Herald-Leader blasts UK for secrecy surrounding children's heart program and its efforts to rebuild it despite nearby competition

The Lexington Herald-Leader blasted the University of Kentucky in an editorial Sunday for "stonewalling questions about the decision to halt pediatric cardiothoracic surgeries and the mysterious sidelining of Dr. Mark Plunkett, the high-profile surgeon UK hired in 2007 to rebuild that program."

Mark Plunkett

The editorial says UK officials implied that "all would be clear" after their examination of the children's heart program, but "nothing is clear" after they issued a 100-page report that "offers no explanation about what went wrong. In fact, Plunkett's name never appears in the report."

But the report does acknowledge two challenges in rebuilding the program: "There are several excellent congenital heart centers in close proximity" to Lexington, and "In some cases we must regain the trust of our referring providers." Dr. Michael Karpf, UK's vice president for health, has been publicly appealing for referrals of all types from hospitals and physicians in Western Kentucky, where UK competes with Vanderbilt University.

Michael Karpf

"After two unsuccessful, no doubt very expensive, efforts to build this program, UK wants to try again," the editorial says. "And it wants to regain trust of referring physicians and families with very sick, very young children despite the fact that it has consistently undermined trust by refusing to answer legitimate questions. UK has in fact agreed to pay a lot of money to avoid a public discussion of what went wrong," keeping Plunkett on the payroll, then paying him $1.5 million for "a vow of silence on both sides."

The editorial concludes, "It is aggravating that UK, a public land-grant institution in a very sick state, is intent on carving out a specialized, expensive health-care niche that's already filled when there are so many needs that are not being met. It is also deeply disturbing that UK's energy and treasure are aimed at maintaining a shroud of secrecy over this program. We still don't know much about what happened in Plunkett's operating rooms but it is clear that UK botched this opportunity to regain the public's trust." (Read more)

Asked to reply, UK spokesman Jay Blanton said, "First, our job is to make sure that Kentuckians have access to the most complex health care. Kentuckians should not have to go outside Kentucky to have access to such high-quality, complex care. . . . If we didn’t have such a program, Kentuckians – particularly those in Eastern Kentucky – will have to leave the state for critically important pediatric care. Moreover, part of the requirements of having a Level 1 trauma center and service for this region is to have an appropriate presence in this critical area of children’s care.

"Second, we’ve been totally forthright. Our standards and expectations – for both transparency and quality – are evidenced by, among other things, our ranking just this month of 12th out of 118 academic medical centers for quality, by University Health Consortium. UHC provides an objective, impartial analysis across a range of quality measures. You don’t rank 12th in the country if you are not putting forward, in a transparent fashion, your numbers and outcomes across an array of metrics and quality measurements."

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

New type of artificial knee, designed for individual patients, is being implanted at St. Joseph East in Lexington

Saint Joseph East hospital in Lexington is Kentucky's first hospital to offer a customized total knee replacement system in which each the knee implant is made to match the individual patient’s anatomy, says a news release from ConforMIS, manufacturer of the implants. So far, about 20 patients in Lexington have received the ConforMIS total-knee replacement surgery, says the release.

“With this new technology, we’re able to offer an implant that is molded to each individual patient precisely,” said Wallace Huff of Bluegrass Orthopaedics, part of KentuckyOne Health, which includes Saint Joseph. “We’re seeing patients healing faster and more easily acclimating to the new knee.”

Typically, knees are replaced due to osteoarthritis and its breakdown and eventual loss of cartilage of one or more joints. Unlike traditional knee replacements, the ConforMIS system uses technology to design and manufacture knee implants for each individual patient, so less bone is removed during the surgical procedure. This provides the potential for faster recovery from the surgery.

Petition drive from parents asks UK Healthcare to release mortality rates for cardiothoracic surgeries on children

More than 250 people have signed a petition asking the University of Kentucky hospital "to make public the mortality rates for pediatric cardiothoracic surgery patients from 2010, 2011 and 2012," Linda Blackford reports for the Lexington Herald-Leader. "All pediatric cardiothoracic surgeries were suspended at UK last fall amid an internal review." UK spokesman Jay Blanton said Monday the investigation is not complete.

"In May, the state attorney general's office issued an opinion that said UK must release mortality rates and other data about the cardiothoracic surgery program to WUKY, the university-owned radio station," Blackford reports. "UK has acknowledged that it calculated mortality rates for the program as part of its investigation, but has refused to release them, citing patient confidentiality laws." The Herald-Leader also requested the information under the Kentucky Open Records Act.

