Monday, March 7, 2011

Unneeded medical procedures due in part to lack of standardization

My last post here, talked about a couple of Westmoreland doctors accused of having implanted 141 patients with cardiac stents that they did not need. A number of other articles have cropped up about this that you can read at the following sites: MSNBC, WTAE , Herald Standard, Pittsburgh Business Times.

If these two Westmoreland doctors were, in fact, prescribing unnecessary medical procedures then they should be punished civilly and maybe even criminally. But, though I do not practice criminal law, the first thing that jumped to mind while reading these articles was whether people are still considering these doctors innocent until proven guilty. Everything I have read has been pretty condemning of the doctors actions when we really do not know exactly what is going on. We know the allegations but we have not been provided much evidence to support the charges. Keep in mind that these are procedures that, for better or worse, are often at a doctors discretion to recommend. And, so far as I know, these doctors have not been formally charged with any misconduct.

I wonder about this because of the many articles that I have read about other doctors around the country that have been accused of performing unnecessary medical procedures. For example, well respected interventional cardiologist Dr. Sam DeMaio of Texas, is under investigation for this same misconduct. But DeMaio, and others supporting him, claim that the allegations of violations are part of a smear campaign related to his leaving his former hospital for a position at a competing facility. Because of the lack of specifically mandated medical protocols for treatment and surgery in United States health care, we must keep in mind that the necessity of many medical procedures, cardiac stents included, is at the discretion of a given doctor’s experience and expertise. With that in mind, there is a lot of research being conducted right now by various public health agencies looking into the implications of doctor’s case by case determinations of treatment. You can read two great articles about this here and here.

Arguably, many procedures that are beneficial from both a monetary and patient well-being perspective, are not being prescribed enough. Conversely, there are many procedures of questionable benefit that may be being prescribed too often. Cardiac stents may fall into the latter category. One of the reasons for this problem, again, is the lack of standardization of medical care in the United States.

The combination of these two factors may be exactly what is occurring with doctors Morcos and Bousamra. We do not know what really prompted the initial investigation. We do not know who it was that apparently “blew the whistle” on their actions. Thus I think it is important to presume these doctors innocent until we receive a final determination and the evidence proving them wrong. It seems to me that everyone is jumping to the conclusion that these two doctors are villains and crooks before anything has been definitively proven. From what I have read there is simply not enough information to reach a conclusion. More troubling yet is the possibility that these doctors may have over prescribed stenting procedures as a result of the discretionary leeway doctors are given in determining such treatment. Case by case decisions are going to lead to troubling variations in medical treatment across the country. This is why the U.S. health care system could benefit from increased standardization of treatment.
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