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When on deadline she fuels herself almost exclusively on chocolate chips.\r\n\r\n ","avatar":"https://secure.gravatar.com/avatar/3fb78e873af3312f34d0bc1d60a07c7f?s=600&d=blank&r=g","twitter":"lesleywmcclurg","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"news","roles":["editor"]},{"site":"futureofyou","roles":["editor"]},{"site":"stateofhealth","roles":["author"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["author"]}],"headData":{"title":"Lesley McClurg | KQED","description":"KQED Health Correspondent","ogImgSrc":"https://secure.gravatar.com/avatar/3fb78e873af3312f34d0bc1d60a07c7f?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/3fb78e873af3312f34d0bc1d60a07c7f?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lesleymcclurg"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"futureofyou_441764":{"type":"posts","id":"futureofyou_441764","meta":{"index":"posts_1591205157","site":"futureofyou","id":"441764","score":null,"sort":[1526943625000]},"guestAuthors":[],"slug":"sticker-shock-jolts-oklahoma-patient-15076-for-4-tiny-screws","title":"Sticker Shock Jolts Foot Patient: $15,076 For 4 Tiny Screws","publishDate":1526943625,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Sherry Young just wanted to be able to walk without pain.\u003c/p>\n\u003cp>About three years ago, she began to experience sharp pain in her left foot. Her big toe had become crooked and constantly rubbed up against the adjacent toe, making it painful to run, walk or even stand. \"I could not walk without intense pain unless I had a pad underneath my toes for cushioning,\" Young said.\u003c/p>\n\u003cp>An orthopedic surgeon told her that he could fix her problem for good. \"He thought my foot was hitting the ground too hard and causing pain,\" said Young. \"That's what he was trying to correct.\"\u003c/p>\n\u003cp>Though Young had had several orthopedic surgeries, she had always had good insurance and never scrutinized her bills.\u003c/p>\n\u003cp>At the time of her foot surgery, Young of course knew nothing about hospital charges for surgical screws, medical saws and other hardware used in the operating room.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Then the bill came.\u003c/p>\n\u003cp>\u003cstrong>Patient: \u003c/strong>Sherry Young, 57, a retired librarian on disability and a mother of two in Lawton, Okla.\u003c/p>\n\u003cp>\u003cstrong>Total bill:\u003c/strong> $115,527 for a three-day hospital stay, including $15,076 for four tiny screws — measuring 2.8 millimeters wide and no more than 14 millimeters long — placed in the two middle toes of her left foot.\u003c/p>\n\u003cp>\u003cstrong>Service provider:\u003c/strong> OU Medical Center, located at the University of Oklahoma Health Science Center in Oklahoma City\u003c/p>\n\u003cp>\u003cstrong>Medical treatment:\u003c/strong> Young underwent two operations on the same day in June 2017. One surgeon addressed an injury in Young's shoulder, caused by arthritis and overuse. A second surgeon performed several procedures on her foot, including removing a \u003ca href=\"https://www.footeducation.com/page/great-toe-cheilectomy-bone-spur-removal\" target=\"_blank\" rel=\"noopener\">bone spur.\u003c/a> To better align Young's middle toes, the doctor removed a slice of bone from the center of each toe, and then reconnected the two ends with surgical screws made by \u003ca href=\"https://www.arthrex.com/\" target=\"_blank\" rel=\"noopener\">Arthrex,\u003c/a> a medical device manufacturer based in Naples, Fla.\u003c/p>\n\u003cp>\u003cstrong>What gives:\u003c/strong> Two weeks after surgery, Young received a letter from her insurance plan, BlueCross BlueShield of Oklahoma, stating that it had not approved her hospital stay. Staying overnight was not \"medically necessary,\" according to the letter, because foot and shoulder surgery are typically performed as outpatient procedures.\u003c/p>\n\u003cp>The letter \"put me in a panic,\" said Young, who was suddenly worried that she would have to pay the entire $115,000 bill herself. That's about how much her home is worth, and five times her annual income.\u003c/p>\n\u003cp>Faced with the astronomical cost, Young asked for an itemized copy of her bill and began checking every charge.\u003c/p>\n\u003cp>She was floored by the price of the screws, each of which cost more than a high-end computer.\u003c/p>\n\u003cp>\"Unless the metal [was] mined on an asteroid, I do not know why it should cost that amount,\" Young said.\u003c/p>\n\u003cp>She repeatedly asked officials at OU Medical Center for part numbers for the screws, so she could find out how much they cost the hospital. Hospital officials never provided the information, Young said.\u003c/p>\n\u003cp>John Schmieding, senior vice president and general counsel for Arthrex, declined to tell Kaiser Health News exactly how much his company charges hospitals for the type of screws implanted in Young's foot. But he did offer ballpark figures: \"Our sale price for screws used in foot and ankle procedures would be below $300 per screw, with the most expensive around $1,000.\"\u003c/p>\n\u003cp>As for what the hospital charges, Schmieding said, \"We do not direct or control how a facility bills for their procedure.\" Based on the numbers Schmieding provided, the hospital markup on Young's screws could range from roughly 275 percent to upwards of 1,150 percent.\u003c/p>\n\u003cp>\"It's mind-boggling,\" said Dr. James Rickert, an orthopedic surgeon in Bedford, Ind., and president of the Society for Patient Centered Orthopedics, which advocates for affordable health care. \"We are talking about little pieces of metal.\"\u003c/p>\n\u003cp>Yet such steep markups are common at hospitals, said Rickert, who was not involved in Young's care.\u003c/p>\n\u003cp>Clearly, the screws used in Young's surgery are more sophisticated than those sold at the local hardware store. Many of the screws in Arthrex's online catalog are made of titanium, which is popular for surgery because it's strong and durable. The screws are also hollow, designed to fit over a guidewire so that doctors can place them in precisely the right place.\u003c/p>\n\u003cp>Surgical device manufacturers also must comply with strict regulations, said Steve Lichtenthal, vice president of business development at the Orthopaedic Implant Co., based in Reno, Nev., which makes surgical supplies.\u003c/p>\n\u003cp>But even the fanciest screw is still pretty simple, Lichtenthal said. Tiny screws cost only about $30 to manufacture, and the technology hasn't changed much in decades, he said. About half the cost of a surgical implant goes toward paying sales and marketing staff, who develop close relationships with doctors and sometimes even attend surgery, Lichtenthal said.\u003c/p>\n\u003cp>Screws weren't the only expensive devices figuring into Young's bill. A drill bit, used for making holes in bone, carried a charge of $4,265; a tool for removing and cauterizing tissue was $5,047; a saw blade, $619.\u003c/p>\n\u003cp>While screws can be used only once, there's no reason that other surgical equipment, such as saw blades, should be disposable, Rickert said. Hospitals routinely sterilize tools such as scalpels and scissors, then use them again.\u003c/p>\n\u003cp>A hospital spokesman declined to comment on the specifics of Young's bill, as did the surgeon who operated on her foot.\u003c/p>\n\u003cp>OU Medical Center issued a statement that said: \"OU Medical Center provides the highest-quality patient care. We are focused on acquiring the latest tools, treatments and technology, while diligently making sure we have the resources to maintain this commitment our patients deserve. We strive to keep costs down and focus investment on where it really matters — our patients.\"\u003c/p>\n\u003cp>In the statement, OU Medical Center said few patients pay the full price. Instead, insurance companies typically negotiate discounts with hospitals, allowing them to pay less than the amount on the list of charges.\u003c/p>\n\u003cp>Yet, as Young learned, people who are uninsured — or whose insurance plan refuses to pay — get no discount.\u003c/p>\n\u003cp>\u003cstrong>Resolution:\u003c/strong> Young is now off the hook. In a statement in response to a reporter's questions, BlueCross BlueShield of Oklahoma said it never actually denied Young's insurance claim but simply needed \"additional information from the provider in order to process it correctly.\"\u003c/p>\n\u003cp>According to Young's most recent billing statement from OU Medical Center, she does not owe anything for her hospital stay. However, her latest statement from the hospital includes a $413 charge for an \"appeal denied.\"\u003c/p>\n\u003cp>Surgery relieved the chronic pain in her shoulder and alleviated some but not all of the pain in her foot, Young said.\u003c/p>\n\u003cp>\u003cstrong>The takeaway:\u003c/strong> Companies can charge big prices for small surgical supplies, and hospitals can mark them up at will.\u003c/p>\n\u003cp>If you want to know exactly why your bill is so high, ask for an itemized list of charges. Since patients have no ability to shop around for different screws before the surgery, it's important to complain loudly to the hospital, your insurer and your employer if you see charges that seem outrageous.\u003c/p>\n\u003chr>\n\u003cp>\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>\u003cem> is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente. \u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Jane Greenhalgh produced and edited the interview with Elisabeth Rosenthal for broadcast. Jackie Fortier from StateImpact Oklahoma reported from Lawton, Okla. Member station KGOU is part of StateImpact Oklahoma, a multistation reporting collaboration. KGOU is owned by the University of Oklahoma, which also owns and operates OU Medical Center.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Sticker+Shock+Jolts+Oklahoma+Patient%3A+%2415%2C076+For+4+Tiny+Screws&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"A woman with foot pain was floored by the high cost of titanium screws used in her surgery. \"Unless the metal [was] mined on an asteroid, I do not know why it should cost that amount,\" she said.","status":"publish","parent":0,"modified":1526927895,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":38,"wordCount":1289},"headData":{"title":"Sticker Shock Jolts Foot Patient: $15,076 For 4 Tiny Screws | KQED","description":"A woman with foot pain was floored by the high cost of titanium screws used in her surgery. "Unless the metal mined on an asteroid, I do not know why it should cost that amount," she said.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Sticker Shock Jolts Foot Patient: $15,076 For 4 Tiny Screws","datePublished":"2018-05-21T23:00:25.000Z","dateModified":"2018-05-21T18:38:15.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"441764 https://ww2.kqed.org/futureofyou/?p=441764","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/05/21/sticker-shock-jolts-oklahoma-patient-15076-for-4-tiny-screws/","disqusTitle":"Sticker Shock Jolts Foot Patient: $15,076 For 4 Tiny Screws","source":"Health","nprByline":"Liz Szabo, KHN","nprImageAgency":"Nick Oxford for Kaiser Health News","nprStoryId":"610072486","nprApiLink":"http://api.npr.org/query?id=610072486&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/05/14/610072486/sticker-shock-jolts-oklahoma-patient-15-076-for-4-tiny-screws?ft=nprml&f=610072486","nprRetrievedStory":"1","nprPubDate":"Thu, 17 May 2018 15:04:00 -0400","nprStoryDate":"Mon, 14 May 2018 04:58:00 -0400","nprLastModifiedDate":"Fri, 18 May 2018 11:23:12 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2018/05/20180514_me_sticker_shock_jolts_oklahoma_patient_15076_for_4_tiny_screws.mp3?orgId=105043435&topicId=1128&d=392&p=3&story=610072486&ft=nprml&f=610072486","nprAudioM3u":"http://api.npr.org/m3u/1610905365-d98fad.m3u?orgId=105043435&topicId=1128&d=392&p=3&story=610072486&ft=nprml&f=610072486","path":"/futureofyou/441764/sticker-shock-jolts-oklahoma-patient-15076-for-4-tiny-screws","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2018/05/20180514_me_sticker_shock_jolts_oklahoma_patient_15076_for_4_tiny_screws.mp3?orgId=105043435&topicId=1128&d=392&p=3&story=610072486&ft=nprml&f=610072486","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sherry Young just wanted to be able to walk without pain.\u003c/p>\n\u003cp>About three years ago, she began to experience sharp pain in her left foot. Her big toe had become crooked and constantly rubbed up against the adjacent toe, making it painful to run, walk or even stand. \"I could not walk without intense pain unless I had a pad underneath my toes for cushioning,\" Young said.\u003c/p>\n\u003cp>An orthopedic surgeon told her that he could fix her problem for good. \"He thought my foot was hitting the ground too hard and causing pain,\" said Young. \"That's what he was trying to correct.\"\u003c/p>\n\u003cp>Though Young had had several orthopedic surgeries, she had always had good insurance and never scrutinized her bills.\u003c/p>\n\u003cp>At the time of her foot surgery, Young of course knew nothing about hospital charges for surgical screws, medical saws and other hardware used in the operating room.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Then the bill came.\u003c/p>\n\u003cp>\u003cstrong>Patient: \u003c/strong>Sherry Young, 57, a retired librarian on disability and a mother of two in Lawton, Okla.\u003c/p>\n\u003cp>\u003cstrong>Total bill:\u003c/strong> $115,527 for a three-day hospital stay, including $15,076 for four tiny screws — measuring 2.8 millimeters wide and no more than 14 millimeters long — placed in the two middle toes of her left foot.\u003c/p>\n\u003cp>\u003cstrong>Service provider:\u003c/strong> OU Medical Center, located at the University of Oklahoma Health Science Center in Oklahoma City\u003c/p>\n\u003cp>\u003cstrong>Medical treatment:\u003c/strong> Young underwent two operations on the same day in June 2017. One surgeon addressed an injury in Young's shoulder, caused by arthritis and overuse. A second surgeon performed several procedures on her foot, including removing a \u003ca href=\"https://www.footeducation.com/page/great-toe-cheilectomy-bone-spur-removal\" target=\"_blank\" rel=\"noopener\">bone spur.\u003c/a> To better align Young's middle toes, the doctor removed a slice of bone from the center of each toe, and then reconnected the two ends with surgical screws made by \u003ca href=\"https://www.arthrex.com/\" target=\"_blank\" rel=\"noopener\">Arthrex,\u003c/a> a medical device manufacturer based in Naples, Fla.\u003c/p>\n\u003cp>\u003cstrong>What gives:\u003c/strong> Two weeks after surgery, Young received a letter from her insurance plan, BlueCross BlueShield of Oklahoma, stating that it had not approved her hospital stay. Staying overnight was not \"medically necessary,\" according to the letter, because foot and shoulder surgery are typically performed as outpatient procedures.