Is this covered?

As the free for all and chaos ensues regarding the Affordable Care Act and will he or won’t he support reform, little changes with regards to the Medical Industrial Complex. I recall an Attorney once reprimanding me for using that term and I laughed and said I can’t take credit for it but thanks. Lawyers dumber than Doctors.

When I read the headline I thought Angelina Jolie has changed her mind or one of the Real Housewives went too far this time. But no this was an accident. Alright then.

And no this is not the first time nor will it be the last.   Think the Criminal Justice system is a hot mess well this is the same industry that shares a lab space. Think about that and what it means when technicians can find you guilty or innocent and in turn destroy your life.  These people are not geniuses who are exempt from stupidity.

Think of all the great Scientists and other minds that are being assembled in the White House that will place your health and life at risk as they choose to believe their science.  That is akin to the statement “my truth” which means what exactly?

The real issue here is that we are sure that Doctors and Scientists are infallible and bad news they aren’t and neither is the Pope.  This comment says quite a bit about how people feel regarding Physicians. 

My collegue’s pregnant wife was told she had a 4-inch ovarian cyst and required surgery. They were Kaiser patients, so the second and third opinions came from within Kaiser. I said to my collegue that I was sorry for his wife and her severe pain, and now facing a surgery while pregnant. He said she had no pain. I was immediately alarmed. How can she have a huge cyst with no pain? He proceeded to tell me about the fancy, expensive schools where these three doctors had gotten their medical training. He said there was an ultrasound that showed the cyst. I said it could be the baby, not a cyst. They put the wife under, cut her open, and there was NO CYST. My collegue recounted their surprise after the surgery. I said, so you are telling me none of these doctors bothered to FEEL this supposed cyst that somehow caused no pain with their hands before cutting her? He said, “I guess not, but they ARE the best.” This couple didn’t even report these dangerous doctors to the medical board. I’m sure they and their fancy parchment are out there endangering people daily. I don’t care if they went to Stanford and Harvard. These guys are idiots

And when Angelina Jolie went all nuts, well further nuts, and wrote about her bizarre need to have a double Mastectomy and Hysterectomy I knew that it was going to be a gold mine for Surgeons – both Oncology and Plastic – as women would run amok getting tested. If you have never watched the Real Housewives of Orange County I suggest you do as I get all my mental health and cancer knowledge via these crazy bitches.  I miss the lunatic star fucker Terry Dubrow who never saw a boob he could not fix.  This is the great mind behind The Swan where debasing and degrading women is a sport in Hollywood just ask anyone!  

But as you can read below it doesn’t work out that well and whoops! I hope she met her deductible. 

Damaged for the rest of my life’: Woman says surgeons mistakenly removed her breasts and uterus

The Washington Post
By Lindsey Bever October 24 2017

Elisha Cooke-Moore had been told she had cancer-causing genes.

The 36-year-old mother said an obstetrician-gynecologist noted that the results of her genetic testing showed she had a 50 percent chance of getting breast cancer and up to an 80 percent chance of getting uterine cancer, so she underwent a recommended double mastectomy and hysterectomy to try to beat the odds.

But Cooke-Moore, 36, from Gold Beach, Ore., said that months after she had the surgeries, she learned that her medical team was wrong — the test results were negative. Now she is suing Curry County Health District and members of her medical team for $1.8 million.

“I am damaged for the rest of my life,” she told The Washington Post in a phone interview Tuesday afternoon, her voice cracking.

The lawsuit states that Cooke-Moore had a total hysterectomy in August 2016 and, not two months later, a prophylactic bilateral nipple-sparing mastectomy along with breast implants.

During an annual exam in 2015, Cooke-Moore received genetic testing to determine her risk of breast and other cancers. Cooke-Moore said she had expressed concerns to her doctor regarding a family history of cancer, so it was agreed she would be tested for a BRCA 1 and BRCA 2 gene mutation. Although the results were negative, her nurse practitioner misinterpreted them — and Cooke-Moore was told she had the MLH1 gene mutation and Lynch syndrome, according to the medical malpractice lawsuit.

The National Institutes of Health states that Lynch syndrome increases the risks of many types of cancer, particularly those in the colon and rectum, but also ovarian, uterine and other cancers.

Cooke-Moore said her nurse practitioner, who seemingly misread the results, referred her to specialists within the Curry Health Network — gynecologist William Fitts, who performed her hysterectomy and then recommended surgeon Jessica Carlson to handled her double mastectomy and reconstruction. But Cooke-Moore said neither of the doctors independently confirmed the results.

The lawsuit claims that Cooke-Moore’s medical team “continued to negligently rely upon the misinterpreted genetic testing results.”

Cooke-Moore said a doctor even wrote a letter to her children, who do not live with her, urging them to get tested for the mutation.

“I’m dumbfounded. We’re all dumbfounded,” said Cooke-Moore’s attorney, Christopher Cauble. “They all should have caught this.”

Cauble said that in addition to needless operations, his client’s replacement implants were placed during the double mastectomy surgery, prompting at least 10 corrective surgeries to manage complications.

Representatives for the Curry Health Network and an attorney for the hospital and Fitts did not respond to requests for comment. An attorney for Carlson said she could not comment on pending litigation.

Cooke-Moore said she discovered the mistake earlier this year while reading through her test results and noticed that it read “negative.”

“Devastated,” she said, remembering how she felt at the time. “I’m just not sure how you can mistake a negative for a positive.”

If she had it to do over, Cooke-Moore said that she would probably get a second opinion before she agreed to have the surgeries.

More and more, medical experts are encouraging second opinions — not out of distrust, but to ensure that the doctor and patient are making the best decisions.

