Local neurosurgeon Dr. Adam Lewis made the front page of the Wall Street Journal this weekend. Dr. Lewis apparently owns part of a medical device company and uses its products for his patients. The article questioned whether some of the surgeries were actually necessary and might have been performed to generate sales of the devices. Some excerpts from the story:
"JACKSON, Miss.--On April 7, a 48-year-old Baptist preacher named Gary
Steve Moore had spinal-fusion surgery at St. Dominic Hospital here.
Hours later, he was dead.
Mr. Moore had been suffering from a degenerating disk in his lower
back. Two spine surgeons who later reviewed his medical records say
his history of heart disease and bowel obstructions made him a poor
candidate for a 360-degree spinal fusion, a complex operation that
involved opening up both his abdomen and his back.
His neurosurgeon, Adam Lewis, felt that "surgery was indicated" given
Mr. Moore's worsening back pain and the fact that more conservative
treatments he had tried, such as physical therapy, had provided no
relief, says Dr. Lewis's lawyer, Whit Johnson.
However, there was one element of the surgery that Dr. Lewis didn't
mention to the patient, according to his widow: The surgeon was part-
owner of the company, Spinal USA, that makes the devices he implanted
in Mr. Moore's spine.
Dr. Lewis's part-ownership of a medical-device company is far from
unique in the world of back surgery. Rather than use spinal implants
from third-party manufacturers, scores of surgeons have started their
own device makers to churn out similar designs, putting themselves in
a position to benefit financially from the hardware they insert into
patients.
Critics of such arrangements say they give surgeons an incentive to do
more operations, and that the conflict of interest has led to a spate
of unnecessary back surgeries that waste health-care dollars and often
do patients more harm than good. "Patients are having huge operations
that are un-indicated because of this," says Scott Lederhaus, a
neurosurgeon in Pomona, Calif., and member of the Association for
Medical Ethics, an organization of doctors that focuses on conflicts
of interest.
Dr. Lewis's lawyer says his client's financial interest in Spinal USA
had nothing to do with his decision to operate on Mr. Moore. Dr. Lewis
used Spinal USA implants because he helped design them and believed
they "were the best on the market for the procedure," not because he
stood to profit from them, says Mr. Johnson. He says Dr. Lewis "is
truly sorry about Mr. Moore's death."
Spinal-fusion surgery, which involves fusing together vertebrae, is
used to treat a variety of back problems, particularly serious ones
such as spinal fractures and scoliosis. It went from being the 37th
most common hospital inpatient procedure in the U.S. in 1998 to the
16th most common in 2008, according to a study to be published soon in
the journal Spine. It now accounts for around $10 billion a year in
U.S. medical spending.
Spine surgeons began implanting plates, rods and screws in patients'
backs in the early 1990s. A federal antikickback law prohibits medical-
device makers from paying surgeons to use their products. Mindful of
the law, big device makers entered into partnerships with spinal
surgeons, paying them consulting fees and royalties for help designing
their products. In some cases, surgeons receiving payments would use
that company's devices exclusively and would author research favorable
to those products, company documents obtained by congressional
investigators show.
Eventually, some entrepreneurial surgeons started making their own
hardware. Surgeons often get to choose what devices they use, so some
hospitals had no choice but to buy their products.
In addition to Dr. Lewis's Spinal USA, spinal-implant manufacturers
created and co-owned by surgeons include Titan Spine in Mequon, Wis.;
X-spine in Miamisburg, Ohio; and Innovasis in Salt Lake City. Surgeon
Peter Ullrich, chief executive of Titan Spine, says he uses its
products when he operates. X-spine and Innovasis didn't respond to
requests for comment.
The Food and Drug Administration has a less stringent approval process
for medical devices nearly identical to ones on the market. Surgeons
only have to submit mechanical-testing data attesting that their
implants are "substantially equivalent" to existing ones. The FDA
usually gives its green light within 90 days.
Surgeon-owned implant makers, including Spinal USA, say they reduce
health-care costs because their companies don't have marketing
expenses and sales staffs, and they charge hospitals less than
established medical-device makers do.....
Dr. Lewis, the Jackson, Miss., neurosurgeon, has long had financial
ties to device makers. From 2004 to 2006, he received payments from
Blackstone Medical Inc., according to his lawyer, Mr. Johnson.
