The Fresno Bee Investigation 

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The following are excerpts from a series of articles which appeared in the Fresno Bee, Dec 30, 2001.  The first is about a patient who died and the second is about a hospital which seeing too many complications from gastric bypass, decided to stop doing them. Finally, two respected psychologists give their opinion on the psychological repercussions of this surgery based on their observations of the patients they have worked with. Seeming to agree with them, Dr Fobi, Roseanne's surgeon, calls the gastric bypass, "surgically induced bulimia".

Pundits will tell you that the surgery is safer now but there is no evidence of this... In a hospital in Phoenix, I am told that they have an entire floor dedicated to gastric bypass patients with complications and a nurse practitioner who works in an emergency room stated about about 33 percent of the patients he sees in any given night are gastric bypass patients.

As these new substances [nutrients] are located and understood it will probably emerge that our stomachs have to be a given size just to take them all in. Because of this surgery, you will not be able to do so. Biologically, we have the G.I. tract we have for a reason. Changing it is purely experimental.
(Release form for gastric bypass and duodenal switch surgeries)

(Fresno, CA, Dec 30,2001) Former nurse Cathy Ardemagni seemed like an unlikely candidate for the operation. At 5 feet and 192 pounds, she could hardly be considered severely overweight. Her body-mass index was 37.5, below the recommended 40. But she suffered from back pain, and doctors told her the surgery could help.

She had the surgery three years ago at Fresno Community Hospital. Gladen was her surgeon.

After the operation, things went terribly wrong.

According to a lawsuit filed by Ardemagni, she developed an intestinal leak that carried toxins throughout her body, threatening to kill her. She endured four operations within a week. A fifth operation followed months later.

She survived, but for months Ardemagni had to use a wheelchair. She was unable to eat solid food for six months. Today, at age 50, she walks with a limp and can't stand for more than 15 minutes without back pain. She never returned to her job at Sierra Kings District Hospital in Reedley.

Her back pain is worse.

"This is not a surgery to be taken lightly," she said. "It backfired on me."

The doctors, when they explain the surgery, don't impress upon you that you can die, she said. They don't dwell on the terrible side-effects.

"They don't tell you that you heave up your toe-nails ... or the horrible pain that comes from not chewing your food thoroughly," Ardemagni said.

She sued Gladen and recently reached an out-of-court settlement. Ardemagni signed a confidentiality agreement and won't disclose specifics of the case.

Dr. Edward Livingston, the UCLA surgeon, said gastric leaks are common and manageable. If surgeons are doing their job correctly, they should be able to detect them, he said.

"The real difference between a real good surgery and not real good surgeries," he said, "is how you deal with the complications."

Deaths reviewed in The Bee's investigation show a majority of the patients died from gastric leaks following their surgery.

Livingston said surgeons should provide adequate post-surgery care, but some are taking on too many patients and can't monitor them all properly in the critical days and weeks following the operation, when complications are most likely to set in.

"Do the math," he said. "How are you are going to see 1,000 new patients a year and monitor them all?"

Tova Winrow, 28, of Fresno, suffered serious complications from a gastric leak before her death last year.

Winrow was a strikingly beautiful woman. At 5-foot-4 and 250 pounds, she had been unhappy with her weight for years. A single mother, she had four children and put on weight with each pregnancy.

Gladen performed Winrow's gastric bypass surgery at UMC on March 15, 2000. She went home two days later but returned to UMC on March 20 after complications set in, including a gastric leak at one of the stapled intestinal connections.

Winrow's parents are suing Gladen on behalf of her children, who all are younger than 12. The parents declined to be interviewed on the advice of their attorney. Gladen declined comment about the lawsuit.

According to court documents, doctors operated on Winrow three times as her problems escalated. Blood clots developed in her right leg. Doctors decided to amputate the leg just below the knee on March 27, 2000. Winrow died the next day.

Winrow's death certificate lists "failed gastric stapling" leading to "complications of sutural leak" following gastric bypass surgery.

Herman Praszkier, whose St. Louis law firm is handling five wrongful death lawsuits related to gastric bypass surgeries, none of them in the Valley, says many hospitals and surgeons are ill-equipped or too busy to deal adequately with patients suffering complications.

In many cases, hospitals don't have a large enough CAT scan machine to accommodate these overweight patients. CAT scans are the only sure-fire way to detect a potentially deadly leak, he said.

