Tuesday, March 26, 2013

Fwd: qotd: A joint-replacement pavilion limited to prima donna doctors and rich patients

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-------- Original Message --------
Subject: qotd: A joint-replacement pavilion limited to prima donna
doctors and rich patients
Date: Tue, 26 Mar 2013 12:16:29 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>

March 25, 2013
Fremont's Washington Hospital: Joint replacement patients, doctors
excluded from new facility
By Ashly McGlone

When Robert Cantley needed both knees replaced in August, he was
expecting to recover from the surgery at Washington Hospital's fancy,
new $42.7 million Center for Joint Replacement.

According to hospital marketing brochures, the center offered "A Higher
Level of Care" in a 20,000-square-foot space featuring 25 private
patient rooms, a "breathtaking physical therapy space" and a beautifully
landscaped therapy garden.

Instead, Cantley did his physical therapy sessions in a dimly lit
hallway on the sixth floor of the main hospital in what he described as
"a miserable set of circumstances."

Cantley's physician, Dr. John Jaureguito, who has been on the medical
staff at Washington for 18 years, said the arrangement means his
patients get "second-class" treatment. "Therapy is literally in the
hallway," he said. "I've never come across anything like this before."

What Cantley and many other patients at the public hospital didn't know
was that access to the new center, the only facility of its kind in the
Bay Area, is restricted to just two orthopedic surgeons at the hospital
-- the only ones on the Washington staff who met 24 criteria set by the

Those two doctors -- long the hospital's primary joint replacement
specialists -- played a critical role in the creation of the lucrative
new center, and one of them acknowledges he helped create the criteria
that have excluded many of his fellow surgeons. Some of those surgeons
and their patients are crying foul, saying the result is a "two-tier"
system of care that favors wealthier patients and chosen doctors.

"It is a community hospital, serving the public," Cantley, 78, told the
publicly elected Washington Township Health Care District board at a
meeting last month. "The public in no way, shape or form should be
excluded from the new wing."

The only two surgeons who qualified, Dr. John Dearborn and Dr. Alexander
Sah, received a five-year contract from the hospital to staff the center
through May 2017 while maintaining their status as independent
contractors, not employees, according to the contract.

The average single joint-replacement surgery performed at Washington
Hospital in 2011 cost nearly $160,000, more than twice the California
average, state data show.

According to one of Dearborn's secretaries, neither he nor Sah accepts
Medi-Cal or Alameda Alliance, which serve low-income residents, but
typically carry lower reimbursement rates for doctors and hospitals than
does Medicare.


Comment: There are ten orthopedists on the staff of Washington Hospital
in Fremont, California who perform joint-replacement surgery, but only
two are allowed to use the hospital's state-of-the-art Center for Joint
Replacement. The Center charges more than twice the average for
California, while the two approved surgeons apparently have a policy of
discouraging low-income residents, including Medi-Cal patients.

Perhaps the most appalling consequence is that the patients of the other
eight orthopedists receive their post-op physical therapy in the hallway
of the main hospital rather than in the new "breathtaking physical
therapy space."

As a community hospital, serving the public, and with pressure from the
state Department of Public Health and the Washington Township Health
Care District, it is likely that this arrangement will be modified.

So what does this have to do with health care reform? We can ask
ourselves if a single payer system that separately budgets capital
improvements would have ever allocated funds for a state-of-the-art
center serving only two prima donna surgeons and their affluent patients
exclusively. Of course not. Attention surely would have been directed to
a decision on whether or not it was even appropriate to establish a
separate joint replacement pavilion. Likely the funds would have been
better spent on improving or replacing existing surgical and physical
therapy facilities.

Achieving the goal of health care justice for all will be made that much
more difficult if our health care professionals and administrators fall
below the ethical plane that we envision for the healing arts.

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