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Saturday, March 19, 2011

Patients losing patience; Newspaper series missing the mark

Without apparently realizing it, Randy Richmond of The London Free Press has been writing a series praising the Canadian health care system.

His series on health care in Canada is unfolding in the pages of the local Sun Media-owned paper. Saturday readers were introduced to a woman who emigrated to Canada from Romania where, she told Richmond, health care was better under Communist rule than it is today in Canada today.

She finds our system "cold and outdated." In Romania she once saw three specialists in one day. She compared that to her experience in Canada. "I was really shocked. All three had better equipment than I have seen in London." An incredible story. She may have seen the only three well equipped specialists in all of Romania.

Just seven month ago the BBC reported:

Romanian health care on verge of collapse.   

Romanian Cristian Grigore, 9, died after breaking his arm.
"Romania spends less on healthcare than any other country in the European Union, and because of the worst recession on record, it is planning to spend even less. This chronic underfunding and a brain-drain of medical staff could be putting patients at risk. . . .

(Romanian farmer) Constantin Grigore chokes up when he talks about his nine-year-old son. Cristian broke his arm in May and was taken to the hospital in the nearest town, Slatina.

But four days later, he was dead, apparently of a severe infection he had caught there. The picture of a little boy with big dark eyes now hangs on the outside wall of the family's ramshackle mud-brick house.

Cristian's father said the doctors simply ignored his son. The family had to buy painkillers with their own money. . . .

Across Romania, hospitals . . . can only afford to pay for some of the drugs or medical supplies they need. Often they run out of the most basic things, like antibiotics or stitches. . . .

Since 2007, almost 5,000 doctors - 1 in 10 - have left Romania for Western Europe . . . "

When this woman's daughter began having trouble sleeping and suffered sore throats and sinus trouble, she took her to their family doctor. He referred the youngster to a specialist who said her adenoids were swollen. The specialist said an operation wasn't worth the trouble and the girl would outgrow the problem.

Without knowing more details, all I can say is: The Canadian specialist may have made a very good call, and a brave one. A lot of parents will push for the removal of swollen tonsils and/or adenoids (T and A surgery).

A study in Clinical Otolaryngology (2000, Vol 25, Iss 5, pp 428-430) showed that after waiting for surgery for 9 months, almost 30 percent of children scheduled for T and A surgery got better and no longer required the surgery. Score one for the woman's Canadian doctor.

More than three decades ago doctors at the Faculty of Medicine in Winnipeg, Manitoba wrote that although tonsillectomy-adenoidectomy rates are declining across North America, they are not falling fast enough. Nonindicated T and A surgery is a prevalent problem deserving of widespread attention. Score two for the Canadian doctor.

Tonsillectomy is one of the most common surgical procedures in the United States, with over 530,000 procedures performed annually in children under 15 years old. This is a multi-billion dollar industry! Many believe that this procedure has become a staple of pediatric health care in the States because it is a cash cow. President Obama said that when it comes to tonsillectomies doctors in the States may think: " 'You know what? I make a lot more money if I take this kid's tonsils out.' "

Just this year The American Academy of Otolaryngology published guidelines for Tonsillectomy in Children. Tonsillectomy being the surgical procedure often performed in tandem with an adenoidectomy. The very first point made in the guidelines is:

Most children with frequent throat infection get better on their own; watchful waiting is best for most children with less than seven episodes in the past year, five a year in the past two years, or three a year in the past three years. Her Canadian doctor appears to have possibly scored again.

No operation is without risk. A study by Children's Hospital of Pittsburgh reported nearly 10% of the children who had  T and A surgery developed complications. One more point in favour of the Canadian health care system.

Some doctors, such as American Gabe Mirkin, argue that because tonsils and adenoid tissue are lymphatic tissue doctors should almost never remove tonsils before age 4, because prior to age 4, they are major suppliers of the cells and proteins that help to protect a child from being infected with viruses and bacteria.

Not liking the Canadian specialist's position, Richmond's contact sought the opinions of three Romanian doctors during a visit to her homeland. All opted for an operation. It would be good medical practice in Romania.

On returning to Canada she was unable to get a quick appointment with a specialist in Canada and was not prepared to wait any longer. She wanted treatment for her child and she wanted it now. She saw Detroit as her best option. She took her daughter to the Detroit Medical Centre where she had the young girl's adenoids removed.

"I went in the morning and by three o'clock we were back on our way to London." I wonder if the trip home went quicker than the trip there; They were traveling about $7000 lighter. $7000 for an outpatient procedure! Some sources on the Internet claim American insurers usually only pay a surgeon $200 to $300 for tonsil surgery. If this is true, it is no wonder American hospitals love Canadian cash-paying patients.

It is impossible to know whether this woman's daughter was in desperate need of having her adenoids removed or not. But as I mentioned earlier, Randy reports the Canadian specialist wasn't keen to do the operation as he believed the girl would outgrow the problem.

But it is not hard to know why the U.S. doctors may have been keen to operate. The little girl was a cash cow.
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Detroit Medical Centre background:

Struggling Detroit Medical Centre was transformed into an 8 hospital system for profit entity by the takeover Dec. 30, 2010, by Vanguard Health. VH promised to keep all 8 DMC facilities open for a decade, at least, including maintaining care for uninsured and poor patients.

The deal was prevented from closing earlier due to a conflict arising over Vanguard's potential liability for DMC's past Medicare and Medicaid billings, in the fall. As DMC made preparations for being sold to Vanguard, it discovered certain irregularities in billing and leases with unaffiliated physicians and informed the government of the violations. Most involved favourable lease deals and independent contractor relationships not put in writing, nor reflecting fair market value.

Despite federal law restricting financial deals between hospitals and doctors referring patients, DMC gave doctors tickets for sporting events, entertainment and charity dinners between 2004 and 2010.

A Justice Department press release dated 30th December says DMC agreed to pay the U. S. $30 million for violating the False Claims Act, the Anti-Kickback Statute and the Stark Statute by engaging in improper financial relationships with referring physicians.
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In 2002 the American Academy of Pediatrics recommended that children have a sleep study before surgery is considered if the problem being addressed by the T and A operation is sleep related. Randy makes no mention of any sleep study being done on the little girl.

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