A whistleblower lawsuit filed against Blackstone in a Massachusetts
federal court by one of its former sales representative and a former
distributor of its products alleges that the payments of up to $8,000
a month were to induce Dr. Lewis and other surgeons to use the
company's devices, in violation of the federal antikickback statute,
rendering Medicare reimbursement claims fraudulent.
Mr. Johnson says the payments were legitimate consulting fees his
client received for helping Blackstone develop two products.
Blackstone has denied the allegations, and the case is pending.
St. Dominic Hospital, where Dr. Lewis performs most of his surgeries,
says it temporarily stopped doing business with Blackstone in
September 2006 when the company declined to provide it with
information about its financial relationships with any hospital staff
members. Blackstone has since been acquired by another company.
Dr. Lewis teamed up that same year with a former medical-device
salesman and two other spine surgeons in Jackson and Hattiesburg,
Miss. to manufacture their own devices. Their company, Spinal USA, is
based in Pearl, Miss.
In the spring of 2007, FDA inspectors paid a surprise visit to Spinal
USA's offices. They assessed the company with 14 violations, ranging
from failing to maintain master records for its devices to having no
system in place to track and label them, according to a warning letter
the agency issued to the company. The violations were "symptomatic of
serious problems," the warning letter stated.
A spokesman for Spinal USA says its rapid growth caused it to run
afoul of FDA procedures. He says the company hired an experienced
manager to oversee quality control in February 2008, and a second FDA
inspection that September cleared the company of the violations.
During a third visit in December 2010, FDA inspectors found problems
with the way Spinal USA was storing bone products, which the company
also addressed.
In the summer of 2007, Dr. Lewis and his partners recruited four spine
surgeons in Huntsville, Ala. to invest in the company. Those surgeons,
Gilbert Aust, Cyrus Ghavam, Morris Seymour and Larry Parker, switched
to using Spinal USA implants in most of their surgeries, according to
a local representative for a big medical-device maker.
Four more Huntsville spine surgeons subsequently joined Spinal USA,
giving the company a relationship with eight of Huntsville's current
15 spine surgeons. Spinal USA also expanded to Mobile, Ala., where it
recruited two surgeons.
Dr. Aust, who is chairman of Spinal USA, confirmed that he and Drs.
Ghavam, Seymour and Parker are investors. The company declined to
comment on its other surgeon investors.
At Huntsville Hospital, one of the city's two hospitals, 351 spinal-
fusion surgeries were performed on Medicare patients in 2009, up from
333 in 2006, before Spinal USA came to town, a Wall Street Journal
analysis of Medicare claims data shows. At Crestwood Medical Center,
the city's other hospital, there were 187 such operations on Medicare
patients in 2009, up from 107 in 2006, the analysis shows. Huntsville
Hospital says it spent $5.6 million on Spinal USA products in its most
recent fiscal year.
Dr. Aust attributes the surgery increases to more spine surgeons
coming to town and to an aging local population.
Spinal USA's surgeon-owners sometimes operate on patients whose spines
already contain implants made by other manufacturers, placed during
prior surgeries. At times, as they insert additional Spinal USA
devices, they remove some hardware made by the other manufacturers and
replace it with Spinal USA products.
Dr. Aust says he performs such hardware replacements for medical
reasons, not financial ones. He says he doesn't see anything wrong
with the fact that they benefit him financially by contributing to
Spinal USA's sales. "I know some people in the profession don't think
it's ethical, but I just don't see it," he says.
The federal antikickback law doesn't specifically address the issue of
surgeons using medical devices made by companies they co-own....
Dr. Aust says he and Spinal USA's other surgeon investors own "the
majority of the company," but are working on lining up outside
investors. The Spinal USA spokesman says its surgeon owners are in
compliance with federal laws because their shares of profits are
proportional to their ownership stakes, not to how much business they
generate through their surgeries. He adds that more than 60% of the
company's business is generated by surgeons who aren't owners.
Spinal USA declines to say how much its surgeon owners earn from the
company. But a filing in the personal bankruptcy case of spine surgeon
Michael Molleston, one of its investors, says Dr. Molleston received
$26,000 a month from Spinal USA as of Nov. 19, 2008, when the filing
was made. Dr. Molleston couldn't be reached for comment.
