DANGERS OF WEIGHT-LOSS SURGERY GROWING AND RAISING CONCERNS OF NUMEROUS HEALTH EXPERTS

Linda Culpepper was admitted to Vanderbilt University Medical Center, hair falling out, skin flaking, and barely able to walk. She had frequent bouts of diarrhea and couldn’t eat without vomiting. She was admitted to the hospital with life-threatening malnutrition; complications that resulted from a recent weightloss operation at another hospital. 

In 1995, some 20,000 weight loss operations were performed in the U.S. In 2003, that number increased to 103,000 and 144,000 weight loss surgeries are expected to be performed in 2004.

Bariatric surgery, or gastric bypass, is a weight-loss surgery that closes most of the stomach and shortens the small intestine. Patients often lose 100 pounds following this surgery. 

Despite the popularity, some medical experts are expressing their concerns, warning patients about inexperienced surgeons and inadequate screening procedures that may result in problems later on.

According to Gordon Jensen, director of the Vanderbilt Center for Human Nutrition in Nashville, TN, there has been a “tremendous surge” in patient complications following surgery.

Like Linda Culpepper, patients aren’t always taught how to change their eating habits to adapt to the drastic changes made in their digestive system. 

Jenson noted that some surgeons perform the surgery on children and teenagers, despite the lack of evidence of the procedure’s long term effects. And, some doctors encourage their obese patients to gain more weight in order to qualify for the surgery, as the procedure is typically limited to people 100 pounds overweight. 

According to Dr. Philip Schauer, director of Bariatric surgery, at Magee-Women’s Hospital of the University of Pittsburgh, “There are a lot of surgeons who are new to this field and haven’t had much training…I’ve got three patients now that were treated by other surgeons, with major complications.”

A recent study of gastric bypass suggests that the overall death rate is two times as high as .5% to 1%, and even higher if the surgeon lacks experience. 

Due to the associated dangers and increased costs of the surgery, some insurance companies have stopped covering this procedure. The Massachusetts State Health Department convened an expert panel after three patients died during or after the operation last year; and the National Institute of Health has also launched a study on this procedure. 

SOURCE: New York Times, 2004; International Herald Tribune, www.iht.com, May 6, 2004.

Study Shows Chiropractic for Young Children Safe and Effective

Scientists at the University of Rochester have taken a new step toward understanding how Acupuncture works at the molecular level to ease pain.

A 3-year retrospective study of pediatric case files of Chiropractic treatments for young children and infants has revealed improvement with remarkably few adverse reactions, all temporary and very mild.

To perform the study, researchers pulled all the case files for pediatric patients younger than 3 years old, totaling 781 cases, at the Anglo-European College of Chiropractic (AECC) in Bournemouth, England. Files were viewed manually and in sequential order, with no prequalification other than the target age group.

It was found that 697 children received a total of 5,242 Chiropractic treatments. Most of the young patients, about 73 percent, were 12 weeks of age or younger when they arrived for treatment.

Obviously, a 12-week-old infant cannot communicate about possible adverse effects. Parents were therefore consulted to help determine the effects of treatment. No parents reported a worsening of their child's presenting symptoms, and only seven reported reactions, six of which were increased crying.

This translates to a reaction rate of approximately 1 child in 100. The actual rate of adverse reactions, says the study, would be about 1 case in approximately 1300 Chiropractic treatments.

There were no serious complications resulting from Chiropractic treatment, such as a reaction lasting more than 24 hours or severe enough to require hospital care. The reactions were short-lived — less than 24 hours — and had no effect on the usual activities of daily living, such as normal movement and mobility, nursing and eating.

Since it is well known that adults can have mild reactions to Spinal Manipulation Therapy (SMT), such as increased soreness, the researchers noted that it’s entirely possible that infants might experience the same type of reaction — even when pediatric SMT forces are reduced to match the patient's size and weight.

The authors of the study say it is difficult to compare the reported adverse reactions risk assessment with already published work in the literature because there have been no similar studies. One systematic review showed a very low risk of severe reactions to Pediatric Chiropractic care — nine cases in a 30-year period.

Also, the authors note that it is difficult to precisely compare pediatric adverse effect rates to those of adults, as the negative side effects experienced by adults are different. In adults, the range of temporary and mild side effects is reported to include local discomfort, headache, tiredness, and radiating discomfort — information impossible to obtain from the youngest patients, which were in the majority.

Similarities with reported infant side effects were that the discomfort occurred the same day or one day after treatment, and lasted a short period — less than 2 days in adults and less than 24 hours in infants. In adults, 11 percent of those with an adverse effect experienced loss in activity of daily living, whereas none was reported in the infants.

