Time for your annual checkup
July 10, 2015 8:34 PM   Subscribe

Dr. Farid Fata, a prominent cancer doctor in Michigan, admitted in court to intentionally and wrongfully diagnosing healthy people with cancer. Fata also admitted to giving them chemotherapy drugs for the purpose of making a profit. The cancer doctor’s guilty plea shocked many in the courtroom, according to The Detroit Free Press. Fata owned Michigan Hematology Oncology, which had multiple offices throughout Detroit’s suburbs.
One of the more horrifying crimes I've heard of. You're welcome.
“In this case, we had Dr. Fata administering chemotherapy to people who didn’t need it, essentially putting poison into their bodies and telling them that they had cancer when they didn’t have cancer,” the prosecutor told the Detroit Free Press.
He also committed tens of millions of dollars of insurance fraud!
posted by grobstein (86 comments total) 35 users marked this as a favorite
Nightmare fuel via John Cohen. I'm passing on the fun!
posted by grobstein at 8:35 PM on July 10, 2015

I've had cancer, and until today I would have said that I wouldn't wish it anybody.

Until today.
posted by Ursula Hitler at 8:39 PM on July 10, 2015 [54 favorites]

Aaaaand there's the crawling skin sensation I'm going to need to not sleep at all tonight.
posted by mephron at 8:53 PM on July 10, 2015 [1 favorite]

A cancer diagnosis doesn't just cause stress and anxiety for the person undergoing the treatment, but for their entire group of friends and family. This guy did a tremendous amount of harm.
posted by Ray Walston, Luck Dragon at 8:56 PM on July 10, 2015 [9 favorites]

[Chemo nurse Angela Swantek] wrote a letter to the state suggesting an investigation that day. In 2011, the state informed her they found no proof of wrongdoing at Fata’s office.

Sounds like Fata shouldn't be the only one on trial here.

Deeply, deeply horrifying all around.
posted by somedaycatlady at 9:07 PM on July 10, 2015 [24 favorites]

Sounds like Fata shouldn't be the only one on trial here.

Yeah, Swantek says she what was going on in the first 90 minutes of her first day on the job. If true, it seems to imply that a bunch of people were complicit, or at least looking the other way.
posted by grobstein at 9:17 PM on July 10, 2015 [24 favorites]

So, I've had cancer. Let's consider what this man put his patients through.

First, your blood counts tank. The red blood cell drop feels like a massive energy suck. After a few days of infusions you basically feel like you have a hangover all the time, massive headache, can't concentrate, can't nap, no appetite, nausea. This can last for weeks if you have multiple days of infusions sequentially. The white cell drop is worse; you can develop neutropenia, an inability to fight off infections, which can be fatal. I did. It manifests as a low grade fever, and if you're lucky you get a couple week stay in the hospital. Neulasta can help fend off the neutropenia, but at significant expense.

The nausea is its own fun. There are good treatments, ativan for one, but miss a dose and you'll regret it.

While you're being infused, you're also receiving significant saline volume intravenously (I got up to five liters a day for five days). This is to keep the chemotherapeutics from damaging your kidneys and liver. Reconcentration for urination is dangerous without the dilution of the saline. Of course, you bloat up delightfully, can't wear shoes, and feel pretty gross. It takes over a week to lose all that volume.

Eventually, your fast-dividing cells start to suffer: hair, tastebuds, fingertips, nails, and most humiliatingly your GI tract. You lose your hair gradually, in patches. If you play guitar or do fine work with your hands, you'll stop because it hurts. Not only do you have little appetite, but everything you eat tastes weird and hot food can really burn your mouth. You may wind up pooping mucus because your mucus membranes are damaged too.

One of these patients received a two-year course of chemo for a cancer he didn't have.

Hell is too good for this man.
posted by Existential Dread at 9:21 PM on July 10, 2015 [95 favorites]

Swantek figured it out in 90 minutes while the gov't official she reported Fata to, Sherri Johnson, found no wrong doing.

(Every other case report I can find from Johnson is also reporting no wrongdoing found, no need to investigate)
posted by Cosine at 9:22 PM on July 10, 2015 [7 favorites]

Yeah, it took three years to prosecute this guy after the first report. How many other less-obvious abuses are going on? Worse than the time my new dentist told me I had six cavities and my old dentist told me no, I actually had two?
posted by RobotVoodooPower at 9:36 PM on July 10, 2015 [7 favorites]

As if conventional healthcare isn't bad enough. I mean, this stuff is torture when you actually need it.

Oh, God.

What will it take to convince the world that there is something fundamentally wrong with our current medical paradigms? That we focus too much as is on a for profit model and too little on patient comfort and quality of life? He tortured people and ruined their health to line his pockets. We should set a higher bar on that expectation of first, do no harm. If we were less cavalier about accepting drug side effects and the like as a necessary evil there would be so much less opportunity for something like this to happen.

posted by Michele in California at 9:37 PM on July 10, 2015 [20 favorites]

(Never mind, I just have to google "pain clinic raid" to answer my own question)
posted by RobotVoodooPower at 9:39 PM on July 10, 2015

He actually got 45 years. So there's a chance he still could get out of prison alive.

What would be better than a longer sentence though would be to figure out why he wasn't prosecuted earlier when someone spoke up, and why no one else spoke up afterwards, and correct this behavior. Apparently people were quitting left and right but not saying anything.

Imagine if someone was going around subways for three years injecting people with chemo drugs, and there had been multiple witnesses and investigations, and nothing was done. Heads would roll.
posted by RobotVoodooPower at 10:05 PM on July 10, 2015 [13 favorites]

I can't help but wonder why. I get greed, and the rest of his crimes were more stealing from the undifferentiated masses. But intentionally causing unnecessary harm to someone sitting right in front of you? Not just once, but repeatedly for years?
posted by mantecol at 10:11 PM on July 10, 2015 [1 favorite]

SE Michigan checking in; this was the talk of the office today. Dude should count himself to be lucky to be behind bars, because if what I was hearing was the consensus on the street in general, he wouldn't last a day outside.
posted by fifthrider at 10:13 PM on July 10, 2015 [4 favorites]

He will be 95 when he completes his sentence. His wife and kids fled to Lebanon. I doubt he will see daylight ever again.

