Dangerous doctors rip off Medicare, creep out coeds, harm transplant patients

medicare-300x109Callous institutional inertia can allow dangerous doctors to keep harming patients. But media digging deserves credit for raising needed alarms when professional caregivers and others fail to step up to protect individuals as disparate as taxpayers, seniors, coeds, and heart transplant recipients.

The Milwaukee Journal-Sentinel and MedPage Today performed a public service, reporting that they found more than 200 doctors nationwide who surrendered a license, had one revoked, or were excluded from state-paid health care rolls in the previous five years  but somehow remained on the federal Medicare rolls in 2015.

This meant the problem doctors could keep bad practices afloat, in part because Uncle Sam ─ that’s taxpayers like you and me ─ paid these hundreds of MDs $25.8 million to care for seniors, among the nation’s most vulnerable patients.

The news organizations found the disciplined doctors by working with groups that tracked bad performers across a state-by-state maze of oversight actions by medical boards. They then cross-checked databases to see if federal officials, as common sense would suggest and the law can require, had duly ousted the bad physicians from qualifying to receive Medicare payment.

Nope, they hadn’t. Federal officials defended their dismal performance by saying they lack the staff and resources needed,  noting that just two dozen Medicare watchdogs are supposed to track hundreds of thousands of doctors, nurses, dentists, therapists, clinics, adult care centers, and nursing homes. Just one investigator oversees 150,000 doctors in California alone.

These excuses, however, sound particularly lame because Pro Publica, a Pulitzer Prize-winning investigative site, three years ago published a similar, damning dig into Medicare’s failure to disqualify doctors with dubious records, including those with big problems with the agency itself.

The offenders uncovered by the Journal-Sentinel and MedPage Today included two Maryland doctors:

  • One was an ear, nose, and throat specialist reprimanded and fined $5,000 after he was accused of performing “back and abdominal liposuction on a woman who died as a result of the procedure.” The Maryland Board of Physicians, which received a complaint the otolaryngologist was unqualified to perform plastic surgery in areas of the body so far from his expertise, found the specialist failed to properly supervise a nurse anesthetist, and violated the law by performing the liposuction in his office, which was not an accredited facility. He permanently surrendered his licenses in New York and Pennsylvania in 2014. But in 2015, he received $272,000 from Medicare.
  • Another surgeon in 2003 was reprimanded by the Maryland Board of Physicians in a case in which he was accused of failing to diagnose and treat an infection that led to a man’s death. In a 2011 malpractice lawsuit, the Journal-Sentinel and MedPage Today reported, he was accused in the 2008 death of a 70-year-old Maryland man after an angioplasty.  In each case, the surgeon paid $250,000 settlements, contending it was cheaper to do so than going to trial. In 2012, a Maryland hospital suspended him for 90 days after complaints that included abusive language, angry and intimidating behavior, and rudeness in the operating room toward staff and patients — in one case yelling at a woman on the operating table. The Maryland allegations led to a reprimand,two years’ probation and a $5,000 fine. California then took action that led to the surrender of the surgeon’s license there in 2014. In 2015, Medicare paid him $321,000.

Medicare, the news organizations found, also kept paying doctors disciplined and fined for improper dispensing of risky opioid painkillers, a specialist who settled with Uncle Sam over allegations that he improperly over-billed the agency for almost $750,000, and an MD with multiple malpractice settlements and a proven problem with inappropriate sexual behavior with female patients.

USC embarrassments wax on

The University of Southern California, meantime, is facing a firestorm for allowing George Tyndall, the lone, full-time gynecologist in its student health service to treat coeds for decades, despite growing complaints about his pervy conduct, the Los Angeles Times reported.

As the newspaper found:

The complaints began in the 1990s, when co-workers alleged he was improperly photographing students’ genitals. In the years that followed, patients and nursing staff accused him again and again of ‘creepy’ behavior, including touching women inappropriately during pelvic exams and making sexually suggestive remarks… In recent years, some colleagues feared that he was targeting the university’s growing population of Chinese students, who often had a limited understanding of the English language and American medical norms. Still, [the doctor] was allowed to continue practicing. It was not until 2016, when a frustrated nurse went to the campus rape crisis center, that he was suspended. An internal USC investigation determined that [the doctor’s] behavior during pelvic exams was outside the scope of current medical practice and amounted to sexual harassment of students. But in a secret deal last summer, top administrators allowed [him] to resign quietly with a financial payout. The university did not inform [his] patients. Nor did USC report him at the time to the Medical Board of California…

tyndall-150x150USC publicly discussed its problem doctor only after the newspaper called officials for comment before publishing its investigation of him. Since then, the school’s switchboard has lit up with angry alumnae callers, and the Chinese government has expressed deep concern that its citizens may have been exploited by the school, which long has boasted about its prowess in recruiting top international scholars to create a globally sophisticated campus.

