Category Archives: Surgery

Check the fine print: Some work-based health plans exclude outpatient surgeries

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By Jay Hancock
KHN

Libbi Stovall couldn’t believe it last month when she looked at the fine print in her company’s 2016 health plan, which supposedly meets the strictest standard for employer obligations under federal rules.

The insurance paid for inpatient hospital care, office visits and diagnostic imaging. But it provided no coverage for outpatient surgery, which accounts for two out of every three operations in the nation, according to hospital industry data.

Libbi Stovall, 52, of Carrollton, Texas, has a history of back problems, including an outpatient surgery in 2014. She was shocked to find that her employer's 2016 health plan provides no coverage for outpatient surgery. (Kim Leeson for KHN)

Libbi Stovall, 52, of Carrollton, Texas, has a history of back problems, including an outpatient surgery in 2014. She was shocked to find that her employer’s 2016 health plan provides no coverage for outpatient surgery. (Kim Leeson for KHN)

After reviewing the plan, she realized “their policy would not give my family the coverage we need,” said Stovall, 52, who lives in Carrollton, Texas, and has a history of back problems, including outpatient surgery in 2014 to remove a cyst. Her doctor, she added, said that “I absolutely have to be on an insurance plan that covers both outpatient and inpatient hospitalization.”

Worse for her, being offered such a plan through her workplace, an international staffing firm called Open Systems Technologies, barred Stovall from federal subsidies to buy more comprehensive coverage in the online insurance marketplaces.

Her experience illustrates the latest chapter in the story of employers and insurance designers pushing the limits of the Affordable Care Act. Continue reading

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Telenovelas, Spanish website seek to inform Hispanics about kidney donation

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KHNTelenovela_1_770

Will Roberto be able to carry the heavy boxes his job requires if he donates a kidney to his brother, Jorge? How will his family pay their bills if Roberto has to take several weeks off from work to recover from the surgery?

Will Mama consider a kidney donation from her daughter, Carla, or turn her down, worried the procedure will keep Carla from having another baby?

These two telenovela plots have gripped some viewers in the past few months. But don’t expect to see the Spanish-language dramas on a network or streaming service. They’re customized for Infórmate, a new bilingual website dedicated to using culturally familiar methods to educate Latinos about options for living kidney donation.

The marketing strategy is intended to address a growing need among Latinos. Kidney failure in this population has increased by more than 70 percent since 2000, and more than 23,000 Latinos are on the kidney transplant list, according to federal statistics.

But too often, researchers and doctors said, families are not aware of the transplant regimen involving a live donor and have unfounded fears about what could happen if they volunteer to offer a kidney to a relative or friend.

“Right now, Latino patients often don’t learn about live kidney donation until they are in crisis, and that is a bad time to be learning about something complex and somewhat foreign to their culture,” said Junichiro Sageshima, a transplant surgeon at the University of California, Davis. Continue reading

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Military Doctors Fault Pentagon on Battlefield Casualty Care – WSJ

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Silhouettes of U.S. Soldiers at night in IraqTop military doctors are warning that medical advances won on Afghan and Iraqi battlefields might be lost unless Secretary of Defense Ash Carter orders the Pentagon to make these techniques, drugs and devices mandatory for military physicians, nurses and medics.

Fourteen years of combat gradually produced a system that generated survival rates unprecedented in modern warfare, from front-line first aid to helicopter medevacs.

The Pentagon, these doctors say, has failed to institutionalize many of those practices.“Things are as good as they have ever been anywhere in combat-casualty care,” said Dr. Frank Butler, a former Navy SEAL and leading advocate of improved military trauma treatment. “And we need to understand what was done in the recent conflicts and do what we can to preserve it.”

Source: Military Doctors Fault Pentagon on Battlefield Casualty Care – WSJ

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Inslee calls for public health approach to gun violence

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GunFrom the Office of the Governor

Gov. Jay Inslee today signed an executive order that launches a statewide public health initiative to reduce and prevent gun-related fatalities and injuries.

The order uses the same data-driven public health approach that has significantly reduced motor vehicle deaths over the past two decades.

The initiative will help the state understand the people and places most at risk of gun violence or suicide, determine the best approaches to reducing gun violence and work with its partners to develop strategies and actions to prevent gun violence.