I wonder if any of his other staff were convicted.
posted by clavdivs at 10:15 PM on July 10, 2015

Donna’s father never had the cancer, a review of Donald’s medical files showed. Yet, the prestigious cancer doctor ordered two years of chemo. The civil suit alleges that Donald developed a blood-related cancer as an effect of the chemotherapy treatments. Donald later died.
I'm just going to echo Existential Dread before going to bed: Hell is too good for this man.

This taking the most intimate, personal, and downright existential aspect of an individual's life and exploiting it for personal gain. Physicians are literally entrusted with giving edicts of either life or death to people, and the abuse of that power that Fata engaged in is not simply an abuse of his own power, but of the basic trust between doctor and patient that underpins the foundation of the entirety of the western medical system.

And this was with cancer? Seriously, fuck. this. guy. I'm speaking now as someone who has worked in oversight and admin of clinical trials at an NCI cancer center, but literally every PI I've known would be puke-in-the-mouth disgusted with Fata.

The common refrain in oncology is that treatment is research (which is where I come in). Essentially, cancers are the default disease. The happen to almost everyone once you get old enough. Their causes though, that's such an ambiguous topic that it can spawn "X causes/prevents cancer" articles every week. Combine that with cancer being something that happens inside your body and it's presentation being so diffuse, and you end up with such a potential for abuse.

Imagine this:

Pt: I've been having heartburn, bloating, and stomach cramps.

MD: This could be any number of things. Let me run some tests.

Pt: Thanks, Doc!

MD: I've run the tests, you have cancer. We need to start you on extremely expensive and extremely toxic chemotherapy right now.

Pt: That seems extreme! What are my alternatives?

MD: You die.

Pt: Sign me up.

And that's the fucked up part. Oncologists are literally one of the few groups of people who hold life and death in their hands, and thus their absolute honesty is crucial. The other thing to keep in mind is that cancer treatments basically come down to one particular treatment protocol:

- Take a bunch of poison

- Poison should be more poisonous to tumor cells than normal cells

- You're taking poison regardless

Cancer therapies are literally hurting yourself so bad part of you dies. You just place your trust in trained professionals that they know the thin line between therapy and poison, and you literally put your life in their hands.

Like I said earlier though, cancer treatment is synonymous with cancer research. While a "new" drug is pretty rare, there are always new combinations of drugs to be tried. There are also different timings of the drugs. Or different timings of FDA approved drugs. Or different dosages. Or different populations. Or different anything else.

An amazing oncology nurse once told me that cancer treatment is basically alchemy, just with marginally better standards of evidence (the actual quote contains much more meandering and swear words). All this makes the abuse of cancer patients so much the worse. Cancer is a black box which, possibly more than any other disease, relies on the trust placed in highly trained professionals to diagnosis a disease is multifactorial; often invisible; and increasingly fatal if diagnosed too late.

Cancer docs get a lot of faith put in them, is the point. And this guy abused that trust, a trust which is literally the difference between life and death.
posted by Panjandrum at 10:26 PM on July 10, 2015 [42 favorites]

Sitting here with a hand clasped over my mouth. My best friend's dad just died of leukemia three days ago. I cannot even imagine.

Let this be the edge-case horror story helps us remember a much more mundane lesson - no matter how much you trust your doctor, or how much of a burden it might seem, when it comes to major diagnoses, if you possibly can, you should always, always get a second opinion.
posted by pretentious illiterate at 10:27 PM on July 10, 2015 [7 favorites]

Does anybody know why he seems to have been charged with fraud, rather than murder, deliberate infliction of bodily harm, etc?
posted by LobsterMitten at 10:30 PM on July 10, 2015 [12 favorites]

And just to engage in some light partisanship: I find it fitting that the oncology nurse was the whistleblower. Nurses are, overwhelmingly, the ones who interact with patients on a consistent basis. This responsibility includes literally being the person responsible for putting medicine into another human being's body. MD's may order the meds to be dispensed, but it is overwhelmingly nurses who actually do the dispensing, which tends to produce people who are good at second guessing and double checking orders.
posted by Panjandrum at 10:34 PM on July 10, 2015 [26 favorites]

There's a Newsweek article with more detail, like that he was receiving kickbacks from a hospice.

Really, the 45 years is professional courtesy, a jury would have strangled him themselves.
posted by RobotVoodooPower at 10:39 PM on July 10, 2015 [12 favorites]

"Does anybody know why he seems to have been charged with fraud, rather than murder, deliberate infliction of bodily harm, etc?"

"Because of the seriousness of the allegations and the potential risk to the health of Fata’s current patients and any future patients, FBI and HHS-OIG investigators, as well as Assistant U.S. Attorneys and DOJ Criminal Division prosecutors, moved quickly to collect corroborating information from employees in his practice. Within days, there was enough evidence to arrest him and shut down his businesses."

Above paragraph may explain. A long drawn out trial could have caused more harm to the community if the fetid excuse for a human pled not guilty. Oddly, the charges he pled too do encompass harm but not death. It was also a federal case so I believe the state can try him if this monster does ever walk.
posted by clavdivs at 11:30 PM on July 10, 2015 [2 favorites]

I've been avoiding this all day as it came across the various feeds. It's just so base and brutal, you want it to be elsewhere. On TV. In a movie. Clickbait. Godspeed, dude. You have a lot to atone for.
posted by notyou at 11:32 PM on July 10, 2015

There was a terrific article from The Detroit News last month:
Whistle-blower: How doctor uncovered nightmare
posted by The Hamms Bear at 11:56 PM on July 10, 2015 [15 favorites]

and this is why health care shouldn't have a profit motive
posted by mattoxic at 12:02 AM on July 11, 2015 [61 favorites]

How exactly is this possible? Are there no second opinions required? Do other people not see the test results? I can understand that patients may only get their information from their primary care provider but surely the insurance companies do some sort of quality control? (OK, apparently not but the US healthcare system can't be this much of a joke, surely?)
posted by epo at 12:15 AM on July 11, 2015

Want to know who is bribing your doctor? Check them out at Open Payments Data, which forces medicare docs to disclose payola from drug companies. Nice to see Allergan has been buying $200 lunches for my eye doc every week.
posted by benzenedream at 12:24 AM on July 11, 2015 [53 favorites]

he was receiving kickbacks from a hospice.