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

The three-year span includes the tenure of ardiothoracic surgeon Dr. Mark Plunkett, who no longer works at UK. Jennifer Allen, whose one-year-old daughter died after having three surgeries performed by Dr. Plunkett, wrote on the petition, "We deserve to know this information, we CAN understand and comprehend this information. It is our right to know and the right of the public!" Allen's daughter suffered from hypoplastic left heart syndrome, where the left side of the heart is underdeveloped and can't pump blood properly. Allen told Blackford she finds it "very suspicious" that UK won't release the information. UK says there were so few surgeries at times that patients' identities could be deduced.

Tabitha Rainey, whose son survived cardiothoracic surgery at UK, before being moved to another hospital, started the petition after being interviewed by CNN, which reported on the issue over the weekend and updated its story today with news of the petition. She said she doesn't accept UK's response that publicly releasing mortality rates would somehow harm patient confidentiality, telling Blackford, "There are no names and no dates, just the data on how many have passed on." (Read more)

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Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

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Chief of cardiothoracic surgery and pediatric heart program at UK, suspended from surgeries, takes job in Florida

Dr. Mark Plunkett, the chief University of Kentucky cardiothoracic surgeon whose surgery program was suspended last year for unspecified reasons, has accepted a new job a the University of Florida.

The internal review of UK HealthCare's pediatric cardiothoractic program is ongoing and should be completed in the next few weeks, Michael Karpf, UK's executive vice president for health affairs, told Linda Blackford of the Lexington Herald-Leader.

In December, Brenna Angel, reporter for university radio station WUKY, identified Plunkett as the surgeon at the center of the program review. At the time, Plunkett was on a leave of absence but remained on staff with a $700,000 salary, Angel reported. WUKY requested data under the Kentucky Open Records Act about Plunkett's most recent surgery and his patient mortality rate, but UK denied such requests. Attorney General Jack Conway ruled that UK must release the mortality rates and other data, but UK Has appealed to Fayette Circuit Court, citing privacy rules in the federal Health Insurance Portability and Accountability Act, even though Conway said HIPAA doesn't preempt the Open Records Act, as Angel reported. Angel has since left the station for Lexington city government but the station and the Herald-Leader are defending the appeal.

In addition to being chief of UK's Division of Cardiothoracic Surgery, Plunkett was director of its pediatric cardiac program and a co-director of UK's Gill Heart Institute, says his UK biography. He came to UK in 2007 from the UCLA medical center, where he worked with Karpf. His resignation is effective Aug. 14, UK officials told Blackford.

UK Healthcare says it must get even bigger, and expand its market area, to provide needed services to Kentucky

By Molly Burchett and Al Cross
Kentucky Health News

The University of Kentucky's health-care system has grown by leaps and bounds in the last decade, becoming one of the state's largest businesses, but its boss says it must expand its geographical reach to maintain its newly raised national status and to ensure access to quality care for Kentuckians.

Over the last decade, UK HealthCare’s caseload has increased 85 percent, and its annual hospital budget has increased from $300 million to $922 million, Dr. Michael Karpf, executive vice president for health affairs, said in an interview.

This explosive growth, in addition to the growth of the UK medical school, has jacked up the enterprise's national ranking. It has grown from about the 85th largest academic hospital in the U.S. to approaching the 35th largest in terms of total discharges, the benchmark it uses. That means it has jumped from the bottom third to the top third in less than a decade. (For a more precise measurement over time, based on a Council of Teaching Hospitals standard, see chart.)

The push for growth and development began in 2003, after UK's caseload hit a plateau even though the 1998 General Assembly had mandated it to become a top 20 public research institution. Karpf came aboard and combined the Chandler Medical Center, clinics, faculty practice plans and the College of Medicine into a single integrated system of care -- branded as UK HealthCare -- which he commands. Good Samaritan Hospital in Lexington was added in 2007.

"Ten years ago people viewed this a safety-net hospital," Karpf said of the Chandler facility. "We've had to redo the brand." Now more people are choosing the hospital, as suggested by who's paying the bills. Medicare now covers a plurality of the patients; a decade ago, it trailed Medicaid, the program for the poor and disabled. In that time, the total caseload grew 7.2 percent; Medicare cases rose 10.9 percent.