“This will be a data-driven approach that helps us identify the people and places most susceptible to gun crime and suicide,” Inslee said. “Gun crime is a scourge that has scarred thousands of families in every corner of our state. It’s a scourge we can, should and will help prevent.”

Between 2012 and 2014, 665 people died in Washington state from firearm injuries, compared to 497 deaths from automobile accidents. Approximately 80 percent of the firearm deaths were suicides.

Inslee’s order requires the Department of Health and the Department of Social and Health Services, in collaboration with the University of Washington and other state and local agencies to collect, review and disseminate data on deaths and injury hospitalizations related to firearms, as well as recommend strategies to reduce firearm-related fatalities and serious injuries.

Inslee said he also wants to further strengthen the background check law approved by Washingtonians in 2014. He is directing the state Office of Financial Management to analyze the effectiveness of information sharing between state agencies, the courts, local jurisdictions, law enforcement and other entities to determine if there are ways to improve the effectiveness of the system.

He is also requesting the Attorney General’s office to analyze current enforcement practices to make sure those attempting to purchase a firearm illegally are held accountable.

He is also asking them to update a 2007 white paper regarding access to firearms for those with mental illness. The white paper included recommendations that have yet to be implemented such as a centralized background check system.

Inslee is directing agencies to submit recommendations by October of 2016. Continue reading

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Gunshot wounds have gotten more lethal

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Researchers take on ‘Great Problem in data’ with study of gunshot wounds

GunTwenty years ago — under threat from Congress — the Centers for Disease Control and Prevention stopped studying gun violence.

That didn’t stop Dr. David Livingston and his colleagues: In a new study, the researchers in Newark, N.J., found — among other things — that over a 12-year period, gunshot wounds have gotten more lethal, and that more patients had multiple wounds.

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Contraceptive implant under microscope amid questions of safety, altered trial data

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Portrait of Kimberly Lira at her home in Peoria, Az.

Portrait of Kimberly Lira at her home in Peoria, Az. (Photo by Nick Oza for KHN)

By Roni Caryn Rabin
KHN

Kim Hudak was a young mother who was done having children when she volunteered for a clinical trial to an experimental birth control implant designed to make her sterile without tube tying surgery.

But soon after Hudak, 28 at the time, got the Essure implants in 2000, she said she developed health problems, including severe pelvic and lower back pain, difficult menstrual periods and pain during intercourse.

She complained to researchers at the Cleveland Clinic and was told her problems were not related to the implant. In an affidavit to the Food and Drug Administration, Hudak alleges that answers she gave researchers in response to questions about pain, adverse health effects and even whether her period was late had been altered on her medical record, without her knowledge. Those statements were part of the usual data collection for FDA approval of the device.

“I realized something could go wrong in a clinical trial, but I thought they would take care of me, and that if something wasn’t right, they’d fix it,” said Hudak, who eventually had a hysterectomy to remove the implants in 2013 and has filed a claim against Essure’s manufacturer for compensation for her injuries.

Hudak is one of several clinical trial participants who say that when they experienced complications with the implant, doctors and nurses ignored or belittled their symptoms, insisted they could not possibly have been caused by Essure, and referred them elsewhere for treatment. Continue reading

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New heart procedure boon to patients and hospitals

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Dr. Josh Rovin, left, and Dr. Douglas Spriggs, right, perform TAVR procedure at Morton Plant Hospital in Clearwater, Florida (Photo by Phil Galewitz/KHN)

Dr. Josh Rovin, left, and Dr. Douglas Spriggs, right, perform TAVR procedure at Morton Plant Hospital in Clearwater, Florida (Photo by Phil Galewitz/KHN)

New Hope Beats For Heart Patients And Hospitals

By Phil Galewitz
KHN

CLEARWATER, Fla. – Inch by inch, two doctors working side by side in an operating room guide a long narrow tube through a patient’s femoral artery, from his groin into his beating heart. They often look intently, not down at the 81-year-old patient, but up at a 60-inch monitor above him that’s streaming pictures of his heart made from X-rays and sound waves.

As with other new medical technology, TAVR draws concerns about possible overuse or adoption by hospitals lacking proficiency, which could harm patients and increase health care costs.

The big moment comes 40 minutes into the procedure at Morton Plant Hospital. Dr. Joshua Rovin unfurls from the catheter a metal stent containing a new aortic valve that is made partly out of a pig’s heart and expands to the width of a quarter outside the catheter. The monitor shows it fits well over the old one. Blood flow is normal again.  “This is pretty glorious,” Rovin said.