\u003c/p>\n\u003cp>The letter \"put me in a panic,\" said Young, who was suddenly worried that she would have to pay the entire $115,000 bill herself. That's about how much her home is worth, and five times her annual income.\u003c/p>\n\u003cp>Faced with the astronomical cost, Young asked for an itemized copy of her bill and began checking every charge.\u003c/p>\n\u003cp>She was floored by the price of the screws, each of which cost more than a high-end computer.\u003c/p>\n\u003cp>\"Unless the metal [was] mined on an asteroid, I do not know why it should cost that amount,\" Young said.\u003c/p>\n\u003cp>She repeatedly asked officials at OU Medical Center for part numbers for the screws, so she could find out how much they cost the hospital. Hospital officials never provided the information, Young said.\u003c/p>\n\u003cp>John Schmieding, senior vice president and general counsel for Arthrex, declined to tell Kaiser Health News exactly how much his company charges hospitals for the type of screws implanted in Young's foot. But he did offer ballpark figures: \"Our sale price for screws used in foot and ankle procedures would be below $300 per screw, with the most expensive around $1,000.\"\u003c/p>\n\u003cp>As for what the hospital charges, Schmieding said, \"We do not direct or control how a facility bills for their procedure.\" Based on the numbers Schmieding provided, the hospital markup on Young's screws could range from roughly 275 percent to upwards of 1,150 percent.\u003c/p>\n\u003cp>\"It's mind-boggling,\" said Dr. James Rickert, an orthopedic surgeon in Bedford, Ind., and president of the Society for Patient Centered Orthopedics, which advocates for affordable health care. \"We are talking about little pieces of metal.\"\u003c/p>\n\u003cp>Yet such steep markups are common at hospitals, said Rickert, who was not involved in Young's care.\u003c/p>\n\u003cp>Clearly, the screws used in Young's surgery are more sophisticated than those sold at the local hardware store. Many of the screws in Arthrex's online catalog are made of titanium, which is popular for surgery because it's strong and durable. The screws are also hollow, designed to fit over a guidewire so that doctors can place them in precisely the right place.\u003c/p>\n\u003cp>Surgical device manufacturers also must comply with strict regulations, said Steve Lichtenthal, vice president of business development at the Orthopaedic Implant Co., based in Reno, Nev., which makes surgical supplies.\u003c/p>\n\u003cp>But even the fanciest screw is still pretty simple, Lichtenthal said. Tiny screws cost only about $30 to manufacture, and the technology hasn't changed much in decades, he said. About half the cost of a surgical implant goes toward paying sales and marketing staff, who develop close relationships with doctors and sometimes even attend surgery, Lichtenthal said.\u003c/p>\n\u003cp>Screws weren't the only expensive devices figuring into Young's bill. A drill bit, used for making holes in bone, carried a charge of $4,265; a tool for removing and cauterizing tissue was $5,047; a saw blade, $619.\u003c/p>\n\u003cp>While screws can be used only once, there's no reason that other surgical equipment, such as saw blades, should be disposable, Rickert said. Hospitals routinely sterilize tools such as scalpels and scissors, then use them again.\u003c/p>\n\u003cp>A hospital spokesman declined to comment on the specifics of Young's bill, as did the surgeon who operated on her foot.\u003c/p>\n\u003cp>OU Medical Center issued a statement that said: \"OU Medical Center provides the highest-quality patient care. We are focused on acquiring the latest tools, treatments and technology, while diligently making sure we have the resources to maintain this commitment our patients deserve. We strive to keep costs down and focus investment on where it really matters — our patients.\"\u003c/p>\n\u003cp>In the statement, OU Medical Center said few patients pay the full price. Instead, insurance companies typically negotiate discounts with hospitals, allowing them to pay less than the amount on the list of charges.\u003c/p>\n\u003cp>Yet, as Young learned, people who are uninsured — or whose insurance plan refuses to pay — get no discount.\u003c/p>\n\u003cp>\u003cstrong>Resolution:\u003c/strong> Young is now off the hook. In a statement in response to a reporter's questions, BlueCross BlueShield of Oklahoma said it never actually denied Young's insurance claim but simply needed \"additional information from the provider in order to process it correctly.\"\u003c/p>\n\u003cp>According to Young's most recent billing statement from OU Medical Center, she does not owe anything for her hospital stay. However, her latest statement from the hospital includes a $413 charge for an \"appeal denied.\"\u003c/p>\n\u003cp>Surgery relieved the chronic pain in her shoulder and alleviated some but not all of the pain in her foot, Young said.\u003c/p>\n\u003cp>\u003cstrong>The takeaway:\u003c/strong> Companies can charge big prices for small surgical supplies, and hospitals can mark them up at will.\u003c/p>\n\u003cp>If you want to know exactly why your bill is so high, ask for an itemized list of charges. Since patients have no ability to shop around for different screws before the surgery, it's important to complain loudly to the hospital, your insurer and your employer if you see charges that seem outrageous.\u003c/p>\n\u003chr>\n\u003cp>\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>\u003cem> is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente. \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Jane Greenhalgh produced and edited the interview with Elisabeth Rosenthal for broadcast. Jackie Fortier from StateImpact Oklahoma reported from Lawton, Okla. Member station KGOU is part of StateImpact Oklahoma, a multistation reporting collaboration. KGOU is owned by the University of Oklahoma, which also owns and operates OU Medical Center.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Sticker+Shock+Jolts+Oklahoma+Patient%3A+%2415%2C076+For+4+Tiny+Screws&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/441764/sticker-shock-jolts-oklahoma-patient-15076-for-4-tiny-screws","authors":["byline_futureofyou_441764"],"categories":["futureofyou_1060","futureofyou_1"],"tags":["futureofyou_190","futureofyou_419","futureofyou_685","futureofyou_177","futureofyou_349"],"collections":["futureofyou_1093"],"featImg":"futureofyou_441765","label":"source_futureofyou_441764"},"futureofyou_440027":{"type":"posts","id":"futureofyou_440027","meta":{"index":"posts_1591205157","site":"futureofyou","id":"440027","score":null,"sort":[1520381149000]},"guestAuthors":[],"slug":"as-surgery-centers-boom-patients-are-paying-with-their-lives","title":"As Surgery Centers Boom, Patients Are Paying With Their Lives","publishDate":1520381149,"format":"standard","headTitle":"Future of You | KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>The surgery went fine. Her doctors left for the day. Four hours later, Paulina Tam started gasping for air.\u003c/p>\n\u003cp>Internal bleeding was cutting off her windpipe, a well-known complication of the spine surgery she had undergone.\u003c/p>\n\u003cp>But a Medicare inspection report describing the event says that nobody who remained on duty that evening at the Northern California surgery center knew what to do.\u003c/p>\n\u003cp>In desperation, a nurse did something that would not happen in a hospital.\u003c/p>\n\u003cp>She dialed 911.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>By the time an ambulance delivered Tam to the emergency room, the 58-year-old mother of three was lifeless, according to the report.\u003c/p>\n\u003cp>If Tam had been operated on at a hospital, a few simple steps could have saved her life.\u003c/p>\n\u003cp>But like hundreds of thousands of other patients each year, Tam went to one of the nation’s 5,600-plus surgery centers.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Some surgery centers risk patient lives by skimping on training or lifesaving equipment.'\u003c/aside>\n\u003cp>Such centers started nearly 50 years ago as low-cost alternatives for minor surgeries. They now outnumber hospitals as federal regulators have signed off on an ever-widening array of outpatient procedures in an effort to cut federal health care costs.\u003c/p>\n\u003cp>Thousands of times each year, these centers call 911 as patients experience complications ranging from minor to fatal. Yet no one knows how many people die as a result, because no national authority tracks the tragic outcomes. An investigation by Kaiser Health News and the USA TODAY Network has discovered that more than 260 patients have died since 2013 after in-and-out procedures at surgery centers across the country. Dozens — some as young as 2 — have perished after routine operations, such as colonoscopies and tonsillectomies.\u003c/p>\n\u003cp>Reporters examined autopsy records, legal filings and more than 12,000 state and Medicare inspection records, and interviewed dozens of doctors, health policy experts and patients throughout the industry, in the most extensive examination of these records to date.\u003c/p>\n\u003cp>The investigation revealed:\u003c/p>\n\u003cp>Surgery centers have steadily expanded their business by taking on increasingly risky surgeries. At least 14 patients have died after complex spinal surgeries like those that federal regulators at Medicare recently approved for surgery centers. Even as the risks of doing such surgeries off a hospital campus can be great, so is the reward. Doctors who own a share of the center can earn their own fee and a cut of the facility’s fee, a meaningful sum for operations that can cost $100,000 or more.\u003c/p>\n\u003cp>To protect patients, Medicare requires surgery centers to line up a local hospital to take their patients when emergencies arise. In rural areas, centers can be 15 or more miles away. Even when the hospital is close, 20 to 30 minutes can pass between a 911 call and arrival at an ER.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The money overshadows everything.'\u003ccite>Dr. Larry Teuber\u003c/cite>\u003c/aside>\n\u003cp>Some surgery centers are accused of overlooking high-risk health problems and treat patients who experts say should be operated on only in hospitals, if at all. At least 25 people with underlying medical conditions have left surgery centers and died within minutes or days. They include an Ohio woman with out-of-control blood pressure, a 49-year-old West Virginia man awaiting a heart transplant and several children with sleep apnea.\u003c/p>\n\u003cp>Some surgery centers risk patient lives by skimping on training or lifesaving equipment. Others have sent patients home before they were fully recovered. On their drives home, shocked family members in Arkansas, Oklahoma and Georgia discovered their loved ones were not asleep but on the verge of death. Surgery centers have been criticized in cases where staff didn’t have the tools to open a difficult airway or skills to save a patient from bleeding to death.\u003c/p>\n\u003cp>Most operations done in surgery centers go off without a hitch. And surgery carries risk, no matter where it’s done. Some centers have state-of-the-art equipment and highly trained staff that are better prepared to handle emergencies.\u003c/p>\n\u003cp>But Kaiser Health News and the USA TODAY Network found more than a dozen cases where the absence of trained staff or emergency equipment appears to have put patients in peril.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-436004 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/10/depression-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\">And in cases similar to Tam’s, upper-spine surgery patients have been sent home too soon, with the risk of suffocation looming.\u003c/p>\n\u003cp>In 2008, a 35-year-old Oregon father of three struggled for air, pounding the car roof in frustration while his wife sped him to a hospital. A Dallas man collapsed in his father’s arms waiting for an ambulance in 2011. Another Oregon man began to suffocate in his living room the night of his upper-spine surgery in 2014. A San Diego man gasped “like a fish,” his wife recalled, as they waited for an ambulance on April 28, 2016.\u003c/p>\n\u003cp>None of them survived.\u003c/p>\n\u003cp>Spinal surgery patient McArthur Roberson, 60, lost more than a quart of blood during the operation and struggled to breathe after surgery, his family claimed in a lawsuit. He died on the way home.\u003c/p>\n\u003cp>If he “had been observed in a hospital overnight,” said Dr. Daniel Silcox, an Atlanta spine surgeon and expert for the family in their lawsuit, “his death would not have occurred.”\u003c/p>\n\u003cp>The surgery center denied wrongdoing in the case, which reached a confidential settlement in 2017.\u003c/p>\n\u003cp>Many in the health care field — from doctors to private insurance companies to Medicare — have dismissed the mounting deaths as medical anomalies beyond the control of physicians.[contextly_sidebar id=\"yGkONjf2A21M8TI9B7IbDLgIYlcEIWeB\"]\u003c/p>\n\u003cp>USA TODAY Network and KHN reporters contacted 24 doctors and surgery center administrators about patient deaths and none would answer questions about what went wrong, citing patient privacy laws, or referring reporters to attorneys. Responding to lawsuits around the nation, surgery centers have argued that fatal complications were among the known outcomes of such surgeries. Two centers blamed patients for negligence in their own demise.\u003c/p>\n\u003cp>Bill Prentice, chief executive of the Ambulatory Surgery Center Association, declined to speak about individual cases but said he has seen no data proving surgery centers are less safe than hospitals.\u003c/p>\n\u003cp>“There is nothing distinct or different about the surgery center model that makes the provision of health care any more dangerous than anywhere else,” Prentice said. “The human body is a mysterious thing, and a patient that has met every possible protocol can walk in that day and still have something unimaginable happen to them that has nothing to do with the care that’s being provided.”\u003c/p>\n\u003cp>However, Dr. Kenneth Rothfield, board member of the Physician-Patient Alliance for Health & Safety, said many surgery centers and physicians push the envelope on how much can be done in outpatient centers.[contextly_sidebar id=\"nTpXhL5UY41KmxUslysOyQnfIH1Es3fu\"]\u003c/p>\n\u003cp>“It’s important to realize that surgery centers are not hospitals,” he said. “They have different resources, different equipment.”\u003c/p>\n\u003cp>The explosive growth of surgery centers — which receive $4.1 billion a year from Medicare — has taken place under circumstances some medical experts consider unseemly.\u003c/p>\n\u003cp>Federal law allows surgery center doctors — unlike others — to steer patients to facilities they own, rather than the full-service hospital down the street. In some cases, doing so could increase the risk to a patient, but double a physician’s profits.