Articles Posted in Surgery

javaid-300x169A Virginia criminal case, while focusing on claims of fraud against the federal government, also has exposed a long-running and nightmarish pattern of what prosecutors assert has been a Chesapeake gynecologist’s rampant mistreatment of his patients, many of them women of color and poor.

Dr. Javaid Perwaiz is on trial because authorities say he “manipulated records to cover crimes that enriched him but endangered pregnancies, sterilized women unnecessarily, and pressured them into needless procedures to finance his lavish lifestyle,” the Washington Post reported.

The newspaper’s articles, as well as the efforts by the FBI and federal prosecutors to develop the charges against the jailed specialist, raise disturbing questions about not only Virginia medical regulators but also the hospitals where the gynecologist practiced and colleagues who have described a “frenzied environment in which hospital staff struggled to keep pace with Perwaiz as he rushed from procedure to procedure.”

doc-300x169The Covid-19 pandemic continues to slam the practice of medicine, with patients’ infection fears and treatment delays putting at serious financial risk the providers of crucial medical services like primary care doctors and pediatricians.

At the same time, as is too often the case in U.S. medicine, the rich may be getting richer, as resuming care gives patients eye-opening information on the big money in orthopedic and plastic surgery and other cosmetic procedures.

The coronavirus’s economic shocks may most accelerate changes — not all of them happy for patients — for primary care physicians, who account for half the annual doctor visits annually in this country, the independent, nonpartisan Kaiser Health News service reported.

burkedbglobe-212x300A big Boston hospital has offered 13 million and one ways to try to make good with a former orthopedic surgeon who assailed the respected institution and colleagues for performing simultaneous operations in which doctors went from suite to suite, working for hours on multiple patients at once.

Massachusetts General Hospital insisted this practice was safe. Dr. Dennis Burke, a hip and knee specialist whose patients have included former Secretary of State John Kerry, disagreed. He told his bosses at the Harvard-affiliated hospital that simultaneous procedures put patients at risk, and, at minimum, they should be told that the surgeons they flocked to for surgery on them might pop in and out of their procedures.

Burke infuriated his bosses by taking his criticisms outside the hospital, including to investigative reporters for the Boston Globe. The newspaper dug into hospital surgeries, particularly in orthopedic cases where operations lasted for hours.

ambcenterleapfrograting-300x109They may be more appealing and convenient because they’re located in the neighborhood with better hours and more parking. They also may be less costly because they lack the high overheard of big hospitals. But those booming same-day surgery centers have patient safety issues of their own.

Their doctors and nurses may not be as well-trained as patients might find at big hospitals or academic medical centers, with 1 in 3 centers not having staff who were all board-certified, according to the Leapfrog Group, a consortium of big companies and other major health care users focused on patient concerns.

Leapfrog has issued — to its considerable credit — its first safety and quality study of the facilities, also finding that, “not all ambulatory surgery centers and hospital outpatient departments provide surgery consent materials before the day of surgery. Just 14% of ambulatory surgery centers provided the information one to three days before the surgery, while just 20.7% of hospital outpatient departments do so,” Modern Healthcare, an industry news source, reported.

feresstayskal-150x150Although members of Congress have fled the nation’s capital for their annual August recess, there’s guarded optimism that lawmakers may be open to reversing a seven-decades-old U.S. Supreme Court ruling that bars active duty military personnel from their constitutional right to pursue  in the civil justice system claims that they have suffered harms while seeking medical services.

Advocates of this change saw cause for optimism that President Trump met briefly in July in North Carolina and encouraged Army Sgt. 1st Class Richard Stayskal, a terminally ill Green Beret who has become the focus of efforts to fixing the Federal Tort Claims Act (FTCA), Bloomberg news service reported. Jackie Speier, a California Democratic congresswoman, introduced a bill named after Stayskal and that would allow troops to file medical malpractice suits in federal court, because, as Bloomberg said:

“Stayskal went to Womack Army Medical Center at Fort Bragg in 2017 after feeling suffocated and coughing up blood, but the hospital misdiagnosed him with pneumonia during two visits, according to his congressional testimony before the House Armed Services Committee. By the time he saw a civilian doctor six months later, the lung tumor causing the problems had doubled in size. The tumor had showed up in X-rays done before he went to dive training, but nobody told Stayskal or diagnosed him.”

surgicaltools-300x200
Would a major league baseball team start a pitcher who played only once in the season for the deciding game of the World Series? Would passengers want to be aboard a jet whose pilot flew just once a year? Would any high-end sports car owner let a mechanic under the vehicle’s hood if she fixed that model one time every 365 days?

If rigorous tasks benefit from regular, quality practice — and they do — then why do hospitals allow low-volume surgeons to undertake procedures they rarely perform? That’s a tough question posed by new research from the Leapfrog Group, a national nonprofit organization seeking to improve the quality and safety of American health care.

Leapfrog, working with medical experts, identified eight high-risk surgeries and sought to estimate from rigorous published research the correlation between how often surgeons perform these and their procedures optimal outcomes.

covervf-300x210As the nation’s opioid and drug overdose crisis deepens, it can be hard to watch as the “Not My Fault” crowd clucks about its blamelessness in pushing potent painkillers that have played a part in killing more Americans in 2016 and 2017 alone than lost their lives in the Vietnam War.

The latest NMF protagonists include:

childrensunclogo-300x51Although big hospitals may love to pat themselves on the back and boost their profits and professional standings by claiming to offer “comprehensive” services, children may suffer and die due to the reality versus the hubris of institutions’ excessive initiatives with specialized care.

Officials at the University of North Carolina blew past anguished warnings from their own pediatric cardiology staff of significant problems in the pediatric heart surgery program at the medical center’s children’s hospital, the New York Times reported. Brushing aside their concerns about a lack of resources within and to support the program, UNC declined to make public, as most similar specialty efforts do, key performance measures. They would show that the UNC pediatric heart surgery program had a higher death rate than “nearly all 82 institutions that do publicly report” this and other measures of patient care.

The newspaper, in a rare move, has internal tape recordings of doctors disputing among themselves whether dwindling resources, staff departures, and other problems meant that UNC should do what many of the specialists demanded — take a long hard look at what was going wrong, and, in the meantime, refer sick kids to other institutions to safeguard their care.

kneestemcell-300x169When doctors and regulators crack down on the burgeoning and risky use of purported stem cell therapies, some well-known and respected big hospitals and health systems may have their own practices to explain, too.

As Liz Szabo reported for the nonpartisan Kaiser Health News Service:

Swedish Medical Center, the largest nonprofit health provider in the Seattle area … is one of a growing number of respected hospitals and health systems—including the Mayo Clinic, the Cleveland Clinic and the University of Miami—that have entered the lucrative business of stem cells and related therapies. Typical treatments involve injecting patients’ joints with their own fat or bone marrow cells, or with extracts of platelets, the cell fragments known for their role in clotting blood. Many patients seek out regenerative medicine to stave off surgery, even though the evidence supporting these experimental therapies is thin at best

aspirinlowdose-300x225After persuading as many as 7 in 10 American adults to take a daily low dose of a common painkiller to protect against heart disease and cancer, experts now say it is time for more nuanced advice on who should and who shouldn’t take the daily baby aspirin regimen.

Recent studies have shown that the believed protective benefits of low-dose aspirin need to be balanced against the risks of bleeding caused by the drug, the American Heart Association and the American College of Cardiology have declared.

Here is who should NOT go on low-dose daily aspirin:

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