These are words I would like very much to have gone my whole life without ever reading.
posted by George_Spiggott at 12:41 AM on July 11, 2015 [76 favorites]

I still want to hit the doctor that casually dropped that the cancer that was killing my dad was genetic.
I'd want to go the full horror movie torture scene with this asshole.
posted by lmfsilva at 12:50 AM on July 11, 2015

This was literally a plot point on Gossip Girl. When you are enacting any Gossip Girl plot point in real life, you fucking suck.
posted by Eyebrows McGee at 1:11 AM on July 11, 2015 [5 favorites]

So did they determine how many people he killed via chemotherapy?

Also, everyone get a second diagnosis. And maybe a third and fourth. And fifth and sixth. And a seventh. And eighth. That should prevent stuff like this. And a ninth and tenth.
posted by hal_c_on at 2:11 AM on July 11, 2015

He couldn't have done this alone.
To paraphrase Mr Bevan, either someone knew and was too evil to be in charge or didn't know and was too stupid.
posted by fullerine at 3:21 AM on July 11, 2015

One of the failure modes of a profit-driven health care system as in the U.S. is the overtreatment of those able to pay. This appears to be the extreme form of this.

I also wonder how common things of this sort (perhaps not involving cancer or chemotherapy, but with fraudulent diagnosis and treatment of other conditions) is. Is there a constant background hum of low-level medical fraud, with egregious incidents of this sort being more of a Bernie Madoff-esquire outlier?
posted by acb at 4:03 AM on July 11, 2015 [8 favorites]

They busted a spine surgeon in Michigan a while back for similar shit. Opened people up, left them there for a while, then sewed them back up and billed for the fusion or laminectomy or whatever he was supposed to have done. Took years for him to get caught... apparently he was a whiz kid too - could have made plenty of $$ doing it the right way.
posted by mrbigmuscles at 5:09 AM on July 11, 2015 [3 favorites]

Dr. Fata was unique in that he saw patients not as people to heal, but as commodities to exploit.

He was unique in that he got caught. And that a whistleblower risked being a casualty of the war on whistleblowers.
posted by Obscure Reference at 5:13 AM on July 11, 2015 [9 favorites]

and this is why health care shouldn't have a profit motive

It's interesting and a little horrifying how people don't blink at the idea that a physician should retire a millionaire, in their mid forties if they wish.

My idea is that medical schools should be government run in the same way jet fighter schools are (having worked both in the Navy flight community and the emergency medicine field, I can tell you there are a LOT of similarities between the mindsets) - no one expects to get rich flying fighters, they do it because they love it. I think if we returned healthcare to the same principles, we could save a lot of money.

And people, too.
posted by Mooski at 5:18 AM on July 11, 2015 [12 favorites]

The article linked by The Hamms Bear is an excellent read to go with the post. It shows even more of the extent and how the doctor managed to cover his tracks
posted by biggreenplant at 5:36 AM on July 11, 2015 [1 favorite]

There was a very similar highly visible case in the Netherlands. A neurologist diagnosed people with serious diseases like ALS. Some of them died in treatment, one person committed suicide because of the awful diagnosis. Public opinion was very harsh on him, like in this thread. It turned out that he had frontal lobe damage which likely caused his strange behaviour and his initial prison sentence was recently overturned in appeals. It is a sad story all around. I found it shocking that people really wanted to sent him to prison, but nobody held anyone else in the hospitals responsible for even a small part. People had noticed for years (after a car accident in 1992) that there was something wrong with the doctor, and nobody did anything.
It does seem like Dr Fata knew exactly what he was doing, but that was the image we got from Jansen-Steur as well. He was described as horror doctor in the media for years.
posted by blub at 5:37 AM on July 11, 2015 [4 favorites]

What an odd crime. There are so many ways to legally fleece the medical system, it seems odd to risk it in this way. I mean, he could have become a dermatologist or plastic surgeon and built his castle on ill-advised, but elective, procedures. But this fake chemo is truly something out of a horror film.

I'm also surprised none of the patients got a second opinion. With something as serious as cancer, I'd always been told (by my former oncologist father and all my doctor friends), it's a good idea to get multiple doctors' advice on treatment.
posted by bluefly at 5:45 AM on July 11, 2015 [3 favorites]

One of the failure modes of a profit-driven health care system as in the U.S. is the overtreatment of those able to pay. This appears to be the extreme form of this.

To be fair, in a highly regulated single payer system a lot of doctors overtreat patients because they can get more money.
posted by Literaryhero at 5:45 AM on July 11, 2015 [2 favorites]

(╯°□°)╯︵ ┻━┻
posted by Fizz at 6:00 AM on July 11, 2015 [3 favorites]

I'm also surprised none of the patients got a second opinion.

We don't know that none did. If some did, how likely do you think it would be that Fata would suffer any repercussions for his misdiagnosis?

To be fair, in a highly regulated single payer system a lot of doctors overtreat patients because they can get more money.

I would like more than just a bald assertion of this. In the case of American medicine, I have personal experience that the profit motive affects treatment, as this story also shows.
posted by Kirth Gerson at 6:11 AM on July 11, 2015 [2 favorites]

I'm also surprised none of the patients got a second opinion.