\u003c/p>\n\u003cp>Prentice said physician ownership of surgery centers is a good thing.\u003c/p>\n\u003cp>“The physicians who practice there are responsible for everything that happens in that surgery center from the moment the patient walks out of their car in the parking lot to the moment they leave,” he said.\u003c/p>\n\u003cp>But several studies have shown that surgery center doctors who are owners perform operations more frequently. And in lawsuits across the country, surgery center doctors have been accused of taking risks with patients.\u003c/p>\n\u003cp>Even some who’ve made their living in the surgery center industry have expressed concerns. Dr. Larry Teuber, a South Dakota neurosurgeon who worked as an executive in the surgery center industry for 22 years, said he has watched surgery center owners take on increasingly complex — and lucrative — orthopedic and spinal surgeries, undercutting a nearby hospital’s profits for their own gain.\u003c/p>\n\u003cp>“When you’re making money doing [complex surgeries] you get on a slippery ethical slope,” Teuber said. “The money overshadows everything.”\u003c/p>\n\u003cp>\u003cstrong>The History\u003c/strong>\u003c/p>\n\u003cp>The first surgery center in the U.S. opened in Phoenix in 1970, a place “squeezed between neighborhood shops and a Baptist church,” where, for $90, a child could receive an incision to relieve pressure on the inner ear, The Arizona Republic reported at the time.\u003c/p>\n\u003cp>The pioneering doctors, John Ford and Wallace Reed, didn’t see why patients needed to be hospitalized for such minor surgeries.\u003c/p>\n\u003cp>Taking the procedures out of hospitals reduced the cost for patients and insurers because surgery centers don’t require the same level of staffing or lifesaving equipment.\u003c/p>\n\u003cp>Medicare helped drive the expansion of surgery centers when it began paying for procedures in 1982.\u003c/p>\n\u003cp>Then in 1993, Congress encouraged doctors to open surgery centers by exempting them from the second Stark Law, which prevents doctors from steering patients to other businesses they own.\u003c/p>\n\u003cfigure id=\"attachment_440038\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440038\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-638540542-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1920x1281.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Surgeons passing scissors to each other \u003ccite>(gpointstudio/IStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Doctors-turned-entrepreneurs drove early growth, urging their patients to give the centers a chance. Seeing lucrative elective surgeries moving away, hospitals increasingly bought centers of their own. Last year, insurance giant UnitedHealth Group spent $2.3 billion buying a national surgery center chain.\u003c/p>\n\u003cp>The centers have been popular with patients, who enjoy the convenience and personalized care. Doctors say they like the ease of planning operations without unexpected trauma surgeries upending the schedule. And surgery centers have thrived even as hospitals have battled to contain the spread of infections.\u003c/p>\n\u003cp>Today, there are 5,616 Medicare-certified centers. The expansion has come despite lingering safety concerns. In 2007, Medicare noted that surgery centers “have neither patient safety standards consistent with those in place for hospitals, nor are they required to have the trained staff and equipment needed to provide the breadth of intensity of care. …” Some procedures are “unsafe” to be handled at surgery centers, the report concluded.[contextly_sidebar id=\"Oh8vuiOByjR9KfyFdmF17zW0bJKBCpIa\"]\u003c/p>\n\u003cp>Medicare advised the centers to transfer patients to hospitals when emergencies arise. Only a third of surgery centers participate in a voluntary effort to report how often that happens. They sent at least 7,000 patients to the hospital in the year that ended in September 2017, a KHN analysis of surgery center industry data shows. Not all survive the trip.\u003c/p>\n\u003cp>They include James Long, 56, who had no pulse when an ambulance came to the Colorado surgery center where he’d undergone more than five hours of lower-spine surgery in 2014, according to the center’s medical records provided to the family’s attorney.\u003c/p>\n\u003cp>The state reviewed the case and cited no deficiencies. Jen Kenitzer, the Minimally Invasive Spine Institute administrator, said the center has “extensive procedures in place to respond quickly and appropriately” in emergencies.\u003c/p>\n\u003cp>Yet Long’s loved ones remain troubled by the case.\u003c/p>\n\u003cp>“In the 21st century in the USA, a doctor doing a surgery on a patient has to call 911?” said Robin Long, his ex-wife, who did not sue the center. “Give me a break. … It’s just absolutely ignorant.”\u003c/p>\n\u003cp>\u003cstrong>Preparation Under Par\u003c/strong>\u003c/p>\n\u003cp>Patients enter hospitals with heart attacks, gunshot wounds and traumatic injuries. There, doctors and nurses become skilled at saving lives in emergencies.\u003c/p>\n\u003cp>Doctors in surgery centers may excel at the procedures they perform most often. But the centers aren’t always prepared and sometimes struggle in a crisis, according to a review of Medicare records and more than 70 lawsuits.\u003c/p>\n\u003cp>Health inspectors working on behalf of Medicare have discovered 230 lapses in rescue equipment or training regulations at surgery centers since 2015.\u003c/p>\n\u003cp>A center in California had empty oxygen tanks. One operating on children in Arkansas didn’t have a pediatric tracheotomy set to restore breathing; another lacked pediatric defibrillator pads to shock hearts back into rhythm.[contextly_sidebar id=\"xgSiNPNFJJTyDToF3ZdazMurAQ4SAxDl\"]\u003c/p>\n\u003cp>In an ongoing lawsuit against her and the center, anesthesiologist Dr. Yoori Yim testified that she came up empty-handed on Dec. 23, 2015, when grappling to find the right-sized airway tube to save a patient who had stopped breathing.\u003c/p>\n\u003cp>Rekhaben Shah, 67, had come to Oak Tree Surgery Center in Edison, N.J., for a simple colonoscopy.\u003c/p>\n\u003cp>Yim tried a variety of methods to help Shah breathe, with limited success. From the moment Shah stopped breathing on the operating table, 33 minutes passed before a paramedic effectively inserted a breathing tube, according to medical and EMS records.\u003c/p>\n\u003cp>Paramedics responding to the center’s 911 call had to use a video GlideScope to see inside the patient’s throat, equipment the surgery center didn’t have, court testimony says.\u003c/p>\n\u003cp>By then it was too late. Shah was removed from life support at a nearby hospital on Christmas Day.\u003c/p>\n\u003cp>Neither Yim nor the center returned calls for comment. In court records, an expert for the surgery center said Shah’s airway was obstructed and it was cleared around the time the paramedics arrived. He said the GlideScope is not required in New Jersey, nor would it likely have made a difference. An expert for Yim, however, said her actions were appropriate and if a GlideScope had been at the center, “we would probably not be discussing this case at all.”\u003c/p>\n\u003cp>When emergency crews arrive, surgery centers are not always prepared to receive them.\u003c/p>\n\u003cp>In Yim’s case, paramedics testified that she refused to move away from Shah and allow them to attempt lifesaving measures.\u003c/p>\n\u003cp>In Florida, paramedics who rushed to a surgery center after its usual operating hours hit a locked door while a patient inside gasped for breath. The 55-year-old remains in a vegetative state.\u003c/p>\n\u003cp>In 2016, paramedics arrived at West Lakes Surgery Center in Iowa as staff tried to revive 12-year-old Reuben Van Veldhuizen after he experienced complications during a tonsillectomy, according to a Medicare inspection report.[contextly_sidebar id=\"iy3S1eIYgobood9l19mbUsM4p7gpgSwB\"]\u003c/p>\n\u003cp>One paramedic told state inspectors she had to ask who was in charge of the resuscitation efforts. No one replied, the inspection report says.\u003c/p>\n\u003cp>The boy made it to the hospital 37 minutes after the surgery center staff called 911. There, he was pronounced dead.\u003c/p>\n\u003cp>The family filed suit, alleging that the center and anesthesiologist erred in giving the boy an anesthetic that carries a warning about cardiac arrest risk in young boys.\u003c/p>\n\u003cp>In court records responding to the lawsuit, the surgery center and anesthesiologist said Reuben’s death was a result of “pre-existing conditions, acts of others, or conditions over which (Defendants) had no control or responsibility.”[contextly_sidebar id=\"VI9AZs5TNC51Y7UgdHVDpUXpakSmw0kK\"]\u003c/p>\n\u003cp>Yet lawyers who sue the centers and scrutinize their internal records say they often see deadly delays in care.\u003c/p>\n\u003cp>Pedro Maldonado, 59, went to Ambulatory Care Center in New Jersey to have his upper digestive tract scoped. He was discovered unresponsive 10 minutes after the seven-minute procedure, according to his widow’s lawsuit.\u003c/p>\n\u003cp>It took surgery center staff 25 more minutes to start CPR, according to a lawsuit that Philadelphia attorney Glenn Ellis filed on behalf of Maldonado’s widow. Twenty-seven more minutes passed before Maldonado was wheeled into an ER, the widow’s ongoing suit alleges. Maldonado never regained consciousness.\u003c/p>\n\u003cp>Reached by phone, a center administrator declined to comment. In a legal filing, the center denied claims of wrongdoing.\u003c/p>\n\u003cp>“At a hospital, doctors and nurses … know how they are going to respond,” Ellis said. “These guys at the surgery centers are walking on a tightrope with no safety net.”\u003c/p>\n\u003cp>\u003cstrong>Conveyor Belt Of Care\u003c/strong>\u003c/p>\n\u003cp>While the thrum of a hospital continues through the night, some surgery center doctors keep banker’s hours. That means patients whose surgeries end later in the day are sometimes left in the care of one or two nurses for up to 23-hour stays. Some patients have been sent home to grapple with complications on their own.\u003c/p>\n\u003cp>Sondra Wallace went to the Surgery Center of Oklahoma in early 2017 for a sinus procedure.\u003c/p>\n\u003cp>After the procedure, doctors saw her blood-oxygen level sinking. They realized she had had a reaction to the anesthesia and at 2 p.m. gave her a drug to reverse the effects, an ongoing lawsuit filed by her husband says.[contextly_sidebar id=\"9BEvkmOwOv0XN6LAFVyarPQ0ptuu9CWR\"]\u003c/p>\n\u003cp>Then, an hour later, they sent her home with her husband, Larry, the lawsuit says.\u003c/p>\n\u003cp>It was 3 p.m. on the Friday before Presidents Day weekend.\u003c/p>\n\u003cp>“I just think they wanted to start their three-day weekend,” said daughter Casey Podoll.\u003c/p>\n\u003cp>Larry Wallace alleges in the suit that the center gave him no hint that Sondra had a reaction to the anesthesia.\u003c/p>\n\u003cp>So, Wallace thought nothing of her napping in the back seat as he drove for more than two hours through Oklahoma pastures on his way home. When he arrived, he discovered his wife cold in the back seat. She was pronounced dead at Jackson County Memorial Hospital at 6:30 p.m. that day.\u003c/p>\n\u003cp>“They didn’t give any indication … that there were any red flags whatsoever,” Podoll said.\u003c/p>\n\u003cp>Craig Buchan, attorney for the Surgery Center of Oklahoma, said Wallace met discharge criteria and her cause of death has not been determined. He said the center did not close any earlier “than often occurs after the last patient is discharged.”\u003c/p>\n\u003cp>Cecilia Aldridge said she also felt as if the staff at a surgery center was rushing her out the door, after her 2-year-old daughter’s tonsil surgery in Arkansas in 2015.\u003c/p>\n\u003cp>A lawsuit filed by the parents said the surgery center “discharged Abbygail too early because a snow storm was moving into the area.”\u003c/p>\n\u003cp>Abbygail turned blue in the car on the way home. Her mother said she raced into an emergency room, shouting for help, her toddler in her arms.\u003c/p>\n\u003cp>“She never woke up,” Aldridge said tearfully in an interview.\u003c/p>\n\u003cp>Abbygail’s parents now question whether the surgery center ever should have been willing to treat their daughter.\u003c/p>\n\u003cp>\u003cstrong>Risky Patients\u003c/strong>\u003c/p>\n\u003cp>Because surgery centers have less safety equipment and staffing than hospitals, industry leaders stress the importance of selecting patients healthy enough to fare well. Their predictions, though, are not always correct.\u003c/p>\n\u003cp>Abbygail, who loved her hand-me-down blanket and the film “Frozen,” had sleep apnea, an irregular heartbeat and was very heavy for her age, according to the lawsuit.\u003c/p>\n\u003cp>Sleep apnea increases the risk of serious complications in surgery and the night after, medical research shows. Given her condition, Abbygail “should have been admitted [to a hospital] and monitored post-procedure,” said Dr. Charles Cote, a retired Harvard pediatric anesthesiology professor who was not involved in the family’s lawsuit.[contextly_sidebar id=\"gjUHM4nwVAL7lCCCNoVNHgGksiZfeuxR\"]\u003c/p>\n\u003cp>The lawsuit says Abbygail’s risk factors “were documented and known by the Defendants,” including the doctor. It said the toddler should have been operated on “in an inpatient setting under hospital care and monitored overnight.”\u003c/p>\n\u003cp>Dr. Michael Marsh performed Abbygail’s tonsillectomy at Executive Park Surgery Center in Fort Smith, Ark.\u003c/p>\n\u003cp>The surgery center’s lawyer declined to comment. The doctor’s lawyer did not return email and voice messages. In court documents responding to the lawsuit, Marsh and the center denied wrongdoing.\u003c/p>\n\u003cp>In the court filing, Marsh said the toddler’s injuries were “the natural progression” of her illness. Executive Park Surgery Center said in a court filing that “no action on their part … was a proximate cause of any damages or injury.” The case was settled.\u003c/p>\n\u003cp>In at least 25 cases, surgery centers opened their doors to ailing and fragile patients who died after simple procedures, such as tonsillectomies, retinal repairs or colonoscopies, KHN and USA TODAY Network found.\u003c/p>\n\u003cp>Medicare asks surgery centers to assess each patient’s risk, but inspectors flagged 122 surgery centers in 2015 and 2016 alone for lapses in risk assessments. Some centers failed to gauge risk at all. Others overlooked their own policies.\u003c/p>\n\u003cp>Doctors can use an anesthesia risk assessment to screen out fragile patients — healthy patients get a score of 1, and a score of 5 means a person is nearly dead.\u003c/p>\n\u003cp>A few states, including Pennsylvania and Rhode Island, bar certain surgery centers from operating on patients with an anesthesia risk score of 4. But most states don’t go that far. They leave such decisions up to doctors.