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She finds our system "cold and outdated."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.

Sick of waiting: Are some Canadians paying for expensive, risky medical treatment?

The pain from his affliction left him desperate for a medical solution.

Randy Richmond is writing a three part series, Patients losing patience,which is taking a look at the hundreds of thousands of seriously ill Canadians who have been left without satisfactory care by the Canadian heath system. Richmond is focusing on the folk who are going outside the country seeking medical help.

Randy is a writer I really liked when I worked at the paper. He's an excellent reporter. I'm sure this series will be part of his WONA (Western Ontario Newspaper Awards) portfolio next year. Still, this first story, as interesting as it was, left me with some serious questions, such as: "What is the Laser Spine Institute?"

You see this question was important to me as I also have a bad back. I have come to believe, based on what I've been told by a number of doctors, that when it comes to bad backs often less treatment may be the best treatment. I read in a Harvard Medical School health newsletter that "doctors are beginning to question whether too many surgeries are performed to treat degenerative disease. As for herniated disks, a recent study found that surgical and nonsurgical treatments worked equally well." The newsletter editorial told me "the decision whether to have surgery is a matter of patient preference more than anything else."

On LiveStrong.com I read that the Cleveland Clinic and the Mayo Clinic both advise trying other less intrusive therapies, like massage, physical therapy and anti-inflammation drugs before back surgery. Laser surgery has been touted as the latest, least invasive, most successful technique with the least amount of recovery time but these hospitals warn that there are several disadvantages to laser spine surgery.

Without a cane, I would not get to my computer.

Unsuccessful back surgeries have become so common in the States that there is now an acronym: FBSS (Failed Back Surgery Syndrome.)

My back can be so bad that it drops me to my knees but my family doctor has poo-pooed my complaints. High tech laser surgery has never been an option. It has never been offered to me by my present doctor nor by my former.

I've been advised to apply cold to alleviate pain and to prevent or reduce the swelling. After 48 hours I've been told to apply warmth to increase blood flow and promote healing. I should limit bed rest to a couple of days, at most,  and then add limited exercise therapy. The theory is that strong, flexible muscles are less prone to injury and will help to strengthen the back and support the spine.

All my family doctors over the years have given me sheets detailing back exercises. I have never been given so much as a prescription for the pain. For me, this has been the extent of the Canadian solution to serious back pain. And so far, it's working. Hold the knife and hold the laser, thank-you. (I wrote this in 2011. I'm adding this in 2018. My back pain situation may have improved a little.  I'm glad that I have not had back surgery.)

In Randy's first installment, a fellow from Windsor suffering from a spinal problem was unable to get the medical help he perceived he needed. In desperation, he turned to Kelly Meloche, the head of Windsor's International Health Care Providers.

The man told Randy. "Before I knew it, I was in Tampa, Florida, at the Laser Spine Institute. There, doctors did a laser procedure not available in Canada. The fellow said, "I walked off the operation table. I felt great. It was crazy. It was almost surreal."

As it turned out, the 2007 operation worked only for a time. Things looked great for a year and a half, then the Windsor fellow's headaches returned. I wondered if his experience was common. I googled "Laser Spine Institute Tampa complaints" and I read:

My husband had surgery in May 2008. A decent experience, and he was mostly pain free after...for a few months. Now he is just as he was before surgery. Why? I can't explain it, but this certainly makes the out of pocket payment not worth it for us. Apart from the medical, they dropped us like a hot potato after the cash was in hand. Multiple phone calls were not returned. A 3 month and 6 month follow up came in the same envelope. When we managed to reach someone, and complain about calls not being returned, we were directed to call others on the staff. Apparently they were too busy to call us. Insurance forms were not submitted as promised upon our departure - took 4 months to get them to make the claims. BTW, our next door neighbor also went there with unsuccessful results, and the same dismissal. They don't like it when you do not become a new testimonial!

I looked down the comment list. Some were positive and then I spotted one from a Canadian out of Lachine, Quebec.

Don't go there!! Please I beg of you not to waste your money or your health. I had a discectomy done at LSI in 2008 and they ruined my back for life. Not only did they damage my nerve endings, they permanently destabilized my spine. My current neurosurgeon is not sure if my S1 nerve will ever fully recover. I had to be rushed to the emergency ward the evening after the LSI surgery. LSI did not take any steps to rectify the issue. The hospital informed me that I was not the first patient from LSI to be rushed to the ER after surgery.

I read more comments:

• . . . all I can say about LSI is DO NOT GO THERE!!!
• . . . everything was fine for six weeks and then the pain came back. now it's as bad as ever.
• . . . bad experience with LSI. I am in much more pain than before I walked in.
• . . . Do NOT go to LSI. I had surgery there on Sept. 26, 2007. I cannot describe the hell I have been through, physically and financially, with these people . . . filing suit for medical malpractice, fraud, and malfeasance.

To be fair, the Windsor fellow still credits the laser surgery in Florida for relieving much of his pain, although he was left with a $17,000 medical fee. But the laser operation didn't stop him from seeking more medical help. He is now crossing the border at Windsor to travel into Michigan to get $1200 botox injections.

As I said, not all the comments on the Internet about LSI are negative. One person wrote: "I had surgery on July 16, 2008 and have considered it a great success."

So, what does one believe? I leave the final word to Mark McLaughlin, MD, FACS, FAANS, from Princeton who wrote an article titled: The Laser Myth in Spine Surgery

Laser Spine Surgery: It has almost zero usefulness in your spine surgery and in fact may be harmful - R. McLaughlin MD

No laser surgery for me, thank you. Now, where did I put those sheets of doctor-recommended back strengthening exercises?
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The following is here simply because it was in the original post. It has been removed as of March 2018.

On the other hand there are the newspaper articles, such as the ones from the St. Petersburg Times, about a questionable Florida surgeon who gained fame for his laser approach to curing spinal problems:  Back doctor sues and Is surgeon innovative, or unfit? or this article titled Treat the Leg or Pull it?

A couple of months after Randy Richmond did his article, Bloomberg did a story on the Florida laser spine surgery clinics: Laser Spine Surgery More Profitable Than Google Sees Complaints. Follow the link if you're interested.

I don't know what to believe but I have decided not to go to Florida. No laser surgery for me, thank you. Now, where did I put those sheets of doctor-recommended back strengthening exercises?
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If you haven't guessed, I support the Canadian health care system. Click the link to discover why.