Why Mayo Cardiology refuses to "clear" an MRI outside of Mayo

Posted by Maxine @maxaz1, Wed, Sep 18 5:26pm

I’m going to post this in a few different groups – in case it rings familiar to anyone else. My husband, Walt, complained to his Mayo cardiologist about shortness of breath upon exertion. He had cardiac workups and pulmonary testing, and because he has a slow heart rate (his whole life), they thought a pacemaker to make sure his heart rate increased with exertion, would help. He had a pacemaker implanted at Mayo in August 2018. Honestly – it hasn’t made any difference in his shortness of breath. None at all, and as far as we know, the only thing the pacemaker has done is ensure that his heart rate does not drop below 60 bpm. Walt has Parkinson’s Disease, and was scheduled for Deep Brain Stimulation (DBS) surgery at Mayo, to take place a few weeks after his pacemaker. MRIs are essential for DBS – and because of this, I spent a long time insisting on confirmation that the pacemaker Mayo was putting in him would be MRI compatible. It is. His DBS surgery was successful, and his Parkinson’s symptoms were greatly reduced. Unfortunately – long story short – Walt’s DBS system, (consisting of electrodes placed in his brain, wires from the electrodes snaking their way across his skull and down his neck, and a “battery pack/controller device under his collar bone like a pacemaker), all had to be removed by the Mayo neurosurgeon in March 2019, when a wire coming from his brain broke through the skin on his head, and was exposed. We have subsequently scheduled another DBS surgery at Barrow’s, Brain and Spine Center. Everything is in place for the surgery – except for one thing. Mayo cardiology gave him cardiac clearance, but will NOT give him a standard signed form clearing his pacemaker for MRI. The form must be completed and signed by Walt’s cardiologist of record, and sent to Barrow’s. Since the pacemaker is monitored remotely and transmissions are evaluated by doctors in the Mayo system; and since there have been no issues with the pacemaker, which is MRI compatible, the cardiologist at MAyo should be able to clear the pacemaker for MRI. They refuse to do so – Mayo says it will not accept liability for the acceptability of an MRI outside of the Mayo system. Barrows’ Patient Care Coordinator tells me that if Mayo will not sign off on it, we need to find another cardiologist to do an evaluation of the pacemaker – either remotely or by wanding him in the office, thus becoming Walt’s cardiologist of record. If we need to do that, there is no way Walt will be able to meet the timelines for his surgery, scheduled 10/2. WTH????? I guess Mayo wants to keep Walt’s business in-house? I feel like his pacemaker is being held hostage. I am furious – this is me venting. Has anyone else ever had to deal with this? Thanks, Maxine

Hi Maxine, what a complicated situation. No wonder you need to vent.
I have included your message in the Heart Rhythm Conditions and Parkinson's Disease groups.

Liability issues are so fraught with complexity. Have you considered contacting the Office of Patient Experience at Mayo Clinic? It's worth a try. You'll find the contact information for all 3 Mayo campuses on this webpage: https://www.mayoclinic.org/about-mayo-clinic/patient-experience
Might your husband be able to get an appointment with a Barrow's cardiologist before the surgery?

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I guess im a little surprised. I had a heart transplant so this is not exactly like your situation. But die to insurance i have had to work with drs outside Mayo and Mayo has worked well to facilitate getting information to in my case a outside Hematologist. I still have to use Mayo for transplant related things but so far they seem willing to work around insurance issues. Sorry for your problems i hope and Pray they get resolved.

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Thank you – I am so glad Mayo is working well with you. I have generally been pleased with them.
I really do not know what's going on with our issue. The MRI Nurse at Barrows tells me that although doctors sometimes are resistant, and sometimes delay signing off, this is the first flat refusal she has seen. I am hoping it is a misunderstanding of some sort, and am still trying to get a response from the cardiologist himself. In the meantime, Barrows is working to try and arrange a short notice appointment with a cardiologist.

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@colleenyoung

Hi Maxine, what a complicated situation. No wonder you need to vent.
I have included your message in the Heart Rhythm Conditions and Parkinson's Disease groups.

Liability issues are so fraught with complexity. Have you considered contacting the Office of Patient Experience at Mayo Clinic? It's worth a try. You'll find the contact information for all 3 Mayo campuses on this webpage: https://www.mayoclinic.org/about-mayo-clinic/patient-experience
Might your husband be able to get an appointment with a Barrow's cardiologist before the surgery?