\u003c/p>\n\u003cp>And some of those decisions have been cited in tragic outcomes. Sabino Sifuentes, 74, had survived triple-bypass surgery. But on March 23, 2015, nine minutes after the start of anesthesia for an eye procedure, he became unresponsive, never to be revived, according to a Medicare inspection report. A nurse anesthetist who reviewed the case at Eye-Q Vision Care’s surgery center in Fresno, Calif., told state health inspectors that Sifuentes should have been given a risk score of 4 and his care was “completely mismanaged,” the inspection report says.\u003c/p>\n\u003cp>In response to the family’s lawsuit, the surgery center said Sifuentes’ injury was caused by his own negligence and others’.\u003c/p>\n\u003cp>Five other patients with the same risk score died after routine procedures at surgery centers across the U.S.\u003c/p>\n\u003cp>\u003cstrong>A Widening Niche\u003c/strong>\u003c/p>\n\u003cp>Such tragedies rarely find their way into the discussion when Medicare decides whether to approve new procedures at surgery centers.\u003c/p>\n\u003cp>Take spinal surgery.\u003c/p>\n\u003cp>Until 2015, Medicare wouldn’t pay for it at surgery centers. Then, the industry’s trade association urged the agency to make the change, and encouraged a letter-writing campaign from surgery centers across the nation.\u003c/p>\n\u003cp>Letter writers included Dr. Alan Villavicencio, a Colorado surgeon who said he’d been doing such surgeries for 12 years and found that his patients “appreciate the convenience and cost savings.” He did not mention that James Long, 56, had died three weeks earlier at a Lafayette, Colo., surgery center where he is an owner, a review of Colorado health department and medical board records shows.\u003c/p>\n\u003cp>United Surgical Partners International, a surgery center chain, also weighed in urging even more procedures to be approved, not mentioning a patient death hours after a spine surgery at one of its affiliate centers several months before, according to court records and securities filings. The chain said in a statement that it stands behind its comments in support of the proposal.[contextly_sidebar id=\"VpVDiD85oVGnFVcTHpIcD2xozEou9ew9\"]\u003c/p>\n\u003cp>Such letters carry weight with Medicare, which approves procedures to be done in surgery centers based on the invasiveness and complexity of the surgery and on input from stakeholders.\u003c/p>\n\u003cp>Robert Beatty-Walters, a Portland, Ore., attorney who has represented the families of three people who died after surgery center spine procedures, said Medicare’s decision-making process is not even-handed.\u003c/p>\n\u003cp>“The stakeholders — they call them — during these regulatory proceedings are the profit-makers, not the people who are being provided the service,” he said. “The spine centers just want to have more people come. They make more money. I hate to be that cynical about it, but that’s just what I’ve seen.”\u003c/p>\n\u003cp>Medicare approved 10 spine-surgery codes to be billed at surgery centers starting in 2015 and added more spinal procedures for 2017. A Medicare spokesman denied a request for a telephone interview. In an email, a spokeswoman said Medicare opened the spine proposal to the public and received no comments suggesting the procedures would pose a threat to Medicare patients. She said the final decision about where a patient will have surgery is up to a doctor and patient.\u003c/p>\n\u003cp>By 2017, at least 14 patients had died soon after spine operations at surgery centers, according to the KHN/USA TODAY Network investigation.\u003c/p>\n\u003cp>The 14 spine-surgery deaths have gleaned little recognition in the industry or beyond. Only one made headlines in local newspapers. The rest are documented in places like the Macon, Ga., courthouse or in obscure regulatory reports. And there may be far more because some states, including New York, Illinois and Florida, disclose no details about surgery center deaths.\u003c/p>\n\u003cp>Paulina Tam’s death at Fremont Surgery Center was a tragic example. At 58, the mother of three had finished careers as a nurse and an educator. Next, she planned to travel the world with her husband of 32 years.\u003c/p>\n\u003cp>“She was the driving force of the family, the spirit I guess,” said her son, Eric Tam, a doctor in New York City, said. “We didn’t expect the worst to happen.”\u003c/p>\n\u003cp>The care she received at the center is documented in court records, EMS reports and a Medicare inspection report that concluded that the center “failed to provide a safe environment for surgery.”\u003c/p>\n\u003cp>Tam’s doctor scheduled her for a procedure to replace two discs in her upper spine on April 7, 2014. Pain from a car crash had bothered her for years. Any such surgery — entering the front of the neck to address pain in the spine — comes with a risk of suffocation, according to the Medicare inspection report.\u003c/p>\n\u003cp>Yet, with her surgeon and anesthesiologist already gone, the only doctor on-site was a digestive health specialist, the inspection report shows. About four hours after her procedure, Tam told a nurse that her surgical collar felt too tight. Then, that she couldn’t breathe.\u003c/p>\n\u003cp>The nurse called a “code blue” just after 6:30 p.m., records say.\u003c/p>\n\u003cp>Medical experts say the first step in helping such patients is removing the surgical staples so the pooled blood can disperse, allowing the patient to breathe.\u003c/p>\n\u003cp>In Tam’s case, staff repeatedly tried and failed to insert a breathing tube through her mouth and into her airway, the inspection report shows. A last-ditch remedy would have been to punch a hole through the front of her throat to restore breathing, but the gastroenterologist later told an inspector that he was “not prepared” to do so.\u003c/p>\n\u003cp>The inability to perform the suffocation-rescue maneuver, the inspection report says, amounted to the center’s “failure to ensure patient safety.”\u003c/p>\n\u003cp>From the time a nurse called 911, it took 24 minutes to get Tam to the nearest hospital, EMS records show. She arrived without a pulse and remained on life support overnight, as her children raced to her bedside to say goodbye.[contextly_sidebar id=\"bLBYWBIiszrFf7LXQxCNRj9SYTbpB4ln\"]\u003c/p>\n\u003cp>The center did not return calls and denied wrongdoing in the court case. Tam’s surgeon declined to discuss the case but filed pleadings in court saying Tam’s “carelessness and negligence” caused her death. It’s unclear what the defense meant by negligence. The case reached a confidential settlement.\u003c/p>\n\u003cp>After Tam’s death, the center told Medicare inspectors that a qualified doctor would stay on-site after all upper-spine cases.\u003c/p>\n\u003cp>Dr. Nancy Epstein, chief of neurosurgical and spine care at New York University Winthrop Hospital, said surgery centers doing delicate work near the spinal cord, windpipe and esophagus in a same-day procedure is “pretty revolting.” But she said the centers are making so much money — “reeling it in hand over fist” that the potential dangers are being ignored.\u003c/p>\n\u003cp>“Medically, it should not be tolerated,” she said, “but it is.”\u003c/p>\n\u003cp>\u003cem>Lindy Washburn of The (Bergen County, N.J.) Record and NorthJersey.com contributed to this report.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"How a push to cut costs and boost profits at surgery centers led to a trail of death. ","status":"publish","parent":0,"modified":1520993480,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":136,"wordCount":4692},"headData":{"title":"As Surgery Centers Boom, Patients Are Paying With Their Lives | KQED","description":"How a push to cut costs and boost profits at surgery centers led to a trail of death. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"As Surgery Centers Boom, Patients Are Paying With Their Lives","datePublished":"2018-03-07T00:05:49.000Z","dateModified":"2018-03-14T02:11:20.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"440027 https://ww2.kqed.org/futureofyou/?p=440027","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/03/06/as-surgery-centers-boom-patients-are-paying-with-their-lives/","disqusTitle":"As Surgery Centers Boom, Patients Are Paying With Their Lives","source":"Future of You","nprByline":"Christina Jewett\u003cbr />Kaiser Health News\u003cbr />Mark Alesia\u003cbr />USA TODAY","path":"/futureofyou/440027/as-surgery-centers-boom-patients-are-paying-with-their-lives","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The surgery went fine. Her doctors left for the day. Four hours later, Paulina Tam started gasping for air.\u003c/p>\n\u003cp>Internal bleeding was cutting off her windpipe, a well-known complication of the spine surgery she had undergone.\u003c/p>\n\u003cp>But a Medicare inspection report describing the event says that nobody who remained on duty that evening at the Northern California surgery center knew what to do.\u003c/p>\n\u003cp>In desperation, a nurse did something that would not happen in a hospital.\u003c/p>\n\u003cp>She dialed 911.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>By the time an ambulance delivered Tam to the emergency room, the 58-year-old mother of three was lifeless, according to the report.\u003c/p>\n\u003cp>If Tam had been operated on at a hospital, a few simple steps could have saved her life.\u003c/p>\n\u003cp>But like hundreds of thousands of other patients each year, Tam went to one of the nation’s 5,600-plus surgery centers.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Some surgery centers risk patient lives by skimping on training or lifesaving equipment.'\u003c/aside>\n\u003cp>Such centers started nearly 50 years ago as low-cost alternatives for minor surgeries. They now outnumber hospitals as federal regulators have signed off on an ever-widening array of outpatient procedures in an effort to cut federal health care costs.\u003c/p>\n\u003cp>Thousands of times each year, these centers call 911 as patients experience complications ranging from minor to fatal. Yet no one knows how many people die as a result, because no national authority tracks the tragic outcomes. An investigation by Kaiser Health News and the USA TODAY Network has discovered that more than 260 patients have died since 2013 after in-and-out procedures at surgery centers across the country. Dozens — some as young as 2 — have perished after routine operations, such as colonoscopies and tonsillectomies.\u003c/p>\n\u003cp>Reporters examined autopsy records, legal filings and more than 12,000 state and Medicare inspection records, and interviewed dozens of doctors, health policy experts and patients throughout the industry, in the most extensive examination of these records to date.\u003c/p>\n\u003cp>The investigation revealed:\u003c/p>\n\u003cp>Surgery centers have steadily expanded their business by taking on increasingly risky surgeries. At least 14 patients have died after complex spinal surgeries like those that federal regulators at Medicare recently approved for surgery centers. Even as the risks of doing such surgeries off a hospital campus can be great, so is the reward. Doctors who own a share of the center can earn their own fee and a cut of the facility’s fee, a meaningful sum for operations that can cost $100,000 or more.\u003c/p>\n\u003cp>To protect patients, Medicare requires surgery centers to line up a local hospital to take their patients when emergencies arise. In rural areas, centers can be 15 or more miles away. Even when the hospital is close, 20 to 30 minutes can pass between a 911 call and arrival at an ER.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The money overshadows everything.'\u003ccite>Dr. Larry Teuber\u003c/cite>\u003c/aside>\n\u003cp>Some surgery centers are accused of overlooking high-risk health problems and treat patients who experts say should be operated on only in hospitals, if at all. At least 25 people with underlying medical conditions have left surgery centers and died within minutes or days. They include an Ohio woman with out-of-control blood pressure, a 49-year-old West Virginia man awaiting a heart transplant and several children with sleep apnea.\u003c/p>\n\u003cp>Some surgery centers risk patient lives by skimping on training or lifesaving equipment. Others have sent patients home before they were fully recovered. On their drives home, shocked family members in Arkansas, Oklahoma and Georgia discovered their loved ones were not asleep but on the verge of death. Surgery centers have been criticized in cases where staff didn’t have the tools to open a difficult airway or skills to save a patient from bleeding to death.\u003c/p>\n\u003cp>Most operations done in surgery centers go off without a hitch. And surgery carries risk, no matter where it’s done. Some centers have state-of-the-art equipment and highly trained staff that are better prepared to handle emergencies.\u003c/p>\n\u003cp>But Kaiser Health News and the USA TODAY Network found more than a dozen cases where the absence of trained staff or emergency equipment appears to have put patients in peril.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-436004 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/10/depression-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\">And in cases similar to Tam’s, upper-spine surgery patients have been sent home too soon, with the risk of suffocation looming.\u003c/p>\n\u003cp>In 2008, a 35-year-old Oregon father of three struggled for air, pounding the car roof in frustration while his wife sped him to a hospital. A Dallas man collapsed in his father’s arms waiting for an ambulance in 2011. Another Oregon man began to suffocate in his living room the night of his upper-spine surgery in 2014. A San Diego man gasped “like a fish,” his wife recalled, as they waited for an ambulance on April 28, 2016.\u003c/p>\n\u003cp>None of them survived.\u003c/p>\n\u003cp>Spinal surgery patient McArthur Roberson, 60, lost more than a quart of blood during the operation and struggled to breathe after surgery, his family claimed in a lawsuit. He died on the way home.\u003c/p>\n\u003cp>If he “had been observed in a hospital overnight,” said Dr. Daniel Silcox, an Atlanta spine surgeon and expert for the family in their lawsuit, “his death would not have occurred.”\u003c/p>\n\u003cp>The surgery center denied wrongdoing in the case, which reached a confidential settlement in 2017.\u003c/p>\n\u003cp>Many in the health care field — from doctors to private insurance companies to Medicare — have dismissed the mounting deaths as medical anomalies beyond the control of physicians.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>USA TODAY Network and KHN reporters contacted 24 doctors and surgery center administrators about patient deaths and none would answer questions about what went wrong, citing patient privacy laws, or referring reporters to attorneys. Responding to lawsuits around the nation, surgery centers have argued that fatal complications were among the known outcomes of such surgeries. Two centers blamed patients for negligence in their own demise.