Thursday, August 22, 2013

Dead' man's recovery shows why prolonged CPR works

When you run out of air to breathe, apparently the best thing to do is to dip your head in ice cubes and hope that someone comes along and revives you.

Dead' man's recovery shows why prolonged CPR works
Barbara Mantel
NBC News
August 22, 2013

An Ohio man’s recovery several minutes after doctors declared him dead shows how murky the decision can be about when to stop resuscitation efforts.

While Anthony Yahle, 37, may not have been dead for 45 minutes, as was widely reported, his remarkable bounce back without suffering brain damage or other ill effects stunned doctors at Kettering Medical Center in Kettering, Ohio.

Yahle, a diesel mechanic from West Carrollton, Ohio, “coded” -- a term meaning emergency -- on the afternoon of Aug. 5, after arriving in the hospital that morning in cardiac arrest. A team of doctors rushed to his hospital bedside and used chest compressions, a bag connected to a breathing tube and medications to force blood and oxygen through his body. After 45 minutes, they gave up and declared him dead.

“He was truly flatlined at the end of that code. He had no electrical motion, no respiration, and no heart beat, and no blood pressure,” says Jayne Testa, director of cardiovascular services at Kettering.

But five to seven minutes later, the team noticed a trace of electrical activity on his heart monitor and resumed their efforts to resuscitate him. Yahle is now home recovering, according to Testa.

While Yahle "was not dead for 45 minutes," the Kettering doctors “have never seen somebody come back after the code was ended and especially after so many minutes,” says Testa.

Michael Sayre, a professor of emergency medicine at the University of Washington in Seattle and a spokesperson for the American Heart Association, says he has seen and heard of similar cases. It’s unusual but not unique, he says. Sayre doesn’t know what happened in Yahle's case, but sometimes during resuscitation air gets trapped and pressure builds in the lungs, preventing blood from flowing into the heart.

“So, I have seen once or twice where we would disconnect the bag from the breathing tube and push on the chest to let the air out, and then the patient would get a pulse and have a blood pressure because they were able to get blood back to the heart,” says Sayre.

In any case, Sayre says more hospitals may want to follow Kettering’s lead and sustain resuscitation efforts for longer than the typical 20 to 25 minutes. A 2012 nationwide study of hospitals showed that “in the hospitals where they worked for longer, they got more people back, who ended up surviving and going home,” says Sayre.

Technology can help a team decide when to stop. Most hospitals now have the ability to measure the amount of carbon dioxide in the air coming out of the patient. Carbon dioxide is a byproduct of living cells. No carbon dioxide would add to the evidence that the patient is dead. Kettering Medical Center does not continuously measure carbon dioxide levels during resuscitation.

“However, you can be faked out,” says Sayre. And sometimes even with fairly normal carbon dioxide levels, a team will stop resuscitation because “we still cannot get the heart to beat on its own,” says Sayre.

But in Yahle’s case, doctors were finally able to get his heart to beat spontaneously.

“This team did a really good job. They were able to keep his brain alive, and that’s why he survived,” says Sayre.

The Kettering doctors cooled Yahle’s body, and that may have preserved his brain function. “People can definitely go seven minutes without blood flow if the brain is cooled. That is something that is well known,” says Sayre. For example, during brain surgery, doctors cool the body and stop blood flow for even longer periods of time.

There are theories about why that works. “But no one really knows the answer to that,” says Sayre.

Wednesday, August 21, 2013

Thousands of doctors practicing despite errors, misconduct

These doctors are just the tip of the iceberg. Plenty of doctors who have negligently killed patients never even lose hospital privileges. The medical establishment has a remarkably high tolerance for mistakes. It's like a fraternity where they stand by each other.

Who's to blame? Largely, it's hospital peer review committees.

"Hospitals' peer review committees — the internal panels of medical staff that oversee and review complaints against clinical personnel — often do a poor job.

"'Much of the bottleneck in the physician discipline system is in the peer review committees,' says Philip Levitt, a retired Florida neurosurgeon who served as chief of the medical staff at two hospitals. 'Virtually everything of serious consequence gets balled up or blocked in the peer review process.'

T"he peer review system is rife with bias, Levitt says, noting that doctors on the committees often are inclined to protect their colleagues — or go after those who cross or compete with them. That dynamic invites lawsuits from doctors who say they've been treated unfairly, so hospitals generally are wary of suspending even those doctors who commit egregious misconduct, Levitt adds. Instead, they tend to look for a deal to persuade the doctor to leave quietly with no misconduct finding."

Thousands of doctors practicing despite errors, misconduct
Peter Eisler and Barbara Hansen
August 20, 2013

Source: USA TODAY analysis of the U.S. government's National Practitioner Data Bank public use file; data include reports filed from Sept. 1, 1990-March 31, 2013
Frank Pompa, Alex Gonzalez and Barbara Hansen

A USA TODAY investigation shows that thousands of doctors who have been banned by hospitals or other medical facilities aren't punished by the state medical boards that license doctors.

Story Highlights

Hundreds of doctors with multiple malpractice claims still have their licenses
Weak oversight by state medical boards has been a concern for decades
Cracking down on bad doctors can take years; meantime, they keep treating patients

Dr. Greggory Phillips was a familiar figure when he appeared before the Texas Medical Board in 2011 on charges that he'd wrongly prescribed the painkillers that killed Jennifer Chaney.

The family practitioner already had faced an array of sanctions for mismanaging medications — and for abusing drugs himself. Over a decade, board members had fined him thousands of dollars, restricted his prescription powers, and placed his medical license on probation with special monitoring of his practice.

They also let him keep practicing medicine.

In 2008, a woman in Phillips' care had died from a toxic mix of pain and psychiatric medications he had prescribed. Eleven months later, Chaney died.

Yet it took four more years of investigations and negotiations before the board finally barred Phillips from seeing patients, citing medication errors in those cases and "multiple" others.

