Plastic surgeon sues former patients for comments made in on-line reviews

Jay Pensler, a plastic surgeon in Chicago, was unhappy with some on-line reviews of his work and is now suing three former patients for defamation. The patients, who are named in various reports of this story, apparently made scathing remarks about his care, his attitude and even his wife who apparently serves as his nurse. According to one report, the comments, recently removed from the websites Citysearch and Yelp, described the doctor as “…’dangerous,’ ‘ruthless,’ a ‘liar’ and ‘horrible.’" And the surgeon was called a “'rude jack***’ and ‘his wife … is a very rude unprofessional b****.’” Another report states that photographs of the alleged botched breast surgery were posted as well and quotes the woman as saying she now had “Frankenstein” breasts. The doctor says the photos have been altered.

One of the more interesting features of the story is that the names of what was thought to be anonymous reviewers were obtained from the two websites by subpoena.

Diligent research by the Skeptical Scalpel reveals the existence of a similar story from earlier this year in Marin County, California. A plastic surgeon named Kimberly Henry is suing former patients for posting critical reviews on the website DoctorsScorecard.com. This report mentions that a 2009 suit by a San Francisco dentist in another such case was dismissed by a California court, which cited that states anti-SLAPP [Strategic Lawsuits Against Public Participation] law, and awarded the patient $43,000.00 to be paid by the dentist for her legal fees. A law professor from UCSF said that the California law protected this type of review as long as the reviewer did not post “false facts [sic].”

A number of talking points arise:

Should a doctor ever sue his patients?
Will these suits simply invite more scrutiny of his work?
Are anonymous on-line reviews really anonymous?
Can people say anything they want on-line [except “false facts”]?
What did the monster's breasts look like or was the reference to Dr. Frankenstein's breasts? Either way, I don't recall seeing them in any of the movies.

Community Outreach: Fake Surgeon Makes (Road)House Calls

I know it’s late on a Friday afternoon and maybe few will read this but as a budding journalist, I feel compelled to write this story as it is a tale that cannot wait to be told.

Today, MSNBC reports that a woman pretended to be a plastic surgeon and talked two or more other women into allowing her to examine their breasts in bars in the Boise, Idaho area. She told them her name was Berlyn Aussieahshowna, which believe it or not, “was bogus” or so the account reads. She gave them the phone number of a real plastic surgeon whose office staff became increasingly concerned after receiving “a number” of calls looking to make appointments for liposuction and breast augmentation with Berlyn Aussieahshowna, whose real name is Kristina Ross.

Then the story gets a little weird as it turns out the Ms. Ross is a “transgendered” individual formerly known as Kristoffer Jon Ross.

The perpetrator has been charged with two felony counts of impersonating a physician.

Not mentioned in the article but follow up questions come to mind. For example, what were the victims thinking when they allowed themselves to undergo breast examinations in bars (not that such a thing has never happened before)? However, it probably has not occurred too often under the guise of a medical procedure. And what sort of woman undergoes the exam (OK, she had a few drinks. She figured she’d get a free exam.) but then apparently when sober, calls for an appointment to schedule surgery with the good doctor? In retrospect, does this still seem like a good idea?

And who says health care is not accessible to the masses?

Update: In April of 2011, Ms. Ross, who had pleaded guilty to two counts of misdemeanor battery, was sentenced to 360 days in jail.

Don't Scan Me, Bro'

The huge uproar about full body scans and harassment of air travelers misses an important point. Yes, there is concern about invasion of privacy, perceived near sexual assault and radiation exposure. Even mild-mannered Captain Sullenberger commented on the absurd practice of x-raying and searching pilots. For God’s sake, if a pilot wanted to make mischief, she wouldn’t need to put C4 in her bra. She could fly the damn thing into a building herself.

My problem with all of this is that the government seems to have an endless reservoir of bad ideas, starting with the thankfully now obsolete question, “Did anyone else pack your bags?” Did they really expect someone to say, “Well, a man named Ahmed knocked on my door this morning and offered to help me pack, so I let him.” And we always seem to be reactive rather than proactive. A guy hides explosives in his shoe in 2001 and to this day, we all have to take off our shoes at the airport. Unless this shoe removal is taking place everywhere else in the world, it seems to me that asking grandma to put her flip-flops on the scanner is unlikely to stop a terrorist. Last year another guy hides explosives in his underwear, and now we need to scan everyone’s underwear and frisk 3-year-olds. Are these procedures really thought to be effective or are they simply window dressing to reassure the public that stern measures are being taken?