\u003c/p>\n\u003cp>Bill Prentice, chief executive of the Ambulatory Surgery Center Association, declined to speak about individual cases but said he has seen no data proving surgery centers are less safe than hospitals.\u003c/p>\n\u003cp>“There is nothing distinct or different about the surgery center model that makes the provision of health care any more dangerous than anywhere else,” Prentice said. “The human body is a mysterious thing, and a patient that has met every possible protocol can walk in that day and still have something unimaginable happen to them that has nothing to do with the care that’s being provided.”\u003c/p>\n\u003cp>However, Dr. Kenneth Rothfield, board member of the Physician-Patient Alliance for Health & Safety, said many surgery centers and physicians push the envelope on how much can be done in outpatient centers.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It’s important to realize that surgery centers are not hospitals,” he said. “They have different resources, different equipment.”\u003c/p>\n\u003cp>The explosive growth of surgery centers — which receive $4.1 billion a year from Medicare — has taken place under circumstances some medical experts consider unseemly.\u003c/p>\n\u003cp>Federal law allows surgery center doctors — unlike others — to steer patients to facilities they own, rather than the full-service hospital down the street. In some cases, doing so could increase the risk to a patient, but double a physician’s profits.\u003c/p>\n\u003cp>Prentice said physician ownership of surgery centers is a good thing.\u003c/p>\n\u003cp>“The physicians who practice there are responsible for everything that happens in that surgery center from the moment the patient walks out of their car in the parking lot to the moment they leave,” he said.\u003c/p>\n\u003cp>But several studies have shown that surgery center doctors who are owners perform operations more frequently. And in lawsuits across the country, surgery center doctors have been accused of taking risks with patients.\u003c/p>\n\u003cp>Even some who’ve made their living in the surgery center industry have expressed concerns. Dr. Larry Teuber, a South Dakota neurosurgeon who worked as an executive in the surgery center industry for 22 years, said he has watched surgery center owners take on increasingly complex — and lucrative — orthopedic and spinal surgeries, undercutting a nearby hospital’s profits for their own gain.\u003c/p>\n\u003cp>“When you’re making money doing [complex surgeries] you get on a slippery ethical slope,” Teuber said. “The money overshadows everything.”\u003c/p>\n\u003cp>\u003cstrong>The History\u003c/strong>\u003c/p>\n\u003cp>The first surgery center in the U.S. opened in Phoenix in 1970, a place “squeezed between neighborhood shops and a Baptist church,” where, for $90, a child could receive an incision to relieve pressure on the inner ear, The Arizona Republic reported at the time.\u003c/p>\n\u003cp>The pioneering doctors, John Ford and Wallace Reed, didn’t see why patients needed to be hospitalized for such minor surgeries.\u003c/p>\n\u003cp>Taking the procedures out of hospitals reduced the cost for patients and insurers because surgery centers don’t require the same level of staffing or lifesaving equipment.\u003c/p>\n\u003cp>Medicare helped drive the expansion of surgery centers when it began paying for procedures in 1982.\u003c/p>\n\u003cp>Then in 1993, Congress encouraged doctors to open surgery centers by exempting them from the second Stark Law, which prevents doctors from steering patients to other businesses they own.\u003c/p>\n\u003cfigure id=\"attachment_440038\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440038\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-638540542-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1920x1281.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Surgeons passing scissors to each other \u003ccite>(gpointstudio/IStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Doctors-turned-entrepreneurs drove early growth, urging their patients to give the centers a chance. Seeing lucrative elective surgeries moving away, hospitals increasingly bought centers of their own. Last year, insurance giant UnitedHealth Group spent $2.3 billion buying a national surgery center chain.\u003c/p>\n\u003cp>The centers have been popular with patients, who enjoy the convenience and personalized care. Doctors say they like the ease of planning operations without unexpected trauma surgeries upending the schedule. And surgery centers have thrived even as hospitals have battled to contain the spread of infections.\u003c/p>\n\u003cp>Today, there are 5,616 Medicare-certified centers. The expansion has come despite lingering safety concerns. In 2007, Medicare noted that surgery centers “have neither patient safety standards consistent with those in place for hospitals, nor are they required to have the trained staff and equipment needed to provide the breadth of intensity of care. …” Some procedures are “unsafe” to be handled at surgery centers, the report concluded.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Medicare advised the centers to transfer patients to hospitals when emergencies arise. Only a third of surgery centers participate in a voluntary effort to report how often that happens. They sent at least 7,000 patients to the hospital in the year that ended in September 2017, a KHN analysis of surgery center industry data shows. Not all survive the trip.\u003c/p>\n\u003cp>They include James Long, 56, who had no pulse when an ambulance came to the Colorado surgery center where he’d undergone more than five hours of lower-spine surgery in 2014, according to the center’s medical records provided to the family’s attorney.\u003c/p>\n\u003cp>The state reviewed the case and cited no deficiencies. Jen Kenitzer, the Minimally Invasive Spine Institute administrator, said the center has “extensive procedures in place to respond quickly and appropriately” in emergencies.\u003c/p>\n\u003cp>Yet Long’s loved ones remain troubled by the case.\u003c/p>\n\u003cp>“In the 21st century in the USA, a doctor doing a surgery on a patient has to call 911?” said Robin Long, his ex-wife, who did not sue the center. “Give me a break. … It’s just absolutely ignorant.”\u003c/p>\n\u003cp>\u003cstrong>Preparation Under Par\u003c/strong>\u003c/p>\n\u003cp>Patients enter hospitals with heart attacks, gunshot wounds and traumatic injuries. There, doctors and nurses become skilled at saving lives in emergencies.\u003c/p>\n\u003cp>Doctors in surgery centers may excel at the procedures they perform most often. But the centers aren’t always prepared and sometimes struggle in a crisis, according to a review of Medicare records and more than 70 lawsuits.\u003c/p>\n\u003cp>Health inspectors working on behalf of Medicare have discovered 230 lapses in rescue equipment or training regulations at surgery centers since 2015.\u003c/p>\n\u003cp>A center in California had empty oxygen tanks. One operating on children in Arkansas didn’t have a pediatric tracheotomy set to restore breathing; another lacked pediatric defibrillator pads to shock hearts back into rhythm.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In an ongoing lawsuit against her and the center, anesthesiologist Dr. Yoori Yim testified that she came up empty-handed on Dec. 23, 2015, when grappling to find the right-sized airway tube to save a patient who had stopped breathing.\u003c/p>\n\u003cp>Rekhaben Shah, 67, had come to Oak Tree Surgery Center in Edison, N.J., for a simple colonoscopy.\u003c/p>\n\u003cp>Yim tried a variety of methods to help Shah breathe, with limited success. From the moment Shah stopped breathing on the operating table, 33 minutes passed before a paramedic effectively inserted a breathing tube, according to medical and EMS records.\u003c/p>\n\u003cp>Paramedics responding to the center’s 911 call had to use a video GlideScope to see inside the patient’s throat, equipment the surgery center didn’t have, court testimony says.\u003c/p>\n\u003cp>By then it was too late. Shah was removed from life support at a nearby hospital on Christmas Day.\u003c/p>\n\u003cp>Neither Yim nor the center returned calls for comment. In court records, an expert for the surgery center said Shah’s airway was obstructed and it was cleared around the time the paramedics arrived. He said the GlideScope is not required in New Jersey, nor would it likely have made a difference. An expert for Yim, however, said her actions were appropriate and if a GlideScope had been at the center, “we would probably not be discussing this case at all.”\u003c/p>\n\u003cp>When emergency crews arrive, surgery centers are not always prepared to receive them.\u003c/p>\n\u003cp>In Yim’s case, paramedics testified that she refused to move away from Shah and allow them to attempt lifesaving measures.\u003c/p>\n\u003cp>In Florida, paramedics who rushed to a surgery center after its usual operating hours hit a locked door while a patient inside gasped for breath. The 55-year-old remains in a vegetative state.\u003c/p>\n\u003cp>In 2016, paramedics arrived at West Lakes Surgery Center in Iowa as staff tried to revive 12-year-old Reuben Van Veldhuizen after he experienced complications during a tonsillectomy, according to a Medicare inspection report.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>One paramedic told state inspectors she had to ask who was in charge of the resuscitation efforts. No one replied, the inspection report says.\u003c/p>\n\u003cp>The boy made it to the hospital 37 minutes after the surgery center staff called 911. There, he was pronounced dead.\u003c/p>\n\u003cp>The family filed suit, alleging that the center and anesthesiologist erred in giving the boy an anesthetic that carries a warning about cardiac arrest risk in young boys.\u003c/p>\n\u003cp>In court records responding to the lawsuit, the surgery center and anesthesiologist said Reuben’s death was a result of “pre-existing conditions, acts of others, or conditions over which (Defendants) had no control or responsibility.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Yet lawyers who sue the centers and scrutinize their internal records say they often see deadly delays in care.\u003c/p>\n\u003cp>Pedro Maldonado, 59, went to Ambulatory Care Center in New Jersey to have his upper digestive tract scoped. He was discovered unresponsive 10 minutes after the seven-minute procedure, according to his widow’s lawsuit.\u003c/p>\n\u003cp>It took surgery center staff 25 more minutes to start CPR, according to a lawsuit that Philadelphia attorney Glenn Ellis filed on behalf of Maldonado’s widow. Twenty-seven more minutes passed before Maldonado was wheeled into an ER, the widow’s ongoing suit alleges. Maldonado never regained consciousness.\u003c/p>\n\u003cp>Reached by phone, a center administrator declined to comment. In a legal filing, the center denied claims of wrongdoing.\u003c/p>\n\u003cp>“At a hospital, doctors and nurses … know how they are going to respond,” Ellis said. “These guys at the surgery centers are walking on a tightrope with no safety net.”\u003c/p>\n\u003cp>\u003cstrong>Conveyor Belt Of Care\u003c/strong>\u003c/p>\n\u003cp>While the thrum of a hospital continues through the night, some surgery center doctors keep banker’s hours. That means patients whose surgeries end later in the day are sometimes left in the care of one or two nurses for up to 23-hour stays. Some patients have been sent home to grapple with complications on their own.\u003c/p>\n\u003cp>Sondra Wallace went to the Surgery Center of Oklahoma in early 2017 for a sinus procedure.\u003c/p>\n\u003cp>After the procedure, doctors saw her blood-oxygen level sinking. They realized she had had a reaction to the anesthesia and at 2 p.m. gave her a drug to reverse the effects, an ongoing lawsuit filed by her husband says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Then, an hour later, they sent her home with her husband, Larry, the lawsuit says.\u003c/p>\n\u003cp>It was 3 p.m. on the Friday before Presidents Day weekend.\u003c/p>\n\u003cp>“I just think they wanted to start their three-day weekend,” said daughter Casey Podoll.\u003c/p>\n\u003cp>Larry Wallace alleges in the suit that the center gave him no hint that Sondra had a reaction to the anesthesia.\u003c/p>\n\u003cp>So, Wallace thought nothing of her napping in the back seat as he drove for more than two hours through Oklahoma pastures on his way home. When he arrived, he discovered his wife cold in the back seat. She was pronounced dead at Jackson County Memorial Hospital at 6:30 p.m. that day.\u003c/p>\n\u003cp>“They didn’t give any indication … that there were any red flags whatsoever,” Podoll said.\u003c/p>\n\u003cp>Craig Buchan, attorney for the Surgery Center of Oklahoma, said Wallace met discharge criteria and her cause of death has not been determined. He said the center did not close any earlier “than often occurs after the last patient is discharged.”\u003c/p>\n\u003cp>Cecilia Aldridge said she also felt as if the staff at a surgery center was rushing her out the door, after her 2-year-old daughter’s tonsil surgery in Arkansas in 2015.\u003c/p>\n\u003cp>A lawsuit filed by the parents said the surgery center “discharged Abbygail too early because a snow storm was moving into the area.”\u003c/p>\n\u003cp>Abbygail turned blue in the car on the way home. Her mother said she raced into an emergency room, shouting for help, her toddler in her arms.\u003c/p>\n\u003cp>“She never woke up,” Aldridge said tearfully in an interview.\u003c/p>\n\u003cp>Abbygail’s parents now question whether the surgery center ever should have been willing to treat their daughter.\u003c/p>\n\u003cp>\u003cstrong>Risky Patients\u003c/strong>\u003c/p>\n\u003cp>Because surgery centers have less safety equipment and staffing than hospitals, industry leaders stress the importance of selecting patients healthy enough to fare well. Their predictions, though, are not always correct.\u003c/p>\n\u003cp>Abbygail, who loved her hand-me-down blanket and the film “Frozen,” had sleep apnea, an irregular heartbeat and was very heavy for her age, according to the lawsuit.\u003c/p>\n\u003cp>Sleep apnea increases the risk of serious complications in surgery and the night after, medical research shows. Given her condition, Abbygail “should have been admitted [to a hospital] and monitored post-procedure,” said Dr. Charles Cote, a retired Harvard pediatric anesthesiology professor who was not involved in the family’s lawsuit.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The lawsuit says Abbygail’s risk factors “were documented and known by the Defendants,” including the doctor. It said the toddler should have been operated on “in an inpatient setting under hospital care and monitored overnight.”\u003c/p>\n\u003cp>Dr. Michael Marsh performed Abbygail’s tonsillectomy at Executive Park Surgery Center in Fort Smith, Ark.