"If the board had moved faster, my daughter would still be alive," says Chaney's mother, Bette King, 72. "They knew this doctor had all these problems … (and) they did nothing to stop him."

Mari Robinson, executive director of the Texas medical board, says the Phillips case took "longer than normal, but we followed what we needed to do (by law)." Phillips could not be reached for comment.

Despite years of criticism, the nation's state medical boards continue to allow thousands of physicians to keep practicing medicine after findings of serious misconduct that puts patients at risk, a USA TODAY investigation shows. Many of the doctors have been barred by hospitals or other medical facilities; hundreds have paid millions of dollars to resolve malpractice claims. Yet their medical licenses — and their ability to inflict harm — remain intact.

The problem isn't universal. Some state boards have responded to complaints and become more transparent and aggressive in policing bad doctors.

But state and federal records still paint a grim picture of a physician oversight system that often is slow to act, quick to excuse problems, and struggling to manage workloads in an era of tight state budgets.

USA TODAY reviewed records from multiple sources, including the public file of the National Practitioner Data Bank, a federal repository set up to help medical boards track physicians' license records, malpractice payments, and disciplinary actions imposed by hospitals, HMOs and other institutions that manage doctors. By law, reports must be filed with the Data Bank when any of the nation's 878,000 licensed doctors face "adverse actions" — and the reports are intended to be monitored closely by medical boards.

The research shows:

Doctors disciplined or banned by hospitals often keep clean licenses: From 2001 to 2011, nearly 6,000 doctors had their clinical privileges restricted or taken away by hospitals and other medical institutions for misconduct involving patient care. But 52% — more than 3,000 doctors — never were fined or hit with a license restriction, suspension or revocation by a state medical board.

Even the most severe misconduct goes unpunished: Nearly 250 of the doctors sanctioned by health care institutions were cited as an "immediate threat to health and safety," yet their licenses still were not restricted or taken away. About 900 were cited for substandard care, negligence, incompetence or malpractice — and kept practicing with no licensure action.

Doctors with the worst malpractice records keep treating patients: Among the nearly 100,000 doctors who made payments to resolve malpractice claims from 2001 to 2011, roughly 800 were responsible for 10% of all the dollars paid and their total payouts averaged about $5.2 million per doctor. Yet fewer than one in five faced any sort of licensure action by their state medical boards.

The numbers raise red flags for several experts in physician oversight, including David Swankin, head of the Citizen Advocacy Center, which works to make state medical boards more effective.

"Medical boards are not like health departments that go out to see if a restaurant is clean; they're totally reactive, because they rely on these mandatory reports — and they're supposed to act on them," Swankin says.

Not all doctors who lose clinical privileges or pay multiple malpractice claims necessarily should lose their licenses. In some malpractice cases, doctors or insurers may settle without admitting fault to avoid potentially expensive litigation.

Read the entire series: When Health Care Makes You Sick

When a disciplinary report shows up, "boards have a range of options," says Lisa Robin, chief advocacy officer at the Federation of State Medical Boards. "It could be a letter requiring that you get training, or it could be monitoring of (a doctor's) practices or, where there is patient harm, it could be something as severe as a (license) suspension or revocation."

The state boards "take their responsibility very seriously in taking actions, being thoughtful, and … protecting the public," Robin adds.


Concerns about medical boards' accountability date to 1986. That year, the Inspector General at the U.S. Department of Health and Human Services reported that the boards, typically comprising doctors and a lesser number of laypeople, imposed "strikingly few disciplinary actions" for physician misconduct. Several follow-up studies suggested improvements, but the reviews ended in the early 1990s after the Justice Department declared that an Inspector General would have no jurisdiction over state boards that are not funded or regulated by the federal government.

Some lawmakers disagree.

Early last year, Grassley and a bipartisan group of senators asked the Inspector General for a "comprehensive evaluation" of state medical boards' performance. But there's been no report, and the IG's 2013 work plan doesn't mention it.

Concerns about the boards resurfaced in a 2011 study by consumer watchdog group Public Citizen. The report was based on the same National Practitioner Data Bank records reviewed by USA TODAY, and it reached a similar conclusion: Medical boards "are not properly acting on (clinical privilege) reports after becoming aware of them."

Yet little has changed since Public Citizen's assessment — and the congressional concern it created. Physicians with records of serious misconduct are clearly still practicing:

• A California doctor made eight payments totaling about $2.1 million to resolve malpractice claims from 1991 to 2008. The doctor's hospital privileges were restricted twice in 2007, once for misconduct that posed an "immediate threat to health or safety" of patients, and surrendered for good in 2008. No action has been taken against the doctor's license.

• A Florida doctor made six payments totaling about $1.1 million to resolve malpractice claims from 1993 to 2009. In 2004, the doctor was hit with an emergency suspension of hospital privileges for misconduct that posed an "immediate threat to health or safety" of patients, and a managed care organization took similar action in 2005. He also kept a clean license.

• A Louisiana doctor made nine payments totaling about $2.7 million to resolve malpractice claims from 1992 to 2007, and at least five payments involved patient deaths, including two young girls. In 2008, a managed care organization indefinitely denied the doctor's clinical privileges. But the doctor's license remains unrestricted.

The doctors' names are a mystery: identifying information is stripped from the Data Bank's public file. Full access is limited to medical boards, hospitals and other institutions that are supposed to weed out bad doctors.

But the tracking system doesn't always work.


By the time Greggory Phillips began treating Jennifer Chaney in 2008, the Texas Medical Board had lifted the license restrictions stemming from his previous mismanagement of prescription drugs.

But more trouble was brewing. First, Phillips was caught pre-signing prescription pads, allowing a nurse to put "dangerous drugs" in the hands of patients who visited when Phillips was off and got no "adequate examination," board records show. Then, Debra Horn, a mother of two, died from an overdose of drugs Phillips prescribed.