The report says more research is required into adverse effects in all age groups of children. But with 85 percent of parents reporting an improvement, and only seven reporting adverse effects, and those being very mild and short-lived, the safety of Chiropractic treatment for infants and children appears to be well under control.

SOURCE: http://www.chiro.org/pediatrics/ABSTRACTS/Adverse_Effects_of_SMT_in_Children.html

Dead Doctors Billing Medicare

Dead doctors may have received upwards of $100 million in fraudulent Medicare payments for the first 7 years of this decade. If this type of criminal billing continues at its current rate, it could chew up as much as 15 to 20 percent of the entire Medicare budget for 2008.

Senator Norm Coleman (R MN), a ranking member of the Permanent Subcommittee on Investigations is conducting investigations into these fraudulent billing practices and recently presented his alarming findings at a Senate hearing entitled “Medicare Vulnerabilities: Payments for Claims Tied to Deceased Doctors.” The hearing was set to examine Medicare payments for durable medical equipment (DME) where claims had doctor identification numbers assigned to physicians who had been dead for at least one year prior to the date on the billing.

“In short, the subcommittee’s investigation uncovered some appalling facts,” Senator Coleman said. “The subcommittee found that between 2000 and 2007, Medicare paid for hundreds of thousands of DME claims in which the prescribing doctor had died years earlier. The estimated payments for those claims could be up to $100 million.” Here are some classic cases of abuse pointed out by the Senator:

• A Florida doctor died in 1999. Since then, his identification has been used by 3 different organizations to file fraudulent claims. The committee identified at least $350,000 in claims, with estimates of up to $500,000.
• Another doctor passed away in 2001, and his ID number was used in over 3,800 claims totaling more than $354,000.
• Still another doctor was listed in some 2,000 claims at over $478,000.

Most alarming, according to the Senator, is that this issue of Medicare fraud was previously addressed with the Department of Health and Human Services in 2001. At that time, the paying agency – the Centers for Medicare and Medicaid Services (CMS) – agreed to work to fix the problem of paying dead doctors by April 2002. Apparently that has not occurred as 63 percent of the improper $100 million in payments were made after that date. The subcommittee investigation shows that thousands of doctors who passed away in the 1990s are still active. 

Senator Coleman wants the system fixed and is calling on the CMS to get this done. He points out that the figure of $34 million made in improper payments in 2004 and 2005 would roughly total the size of the entire State of Minnesota general budget, all wasted on improper payments. As the Senator says, these are loopholes in the system that simply must be fixed and fixed now.

Source: Senator Norm Coleman of the Senate’s Permanent Subcommittee on Investigations. “Senator Coleman’s Opening Statement at PSI Medicaid Dead Doctors Hearing.” July 2009. http://coleman.senate.gov/public/index.cfm?FuseAction=PressReleases.Detail&PressRelease_id=08fe1b37-d0a0-d47b-160c-bcdfebf373ef

Could Specialized Health Courts Help Limit Malpractice Costs?

An end to skyrocketing healthcare costs cannot occur without restoring reliability to the justice system through the creation of specialized healthcare courts, says a report from the not-for-profit group Common Good, titled “Windows of Opportunity: State-Based Ideas for Improving Medical Injury Compensation and Enhancing Patient Safety.” The report draws on several years of research by professors from Harvard School of Public Health, Harvard Medical School, University of Denver Sturm College of Law, and many other medico-legal scholars.

The proposed healthcare courts would have specially trained administrative judges who would be advised by neutral experts and would “make decisions and write opinions on standards of care,” says Philip K. Howard, founder and chairman of Common Good, writing in a recent Wall Street Journal opinion piece. Such courts would provide a standardized way of addressing malpractice claims, provide compensation to patients if the injury was avoidable, and, most importantly, would enhance patient safety.

Injured patients would receive compensation for all their medical bills, as well as lost income, and compensation for pain and suffering would be determined by a preset schedule dependent on the type of injury. Healthcare providers should not “go through the day looking over their shoulders instead of doing what they think is right,” Howard says. “The only way to overcome this distrust, and all its debilitating errors and waste, is to create a special health court that is trustworthy.”

Use States as Laboratories to Test New Systems

At both the Federal and State levels, says the report, there is a policy logjam over medical liability reform. While some evidence suggests that the crisis in malpractice insurance premiums may be abating, future crises are not ruled out. Reforms such as health courts or administrative compensation programs that address system failings relating to patient compensation and inefficiency, as well as secondary impacts of the medical liability system on health quality and coverage should be carried out at the State level, where States could be used as “laboratories” for testing such new ideas, the report says.