A year or two ago I was listening to a story on NPR which discussed the feelings of guilt, fear, pressure/intimidation, whenever a person considers asking for a second opinion from their medical care professional. There is so much trust placed in this relationship that often people are fearful of antagonizing that relationship because it directly impacts the type of medical care they might subsequently receive.

This story is so awful. People should not have to worry about things like this from their Doctors and medical care professionals.
posted by Fizz at 6:22 AM on July 11, 2015 [13 favorites]

When the highest principle in a society is capitalism and the pursuit of profit and most people don't really see dishonesty as a big deal (or even think it's pretty cool when well-executed) this kind of stuff accords perfectly with those social values. It's still awful, but we encourage the kind of thinking that leads to it in so many ways.
posted by saulgoodman at 6:34 AM on July 11, 2015 [10 favorites]

I would like more than just a bald assertion of this.
At one time, I was friends with a doctor who told me that fear of malpractice suits encouraged American doctors to order more tests and try to cover their ass. I have also read some things that assert that one of the best medical facilities in the US is awesome in part because doctors are salaried and the number of tests they order does not impact their income.

I am a former military wife and this is part of why I survived the medical crisis that should have killed me: My access to medical care was substantially less impacted by the question of money. I really lucked out in that we moved to Travis AFB, in spite of my husband being army, right before my health took enough of a nosedive to finally be taken seriously by doctors. The medical facility on base is a regional facility serving military personnel in 8 large western states. It is so large, it has its own gate and people who work there get lost in the building. It has some ridiculously long hallway, like a quarter mile. It is a teaching facility and it is midway between Sacramento and San Francisco. It also works with UCDavis medical.

So, money was mostly not relevant (though they did deny some $5000 test as medically unnecessary) and I had access to an unusually high degree of cutting edge specialty expertise. A relative was just ending one of their rounds of treatment for cancer. We talked often about the bills they had and compared our two different experiences. I was traveling to two different big cities for testing and care and getting MRIs etc and I occasionally had to pay a co-pay at the pharmacy and insurance denied that one test. I was real sick at the time and not together enough to wonder too much about some things. Cleaning out cabinets during my divorce, I ran across a receipt showing I paid a $39 co-pay at the pharmacy. The stuff I picked up was worth about $1200.

I hate the way the American system makes healthcare about money. I hate it so fucking much. I also hate how healthcare has become about doctors playing hero, doing the most dramatic thing possible so they can enhance their ego at the expense of their patients' quality of life. Healthcare has become a euphemism for medical care and that is fundamentally fucked up. Eating right and exercise and clean air and clean water and so on should be our first lines of defense, not afterthoughts while we invent ever more expensive and fancy drugs and surgeries. Unfortunately, things have gone so far down this rabbit hole, it seems to be nearly impossible to discuss that angle. People think it is just crazy talk.
posted by Michele in California at 6:49 AM on July 11, 2015 [15 favorites]

I'd like to add that while I personally went through hell with the chemo, I also had fantastic doctors (in Michigan! Like this shithead!) who went above and beyond to treat me. This monster shouldn't be used to tar all doctors. This is a special case.

Doctors are people. Some are great some are mediocre, some just want a paycheck, and a rare few are monsters. The specter of malpractice suits is ever present for them, as is the persistent med school debt. Most work very hard, both self motivated and driven by their practice scheduling. This can unfortunately lead to errors, but hospital overheads are expensive, doctors are expensive, medicines are expensive. This is not to defend the status quo, but just show that it's not only doctors receiving money from patients, but a whole apparatus and industry.
posted by Existential Dread at 7:01 AM on July 11, 2015 [4 favorites]

Pretty much the only doctors who retire millionaires have to have buisness dealings...running drug infusion companies, owning multiple clinics, owning surgical centers, etc. I think owning these sort of things is defitely dangerous ethically. The profit motive and pay by volume rather than quality or even fixed pay cause distorted decision making in subtle ways. I think Dr. Fata is just a symptom of system that views wealth as success instead of reducing human suffering and the burden of disease on society.
posted by roguewraith at 7:22 AM on July 11, 2015 [1 favorite]

Okay, he got a 45 year sentence, which means with any luck he'll die in prison, although we all know he'll probably be out in half that. Meanwhile, reports say his wife & family scooted back to Lebanon: fine, good luck to them, bon voyage and all that.

But how about all his assets? Please tell me everything that could be seized, was seized. Because damn if he (or his family) should spend their lives living off the profits of his injuring innocent people!
posted by easily confused at 7:25 AM on July 11, 2015 [5 favorites]

I'm curious how many people currently suffering through chemo presently are going to get a second opinion, now, after hearing of this case.
posted by You Should See the Other Guy at 7:32 AM on July 11, 2015

easily confused: "Meanwhile, reports say his wife & family scooted back to Lebanon: fine, good luck to them, bon voyage and all that.
But how about all his assets? Please tell me everything that could be seized, was seized. Because damn if he (or his family) should spend their lives living off the profits of his injuring innocent people!

I'm curious about this as well. Especially since I read in some articles that his wife was the CFO of his practice.
posted by bluefly at 7:47 AM on July 11, 2015 [5 favorites]

I'm also surprised none of the patients got a second opinion.

We don't know that none did. If some did, how likely do you think it would be that Fata would suffer any repercussions for his misdiagnosis?

All he has to do is apologize for the "misdiagnosis" with enough charm to allay suspicions. He'll still make his obscene profits from the patients who trust him.

In the days before medical tests could determine the sex of a baby before it was born, there used to be services that would predict the gender of the child using some proprietary method. So confident where they of their predictions, they'd refund their fee if they were wrong. And all they had to do is reply with one of two choices to make money 50% of the time.
posted by King Sky Prawn at 8:06 AM on July 11, 2015 [7 favorites]

I just discovered -- via the Medicare open payments website listed above -- that my personal physician has accepted over $5000 in gifts from pharmaceutical companies in 2014.

I have no idea how I'm supposed to trust him now.