Jennifer Chaney died after being prescribed a high dose of oxycodone, a narcotic more potent than morphine, plus an added prescription for hydrocodone — one the state medical board later described as "not medically indicated."

None of that was public when Chaney's family started seeing Phillips. He treated Jennifer for poor thyroid function and residual pain from neck surgeries after a car accident, board records show. He prescribed a mix of thyroid medicine, muscle relaxants, anti-anxiety drugs and painkillers.

Just before Christmas, Chaney fell in a parking lot and reinjured her neck. Phillips prescribed a high dose of oxycodone, a narcotic more potent than morphine, board records show. He also gave her an added prescription for hydrocodone, a painkiller already included in Chaney's ongoing drug regimen — and one the board later described as "not medically indicated."

A week later, Chaney complained one evening about feeling loopy from her medications. As her husband, three sons and mother headed to bed, she stayed up to watch TV.

She was still on the couch when her mother got up in the morning.

"I noticed Jennifer was on her back, and she never slept on her back, always her side," Bette King recalls. "I didn't think anything of it; I went into the kitchen, and then it dawned on me and I went back into the den and tried to wake her up. And I couldn't."

King yelled for Jennifer's husband, who tried CPR while King called 911.

The paramedics never found a pulse. The autopsy findings: "Cause of death: mixed drug intoxication. … Manner of death: Accident."

As weeks passed, Phillips' problems mounted.v The medical board, which fined him $1,000 in the prescription pad case, sent notice that it was preparing to charge him with substandard care and prescription drug violations in the death of Horn a year earlier. The Horn and Chaney families each filed malpractice claims, and Phillips' clinical privileges were terminated at North Hills Hospital in suburban Fort Worth.

Yet Phillips' license remained unrestricted. He would keep seeing patients — and mismanaging their medication.

"There's no question that Dr. Phillips had (practice) violations; the question is what authority does the board have to act once those are found out," says Robinson of the medical board. "We want something to happen and we want it as quickly as it can happen. But the system isn't always set up for that. ... That can be frustrating."


There's nothing tougher for state medical boards than competency and malpractice cases.

"There are laws, there is due process and there is confidentiality, and all those things make it difficult for state medical boards to do what they do," says Jon Thomas, a surgeon and past president of the Minnesota Board of Medical Practice.

"You have to get all the facts and you have to follow the law. And it's complicated," adds Thomas, an officer with the Federation of State Medical Boards. If a board is pursuing disciplinary action, "a good lawyer representing that physician will know all the appropriate levers to push, and they push every one of them. That can take a lot of time."

The cases typically require exhaustive investigation and legal preparation — a challenge for many boards wrestling with tight budgets and short staffs.

As the recession crimped state finances, "we saw a lot of boards having to do more with less," says Robin, the federation's advocacy officer.

With disparate funding and statutory authority, various boards use vastly different approaches to keep tabs on physicians.

Florida spends more than $200,000 a year to have the National Practitioner Data Bank continuously monitor the licenses of all of its physicians, so the board is alerted automatically when malpractice cases, hospital privilege actions and other problems are reported.

In Texas, doctors must submit a Data Bank report on themselves when they first apply for a license (the Data Bank allows doctors to query their own license records), but additional checks are not required for license renewals and are done only if a need arises, such as in complaint investigations. In California, there are no set requirements for checking the Data Bank and it is not queried routinely; officials check doctors' records on an as-needed basis.

"The states vary all over the lot in terms of the resources the boards have, whether they have good leadership, and whether they are regularly querying the (Data Bank)," says Sidney Wolfe, a physician and founder of Public Citizen's Health Research Group. "Some states do a pretty good job; a lot of them don't."

And it's getting more difficult to assess their work.

The Federation of State Medical Boards has stopped issuing medical board enforcement data that Public Citizen uses to rank the rate at which different boards discipline physicians. Wolfe says the federation wants to kill the state-by-state rankings because many boards detest them. The federation says it's figuring out how to release data that don't foster unfair comparisons between states that may have different disciplinary rules.


Phillips wasn't giving up his medical license without a fight.

In May 2009, nearly 14 months after Debra Horn's death, the medical board invited Phillips to a settlement conference. He accepted the board's invitation but didn't accept its deal. That left the board one option: to take the case to a judge.

In Texas, as in many states, medical board complaints are adjudicated in administrative hearings, with their own judges and all the trappings of a full-blown trial. The board spent five months gathering evidence and lining up expert testimony before filing formal charges: negligence, non-therapeutic prescribing, failure to meet standards of care and poor medical decision-making.

Then, just before the hearing, Phillips opted for mediation — and the case stalled again.

"If a physician takes advantage of every hearing, every right to trial, it takes much, much longer" to resolve a case, says Robinson, the medical board's director. "He took advantage of every hearing, everything."

At about the same time, Bette King filed her own, handwritten complaint with the board in the death of Jennifer Chaney. Another investigation was launched.

King wanted the board to exercise its power to issue an emergency suspension of Phillips' license. But the burden of proof is extremely high, and the board's staff concluded that his misconduct did not meet the two-pronged legal test for an emergency order: The conduct has to be egregious and the doctor has to be an imminent, present danger. In 2012, just a dozen cases met that standard.

By the time King filed her complaint, nearly a year had passed since her daughter's death.

"We rely on complaints to (start) investigations, and people often wait a year or more to file," Robinson says. "But to show that a physician is a present danger, it's got to be now. If we are monitoring a physician for drug use and he fails a drug test, we have recent proof that he's a danger today. If we're talking about (actions) many, many months ago, it has to go through the regular disciplinary process."

So the Phillips case dragged on. It would be another year before his mediation, and it wouldn't end there. Throughout the process, anyone who checked Phillips' status on the board's website saw a license in full force — no mention of the malpractice cases or the terminated clinical privileges, even though all of that should have been listed.

