Look at my shadow! I'm a big girl!

Fiona thinks she is a big girl. She is 19-months going on 19 years. This is probably not quite true. I never had children of my own and so I'm just so surprised at the all the thinking that clearly goes on in young heads.

This is Fiona's first spring. This is her first foray into the outside world on her own two feet. And Fiona is quite enchanted with the world she is discovering. She can't get enough of the outside.

Yesterday I was doing the dishes and Fiona wandered out of the kitchen and into the front hallway. I could hear her puttering about and wondered what she was up to. Before I could dry my hands and take a look, Fiona appeared carrying my large coat. That coat is bigger than she is but she carried through the kitchen and handed it right to me. I knew what was up. She wanted to go outside.

I dried my hands and started putting on my coat when Fiona appeared again. This time she was carrying my shoes. I put them on, but before I could lace them up she was back. This time carrying my camera bag.

I slipped the camera bag strap over my shoulder and looked down to see Fiona. She was holding out my house keys. The kid's amazing.

Content that I had everything, Fiona waited patiently by the front door for my assistance in getting her into her coat and shoes.

19-months and she already knows enough to make sure granddad has his house keys. Like I said, "The kid's amazing."

Now I'm getting spam!

I called the ad questionable and wondered why newspapers don't treat their advertising business with more respect. Advertising is how newspapers make money. Accepting questionable ads, and often placing them in prominent positions in the newspaper and on the companion Website, lessens the value of the newspaper ad franchise.

As I wrote in the previous post,

"The ad prominently displaced on the opening screen of The London Free Press Web page read, "View your credit score now". Just go to Free Credit Reports in Canada. It was clear this was a free service; There was no charge."

Well, I did go and I'm sorry. I worked through a number of screens but when asked for my credit card number I stopped. Today I got my first spam from these Free Credit Report people.

It makes me feel very uneasy that one of the companies that tracks our credit history and rates our credit worthiness may be behind this. You see, credit reports are free in Canada, if you don't count the cost of the stamp and business envelope necessary to send in a request for the information on file. To find out how to obtain a copy of your credit records for free, see my last post.

Questionable ads question a newspaper's integrity.

The ad prominently displaced on the opening screen of The London Free Press Web page read, "View your credit score now". Just go to Free Credit Reports in Canada. It was clear this was a free service; There was no charge.

Interested, I clicked; I got a screen asking for my name, complete address plus e-mail. This seemed reasonable. How else could they provide my credit score? Reasonable or not, I balked. I noticed the name TransUnion in the top right of the screen.

I googled "TransUnion" and discovered this was a major player in the credit reporting business in Canada. The other company is Equifax Canada. I also came across a CBC News in Depth report: "Checking your credit rating".

The first thing I learned from the CBC was that credit reports are free:

"You can ask for a free copy of your credit report by mail. . . . Complete details on how to order credit reports are available online." (Here are the links: TransUnion and Equifax Canada.)

So, what's up with the whole Free Credit Reports in Canada stuff? What's with the ad on The London Free Press Web site? Before continuing, I decided to do a little googling. I found a post on the blog Moo's virtual world: Privacy Protection Plus is a fraud. This privacy protection name was a new wrinkle, but interested I read on:

I read the blogger's post and then scanned the comments:

"I renewed my classmates.com account using my Visa. . . . 1st mistake. I don't recall being asked about any Privacy Protection or 24-hour Assistance. Just received this months bill and that I was being billed 19.95 for Privacy Proctection and another 19.95 for 24-hour Assistance. I called my credit card comp and they couldn't help me as it is Sunday. I tried contacting the company Privacy Proctection and again they are closed. I can't go online cuz I don't have a username and password. . . . what a scam. . . . I tried contacting Classmates and that was hopeless. I am not impressed with their underhanded techniques. How dare they allow another company to have access to my personal info and especially my credit card info? . . . ya I am PO'd and will be dealing with this first thing in the morning. Then I will be canceling my credit card.

posted by Anonymous"

With my curiosity peaking, I got brave and went back to the original Free Press ad and clicked. I wondered if I would come across an offer for Privacy Protection. Yes, it was offered on the second screen. I filled in the fields and unclicked the box indicating my lack of interest in Privacy Protection. I clicked "Get Yours Now!"