The surgeon has performed one of the fastest-growing procedures in U.S. heart care known as a transcatheter aortic valve replacement, or TAVR. The operation was approved in the U.S. in late 2011 to help patients too ill or frail for traditional “open-heart” valve surgery. The procedure has rapidly gained doctors’ acceptance, particularly for patients in their 80s and 90s. Continue reading

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Is a double knee replacement right for you?

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Having both knees replaced at the same time has advantages

By Dr. David Kieras
Virginia Mason

samIf someone you know has severe arthritis in both knees that greatly reduces their quality of life, they may be a candidate for bilateral simultaneous knee replacement surgery, where both joints are simultaneously operated on in one surgical procedure.

Although not an option for everyone, this approach is enticing to many people who dread the idea of recovering from two separate surgeries, which delays recovery and a return to normal activities for several months, if not years.

Bilateral ‘staged’ knee replacement – one knee surgery followed by another – is not uncommon.  However, bilateral simultaneous knee replacement is more advanced and uncommon due to the special expertise and team coordination required.

It can be beneficial for people who have limited time off from work for rehabilitation and need to return to a more normal lifestyle as quickly as possible. Continue reading

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Online scorecard helps you pick a surgeon

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surgeons performing surgery in operating roomThe independent investigative journalism website ProPublica has created online “Surgeon Scorecard” that you can use to find out a surgeon’s complication rate for eight commonly performed operations.

To learn about the complication rates of surgeons working at hospitals in Washington state go here.

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Do cell phones belong in the OR?

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Next time you’re on the operating table and you have one last look around as the anesthesiologist approaches, don’t be too sure that that person in scrubs looking at a smartphone is pulling up vital health data.

He or she might be texting a friend, or ordering a new carpet.

Cellphone use is not generally restricted in the operating room, but some experts say the time for rules has come. In interviews, many described co-workers’ texting friends and relatives from the surgical suite. Some spoke of colleagues who hide a phone in a drawer and check it when they think no one is watching.

Cellphone use is not generally restricted in the operating room, but some experts say the time for rules has come.

“Sometimes it’s just stuff like shopping online or checking Facebook,” said Dwight Burney, an orthopedic surgeon from Albuquerque. “The problem is that it does lead to distraction.” This can result in medical errors or lax safety procedures, such as forgetting to check a patient’s identity, he said.

In one 2011 incident, a Texas anesthesiologist was accused of sending text messages and e-mails while monitoring a patient. Her oxygen levels dropped, which the anesthesiologist allegedly didn’t notice for close to 20 minutes, and she died in surgery. The woman’s family sued the anesthesiologist. The case was settled before going to trial. Continue reading

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Boston bombing survivors struggle with medical and emotional recovery

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Map of BostonBy Martha Bebinger, WBUR

It’s just the crumb of a muffin but Martha Galvis must pick it up. Lips clenched, eyes narrowed, she goes after the morsel, pushing it back and forth, then in circles, across a slick table top.

“I struggle and struggle until,” Galvis pauses, concentrating all her attention on the thumb and middle finger of her left hand. She can’t get them to close. “I try as much as I can. And if I do it I’m so happy, so happy,” she says, giggling.

Martha Galvis has undergone 16 surgeries for her hand, which was injured in the Boston Marathon bombing. (Jesse Costa/WBUR)

Martha Galvis has undergone 16 surgeries for her hand, which was injured in the Boston Marathon bombing. (Jesse Costa/WBUR)

Galvis, 62, has just finished a session of physical therapy at Brigham and Women’s Faulkner Hospital where she goes twice a week.She’s learning to use a hand doctors are still reconstructing.

It’s been two years since she almost lost it.

On April 15th, 2013 Martha and her husband Alvaro Galvis headed for three spots from which they’d enjoy the race and boisterous crowd. Their last stop would be at or near the finish line.

Watching the marathon was a ritual that began in the mid 1970s when the Galvises, who are both from Columbia, met in Boston. Their three children grew up with the marathon as family holiday. The Galvises planned to continue the annual event after retirement.

“But not anymore,” says Martha Galvis, waving both hands in front of her face. “I don’t feel secure to do this.” Continue reading

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