The company says it generates more than $20 million in annual
revenues. Its spokesman notes, however, that its owners also are
"personally responsible for debts of the company."
Medicare data show Dr. Lewis in Jackson performs spinal fusions more
frequently than many of his peers. In 2008 and 2009, he performed 278
spinal fusions on Medicare patients, tenth most in the nation,
according to the Journal's analysis of Medicare claims data. In 150 of
those cases, or 54%, the patients' diagnosis was degenerative disks.
On March 25, Mr. Moore went to see Dr. Lewis complaining of lower-back
pain. After reviewing a magnetic resonance imaging of Mr. Moore's
spine, taken a few weeks earlier, Dr. Lewis concluded that he suffered
from a degenerative disk at the base of his spinal column, his medical
records indicate.
Mr. Johnson, Dr. Lewis's lawyer, says that, in addition to physical
therapy, Mr. Moore already had tried chiropractic care, pain
medication and steroid injections, to no avail, and his back pain was
"significantly interfering with his lifestyle."
Dr. Lewis scheduled surgery--a 360-degree fusion. The procedure
involves cutting open a patient's abdomen and back and fusing the
vertebrae from front and rear, rather than from just one side.
Many people over age 55 show evidence of disk degeneration, even if
they feel no pain, studies have shown. Advocates of treating back
problems conservatively say pain associated with disk degeneration can
be alleviated by physical therapy and rarely requires surgery. Other
surgeons say fusion surgery can relieve pain from the condition.
Two spine surgeons who have reviewed Mr. Moore's medical records and
films for the Journal say his disk's deterioration looked mild and did
not require a 360-degree fusion. One of them, Charles Rosen, president
of the Association for Medical Ethics and a spine surgeon at the
University of California, Irvine School of Medicine, contends: "No
operation of any kind could be justified." The other surgeon says a
less aggressive procedure might have been warranted, although the
patient's records don't suggest it was needed.
Both surgeons say Mr. Moore was a poor candidate for the 360-degree
fusion because he had had 11 abdominal surgeries for an obstructed
bowel. He also suffered from diabetes and had had a stent implanted to
treat his heart disease.
Mr. Johnson, Dr. Lewis's lawyer, says "different doctors can have
different opinions about the best treatment option, but that doesn't
make one right and one wrong." He says Mr. Moore wanted the surgery,
and he had been cleared by other specialists who deemed him capable of
withstanding the operation.
At St. Dominic Hospital, where the surgery was scheduled, a peer-
review committee in 2010 had asked the hospital's chief of
neurosurgery, John Lancon, to compile a report on 360-degree fusions
of the lower spine following a series of complications involving the
procedure, including two deaths, according to one person familiar with
the matter. One of the patients who died had been operated on by Dr.
Lewis, this person says. Dr. Lancon's report concluded that the risks
of the surgery outweighed the benefits in most instances it was
performed at the hospital, this person says.
Mr. Johnson says Dr. Lewis believes any deaths that followed 360-
degree spinal fusions he performed "were from unrelated health issues"
that developed after the surgeries. He declines to comment on any
cases other than Mr. Moore's.
The peer-review committee decided to form a working group to review
such cases before surgery, but under pressure from hospital
management, shifted to reviewing the cases only after the surgeries
were performed, the person familiar with the situation says.
Consequently, Mr. Moore's surgery wasn't reviewed beforehand. St.
Dominic's declined to comment on the matter, saying its peer-review
process is confidential.
During the surgery on Mr. Moore, Dr. Lewis implanted a titanium Spinal
USA cage and a Spinal USA plate with four screws. St. Dominic's
charged the Moores $13,960 for the implants. Spinal USA itself would
have received no more than $6,640 under the hospital's price-capping
policy. Dr. Lewis received $11,514 in surgical fees.
After the surgery, Mr. Moore was feverish and nauseous, says Kasey
Moore, his widow. Soon he was gasping for air. Doctors and nurses
tried to revive him for 40 minutes. He was pronounced dead at 5 p.m.
In a discharge summary, Dr. Lewis wrote that Mr. Moore's heart gave
out suddenly.
Neurosurgeons nationwide are sued for medical malpractice, on average,
about once every two years. Dr. Lewis has been sued for malpractice 18
times since 2002. He has won two cases at trial, lost one, and 10 have
been dismissed. Another five are pending, including one wrongful-death
suit. (Mr. Moore's family has not sued.) His operating privileges at
St. Dominic's have been suspended twice, court records show.