"I kept waiting for them to stop him," King says, "and they just let him keep going."


By law, hospitals and other health care institutions — from managed care operations to public health centers — must report to the National Practitioner Data Bank when doctors lose clinical privileges in connection with investigations of substandard care or misconduct. Insurers also must report any payments in a malpractice case, regardless of whether guilt was admitted.

In Texas and many other jurisdictions, state laws require similar reporting directly to medical boards, often by doctors themselves.

The reports are critically important — hospitals and other health care organizations typically are the first to know when a bad doctor is putting patients at risk. Yet they are notorious for skirting reporting requirements when they part ways with a physician.

At the start of 2011, more than 20 years after the National Practitioner Data Bank was set up, 47% of hospitals had never reported restricting or revoking a doctor's clinical privileges, according to data from the U.S. Health Resources and Services Administration, which runs the Data Bank. Public Citizen reported in 2009 that some hospitals mask cases by giving bad doctors a chance to resign before investigations are launched, or by restricting privileges for just under the 30-day threshold that requires reporting.

But the group also found another grave problem: Hospitals' peer review committees — the internal panels of medical staff that oversee and review complaints against clinical personnel — often do a poor job.

"Much of the bottleneck in the physician discipline system is in the peer review committees," says Philip Levitt, a retired Florida neurosurgeon who served as chief of the medical staff at two hospitals. "Virtually everything of serious consequence gets balled up or blocked in the peer review process."

The peer review system is rife with bias, Levitt says, noting that doctors on the committees often are inclined to protect their colleagues — or go after those who cross or compete with them. That dynamic invites lawsuits from doctors who say they've been treated unfairly, so hospitals generally are wary of suspending even those doctors who commit egregious misconduct, Levitt adds. Instead, they tend to look for a deal to persuade the doctor to leave quietly with no misconduct finding.

In the rare cases where a hospital does sanction a doctor, he says, "it usually means there were really bad things going on."

In the Phillips case, North Hills Hospital says the doctor's clinical privileges ended in May 2009, not long after Phillips was fined for signing blank prescriptions. The hospital would not comment on why it parted ways with him or whether it had anything to do with misconduct that would have required reporting to the medical board.

Whatever the circumstances, the board never heard about it. "There is no public information available to suggest that a report was ever made," says the board's Robinson.

To this day, Phillips' official profile on the board's website shows that he still has clinical privileges at North Hills. And the malpractice cases, which Phillips paid to settle years ago and was required to report to the board, are unmentioned.


Based on a negotiated agreement with Phillips, the Texas Medical Board finally ordered sanctions in the Horn and Chaney cases in April 2011 — more than two years after Chaney's death; three years after Horn's.

The order charged that he "prescribed excessive quantities of high dosages of controlled substances and dangerous drugs … and engaged in a pattern of non-therapeutic prescribing of narcotics that were being used by (both) patients at the time of their deaths by drug intoxication."

Phillips agreed to pay for independent monitoring of his practice for two years, including quarterly reviews of at least 30 patients' records. He also had to take classes to correct deficient practices, including instruction in treating chronic pain and medical record-keeping, and pay a $3,000 penalty.v But Phillips still was allowed to see patients and continue writing prescriptions.

Repeated efforts to reach Phillips for comment, including requests through his lawyers, were unsuccessful. But Jon Porter, one of his attorneys, said the sanctions were significant. He noted that paying to have a practice monitored and enrolling in the required courses can cost well over $10,000.

Still, the Phillips case wasn't over. In 2012, the board found that he'd continued to mishandle prescriptions while the Horn and Chaney investigations unfolded.

Phillips engaged in "non-therapeutic prescribing" for one patient and lacked documentation to justify the drugs he administered, the board found. In another case, he again prescribed drugs without documenting their necessity — and provided early refills without justification.

This time, the board struck a tougher deal: Phillips had to give up his certification to prescribe controlled substances.

Within a year, he'd stopped practicing, board records show. But last February, the board issued another, final order that forever bars Phillips from treating patients.

Phillips "prescribed controlled substances to multiple patients without documented medical justification … (and) without adequate evaluation and need," the order charged, noting that he also violated rules by prescribing drugs to family and close friends.

Again, though, the sanctions were negotiated and stopped short of revoking Phillips' license, allowing him to work in "administrative medicine" with no patient contact, such as evaluating insurance claims.

The deal reflects the tough choices the board often faces, Robinson says.

"This doctor was willing to agree to something that's very strict — he'll never be in contact with patients again — or we'd have to go to trial, which could take years, and he'd be practicing for all that time," she says.

Friday, August 16, 2013

Sharp fined for almost removing wrong testicle--but the reporting system is voluntary for hospitals; most mistakes are covered-up

Shockingly, the 109 wrong site surgeries reported in 2012 were a "small proportion of actual events" according to the Joint Commission, which relies on hospitals to voluntarily report mistakes.

I am impressed that the Joint Commission would admit that hospitals cover-up a lot of mishaps. And I'm not surprised that the problem is increasing, since there is so little accountability. I imagine Sharp preferred to report a case of ALMOST removing the wrong testicle than to report cases where organs were mistakenly removed. In the more serious cases, the hospitals most likely pay a settlement to patients in exchange for a promise of silence.

Sharp fined for almost removing wrong testicle
State report says surgical team failed to follow procedure
By Paul Sisson
Aug. 15, 2013

In a written response to the state, Sharp stated that it conducted mandatory training of all operating room staff after the incident and conducted 70 randomly selected audits of procedures per month to make sure that surgical sites were being properly marked. Those audits, Sharp said, resulted in a 100 percent compliance rate.

Wrong-site surgeries have been a topic of focus in the health care industry for more than a decade. Despite that focus, data suggest that the mistakes have increased over time.