“Every patient has a right to a second opinion,” Joseph Fins, chief of medical ethics at New York-Presbyterian and Weill Cornell Medicine, told Columnist Steven Petrow, “and it would worry me if a physician was opposed.”

Major hospital systems, including the Cleveland Clinic and Johns Hopkins, even have remote second-opinion services so that patients across the country can more easily seek peace of mind.

Petrow recently wrote an op-ed for The Post titled: “I heard what my doctor thinks; now I want a second opinion. How do I get one?” In it, he bullet-pointed how patients should handle second opinions:

•Don’t be talked out of seeking another opinion by your current doctor or anyone else; this is your decision.

•Be upfront but respectful with your doctor. You are partners in this, and having your doctor on your side makes it easier to transfer your medical records and coordinate care.

•Don’t shop for a specialist who will tell you what you want to hear. You need the unvarnished truth.

•Provide the second doctor with all relevant information in your medical record. Fins warns about the “discontinuity of care if all the facts don’t follow you.”

Cooke-Moore said she was too trusting.

“I trusted my community,” Cooke-Moore said, adding that she has since been diagnosed with PTSD. “I guess shame on me. Maybe I shouldn’t have, but I did.”

Confused Much?

Well as I have been writing of my own trip down surgical lane, I have been relentless about the use of General Anesthesia and how there is a move to have more surgeries done with local to have better recovery and less costs and risks. 

I can only speak of my limited experience and in turn how panicked I was prior to Surgery.  I get now why I was under and in my case it was wise as it turned out to be more complex than originally planned.  I was, however, und er for longer than necessary and I was not given the 30 minutes transition time needed post surgery as they needed to hustle me out.   I was fortunate that I hired a Nurse experienced with this as she was quite aware of my mental and physical state when she came in to get me and in turn take me home.  She was only scheduled to stay with me an hour post surgery but due to their delays she was with me less than 30 minutes. However, I am going to believe that if I was not capable she would have found arrangements that I not be alone. But again this is all hindsight and again I was functioning.   But again that is why the 30 minutes is valuable to ascertain the state of the patient and their ability.  As in most cases it is a friend or family member who may not realize the reality and demands of the situation.     It was only after I vomited it all out of my system did I actually feel well.  And that was about 2 hours of me being home alone.   I should never been given an anti nausea patch which I removed it immediately as I wanted that toxic shit out of my system immediately.   Now having a Nurse would have been useful but a Maid more so to assist in the whole cleaning up and getting me comfortable after projectile vomiting in my shower.  That was a risk and I could have fallen but again I knew what was happening and stood with a cane to make sure I did not slip and had the cane for support to step out and up after showering with all my clothes on.  (I had actually changed in lounge wear but all of that had to be removed after the incident and in turn washed with the towels, shower curtain, etc)   But much of that could have been avoided with less time under and some transition where vomiting was actually encouraged under observation.

But this is not about Patients this is about a revolving door and getting people in and out and the rest of it – you are on your own.  

So when I read this and went:  Really?

Confusion after surgery linked to later dementia in older people, study finds

By Tara Bahrampour The Washington Post  July 28 2106

Older patients who become disoriented or confused after surgery are more than three times more likely to develop dementia later, a new study has found.

The report, published Friday by the British Journal of Anaesthesia, assesses the effects of postoperative delirium (POD) on people 65 and older who were cognitively normal before their operations. Of 1,152 such patients, 9.5 percent met criteria for mild cognitive impairment or dementia a median of nine months after surgery.

The frequency of being diagnosed with MCI or dementia after surgery was much higher — 33.3 percent — among those who had experienced postoperative delirium, compared with 9 percent among those who had not.

While earlier studies have shown a relationship between POD and dementia, this is the first to look entirely at subjects who showed no cognitive decline in pre-surgery assessments, said David Warner, an anesthesiologist at Mayo Clinic in Rochester, Minn., and the study’s senior author.

Delirium is defined by an acute state of confusion, inattention, disorganized thinking and a fluctuating mental state. Older patients are more likely than younger ones to develop it after surgery, as are people with lower education levels and those who undergo vascular procedures.

Further study is needed to determine whether delirium contributes to later cognitive decline or is an indicator of some underlying factor that made people more likely to develop dementia, Warner said.

“Either it’s a marker,” he said, “or maybe there’s something about developing delirium that increases your risk for dementia. If it is the latter, then you really ought to do something” to reduce the incidence of delirium.

That could include using different techniques for anesthesia or postoperative pain management.

Most of the patients in the study underwent general anesthesia, and while there was no indication that this put them at higher risk, it could be worth studying whether using regional anesthesia techniques, such as spinal epidurals, reduced the incidence of delirium, Warner said.

Pain-control techniques could also be adjusted. “We’ve used opioids for pain control traditionally after surgery almost exclusively,” he said. “Now, partly because of the opioid epidemic, we are looking more at multimodal techniques.”

Adjustments to the postoperative environment could also reduce delirium. Earlier studies have recommended the use of clocks, calendars and similar materials to help reorient a patient after surgery. The presence of family members and minimization of staff changes and nighttime disruptions, and providing access to glasses and hearing aids can also help.

Older people are not the only ones who may suffer deleterious cognitive effects after surgery — studies have shown that exposing babies to general anesthesia may negatively affect their future cognitive development, Warner said.

“This is just another sign that we really need to pay attention to brain health at the time of surgery,” he said.

Cut once measure twice

I shared the story of the man who lost the wrong testicle and of course this is a strike out but is it that uncommon? Likely no.

As we enter July this is the time when Hospitals have the big turnover with regards to Residents and Interns. Then we have the 24 on call that contributes to exhaustion and frustration by those just getting their feet wet with regards to their rotation and in turn their specialty.