Mr. Johnson, his lawyer, says Dr. Lewis has never been in trouble with
Mississippi's medical board, and most of the suits filed against him
have proven to be without merit. Dr. Lewis is appealing the one case
he lost at trial, in which a jury in May returned a $553,000 verdict.
Mr. Johnson says Dr. Lewis's suspensions occurred because he fell
behind on patient charts.
Zoe Musick, Dr. Lewis's sister and his practice administrator, says
his surgeries are always medically necessary and his financial
interest in Spinal USA doesn't influence his decisions on whether or
not to operate.
Dr. Lewis never told the Moores of his involvement in Spinal USA,
according to Ms. Moore. A treatment authorization signed by Mr. Moore
says patients might be referred to "a health care facility" with which
their physician could have a "financial relationship." It says nothing
about medical devices.
Ms. Moore says she would have liked to know that Dr. Lewis stood to
profit from the implants he planned to insert in her husband's back.
"It might have caused me to ask: Is the surgery really necessary, or
is he out to make more money?" she says. Article
Monday, October 10, 2011
Local doctor & St. Dominic make front page of Wall Street Journal
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Trollfest '09
Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.
Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).
Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.
Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".
In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.
In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.
Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.
Relax at the Fox News Tent. Since there are only three blonde reporters in Jackson (being blonde is a requirement for working at Fox News), Megan and Kathryn from WAPT and Wendy from WLBT will be on loan to Fox. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both and a torn-up Obama yard sign will entitle you to free drinks served by Megan, Wendy, and Kathryn. Get your tickets now. Since this is an event for trolls, no ID is required. Just bring the hate. Bring the family, Trollfest '09 is for EVERYONE!!!
This is definitely a Beaver production.
Note: Security provided by INS.
Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).
Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.
Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".
In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.
In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.
Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.
Relax at the Fox News Tent. Since there are only three blonde reporters in Jackson (being blonde is a requirement for working at Fox News), Megan and Kathryn from WAPT and Wendy from WLBT will be on loan to Fox. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both and a torn-up Obama yard sign will entitle you to free drinks served by Megan, Wendy, and Kathryn. Get your tickets now. Since this is an event for trolls, no ID is required. Just bring the hate. Bring the family, Trollfest '09 is for EVERYONE!!!
This is definitely a Beaver production.
Note: Security provided by INS.
Trollfest '07
Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.
There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.
If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!
This is definitely a Beaver production.
Note: Security provided by INS.
There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.
If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!
This is definitely a Beaver production.
Note: Security provided by INS.
39 comments:
What's new about this? ...Doctors benefitting financially from their own decisions involving patient care. Whether its the dentist saying a filling needs to be replaced with a crown or the orthopaedic surgeon sending you down the hall in his own clinic to be scanned by the machine he has ownership in.
Dentists can scam us every day and we never know it. When they get all the fillings done over the course of years, then they start seeing the need for crowns and root canals.
Doctors used to send us across town to another facility for MRIs but many now have an interest in the machines or own them outright. It used to be just X-Ray machines that every clinic owned and of course every visit could potentially result in an X-Ray.
And we don't know which doctors are part owners of drug stores or which have considerable stock holdings in which pharmaceutical companies.
Shadowfax: Your likelihood of dying from an unnecessary crown is a whole lot less than from being put under anesthesia, cut from both the front AND the back and having a neurosurgeon mess with your spine.
Also, St. D's knew there was a problem and they didn't do anything about it.
is St. D a defendant in any lawsuits that involve Dr. Lewis?
Physicians are required to reveal such conflicts of interest to maintain their staff privileges. Did St. D know about this? If so, how did they monitor it?
I don't know if they are required to divulge such ownership relationships to their patients when they recommend surgery using a device they manufacture.
1:20; What is your evidence of this: "Also, St. D's knew there was a problem and they didn't do anything about it".
PS: The issue here is the apparent financial interest in procedures and devices, not the complexity of the procedure.
No different from the Highway Controlman owning the two truck.
I had spine surgery at St D's in 2007 by Dr Lewis's former partner Dr Ilercil. Mine went off without a hitch. I can also honestly say that Dr. Ilercil exhausted every option before surgery. I cannot, however, speak for Dr. Lewis.