According to The Joint Commission, which accredits hospitals nationwide, 67 wrong-site surgeries were reported to the agency in 2002 and 109 were reported in 2012. That number is down significantly from 152 in 2011. The commission cautions that those numbers represent only the cases voluntarily reported and represent a “small proportion of actual events.”

In a written response to the state, Sharp stated that it conducted mandatory training of all operating room staff after the incident and conducted 70 randomly selected audits of procedures per month to make sure that surgical sites were being properly marked. Those audits, Sharp said, resulted in a 100 percent compliance rate.

Wrong-site surgeries have been a topic of focus in the health care industry for more than a decade. Despite that focus, data suggest that the mistakes have increased over time.

According to The Joint Commission, which accredits hospitals nationwide, 67 wrong-site surgeries were reported to the agency in 2002 and 109 were reported in 2012. That number is down significantly from 152 in 2011.

The commission cautions that those numbers represent only the cases voluntarily reported and represent a “small proportion of actual events.”

Monday, August 12, 2013

Doctor falsely diagnoses patients with cancer so he can give treatment, collect Medicare

Michigan doctor arrested for purposely misdiagnosing cancer
by Jen Hayden
Daily Kos
Aug 07, 2013

Greed knows no bounds. It pushes people to do unspeakable things. For Dr. Farid Fata, a Michigan oncologist, there were no limits:

Dr. Farid Fata, 48, of Oakland Township was arrested Tuesday and charged for allegedly submitting false claims to Medicare for services that were medically unnecessary, including chemotherapy treatments, Positron Emission Tomograph (PET) scans and a variety of cancer and hematology treatments for patients who did not need them. Dr. Fata owns and operates Michigan Hematology Oncology Centers (MHO) which has offices in Clarkston, Bloomfield Hills, Lapeer, Sterling Heights, Troy and Oak Park.

Dr. Fata was scamming Medicare to the tune of $35 million.

In the course of the scheme, prosecutors say Dr. Fata falsified and directed others to falsify documents. MHO billed Medicare for approximately $35 million dollars over a two-year period, approximately $25 of which is attributable to Dr. Fata, federal officials said.

The complaint further alleges that Dr. Fata directed the administration of unnecessary chemotherapy to patients in remission; deliberate misdiagnosis of patients as having cancer to justify unnecessary cancer treatment; administration of chemotherapy to end-of-life patients who will not benefit from the treatment; deliberate misdiagnosis of patients without cancer to justify expensive testing; fabrication of other diagnoses such as anemia and fatigue to justify unnecessary hematology treatments, and distribution of controlled substances to patients without medical necessity or are administered at dangerous levels.

Dr. Fata was prescribing painful and unnecessary treatments to patients:

The feds say he also deliberately misdiagnosed patients “as having cancer to justify unnecessary cancer treatment,” WXYZ reported.

Federal agents say Fata directed the “administration of chemotherapy to end-of-life patients who [would] not benefit from the treatment,” and deliberately misdiagnosed “patients without cancer to justify expensive testing.”

Thankfully, Dr. Fata isn't likely to get out of jail any time soon:

Dr. Fata faced a federal magistrate Tuesday afternoon. Assistant U. S. Attorneys assigned to the case argued Fata is a flight risk because he has access to about $14 million in liquid assets and a home in Lebanon. The magistrate is temporarily detaining Fata until another hearing can be held on Thursday. He faces up to 20 years behind bars if he’s convicted.

Twenty years? Not long enough. Not nearly long enough.

Tuesday, August 6, 2013

Patient: Kaiser Told Me 'Redheads Bleed More'

This patient was lucky that one person at Kaiser was looking out for her. This surgery might have had an even worse outcome if someone had tried to put her back to sleep when she awoke and saw a problem. I suggest an award for the staff member who insisted, "We can't give her any more medication."

Patient: Kaiser Told Me 'Redheads Bleed More'
(Click link to see documents)
Courthouse News Service
August 05, 2013

ROSEVILLE, Calif. (CN) - Kaiser staff dismissed "blood pouring uncontrollably out of" a woman's hand during surgery and "unbearable" pain afterward by saying "redheads bleed more," she claims in court.

Deborah Kossick woke up during surgery for carpal tunnel syndrome to see "blood pouring uncontrollably out of her hand and extremity, while there was chaos amongst the staff conducting the surgery, one of which kept yelling, 'we can't give her any more medication,'" she says in a complaint filed in Placer County Superior Court.

"Several days after the surgery, plaintiff was in unbearable and uncontrollable pain in her right hand," which was swollen and blackened, the complaint continues. Kossick says she "advised defendants that the pain was unbearable, and she believed that something had gone wrong during the surgery, as there was too much blood. Defendants advised plaintiff that she had nothing to worry about because 'redheads bleed more' than other patients."

At a follow-up appointment with her surgeon, Steven Hatton Ryder, M.D., a month after the operation, Kossick says she complained of continuing pain, swelling and discoloration of her hand. "Defendant showed no sympathy or concern whatsoever, and, instead, told her that there was nothing more he could do for her," the complaint says.

"To this date, plaintiff Deborah Kossick continues to be in an extreme amount of pain in her right hand, which is now permanent. The hand is also swollen and blackened, which will impact her ability to work and care for herself for the remainder of her life," according to the complaint.

Plaintiff seeks general, special and punitive damages, attorney's fees and costs of suit. Her husband, Robert Kossick, sued for loss of consortium. They are represented by David M. Poore of Brown Poore in Walnut Creek, Calif.

Monday, August 5, 2013

A safe, effective vaccine for cancer that some insurance companies don't cover

A safe, effective, cancer-fighting vaccine shunned
By Katy Waldman
August 5, 2013

Why aren't more teenage girls getting vaccinated against the human papillomavirus?

The New York Times reported recently that vaccination rates for the disease, the most common sexually transmitted infection and “a principal cause of cervical cancer,” failed to improve from 2011 to 2012.

