Published September 14, 2004
When it comes to gastric-bypass surgery for the obese, insurance companies and lawyers are becoming the protectors of patient health, which is essential in the absence of other safeguards. Last week, Iowa Methodist Medical Center in Des Moines announced it would suspend its weight-loss surgery program. The number of patients filing lawsuits and subsequent increases in malpractice insurance contributed to the decision. In addition, Wellmark Blue Cross/Blue Shield has sent letters to Iowa surgeons saying it's working toward only allowing patients to obtain the surgery at hospitals with the best outcomes.
Great.
Insurance companies are in the business of assessing risk.
Patients need someone to help them assess the risk of weight-reduction surgery,
as well as other procedures.
Because now they're in the dark. As gastric-bypass surgery grows in popularity,
more hospitals offer it. In the past three years, at least nine Iowa hospitals
have added a gastric-bypass program. A Register survey found at least 11 Iowans
have died. Yet there is no reliable system that records and reports medical
errors and death rates for consumers. In Iowa, hospitals aren't required to
report or disclose deaths that result from medical errors. "Accidental deaths"
are reported to the Iowa Department of Public Health, but information isn't made
public.
So if you are considering gastric-bypass surgery at an Iowa hospital and
happen to be a regular reader of the newspaper, you would know several Iowans
have died in the past few years after undergoing the surgery. Or you might hear
a story from a neighbor. Or you might ask the doctor. Or you might just trust
the word of Carnie Wilson, a celebrity who has accepted money to promote the
procedure for an Iowa medical center.
But dependable information that compares and rates facilities and physicians
isn't available.
What's more, there is no national, mandatory reporting system for medical
errors. Dr. Akella Chendrasekhar, a Des Moines doctor who performed
stomach-reduction surgeries and faced several lawsuits from patients or their
survivors, has moved to Ohio. His patients there can't easily know his history
in Iowa. Likewise, Iowans have little history about surgeons who move here from
other states.
The truth: Stomach-reduction surgery is risky, and potentially life-threatening.
A small pouch is created by stapling the top of the stomach. This causes a
reduction in food intake. Then a section of the small intestine is attached to
the pouch so food can bypass the stomach. Complications include the same risks
from any invasive procedure, plus hernias, leaks in the stomach and infection.
Those undergoing the surgery are likely in poorer health and more susceptible to
complications.
Someone has to inform and protect people.
In the absence of a system that shines light on facilities and physicians, that
job is falling to insurance companies. A comprehensive, accessible system should
be put in place, but, in the meantime, at least insurance companies have the
power to increase malpractice rates on hospitals and physicians with poor
records.
That works in the best interests of patients.