How can I ever be sure that he's prescribed me a certain drug because I really need it and not, at least in part, because AstraZenica regularly buys him $200 lunches?
posted by Avenger at 8:07 AM on July 11, 2015 [8 favorites]

how about all his assets? Please tell me everything that could be seized, was seized. Because damn if he (or his family) should spend their lives living off the profits of his injuring innocent people!"

From The Hamms Bear's link: "His assets were auctioned, and his wife and three children were allowed to leave the country." This makes me wonder if he had bank accounts elsewhere.
posted by GrammarMoses at 8:11 AM on July 11, 2015 [1 favorite]

On the issue of second opinions, from the Newsweek link:

At seemingly every stage of cancer (including no cancer at all), Fata promised his patients that remission was 70 percent likely, but only if they were completely loyal to him.


Elsewhere, he kept a tight leash on information by denying patients access to their full medical files—preventing them from being able to effectively seek a second opinion.

posted by bardophile at 8:13 AM on July 11, 2015 [4 favorites]

denying patients access to their full medical files

This too is against the law (obv). Cite: HIPAA documentation here.
posted by GrammarMoses at 8:21 AM on July 11, 2015 [6 favorites]

That spine surgeon also had ties to a kickback scheme in CA before he moved shop, he owned part of a medical device company and convinced the hospital to use their products.
posted by ghost phoneme at 8:21 AM on July 11, 2015 [1 favorite]

From the HIPAA link:
Access. Except in certain circumstances, individuals have the right to review and obtain a copy of their protected health information in a covered entity’s designated record set.55 The “designated record set” is that group of records maintained by or for a covered entity that is used, in whole or part, to make decisions about individuals, or that is a provider’s medical and billing records about individuals or a health plan’s enrollment, payment, claims adjudication, and case or medical management record systems.56 The Rule excepts from the right of access the following protected health information: psychotherapy notes, information compiled for legal proceedings, laboratory results to which the Clinical Laboratory Improvement Act (CLIA) prohibits access, or information held by certain research laboratories. For information included within the right of access, covered entities may deny an individual access in certain specified situations, such as when a health care professional believes access could cause harm to the individual or another. In such situations, the individual must be given the right to have such denials reviewed by a licensed health care professional for a second opinion.57 Covered entities may impose reasonable, cost-based fees for the cost of copying and postage.
I had annual HIPAA training for five years and had to go looking for it. And it isn't hard to deny people access when they are sick (because you poisoned them) and stressed out etc. Even when doctors are doing their absolute best to serve their patients, records and big bureaucracies and so on are a big problem for patients. It's overwhelming.
posted by Michele in California at 8:32 AM on July 11, 2015 [2 favorites]

I just discovered -- via the Medicare open payments website listed above -- that my personal physician has accepted over $5000 in gifts from pharmaceutical companies in 2014.

I have no idea how I'm supposed to trust him now.

As in all cases, your judgment is needed. Is this breakfast once a quarter while staff is updated during his drop off of med samples? Or is it a free trip to a "educational seminar"? Are you otherwise satisfied with services? Are you willing to never take the free medication sample? Are you willing to be an educated questioning patient whether with this MD or others? I agree with the need for transparency and I agree pharm and surgical reps are among the most abusive of this type of issue. I'm less certain that the causing everyone to doubt everything said by every doctor ever is a good or reasonable alternative. And $5000 is nothing compared to others.
posted by beaning at 8:50 AM on July 11, 2015 [3 favorites]

Yeah, but the whole point of having doctors is that you don't have to second guess them because they've spent 10+ years in school and are more knowledgeable than you can ever hope to be.

Saying "well, do your research" and "do you *feel* like your doctor is good?" defeats the whole purpose of having ultra-highly trained professionals. You put your life in their hands, and they either do the right thing or they don't.

Also: saying "don't worry, your doctor is only a little corrupt compared to others" is....well, it's probably the best response that American medicine has right now, and that's sad.
posted by Avenger at 9:06 AM on July 11, 2015 [13 favorites]

acb: "Is there a constant background hum of low-level medical fraud, with egregious incidents of this sort being more of a Bernie Madoff-esquire outlier?"

I'd say that's correct. But most fraud is more along the lines of, a local Day Surgery clinic couldn't get in-network status that would allow him to compete with other in-network places, so what he did instead was inflate his bill by the amount of the co-payment the patient would have owed, and then refunded that amount to the patient. (So for example, he was doing a surgery that cost $1000 and the patient had to pay 30%, or $300. So he bills the insurance company $1300 instead of $1000, and refunds the patient's $300 copay. He gets the full $1000, the patient has no copay. Same guy different scheme -- urologists are automatically in-network for this health plan, so he opens a urology clinic, and then he processes all bills from his day surgery through his urology clinic. It apparently took two years for the insurance company to notice that its computers were automatically kicking payment to a urologist for doing mole removals and varicose vein treatments and whatnot.

That is, medical fraud is typically more about overbilling and screwing insurance companies, and less about doing unnecessary procedures or trying to get money from patients.

(And then the same guy threatened some of the people involved in the case with a gun he was illegally carrying around and anyway he eventually managed to get a RICO charge which is hard work when you're a small town urologist!)
posted by Eyebrows McGee at 9:10 AM on July 11, 2015 [6 favorites]

He actually got 45 years.

That's an average of 29 days for each person affected, not including the fraud question. 29 days for not just the anxiety and distress caused from thinking you have cancer, but the actual physical harm that happens to your body through chemotherapy.
posted by SpacemanStix at 9:22 AM on July 11, 2015 [3 favorites]

Saying "well, do your research" and "do you *feel* like your doctor is good?" defeats the whole purpose of having ultra-highly trained professionals. You put your life in their hands, and they either do the right thing or they don't.