This despite the fact that the rates at which people get “new vaccines typically increase by about 10 percentage points a year,” according to Thomas Frieden, director of the Centers for Disease Control and Prevention. And despite that experts have recommended since 2007 that girls receive the triptych of shots at age 11 or 12.

Every year, HPV causes about 19,000 cancers in women (mostly cervical) and close to 8,000 cancers in men (mostly throat). Yet, reported the Times, “only 33 percent of teenage girls finished the required three doses of the vaccine in 2012 ... putting the United States close to the bottom of developed countries in coverage.”

This distressing news launched a fleet of theories: that teenage girls go to the doctor less frequently than toddlers, leading to fewer opportunities for vaccination; that patients — or their parents — are embarrassed to ask for a vaccine for sexually transmitted infections, and doctors are reluctant to broach the topic; that neither doctors nor patients are well-versed enough in immunization literature to get the ball rolling.

A study in the (delightfully named) Morbidity and Mortality Weekly Report, however, rules out hypothesis No. 1. Teenagers are receiving plenty of other inoculations. (“If HPV vaccine had been administered during health-care visits when another vaccine was administered,” the authors of the study wrote, “coverage. ... could have reached 92.6 percent.”)

The vaccination flat line may flow from a combination of underinformed families and inconsistent doctors. “Providers give weaker recommendations for HPV vaccination compared with other vaccinations recommended for adolescents,”

researchers found. Plus, “the HPV vaccine is controversial,” says Tai Warren, a receptionist at Washington Pediatric Associates in Washington, D.C. “A lot of parents don't want them for their children.”

Warren couldn't say whether parents most often object to the vaccine because they perceive it as a license to have sex, because they are concerned about safety, or for some other reason. (More than seven years of study can attest that the procedure is safe, as well as effective.)

Sadi Bhattarai, a nurse at Chevy Chase Pediatrics in Washington, D.C., was not aware of any stigma surrounding the HPV vaccine. The procedure does prove slightly inconvenient.

“We often have to call after the first round and remind families to get the second and third shots,” she said.v Still, “at our practice, everybody gets vaccinated — boys and girls — when they come in for a physical and if they're the right age.”

Bhattarai ventured that plateauing rates “are both doctor- and patient-driven,” since not all clinics have adopted the immunizations as a standard part of their procedure, and not all families know to ask.

But Chris Griffiths of the Columbia, Mo., Health Department, said institutional lethargy is not wholly to blame. She senses a lingering wariness.

“As a nurse, I bring (the vaccine) up to people, and they associate it with promiscuity,” she said.

While her clinic makes a point of recommending the shots, other facilities in the state do not. Funding plays a role — to administer vaccines, a practice needs a separate locked refrigerator kept at a specific temperature and may rack up other expenses — but it is only part of the story. Patients and their families may also be dissuaded by insurance policies that fail to cover HPV inoculation. (The triplicate shot can cost up to $140 per dose.) Doctors may not want to incur a backlash by suggesting the vaccine.

Whatever the reason, we've trekked too far into the 21st century to be dithering over safe, easy, cancer-blasting vaccinations for children. Though the explanations behind the plateau may be complicated, the solutions are simple: Insurance companies should cover HPV shots. Doctors should promote them. Patients and their families should embrace them.

Saturday, August 3, 2013

Health exchange releases new small business rates

"In San Diego County, four companies will offer SHOP plans: Sharp HealthCare, Health Net, Kaiser Permanente and Blue Shield."
Health exchange releases new small business rates
Says San Diego companies with fewer than 50 employees could save 12 percent
By Paul Sisson
Aug. 1, 2013
San Diego County small businesses will be able to save 12 percent on health insurance premiums for their employees if they buy coverage next year from the state’s newly created health exchange, officials announced Thursday.
Covered California, the state agency tasked with creating and running the new health insurance exchanges mandated by the Affordable Care Act of 2010, released selected rates for many California regions that it says are less expensive than those now available to businesses with 50 or fewer employees.
Federal health reform calls for each state to create a Small Business Health Options Program, often called SHOP, which will operate alongside a larger exchange tailored to individuals and families.
Both exchanges must be running by Oct. 1 to provide enough shopping time before Jan. 1, 2014, the date when most uninsured Americans must purchase coverage or pay a small penalty.
Small business rates are separated into 19 different geographical regions. In San Diego County, four companies will offer SHOP plans: Sharp HealthCare, Health Net, Kaiser Permanente and Blue Shield.
Covered California did not provide a full list of potential premiums for each company but instead compared prices for a single 40-year-old employee.
Sharp, the only local company offering its own plan in the health exchange for individuals and families, said in a statement that serving businesses made sense because the health system has “long been active in serving the small group market in San Diego.”
In San Diego County, the average of the three lowest premiums offered in the exchange was $290, a rate that the state claims is 12 percent less than an average of $324 for “comparable” small group plans sold this year.
Scott Hauge, president of Small Business California, a nonprofit advocacy group that lobbies in Sacramento on issues that affect small businesses, lauded the rates as a step toward controlling costs.
“It’s a good first step. It adds competition to the market, and any time you add competition, it’s a positive,” Hauge said.
But not everyone was so impressed. Bill Hammett, a San Diego area insurance broker, said there was no way to tell how the state selected a comparable plan to make its cost comparison. He said that, overall, there is just not much difference in costs between companies offering plans on the exchange and those operating in the open market.v “I have no ax to grind with the SHOP exchange, but I just don’t think it’s going to be the huge splash they were hoping for,” Hammett said.
Dana Howard, deputy director of media and public relations for Covered California, said prices are only one aspect of the SHOP exchange. He said the exchange is designed to allow small companies to act like their bigger competitors by allowing flexibility in the plan selected.
The SHOP exchange, he said, allows a company to “anchor” their coverage on a certain plan and allocate a set amount of money, say 50 percent, that they want to spend on an employee’s premium. But employees can decide on their own to go with a different insurance company offered on the exchange if they don’t like the one their employer selected. That ability [for employees] to move to different plans, Howard said, is usually an expensive option that most small companies can’t afford...