“Creating health court or administrative compensation demonstration projects now could serve as a major catalyst leading to major breakthroughs across the country — since ideas that are successfully adopted in one state can spread to others. Doing so could also send a strong message to Congress, increasing the likelihood of federal action,” the report states. “Moreover, these reforms have substantial potential to promote the creation of healthcare environments where professionals can learn from their mistakes — and take steps to prevent such mistakes from re-occurring in the future.”

Most importantly, by showcasing new injury dispute mechanisms that better compensate patients, reduce administrative costs, and promote a culture of patient safety, these demonstration projects can also provide substantial benefits to the healthcare system as a whole, the report concludes.

SOURCE: Common Good, (http://cgood.org/assets/attachments/Windows_of_opportunity_web.pdf)

Colonoscopies May Have Infected Miami Vets

It has recently come to light that as many as 3,260 veterans treated at the Miami Veterans Affairs Healthcare Center may be at risk for developing Hepatitis B, Hepatitis C and HIV. The cause of this potential problem is colonoscopies done on ex-service personnel when equipment used in the procedure was not properly sanitized. An investigation has been launched into this error and in the meantime all colonoscopies have been suspended at the hospital.

Patients who received colonoscopies at the hospital dating all the way back to May 2004 are considered to be at risk. These individuals are being notified of the error and the possibilities of developing a medical problem. In addition to the Miami hospital, similar errors have been discovered at veteran’s facilities in Murfreesboro, Tennessee, and Augusta, Georgia. The problem has occurred because tubing used on the colonoscopy equipment has not been properly serviced or sterilized according to guidelines provided by the manufacturer.

Response from the U.S. Department of Veterans Affairs has been two-fold. A team of officials was sent to the hospital to determine responsibility for the lapse in properly cleaning the equipment and to determine how veterans could have been affected. In addition, a campaign has been launched to inform all of the persons who had a colonoscopy at the hospital since May 2004 of the possible health concern. These individuals are being urged to visit a veteran’s facility in their area to be tested. It is estimated that some 2,500 of these individuals reside in the Miami area.

“Infection control is a critical concern for patients as well as healthcare workers,” said Congressman Kendrick B. Meek (D-FL). “Infection control measures are designed to combat everything from the spread of colds and flu to hepatitis B and C, SARS, HIV/AIDS, and other potentially life threatening diseases. That, somehow, these standard protocols were not followed will undoubtedly leave our veterans with serious misgivings about our VA system despite everything done in a short period of time to give them renewed confidence.”

The U.S. Veterans Administration sent a safety alert to all of its facilities in December 2008 regarding the cleaning procedures and the proper use of the tubing associated with the equipment. Following the discovery of problems with machine usage at the three veteran’s facilities, it remains a grim possibility that the full ramifications of the error and the extent of the potential problems nationwide have yet to be determined.

In the meantime, as Rep. Meek pointed out in his communication to Veterans Affairs, it is important that all potentially harmed veterans be contacted, tested and treated if so needed. “I know you are acting quickly to find and test the 3,260 patients,” said Rep. Meek. “We share in the hope that these veterans are found to be healthy and safe.”

Sources: The Office of Congressman Kendrick B. Meek. “U.S. Rep. Kendrick B. Meek Calls for Full Inquiry into Medical Mistakes at the Miami Veterans Affairs Healthcare Center.” March 2009. http://kendrickmeek.house.gov/apps/list/press/fl17_meek/pr_090323_veterans_healthcare.shtml.
U.S. Veterans Administration. “Safety Alert: Improper Set-up and Reprocessing of Flexible Endoscope Tubing and Accessories.” December 2008.” http://www.va.gov/NCPS/alerts/OlympusScopesAlertAL09-07-WWW.pdf

Are All Medical Tests Necessary?

According to the Archives of Family Medicine, for years medical doctors have been performing numerous tests on patients, especially those covered by insurance, when many of those tests may have been unnecessary.

The article describes several potential risks of screening tests with controversial benefits, including:

• Reliance on screening tests before the effectiveness of the testing procedures has been proven by adequate research.
• The patient can get the wrong idea that a test can reduce the patient’s risk of disease or illness to zero, possibly leading them to make uninformed medical decisions.
• Inaccurate, false positive test results which can cause profound anxiety for the patient and require additional testing that can be increasingly invasive, costly and in the end unnecessary.

The researchers claim that doctors often provide controversial screening tests because they fear a future lawsuit by a patient who later develops a disease.

In addition, patients request a test because they read an article about it in a magazine, or found out that their insurance company will pay for it.

Rather than educate patients about the risks involved, many doctors simply give the test upon demand – and charge patients for them.

The article suggests the ethical approach would be the physician explaining that tests with controversial benefits are unlikely to be helpful.

SOURCE: Archives of Family Medicine, Oct. 17, 1997 as reported in Health Watch Newsletter