I'm not saying doctors should not do the right thing and that you shouldn't trust them. But if you're going to not trust your personal MD because of stories like this, then those are the next steps in assessing if you need to move on. And given the numerous responses in this thread and other medical posts about "why weren't second opinions sought?" vs "why won't my doctor let me do this alternative holistic approach that involves apricot pits?" I say the average MD and the average patient are both damned either way (because Dr Google is not your doctor and cannot assess your specifics). I agree the current medical system is rapidly approaching breakdown.
posted by beaning at 9:27 AM on July 11, 2015 [5 favorites]

Doctors are, unfortunately, just as liable to be incompetent and/or unscrupulous as any other profession in which there is a high level of knowlege imbalance. You must, must must get a second opinion for any serious diagnosis which requires surgery and/or CRT. There are a lot of roadblocks, not the least of which is the personal bond between physician and patient. A competent, trustworthy doctor will encourage the second opinion. If the doctor balks in any way or tries to give you a guilt trip, run screaming to the hills. Particularly with cancer, doctors are often trying to establish a practice and need patients who are essentially guinea pigs. If at all possible get your second opinion at the nearest major cancer center, especially if the diagnosis is for a difficult-to-treat type like esophageal cancer, where the location of treatment has a significant effect on survival rates.

It is not right or fair that we cannot just trust doctors at their word, but it is the reality of contemporary, profit-driven medical care.

A close relative of mine just went through this very scenario. If I hadn't forced them to get a second opiniom they would no longer have an esophagus.
posted by grumpybear69 at 9:33 AM on July 11, 2015 [4 favorites]

Years ago, my knee was injured.

I was diagnosed with a torn ACL by a very reputable surgeon (head of orthopedic surgery at [respectable hospital] - "immediate surgery" for two days' hence. I believed in my heart it was a pulled ligament but I was, "Oh, guess he knows."

My girlfriend at the time said, "See a sports medicine doctor!" So I did. He gave the knee an incredibly thorough examination (and very painful, even though he was super gentle and apologetic - he had to try the knee out in every direction). At the end, he said, "It's a pulled ligament, physio only." At that point I told him about the other diagnosis. "Interesting! What did the MRI show?" "He didn't give me one."

It was the only time I saw a doctor surprised professionally. He gathered himself together quickly and said, "That's unusual."

I did the physio - lots of fun. The week after I ended it, I helped a friend with a traumatic move - l literally did hundreds of flights of stairs! - and my OTHER knee ached afterward. Yes, the injured knee was in such good shape from the workout that it was fine, and I've never had a day's issue with it. (And if I'd had the surgery, I'd still have had to do physio...)

Just last Sunday I went for a super-expensive emergency dentist visit to a dentist who wanted to upsell me and pull two of my teeth. I opted for antibiotics, painkillers, and a visit to my actual dentist (soon) - because I remembered that knee.

The correct procedure in that case is in fact to stabilize the area with antibiotics first and then take a look at the tooth first, says both my real dentist and references.

If it's irrevocable, if you have the slightest doubts, GET A SECOND OPINION.

Not that there is any blame attached to these poor victims. I don't want to be victim-blaming here, they simply trusted their doctors as everyone is supposed to do, and got damaged. Learn from their loss. Get a second opinion (for anything major, irrevocable, or surprising, of course).
posted by lupus_yonderboy at 10:09 AM on July 11, 2015 [26 favorites]

If I hadn't forced them to get a second opiniom they would no longer have an esophagus.

And if I had not consulted Dr. Google, I would probably have an implanted pacemaker today, instead of being cured of the A-fib that was enriching my cardiologists*. My previously told story here.

* In my case, a second opinion was not enough.
posted by Kirth Gerson at 10:13 AM on July 11, 2015 [1 favorite]

That Open Payments site mentioned above was fascinating.

My allergist, who I rely on most, got from four companies total somewhat over a dozen meals each worth $15-20 in 2014. That's top-notch - reads to me as "every three weeks he goes to a presentation by a different pharmaceutical company and gets coffee and donuts" ($15 doesn't get you much in NYC). I call that "doing your homework". Whew!

But sorry, the guy getting $5000 in bribes is a crook. Perhaps he's a good doctor, but that's too much money. The fact that there are people getting ten times as much doesn't make him not a crook.

Somewhere between AstraZeneca's $14.76 meal on 1/14/2014 for my guy, and AstraZeneca's $200 meal mentioned for someone else's doctor above, I move from "professional courtesy" to "bribe".
posted by lupus_yonderboy at 10:38 AM on July 11, 2015 [6 favorites]

Imagine if someone was going around subways for three years injecting people with chemo drugs

Really now, their sandwiches aren't that bad.
posted by pwnguin at 12:23 PM on July 11, 2015 [1 favorite]

I think there's a big difference between diagnosing yourself via Dr Google, and doing background research.

Sites like WebMd are probably an easy way to hypochondriac yourself. But if a doctor tells you that you have plantar fasciitis, reading up on it on,.say, the Mayo clinic's website (which is fantastic!) is prudent.

I have uncommon health issues, and unless I'm seeing a specialist I typically know more offhand about my issue than they do. Being educated (without being an ass about it) is an important part of healthcare.
posted by Adamsmasher at 12:30 PM on July 11, 2015 [4 favorites]

I have breast cancer and over the past several months of treatment have met many women who are also going through chemo and radiation and the whole nine yards along with me. It's been absolutely shocking to me that not just a few, but I would say the majority of women I talk to, don't know the stage or type of their cancer, the name of their chemo drugs, or why they're getting the treatment they are. It's not surprising to me that this guy got away with what he did for so long. Not only do most patients not seek a second opinion, many don't even bother - whether out of fear or laziness or something else - to understand the first opinion.
posted by something something at 1:11 PM on July 11, 2015 [6 favorites]

I've been seeing my GP for maybe nine years. My husband sees him too. He's the medical professional with whom I have my longest running relationship. He has called me at 6:30 in the evening to let me know my test results were good. I've called him on the weekend when I was traveling and realized I left a prescription at home.

One day, I went in for an appointment and saw a sign on the door that said that he's not interested in lunches, dinners, or presentations from pharma people but they can drop off samples. Last year, he received two textbooks from pharmaceutical companies valued at about $70 each.
posted by kat518 at 1:18 PM on July 11, 2015 [6 favorites]

Ooof. Apparently my endocrinologist got an $11,000 speaking fee from the company that makes Thyrogen.