Memo to the TSA: they’re going to try something other than a bomb in a shoe or Jockey shorts next time. Good intelligence such as the discovery of the plot to send explosives via cargo planes last month will do far more than all of the airport screening measures.

The public is fighting back. Just Google “TSA boycott” and see that a number of people are calling for a boycott of air travel altogether. Over 5000 people “Like” a Facebook page suggesting that all passengers opt out of the full body scan on 11/24 (the day before Thanksgiving), although I am not sure just how that will hurt the TSA. And there are courageous individuals like John Tyner ("If you touch my junk, I'm gonna have you arrested.") refusing to play the game at all. But of course, he did not get to take his trip either.

For me, the terrorists have already won. If their goal was to disrupt air travel and cause the American people to lose confidence in their government, they have succeeded.

[TSA logo by Ogel Volk via The Consumerist]

Liver Transplant Denied Medicaid Patient

Medical Quack, a blogger/tweeter on various topics, posted a story about a man who was denied a liver transplant in Phoenix. Due to budget cuts, Arizona Medicaid recently decided not to pay for such transplants for patients who had liver failure due to hepatitis C. The hospital would have had to absorb the cost of the procedure, estimated at some $200,000 to $500,000, and a hospital spokesman pointed out that there are 22 other patients with Medicaid on their liver transplant waiting list. The local news reports deplored the situation as did Medical Quack.

This is a sad story but what is the solution to the problem? Who is going to pay for this man's (and the other 22 patients') liver transplant? Both the news reporters and Medical Quack did not offer any suggestions. I have always been amazed that people seem to believe that the money will appear like magic. The fact is that health care for people without money has to be funded by people with money. It can come from taxes, surcharges on insurance or whatever. The reality is that some degree of health care rationing is inevitable, especially in a down economy.

Other ethical questions to ponder:

What if the patient had been an illegal alien lacking even Medicaid coverage? Should the taxpayers foot the bill? The cost of care of illegal aliens has been paid for by the taxpayers or absorbed by hospitals for years but how much longer can it continue?.

Did the Phoenix patient acquire hepatitis C while abusing drugs? If so, should it matter? Should the taxpayers have to fund all of his medical care including a liver transplant?

Should the taxpayers have to pay to support people who abuse themselves by using drugs,alcohol or tobacco? What about obesity? Somewhat of a precedent exists regarding alcohol. Over 2/3 of states still have the Uniform Accident and Sickness Policy Provision Law on their books. This law permits insurers to deny coverage for any policyholder who is injured while under the influence of alcohol or narcotics. I recently participated in the care of a patient who was readmitted to the hospital for the umpteenth time with acute respiratory failure secondary to chronic obstructive lung disease. She is on oxygen at home and continues to smoke. Yes, it can be done. She removes the oxygen tubing and lights up.

Research Study of the Day: Postoperative Outcomes Worse in COPD Patients

Internal Medicine News reports that a paper recently presented at the American College of Chest Physicians annual meeting found that patients with chronic obstructive pulmonary disease [COPD] fared much worse after all types of surgery than patients who did not have COPD. The authors reviewed outcomes of over 468,000 patients in a clinical database, 5% of whom had COPD. Not surprisingly, the COPD patients had significantly longer hospital lengths of stay and higher rates of complications and mortality.

The database contained no information about how the COPD patients were managed in preparation for their operations. Thus, the authors could not recommend any specific advice on how to limit the adverse outcomes.

Meaning no disrespect to the authors of this study and knowing how hard it sometimes can be to think of ideas for research, I wonder what they expected to find. Is there anyone who would not surmise that patients who have a major medical illness such as COPD would do worse than those who are not?