\u003c/p>\n\u003cp>The surgery center’s lawyer declined to comment. The doctor’s lawyer did not return email and voice messages. In court documents responding to the lawsuit, Marsh and the center denied wrongdoing.\u003c/p>\n\u003cp>In the court filing, Marsh said the toddler’s injuries were “the natural progression” of her illness. Executive Park Surgery Center said in a court filing that “no action on their part … was a proximate cause of any damages or injury.” The case was settled.\u003c/p>\n\u003cp>In at least 25 cases, surgery centers opened their doors to ailing and fragile patients who died after simple procedures, such as tonsillectomies, retinal repairs or colonoscopies, KHN and USA TODAY Network found.\u003c/p>\n\u003cp>Medicare asks surgery centers to assess each patient’s risk, but inspectors flagged 122 surgery centers in 2015 and 2016 alone for lapses in risk assessments. Some centers failed to gauge risk at all. Others overlooked their own policies.\u003c/p>\n\u003cp>Doctors can use an anesthesia risk assessment to screen out fragile patients — healthy patients get a score of 1, and a score of 5 means a person is nearly dead.\u003c/p>\n\u003cp>A few states, including Pennsylvania and Rhode Island, bar certain surgery centers from operating on patients with an anesthesia risk score of 4. But most states don’t go that far. They leave such decisions up to doctors.\u003c/p>\n\u003cp>And some of those decisions have been cited in tragic outcomes. Sabino Sifuentes, 74, had survived triple-bypass surgery. But on March 23, 2015, nine minutes after the start of anesthesia for an eye procedure, he became unresponsive, never to be revived, according to a Medicare inspection report. A nurse anesthetist who reviewed the case at Eye-Q Vision Care’s surgery center in Fresno, Calif., told state health inspectors that Sifuentes should have been given a risk score of 4 and his care was “completely mismanaged,” the inspection report says.\u003c/p>\n\u003cp>In response to the family’s lawsuit, the surgery center said Sifuentes’ injury was caused by his own negligence and others’.\u003c/p>\n\u003cp>Five other patients with the same risk score died after routine procedures at surgery centers across the U.S.\u003c/p>\n\u003cp>\u003cstrong>A Widening Niche\u003c/strong>\u003c/p>\n\u003cp>Such tragedies rarely find their way into the discussion when Medicare decides whether to approve new procedures at surgery centers.\u003c/p>\n\u003cp>Take spinal surgery.\u003c/p>\n\u003cp>Until 2015, Medicare wouldn’t pay for it at surgery centers. Then, the industry’s trade association urged the agency to make the change, and encouraged a letter-writing campaign from surgery centers across the nation.\u003c/p>\n\u003cp>Letter writers included Dr. Alan Villavicencio, a Colorado surgeon who said he’d been doing such surgeries for 12 years and found that his patients “appreciate the convenience and cost savings.” He did not mention that James Long, 56, had died three weeks earlier at a Lafayette, Colo., surgery center where he is an owner, a review of Colorado health department and medical board records shows.\u003c/p>\n\u003cp>United Surgical Partners International, a surgery center chain, also weighed in urging even more procedures to be approved, not mentioning a patient death hours after a spine surgery at one of its affiliate centers several months before, according to court records and securities filings. The chain said in a statement that it stands behind its comments in support of the proposal.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Such letters carry weight with Medicare, which approves procedures to be done in surgery centers based on the invasiveness and complexity of the surgery and on input from stakeholders.\u003c/p>\n\u003cp>Robert Beatty-Walters, a Portland, Ore., attorney who has represented the families of three people who died after surgery center spine procedures, said Medicare’s decision-making process is not even-handed.\u003c/p>\n\u003cp>“The stakeholders — they call them — during these regulatory proceedings are the profit-makers, not the people who are being provided the service,” he said. “The spine centers just want to have more people come. They make more money. I hate to be that cynical about it, but that’s just what I’ve seen.”\u003c/p>\n\u003cp>Medicare approved 10 spine-surgery codes to be billed at surgery centers starting in 2015 and added more spinal procedures for 2017. A Medicare spokesman denied a request for a telephone interview. In an email, a spokeswoman said Medicare opened the spine proposal to the public and received no comments suggesting the procedures would pose a threat to Medicare patients. She said the final decision about where a patient will have surgery is up to a doctor and patient.\u003c/p>\n\u003cp>By 2017, at least 14 patients had died soon after spine operations at surgery centers, according to the KHN/USA TODAY Network investigation.\u003c/p>\n\u003cp>The 14 spine-surgery deaths have gleaned little recognition in the industry or beyond. Only one made headlines in local newspapers. The rest are documented in places like the Macon, Ga., courthouse or in obscure regulatory reports. And there may be far more because some states, including New York, Illinois and Florida, disclose no details about surgery center deaths.\u003c/p>\n\u003cp>Paulina Tam’s death at Fremont Surgery Center was a tragic example. At 58, the mother of three had finished careers as a nurse and an educator. Next, she planned to travel the world with her husband of 32 years.\u003c/p>\n\u003cp>“She was the driving force of the family, the spirit I guess,” said her son, Eric Tam, a doctor in New York City, said. “We didn’t expect the worst to happen.”\u003c/p>\n\u003cp>The care she received at the center is documented in court records, EMS reports and a Medicare inspection report that concluded that the center “failed to provide a safe environment for surgery.”\u003c/p>\n\u003cp>Tam’s doctor scheduled her for a procedure to replace two discs in her upper spine on April 7, 2014. Pain from a car crash had bothered her for years. Any such surgery — entering the front of the neck to address pain in the spine — comes with a risk of suffocation, according to the Medicare inspection report.\u003c/p>\n\u003cp>Yet, with her surgeon and anesthesiologist already gone, the only doctor on-site was a digestive health specialist, the inspection report shows. About four hours after her procedure, Tam told a nurse that her surgical collar felt too tight. Then, that she couldn’t breathe.\u003c/p>\n\u003cp>The nurse called a “code blue” just after 6:30 p.m., records say.\u003c/p>\n\u003cp>Medical experts say the first step in helping such patients is removing the surgical staples so the pooled blood can disperse, allowing the patient to breathe.\u003c/p>\n\u003cp>In Tam’s case, staff repeatedly tried and failed to insert a breathing tube through her mouth and into her airway, the inspection report shows. A last-ditch remedy would have been to punch a hole through the front of her throat to restore breathing, but the gastroenterologist later told an inspector that he was “not prepared” to do so.\u003c/p>\n\u003cp>The inability to perform the suffocation-rescue maneuver, the inspection report says, amounted to the center’s “failure to ensure patient safety.”\u003c/p>\n\u003cp>From the time a nurse called 911, it took 24 minutes to get Tam to the nearest hospital, EMS records show. She arrived without a pulse and remained on life support overnight, as her children raced to her bedside to say goodbye.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The center did not return calls and denied wrongdoing in the court case. Tam’s surgeon declined to discuss the case but filed pleadings in court saying Tam’s “carelessness and negligence” caused her death. It’s unclear what the defense meant by negligence. The case reached a confidential settlement.\u003c/p>\n\u003cp>After Tam’s death, the center told Medicare inspectors that a qualified doctor would stay on-site after all upper-spine cases.\u003c/p>\n\u003cp>Dr. Nancy Epstein, chief of neurosurgical and spine care at New York University Winthrop Hospital, said surgery centers doing delicate work near the spinal cord, windpipe and esophagus in a same-day procedure is “pretty revolting.” But she said the centers are making so much money — “reeling it in hand over fist” that the potential dangers are being ignored.\u003c/p>\n\u003cp>“Medically, it should not be tolerated,” she said, “but it is.”\u003c/p>\n\u003cp>\u003cem>Lindy Washburn of The (Bergen County, N.J.) Record and NorthJersey.com contributed to this report.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/440027/as-surgery-centers-boom-patients-are-paying-with-their-lives","authors":["byline_futureofyou_440027"],"programs":["futureofyou_54"],"categories":["futureofyou_452","futureofyou_1"],"tags":["futureofyou_190","futureofyou_61","futureofyou_685","futureofyou_177","futureofyou_1056","futureofyou_349"],"collections":["futureofyou_1093"],"featImg":"futureofyou_440030","label":"source_futureofyou_440027"},"futureofyou_439151":{"type":"posts","id":"futureofyou_439151","meta":{"index":"posts_1591205157","site":"futureofyou","id":"439151","score":null,"sort":[1517817671000]},"guestAuthors":[],"slug":"what-a-pediatrician-learned-from-a-9-year-old-transgender-child","title":"What a Pediatrician Learned from a 9-Year-Old Transgender Child","publishDate":1517817671,"format":"audio","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>The number of transgender people in America has \u003ca href=\"http://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-the-United-States.pdf\" target=\"_blank\" rel=\"noopener\">doubled\u003c/a> in the last decade, but that doesn't mean the medical profession has caught up. Transgender patients are often unable to find quality health care. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802845/\" target=\"_blank\" rel=\"noopener\">Research\u003c/a> shows they may face stigma and discrimination, and that they can't find medical interventions like hormone therapy and/or sex reassignment surgery.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>Tell Us Your Story\u003c/h3>\n\u003cp>Are you a transgender person who has struggled to find appropriate care, or a doctor who has struggled to learn to provide care? \u003ca href=\"#health\">Tell us your story\u003c/a> in the question box at the bottom of this post. Your responses will be kept confidential and will not be shared without your permission.\u003c/p>\n\u003c/aside>\n\u003cp>Ximena Lopez is a pediatric endocrinologist at Children’s Health in Dallas, Texas, one of the few in the country who specialize in care for transgender youth. Recently she shared the story of her steep learning curve at the \u003ca href=\"http://www.tedmed.com/\">TEDMED\u003c/a> conference in Palm Springs.\u003c/p>\n\u003cp>I caught up with her afterward. The following interview, in Lopez's words, has been edited for length and clarity:\u003c/p>\n\u003cp>\u003cstrong>Parents Desperate for Help\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>I was not prepared when my first transgender child walked into my clinic. I didn’t get any training in medical school, my residency or my sub-specialty training to care for transgender children. And there were people in my clinic who questioned whether I should take the appointment. I decided to see whether I could help, but I didn't think I'd actually provide care.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>During the first appointment, the most striking thing was how desperate the parents were for help. They told me they had called 100 doctors and nobody wanted to provide treatment to stop Tyler's puberty. Then they said, 'We don't care if you experiment with our child. We will do anything for his mental health.'\u003c/p>\n\u003cp>They used a phrase that really stayed with me, 'We prefer to have a living son than a dead daughter.'\u003c/p>\n\u003cp>I knew I had to help.\u003c/p>\n\u003cp>\u003cstrong>[contextly_sidebar id=\"ypQ0S1VFkkumYcqXsE0vYCCbmOzMzDkc\"]Very Little Expertise Available\u003c/strong>\u003c/p>\n\u003cp>I went to the mental health team in my hospital for their expertise and they said, 'We have no experience whatsoever. The only time we've seen transgender patients is when they're trying to commit suicide and admitted to the psychiatric unit.'\u003c/p>\n\u003cp>Fortunately, I eventually found a specialist in Boston and a local psychiatrist to help me navigate suppressing Tyler's puberty.\u003c/p>\n\u003cp>Puberty suppression is a reversible step. It buys time to explore gender identity. So even if the child changed his or her mind later on, we could stop the puberty suppression and puberty will just restart.\u003c/p>\n\u003cp>\u003cb>It's Not a Choice\u003c/b>\u003c/p>\n\u003cp>Gender dysphoria is the conflict that exists when a person's physical or assigned gender is different than how they feel or identify. It's very clear that it's not a choice. That's what I've learned from my patients. Parents have been dealing with this for a long time. They've had years of denial -- mourning the child that they're losing, and then accepting the child they have.\u003c/p>\n\u003cp>When parents are not supportive the risk of suicide attempt can be as high as 60 percent. And when parents are very supportive it can be as low as 4 percent. The difference is just incredible, so parental support is more than critical.\u003c/p>\n\u003cp>Society should see transgender people as just normal people. I think we as humans tend to be afraid of what's different and what's new.\u003c/p>\n\u003cp>\u003cstrong>[contextly_sidebar id=\"3gWXSODBjp95u08FGWK1bohVUcxSPy5g\"]Biological Basis for Transgender Identity\u003c/strong>\u003c/p>\n\u003cp>There's very little known. There's no genetic explanation. We do know that 40 to 60 percent of identical twins are transgender. For example, if one identical twin is transgender, the odds of the other twin being transgender is 40 to 60 percent. That means there probably is a genetic link because that's a high prevalence. But it's not 100 percent. We don't know anything about the specific gene or genes.\u003c/p>\n\u003cp>The other thing is there is a new brain imaging study that is called a functional MRI (fMRI) that show subtle differences in movement in the brain between regular males and females. \u003ca href=\"http://scholar.google.com/scholar_url?url=https://www.researchgate.net/profile/Alicia_Garcia-Falgueras/publication/24377907_Sexual_differentiation_of_the_human_brain_in_relation_to_gender_identity_and_sexual_orientation/links/0046353982a9ca6d8e000000.pdf&hl=en&sa=X&scisig=AAGBfm19NmQGvQy8twJNvMaPYGD17MaCvg&nossl=1&oi=scholarr\" target=\"_blank\" rel=\"noopener\">Researchers\u003c/a> looked at transgender people before they received any hormone therapy or any treatment that could affect brain function or morphology, and transgender people have differences that put them more aligned with the gender they identify with. In other words, their brains are actually acting more like the brain that they identify with rather than their biological gender.