I didn't get mine now; I got another screen asking for personal information. I also got another automatically checked box for Privacy Protection. I filled in the fields, I unclicked the PP box again and I clicked "Continue".

Still no report. Now they wanted my credit card number. Odd. These are the folk checking on my credit worthiness. The only reason they would want me to supply my credit card info is if they were intending on possibly billing me for something. I read the small type:

"By . . . clicking the 'View Report' button, I confirm that I have read and agree to the Offer Details on the right side of this page . . . for Privacy Protection Plus."

That's right, it appears if I view the report, I also agree to take Privacy Protection Plus even though I unclicked the box each time it was offered. I read the "Offer details" on the right side of the page:

"Simply click 'View Report' on this page to claim your FREE Credit Profile and Score and activate your trial membership in Privacy Protection Plus. After your 7-day FREE trial period it’s just $29.95 plus applicable taxes."

Let's be very clear. Much of the remaining small print spelled out how to cancel the Privacy Protection Plus plan. But still, what an iffy way to get folk to take a one week free trial and end up getting hit by an automatic charge to their credit card. I didn't continue. I had lost all trust.

But I had learned how to obtain my credit card profile; It would only cost me the price of a couple of stamps and business envelopes. The reports themselves would be free!


Questions Raised

This whole thing raises a number of questions:

1:   Why do papers like The London Free Press accept questionable ads? These stunts make me question all the ads featured in The Free Press. This stuff tarnishes the brand.

Years ago I complained to the editorial department at The Freeps about the car ads claiming buyers were being offered zero percent loans on certain new cars. I made quite a pest of myself, as I am sure you can imagine.

In the end, the editor with whom I was dealing could waste no more time listening to my arguments. He told  me straight out that the paper was not going to carry any opinion piece detailing the truth behind the questionable car company ads. The car companies bought too many expensive full-page, full-colour ads. Such great advertisers were untouchable.

Eventually, I believe, the government stepped in and forced the car companies to publish the true cost of their zero interest loans. In some cases the true rate, revealed in the small print, was astounding. After leaving the paper, I was able to blog about this. I had more power to reveal the truth than the newspapers when it came to this story.

And there was actually a book written on this: The Zero-Percent Financing Scam. But there was never a story in The Free Press.

2:   How does one obtain a credit report?

The Financial Consumer Agency of Canada has a posted PDF file, "Understanding Your Credit Report and Credit Score". Read it. It's rather interesting. Did you know:

• Having too much available credit can sometimes harm your credit score.
• Charging more than 35 percent of your available credit limit could damage your credit score.
• Using your credit cards regularly builds a healthy credit history.

According to the government, it’s a good idea to request a copy of your credit report from the two credit-reporting agencies at least once a year. This ensures you have not been the victim of identity fraud.

Because your credit information can be kept by more than one credit-reporting agency, and because those agencies do not necessarily share information, it’s important to check both credit reports carefully, all three if you live in Quebec.


Equifax Canada
National Consumer Relations
P.O. box 190, Station Jean-Talon,
Montreal, Quebec H1S 2Z2
Tel. (toll-free): 1-800-465-7166
Fax: 514-355-8502
Web site: www.equifax.ca

TransUnion Canada
All provinces except Quebec:
Consumer Relations Centre
P.O. Box 338, LCD 1
Hamilton, Ontario L8L 7W2
Tel. (toll-free): 1-866-525-0262
Fax: 905-527-0401
Web site: www.transunion.ca

For Quebec Residents:
TransUnion (Echo Group)
1 Place Laval, Suite 370
Laval, Quebec H7N 1A1
Tel. (toll-free): 1-877-713-3393
Fax: 905-527-0401
Web site: www.transunion.ca

Yes, sex can kill you, study shows

"Yes, sex can kill you." This downer news comes from a study published in the Journal of the American Medical Association.