But despite the huge growth in the last decade, the enterprise is still not big enough, Karpf said.

"We want the hospital to be the first choice when it comes to complex care,” he said. “We must advance to better serve the health-care needs of Kentucky.” To do this, he said, UK HealthCare is rejuvenating its brand as "Kentucky's Best Hospital," with a broad range of advanced specialties to keep Kentuckians from leaving the state for care, and is moving to expand its geographic reach to Western Kentucky and out-of-state markets.

Karpf said UK must expand because its traditional market, approximately the eastern half of the state, is not large enough to provide the number of cases that UK will need to receive certification as a federal “Center of Excellence” for complex services like brain surgery and heart, liver, kidney and lung transplantation. He said such a designation will be necessary to get enough referrals from doctors and smaller hospitals to maintain these services and to guarantee that Kentuckians can get the care they need inside the state. "What we make money on is the complex stuff," he said.

Unless UK secures half the available business from out-of-state competitive areas over the next 10 years, Karpf said, "It becomes an issue of access for Kentuckians."

He said the out-of-state institutions that are large and advanced enough to effectively compete with UK as a major referral center include Vanderbilt University, Washington University in St. Louis, Indiana University, Ohio State University, Cleveland Clinic, the University of Pittsburgh Medical Center and the University of Virginia. Vanderbilt is the nation's 10th largest academic medical center and gets many patients from Western and Southern Kentucky. 

UK HealthCare map shows out-of-state markets and institutions it targets for its expansion.

What about Louisville, Cincinnati, Knoxville and other cities? Karpf said the University of Louisville, the University of Tennessee, the University of Cincinnati and West Virginia University are too small and too far behind to be Centers of Excellence. U of L's hospital ranks 88th in total discharges among academic medical centers.

All hospitals are facing challenges from federal health-care reform, but Karpf said at UK it has prompted a culture change centered on quality of care, which the reform law is designed to reward. As UK tries to expand its market, he said, it is critical to stay focused on, safety, service and patient satisfaction. One issue Karpf is dealing with now is the hospital's cardiothoracic surgery program for children, which has been suspended pending an internal review.

As UK seeks more referrals, Karpf said, it is building better relationships with smaller hospitals. "in the past, academic medical centers have been seen as predatory," he said. "We concluded that we need to be seen as in another line of business. . . . We have very strong relationships with community hospitals in Western Kentucky."

For example, UK is  training a cardiologist who is dedicated to practicing in Paducah once his training is complete, and kidney specialists from the area are in its transplant network. The specialists evaluate patients, send them to Lexington for transplants, and provide follow-up care upon their return. Such coordination helps community hospitals keep patients and recruit professional staff, and helps UK capture the cases it might lose to Vanderbilt and other out-of-state hospitals.

Baptist Hospitals Inc. has a large facility in Paducah and recently bought the Trover Health System hospital in Madisonville, making Baptist the largest hospital system in Kentucky, but Karpf said UK has a strong relationships with Baptist and the Norton Healthcare hospitals in Louisville. "They do not compete with us for complex care," he said. "We don't go after the bread-and-butter cases."

Complex care, for which insurance companies pay well, accounts for 5 to 7 percent of UK's cases but almost all its profits. Karpf said UK loses money on another 5 to 7 percent and breaks about even on the rest. He said the profits are invested in buildings, technological equipment and attracting nationally recognized specialists.

The most visible evidence of that is the hospital's new bed tower, part of $1.4 billion UK Healthcare has spent revitalizing itself, mostly with its own profits. But the larger impact is probably in expansion of good-paying jobs.

Dr. Michael Karpf

"We've been the most important growth engine in this region," said Karpf. UK HealthCare went from paying $350 million in salaries and benefits in 2004 to more than $700 million last year. The College of Medicine went from 1,810 employees in 2004 to 2,337 in 2012. The hospital grew from 2,562 full time employees in 2004 to 5,544 in 2012, a 116 percent increase.

The medical school's full-time faculty has expanded from 443 a decade ago to 625 now. "We know the stronger you are clinically, the better your research profile," Karpf said. UK Healthcare hopes to achieve National Cancer Institute designation for the Markey Cancer Center, and it must continue to evolve in its clinical, education and research missions, Karpf said.