This story has erupted after other institutions, including the U.S. Olympic women’s gymnastics team, Michigan State University, and, yes, Penn State have gotten caught up in major scandals involving big breaches of trust between adults in positions of power and young people put in their trust. Matters have eroded sufficiently that the New York Times has published a primer of sorts on what constitutes an appropriate gynecologic exam.

The revelations about its students health service is yet another big blow to the West Coast university’s hopes for raising its national and international standing: The Los Angeles Times reported earlier that the dean of USC’s medical school led a double-life ─ on the one hand overseeing hundreds of medical students, thousands of professors and clinicians, more than $200 million in research grants, and raising as much as $1 billion in donations, and on the other hand, running with a  young, dubious crowd of men and women, who photographed and videotaped themselves apparently abusing drugs, and for whom the academic and eye specialist wrote prescriptions freely.

The university, which has fired administrators tied to its health services’ scandal and asked Los Angeles police to consider stepping in the matter, took months of withering criticism for apparently ignoring repeated warnings about its medical school dean’s problems, partly because he appeared successful both in raising money and the institution’s academic luster.

Texas-sized plunge

morgan-150x150Pro Publica, the investigations site, and the Houston Chronicle have detailed the perils for heart transplant patients of relying on a hospital’s renown.  They have posted a devastating take-down of Baylor St. Luke’s Medical Center, a Houston hospital affiliated with Baylor College of Medicine and the Texas Heart Institute.

Although the hospital, the media organizations say, “has long held itself out as one of the best in the world for heart surgery,” they investigated and found:

St. Luke’s heart transplant survival rate, the most important measure of a program’s quality, now ranks near the bottom nationally, according to the most recently published data. Among St. Luke’s patients who received a new heart between the summer of 2014 and the end of 2016, just 85 percent survived at least one year, compared to 91.4 percent nationally. Put another way, twice as many St. Luke’s patients died within a year as would have been expected, taking into account patient characteristics and illnesses. In January, the federal Centers for Medicare and Medicaid Services cited the heart transplant program for its significantly worse-than-expected outcomes and threatened to cut off Medicare funds in August if the problems were not fixed …. The program has since submitted a plan of correction and avoided the loss of federal funds.

Pro Publica and the Chronicle quote hospital officials as acknowledging problems, which they said they tried to address in 2015 by hiring Jeffrey Morgan, a new surgical director of the institution’s heart transplant program. But, the news organizations found of him:

In one of [his] first transplant surgeries at St. Luke’s, in early 2016, he sewed shut one of two major veins that carry blood back to the heart, and the patient died a few weeks later, according to six medical professionals familiar with the case. In another patient’s transplant a year later, [he] stitched through the other major vein, according to the patient’s cardiologist, though [the surgeon] said the man’s previous cancer treatments complicated the case. After the initial surgery, the blocked vein caused blood to pool in the patient’s head, leading to an emergency repair, weeks of follow-up operations, a three-month hospital stay and ongoing health struggles, including kidney failure.

St. Luke’s has been plagued by staff churn, adding to patient problems, including some of the longest post-transplant stays ─ hospitalizations of a month or more on average that indicate to some experts issues in surgical procedures. The institution, made famous by pioneering transplant surgeon Denton Cooley, also struggles now with its longer-term rate of transplant failures.

In my practice, I see the significant harms that patients suffer while seeking medical services, and the too common total failure of medical professionals ─ doctors, nurses, and institutional administrators of various kinds ─ to step up to protect patients from destructive practices and practitioners. State medical boards seemingly show greater self-interest in shielding doctors’ reputations and practices than in saving patients from harm. And the current national system, which purports to prevent bad physicians from just scooting off to another jurisdiction to avoid consequences of their malpractice, clearly isn’t working, whether it is for patients to learn about their doctors, or even Uncle Sam to figure how to stop Medicare payments to poor performers.

There also needs to be a special toasty spot, now and in the days of personal and professional accounting, for institutional chiefs who countenance bad and perverse medical practice, ignoring the damage that it inflicts on patients, while worrying more about selling goods and services  ─ whether it is to drag in more transplant patients or high tuition-paying students.

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