Research Study of the Day: Seeing Meat Makes People Less Aggressive

Who thinks up these experiments? According to a study from McGill University in Montreal, people who look at pictures of meat are significantly less aggressive than those who don’t. The report on Science Daily states that subjects were asked to punish a script reader for mistakes he made while sorting photos, some of which depicted meat and some which did not. The subjects were told that the punishment consisted of varying degrees of noise to the point of actual pain. It seems that photos of meat made the subjects less prone to inflicting the severest punishment. The study’s leader was surprised by the finding having felt that the sight of meat would have the opposite effect because of its association with hunting and other aggressive behaviors.

The report also contains the following amusing sentence. “The idea that meat would illicit aggressive behaviour [sic] makes sense, as it would have helped our primate ancestors with hunting, co-opting and protecting their meat resources.” This is another example of the mischief that can result from too much faith in spell-checker.

Just how crazy are people?

[“Contrail” is short for “condensation trail,” which is a visible plume of water vapor or ice crystals formed by condensation created when the hot exhaust of a jet or rocket meets cold air at high altitudes.]

While researching the story of Mick West, the computer programmer who runs the website ContrailScience.com and who identified and explained in detail the November 8 “mystery missile” seen over Los Angeles (where else?) as an airliner contrail even providing the flight number, I discovered a rather incredible mass delusion.

It seems that numerous people think that the government is spraying chemicals into the air for nefarious purposes. The deluded ones see long-lasting contrails as what they call “chemtrails.” There is a website called ChemtrailCentral.com which is filled with all manner of paranoid ramblings about this. For example, this gem from the FAQ section of the site describes the possible reasons for the government’s alleged activity:

Weather Modification
NASA is currently conducting several programs that are studying the effects of contrails on weather and the effects do not appear to be beneficial. [Truncated by me.]

Population Control
The use of chemical and biological agents by a government against it's own people is, unfortunately, a historical fact. Even unintentional accidents can occur. But, some people suggest that Chemtrails could actually be part of a program to reduce the population and many feel Chemtrails have caused them to become ill and perhaps they are right. If the Chemtrails contain biological agents then people already weakened by other factors may have even died as a result of the additional strain on their systems, but could such a diabolical purpose be the ultimate goal? History has taught that even the most unconscionable schemes can be made into reality by men filled with fear and hate, and with such weapons in the hands of government we must remain vigilant until answers are forthcoming.

Inoculation Program
Chemical and biological weapons have been used for centuries but have recently entered the world stage as a primary threat. Biological agents have the ability to spread and multiply in casualties. These bioweapons are easy to produce and difficult, but possible, to defend against. The recent actions of the military to require anthrax vaccines for all service personnel show that this matter is of high importance. Some propose that the government may be quietly releasing bioagents to vaccinate citizens via the air. This could account for reported illnesses since a vaccine sometimes makes a person sick. Municipal water supplies might not be universal enough and could be easily sampled and tested, but everyone breathes the air. And the federal government rules the air.

By my rough count, there are over 1500 registered users of the ChemtrailCentral website. Apparently these folks are allowed outside unsupervised and can vote. They also have access to Twitter. Just search "#chemtrail" on Twitter to read the current speculation that the government is spraying aluminum and barium or my favorite, that North Korea is spraying Ebola virus. Or you can Google "chemtrail" to find out more.

Sometimes the Internet makes me nervous.

Surprising common sense from website Cracked.com: “5 common medical procedures that secretly aren’t worth it”

Yesterday, the humor website Cracked.com published a list of 5 common medical procedures that, in its opinion, aren’t worth it. They are CT scans, physical examinations, circumcisions, Cesarean sections and antibiotics. OK, antibiotics are not really procedures, but you get the point. Of course, the author uses exaggeration to bolster his case but there is a lot of truth in the article. Let’s take them one by one.

5. CT scans. No doubt about it, they are overused and they are expensive. And there is a theoretical and possibly real risk, albeit small, of an increase in cancer rates in the future. Cracked thinks the increase in the use of CT scans is about money and greed but the fact is that doctors who order CT scans almost always do not own the scanner and do not profit from ordering the test. I think it’s about the public’s demand for diagnostic accuracy (I blogged about this in August) and the pervasive practice of defensive medicine. Physicians feel compelled to cover their asses by over-ordering confirmatory tests before doing anything and they fear being sued for missing something. As an alternative, Cracked.com suggests increasing the use of MRI. Although MRI does not involve radiation to the patient, it is also very expensive and not routinely available on a 24/7 basis. For some illnesses, it is just not as good as a CT scan for diagnosis.