If UK HealthCare can do that, it will continue to be a major economic driver for Kentucky while ensuring that all Kentuckians have access to quality care.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

UK has its pediatric heart program under review; chief is on leave, and patients are being referred to other hospitals

Kentucky Children's Hospital at the University of Kentucky is reviewing its cardio-thoracic surgery program and referring surgical patients to other hospitals, "but the reasons why are unclear," Brenna Angel reported Dec. 21 for WUKY-FM, the university-owned station.

Angel did identify "the surgeon at the center of the review," Dr. Mark Plunkett, left, who is on a leave of absence but "remains on staff at UK with a $700,000 annual salary," as chief of cardio-thoracic surgery. "UK denied an open-records request for the date of his most recent surgery and his patient mortality rate," citing privacy rules in the federal Health Insurance Portability and Accountability Act. It was unclear how release of such statistics, without any personally identifying information, would compromise privacy. Plunkett and officials of the medical center refused to be interviewed.

"It's been pretty hush-hush," Tabitha Rainey of Lexington, the mother of a Plunkett patient, told Angel, who reported: "Plunkett and his assistant Dr. Deborah Kozik operated on Waylon seven days after he was born. Tabitha was later told that Dr. Plunkett was taking a leave of absence." Rainey told Angel, "Months went past and they lost another patient, who was a dear friend of mine, and it was pretty heavy in the unit at the time. Then soon after I guess they decided to stop doing the surgeries and review the entire program."

Angle was able to get some records from UK and reported they showed that "The number of children Dr. Plunkett operated on this year is down around 43 percent from two years ago." UK Trustee Dr. Charles Sachatello, a surgeon who sits on the Board of Trustees' health-care committee, told Angel, "I was not aware of that, and that was never announced at the Board of Trustees meeting." Sachatello told Angel that UK should merge its pediatric heart program with the one at the University of Louisville because of the high operational costs of such programs. (Read more)

Health care decisions by and for Medicare patients differ widely by place; Lexington big in back surgery, low in mastectomy

All medicine involves decisions and, according to a new series of nine reports published by the Dartmouth Atlas Project, those decisions differ drastically by location for Medicare patients. In the East South Central region -- Kentucky, Tennessee, Alabama and Mississippi), the variation between how things are diagnosed and treated can change when one crosses county lines.

An example, with numbers but without explanation: The total knee replacement rate in Harlan is 3.3 per 1,000 Medicare beneficaries; in Bardstown, it's 13.8. As the report goes on to note: "If you have heart disease and live in Huntsville, Ala., you are half as likely to undergo balloon angioplasty than if you live in Hattiesburg, Miss., and twice as likely to undergo back surgery if you live in Lexington, Ky." The greatest variation in the region was seen in mastectomy, ranging from a low of 0.3 percent per 1,000 female Medicare beneficiaries in Lexington to 2.1 per 1,000 in Tupelo, Miss.

The point, researchers say, is that providers and patients need to work together to determine care. The report looked at rates for early-stage breast cancer, stable angina, low back pain, arthritis of the knee or hip, carotid artery disease, gallstones, enlarged prostate, and early-stage prostate cancer. Read the report here.

UK music therapy helps manage surgical anxiety, pain, recovery

A University of Kentucky study has found that music therapy can reduce pain before, during and after a surgical procedure, and shorten recovery time. The study report, published in the Southern Medical Journal, showed music was also useful in managing surgical anxiety. According to Lori Gooding, UK director of music therapy and lead author of the report, the music should be selected by trained personnel with a mind toward specific guidelines for music selection in order to maximize its positive effect on patients, though the patient's musical tastes should still be considered. Gooding suggests patients be offered several playlists from which to choose so they can have something to suit their tastes as well as the medical protocol. (UK video)



Gooding writes that the tempo, rhythm and volume of the music should be carefully controlled to maximize its effect. Calm, slow, gentle music was shown to produce the most positive results and facilitate relaxation and pain reduction in patients. UK began providing music therapy for patients in Kentucky Children’s Hospital, UK Chandler Hospital and UK Good Samaritan Behavioral Health in October 2010. The UK Music Therapy program was established as part of the Lucille Caudill Little Performing Arts in HealthCare Program, a unique partnership between the UK School of Music and UK HealthCare. (Read more)

First heart-lung transplant in Ky. in 15 years performed at UK

University of Kentucky surgeons performed Kentucky's first combined heart-lung transplant in 15 years this summer, UK announced today.

