Articles Posted in Back/Spine Surgery

money-300x193What if you bought the hottest car around, only to find a neighbor found a model just as sporty and paid much less? How would you react if you opened your credit card bill and learned that the family budget was in tatters because your daughter commuted a few blocks to school by taxi, and your son had racked up huge charges for junky electronic gadgets and questionable movies online? Your consternation would be a tiny fraction of the great concern that most of us should experience due to a new study that finds that Americans spent $3.2 trillion on health care in 2014.

If you’re like me, when figures get that big, they become hard to grasp. But for comparison’s sake, the United States’ medical spending  exceeded the 2015 gross domestic product (the monetary value of all the finished goods and services produced within a given country’s borders in a specific time period) for the economies of: Britain, France, Canada, Russia, Italy, Mexico, Indonesia, Australia, South Korea, Spain, Turkey, Saudi Arabia, Nigeria, and the Netherlands.

Americans spent more on back and neck pain than Russia did on its military and national defense.

d magazineJust how difficult can it be to stop a highly credentialed but dangerous doctor from hop-scotching around a metropolitan area to perform brutal spinal surgeries in different hospitals, including a respected academic medical center? Just ask crippled patients, neurosurgeons, medical licensing officials, and prosecutors in Dallas what it took to derail Dr. Christopher Duntsch.

As detailed well in the latest edition of the upscale city magazine D, Duntsch was a high-flying physician who moved from Tennessee to Texas, carrying with him an excellent reputation, which later would be challenged, as a medical scientist. Although established as a cancer stem cell-researcher, the neurosurgeon also morphed himself into a spinal surgeon based on training earlier in his career.  He eventually won privileges to operate at three Dallas area hospitals, including the well-regarded Baylor Regional Medical Center at Plano, Texas.

He was a loner and boastful, though colleagues liked him at first. They  quickly were horrified by his surgeries. Among the damages he is criminally accused of inflicting: amputating a patient’s spinal nerve, causing paralysis; cutting another patient’s vertebral artery and ignoring the major bleeding that occurred; installing a too-long screw so that it punctured a big vein, causing extensive bleeding and nerve damage; slashing a patient’s esophagus and a neck artery, leaving the man struggling to eat, breathe, and with blood loss to the brain.

SouthDakota-StateSeal.svgSouth Dakotans will need their state lawmakers’ help now to pry open physicians’ iron grip on secret decisions about which doctors get to practice in hospitals and why. That’s because the state’s Supreme Court ruled this vital information must be kept confidential, even if releasing it would serve a wider good of disclosing possible criminal or fraudulent conduct.

The high court ducked its potential role in helping more than 30 patients who claim they were mangled in excruciating, needless surgeries performed by Allen Sossan, an osteopath with an easily discovered criminal past and a checkered medical practice record in the area around Yankton, S.D. I’ve written about this case before.

Several South Dakota hospitals gave Sossan practice privileges after his credentials were reviewed by physician committees, which, since have fought mightily to keep secret what they knew and when they knew it about him. Sossan since has been indicted for providing false information to medical licensing authorities. The convicted burglar and check kiter apparently has fled the country and may be back in his native Iran.

spinal cordFederal auditors have found that 80 percent of Medicare spending in a recent year on chiropractic care−some $359 million−was medically unnecessary. The federal insurance program for senior citizens should not have thrown taxpayer dollars at chiropractors to treat strains, sprains, or joint conditions, the Department of Health and Human Services’ Office of Inspector General says.

Its auditors, reporting on 2013 claims, said Medicare should impose limits on how often seniors can receive chiropractic care, which they said became excessive after a dozen visits; after 30 sessions of treatment, the federal watchdogs said, patients were receiving unnecessary care.

The chiropractors’ association denounced the audit and the proposed curbs on their practitioners’ care. The acting director of the Centers for Medicare and Medicaid Services resisted the recommendations for caps on chiropractic treatment, noting the absence of cited evidence and differences in individual patients. The agency noted that it has tightened its rules on chiropractic claims, including requirements soon to take force that will require advance approval for certain kinds of this care.

SupremeCourtSealSouth Dakota’s highest court has been asked to reject hospitals’ attempts to keep secret why a doctor, who also is a convicted burglar with a checkered medical past that could have easily been uncovered, passed a peer review that permitted him to perform brutal, excruciating, and unnecessary spinal surgeries on dozens of patients.

A lower court rejected the sweeping claims by the hospitals that the reviews can never be disclosed. The judge said that indications of crimes or fraud, as raised by evidence-based malpractice lawsuits, are sufficient reason to breach confidentiality protections shielding vital insights into how hospitals judge physician performance and permit doctors to practice in their institutions.