4. Physical examinations. I could not agree more that they are useless in asymptomatic patients.

3. Circumcisions. More than 35 years ago, circumcision was shown to be not only unnecessary, but probably harmful in that occasionally a child was mutilated by technical errors with the procedure. Children with unsuspected hereditary bleeding disorders have even died during circumcision. Why the practice continues is inexplicable. I tweeted about this a few months ago and am proud to be now listed by the tweeter “Intact by Default” as disfavoring circumcision.

2. Cesarean sections. There are certainly too many Cesarean sections done in the U.S. Some are performed for the convenience of the patient or the obstetrician. However, the procedure can be “worth it” in selected patients. Examples of necessary Cesarean sections are the baby is too big to be delivered vaginally, the mother has a major complication of pregnancy or labor, some multiple births and others. Cesarean sections may also fall into the defensive medicine category as one can always question why a baby with a subsequent problem was delivered vaginally instead of by Cesarean section.

1. Antibiotics. Please, don’t get me started. Again although not a procedure, Cracked.com is spot on that antibiotics are vastly overused in medicine (and agriculture, by the way). In most hospitals, anyone who develops a fever gets antibiotics. Everyone wants antibiotics for a cold despite the fact that colds are caused by viruses (not affected by antibiotics) and colds are self-limited, non-fatal diseases. Overuse of antibiotics leads to bacterial resistance, which is now a major problem worldwide. They also cause diarrhea and a sometimes lethal infection called C. difficle colitis, which often attacks hospitalized, debilitated patients.

So let’s give Cracked.com an A- for its list. Too bad more physicians don’t read it. And too bad we live in a litigious society which fosters defensive medicine.

20th Century Archeological Discovery in New England

Nov. 8, 2010. An amazing find, a fully functioning communication device of the 20th century, was unearthed in New England this morning. Researchers found and photographed a rarely seen “pay telephone.” Investigation revealed that this phone could only transmit voices through its rather bulky apparatus. Attempts to send text messages and pictures were unsuccessful. The internet also could not be accessed, nor could music or games be played on it. It seems there is no screen display.

As can be seen in the photograph, a giant keypad must have been used to input numbers. Even more curious was the revelation that when the large hand piece was lifted from its cradle, a continuous sound could be heard. It was later identified as a “dial tone.” This tone apparently signaled the user that a series of numbers could be input after inserting coins in a receptacle.

A team of scientists from the Smithsonian Institution has been dispatched to the scene to run further tests and attempt to decipher the meaning of an inscription having to do with “collect calls.” As more information becomes available, we will bring it to you.

Key to Solving Obesity Crisis Discovered

Nov. 5, 2010. FLASH!!! From the EurekAlert! Website.

As confirmed by a group from Norway who studied 924 fourth-graders, overweight children have different eating patterns than normal weight children. Obese children ingest more sugar. In addition, they are less active and more likely to have obese parents.

I imagine that you are as astounded by these revelations as I am. Perhaps this is the spark that will ignite the reversal of the worldwide epidemic of obesity. All we need to do is get children to eat and drink less sugar, exercise more and convince their parents to lose weight.

Now that this is settled, let’s address the second most important health problem of this century, chapped lips. If we focus all of our resources on finding a cure, we should be able to lick chapped lips by the year 2020.

Alcohol Is the Most Harmful Drug? Nonsense!

An article published yesterday by the prestigious journal The Lancet claims that alcohol is the most harmful drug of all, including crack cocaine and heroin. The story was reported uncritically by the science news media such as Reuters Health, MedPageToday and Science Daily as well as the lay media [CBS News, New York Daily News, and many others]. At least one outlet, The Atlantic Wire, was skeptical, pointing out that the study’s lead author, Professor David J. Nutt [yes, Nutt] had an axe to grind. It seems he was fired as the UK’s adviser on drugs for insisting that alcohol was a worse problem than marijuana. They also added comments from other skeptics.

