Tests show she is in target range of only 20% of the time. What steps can I take.. Mother has been receiving warfarin for over 4 years due to a clot in her lungs . She also has been diagnosed with micro vascular dementia. I live over 1000 miles from the nursing home but review her medical records and talk to nurses at the home regularly. The clotting reduction is measured by a test called PT/INR. For treatment to be considered effective she should show results between 2-3 in at least 80% of the tests. Instead, she is in this range only 20% of the time and is thus not receiving the intended benefit. There are few doctors who are willing to treat Medicade patients, but I have persisted in questioning why she is resistant .The doctor depends heavily on the nurse practitioner and tells her to inform the nurses at the home to tell me she is well controlled. Based on every medical article I have read as well as documents from the American Association of Cardiology she is NOT. I was able to have her seen by a cardiologists who conducted an ECHO and found severe aortic stenosis. Probably the reason for her clot production. I have also finally been approval for referral to a hematologists to determine reason for resistance. After I receive his opinion I will fire her internist. who I believe has hasten her mental decline as a result of micro vascular brain damage and increased the probability of a stroke.. He has never taken my calls or returned my letters, further, he has subjected mother to vena punctures approximately 300 times in the past 4 years and changes her dose of warfarin frequently. The doctor practices in Ohio. What steps can I take to report his apparently lack of medical expertise and prevent others from being victimized.. Money is not my goal, rather a sanction or license removal. I have no money for an attorney.