And as I am having dental surgery July 7 this has crossed my mind repeatedly but I am assured that the team I have met will be the team performing the work but that does not amend my concerns and add to that Nurses whom I have had negative to non-existent encounters that in fact ameliorate the situation.

Whether you elect to have surgery or it is a medical necessity the stress and fears are natural and in turn you hope to find ways to reduce said stress by having a medical team that are competent and capable in what they have been hired to do. Bad news not always the case.

Do you need complex surgery? Some doctors may not have much practice.

By Sandra G. Boodman The Washington Post  April 25, 2016

After James Happli of Mosinee, Wis., was diagnosed with pancreatic cancer, he was referred to a surgeon at a local hospital where he had been treated for lymphoma 28 years earlier. The surgeon told Happli and his wife that although she had never successfully performed a Whipple procedure — the pancreatic cancer operation widely regarded as among the most difficult in surgery — she believed she could do it with the help of a second surgeon.

But Happli’s operation had to be aborted after it proved too difficult. Several months later, the pipe fitter, now 58, traveled to Froedtert Hospital in Milwaukee, 175 miles from his home. His operation, one of 127 Whipples done at Froedtert last year, was performed successfully by chief surgeon Douglas B. Evans.

The procedure involves removing part of the pancreas and small intestine as well as the gall­bladder, and reconnecting the digestive organs. It proved to be particularly complicated in Happli’s case, Evans said, because of tissue damage caused by radiation treatment for his lymphoma.

“If this patient is not getting referred [to a specialist], then who is?” asked Evans, who said he has seen a recent uptick in patients treated unsuccessfully by inexperienced surgeons at smaller hospitals.

The largely unfettered ability of surgeons with minimal expertise to perform high-risk procedures — particularly at hospitals that lack experience caring for significant numbers of patients — has been the subject of a contentious, long-running battle known as the volume-outcome debate.
Baltimore’s Johns Hopkins is one of three prominent hospital systems pledging that their surgeons will meet minimum annual thresholds for 10 high-risk procedures. (Patrick Semansky/AP)

A groundbreaking 1979 Stanford study found that patients who underwent operations at hospitals that did more of those surgeries had significantly lower death rates than those treated at hospitals where they were done infrequently. That finding has since been replicated repeatedly across many specialties and found to apply to surgeons as well as hospitals. Last month, a large study found that the risk of complications was far higher among surgeons who performed only one thyroid removal annually than among those who did 25 or more of the tricky procedures per year.

Recently the volume battle was reignited when a trio of prominent health systems — Johns Hopkins, Dartmouth-Hitchcock and the University of Michigan — pledged that they will require their surgeons and 20 affiliated hospitals to meet minimum annual thresholds for 10 high-risk procedures. The three systems have asked other hospital networks around the country to join them.

Under the terms of the volume pledge, believed to be the first of its kind, surgeons must perform at least five pancreatic cancer surgeries annually in hospitals where 20 such operations are done each year. For knee or hip replacements, the requirement is 25 per surgeon and 50 per hospital. There are provisions for emergency surgery and for surgeons who sometimes do not meet the threshold because they were on leave; such surgeons might be required to perform a certain number of procedures under supervision.

“There is this intractableness of patients undergoing surgical care in places that have no business doing it” or performed by “hobbyists” — surgeons who infrequently perform risky surgeries, said John Birkmeyer, chief academic officer at Dartmouth. Birkmeyer devised the pledge with Peter Pronovost, an internationally known expert who directs the Armstrong Institute for Patient Safety and Quality at Johns Hopkins.

At large teaching hospitals, Birkmeyer noted, “there are usually one or two or three surgeons who are recognized as go-to doctors” for certain procedures and do them frequently. “But there’s this tail of other surgeons who do only a few a year,” such as a shoulder surgeon who performs a handful of hip replacements or a breast cancer surgeon who occasionally attempts a Whipple.

“We decided to use volume as a pilot case, an initial foray into setting quality and safety standards,” he said. “And we wanted to do it in a way” that was not subject to the discretion of hospital officials.
Critical information

As smaller community hospitals affiliate with larger ones, the questions of which surgeons should do which procedures and where are increasingly confronting health systems. Hospitals of all sizes — both large academic centers and smaller community institutions — face a variety of sometimes competing incentives: to retain lucrative surgical cases and to avoid angering surgeons, who fiercely prize autonomy and wield considerable clout because they generate substantial revenue. And while hospitals formerly reaped a financial reward if patients suffered complications and had to be readmitted, they now face penalties under the Affordable Care Act.

The Leapfrog Group, a nonprofit organization that represents large employers and purchasers of health care and seeks to advance patient safety, has focused on volume in its hospital rating system. “Volume is a really critical piece of information,” said the group’s chief executive officer, Leah Binder.

“I think every medical staff should be grappling with these volume benchmarks,” she said, endorsing the pledge. “It’s fundamental.”

Ashish K. Jha, a practicing internist and professor of health policy at the Harvard T. H. Chan School of Public Health who has written about efforts to improve medical quality, calls the pledge “very reasonable.”

Low-volume hospitals, he said, typically lack specialized teams to care for patients as well as state-of-the-art equipment and systems designed to prevent or quickly spot complications — critical factors in improving outcomes. “None of us care about volume; we care about outcomes, and volume is a surrogate” measure of outcomes, Jha noted. “Even though we’ve been talking about this for 35 years, a ton of high-risk surgery still happens among low-volume providers.”

But surgeons’ groups and the president of the Joint Commission, the Chicago group that accredits the nation’s hospitals, have criticized the pledge as simplistic and overly prescriptive. Some officials say they fear it could unfairly penalize low-volume surgeons and smaller hospitals that have good outcomes.