Shadowfax: my read of the article is that there are 2 issues. One...conflict of interest. Two...is Dr. Lewis performing unnecessary surgeries. The two neurosurgeons who reviewed the case of the man who died both said the surgery was not warranted. Dr. Lewis performs the 10th greatest number of the surgeries in question on medicare patients in the country.
Did St. D's know there was a problem? The article states that they asked their chief of neurosurgery to investigate these surgeries. He and/or his committee determined most were unnecessary and recommended these surgeries be reviewed before they took place. According to the article, under pressure from hospital management it was agreed that these surgeries would be reviewed after they took place.
From where I sit it sure looks as though St. D's knew that things were not as they should be.
Anon 7:26; your first statement is that "St D knew of the problem and didn't do anything about it". Your followup comment is that "from where (you) sit, it looks as though St D's (sic) knew that things were not as they should be.
That sort of testimony would never fly in court. Anybody who has ever been involved in the contesting of medical treatment/surgeries/etc knows that you can always find someone to state that they appear to be unnecessary or are questionable as to necessity.
Lots of Monday morning quarterbacks out there. Dime a dozen, especially if motel allowance and steak at Tico's is included with travel allowance for the testifying "medical expert".
The problem here is that Lewis's own hospital said a lot of the surgeries appeared to be unwarranted - not some paid expert. In fact, quite the opposite is true. St. D. was making quite a few coins off this and had every reason to find the surgeries proper. The fact that people were sounding the alarm, in spite of its unpopularity, speaks volumes.
And there is such a thing as negligent credentialing, and testimony like that does, indeed, fly.
St. D. is in the business of making money. Even those nuns walking the halls pressing their fingertip to the foreheads of patients have a money-belt and padlocked strong box under those habits. Everybody knows that.
(No followup comments about the padlocked strong-box under the habit, please).
I have been in the medical business in one way or another all my life, and one constant has held true: Physicians do not like to police themselves. Yes, there are plenty of good doctors who will quickly work to identify and apply corrective behavior to bad ones, but it's rare when a physician is censured by a group of his peers to the point where he's forced to stop the offending behavior. Like legislators, doctors seem to be too self-protective to make the tough calls it takes to get a poor practitioner out of the business. Hospitals don't want to restrict their surgeons - they're the moneymakers and need to keep cutting - so it's up to the doctors on the hospital staff to keep their own house clean. Bill Billingsley
Interesting coincidence that Dr. Adam Lewis kicked in $5000 to Dorsey Carson's struggling campaign in late August.
1) To BB: Most physicians have no knowledge of how their associates decide on a recommendation for a particular patient; we do not routinely review every chart of every patient seen by every other doctor in the hospital. It usually takes a fatal event (such as this case) or a more than one complaint about a provider to the hospital to get an investigation started. We're not "too self-protective" - we're "too busy" to mind somebody else's business.
2) If the hospital was notified of serious suspicions about this doctor's mode of operation, and chose not to investigate, that may be something that could affect their accreditation - does anyone know if JCAHO has contacted the hospital yet?
Fair enough, 1:48. I admit that it's been a few years since I was in the hospital business and things may have changed. I remember that hospital administration didn't have the final say over who's on the medical staff and who's not. You may not be on any of them where you practice, but the medical staff committees - especially executive and credentialing - were there to address things like this, and they were the only ones who could restrict or revoke a surgeon's privileges. This doctor's trends should have been discovered in the normal course of case review in the Department of Surgery and passed up from there for review and appropriate corrective action if necessary. BB
Just from reading the article and not knowing any other specifics would seem to be the classic case of an outlier (18 lawsuits, top 10 in US in procedure numbers-many arguably unnecessary)corrupted by the pursuit of the dollar bill. This would make a good episode of American Greed.
So, as a diagnostic radiologist, I can not own an outpatient imaging center as reading for that center would be considered a "kickback", even though I would only be reading the studies, not ordering them. An orthopaedic surgeon, on the other hand can. He can send his patients all day long to his imaging center for studies he ordered without concern. A neurosurgeon can own the company that sells implants and surgical hardware (seemingly exclusively) to himself and that is legal. I hate to say it, but I am not feeling sympathetic at this time. Fair is fair.
Actually, looks the "The Good Wife" beat them to it. The episode on Sunday was eerily similar...
