review issues of concern about accredited organizations at any time and will act in accordance with all the information that is provided to us.

      Sincerely,
      Ms Ally
      Office of Quality Monitoring