“There’s room to improve in low-volume and high-volume hospitals,” said Kevin Bozic, chair of the department of surgery at the Dell Medical School at the University of Texas at Austin, who heads the committee on research and quality for the American Academy of Orthopaedic Surgeons. “There are high-volume, low-quality hospitals” as well as the converse.

“I know Harvard may be better than McPherson, Kansas,” said Tyler Hughes, a surgeon at the 25-bed hospital in McPherson and a director of the American Board of Surgery. “But for many patients, the best possible surgery is closest to home.”

Irate surgeons

Although patient-safety experts and some insurance companies have long encouraged patients, especially those with serious illnesses or complex diagnoses, to seek care from experienced specialists at high-volume hospitals, there is little to prevent doctors and hospitals from doing whichever surgeries (other than organ transplants) they see fit, no matter how rarely they do them.

Many patients don’t know to ask a doctor about volume or outcomes or are unable to ferret out relevant information when choosing a surgeon or hospital. One reason, Leapfrog’s Binder said, is that much important information such as complication rates remains hidden. Hospitals report detailed data about surgical outcomes to registries for internal use, but the information is not publicly available.

Kerry O’Connell, 59, a Denver construction executive, said that only after a botched elbow operation that required seven corrective surgeries did he learn that his was the second such procedure his orthopedist had performed. “I went to the one clinic where the ER sent me, and the surgeon seemed like a nice guy,” he said.

“We don’t have enough transparency in health care,” Binder said. “It’s the first thing everyone wants to know: Who’s the best surgeon? And anyone in health care picks up the phone and asks their friends.”

Recently, Binder notes, there have been new efforts to inform patients. In the past year, the journalism organization ProPublica and Consumer’s Checkbook have launched databases that rate surgeons. Since 1995 New York state has published some data on heart surgeons. And Consumer Reports and the federal government’s Hospital Compare website provide hospital-specific information.

A report by Leapfrog found that in 2013, one-third of hospitals that performed procedures to remove all or part of the esophagus, a demanding surgery to treat cancer, did only one or two annually, far below the level needed to achieve proficiency. A CNN investigation of an extremely low-
volume Florida heart surgery program launched in 2011 found that six babies died in a two-year period, far more than expected; the program has since closed. And a U.S. News analysis last year found that Medicare patients who had knee replacements at the lowest-volume hospitals in the country were 70 percent more likely to die than those whose surgery was performed at the highest-volume centers; for hip replacement, the figure was 50 percent.

Disparities can be seen among hospitals in the same system, Birkmeyer noted.

“One of our highest priorities is insuring consistent quality and safety” regardless of where a patient seeks treatment, he said. In the past decade, Dartmouth has grown from a single hospital in Hanover, N.H., to eight in northern New England. Baltimore-based Hopkins has affiliated with smaller hospitals in the District and suburban Maryland.

Among the most irate reactions Birkmeyer said he encountered came from about 10 surgeons affiliated with Dartmouth’s main hospital who were told they would no longer be allowed to do procedures for which they didn’t meet annual minimums. “They said things like, ‘I’ve been credentialed to do this for 20 years and I’ve never had a complication, and now you’re telling me I can’t do it?’ ”

That anger and the months required to get the boards of hospitals and their executive committees to agree to the new rules may be among the reasons only three systems have signed on so far, Birkmeyer said. More than a dozen others have expressed interest.

Some surgeons say that the focus on volume is misguided.

The problem “is actually much more complicated than volume,” said David Hoyt, executive director of the American College of Surgeons. Hoyt said that the group is drafting its own guidelines that will address volume.

Beyond numbers

To Mark Chassin, president of the Joint Commission, the pledge misses the mark. “The surgeon’s contribution to the outcomes patients experience is only one component,” he said.

“Volume should never be used by an accrediting organization as a measure of quality” because it is too imperfect a measure, Chassin added.

Patients can help protect themselves, he added, by taking “as much responsibility and interest” as possible in their care.

In the view of general surgeon Linda Halderman, doctors are the best judges of their abilities. “Every surgeon has to exercise judgment of their own capabilities” and know when to refer to a more experienced colleague, said Halderman, who is based in Selma, Calif.

But Harvard’s Jha disagrees. Many surgeons, he said, tell him they “have excellent results and I’ll say, ‘How do you know? Do you actually track your outcomes?’ ” Most, he said, do not.

Two months ago, Linus Linaweaver, 76, chose to undergo elective abdominal surgery in his home town of McPherson, Kan., after robotic prostate surgery at a larger hospital in Wichita nearly killed him and left him with a colostomy.

“I wanted to be back in our town,” he said, adding that he had confidence in Tyler Hughes, his surgeon, and McPherson Hospital. His seven-hour operation went well, and Linaweaver recently said he is “almost back to normal.”

James Happli is back at work after a year’s medical leave. Following his failed Whipple surgery, the local surgeon proposed trying again. That offer was withdrawn after a second specialist refused to participate. At that point, Happli was referred to Evans in Milwaukee.

If he had it to do over again, Happli said, “I would have gone to a bigger place” and a more experienced surgeon the first time.

— Kaiser Health News

Grade C for Care

A couple of weeks ago I read about Stem Cell treatments that are doing more harm than good but as we have no regulation nor ability to actually ensure that half the shit the quack professional class are pedaling, we must make ultimately life saving or debilitating decisions on our own.

