Friday, July 20, 2012

Health Transparency 9: Physician Misdiagnosis, Dispensing Medicines

Note: I originally posted this last Monday, expanding this today to include some updates...

July 16, 2012

I posted this last night in my facebook wall to help a friend of mine....

Seeking advice from lawyers and physicians: A good friend of mine has been sick, almost 3 weeks fever, they consulted 3 physicians, they all gave different diagnosis. A 4th doctor said he shd be confined. The family felt robbed by the 3 previous doctors. Any remedial action?

A friend commented why sue doctors for having different opinions. I replied that suing a doctor is a last resort due to the high costs and legal hassles involved. That is why I was asking other remedial measures/actions. For now, the immediate concern is how the patient can recover, 19 days of fever. They hope the 5th doctor can give a more correct diagnosis.

This is how the disease has dragged on, as narrated to me by the wife of the patient. Well, she's my friend too.

July 4, wife bought him to The Medical City Satellite clinic in Antipolo. Had fever for about 3-4 days already. Doctor advised him to have CBC, urine test, Xray. After 30 mins the 2 tests were released and he was asked to take antibiotics for his UTI. He was asked if he has allergies, there is none. Next day, wife took the XRay results.

Patient still suffering from high fever, brought him back to TMC clinic. Again cbc tests, but doctor had an emergency and results was never read. Wife had limited money at that time, was told another doctor can see them but then she/he will ask for another consultation fee. Wife got pissed because they already paid the previous doctor w/o prescribing them and interpreting the tests results.

So they looked for another doctor in a different clinic. Come Sunday, rashes in the patient's body mostly from tummy. And still suffering from fever. Wife thought those rashes were reaction from the Med he was taking.

Come Monday they went to Clinica Antipolo and decided to have another blood tests before seeing new doctor. Wife explained to the doctor what transpired in their consultation at TMC Clinic. Gave her all the previous and present tests results . And the rashes have come out almost all of his body. Doctor said those were measles. She advised wife to stop giving patient those antibiotics and instead to take Vitamin C with Zinc and Paracetamol if with fever.

The fever continued and so paracetamol was given to him every 4 hours. Last Friday, wife noticed that in his personal urinal, he only peed few from the previous night. So come Saturday monitored all his water intake and his Urine. From the 5 glasses that he drunk the whole day he ony peed only about half glass.

Wife was alarmed, called up his doctor that told them earlier that it was measles, advised them to have another urine and blood tests. At this time, patient was already weak and manas na sya. So after results was released this morning, new doctor from Clinica Antipolo advised her to confine the patient. New doctor said that those rashes weren't measles but instead Stevens-Johnson, wife was shocked.

Two of my friends made these observations:

1. Erwin, a physician: "Mukhang nag ACUTE RENAL FAILURE."
2. Arnel, a lawyer: "If legal remedy, none, based on the facts; consultation lang naman, at humingi ka ng second opinion."

I thanked them and others who pitched in short advice.

July 20, 2012

The wife posted this yesterday in facebook, patient still in the hospital:

Confirmed he's suffering from Stevens Johnson. His case is a severe allergic reaction from taking antibiotics. He is now under close supervision from his 2 doctors....

The steroids made him awake for more than 24 hours. And so we ask the doctors to give remedy for his being awake. He had his 8-hour seep after given half of the sleeping pills. The first time I've seen him sound asleep. I enjoyed my sleep too :-)

Finally, he was able to eat his complete meal. No more struggling from pains, no more fever. I think he is on his way to recovery :-)

So it's a clear misdiagnosis or medication error by the first doctor from The Medical City who prescribed the antibiotics. Perhaps if the same doctor saw the patient the next day, he could have advised to discontinue the antibiotics but as the wife narrated above, that doctor attended to an emergency case of another patient.

Adverse drug reaction (ADR) is an important issue in healthcare and pharmacovigilance. Drugs can heal, but drugs can also kill. I briefly wrote about it here,  Counterfeit Drugs 4: Drugs Can Kill.

Meanwhile, here's an interesting report from the NYT last week. In the US, medical bills are soaring in some states because physicians and middlemen put a huge mark up on medicines that they dispense.

Insurers Pay Big Markups as Doctors Dispense Drugs

Published July 11, 2012

When a pharmacy sells the heartburn drug Zantac, each pill costs about 35 cents. But doctors dispensing it to patients in their offices have charged nearly 10 times that price, or $3.25 a pill.

The same goes for a popular muscle relaxant known as Soma, insurers say. From a pharmacy, the per-pill price is 60 cents. Sold by a doctor, it can cost more than five times that, or $3.33.

At a time of soaring health care bills, experts say that doctors, middlemen and drug distributors are adding hundreds of millions of dollars annually to the costs borne by taxpayers, insurance companies and employers through the practice of physician dispensing.

Most common among physicians who treat injured workers, it is a twist on a typical doctor’s visit. Instead of sending patients to drugstores to get prescriptions filled, doctors dispense the drugs in their offices to patients, with the bills going to insurers. Doctors can make tens of thousands of dollars a year operating their own in-office pharmacies. The practice has become so profitable that private equity firms are buying stakes in the businesses, and political lobbying over the issue is fierce.

Doctor dispensing can be convenient for patients. But rules in many states governing workers’ compensation insurance contain loopholes that allow doctors to sell the drugs at huge markups. Profits from the sales are shared by doctors, middlemen who help physicians start in-office pharmacies and drug distributors who repackage medications for office sale.

Alarmed by the costs, some states, including California and Oklahoma, have clamped down on the practice. But legislative and regulatory battles over it are playing out in other states like Florida, Hawaii and Maryland.

In Florida, a company called Automated HealthCare Solutions, a leader in physician dispensing, has defeated repeated efforts to change what doctors can charge. The company, which is partly owned by Abry Partners, a private equity firm, has given more than $3.3 million in political contributions either directly or through entities its principals control, public records show....

Physician prescribing works like this: Middlemen like Automated HealthCare help doctors set up office pharmacies by providing them with billing software and connecting them with suppliers who repackage medications for office sale. Doctors sell the drugs but they do not collect payments from insurers. In the case of Automated HealthCare, the company pays the doctor 70 percent of what the doctor charges, then seeks to collect the full amount from insurers.

The number of doctors nationwide who dispense drugs in their office is not known and the practice is prevalent only in states where workers’ compensation rules allow for large markups.

Dr. Paul Zimmerman, a founder of Automated HealthCare, said that insurers and other opponents of doctor dispensing were distorting its costs by emphasizing the prices of a few drugs, rather than the typical price spread between physician- and pharmacy-dispensed drugs.

Both Dr. Zimmerman and physicians who sell drugs also said the workers’ compensation system was so bureaucratic and complex that an injured employee could wait days before getting a needed medication through a pharmacy.

“We did not institute this because of the money,” Dr. Marc Loev, a managing partner of the Spine Center, a chain of clinics in Maryland, testified last year at a public hearing in Baltimore. “We instituted it because we were having significant difficulty providing the care for workers’ compensation patients.”...

See also:
Health Transparency 4: Drug Promotions and Government, September 03, 2010
Health Transparency 5: Forum on Good Governance in Health, March 08, 2012
Health Transparency 6: Physician Protectionism, May 19, 2012
Health Transparency 7: DOH Advisory Council, CHAT, June 04, 2012
Health Transparency 8: Advisory Council on RA 9502, June 11, 2012

1 comment:

Physician Dispensing said...

Your Article Is Very Nice Article.
physician dispensing