So far, no one has addressed the “science” of the paper, the full text of which is available free on line. I’ll have a go at it. Dr. Nutt and colleagues established their own rating system for harm. It has not been validated by others. It rates 16 “harm criteria” on a scale from 1 to 100. The paper’s methods section does not indicate how the “harm criteria” were chosen or how the ratings were assigned. It certainly seems rather arbitrary to say the least. The third paragraph of the description of how the scores were weighted is incomprehensible to me. Here it is in its entirety:

“During the decision conference participants assessed weights within each cluster of criteria. The criterion within a cluster judged to be associated with the largest swing weight was assigned an arbitrary score of 100. Then, each swing on the remaining criteria in the cluster was judged by the group compared with the 100 score, in terms of a ratio. For example, in the cluster of four criteria under the category physical harm to users, the swing weight for drug-related mortality was judged to be the largest difference of the four, so it was given a weight of 100. The group judged the next largest swing in harm to be in drug-specific mortality, which was 80% as great as for drug-related mortality, so it was given a weight of 80. Thus, the computer multiplied the scores for all the drugs on the drug-related mortality scale by 0.8, with the result that the weighted harm of heroin on this scale became 80 as compared with heroin's score of 100 on drug-specific mortality. Next, the 100-weighted swings in each cluster were compared with each other, with the most harmful drug on the most harmful criterion to users compared with the most harmful drug on the most harmful criterion to others. The result of assessing these weights was that the units of harm on all scales were equated. A final normalisation [sic] preserved the ratios of all weights, but ensured that the weights on the criteria summed to 1.0. The weighting process enabled harm scores to be combined within any grouping simply by adding their weighted scores. Dodgson and colleagues provide further guidance on swing weighting. Scores and weights were input to the Hiview computer program, which calculated the weighted scores, provided displays of the results, and enabled sensitivity analyses to be done.”

The figures are equally bizarre especially figure 3. The paper does not allow for variations in amount of drug used. For example, is one alcoholic drink per day a problem?

Certainly alcohol abuse can be a quite harmful but what about the recent research showing that 1 to 2 drinks per day improves health? The way this story was reported might actually be detrimental by causing social drinkers to stop thereby possibly harming themselves.

Honestly, I am surprised that The Lancet would publish a paper such as this. It’s not April 1, so I don’t think it’s a joke. Did they just want to be controversial or get publicity? If so, I guess it worked. And what about the media? Should they just report these press releases without question? Widespread uncritical dissemination of junk science like this gives it unwarranted credibility.

Can Wrong-Site and Wrong-Patient Procedures Be Totally Eliminated?

Last week, MedPageToday asked its readers to answer the question “Can wrong-site and wrong-patient procedures be totally eliminated?” About 70% of the 727 respondents said “Yes.” I say, “No.” Here is why.

The paper from Archives of Surgery, “Wrong-site and wrong-patient procedures in the Universal Protocol Era,” which generated a lot of media interest, contains the answer. The paper is a retrospective study of a medical liability insurance company’s self-reported database of adverse occurrences. There were 25 wrong-patient and 107 wrong-site procedures reported over a 6.5 year period [2002 to mid-2008]. The Joint Commission mandated the Universal Protocol as of July 1, 2004. It called for a pre-procedure verification of the patient, procedure and site, marking of the procedure site and a “time-out” or review of the planned procedure involving all care-givers. According to Figure 3 of the Archives paper, the number of wrong-patient and wrong-site procedures was remarkably consistent over the years of the study which included years before and after the institution of the Universal Protocol. Providers either ignored the protocol or failed to execute it properly.

The factor that will prevent the total elimination of wrong-patient and wrong-site procedures is us. As long as humans are in the equation, human errors will persist.

A recent paper from the British Journal of Surgery entitled “Nature, causes and consequences of unintended events in surgical units,” described 881 self-reported unintended events in 10 hospitals in the Netherlands over a one year period. Human error was the root cause in over 70% of instances, with system errors comprising only 16%. Similarly, an article from San Diego by the leaders of one of the most mature trauma systems in the country, noted a stable rate of complication ocver a 12-year period. While human errors decreased over time, they could not be entirely eliminated. Lack of adherence to guidelines, fatigue, inexperience and other human issues were cited as continuing problems.

Finally, no less an authority than Donald M. Berwick himself has stated “The search for zero error rates is doomed from the start.” [Quoted in Graber M, Gordon R, Franklin N. Reducing diagnostic errors in medicine: what's the goal? Acad Med. 2002;77:981-92.]