Then the past few days the New York Times did a series on immunotherapy treatments with regards to cancer and who knew that actually using the bodies own defense mechanisms were more beneficial that the toxic shit that western medicine loves to use to treat cancer. That said, the minute drug companies and other members of the medical industrial complex get on board you know the train trip is going to get way more expensive and take way longer than it should

Again, whatever you need, want and more importantly can afford then have at it. I want to say my skepticism about western medicine is in response to the abusive and negligent treatment by the abusive providers at Harborview Medical Center, but no it was way earlier than that. I think the first exposure to Quacks was the Doctor who broke a needle in my arm doing a blood draw, then we have the other quacks treating my Mother for her high blood pressure, the varying Dentists that have been unbelievably amazing or unbelievably incompetent;  the therapists and other assorted individuals I have seen over the years to try to reconcile my pain and anger over the years for whatever ailed me. Yes I have tried to actually understand and seek professional help of all kinds for varying injuries or ailments but over time the bad simply outweighed the good so my respect and more importantly trust of the medical industrial complex is slim to none.

And so I go out of my way to understand and validate that by finding information so that others don’t have to and in turn make educated and more importantly informed decisions about their care. And here is just another example.

Why ‘Useless’ Surgery Is Still Popular

Gina Kolata
THE NEW YORK TIMES
AUG. 3, 2016

Before a drug can be marketed, it has to go through rigorous testing to show it is safe and effective. Surgery, though, is different. The Food and Drug Administration does not regulate surgical procedures. So what happens when an operation is subjected to and fails the ultimate test — a clinical trial in which patients are randomly assigned to have it or not?

The expectation is that medical practice will change if an operation turns out not to help.

If only.

It looks as if the onus is on patients to ask what evidence, if any, shows that surgery is better than other options.

Take what happened with spinal fusion, an operation that welds together adjacent vertebrae to relieve back pain from worn-out discs. Unlike most operations, it actually was tested in four clinical trials. The conclusion: Surgery was no better than alternative nonsurgical treatments, like supervised exercise and therapy to help patients deal with their fear of back pain. In both groups, the pain usually diminished or went away.

The studies were completed by the early 2000s and should have been enough to greatly limit or stop the surgery, says Dr. Richard Deyo, professor of evidence-based medicine at the Oregon Health and Sciences University. But that did not happen, according to a recent report. Instead, spinal fusion rates increased — the clinical trials had little effect.

Spinal fusion rates continued to soar in the United States until 2012, shortly after Blue Cross of North Carolina said it would no longer pay and some other insurers followed suit.

“It may be that financial disincentives accomplished something that scientific evidence alone didn’t,” Dr. Deyo said.

Other operations continue to be reimbursed, despite clinical trials that cast doubt on their effectiveness.

In 2009, the prestigious New England Journal of Medicine published results of separate clinical trials on a popular back operation, vertebroplasty, comparing it to a sham procedure. They found that there was no benefit — pain relief was the same in both groups. Yet it and a similar operation, Kyphoplasty, in which doctors inject a sort of cement into the spine to shore it up, continue to be performed.

Dr. David Kallmes of the Mayo Clinic, an author of the vertebroplasty paper, said he thought doctors continued to do the operations because insurers pay and because doctors remember their own patients who seemed better afterward.

“When you read a study, you reflect on whether it is representative of your patient population,” Dr. Kallmes said. “It is easy to conclude that the answer is ‘no.’ The mean age in the study is different or ‘I do it differently.’”

“I think there is a placebo effect not only on patients but on doctors,” Dr. Kallmes adds. “The successful patient is burned into their memories and the not-so-successful patient is not. Doctors can have a selective memory that leads them to conclude that, ‘Darn it, it works pretty well.’”

The latest controversy — and the operation that arguably has been studied the most in randomized clinical trials — is surgery for a torn meniscus, a sliver of cartilage that acts as a shock absorber in the knee. It’s a condition that often afflicts middle-aged and older people, simply as a consequence of degeneration that can occur with age and often accompanying osteoarthritis. The result can be a painful, swollen knee. Sometimes the knee can feel as if it catches or locks. So why not do an operation to trim or repair the torn tissue?

About 400,000 middle-aged and older Americans a year have meniscus surgery. And here is where it gets interesting. Orthopedists wondered if the operation made sense because they realized there was not even a clear relationship between knee pain and meniscus tears. When they did M.R.I. scans on knees of middle-aged people, they often saw meniscus tears in people who had no pain. And those who said their knee hurt tended to have osteoarthritis, which could be the real reason for their pain.

Added to that complication, said Dr. Jeffrey N. Katz, a professor of medicine and orthopedic surgery at Harvard Medical School, is the fact that not everyone improves after the surgery. “It is not regarded as a slam-dunk,” he said. As a result, he said, many doctors have been genuinely uncertain about which is better — exercise and physical therapy or surgery. That, in fact, was what led Dr. Katz and his colleagues to conduct a clinical trial comparing surgery with physical therapy in middle-aged people with a torn meniscus and knee pain.

The result: The surgery offered little to most who had it. Other studies came to the same conclusion, and so did a meta-analysis published last year of nine clinical trials testing the surgery. Patients tended to report less pain — but patients reported less pain no matter what the treatment, even fake surgery.

Then came yet another study, published on July 20 in The British Medical Journal. It compared the operation to exercise in patients who did not have osteoarthritis but had knee pain and meniscus tears. Once again, the surgery offered no additional benefit.

An accompanying editorial came to a scathing conclusion: The surgery is “a highly questionable practice without supporting evidence of even moderate quality,” adding, “Good evidence has been widely ignored.”

So what should patients be told? Should they even be offered the surgery?

Patients should be told that physical therapy is a good first-line therapy for pain relief, Dr. Katz said, but that surgery also relieves pain. Pain relief can take longer with physical therapy, he says. With surgery, he said, patients have to recover from the operation but are likely to be back at work within two weeks.

“At the end of the day,” he said, “patients ought to choose.”

Of course, how they choose might depend on how the choice is presented.