\u003cbr>\n\u003ca name=\"health\">\u003c/a>\u003c/p>\n\u003ch2>Have you been able to find appropriate health care for your needs as a transgender person? Why or why not? Tell us your story; your responses will be kept confidential and will never be shared without your permission.\u003c/h2>\n\u003cp>[transgenderhealthcare]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's Note: We will post Ximena Lopez's TEDMED talk here as soon as it is available.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"When Ximena Lopez received her first transgender child patient she had no idea how her life and practice would change. ","status":"publish","parent":0,"modified":1518032392,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":821},"headData":{"title":"What a Pediatrician Learned from a 9-Year-Old Transgender Child | KQED","description":"When Ximena Lopez received her first transgender child patient she had no idea how her life and practice would change. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"What a Pediatrician Learned from a 9-Year-Old Transgender Child","datePublished":"2018-02-05T08:01:11.000Z","dateModified":"2018-02-07T19:39:52.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"439151 https://ww2.kqed.org/futureofyou/?p=439151","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/02/05/what-a-pediatrician-learned-from-a-9-year-old-transgender-child/","disqusTitle":"What a Pediatrician Learned from a 9-Year-Old Transgender Child","source":"KQED Future of You","audioUrl":"https://www.kqed.org/.stream/anon/radio/science/2018/02/TransgenderforWEB.mp3","path":"/futureofyou/439151/what-a-pediatrician-learned-from-a-9-year-old-transgender-child","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The number of transgender people in America has \u003ca href=\"http://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-the-United-States.pdf\" target=\"_blank\" rel=\"noopener\">doubled\u003c/a> in the last decade, but that doesn't mean the medical profession has caught up. Transgender patients are often unable to find quality health care. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802845/\" target=\"_blank\" rel=\"noopener\">Research\u003c/a> shows they may face stigma and discrimination, and that they can't find medical interventions like hormone therapy and/or sex reassignment surgery.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>Tell Us Your Story\u003c/h3>\n\u003cp>Are you a transgender person who has struggled to find appropriate care, or a doctor who has struggled to learn to provide care? \u003ca href=\"#health\">Tell us your story\u003c/a> in the question box at the bottom of this post. Your responses will be kept confidential and will not be shared without your permission.\u003c/p>\n\u003c/aside>\n\u003cp>Ximena Lopez is a pediatric endocrinologist at Children’s Health in Dallas, Texas, one of the few in the country who specialize in care for transgender youth. Recently she shared the story of her steep learning curve at the \u003ca href=\"http://www.tedmed.com/\">TEDMED\u003c/a> conference in Palm Springs.\u003c/p>\n\u003cp>I caught up with her afterward. The following interview, in Lopez's words, has been edited for length and clarity:\u003c/p>\n\u003cp>\u003cstrong>Parents Desperate for Help\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>I was not prepared when my first transgender child walked into my clinic. I didn’t get any training in medical school, my residency or my sub-specialty training to care for transgender children. And there were people in my clinic who questioned whether I should take the appointment. I decided to see whether I could help, but I didn't think I'd actually provide care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>During the first appointment, the most striking thing was how desperate the parents were for help. They told me they had called 100 doctors and nobody wanted to provide treatment to stop Tyler's puberty. Then they said, 'We don't care if you experiment with our child. We will do anything for his mental health.'\u003c/p>\n\u003cp>They used a phrase that really stayed with me, 'We prefer to have a living son than a dead daughter.'\u003c/p>\n\u003cp>I knew I had to help.\u003c/p>\n\u003cp>\u003cstrong>\u003c/p>\u003cp>\u003c/p>\u003cp>Very Little Expertise Available\u003c/strong>\u003c/p>\n\u003cp>I went to the mental health team in my hospital for their expertise and they said, 'We have no experience whatsoever. The only time we've seen transgender patients is when they're trying to commit suicide and admitted to the psychiatric unit.'\u003c/p>\n\u003cp>Fortunately, I eventually found a specialist in Boston and a local psychiatrist to help me navigate suppressing Tyler's puberty.\u003c/p>\n\u003cp>Puberty suppression is a reversible step. It buys time to explore gender identity. So even if the child changed his or her mind later on, we could stop the puberty suppression and puberty will just restart.\u003c/p>\n\u003cp>\u003cb>It's Not a Choice\u003c/b>\u003c/p>\n\u003cp>Gender dysphoria is the conflict that exists when a person's physical or assigned gender is different than how they feel or identify. It's very clear that it's not a choice. That's what I've learned from my patients. Parents have been dealing with this for a long time. They've had years of denial -- mourning the child that they're losing, and then accepting the child they have.\u003c/p>\n\u003cp>When parents are not supportive the risk of suicide attempt can be as high as 60 percent. And when parents are very supportive it can be as low as 4 percent. The difference is just incredible, so parental support is more than critical.\u003c/p>\n\u003cp>Society should see transgender people as just normal people. I think we as humans tend to be afraid of what's different and what's new.\u003c/p>\n\u003cp>\u003cstrong>\u003c/p>\u003cp>\u003c/p>\u003cp>Biological Basis for Transgender Identity\u003c/strong>\u003c/p>\n\u003cp>There's very little known. There's no genetic explanation. We do know that 40 to 60 percent of identical twins are transgender. For example, if one identical twin is transgender, the odds of the other twin being transgender is 40 to 60 percent. That means there probably is a genetic link because that's a high prevalence. But it's not 100 percent. We don't know anything about the specific gene or genes.\u003c/p>\n\u003cp>The other thing is there is a new brain imaging study that is called a functional MRI (fMRI) that show subtle differences in movement in the brain between regular males and females. \u003ca href=\"http://scholar.google.com/scholar_url?url=https://www.researchgate.net/profile/Alicia_Garcia-Falgueras/publication/24377907_Sexual_differentiation_of_the_human_brain_in_relation_to_gender_identity_and_sexual_orientation/links/0046353982a9ca6d8e000000.pdf&hl=en&sa=X&scisig=AAGBfm19NmQGvQy8twJNvMaPYGD17MaCvg&nossl=1&oi=scholarr\" target=\"_blank\" rel=\"noopener\">Researchers\u003c/a> looked at transgender people before they received any hormone therapy or any treatment that could affect brain function or morphology, and transgender people have differences that put them more aligned with the gender they identify with. In other words, their brains are actually acting more like the brain that they identify with rather than their biological gender.\u003cbr>\n\u003ca name=\"health\">\u003c/a>\u003c/p>\n\u003ch2>Have you been able to find appropriate health care for your needs as a transgender person? Why or why not? Tell us your story; your responses will be kept confidential and will never be shared without your permission.\u003c/h2>\n\u003cp>[transgenderhealthcare]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's Note: We will post Ximena Lopez's TEDMED talk here as soon as it is available.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/439151/what-a-pediatrician-learned-from-a-9-year-old-transgender-child","authors":["11229"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_1275","futureofyou_1244","futureofyou_685","futureofyou_80","futureofyou_656","futureofyou_1018"],"label":"source_futureofyou_439151"},"futureofyou_72960":{"type":"posts","id":"futureofyou_72960","meta":{"index":"posts_1591205157","site":"futureofyou","id":"72960","score":null,"sort":[1450886408000]},"guestAuthors":[],"slug":"what-are-apple-google-samsung-and-intel-doing-in-health-care","title":"What are Apple, Google, Samsung and Intel doing in Health Care?","publishDate":1450886408,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>What these four tech giants are aiming to do in health care is change your life in some way for the better. Like they already have with phones, search, televisions and computer processing.\u003c/p>\n\u003cp>These companies have decades of experience building consumer products that revolutionize how people live and work, and they have ample resources to throw at any problem. Here's a look at where they're throwing resources in healthcare, from personal health to disease treatment:\u003c/p>\n\u003cp>\u003cstrong>APPLE \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_73814\" class=\"wp-caption alignright\" style=\"max-width: 369px\">\u003cimg class=\" wp-image-73814\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/11/apple-watch-sport-800x533.jpg\" alt=\"The Apple Watch Sport is designed for workouts. \" width=\"369\" height=\"246\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/11/apple-watch-sport-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/apple-watch-sport-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/apple-watch-sport-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/apple-watch-sport-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/apple-watch-sport-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/apple-watch-sport.jpg 2048w\" sizes=\"(max-width: 369px) 100vw, 369px\">\u003cfigcaption class=\"wp-caption-text\">The Apple Watch Sport is designed for workouts. \u003ccite>(LMYang/Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Accomplishments?\u003c/strong> In the past few years, Apple has signaled a major interest in health care. The company announced a slew of products including the Apple Watch, which tracks everything from your steps to your heart rate, and \u003ca href=\"http://www.apple.com/researchkit/\" target=\"_blank\">ResearchKit\u003c/a>, which allows researchers to conduct clinical studies using iPhones. Apple CEO Tim Cook \u003ca href=\"http://www.businessinsider.com/tim-cook-on-jim-cramer-2015-3\" target=\"_blank\">recently said\u003c/a> he sees health care as one of the top three frontiers for Apple.\u003c/p>\n\u003cp>\u003cstrong>What can we expect?\u003c/strong> Some journalists (\u003ca href=\"http://www.reuters.com/article/2014/05/05/us-apple-hiring-insight-idUSBREA4409020140505\" target=\"_blank\">myself included\u003c/a>) have speculated that Apple might delve deeper into diabetes management. The company has poached some top biomedical engineers, who were previously working on the holy grail for diabetes: a non-invasive device to monitor blood sugar continuously.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Challenges?\u003c/strong> Apple will face competition from Android, its chief rival, as the company attempts to push its operating system into health care. It may also need to grapple with federal regulators, like the U.S. Food and Drug Administration, if it transitions from \"wellness\" apps and tools to helping the chronically-ill.\u003c/p>\n\u003cp>\u003cstrong>GOOGLE/ALPHABET \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_73809\" class=\"wp-caption alignright\" style=\"max-width: 380px\">\u003cimg class=\" wp-image-73809\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/11/google-lens_custom-8ac35584f948f9c4f4703d6c59fe59a47869c7bc-s800-c85-800x533.jpg\" alt=\"An experimental contact lens being developed by Google can painlessly measure glucose levels in tears.\" width=\"380\" height=\"253\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/11/google-lens_custom-8ac35584f948f9c4f4703d6c59fe59a47869c7bc-s800-c85.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/google-lens_custom-8ac35584f948f9c4f4703d6c59fe59a47869c7bc-s800-c85-400x267.jpg 400w\" sizes=\"(max-width: 380px) 100vw, 380px\">\u003cfigcaption class=\"wp-caption-text\">Google is developing an experimental contact lens that would measure glucose levels painlessly in tears. \u003ccite>(Google)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Accomplishments?\u003c/strong> Google's Life Sciences unit is putting its immense resources behind new initiatives to help people with diabetes live better. Researchers are \u003ca href=\"http://www.npr.org/sections/health-shots/2015/09/06/437570402/why-google-is-going-all-in-on-diabetes\" target=\"_blank\">currently working on a contact lens\u003c/a> to measure blood sugar levels. The team is also developing products for other diseases, like the \u003ca href=\"https://www.liftware.com/\" target=\"_blank\">Liftware\u003c/a> stabilizing spoon for people with Parkinson's. The spoon helps people with hand tremors lift food to their mouths reliably and comfortably.\u003c/p>\n\u003cp>\u003cstrong>What can we expect?\u003c/strong> Google will likely release its products for people with diabetes in the next five to ten years. Some hospitals are hoping Google will release software equivalent to Apple's HealthKit and ResearchKit, so they can develop programs to monitor patients who have Android devices. Google Glass,\u003ca href=\"https://med.stanford.edu/news/all-news/2015/02/medical-students-startup-uses-google-glass.html\" target=\"_blank\"> the company's Internet-connected headgear\u003c/a>, is already showing promise for surgical training, telemedicine and other uses, and will continue to make inroads in health care.\u003c/p>\n\u003cp>\u003cstrong>Challenges? \u003c/strong>Google's first health product, Google Health, shut down in 2011 because of a lack of traction. And the health sector doesn't respond as well to failure as techies in Silicon Valley do. Google may need to prove it learned from its mistakes.\u003c/p>\n\u003cp>\u003cstrong>SAMSUNG\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_73810\" class=\"wp-caption alignright\" style=\"max-width: 395px\">\u003cimg class=\" wp-image-73810\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/11/samsung-800x533.jpg\" alt=\"A Samsung Galaxy Gear smartwatch, which tracks steps and other health metrics.\" width=\"395\" height=\"263\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/11/samsung-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/samsung-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/samsung-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/samsung-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/samsung-960x640.jpg 960w\" sizes=\"(max-width: 395px) 100vw, 395px\">\u003cfigcaption class=\"wp-caption-text\">The Samsung Galaxy Gear smartwatch tracks steps and other health metrics. \u003ccite>(Cheon Fong Liew/Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Accomplishments?