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Thank you, Colleen! I am glad to have the Office of Patient Experience info. I will be reaching out to them, however this plays out. After posting earlier, after I sent a message to Walt's Mayo cardiologist, I received a call from the head of the Mayo Pacemaker Clinic – I think my message on the Patient Portal had been routed to her. She wanted to make sure I "and the person from Barrows who had repeatedly called" understood the reason the form we needed would not be signed off on. She said the form asks for recommended settings for the pacemaker during the MRI, and that Mayo could not complete the form because they would not be at the MRI site or appt, and could not be responsible. I asked her for a copy of the form, which she said she did not have. I asked her if she was sure the form asked for settings, but she said she was not sure. Speaking to Barrow's again, I confirmed that the form is a standard form; it does ask for the recommended settings; and despite the fact that some doctors are reluctant, and that sometimes there is some delay – this is the first time she has ever received, from a specific medical group, a flat refusal to complete and sign the form. I then contacted the Pacemaker Clinic again and left a message that I wanted my Portal Message re-routed to the doctor, and that I expected a response. Inn the meantime, Barrow's called me back to tell me they were trying to arrange a short notice cardiology appointment there. Thank you for your suggestions. I will keep you posted….

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Hi Maxine, Hearing your story reminds me that problems that should never be are happening in many places, in many ways and Colleen’s suggestion sounds like a good place to explore your options.
My mother just had the battery in her pacemaker replaced and after a complication arose, a solution has been a struggle to find.
It really stinks that when things happen no one knows exactly what to do. I have a theory but if you read any of my posts you probably don’t want to hear it; at least others might be praying that you don’t ask me what it is. LOL
But I do hope you find a solution and if you do please let’s us know what it is

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@maxaz1

Thank you, Colleen! I am glad to have the Office of Patient Experience info. I will be reaching out to them, however this plays out. After posting earlier, after I sent a message to Walt's Mayo cardiologist, I received a call from the head of the Mayo Pacemaker Clinic – I think my message on the Patient Portal had been routed to her. She wanted to make sure I "and the person from Barrows who had repeatedly called" understood the reason the form we needed would not be signed off on. She said the form asks for recommended settings for the pacemaker during the MRI, and that Mayo could not complete the form because they would not be at the MRI site or appt, and could not be responsible. I asked her for a copy of the form, which she said she did not have. I asked her if she was sure the form asked for settings, but she said she was not sure. Speaking to Barrow's again, I confirmed that the form is a standard form; it does ask for the recommended settings; and despite the fact that some doctors are reluctant, and that sometimes there is some delay – this is the first time she has ever received, from a specific medical group, a flat refusal to complete and sign the form. I then contacted the Pacemaker Clinic again and left a message that I wanted my Portal Message re-routed to the doctor, and that I expected a response. Inn the meantime, Barrow's called me back to tell me they were trying to arrange a short notice cardiology appointment there. Thank you for your suggestions. I will keep you posted….

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@maxine Reading your post, I can see why the form was set aside by Mayo. It seems there would be few in the medical field who would sign off on something they would not have control over. Not knowing anything about pacemakers, it seems they are highly individualized for the correct settings to give maximum benefits to a patient. Not being able to control what another medical group might do, and signing off on a form, does that clear their liability if something goes wrong during the procedure and the form is referenced as the source for the error? Hopefully you can see where I am headed with this. [I was in the legal field for a long time] That said, I hope you get an outcome you can live with.
Ginger

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Thank you, Ginger. I agree, in part. The mind-boggling parts of this for us are: 1.We had no warning – not at the time of the pacemaker implant. All the risks and legal disclosures….we were never told that although this device was "MRI compatible," Mayo would decline to sign-off for another MRI center; and 2. Barrows MRI assures me that not only is the form a standard form, a standard practice, but that this is the FIRST flat refusal they have received from any medical group. Sometimes there is reluctance, she said, and sometimes there is delay – but the doctors sign. We'll see how this plays out. It might indeed be an outcome he cannot live with. Literally.

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@maxaz1

Thank you, Ginger. I agree, in part. The mind-boggling parts of this for us are: 1.We had no warning – not at the time of the pacemaker implant. All the risks and legal disclosures….we were never told that although this device was "MRI compatible," Mayo would decline to sign-off for another MRI center; and 2. Barrows MRI assures me that not only is the form a standard form, a standard practice, but that this is the FIRST flat refusal they have received from any medical group. Sometimes there is reluctance, she said, and sometimes there is delay – but the doctors sign. We'll see how this plays out. It might indeed be an outcome he cannot live with. Literally.

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Wishing you and Walt the best, @maxaz1. It sounds like a complicated situation on both sides. Will you post again and let me know how this works out?

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I am so sorry to hear of your situation. This is a lesson for all of us to have a local cardiologist as well as Mayo. Can Barrows assist your husband with a cardiology consult and sign off prior to his procedure? Good luck to you.

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