A leak affects all other areas in the body, including the circulatory system, then the organs. Said Praszkier: "It's a leak of gastric content with the pH of battery acid."

He believes the number of fatalities caused by these operations is higher than most people realize: "Nobody knows how many people have died from this. Nobody wants to."

 

Also in the companion article, the head doctor at one of the large hospitals in Fresno had noted that the surgery was too risky to continue at the hospital. 

(Fresno, CA, Dec 30, 2001) Dr. William Feaster, Community Medical Center's chief medical officer. Community Medical operates UMC, Clovis Community and Fresno Community hospitals.

The future of gastric bypass surgery at UMC is unclear.

"For now, I doubt there will be any done at UMC," said Dr. William Feaster, Community Medical Center's chief medical officer. Community Medical operates UMC, Clovis Community and Fresno Community hospitals. Hospital officials noticed some patients were suffering complications after surgery. "High volume, high risk and we identified problems. Across the whole Community system. ... It was driven by the rapid rise in numbers of patients," Feaster said.

Asked why hospital officials had not reviewed the number of deaths sooner, Feaster said: "Unlike, we don't go through death records."

"But so many UMC patients had developed complications from gastric bypass surgery that a doctor says hospital nurses coined a new phrase: "GB-GB."

Gastric Bypass Gone Bad.

Feaster said he had not heard of the term, adding that risks involving gastric bypass surgery at UMC are no higher than anywhere else.

He said gastric bypass can be riskier than heart surgery. "

Certainly, obese patients carry a higher risk of dying during any surgery. They are more likely to develop blood clots or suffer from complications from general anesthesia. But the deaths, by and large, do not occur in the operating room, or in the hours immediately following surgery. They happen in the days, weeks and months after surgery, when patients return home and find themselves coming apart from the inside -- sometimes leaking from the abdomen.

Gastric bypass is becoming the most performed operation in the nation. It has a higher mortality rate than other abdominal procedures, such as gallbladder removals and appendectomies.

Daniel Daley, 52, died of complications from his gastric bypass surgery. Daley's death certificate lists the causes of death as heart attack, sepsis, gastric bypass and morbid obesity. During Daley's original surgery, he had a hernia repaired. The death certificate doesn't list the hernia as contributing to his death.

A three-month Fresno Bee investigation reviewed death certificates, hospital data and lawsuits to determine the number of area deaths following gastric bypass surgery. The exact number of fatalities is hard to pin down. Death certificates don't always cite gastric bypass as the cause of death, but instead often attribute the death to complications such as heart attacks, blood clots or morbid obesity.

About 20% of gastric bypass patients suffer complications requiring additional operations. Complications include abdominal hernias and staple or suture ruptures resulting in leaks. More than one- third of patients will develop gallstones -- clumps of cholesterol and other matter that form in the gallbladder.

Nearly 30% will suffer nutritional deficiencies such as anemia, osteoporosis and metabolic bone disease. Some patients will lose their hair. Most patients become lactose intolerant and give up dairy products. Tough meats are difficult to digest. Breads, rice and pasta can cause problems because they expand in the stomach.

This expose also interviewed renowned psychologists about the ramifications of such a drastic physical change in a patient's body, especially one causing repercussions for a lifetime. I have found many longer term patients suffering from PTSD:

(Fresno, CA, Dec 30, 2001) JoAnn Mann, RN and eating disorders specialist: "I've seen massive infection, I've seen people hospitalized for malnutrition. I've seen people obsessed with food. I've seen people unable to stop vomiting. I've seen people develop massive eating disorders, I've seen people who are terrified of gaining weight. Terrified. It runs their lives."

According to Mann, gastric bypass surgery is a bad idea for most people. "This is a permanent prison, in a sense," she said. "You are choosing to make your stomach a different size. And while it is possible to go back, it is very rare and very risky. This is permanent."

Dr. Jenn Berman, a Los Angeles psychotherapist and an expert on eating disorders, has counseled more than 70 gastric bypass patients in the past six years.

"This is a very traumatic surgery. It not only changes a person's body, but their life," Berman said.

The patients who come to her are unable to keep down food and suffer from chronic diarrhea and/or vomiting. Berman said some patients have developed eating disorders and are afraid that if they eat too much, they will be sick.

"I have seen people become terrified of food. They feel like their body is out of their control because they lose the weight so fast. I have seen people develop terrible phobias of gaining weight or losing weight."

Published, Fresno Bee - Dec 30, 2001

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