Most of the networks fired their writers in favor of reality TV shows, so they just copy what is in the news. Law and Order is really bad about this, too.
If you are a hammer, everything in life becomes a nail, and Adam is most definitely a hammer.
Sounds like we can expect some 'letters to the editor' from all these anonymous professionals who have first hand knowledge of this assault on patient confidence. But I won't hold my breath. After all, they all belong to the fraternity.
Shadowfax: I am not sure what assault on patient confidentiality you are referring to. Are you claiming that Mr. Moore's widow did not speak to the WSJ and the information about her husband was leaked?
You sound like Dr. Lewis' defense attorney.
There have been whispers about Dr. Lewis with respect to the number of surgeries and the number of complications on those surgeries in the Jackson medical community for years. Ultimately (as mentioned by Bill above) it is the responsibility of those he works with at St. Dominic's and the hospital itself to determine if there is merit to the whispers and take corrective action if necessary. It sounds as though the other neurosurgeons at St. Dominic's were attempting to do this and we thwarted by hospital administration.
Unfortunately you are correct about the fraternity. Doctors and hospitals are not inclined to discipline their own...especially those providing the hospital with a large revenue stream.
Unfortunately you are correct about the fraternity. Doctors and hospitals are not inclined to discipline their own...especially those providing the hospital with a large revenue stream.
A veritable medical version of the Mississippi Bar Association.
I am very curious as to why Dr. Lewis is the only one being named in the article. Not that I am taking up for him, but if this specific case was in fact a "360 degree fusion" wouldn't there have been a general surgeon involved to disect the abdomen down? And how did all these risk factors get past anesthesia? Sounds like more than one MD dropped the ball on this one.
Looks to me like there is a HIPPA violation by someone revealing confidential information to the Wall Street Journal. Is St. D. investigating this? Is Dr. Loncon Dr. Lewis's competition? Who told the WSJ about the Moore case? Is a breech of this kind a Federal crime?
Courious
Courious (sic); you need to brush up on HIPAA. The information leaked, as it were, regards an unscrupulous medical doctor, not the confidential medical information of the patient. And if PMI was 'leaked', it was reportedly 'leaked' by the widow which is not a violation of HIPAA. Regardless, I doubt the HIPAA Rabbit Trail is the one that will be pursued.
Meanwhile, smiling St D execs in flowing white habits will continue to appear at various charitable functions and other photo ops.
Dr. J. Patrick Barrett started Spinal USA with Jeffrey Johnson. Lewis then joined.
Taxpayers should be outraged this type of arrangement exists. All those Medicare dollars paying for overpriced hardware.
Wasn't Barret a past president of MSMA?
5:26 I don't work at St. D's; however, I do know that it is very difficult for an anesthesiologist to stop an operation. They can often delay it if the patient is very sick; however, if the patient has OK's from other docs the anesthesiologist can't do much...hospital politics favor surgeons and in this case it definitely appears as though the surgeon is being protected by the hospital given that the hospital rejected the recommendation of the peer review committee about pre-operation review of this type of surgery.
Shadowfax: "St. Dominic's....where every INSURED life matters."
the reporter from the WSJ was in Jackson for at least a week. He spoke to dozens of medical professionals. Basically, the whole medical community in Jackson knew this article was coming. There was a blood lust about it, because most had been wanting someone to put a leash on Lewis. Everyone knew Lewis operated on everyone that walked through door. Period. Then never saw the patient after surgery. Performed 6+ surgeries a day. Often, multiple surgeries on the same patient: you get your neck fused, you get your back fused, then you get an implant for the chronic pain that was never helped by the multiple surgeries you had (but never needed in the first place. Question: Why did certain vocal doctors at River Oaks, who seem to spend most of their day criticizing Dr. Lewis, not go "on the record" with the WSJ? Why turn coward when it might finally matter? Has the coat of self righteousness choked off blood flow to the head? Does NS2 stand for "Not Speaking"?
Question: did the legal team at St. Dominic's intimidate/threaten any St. Dominic's employed doctors from talking to the reporter? Specifically, were the employed neurosurgeons at St. Dominic's directly or indirectly discouraged from talking to the WSJ? Dr. Lancon was mentioned, but he was never able to be quoted directly. His office is at St. Dominic's. Did the powers that be (legal and otherwise) at St. Dominic's demand his silence? Sounds like he was trying to do the right thing.
