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FL’s hyper-aggressive medical culture

A number of HCA hospitals in Florida are currently under review by the U.S. Justice Department, apparently under suspicion of covering up a discovery that some cardiologists were doing internal procedures, such as heart catheterization and stents, on people who didn't need them. The chain denies wrongdoing.

The giant hospital chain told investors about the inquiry on Monday, knowing The New York Timeswas about to publish an article about it.

To its credit, HCA investigated reports that its heart doctors were doing unnecessary procedures. But according to The Times, which cites internal e-mails that someone leaked, HCA failed to report its own findings to the government and pay back its ill-gotten gains to Medicare. HCA also didn't tell the patients who were subjected to the unnecessary risks, the newspaper reported.

I don't know, of course, whether the allegations are well-founded, since I don't have the e-mails. But I do know this:  Florida's medical culture is hyper-aggressive. This has been found over and over again by researchers at Dartmouth University, who periodically look at variation in medical treatment by geography and report on The Dartmouth Atlaswebsite.

Since many of Florida's doctors trained and practiced somewhere else before they came here, it's perplexing. Is aggressive treatment style a cultural norm to which newcomers adhere? In other words, is it socially contagious? 

In my own family, I saw it happen. I took a close relative for a visit with the new cardiologist, her former one having retired. This 84-year-old relative has had Stage 4 ovarian cancer for 16 years (staved off through surgery and chemotherapy), but now has an inoperable tumor on her liver. She also was diagnosed with congestive heart failure last year and uses oxygen to sleep. She can get around with a walker, slowly. She has lost so much weight she looks cadaverous. She is under hospice care.

Nevertheless, when she told the cardiologist that she had had chest pain the previous week, he set her up for a chemical cardiac stress test and echocardiogram. I asked why, and he said that there may be a block in a coronary artery causing the pain, and if so, it could be removed.

I was shocked, and probably showed it. Wouldn't the stress test be too hard on her, much less the procedure?

He dismissed my questions and wrote up the orders. 

A few days later, I took her to see her primary-care physician, Dr. David Levine, who is board-certified in geriatrics and is as close to the perfect doctor as I have ever known. He spent at least 45 minutes with her, listening to her and asking questions in a gentle voice. He seemed surprised when we mentioned that she was scheduled for the stress test.

Levine said that was a bad idea. A really bad idea. Even if she survived the test and it showed an artery was blocked, what then? He said he wouldn't clear her for any surgery or procedure, as sick as she is.

Through his questions, he discovered that she hadn't been prescribed nitroglycerin to alleviate the chest pain. He remedied that.

Best of all, he offered to call the cardiologist and explain to him why the stress test and echo had to be canceled. Our family was spared any further arguments.

Oh, by the way, that cardiologist's group uses an HCA-owned heart center. 

--Health News Florida is an independent online publication dedicated to journalism in the public interest. Editor Carol Gentry can be reached at 727-410-3266 or by e-mail.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.