Hi Bead Dog,
I'm going to write the HMO an informative letter about their failure to provide timely services and lack of qualified MD's
Now this I perhaps know about. Are you a member of a group that has truetees as in a Union group health plan or some other groups? Sometimes it is better to complain to the plan truustees. Also, there is probably a dissatisfaction line which will get these issues very serious consideration. I was in that business for more than 20 years, working for the trustees of a virtual HMO that contracts services, as opposed to facility models, the ones who have their own hosipitals and such. These kinds of things are taken very seriously if you write it up appropriately, or sometimes, get the right form so you supply all required info and things like that.
Now where you are going to run afoul are "standards of care" set by the Joint Commission on Hospital Accreditation. They define all the "by the book" interpretations of CyCbl once a monrth, in the USA. If they did it according to the ambulatory care standards you won't likely get any traction.
My ex wife called be last week and got started on MeCbl, AdoCbl, l-methylfolate and L-carnitne fumarate. Her MCV is 120 and everything is whacked. She is very anemic and feels terrible. How it happened so fast is of concern. However, barring some major underlying problem most everything will correct if not delayed. The faster you get to these things with about 30mg a day injected of MeCbl in 3 or 4 doses for CNS repair the sooner. The longer you delay the greater the chance of permanent damage. Probably 90% of the damage that is "permanent under perodic HyCbl or CyCbl can be significantly reveresed with sufficient doses of MeCbl, AdoCbl and needed cofactors. I reveresed most of the Subacute combined degeneration so I am quite functional and continue to hold it mostly at bay. You could be get a lot better but it will take some determnination to get the treatments needed.