Here’s how Dr. Gordon H. Guyatt, a professor of medicine and epidemiology at McMaster University in Hamilton, Ontario, who wrote the editorial in The British Medical Journal, would deal with the clinical trial data:

“I personally think the operation should not be mentioned,” he says, adding that in his opinion the studies indicate the pain relief after surgery is a placebo effect. But if a doctor says anything, Dr. Guyatt suggests saying this: “We have randomized clinical trials that produce the highest quality of evidence. They strongly suggest that the procedure is next to useless. If there is any benefit, it is very small and there are downsides, expense and potential complications.”

Hearing that, he says, “I cannot imagine that anybody would say, ‘Go ahead. I will go for it.’”

Sleight of Hand

Reading my New York Times I came across a half page ad in the Business section, commissioned by Dr. Harry Persaud.

The gist of this is a letter to the American Public informing them that the the Health Care law is preventing cardiologists from doing “life saving” surgery specifically the procedure surrounding stents. I have written about Dr. Persaud before, but let me refresh your memories from the Cleveland Plain Dealer of a year ago.

 Westlake heart doctor charged with performing unnecessary procedures, overbilling $7.2 million
 The Plain Dealer
 By James F. McCarty
 August 21, 2014

CLEVELAND, Ohio – A Westlake cardiologist whose offices were raided by the FBI in 2012 was charged today in a 16-count federal indictment with performing unnecessary heart procedures and overbilling insurance companies by $7.2 million.

A grand jury returned an indictment charging Dr. Harry Persaud, 55, with health care fraud, 14 counts of making false statements, and money laundering. The indictment seeks the forfeiture of nearly $344,000 contained in two bank accounts in the names of Persaud and his wife, Roberta. Persaud performed dozens of unnecessary stent insertions, catheterizations and tests, and caused unnecessary coronary artery bypass surgeries to be performed as part of a scheme to overbill Medicare and other insurers, according to the indictment.

 At least 14 medical malpractice lawsuits have been filed against Persaud in Cuyahoga County Common Pleas Court since 2012. Persaud pleaded not guilty to the charges during his initial appearance in U.S. District Court this afternoon. Magistrate Greg White ordered him to surrender his passport and avoid contact with any potential witnesses, then released him on a $25,000 personal bond.

“He’s a good physician and has done nothing wrong,” said defense attorney Henry Hilow. U.S. Attorney Steven Dettelbach called the case “deeply troubling.” “Inflating Medicare billings alone would be bad enough,” Dettelbach said.

“Falsifying cardiac care records, making an unnecessary referral for open heart surgery and performing needless and sometimes invasive heart tests and procedures is inconsistent with not only federal law but a doctor’s basic duty to his patients.” stents.jpegHeart stents are mesh supports that hold open blocked arteries and improve blood flow to the heart.

 Stephen Anthony, special agent in charge of the FBI’s Cleveland office, said, “This doctor violated the sacred trust between doctor and patient by ordering unnecessary tests, procedures and surgeries to line his pockets.

 He ripped off taxpayers and put patients’ lives at risk.” Persaud was born in London and graduated in 1983 from the St. Mary’s Hospital Medical School at the University of London. He is board certified in internal medicine and cardiovascular disease, according to the American Board of Medical Specialties. Persaud had a private medical practice in Westlake with hospital privileges at St. John Medical Center, Fairview Hospital in Cleveland and Southwest General Health Center in Middleburg Heights.

Persaud devised a scheme to defraud Medicare and other insurers from 2006 to 2012, according to the indictment, which said the doctor:

 • Reported medical services to Medicare that were more costly than the services actually performed;
 • Performed unnecessary nuclear stress tests on patients;
 • Recorded false nuclear test results to justify unnecessary cardiac catheterization procedures;
 • Falsely recorded the existence and extent of blockage observed during catheterizations;
• Recorded false symptoms to justify testing and procedures on patients;
 • Inserted cardiac stents in patients who did not have at least 70 percent blockage in blood vessels, nor exhibited symptoms of blockage;
 • Placed a stent in an artery that already had a functioning bypass; • Improperly referred patients for unnecessary coronary artery bypass surgery.

Heart stents are mesh supports that hold open blocked arteries and improve blood flow to the heart. At the same time Persaud’s practices were under FBI investigation, his work was being reviewed by the three hospitals where he conducted his practice in an attempt to determine whether he unnecessarily placed stents in the hearts of patients.

Earlier in 2012, St. John Medical Center sent letters of apology to 23 patients telling them they may have had stents placed in their hearts unnecessarily at the hospital in the previous two years. In prepared statements, St. John, Fairview and Southwest General said they have cooperated with federal officials investigating Persaud, and St. John has instituted additional quality measures to more closely monitor heart cases.

 Last August, Persaud filed a $10 million lawsuit against the St. John Medical Center and its chief medical officer, accusing them of making false statements against him, defaming his character and interfering with his ability to practice medicine. Persaud claimed in the lawsuit that the equipment he used to diagnose blocked heart arteries at St. John Medical Center was not functioning properly and provided improper images.

 “Dr. Persaud believes he’s provided his patients with the best medical care,” Hilow, his attorney, said at the time. “He’s always held his patients’ health and welfare first and foremost.”

 As a result of the bad publicity, Persaud said he has lost hundreds of patients, he’s been sued 14 times and his malpractice insurance carrier dropped him, forcing him to pay more than $200,000 a year for insurance that once cost him $16,000

You can click on the link from the newspaper to see the legal filings and then ask how much that ad cost and did his Lawyer’s approve this message?

Having a Laugh!

Remember the crazy writer who has written contradictory articles about the medical profession? I will neither use her name nor promote her hideous book, so you can look through the Washington Post or the New York Times or this blog about how she defended Nurses and Doctors laughing at their patients as a coping strategy. Later she wrote about how mean Nurses are affecting care and compromising the profession.  Which is it? I think it is both frankly as they are human and we are not a perfect breed regardless of what we do for a living.