Babies die; hospital halts heart surgeries

Babies die; hospital halts heart surgeries
By Elizabeth Cohen, Senior Medical Correspondent
August 3, 2013

Connor Wilson was born February 13, 2012. He had his first surgery at Kentucky Children's Hospital a week later and a second surgery on May 11. On August 3, 2012, his heart stopped, but doctors got it beating again. "He never got better," says his mother, Nikki Crew. Connor Wilson was born February 13, 2012. He had his first surgery at Kentucky Children's Hospital a week later and a second surgery on May 11. On August 3, 2012, his heart stopped, but doctors got it beating again. "He never got better," says his mother, Nikki Crew.>
Tabitha and Lucas Rainey were beginning to get suspicious.

The staff at Kentucky Children's Hospital kept telling them their infant son, Waylon, was recovering well from surgery. There had been a few bumps in the road, to be sure, but they said that was normal for a baby born with a severe heart defect.

Months passed. Waylon remained in the intensive care unit. More complications arose.

"Is everything OK?" the Raineys would ask.

Yes, the doctors and nurses assured them. Everything was fine.

Baby heart surgery concern

Then one day, Tabitha Rainey says a cardiologist took her aside.

"She said, 'If I were you, I would move him,' " Rainey remembers. "She told me we should take him somewhere else.'"

A few days later, the Raineys arranged to have Waylon sent by helicopter to the University of Michigan. By then their son, not quite 3 months old, was in heart failure.

Secret data

If Waylon Rainey had been born 30 years ago, he almost surely would have died a few days or weeks after birth. He has a condition called hypoplastic left heart syndrome, which means the left side of his heart is so malformed it can't pump blood.

Today, surgeons perform a series of three operations on babies like Waylon. They're high-stakes surgeries -- cutting into an organ the size of a newborn baby's fist is tricky, to say the least. The blood vessels can be thinner than a piece of angel hair pasta, and one wrong move, one nick, one collapsed artery or vein can be deadly.

These children are medically very fragile, and even the best surgeons lose patients. Surgeons track their deaths and complications and take great pride in the number of babies they save. Some are so proud they publish their success rates right on their hospital websites.

Kentucky Children's Hospital is not one of these hospitals.

Instead, Kentucky Children's Hospital has gone to great lengths to keep their pediatric heart surgery mortality rates a secret, citing patient privacy. Reporters and the Kentucky attorney general have asked for the mortality data, and the hospital has declined to give it to them. In April, the hospital went to court to keep the mortality rate private.

Parents of babies treated at Kentucky Children's say the hospital's effort to keep the data a secret, coupled with troubling events over an eight-week period last year, makes them suspicious something at the hospital has gone terribly wrong...

10 ways to get your child the best heart surgeon COMMENT

Jason Simpson • 12 hours ago

− I am a pediatric cardiologist.

Pediatric heart surgery is the most delicate/complex of any surgical procedure known to man. It is a hundred times more difficult to reconstruct a baby's heart than it is to do brain surgery or colon surgery.

This is why there is such widely divergent rates of mortality and complications between hospitals and between surgeons. There are only a handful of people in the world who have the technical expertise and judgment to do these surgeries well.

There are lots of other hospitals who advertise for pediatric heart surgery programs, but they use surgeons who haven't perfected their craft yet and are still basically in training. You want one of the top flight fully trained surgeons listed at the hospitals below.

The training of a pediatric heart surgeon is the longest training pathway of any doctor. 4 years med school, 5 years general surgery, 3 years adult cardiothoracic surgery, 2-3 years pediatric cardiothoracic surgery = 14-16 years AFTER you finish undergrad. Even surgeons who have completed that pathway still have a LONG way to go in order to be fully competent surgeons and practice at the top of their craft. Many pediatric cardiothoracic surgery fellows simply arent cut out for the job and they wash out and have to pick a different medical specialty. Most of them switch from pediatric to adult heart surgery, which is much less technically complex and far easier to do.

I've worked with dozens of pediatric heart surgeons at every level of their training, and from what I've seen it is impossible to tell for sure if they are going to be good surgeons until at least 3-4 years AFTER their fellowship is completed. So never pick a surgeon who is less than 4 years out from the completion of their fellowship.

IMHO, there are only a few places in the United States who are technically capable of pulling off these highly complex surgeries:

1. Boston Childrens

2. Texas Childrens Hospital (Houston)


4. CHOP (Philadelphia)

5. Univ Michigan

6. Cincinnati Childrens

There are lots of other hospitals who advertise for pediatric heart surgery programs, but they use surgeons who havent perfected their craft yet and are still basically in training. You want one of the top flight fully trained surgeons listed at the hospitals above.

Places in Kentucky and other small volume centers have NO BUSINESS opening up a pediatric heart surgery program. If you live in the middle of the country, you need to take your child to one of these elite academic medical centers in order to get good care.

Montana Experiment Brings NHS-Style Health Care to USA; Saves State Millions, Patients Delighted

"[D]ivision manager Russ Hill says it's actually costing the state $1,500,000 less for healthcare than before the clinic opened."

Montana Experiment Brings NHS-Style Health Care to USA; Saves State Millions, Patients Delighted
by james321
Daily Kos
Jul 31, 2013

Former Montana Gov. Brian Schweitzer has pledged his support for single-payer health care in the past, but his recent efforts to bring zero-cost sharing primary and preventive care to Montana government employees and retirees may be doing something that most progressives would only dream could happen in America: bringing NHS-style, socialized medicine to Montana.

This is a big deal and -- while currently limited to state employees and retirees -- could be laying the groundwork for America's most socially-just health care system. NPR has the details:

A year ago, Montana opened the nation's first clinic for free primary healthcare services to its state government employees. The Helena, Mont., clinic was pitched as a way to improve overall employee health, but the idea has faced its fair share of political opposition.