\u003c/strong> Samsung has ambitious plans in health care. In the past few years, it has released \u003ca href=\"http://www.samsung.com/us/mobile/wearable-tech\" target=\"_blank\">wearable products\u003c/a> with health-tracking capabilities (the Gear smartwatch and Gear Fit wristband), as well as an app called S Health that aims to be a \u003ca href=\"http://shealth.samsung.com/\" target=\"_blank\">personal fitness coach\u003c/a> on a phone. The company has also developed a \u003ca href=\"http://www.samsung.com/us/business/by-industry/healthcare\" target=\"_blank\">slew of medical devices\u003c/a>, including diagnostic imaging equipment.\u003c/p>\n\u003cp>\u003cstrong>What can we expect?\u003c/strong> Like Apple, Samsung is on a mission race to develop more sophisticated health-tracking for its devices. I wouldn't be surprised if Samsung, like Google, were investing resources and energies into innovative ways to track blood glucose.\u003c/p>\n\u003cp>\u003cstrong>Challenges? \u003c/strong>Samsung faces strong competition from Apple and Google, particularly with its consumer health products. It may also need to work more closely with federal regulators in the near future.\u003c/p>\n\u003cp>\u003cstrong>INTEL \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_73811\" class=\"wp-caption alignright\" style=\"max-width: 385px\">\u003cimg class=\" wp-image-73811\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/11/intel-800x600.jpg\" alt=\"Intel is still better known for its chip-making skills than its consumer health products. \" width=\"385\" height=\"288\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/11/intel-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/intel-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/intel-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/intel.jpg 1024w\" sizes=\"(max-width: 385px) 100vw, 385px\">\u003cfigcaption class=\"wp-caption-text\">Intel is still better known for its chip-making skills than its consumer health products. \u003ccite>(Karl-Martin Skontorp/Flickr )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Accomplishments?\u003c/strong> Intel, the computing company that made a name for itself with semiconductor chips, \u003ca href=\"http://www.intel.com/content/www/us/en/healthcare-it/healthcare-overview.html\" target=\"_blank\">now boasts a health and life unit\u003c/a>. The company is delving into consumer health products with its recent acquisition of \u003ca href=\"http://www.mybasis.com/\" target=\"_blank\">Basis\u003c/a>, a health-tracking watch. The company is alsobuilding tools to help health systems deal with a massive amount of data.\u003c/p>\n\u003cp>\u003cstrong>What can we expect?\u003c/strong> Intel's health researcher Eric Dishman, \u003ca href=\"https://www.ted.com/speakers/eric_dishman\" target=\"_blank\">who is also a TED speaker\u003c/a>, is on a mission to provide more effective health care in the home rather than in the hospital. I hope to see more technologies from Intel that monitor people between doctor's visits, especially for people who are sick and/or aging.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Challenges?\u003c/strong> Intel hasn't achieved much success with its wearables, particularly with younger generations. Intel lacks a certain \"cool\" factor when it comes to consumer health products.\u003c/p>\n\n","blocks":[],"excerpt":"These tech giants have revolutionized people's work and personal lives. Can they do the same for healthcare?","status":"publish","parent":0,"modified":1477272879,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":20,"wordCount":796},"headData":{"title":"What are Apple, Google, Samsung and Intel doing in Health Care? | KQED","description":"These tech giants have revolutionized people's work and personal lives. Can they do the same for healthcare?","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"What are Apple, Google, Samsung and Intel doing in Health Care?","datePublished":"2015-12-23T16:00:08.000Z","dateModified":"2016-10-24T01:34:39.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"72960 http://ww2.kqed.org/futureofyou/?p=72960","disqusUrl":"https://ww2.kqed.org/futureofyou/2015/12/23/what-are-apple-google-samsung-and-intel-doing-in-health-care/","disqusTitle":"What are Apple, Google, Samsung and Intel doing in Health Care?","source":"Big Ideas","path":"/futureofyou/72960/what-are-apple-google-samsung-and-intel-doing-in-health-care","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>What these four tech giants are aiming to do in health care is change your life in some way for the better. Like they already have with phones, search, televisions and computer processing.\u003c/p>\n\u003cp>These companies have decades of experience building consumer products that revolutionize how people live and work, and they have ample resources to throw at any problem. Here's a look at where they're throwing resources in healthcare, from personal health to disease treatment:\u003c/p>\n\u003cp>\u003cstrong>APPLE \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_73814\" class=\"wp-caption alignright\" style=\"max-width: 369px\">\u003cimg class=\" wp-image-73814\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/11/apple-watch-sport-800x533.jpg\" alt=\"The Apple Watch Sport is designed for workouts. \" width=\"369\" height=\"246\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/11/apple-watch-sport-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/apple-watch-sport-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/apple-watch-sport-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/apple-watch-sport-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/apple-watch-sport-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/apple-watch-sport.jpg 2048w\" sizes=\"(max-width: 369px) 100vw, 369px\">\u003cfigcaption class=\"wp-caption-text\">The Apple Watch Sport is designed for workouts. \u003ccite>(LMYang/Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Accomplishments?\u003c/strong> In the past few years, Apple has signaled a major interest in health care. The company announced a slew of products including the Apple Watch, which tracks everything from your steps to your heart rate, and \u003ca href=\"http://www.apple.com/researchkit/\" target=\"_blank\">ResearchKit\u003c/a>, which allows researchers to conduct clinical studies using iPhones. Apple CEO Tim Cook \u003ca href=\"http://www.businessinsider.com/tim-cook-on-jim-cramer-2015-3\" target=\"_blank\">recently said\u003c/a> he sees health care as one of the top three frontiers for Apple.\u003c/p>\n\u003cp>\u003cstrong>What can we expect?\u003c/strong> Some journalists (\u003ca href=\"http://www.reuters.com/article/2014/05/05/us-apple-hiring-insight-idUSBREA4409020140505\" target=\"_blank\">myself included\u003c/a>) have speculated that Apple might delve deeper into diabetes management. The company has poached some top biomedical engineers, who were previously working on the holy grail for diabetes: a non-invasive device to monitor blood sugar continuously.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Challenges?\u003c/strong> Apple will face competition from Android, its chief rival, as the company attempts to push its operating system into health care. It may also need to grapple with federal regulators, like the U.S. Food and Drug Administration, if it transitions from \"wellness\" apps and tools to helping the chronically-ill.\u003c/p>\n\u003cp>\u003cstrong>GOOGLE/ALPHABET \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_73809\" class=\"wp-caption alignright\" style=\"max-width: 380px\">\u003cimg class=\" wp-image-73809\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/11/google-lens_custom-8ac35584f948f9c4f4703d6c59fe59a47869c7bc-s800-c85-800x533.jpg\" alt=\"An experimental contact lens being developed by Google can painlessly measure glucose levels in tears.\" width=\"380\" height=\"253\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/11/google-lens_custom-8ac35584f948f9c4f4703d6c59fe59a47869c7bc-s800-c85.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/google-lens_custom-8ac35584f948f9c4f4703d6c59fe59a47869c7bc-s800-c85-400x267.jpg 400w\" sizes=\"(max-width: 380px) 100vw, 380px\">\u003cfigcaption class=\"wp-caption-text\">Google is developing an experimental contact lens that would measure glucose levels painlessly in tears. \u003ccite>(Google)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Accomplishments?\u003c/strong> Google's Life Sciences unit is putting its immense resources behind new initiatives to help people with diabetes live better. Researchers are \u003ca href=\"http://www.npr.org/sections/health-shots/2015/09/06/437570402/why-google-is-going-all-in-on-diabetes\" target=\"_blank\">currently working on a contact lens\u003c/a> to measure blood sugar levels. The team is also developing products for other diseases, like the \u003ca href=\"https://www.liftware.com/\" target=\"_blank\">Liftware\u003c/a> stabilizing spoon for people with Parkinson's. The spoon helps people with hand tremors lift food to their mouths reliably and comfortably.\u003c/p>\n\u003cp>\u003cstrong>What can we expect?\u003c/strong> Google will likely release its products for people with diabetes in the next five to ten years. Some hospitals are hoping Google will release software equivalent to Apple's HealthKit and ResearchKit, so they can develop programs to monitor patients who have Android devices. Google Glass,\u003ca href=\"https://med.stanford.edu/news/all-news/2015/02/medical-students-startup-uses-google-glass.html\" target=\"_blank\"> the company's Internet-connected headgear\u003c/a>, is already showing promise for surgical training, telemedicine and other uses, and will continue to make inroads in health care.\u003c/p>\n\u003cp>\u003cstrong>Challenges? \u003c/strong>Google's first health product, Google Health, shut down in 2011 because of a lack of traction. And the health sector doesn't respond as well to failure as techies in Silicon Valley do. Google may need to prove it learned from its mistakes.\u003c/p>\n\u003cp>\u003cstrong>SAMSUNG\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_73810\" class=\"wp-caption alignright\" style=\"max-width: 395px\">\u003cimg class=\" wp-image-73810\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/11/samsung-800x533.jpg\" alt=\"A Samsung Galaxy Gear smartwatch, which tracks steps and other health metrics.\" width=\"395\" height=\"263\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/11/samsung-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/samsung-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/samsung-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/samsung-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/samsung-960x640.jpg 960w\" sizes=\"(max-width: 395px) 100vw, 395px\">\u003cfigcaption class=\"wp-caption-text\">The Samsung Galaxy Gear smartwatch tracks steps and other health metrics. \u003ccite>(Cheon Fong Liew/Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Accomplishments?\u003c/strong> Samsung has ambitious plans in health care. In the past few years, it has released \u003ca href=\"http://www.samsung.com/us/mobile/wearable-tech\" target=\"_blank\">wearable products\u003c/a> with health-tracking capabilities (the Gear smartwatch and Gear Fit wristband), as well as an app called S Health that aims to be a \u003ca href=\"http://shealth.samsung.com/\" target=\"_blank\">personal fitness coach\u003c/a> on a phone. The company has also developed a \u003ca href=\"http://www.samsung.com/us/business/by-industry/healthcare\" target=\"_blank\">slew of medical devices\u003c/a>, including diagnostic imaging equipment.\u003c/p>\n\u003cp>\u003cstrong>What can we expect?\u003c/strong> Like Apple, Samsung is on a mission race to develop more sophisticated health-tracking for its devices. I wouldn't be surprised if Samsung, like Google, were investing resources and energies into innovative ways to track blood glucose.\u003c/p>\n\u003cp>\u003cstrong>Challenges? \u003c/strong>Samsung faces strong competition from Apple and Google, particularly with its consumer health products. It may also need to work more closely with federal regulators in the near future.\u003c/p>\n\u003cp>\u003cstrong>INTEL \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_73811\" class=\"wp-caption alignright\" style=\"max-width: 385px\">\u003cimg class=\" wp-image-73811\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/11/intel-800x600.jpg\" alt=\"Intel is still better known for its chip-making skills than its consumer health products. \" width=\"385\" height=\"288\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/11/intel-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/intel-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/intel-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/intel.jpg 1024w\" sizes=\"(max-width: 385px) 100vw, 385px\">\u003cfigcaption class=\"wp-caption-text\">Intel is still better known for its chip-making skills than its consumer health products. \u003ccite>(Karl-Martin Skontorp/Flickr )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Accomplishments?\u003c/strong> Intel, the computing company that made a name for itself with semiconductor chips, \u003ca href=\"http://www.intel.com/content/www/us/en/healthcare-it/healthcare-overview.html\" target=\"_blank\">now boasts a health and life unit\u003c/a>. The company is delving into consumer health products with its recent acquisition of \u003ca href=\"http://www.mybasis.com/\" target=\"_blank\">Basis\u003c/a>, a health-tracking watch. The company is alsobuilding tools to help health systems deal with a massive amount of data.\u003c/p>\n\u003cp>\u003cstrong>What can we expect?\u003c/strong> Intel's health researcher Eric Dishman, \u003ca href=\"https://www.ted.com/speakers/eric_dishman\" target=\"_blank\">who is also a TED speaker\u003c/a>, is on a mission to provide more effective health care in the home rather than in the hospital. I hope to see more technologies from Intel that monitor people between doctor's visits, especially for people who are sick and/or aging.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Challenges?\u003c/strong> Intel hasn't achieved much success with its wearables, particularly with younger generations. Intel lacks a certain \"cool\" factor when it comes to consumer health products.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/72960/what-are-apple-google-samsung-and-intel-doing-in-health-care","authors":["3252"],"categories":["futureofyou_1060"],"tags":["futureofyou_235","futureofyou_131","futureofyou_685","futureofyou_684","futureofyou_80","futureofyou_683"],"featImg":"futureofyou_86619","label":"source_futureofyou_72960"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. 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