Well here we have the penultimate in why anyone in the profession should take a big pill and a big dose of STFU. This case makes me laugh as frankly we have to film encounters with cops and medical professionals to ensure our safety and veracity in each encounter. I do. I tell them when I walk in that I record as to ensure I am following instructions, can listen without taking notes or whatever other bullshit I can come up with to record legally. In my state we are not allowed to do so without permission. I do so, regardless, as I don’t plan on using it in court, I transcribe it to make sure my recollections are the same and then I request my medical records immediately after to compare notes.

This is what you do after being exploited and abused by the medical profession to protect your rights. Only once was I asked if I was recording and told not to and that was by the Attorney representing the defendants in my suit against Harborview.  He knew I recorded as I had quoted specific phrases and details that had to come from a transcriptionist which was not present during the original meeting with the witches of Harborview, he is quite smart to have figured it out. Funny he just left that law firm and is now a solo Attorney located in a consortium of offices shared by Attorneys who are personal injury lawyers. Crossing over to the darkside perhaps? Protecting patients vs covering up for Doctors doesn’t pay as much but maybe it does good on some level.

America you are screwed and told to sue. Well not always does it work out. And by the way this judgment will be appealed and in turn possibly settled and the individual will pay taxes on the total amount prior to the attorney fees being deducted. Just so you know that money is not the reason you sue, it is to shame, embarrass and humiliate and possbibly just possibly get the truth and maybe just maybe an apology.

Anesthesiologist trashes sedated patient — and it ends up costing her
Audio: Anesthesiologist trashes sedated patient

These audio clips are excerpts from conversations between a gastroenterologist, an anesthesiologist and a medical assistant during a colonoscopy. This was entered as evidence in a lawsuit filed by the patient for defamation and medical malpractice.

The Washington Post
By Tom Jackman
June 23 2015

Sitting in his surgical gown inside a large medical suite in Reston, Va., a Vienna man prepared for his colonoscopy by pressing record on his smartphone, to capture the instructions his doctor would give him after the procedure.

But as soon as he pressed play on his way home, he was shocked out of his anesthesia-induced stupor: He found that he had recorded the entire examination and that the surgical team had mocked and insulted him as soon as he drifted off to sleep.

In addition to their vicious commentary, the doctors discussed avoiding the man after the colonoscopy, instructing an assistant to lie to him, and then placed a false diagnosis on his chart.

“After five minutes of talking to you in pre-op,” the anesthesiologist told the sedated patient, “I wanted to punch you in the face and man you up a little bit,” she was recorded saying.

When a medical assistant noted the man had a rash, the anesthesiologist warned her not to touch it, saying she might get “some syphilis on your arm or something,” then added, “It’s probably tuberculosis in the penis, so you’ll be all right.”

When the assistant noted that the man reported getting queasy when watching a needle placed in his arm, the anesthesiologist remarked on the recording, “Well, why are you looking then, retard?”

There was much more. So the man sued the two doctors and their practices for defamation and medical malpractice and, last week, after a three-day trial, a Fairfax County jury ordered the anesthesiologist and her practice to pay him $500,000.

The plaintiff, identified in court papers only as “D.B.,” wanted to maintain his anonymity and did not want to comment about the case, said his attorneys, Mikhael Charnoff and Scott Perry.

The anesthesiologist, Tiffany M. Ingham, 42, could not be reached for comment, and her attorney, D. Lee Rutland, did not return messages seeking comment. Ingham worked out of the Aisthesis anesthesia practice in Bethesda, Md., which the jury ruled should pay $50,000 of the $200,000 in punitive damages it awarded. Officials there did not return a call seeking comment. Ingham no longer works there, an Aisthesis employee said, and state licensing records indicate that she has moved to Florida. An anesthesiology practice in Tavares, Fla., said she no longer worked there. Calls to a number believed to be Ingham’s were not returned, and there was not an answering machine or voicemail at that number.

[Opinion: Nurses make fun of their dying patients. And that’s okay.]  **here it is.

On the opening day of the trial last week, the gastroenterologist who performed the colonoscopy, Soloman Shah, 48, was dismissed from the case. Court documents state Shah also made some insulting remarks — “As long as it’s not Ebola, you’re okay,” Shah was recorded saying during the rash discussion — and did not discourage Ingham from her comments or actions, which included writing on the man’s chart that he had hemorrhoids, when he did not.

Neither Shah, who did not return a message left at his office, nor the lawyers on either side would comment.

The lawyers also would not discuss whether Ingham or Shah faced disciplinary action from the Virginia Board of Medicine. No actions are listed against either on the board’s Web site.

The jury awarded the man $100,000 for defamation — $50,000 each for the comments about the man having syphilis and tuberculosis — and $200,000 for medical malpractice, as well as the $200,000 in punitive damages. Though the remarks by Ingham and Shah perhaps did not leave the operating room in Reston, experts in libel and slander said defamation does not have to be widely published, merely said by one party to another and understood by the second party to be fact, when it is not.

“I’ve never heard of a case like this,” said Lee Berlik, a Reston lawyer who specializes in defamation law. He said comments between doctors typically would be privileged, but the Vienna man claimed his recording showed that there was at least one and as many as three other people in the room during the procedure and that they were discussing matters beyond the scope of the colonoscopy.

“Usually, all [legal] publication requires is publication to someone other than the plaintiff,” Berlik said. “If one of the doctors said to someone else in the room that this guy had syphilis and tuberculosis and that person believed it, that could be a claim. Then it’s up to the jury to decide: Were the statements literal assertions of fact? The jury apparently was just so offended at this unprofessional behavior that they’re going to give the plaintiff a win. That’s what happens in the real world.”