I learned about the study from my daily paper. Essentially the paper reported:

When people with heart problems are having sex, they are 2.7 times more likely to have a heart attack. Sudden bursts of moderate to intense physical activity — such as sex — pose a significant risk of heart attack.

Having recently undergone a heart related operation, I can say something is missing from the newspaper report. Sex, per se, is not dangerous; It's sex with a twist, and I don't mean lime! Don't pass on the sex, just hold the spice.

When it comes to sexual activity for heart patients, the following are some of the warnings I've come across on the Internet since my operation:

• Only have sex with your usual partner to minimize heart-racing tension. Paid partners add even more stress. (Just think: Charlie Sheen. Need I say more?)
• Keep to the tried and true. The usual oh-so-comfortable positions are the least stressful. In fact, they can be downright relaxing.
• It is safest to have sex in your usual setting. For instance, refrain from having sex in hot showers. Steamy sex is stressful sex. ;-)
• Don't downplay foreplay; Think of it as the proper warm-up for the big game. We don't speak of sexual athletes for nothing. And just like other athletes, sexual ones often perform better on drugs. But unlike other athletes some of these drugs are recommended. For instance, if one takes nitroglycerin to prevent chest pain, take it before sexual activity. And if you are competing with someone who is not your usual partner, you may have to stop and take more while competing.
• Get some rest before hand. Morning is an ideal time for sexual activity. Remember the old line from Playboy: "Shall I call you in the morning, or just nudge you?" Nudging is safer, at least, if it is your usual nudge.
• Speaking of your usual nudge, masturbation requires less energy than intercourse.
• And whatever you do, choose a position that does not put stress on your breastbone (sternum) if you have just had open heart surgery. Those patients should stay clear of the partner-sternum-superior position.

Jessica Paulus, a Tufts Medical Center in Boston researcher who worked on the study, said the risk found is fairly high but the period of increased risk is brief.

"The period of increased risk is brief"? Damn! The bad news just keeps on coming.

Cheers!

Into the fog: The London Free Press series on Canadian health care

Into the fog might be an apt title for The Free Press series.

There is a battle raging over information. I am NOT referring to the battle between the Main Stream Media (MSM) and bloggers but the war being waged over how we, the readers, process the information we read in either the MSM or in the blogosphere.

An article, Out of the fog, in The London Free Press is an excellent example. In the old days, I'd have read this article and have either believed it or not. Those were the two choices. But today there is a third choice..

Thanks to the Internet, the moment I read something I question I turn to Google. Depending upon what I learn, I may write a blog post. If I am really offended and want to warn others, I post to Digital Journal. I did this with a story about a St. Catherines man who died in Costa Rica of complications from a controversial multiple sclerosis (MS) treatment (CCSVI). 

The London Free Press and reporter Randy Richmond recently seemed to promote CCSVI with an article featuring Paolo Zamboni, the Italian doctor behind the controversial treatment:

"Zamboni believes MS is a vascular, not auto-immune condition. A narrowing of veins -- chronic cerebrospinal venous insufficiency (CCSVI) — is prevalent in MS patients and can be treated by a simple surgical procedure — angioplasty — that widens the veins. The procedure is also known as liberation therapy."

The Free Press article introduced us to a local woman suffering from MS. She found it impossible to have the highly suspect surgical procedure done in Ontario. Richmond tells the reader, "She tried to talk to her neurologist about liberation therapy. He dismissed Zamboni's work."

What Richmond, a Free Press crack investigative reporter, doesn't tell us is "Zamboni himself admits his research lacks scientific rigour: his sample was small; there was no control group. Two studies in the Annals of Neurology have refuted his findings." Source: Macleans.

The following is from the Skepticblog. It is from a post called CCSVI - The Importance of Replication

"We have two independent replications of Zamboni’s research published in the latest issue of the Annals of Neurology – and both are completely negative. The first is a German study by Florian Doepp et al, using ultrasound to test the CCSVI criteria in 56 MS patients and 20 controls. They found almost completely negative results (one MS patient met one criterion, but not the others) – no signs of venous blockage in the MS patients.