Dawn Nelson, 29, of Louisville, received two lungs and a heart from the same donor in one procedure at the Albert B. Chandler Medical Center on July 7. She and her parents discussed it with Courier-Journal reporter Laura Ungar in this video by The C-J's Kylene White:


For Ungar's story, click here. Combined heart-lung transplants are rare; only 27 were performed nationwide in 2011. They are generally performed on younger patients who have a fatal disease and cannot be treated with medication or other interventions.

Nelson was diagnosed with systemic lupus erythematosus at 17 and rheumatoid arthritis at 22. Four years ago, she developed pulmonary hypertension, fatal without timely treatment. The disease destroyed her lungs, and her heart began to fail when it could no longer push blood into them.

Dr. Wesley McConnell, a transplant pulmonologist with Kentuckiana Pulmonary Associates in Louisville, began caring for Dawn two and a half years ago at KPA's Pulmonary Hypertension Center. After she didn't respond to drug therapies, McConnell referred Dawn to UK May 11 for a transplant evaluation. "Dawn was extremely ill and it became clear that her only chance for survival would be a heart-lung transplant," he said. "I knew that UK was her best option because they had the most experienced team in the state."

Dr. Charles Hoopes, director of the UK Transplant Center, performed the surgery, only the seventh such procedure to be performed at UK since it began transplantation in 1964. The last time UK performed this surgery was 1996. "Although the surgery itself is relatively simple, combined heart-lung transplants are rare because they require three donor organs and are reserved for patients who are extremely ill with heart and lung failure," said Dr. Jay Zwischenberger, chair of the UK Department of Surgery. "They also require a great deal of infrastructure and support to perform successfully. At UK, we have that team in place, and moving forward we expect to perform one or two of these combined transplants per year."

More than four months after her surgery, Nelson continues to improve and grow stronger. Dr. Enrique Diaz, medical director for lung transplantation, and Dr. Navin Rajagopalan, medical director of cardiac transplantation, both provide followup care for her at UK, and she continues to see McConnell in Louisville. "Dawn is doing quite well. At the time of transplant, she was so sick she only weighed about 80 pounds," Rajagopalan said. "Now, she feels well, is gaining weight, and is able to do things that she had not been able to do for years.”

Nelson's collaborative treatment is a prime example of the partnership UK is trying to cultivate among Louisville and Lexington doctors, said Dr. Michael Karpf, UK executive vice president for health affairs: “Our goal is to continue to provide highly advanced subspecialty care such as Ms. Nelson’s complex transplant to patients like her who otherwise would either have to leave the commonwealth or, worse, not receive the treatment needed.”

In November 2010, UK in collaboration with Norton HealthCare opened up an outreach Transplant and Specialty Clinic at Norton Audubon Hospital to provide comprehensive pre- and post-transplant care for patients. The partnership ensures that patients like Nelson will not have to leave the state to receive complex acute care or followup treatment, a UK press release said.

State's hospitals see impressive growth spurt from nearly $1 billion in capital investment

Kentucky’s major hospital systems are going big, making high-profile, technology-forward capital investments across the commonwealth. Josh Shepherd of The Lane Report writes that every sector of the state is part of the hospital boom. The state's cumulative total of investment since 2010 is roughly a billion dollars, notes Shepherd, and has meant hundreds of construction and, soon, medical and other hospital-related jobs. Here's the list of the most notable construction projects now under way:

Owensboro Medical Health System,  $385 million, a new complex (pictured, above) that will allow expansion for the next 50 years, completion date: summer 2013.

Norton Healthcare System, Louisville, converting Suburban Hospital into Norton Women's Hospital and Kosair Children's Hospital, $120 million, completion date: 2013.

Pikeville Medical Center, new office building and parking facility, $130 million, completion soon.

Baptist Health, Lexington, expansion of Central Baptist Hospital medical services complex with parking structure, $200 million.

University of Kentucky Healthcare, Chandler Medical Center, $750 million, includes new plans for Shriners Hospital for Children.

Frankfort Regional Hospital,  $8 million expansion, emergency department.

Trigg County Hospital, $7 million, surgery and rehabilitation unit.