BIg Question: St. Dominic's supposedly, from within it's own physician ranks, implemented a protocol to review cases before surgery. What happened? No way to remove the stink from this failure to act. They not only provided the location for the behavior, they licensed it. Lip service about "going to the FBI" has to be viewed from the perspective of…no changes were made. I guess the money Lewis generated was just too much to ignore.
Huge Question: is another hospital system drooling to prostitute itself to get the Lewis business? The other doctor mentioned in the article, Molleston. Didn't this new pimp hospital system recruit him to town in order to facilitate? Are some of the doctors at River Oaks currently protesting "their" hospital system's recruiting practices aiming to help Lewis and Molleston/
The whole physician owned distributorship issue is a sidelight. Most saw it for what it was: a way for Dr. Lewis to just make more money from his already grossly illegitimate practice. Wonder what the Federal Government will do.
Dr. Patrick Barrett was president of the MSMA while actively growing his company, Spinal USA. Do a little research and you will be surprised at what you will find.
Disgusting.
So glad that "Mr." Lewis is finally caught up with! I am a family member that has complained to St. D., called the Medical Licensure Board, and questioned others (i.e., after the death of a family member) did I find out many things that I wish I would have known before my family member had surgery and died a few months later. He went through terrible suffering after "MR" Lewis did surgery on him. Does the Medical Licensure Board have any part in this? Shouldn't they be more honest with the patients that call in? Who is responsible for letting us know that docs have had problems in previous states prior to coming to MS? We have the right to know what rubber has been left on the road before these docs come to MS and cause undue suffering on our family members. By the way who funds the MS Medical Licensure Board?????
Start talking to the nurses and co-workers at St D - did he have surgeries lined up like cattle? money, money, money!!! You would think St D had to be aware and would think to question if a doc is capable physically and emotionally of handling this many surgeries - oh but the money!!! It's a sad time in our culture where self-monetary worth precedes the lives of human beings. But many physicians and hospital administrators, not just St D, idolizes this concept. Those big salaries my dear! BIG SALARIES!
9:34 PM They would have to be BIG salaries to support Dr. Lewis' lifestyle. A look at the Madison County tax rolls is interesting.
9:29 Sorry for your loss. If another family member needs surgery, ask around, get a second opinion from out of town if possible, see who is performing the same surgery on medical professionals or their family members...there are huge differences in quality between doctors.
He was just named the head of neurosurgery at St. D. So much for getting "caught up" with.
4:00 PM: Wow!!! Did John Lancon quit as head of neurosurgery at St. D's in protest or was he pushed out as a result of all of the leaks?
Lewis becomes Chief 1/1/2012 when the current Vice Chiefs rotate by default into the Chief position. I think its the same for all the departments at StD. Its an administrative (ie paperwork) position.
the way it works is as follow; usually there is a trial lawyer involved as many of these cases are worker's comp.Many times the lawyer makes the "suggestion" to the client to go see certain neurosurgeons known to be "friendly" to the trial bar.The patient usually is some poor sod who is looking at a large worker's comp settlement. many of the patients have been on large doses of narcotics including oxycontin. This sets the stage for justifying the surgery;i.e. failure to respond to conservative care.Then comes the first surgery which never solves the problem Interestingly the non-worker comp patients do well and usually praise the doctor,return to work and that is that. However, the w/c patients never get better and so have a second or third surgery despite documentaion in the literature that the subsequent surgeries will not succeed. then come the third surgery to remove the hardware. By now the patient is truly disabled and wrecked for life. At this point the trial lawyer settles the case,gets a bundle, the surgeon has collected a bundle and the patient is a disaster;usually ending up as a narcotic addict on social security, for life.
winners:1.hospital makes a bundle
2.surgeon amkes a bundle
3.trial lawyer makes a bundle
Losers:
1.patient crippled for life
2.you and I pay for social security for this poor victim for life.
this system has worked for years and results in some really neat Xmas presents for the docs from the lawyers and hospitals.
Spinal USA's Dr. Adam Lewis is currently the Chief of Neurosurgery at St. Dominic's Memorial Hospital
http://www.linkedin.com/pub/adam-lewis/20/5b3/9a7
Lewis and Molleston are both Narcissistic to the bone. They don't care about anybody but themselves.
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