A year later, the state says the clinic is already saving money.

Pamela Weitz, a 61-year-old state library technician, was skeptical about the place at first.

"I thought it was just the goofiest idea, but you know, it's really good," she says. In the last year, she's been there for checkups, blood tests and flu shots. She doesn't have to go; she still has her normal health insurance provided by the state. But at the clinic, she has no co-pays, no deductibles. It's free.

That's the case for the Helena area's 11,000 state workers and their dependents. With an appointment, patients wait just a couple minutes to see a doctor. Visitation is more than 75 percent higher than initial estimates.v Yup, nobody is forced to visit this publicly-financed clinic run by a private operator. If they wish, they can take their big-profit, private health insurance and head to any doctor they want, but folks are recognizing that this, err... public option, provides better care. And, when patients do make this choice, both the state and patients save money.

The state contracts with a private company to run the facility and pays for everything — wages of the staff, total costs of all the visits. Those are all new expenses, and they all come from the budget for state employee healthcare.

Even so, division manager Russ Hill says it's actually costing the state $1,500,000 less for healthcare than before the clinic opened.

"Because there's no markup, our cost per visit is lower than in a private fee-for-service environment," Hill says.

Physicians are paid by the hour, not by the number of procedures they prescribe like many in the private sector. The state is able to buy supplies at lower prices.

Bottom line: a patient's visit to the employee health clinic costs the state about half what it would cost if that patient went to a private doctor. And because it's free to patients, hundreds of people have come in who had not seen a doctor for at least two years.

Take a second and let the words above sink in real deep. There you have exactly why the UK, Canada, Australia, Italy, Costa Rica, Cuba and other first-world -- and third-world -- countries are able to secure better health care outcomes than the United States with dramatically lower health care spending. Imagine what -- let's call it the Montana model -- could do for our national debt. And, you know, even more importantly, the health of our people and the wellbeing of our medical professionals.

Hill says the facility is catching a lot, including 600 people who have diabetes, 1,300 people with high cholesterol, 1,600 people with high blood pressure and 2,600 patients diagnosed as obese. Treating these conditions early could avoid heart attacks, amputations, or other expensive hospital visits down the line, saving the state more money.

Clinic operations director and physician's assistant Jimmie Barnwell says this model feels more rewarding to him.

"Having those barriers of time and money taken out of the way are a big part [of what gets] people to come into the clinic. But then, when they come into the clinic, they get a lot of face time with the nurses and the doctors," Barnwell says.v Again, common sense that's not too common in these United States -- with the exception of Montana -- at the moment. High-deductible garbage plans -- promoted by big wigs at Aetna and Cigna who want patients to have more 'skin in the game' -- lead patients to delay putting off that chest pain until it becomes a heart attack...and open-heart surgery. When doctors aren't dealing with private health insurer bureaucracy and any sort of medical billing, the entire resources of the practice go towards taking care of human beings. When doctors are salaried instead of operating with a fee-for-service model, they emphasize quality over quantity. This is how medicine works in the UK, Canada and many other countries where protecting the wealth of hospital and insurance company CEOs is not the primary goal of the health care system.

Even Republicans -- who, you know, are naturally predisposed to hate the idea of patients seeing doctors without cost-sharing -- have a tough time faulting the new clinics.

"For goodness sakes, of course the employees and the retirees like it, it's free," says Republican State Sen. Dave Lewis.


Now, Lewis is a retired state employee himself. He says, personally, he does like going there, too.v "They're wonderful people, they do a great job, but as a legislator, I wonder how in the heck we can pay for it very long," Lewis says.

Well, Mr. Republican, they're saving the state millions -- you just won't admit it, but at least you admit you love the socialized medicine.

What's most exciting about these clinics? More are on the way.

Montana recently opened a second state employee health clinic in Billings, the state's largest city. Others are in the works.

And best of all? Schweitzer went right around the backs of Republicans to set up these life- and money-saving clinics. That's bold, progressive leadership. Let's do our best to spread the news far and wide about how the "Montana model" is proving what much of the rest of the world already knows: the ideal primary health care system should be free at point of use.

Friday, August 2, 2013

Woman Blames Kaiser for Multi-Organ Failure

Woman Blames Kaiser for Multi-Organ Failure
Courthouse News Service
July 31, 2013

PORTLAND, Ore. (CN) - A Kaiser patient started to bleed internally during an elective surgery to remove a mass from her kidney, and within days she was debilitated due to Kaiser's slow response, she claims in Multnomah County Circuit Court.

Patricia and Joseph Moore sued Northwest Permanente, Kaiser Foundation Hospitals and Kaiser Foundation Healthplan of the Northwest dba Kaiser Permanente for $9.5 million for medical malpractice and loss of consortium.

Within hours of the surgery Moore's abdomen was distended. Other symptoms "consistent with acute hemorrhage" followed, but it was not until shortly after midnight the next day that Kaiser "initiated their rapid transfusion protocol," according to the complaint.

Over the next two days Moore's complications escalated, including falling blood pressure, increasing abdominal distention, rapid heart beat and breathing problems, the complaint says.

"Following numerous transfusions, Patricia Moore sustained respiratory failure and was intubated. During the intubation she aspirated abdominal contents into her airway."

The next morning, "Patricia Moore was diagnosed with acute renal failure," and this was followed by removal of her left kidney and three months on a ventilator, after which she was discharged to a care facility, according to the complaint.

Moore blames Kaiser's failure to timely diagnose and surgically correct the internal bleeding for a host of problems she has experienced, including hemorrhagic shock, multisystem organ failure, acute respiratory failure, gangrene of her left leg and foot, anoxic brain injury and prolonged ventilator dependence.

The plaintiffs are represented by Timothy J. Jones and Ken L. Ammann of Salem, Ore.