For those not in the know about thyroid cancer, treatment generally includes two steps: removal of the thyroid, and then treatment with radioactive iodine. In order for the RAI treatment to be effect, your thyroid cancer cells need to be "awake".

This can be done by taking you off of thyroid medication, which induces your body to provide thyroid stimulating hormone (TSH). And, by all accounts, this sucks-- you become hypothyroid, which include weight gain, hair loss, loss of energy, depression, etc. And this can take like, 6 weeks.

Thyrogen is essentially artificial TSH. No need to go off your thyroid medication-- two (rather painful) shots in the rear end, and you're good to go. By all accounts, it works just as well as going off of medication.

So, this could be a case of the doctor's original inclination (not make my patient suffer for six weeks) aligning with the pharmaceutical company (get more people to have this drug!), especially since some insurance companies don't cover the Thyrogen shot (or, at least that's what I found out when I was looking into things 5 years ago and saw the horror stories from folks who weren't able to get it due to cost). If she can get free or reduced price samples, then more patients can get the shot instead of going hypothyroid for a few weeks.

But I'm still very, very glad that I started seeing her *after* I had my surgery and RAI, and the doctor that oversaw my RAI treatment and prescribed the Thyrogen did *not* get money from that company.
posted by damayanti at 1:26 PM on July 11, 2015 [2 favorites]

Just last Sunday I went for a super-expensive emergency dentist visit to a dentist who wanted to upsell me and pull two of my teeth.

Oh god, this shit just makes me fume.

Maybe 10 years ago, I was between dentists, and was clearly having a problem needing immediate attention, so I went to a dentist suggested by my insurance. I didn't realize at the time that it was a big-time chain dentistry operation. I was in unbelievable pain, which later resulted in a root canal with a fantastic endodontist. But, before I could get to that point, there I was being looked at by a dentist who literally cared more about trying to document every single thing they could attempt to sell me than in getting me out of there and off to pick up pain medication.

I kid you not, they made me wait an extra 20 minutes in the waiting room after the fact (in excruciating pain, awaiting them to hand over a prescription for vicodin and antibiotics) so that they could work up a $15,000 plan for all the dental work they claimed I needed, which they then tried to get me to sign up for it on the spot.

I never went back. I found a new dentist, who is amazing, and literally almost 90% of the work they wanted done he identified as unnecessary (and none of it has been done, a decade later, and I'm no worse for the wear).

Years later, one of these chains popped up in my hometown, and let me tell you I have bad thoughts about arson every time I drive by it.
posted by tocts at 2:19 PM on July 11, 2015 [7 favorites]

This should be a death penalty case
posted by knoyers at 3:32 PM on July 11, 2015 [1 favorite]

Maybe not death penalty. Better would be for him to get chemo treatments for the rest of his natural life. I would also like it if he had a bunch of unnecessary surgeries.
posted by merelyglib at 5:10 PM on July 11, 2015 [3 favorites]

Maybe a more fitting punishment would be to take all his money, then get him a job in that Lebanese castle, scrubbing toilets
posted by Ray Walston, Luck Dragon at 5:18 PM on July 11, 2015

Man, I keep trying to convince my dentist to do tooth whitening on me and he's like, "No, go buy whitestrips at the supermarket, your teeth are not discolored enough for me to do that." Apparently he is not being bribed enough by Big Laser.

The hospital that all of our doctors are affiliated with forbade accepting virtually all drug company money and favors several years ago; I ran a bunch of doctors we've seen through the database (all of whom have pretty substantial Medicare/caid practices) and only one of them came up -- a pediatrician who is half-time practicing and half-time researching, who has a $500 grant from a drug company to study one of their drugs. Which I already knew about because they post all the various research trials they're participating in on the bulletin board in the waiting room. Also at some point they bought her a $15 lunch. I asked my friend who's a doctor in that hospital system and she said, "Oh, yeah, we get fired if we so much as accept a freebie a drug sample. They're basically allowed to buy pizza or wraps for us when they come and do a presentation about a new drug, but you're only allowed to go once and the drug has to be reasonably related to your practice area or you get reprimanded and it goes in your HR file. They have to do it in a hospital conference room and an administrator signs all the doctors in, they can't come to your office with donuts or anything."

I do sort-of miss the freebie drug samples where you could get two days of dose so you could go to the pharmacy at your convenience rather than RIGHT THEN, but I guess I do feel a lot better knowing none of my doctors are taking payola.
posted by Eyebrows McGee at 6:14 PM on July 11, 2015 [3 favorites]

I get frustrated by the medical establishment. There are outright shady people who up-sell when something isn't warranted, there are people who push for treatment that may someday be necessary but isn't necessary now, and there are some people who probably feel the pressure to up-sell because it can be a competitive market out there and if they aren't doing a certain amount of work, they can't stay in business. I have sympathy for none of these motivations, and I'm always aware that they might be out there, and I have to be wary of doctors now like I do auto repair people. If I ever find an auto mechanic I can trust, I stay with them for life. The same now with doctors.

I'm convinced that I've had unnecessary work done on my teeth at least once, drilling out a cavity that probably wasn't really there. A lot of it is my feeling about how I was sold on it in the moment, and the fact that I never really get cavities. I have a dentist a couple of years back who I won't go back to who tried to get me to have a cavity drilled, although he showed me x-rays that were perfect. He happened to just find it when looking in my mouth. Maybe this happens at times, but I have no ongoing issues with the area he wanted to work on, and I've confirmed no cavities there with another dentist. The way he couched it though was that "it wasn't quite ready for a root canal." Give me a break.