Lifepoint Hospitals-owned Clark Regional Medical Center, $60 million, 79-bed hospital. (Read more)

18 Kentucky hospitals cited as 'top performers' on accreditation board's annual list

Eighteen Kentucky hospitals have been included on the annual list of hospitals that have excelled at adhering to basic procedures for surgery and other treatment of common illnesses such as heart attacks, heart failure and pneumonia. The Joint Commission, the nation’s major hospital accreditation board, has released this year's list of 620 hospitals considered to be “top performers” for following recommended protocols at least 95 percent of the time. The top 18 percent of accredited hospitals make the list.

Among the Kentucky hospitals that qualified on all four measurements were Greenview Hospital in Bowling Green, Ephraim McDowell Regional Medical Center in Danville, St. Elizabeth Medical Center in both Florence and Fort Thomas, Central Baptist Hospital in Lexington.

Those qualifying in three categories were the Robley Rex Veterans Affairs Medical Center in Louisville (not in surgery) and the Appalachian Regional Hospitals in Harlan and Middlesboro (not in heart attack).

Qualifying in two categories were Twin Lakes Regional Medical Center in Leitchfield, Frankfort Regional Medical Center, the Hospital of Louisa and Jackson Hospital Corp., all for pneumonia and surgical care.

Recognized for pneumonia care were Parkway Regional Hospital in Fulton, Paul B. Hall Regional Medical Center in Paintsville, Logan Memorial Hospital in Russellville and the KentuckyOne Health Hospital in Martin.

Among behavioral-health hospitals, ranked on their in-patient psychiatric care, the Kentucky facilities on the list were the Universal Health Services facility in Bowling Green, the new Cumberland Hall Hospital in Hopkinsville.

According to Kaiser Health News, the Leapfrog Group, a nonprofit organization devoted to patient safety, aided in the rankings process, as did Consumer Reports. The Commission has its own metrics. It's worth noting that next month, Medicare will start using hospital quality rankings on its Hospital Compare website to set reimbursements. (Read more)

After two days with doctors at work, Herald-Leader columnist wonders about patients and future of health-care system

Tom Eblen

Tom Eblen, the Lexington Herald-Leader's local columnist and former editor, spent two days shadowing doctors last week and lived to tell about it. Part of the Lexington Medical Society's Mini-Internship Program, Eblen was given a close-up look at the working lives of physicians and the world in which they, well, operate. He found himself alongside an orthopedic surgeon replacing shoulders, doing fascinating retinal work with an caring opthalmologist, in an emergency room on a slow day and with a busy internal medicine specialist. He learned more than confirming he had probably made the correct career choice, he writes.

In the emergency room: "A middle-aged man with a history of heart trouble came in with chest pains. An elderly man came in suffering from dizziness. A young man came in with an infection from a mouth full of rotten teeth. Like more than one-quarter of all Kentuckians, the young man and several other people Wooster saw that day had no health insurance. What people forget when they debate the cost of universal coverage is that society already pays for treating uninsured people, often at high-cost emergency rooms. . . .

"As I shadowed these physicians, I kept thinking how much of their patients' pain and suffering could have been avoided if they had taken better care of themselves — if they had eaten better, gotten more exercise, and avoided cigarettes and substance abuse. I wondered how we will continue to manage not only our health care system, but our rising expectations. As people live longer and get sicker, we may need to focus more on quality of life rather than simply extending it at all costs." (Read more)

Tonsillectomies not necessary much of the time; among $158 billion spent each year on unnecessary health care

Photo by Matthew Staver, Bloomberg

Tonsillectomies are the most common procedure for children requiring anesthesia. "The only problem is there's no evidence they work for most" kids, reports Sarah Cliff of The Washington Post.

"The procedure does show some benefits for those with really serious symptoms — very sore throats, fevers and other symptoms at least seven times in the past year — but no improvement for those whose indications are milder," Cliff reports.

Yet, more and more of the procedures are being performed. Between 1996 and 2006, the number of tonsillectomies increased by 74 percent.

"It's a silent epidemic of unnecessary care," said David Goodman of the Dartmouth Atlas of Health Care. "In most instances, it's done for patients with much less recurrent symptoms than should be indicated. I think a lot of this is unbeknownst to providers."

Unnecessary health care costs about $158 billion every year, Cliff reports, and the sum is partly to blame on demanding patients, to whom doctors acquiesce. Because doctors are paid based on volume, there is also an incentive to provide more care, even if it's not necessary.

