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Thursday, October 22, 2015

Conflicts of Interest Between Doctors, Hospitals, and Patients Result in Harmful Treatment

OK, I was going to write about the new social caste-system determining how you pay for your health care, but the New York Times article about the errant Dr. Ghandi from Indiana (I kid you not) and his over zealous love of invasive cardiac treatments is too good to pass up. First of all, the full color photo in the New York Times of this woman's scarred chest is a shock. The sleeveless pink floral top (not enough of it to merit calling it a blouse) is the standard rag you find so many many American woman wearing to places they should not. I mean really, this is what you wore for an interview with the New York Times? One could make a case that the cardiac chest-crack surgical scar is more aesthetic than that mom tattoo. I thought you were supposed to put your kids names on your body, not the word mom, isn't that reserved for sailors? Read on to find out how this all went wrong in the midwest.
 Malpractice and Medicare Rip-offs
The woman in the New York Times photo had been treated by Dr. Ghandi for thirty years, originating from the irregular heartbeat diagnosis and devolving into multiple surgeries involving stents,  and other invasive procedures. This plucky female did say no to Dr. Ghandi's insistence on getting a pacemaker (smart move sister) but she was pummeled into the insertion of a heart monitor. Unbeknownst to her, this monitor was linked directly to Dr. Ghandi's bank account. At last count, 293 patients have sued this doctor for installing unnecessary pacemakers, stents, and other cardiac devices. Thanks to Dr. Ghandi and his co-conspirators, little Munster (not to be confused with Muncie), Indiana placed within the top 10% for cardiac defibrillator implants (pacemakers) according to Medicare, which is also investigating. Munster is a town of 23,270 people, so it is pretty difficult to imagine they have that many defective tickers. But please remember, Indiana is pretty close to Wisconsin, where most of the world's cardiac devices are manufactured, so maybe they were being neighborly. However, here is where the story takes an even more twisted turn.
Hospital Administration Conflict of Interest
The hospital administrators knew that Dr. Ghandi and others in his cardiac practice were performing invasive medically unnecessary procedures and they did nothing to stop it. Lest you think this was a for-profit hospital, you'd be wrong. In fact, a nonprofit community hospital, much like any local hospital, such as  Harrison, in Kitsap County, made the decision to ignore the professional complaints brought by Dr. Mark Dixon, whom also practiced at the hospital. The hospital's chief benefactor it seems was a long time patient of  Dr. Ghandi's for his cardiac care, so no conflict there at all. Specifically, Dr. Dixon's complaint was unqualified people were installing some of these cardiac devices and Dr. Ghandi's patients did not meet the medical necessity requirements for some of the treatments.  So, why would the hospital ignore these concerns-because cardiac care is very lucrative and brings in lots of money for the facility. In fact, in hospital administration parlance, this is referred to as a service line, it isn't even called health care. And yes, in hospitals, the doctors who bring in the most money are treated with deference.
What You Can Do
Hold the phone-this is the lesson for all persons reading this article-(1.) ask questions about training and board certification before you consent to any surgery and (2.) get a second opinion. Sure Munster is a small town, but you do not have to have your treatment there, you can go to a bigger city, like Indianapolis or Chicago, or if you are really smart, the Mayo Clinic in Minnesota. Further, if you cannot commute to these locations, you can go to the following web sites to get information which is reliable on cardiac care:

Tip of the Iceberg
Lest you think this scenario of over diagnosis and money making through unnecessary medical procedures is an anomoly, it is one of the biggest problems in the U.S. healthcare system. Thankfully, in the last decade, better information has become available to consumers through websites and other resources, which make it easier for the average person to double-check the facts before submitting to a procedure.  The truth is you can't always trust what your community hospital is telling you, nor can the same be said for every doctor. The responsibility is on the patient and their advocate to ferret out all necessary information and make an informed decision. The Lown Care organization is in the midst of its' Right Care Campaign and that is one example of a collective effort of clinicians to curtail abusive practices in healthcare. I have written about health care scenarios and policies for the past eight years, and in 2013, I specifically targeted the layperson in my book, Unraveling U.S. Healthcare-A Personal Guide, of which five chapters were devoted to figuring out how to gauge health care quality.

Stay healthy by choosing wisely and this is the healthpolicymaven signing off, encouraging you to share this article widely. Roberta E. Winter is a graduate of the University of Washington School of Public Health and the University of Washington Evans School of Public Affairs and publishes under the trademark healthpolicymaven.


Anonymous said...

It is not just the large ticket items where the fee for service model creates waste, and moves into fraud. What about the extra doctor office visits that are unnecessary and a plain waste of time...

One of my coworkers was recently prescribed appropriate 3 month medication regimen for a condition. The RX script was for 1 month. When she called the doctor to get the second month script she was told she had to come back in. When she asked why or was their lab work to be done she was told no labs, it was just a check in (this doctor charges about $300 for a 5 minute visit) She then asked if this check in was included in the cost of the initial treatment the nurse said “no, but don’t worry, your insurance will pay for it” My friend countered with no, the insurance did not pay for it since she has a very high deductible. In fact she would end up paying 100% for it. I was told that twice, when dealing with the nurse she was told not to worry, insurance would cover it. Both times was for what was essentially and medically unnecessary visit, but was simply the doctor's procedure.

So, it is not just the big stuff. Doctors have gotten into the habit of asking for unnecessary office visits that can be handled via phone or email, just because insurance will cover it. With the increased deductibles and HDHP, maybe more people will start to question medical necessity for the small things as well as the big stuff especially when you have to write a $300 check for 5 minutes of their time and nothing really to show for the visit but a pat on the head and "you are doing fine" Follow up is great, but we have to become better consumers and ask questions. Think about it another way...if your auto mechanic fixed your car and then said "bring it back in next week so I can make sure I fixed things properly and it is working fine" would you expect to have to pay an additional fee to have them spend 10 minutes telling you they did the job right in the first place?

We have to start asking for more. If follow up labs are needed, tell the doctor to order the labs, get them done and sent to the doctor and insist on a 5 minute phone consultation if everything is OK. If we start insisting on reduction of waste in the medical field from the bottom up, we will help make the system more viable and affordable for all.

healthpolicymaven said...

Thank you for taking the time to comment on this article. You emphasize the consumer has responsibility and control over health expenditures, which is true primarily for those on private insurance, but still applies to all in the U.S. healthcare system.

mestyqwerty said...
This comment has been removed by a blog administrator.
Anonymous said...

Right on, we have to be informed health care clients and we need to remember that we can refuse, ask questions and don't take a healthcare provider at face value , they are not God.

healthpolicymaven said...

Thank you for taking the time to read and comment. Keep on reading what the healthpolicymaven has to say to inform your healthcare decisions.