By John Ballard
Maggie Mahar points to yet another report about Doctors Gone Wild, this time focused on a NY Times report of a cardiologist in Maryland who " implanted potentially dangerous cardiac stents in the arteries of as many as 585 patients who didn�t need them. A hard worker, he managed to knock off those 585 procedures in just two years, from 2007 to 2009. Medicare paid $3.8 million of the $6.6 million charged for the treatments."
As she pointed out, this sounds shocking but is not news. This kind of malpractice has been going on a long time but almost never gets much attention. As she pointed out in a comment
...physicians rarely go to jail for malpractice.
Even in Redding, California, where a doctor performed hundreds of unnecessary bypasses and angioplasties, he did not go to prison.
Part of the problem is that in these cases, the doctor may well have thought that he was helping the patients.
The physician himself becomes part of a mass cultural delusion about the efficacy of certain procedures. People are thanking and congratulating him-- patients, their relatives, the hospital, etc.
He may well believe he is saving lives.
Though of course there are extreme cases where a doctor is consciously over-treating, but I suspect those are very rare.
With her customary economy of words (this post is over 3,800 words long) Maggie leaves nothing undocumented. Links to past articles by her and others have been accumulating for years and yet the problem persists, likely for reasons summarized in her comment above.The overuse of stents is part of a cultural delusion about the efficacy of certain procedures.
Monday, the Times� story acknowledged that �Prosecutors, malpractice lawyers and state medical boards are only now waking up to the issue . . .The Texas Medical Board last month accused a widely known cardiologist in Austin of inserting unnecessary stents. In September, federal prosecutors accused a cardiologist in Salisbury, Md., of performing unnecessary stent surgeries, and last year a Louisiana doctor was sentenced to 10 years in prison for inserting unneeded stents. . . �The Times went on to quote Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic: �What was going on in Baltimore is going on right now in every city in America.� Nissen added that he �routinely treats patients who have been given multiple unneeded stents. We�re spending a fortune as a country on procedures that people don�t need.�
[...]Why has it taken so long for state medical boards to �wake up?
I am afraid that many hospitals have resisted the news for one simple reason: procedures that involve stents are extremely lucrative. In 2007 Business Week told the story of how stents rescued New York�s Mt. Sinai hospital:
�The 2,000-doctor hospital was struggling in March, 2003, when Dr. Kenneth L. Davis took over as chief executive. During the previous six months, Sinai had lost $50 million, partly as the result of tougher caps on Medicare reimbursement rates. . . . While trimming costs, Davis also decided to build up practices in high-margin specialties. �Interventional cardiology was one of myriad areas where we were eager to facilitate growth,� Davis explains. Dr. Samin Sharma, Mt. Sinai�s �King of Stents,� ran a cath lab which was central to this campaign, performing procedures that typically brought in as much as $20,000 a piece for the hospital.
�Sharma convinced his bosses that to capitalize fully on the stent boom, Mount Sinai should turn his cath lab into a 24/7 operation. At a cost of $400,000 a year, he figured, the hospital could put enough doctors and nurses on call to do emergency angioplasties late at night and on weekends. Soon the lab was averaging 15 off-hours patients a month. Interventional cardiology became a key revenue source for Sinai. By the end of 2006 the hospital's total patient revenues had grown 41%, to $1.2 billion. Cardiology services, excluding surgeries such as heart bypass, contribute 15% of that, most of which comes from Sharma's cath lab.�
Stay tuned, folks. We'll see over the next few years whether features of PPACA will be able to rectify this and many other shortcomings of what many imagine to be the "best healthcare system in the world." My optimism about health care reform is cooling as the Rump Congress finishes up the year.
At this writing Republicans are feeling their oats and Democrats are venting their spleens at the president, fuming over a package of compromises that fell waaay short of what they expected. Having drawn a line in the sandy deserts of their minds, many elected representatives of both parties (more Democrats than Republicans) still cling to the position of My Way or Nothing. Unfortunately that "Nothing at All" stubbornness may cost the Dream Act, DADT repeal, and possibly approval of the START treaty.
If Democrats think Republicans have been hard to live with over the last two years, just wait until the Tea Party freshmen get seated. It's possible they might be bought off as usual. But I hate to think that buying off the opposition (or hoping someone else will) is the best way for a representative government to perform.
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