I went in for some ongoing thyroid issues just this last week, and the first thing that the surgeon said, who I had never met before, as he walked in the door and sat down, is that they he recommends that they remove half of my thyroid. Now, it could very well that this ends up being the case that I'll need to have this done, but I also realized in the moment how wary I am of people in the medical profession who might not always have the Hippocratic oath in mind when they give advice or perform procedures. I'll get a second and third opinion on this, including those who are medical experts on thyroids (like an endocrinologist) and who don't make their primary means of career advancement by removing people's body parts.

I feel very cynical, and I don't like it, as I like to trust people before until prove otherwise. But I also feel like I have to watch my back now, which I do by trying to research my own issues to the best of my ability, get multiple opinions, and also check all my own test results, which fortunately my provider makes available via an online internet portal. I can see them before my doctor often does. My research might be rough, but it allows me to take an active roll in my treatment and at least ask for clarification and semi-informed questions. I'm sure part of my motivation is being a bit freaked out to go under the knife without a good reason, but I really can't imagine not being this involved with anything that requires life-saving measures. I feel so back for all of these people who were cheated out of time, money, and emotional well-being, and who now have to feel levels of mistrust that probably overshoot mine by a country mile.
posted by SpacemanStix at 8:51 PM on July 11, 2015 [3 favorites]

That open payments rule is genius, thanks for the link, benzenedream I will be advocating for this in Canada.

There has been much hullaballo about attacks on independent drug review iny province in Canada, lately. And the reach of the pharmaceutical companies in Canada is extensive.
My doctor does not allow drug detailers/ reps in his clinic because he said it did influence prescribing, even if you tried to be aware of it.

posted by chapps at 9:55 PM on July 11, 2015

I would like to search this database by drug company.
posted by chapps at 10:03 PM on July 11, 2015

Chapps, you totally can. Just click on the "Company Making Payments" tab on the top right.
posted by mysterious_stranger at 10:05 PM on July 11, 2015 [1 favorite]

D'oh!! Thanks, mysterious stranger!
posted by chapps at 10:25 PM on July 11, 2015 [1 favorite]

I just discovered -- via the Medicare open payments website listed above -- that my personal physician has accepted over $5000 in gifts from pharmaceutical companies in 2014.

Piker! My dermatologist accepted over $125,000 from pharma companies in 2014. That's on top of his research grants, so the $125,000 was the actual 'wine and dine' money.

Frankly, I already had a feeling that this would be the case because Dr. Dickweed (not his real name) once went off on a ten-minute rant about the evils of generics and how he was no longer even able to get samples because the poor beleaguered pharma companies could no longer even enter the building due to new policy.

After multiple visits wherein he recommended expensive drugs that had just come out on the market, my protocol is down to one antibiotic and a generic topical that's been out for years. This only came about after I got tired of justifying exotic off-label usages and shiny new drugs to my concerned PCP (and tired of the time spent looking up the relevant research articles in PubMed just to be sure) and pushed back. Because fuck you, Dr. Dickweed, I can do that kind of research--but I shouldn't have to.

It's really hard to decide to get a second opinion, let alone to actually go through with it. It's really hard to push back against your doctor and say 'no, that treatment isn't what I want.' It's really hard to deny a doctor's expertise in order to assert that your own knowledge of your body is valid, too. If my derm hadn't descended to cartoon villain levels of obviousness, I might not have empowered myself to take charge of my treatment.

We no longer endorse the paternal role of doctors in their relationships with patients but that doesn't mean that the authoritative role doesn't exist. How often do we scold friends, family, and fellow Mefites about using Dr. Google? Yet there's a difference between WebMD and PubMed (and a difference between reading a PubMed article and understanding it) which we don't talk about as often when we scold each other about internet self-diagnosing. Using info found through Google to undermine your doctor is different from using info found through Google to respectfully question them. We should do a better job of making that clearer.

It's very easy to see how Dr. Fata's patients could have uncritically accepted his treatments. That is, after all, what society by and large has taught them to do.

I want to add that Dr. Maunglay and the unnamed nurse deserve plenty of credit for taking the hard steps to report Fata's misdeeds. Their stories are the bright spots in this mess.
posted by librarylis at 12:00 AM on July 12, 2015 [8 favorites]

The very idea that the term upselling can be applied to medical treatment just turns my stomach.
posted by Michele in California at 12:18 PM on July 12, 2015 [7 favorites]

This is so weird. I was diagnosed with cancer in '89. I was in pain, and my dad's orthopedic surgeon did an x-ray and thought it might be sarcoma. He suggested I go to the Mayo Clinic in Rochester, MN, because it was hard to diagnose properly, and NM didn't have the facilities for it. Turns out it was non-Hodgkin's lymphoma. The diagnostic tests took four days to do, including CT scans, a biopsy, blood work, an MRI, and who knows what else. They were very thorough, and I trusted their results. The treatments were not fun, though not terrible compared to many people, but they were significantly easier than if I were diagnosed with sarcoma.

I was lucky to have good insurance and a family with the means to deal with it, plus there's no way my parents would have accepted any cancer diagnosis without thoroughly exhausting other opinions, which is pretty much what a facility like Mayo does all in one place. I can't imagine going through those treatments for no good reason. My chemo was relatively mild, but it still sucked, and radiation permanently ate muscle tissue away. It cost a hell of a lot of money, of course, which the insurance mostly covered.

I can imagine some people are tempted by the ability of medical knowledge to fool the insurance companies and their patients, but this is such an egregiously cruel example of a doctor who basically tortured and killed his patients with unnecessary treatments to accomplish the task, and put their families through hell. Plenty of excellent doctors lack empathy and still have a sound sense of ethics, but this is more like a serial killer who lacked the compulsion to murder all his patients.
posted by krinklyfig at 1:32 AM on July 13, 2015 [1 favorite]

Okay, he got a 45 year sentence, [..] although we all know he'll probably be out in half that.

Federal prison doesn't work like that. He could get 6.6 years off for good behavior, but that's about it.
posted by ryanrs at 1:53 AM on July 13, 2015

« Older The heads are rolling today   |   Pete Seeger and Arlo Guthrie, Carnegie Hall Newer »

This thread has been archived and is closed to new comments