Sunday, 16 October 2011

Conveyor-belt medicine

Patients victimized when providers succumb to rapacity
Ah, Las Vegas — a place for booze, gambling and questionable medical practices.
Recently, our city made the national news over shady dealings between University Medical Center doctors and a relatively small, heart-device maker called Biotronik.
This comes on the heels of the Desai-esque events unfolding around Dr. Michael Kaplan. You’d think that doctors (with their Hippocratic oath and other such things) would be immune to the praetorian influence that permeates Las Vegas.
Yet, for some doctors, patient care seems to have taken a backseat to the typical age-old corrupters — money and power. Of course, straight-up criminal negligence has also played its part in this story.
Any mention of medical malpractice in Las Vegas will raise the name Dipak Desai, a gastroenterologist whose mug is now recognizable to most Las Vegans.
After being embroiled in a wash of controversy and investigations for years, Desai was indicted on many charges relating mostly to his staff’s reuse of syringes, which has already caused hepatitis C infections in many of his former patients.
While the investigations are still continuing after two years, for whatever reason, testimony by those who worked with and knew him point to negligent, uncaring and barbaric practices that brought the storm of controversy upon him.
Once a thriving doctor and business man who amassed a sizable fortune, he now finds himself the target of ire from his injured patients (more than 100 infected with hepatitis C) and the Las Vegas community as a whole.
The bigger they are, the harder they fall.
More recently, Kaplan has been scrutinized for his reuse of disposable needle guides that he used repeatedly and only replaced once they “became too bloody,” according to an order from the Nevada State Board of Medical Directors.
His defense? He blamed the vendor, claiming he was told it was acceptable to reuse the guides.
Dr. Kaplan, as a medical doctor you’re held to a higher standard, so “the vendor told me to do it” isn’t going to fly. I’m sure the patients that now have to undergo testing for HIV and hepatitis C would agree with me.
Desai and Kaplan both performed delicate, invasive medical procedures on a regular basis. The frightening part is that both of them showed a callous disregard for patient safety in doing so.
A doctor who worked with Desai, Julian Lopez, said that “[Desai] was always bragging about doing two-minute colonoscopies” when it could take up to “10 times that long” in a normal procedure.
Another former employee noted that “… he wouldn’t allow us to properly clean the scopes because he was in a hurry to get patients through to make more money,” according to the Las Vegas Review Journal.
Kaplan attempted to wash and reuse needle guides used in prostate biopsies until they were simply “too bloody” to be used anymore.
Frankly, the images that come to mind at the thought of Desai’s competitive scoping and Kaplan’s bloody needle guides are horrifying.
This is the kind of gruesome medical malpractice that should have faded long ago with the advent of standardized methods of medical practice and regulatory boards.
Of course, it didn’t help when Desai was able to finagle his way onto the Nevada medical board and manipulate circumstances to his benefit.
Robert Feingold is another Las Vegas doctor who recently received a hefty complaint from the state Board of Medical Examiners.
The 18-page complaint describes Feingold’s failure to “give adequate initial examinations” before prescribing a specific prescription weight-loss drug, according to the Las Vegas Sun.
The Sun also mentions medical records that indicate that patients were hastily handled and thus severely ill-informed about necessary instructions and the specific dangers of the treatment.
One patient’s medical record was described as “practically illegible and extremely sparse” and contained little information regarding her treatment.
All of this points to the cursory “take two of these and call me in the morning” attitude that occasionally and inexcusably flares up among members of the medical community.
This leads patients to question not only the quality of the treatment they receive, but also the relationship between the prescribing doctor and the related pharmaceutical company.
This kind of relationship between doctors and medical companies is the cause of inevitable speculation and eyebrow-raising in the local Biotronik story.
Despite Biotronik’s relatively low profile in the medical industry, the story was so compelling that it earned Las Vegas (specifically UMC) a spot in the New York Times.
The story seems fairly straightforward.
Biotronik, which represents about 5 percent of the heart-device market nationally, began to see a massive increase in product use after doctors at UMC started getting paid as “consultants” by the company in 2008, according to the New York Times.
Despite the response of UMC’s CEO that the hospital hasn’t done anything wrong, the correlation between the sizable consulting fees paid to cardiologists (some up to $5000 per month) and the staggering preference (95 percent) for Biotronik products reeks of ethical and possibly criminal misconduct.
Undoubtedly, the cases described do not represent the majority of doctors. However, what makes these cases notable, especially in regard to Desai and Kaplan, is the astonishing level of harm done to patients, both physically and psychologically.
Doctors are held to higher standards for this reason. The damage inflicted when a doctor prioritizes wealth and self-interest over patient care is extraordinary, and these cases attest to this truth.
From the level of the certified nursing assistant to the loftiest of surgeons, members of the medical community must be unafraid to police each other in the face of any level of medical malpractice.