The second study is a Swedish study . . .  – not yet available online. This study used MRI scanning to assess blood flow in the internal jugular vein in 21 MS patients and 20 controls, and also found no difference."

I am reprinting the last paragraph from the Skepticblog article as author Steven Novella puts it so well:

"I do wish that the media and public would learn the more general lesson here – new dramatic ideas in science, especially those that seem to go against established knowledge, are likely to turn out to be wrong when the dust settles. It is partly the job of the skeptical community to provide cultural memory of such events – so the next time a lone scientist or doctor claims to have made a revolutionary breakthrough that seems a bit dubious, it is the skeptics who will be there to say – remember Zamboni."

As I pointed out in a previous post, when it comes to the Canadian medical system, "One must admit, our system has problems." Out of the Fog was part of a London Free Press series on the shortcomings of our healthcare system. Sadly, this article did little to enlighten anyone and may well have done damage. I've have already stumbled upon links to the Richmond series on American, right-wing, anti-Obamacare, websites. They see the Richmond series as a damning indictment of the Canadian health care system.
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Addendum:

CBC Radio reported in December, 2017, that Dr. Zamboni concluded the therapy he devised is a "largely ineffective technique; [and] the treatment cannot be recommended in patients with MS."

It turns out the London woman was given excellent advice by her doctors. And they were not alone. Doctors around the world dismissed Zamboni's work. Read: Liberation therapy: the 'wave of complications' breaks in Macleans. Going out of the country for a medical treatment not offered in Canada can be dangerous. There may be very good reasons why a procedure is not offered in Canada. If you want to know more, read this article in the Montreal Gazette.

Or read this article in The Globe and Mail that tells us: there is " . . . a growing body of evidence that suggests that they [patients] are wasting their time and their money – and perhaps putting their lives in danger."

Or read an alert issued by the FDA in the States on potential dangers of unproven treatments for multiple sclerosis.

If you are personally suffering from MS and no hope is offered, it is quite understandable that you might turn to liberation therapy for an answer.

The London woman in the article has stated that the CCSVI therapy she has undergone at her own expense was actually less expensive than the drug therapy being offered. In cases like this, where the person is adamant to have the therapy and the cost is actually a savings to the Canadian medical system, maybe the government should consider covering the costs of out-of-country medical treatment.

This remark, of course, is a little flippant as there are moral issues that must be resolved: Is it ethical to send someone out of the country for highly questionable treatment because the patient wants it and the treatment promises to save the Canadian medical system money?

Time to revisit LHSC panel discussion on state of Canadian health care

When just a little girl, my daughter asked her mother, "Mom, what's a bum-ticker?" She had heard that Crusty the Clown on the Simpsons might be dropped from the show because of his "bum-ticker." She placed the accent on "bum."

As a man with a "bum-ticker" who is still alive today thanks to the Canadian health care system, I give our system a thumbs up. But it doesn't get two thumbs up, or rate a ten, or top out in whatever scale of measurement you use. One must admit, our system has problems.

Dr. Nick Kates speaking at the LHSC discussion.

It was almost exactly a year ago that a blue-ribbon panel of doctors was assembled for an interactive panel discussion at University Hospital in London, Ontario. The panel, sponsored by the student Medical Reform Group at the Schulich School of Medicine & Dentistry at the University of Western Ontario was composed of: Dr. Jeff Turnbull , president-elect of the Canadian Medical Association; Dr. Robert McMurtry, former special advisor to the Canadian Royal Commission on the Future of Health Care in Canada; Dr. Nick Kates, Ontario lead for the Quality Improvement and Innovation Partnership, and Dr. Debby Copes, the quality advisor for the Choice in Health Clinic in Toronto.

Dr. Robert McMurtry, the dean of the Faculty of Medicine and Dentistry at the University of Western Ontario from 1992 to 1999, set the tone of the evening as he explained why he believes in the Canadian health caresystem.