One of the jurors, Farid Khairzada, said that “there was not much defense, because everything was on tape.” He said that the man’s attorneys asked for $1.75 million and that the $500,000 award was a compromise between one juror who thought the man deserved nothing and at least one who thought he deserved more.

“We finally came to a conclusion,” Khairzada said, “that we have to give him something, just to make sure that this doesn’t happen again.”

The colonoscopy took place in Shah’s surgical suite on April 18, 2013, according to the man’s lawsuit. While being prepped for the procedure, the man apparently told Ingham that he had passed out previously while having blood drawn and that he was taking medication for a mild rash on his genitals.

Because he was going to be fully anesthetized, the man decided to turn on his cellphone’s audio recorder before the procedure so it would capture the doctor’s post-operation instructions, the suit states. But the man’s phone, in his pants, was placed beneath him under the operating table and inadvertently recorded the audio of the entire procedure, court records show. The doctors’ attorneys argued that the recording was illegal, but the man’s attorneys noted that Virginia is a “one-party consent” state, meaning that only one person involved in a conversation need agree to the recording.

The recording captured Ingham mocking the amount of anesthetic needed to sedate the man, the lawsuit states, and Shah then commented that another doctor they both knew “would eat him for lunch.”

The discussion soon turned to the rash on the man’s penis, followed by the comments implying that the man had syphilis or tuberculosis. The doctors then discussed “misleading and avoiding” the man after he awoke, and Shah reportedly told an assistant to convince the man that he had spoken with Shah and “you just don’t remember it.” Ingham suggested Shah receive an urgent “fake page” and said, “I’ve done the fake page before,” the complaint states. “Round and round we go. Wheel of annoying patients we go. Where it’ll land, nobody knows,” Ingham reportedly said.

Ingham then mocked the man for attending Mary Washington College, once an all-women’s school, and wondered aloud whether her patient was gay, the suit states. Then the anesthesiologist said, “I’m going to mark ‘hemorrhoids’ even though we don’t see them and probably won’t,” and did write a diagnosis of hemorrhoids on the man’s chart, which the lawsuit said was a falsification of medical records.

After declaring the patient a “big wimp,” Ingham reportedly said: “People are into their medical problems. They need to have medical problems.”

Shah replied, “I call it the Northern Virginia syndrome,” according to the suit.

The doctors argued that the Vienna man did not suffer any physical injury or miss any days of work. The man’s complaint said that he was “verbally brutalized” and suffered anxiety, embarrassment and loss of sleep for several months.

“These types of conversations,” testified Kathryn E. McGoldrick, former president of the Academy of Anesthesiology, “are not only offensive but frankly stupid, because we can never be certain that our patients are asleep and wouldn’t have recall.”

Waking Up

Waking up from surgery is essential for determining recovery levels, waking up during surgery however…

Here in Seattle we had a Anesthesiologist who was sexting his girlfriend during surgery. The irony was this was a young woman whom he met as a result of having surgery. Did she wake up during too and said, hi, nice to meet you? But the thought of waking during surgery having no ability to communicate and be fully aware of the assault upon your body is not comforting in the least. Do they deduct that from the bill? Doubtful.

More ways the medical industrial complex continues to demonstrate their sheer hubris, audacity and incompetence.  And while this takes place in the United Kingdom, don’t kid yourself that the U.S is the exception, it is more the rule.

Surgery patients report waking up during surgery but unable to let doctors know

Hospitals in the United Kingdom and Ireland tracked patients who reported regaining consciousness during surgery. “I thought I was about to die,” said a girl who was having a dental procedure.


By Clare Wilson October 6 at 5:24 PM

If you’re facing surgery, this may well be your worst nightmare: waking up while under the knife without medical staff realizing.

The biggest-ever study of this phenomenon is shedding light on what such an experience feels like and is causing debate about how best to prevent it.

For a one-year period starting in 2012, an anesthetist at every hospital in the United Kingdom and Ireland recorded every case where a patient told a staff member that he had been awake during surgery. Prompted by these reports, the researchers investigated 300 cases, interviewing the patient and doctors involved.

One of the most striking findings, says the study’s lead author, Jaideep Pandit of Oxford University Hospitals, was that pain was not generally the worst part of the experience: It was paralysis. For some operations, paralyzing drugs are given to relax muscles and stop reflex movements. “Pain was something they understood, but very few of us have experienced what it’s like to be paralyzed,” Pandit says. “They thought they had been buried alive.”

“I thought I was about to die,” says Sandra, who regained consciousness but was unable to move during a dental operation when she was 12 years old. “It felt as though nothing would ever work again — as though the anesthetist had removed everything apart from my soul.”

The audit found that most episodes of awareness were brief and happened before or after the surgery took place. But waking still caused distress in 51 percent of cases. In addition to paralysis, people reported sensations of pain and choking.

The audit found a much lower incidence of waking up than previous studies: one case for every 19,000 operations involving general anesthesia. Smaller studies had suggested the rate could be as high as one in 500.

The latest study tallied only reports that were volunteered by patients; older studies questioned everyone who underwent surgery. This proactive questioning could overestimate the problem, Pandit says.

But John Andrzejowski, an anesthetist at the Royal Hallamshire Hospital in Sheffield, thinks the latest audit probably missed many non-trivial cases. “The true figure is probably somewhere in the middle,” he says.

The audit team is urging anesthetists to use a device called a nerve stimulator to enable them to give the minimum dose. A lower dose should be enough to stop spontaneous movements yet still allow the patient to move if he becomes conscious enough to feel pain, Pandit says.

Sometimes complete paralysis is essential to avoid severing a nerve, points out Andrzejowski, who advocates using monitors that record brain activity through scalp electrodes. But Pandit argues that these give no clear signal of consciousness and are hard to interpret.