More than 30 patients have sued surgeon Allen Sossan. He is a convicted felon, who had changed his name, and who apparently has fled to Iran. Patients assert he caused them great pain and maimed them with unnecessary, complex back procedures. Further, patients have sued more than a dozen doctors who reviewed his credentials and granted him privileges at Avera Sacred Heart and Lewis & Clark Specialty Hospital, both in Yankton, S.D.

stemcellBeneficial therapies can topple over to medical nightmares in a blink, especially when regulators seem to have looked askance or even shut their eyes and slumbered. The Food and Drug Administration may need to look into what  is going on with the burgeoning business of so-called stem cell treatments.

Two academics took to the Internet and found “at least 351 businesses in 570 locations …marketing stem cell therapies that have not been fully vetted by medical researchers or blessed by the U.S. Food and Drug Administration,” they reported in the peer reviewed, academic journal Cell Stem Cell.

To be sure, they did not visit the facilities in person, and they use care not to describe any of them as violating state or federal laws or regulations. They used rigorous, robust online means, though, to look at the operations’ Internet pitches, which, as The Los Angeles Times notes:

Here are some fast takes on some developments in health worth watching:

Good news: Birth rates among teen moms have declined to historic lows, falling most sharply (by almost half) for blacks and Hispanics, the federal Centers for Disease Control and Prevention has reported. Many factors may have contributed to this important trend, including greater access by the young to contraception and shifting mores and behaviors that lead to teens having less sex. Even with this positive news about declining teen birth rates, those for blacks and Hispanic still are double those for whites. Taking care of young parents and their kids costs the country an estimated $9 billion annually. Teen moms and their kids suffer short- and long-term health and social well-being consequences, experts say.

Back-PainQuestions on a common, painful back procedure: When U.S. patients appear to suffer “degenerative disc disease,” a condition around which a $40 billion industry has sprouted, their doctors more than 70,000 times annually subject them to a painful, costly procedure called provocative discography. Materials are injected under pressure into several discs─both those suspect and some as experimental controls─as a diagnostic technique. But new research shows this invasive procedure has no proven benefit and may lead to faster degeneration of the injected discs, says HealthNewsReview.org, a health information watchdog site. The site asks why this study, praised by experts it quotes, was ignored by media. The study potentially opens the door to further, needed inquiry about questionable, costly, painful, and potentially ineffective care given for the millions who suffer from back pain, site experts write.

Problems with medical devices contribute to 3,000 Americans’ deaths annually, research shows, and fixing any one of the problem devices can cost hundreds of millions. So why aren’t government officials doing more and better in regulating them and protecting the public, a New York Times health policy columnist has asked.

This health economist, Austin Frakt, also has zeroed in on possible solutions, some of which have surfaced after a scandal involving diagnostic scopes used in gastroenterological procedures. Those defective and dirty scopes caused infections that have killed at least 21 and sickened dozens at hospitals nationwide, U.S. Senate investigators confirmed in January.

Experts are starting to think that medical devices each must carry distinctive numbers and tags of some kind, and that this information needs to be recorded in health records each time a device is implanted or used. Such a system exists now for medications. It has helped researchers analyze and find problems in drug prescribing.

MarchCoverFBFor anyone who has doubt about how low physicians and hospitals can stoop for a buck, a city magazine has offered a dismal portrait of breathtakingly bad conduct in a $500 million medical fraud. Prosecutors have accused some powerful California politicians of playing a part in this scandal.

The report in Los Angeles magazine details how a Long Beach, Calif., hospital and other area facilities became veritable medical factories where droves of patients, many of them blue-collar workers injured on the job but lucky enough to be covered under federal and state workman’s compensation programs or private insurace, underwent back surgeries.

The magazine says that many of these patients were given spinal fusions (a costly controversial procedure); many of the operations were medically unnecessary. But worse still: A key figure in the case, who has pleaded to federal charges in exchange for his prospective testimony about the powerful pols, got surgeons to use medical hardware he supplied. An array of civil lawsuits assert that these specialized screws, rods, and plates were shoddily manufactured knock-offs. Patients have packed the courts with lawsuits, claiming the metal junk is breaking apart in their bodies, subjecting them to debilitating pain and significant health risks.

prescriptionNew reports show how physicians can improve patient safety and help themselves with two simple steps: Stopping the practice of conducting surgeries at the same time on different patients, and writing prescriptions electronically instead of by hand.

Jamming up on complex surgeries

Investigative journalists at the Boston Globe deserve credit for reporting on a dispute over elite surgeons’ conducting several complicated operations at the same time. Surgeons defend this long-standing practice, saying it lets them help more patients and teach residents, and hasn’t been shown to be detrimental.

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