Goodman said the medical education system is one main culprit. "Medical schools and graduate schools are failing us deeply," he said. "We need to move some of these ideas about the evidence being uncertain into the beginning of education. There's been such little work on that." (Read more)

A culture of silence remains about medical errors, but things are slowly improving, physician-activist says

There has been a culture of silence when it comes to talking about medical errors, but things are slowly changing, writes Dr. Kevin Kavanagh, right, in an op-ed piece in the Lexington Herald-Leader.

Kavanagh, who is chairman of Health Watch USA, recalls an incident in which a patient came to be treated for a severe sinus infection. Upon being rushed to surgery, Kavanagh discovered "an old smelly gauze pack" had been left in the sinus from a previous operation. When an assistant asked Kavanagh what he should tell the patient, "I answered, 'The truth'," for which he was disciplined by a senior surgeon.

"Years have passed, and things are starting to change in medicine," Kavanagh writes. "Telling patients that something went wrong is slowly being accepted — a revolutionary idea to medicine."

Studies have shown that hospitals with full-disclosure policies actually have lower patient death rates, which Kavanagh just called "common sense." "If preventable patient harm occurs on a ward and the patient is not told, almost all of the employees on the ward will know about the cover-up," he writes. "How then will the administration garner the respect to effectively oversee the functioning of personnel? If hospital staff are not performing adequately, how do you discharge them when there are skeletons in the closet?"

Full disclosure also lowers malpractice expenses, Kavanagh contends. Stanford University hospitals had a 36 percent drop in malpractice claims and has saved $3.2 million since it adopted a full-disclosure policy in 2007. University of Michigan had a 40 percent drop in new claims and saves $2 million each year.

But full disclosure is not common in Kentucky, despite the Veterans Affairs hospitals in Lexington being the first to implement full disclosure in the country. "Instead of this practice spreading throughout Kentucky, the next health-care system to implement it was the University of Michigan," Kavanagh writes.

Things need to change, especially in the face of superbugs like MRSA. As he looked back at the incident involving the botched sinus surgery, "I am most bothered that I apologized for my actions," Kavanagh writes. "Now I would reserve the words, 'I'm sorry' for the patients who have been harmed." (Read more)

Louisville vascular surgeon provides 'hands on' support for troops

Dr. Andrea Yancey, a vascular surgeon from Louisville, has completed two weeks of volunteer service treating wounded American soldiers transported from Afghanistan and Iraq to the U.S. Army’s Landstuhl Regional Medical Center in Germany.

“I now have a better understanding and enhanced respect and appreciation for our military,” Yancey said in a press release from the Society for Vascular Surgery, which has provided continuous two-week rotations of vascular surgeons at LRMC for the past four years, the release said.

“The soldiers were young, polite, and grateful,” Yancey said. “Their mental and physical toughness and capacity for resilience were hard to comprehend. In spite of their injuries, they never complained or asked for pain medicine. They did not want to inconvenience anyone.”

Yancey is an assistant professor of surgery at the University of Louisville and a surgeon at the Robley Rex Veterans Affairs Medical Center in Louisville.

Weight gain after gastric bypass is common; study will see if post-operative supervision helps keep it off

Though 200,000 people undergo gastric bypass surgery to lose weight each year, more than half of patients put back on at least 20 percent of the weight they lost, research-reporting service Newswise reports. A new study will test whether supervising patients' exercise and food intake post surgery will help the pounds from creeping back on. This should be of more than passing interest in Kentucky, given our high nrate of obesity.

"You wouldn't invest $25,000 to remodel your home and not maintain it. Shocking as it may seem, follow-up on diet and exercise just isn't the norm with gastric bypass," said Gary D. Miller, who will head the study at Wake Forest University in North Carolina. "With so many people seeking gastric bypass each year, we can improve the long-term outcome of gastric bypass by keeping up with patients as they figure out their new lifestyle."

In the sixth-month study, one group of patients who recently underwent gastric bypass surgery will receive aerobic training, such as walking or cycling, and resistance training three days a week. They will also be supervised by an exercise psychologist and will be asked to document what they eat in a food diary, which will later be analyzed. They will additionally be encouraged to exercise at least two more days a week.

A second group will receive post-surgery care that is standard to gastric bypass patients. Generally, these patients receive guidance about diet and exercise, but their fitness levels and eating habits are not supervised. "This could show that surgery plus supervised exercise and diet might be the best, most efficient option for weight loss in obese and morbidly obese people," Miller said. (Read more)