He told the story of two lawyers: one his father and the other his brother, the late Bill McMurtry, a tireless crusader for social justice and author of the 1974 McMurtry Report on Violence in Hockey.

His father, Roy McMurtry senior, had had rheumatic heart disease and was unable to buy medical insurance. When his father suffered a stroke in the early '50s, in the days before medicare, McMurtry senior was left financially crippled by the mounting medial expenses.

Years later, when his brother Bill was diagnosed with stage 4 lung cancer, Bill considered leaving Canada for treatment. He searched broadly outside the country but discovered the care being "offered in Toronto was as good as it gets."

Robert McMurtry and the other three panelists all firmly believe in publicly funded health care. Yet there is increasing pressure in Canada to expand the role of the private-sector in health care, he said.

Dr. Jeff Turnbull

According to Dr. Jeff Turnbull, chief of staff, Ottawa Hospital, when it comes to health care in Canada there is "an elephant in the room", and that elephant is cost. He said health care costs make up more than 40 percent of the Ontario government’s total program spending and could hit 50 percent.

McMurtry added that although these percentages do not tell the whole story they do grab headlines. Reporters love these numbers.

The answer is not more private-sector involvement, according to Dr. Debby Copes who cited a McMaster University study: "There's a lot of evidence that shows private for-profit health care costs more and has poorer outcomes (compared to publicly funded systems)." There was a great deal of support for Copes' position on the panel.

Whether the approach is public or private, both must face the same problems — such as an aging population. According to Kates, "The problems are there, and will be there, no matter what."

With a public system, "We are all in the same lifeboat. There is more incentive to make it work."

On the positive side, there are many examples of the public system learning to do what McMurtry was suggesting — "innovate or perish." We not only have to do better than we are doing now, we can do better.

An example of what McMurtry was suggesting is the trauma, emergency and critical care (TECC) program at Sunnybrook Health Sciences Centre in north-central Toronto. The centre is well know for its dedication to innovative, quality care.

Or look to the activity-based funding being championed by Alberta Health Services. "They found they could do it faster, cheaper and better. That should be our model." There is so much we could do better than we do now, McMurty continued.

This was a theme that ran through the presentations of all the panelists. Canadians must get more bang for the their health care buck. We must use our existing resources more efficiently.

All agreed it won’t be easy for the Canadian health system to regain its social justice mojo which was front and centre at its birth those many decades ago. Over the passing years a fiscal agenda has pushed aside the service agenda.

The panel took an aggressive stance when it came to change. "We have to think differently, better, smarter," according to Turnbull. He went on to show how "it can be done." He spoke proudly of Ottawa Inner City Health Inc., rattled off a long list of programs offered, and then added the kicker: "It saves $3.5 million annually."

Wrapping up the night, Kates made it clear the health care system must embrace change but within a social justice framework. He said: " 'Insanity: doing the same thing over and over again and expecting different results.' Albert Einstein."

Dr. Debby Copes

Copes smiled and added: " 'Without deviation from the norm, progress is not possible': Frank Zappa."

After the panel discussion, Dr. Jeff Turnbull, chief of staff Ottawa Hospital, I asked about the furor over the Premier of Newfoundland, Danny Williams, travelling to Florida for heart surgery.

Turnbull was not going to be drawn into commenting but he did say, on the record, there is no long queue of patients awaiting cardiac surgery at Ottawa Hospital where minimally invasive surgery is among the offered surgical procedures.

(We now know Williams' surgery did not go as smoothly as anticipated. The operation took hours longer the originally planned because of unforeseen problems encountered in the repair of Williams' valve. His stay in the Miami hospital was about twice as long as that of many patients who have the full, traditional, sternum cutting, surgery. I am not adding this to knock the Miami hospital. I am just mentioning this to complete the story.)
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A note in passing: The London Free Press, part of the Sun Media chain owned by Quebecor Media Inc., was not able to cover this important panel discussion. Why? My guess is that staffing cutbacks left the paper short staffed and unable to attend. Sad.

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.

__________________________________________________________
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.