Monday, 4 August 2008

My Story so far

A 27 Year old girl with a picture perfect pregnancy and absolutely no health problems goes to her doctor who tells that she won’t be having her baby for next 5 days and dismisses all her concerns. She however refused to leave and demanded that an Ultrasound be performed which showed results that necessitated an emergency c section. She feels stressed by the loss of birth experience. From the time of admission to hospital she has a high heart rate due to anxiety because she was found to have dangerously low amniotic fluid which was never detected and she feels stressed. Following her delivery, she demands that she wants to sleep and rest but a barrage of medical intervention follows her. All the while the girl insists she does not wants any test and she just wants to sleep and rest. She is forced to undergo a CT scan apart from multitude blood and other tests. his poor girl does not knows that she is suppose to hold her breath during the CT scan and thus becomes the start of trauma, pain and suffering that she is to endure for a long time to come

It’s a Friday night and her breathing causes the CT to be degraded. The easiest option was to treat her based on a degraded CT film and start on some dangerous medications called “Blood thinners” because no one wants to be bothered especially doctors on a weekend night. She stabilizes her heart rate during night because all she needed was sleep but how can doctors tell that they did something wrong. She again says she feels fine but no one listens, and keeps on giving her blood thinners.
These blood thinners can cause fatal hemorrhages especially after recent surgery and anemia. Manufactures of these medicine are well aware of this and ask doctors to use prudence and caution in there use. She starts bleeding, starts accumulating abdominal fluid. She is told she is dying without blood thinners and the barrage continues. The baby is not allowed in mother’s room and she is asked to lie absolutely still in bed with Foley between her legs. A multitude of doctors and nurses parade in and out the room checking her bikini cut incision several times a day. She has to undergo pelvic exams thrice a day checking for vaginal bleeding. She develops anemia in spite of oral iron and WBC count continues to rise with antibiotics. All during the time she keeps on draining serum and bloody fluid from abdomen. She keeps on insisting that she is having no symptoms (no chest pain, no shortness of breath, no leg swelling, no leg pain). No symptoms other than tachycardia and the doctors themselves told her that tachycardia was due to anxiety and anemia and discontinued her from telemetry but continued giving hers blood thinners. Her heart shows normal function on ECG and EKG. She is left to bleed for 4 days because doctors are too proud to accept that they did something wrong. Finally the poor girls body gives up. She bleeds uncontrollably and is almost collapsing when she is found by a young nurse. She is then being prepared for an IVC surgery that will require her to be on these blood thinners for life. Before IVC filter surgery she needs another procedure to drain fluid from her stomach.

Fortunately for her, her husband insists that before doing surgery they be shown the CT report. Finally the doctors realize that the patients are aware of something wrong and agree to do clarification CTA and the other required tests like the Ultrasound of legs and VQ Scan and agree that blood thinners were not needed as there were never any clots. She was not required to be on blood thinners ever. The poor girl at this point has a 13 cm long and an inch deep abdominal wound. She walks around draining bloody fluid from her stomach for next 8 weeks. It took 6 more weeks after that for wound to close leaving a permanent depression and disfigurement. She has more than $90,000 in medical bills. And had the surgery possibly Coumadin for life that would not have allowed her to have any more kids and she would have medical bills this large for the rest of her life.

So the cost of breathing fast on a Friday night is $90,000 in medical bills, severe anemia, weakness and anxiety, 14 weeks of open abdominal wound that was to be packed and dressed by her husband. This girl is me Prachi and this is my story a part of health fraud going on at Edward Hospital in Naperville. Patients are being subjected to long term anticoagulants without doing all necessary procedures as an anticoagulated patient earns at least $100,000 in revenue for the heart hospital and the doctors in a year. They often have 5 days stay in hospital and lots of blood tests for CBC, PTT, INR testing. Numerous doctor visits and the havoc this drug plays on the body keeps them coming to the hospital again and again. Anti coagulants or blood thinners are dangerous medications that require careful monitoring and use. While they do save lives, they have a lot of adverse effects too. The manufactures of these blood thinners called Coumadin are well aware of this and they carry black box warning about bleeding urging doctor to use caution and judgment in there use.
At the request of the Food and Drug Administration (FDA), Bristol-Myers Squibb has strengthened its US label for warfarin (Coumadin) to include a black-box warning about the risk for major or fatal bleeding. It says that bleeding is more likely to occur during the starting period. Among others, the risk factors for bleeding include trauma, anemia and concomitant drugs

Warfarin label also reads that warfarin is contraindicated with recent traumatic surgery resulting in large open surfaces. Potential adverse reactions to COUMADIN may include: Fatal or nonfatal hemorrhage from any tissue or organ. This is a consequence of the anticoagulant effect. Therefore, the possibility of hemorrhage should be considered in evaluating the condition of any anticoagulated patient with complaints which do not indicate an obvious diagnosis. (Source:

There were 3 episodes of bleeding
1. On morning of 01\13, patient was placed on bedrest again with foley after wound was opened and drained.
2. On morning of 01\15, entire wound was opened up with wound separation and indurations was noted
3. On night of 01\15 there was wound drainage and patient was running a fever with increased indurations
Why was no affirmative action taken after three bleeding episodes?
4. Why was wound not checked regularly after bleeding and fever on 01\15 night.
5. Why was I discontinued from telemetry in spite of very high Heart Rate

The FDA Med watch announcement also notes that Coumadin prescriptions will also be issued with a new patient medication guide warning about potentially serious bleeding with the drug. FDA regulations state that such medication guides are to be provided with each prescription that is dispensed for products that the FDA determines pose a serious and significant public health concern. I was also not made aware of the possibility of bleeding on Coumadin.

When an educated young couple like us can be manipulated into the scenario of dangerous medications, I shudder to think what happens to the general public. So many people never even care to check there records later to Verify the medication was ever needed. They all endure years of medication and have thousands and thousands in medical bills.
Let us consider what would it have cost Edward had
1. Carried all definitive studies
The heparin was started as a preventive dose but the patient had all stable vital signs normal ECG and EKG and repeatedly denied all symptoms. A second radiologist could have been asked to review reports since it was just suspicion or VQ Scan, Leg ultrasound and if need be a repeat CTA carried out. Edward would have earned only on the diagnostic tests and possibly even all diagnostic tests were not needed.
2. Started on anti coagulation
Person would have had hospital stay of minimum 5 days, and she would be on Coumadin for a year. She would have had several visits during the course of the year with Edward doctors, weekly blood draws, possible couple transfusions and definitely repeat CTAs throughout the year. They knew the patient desired more kids and they could again give her blood thinners throughout her subsequent pregnancies again adding to profit.

Yes there was a very high risk of bleeding because of recent surgery, trauma and anemia but this weighed no where near the profit Edward would generate. Even if patient starts bleeding they would put up IVC Filter. A surgery which would cost thousands. If IVC Filter becomes permanent, person would have to take Coumadin for rest of life and Edward would have revenue for next several years. Even if IVC Filter is temporary, there would have been one more surgery to take out the filter and that would again generate revenue. Plus there was always the anti coagulation for the year which maybe they can now extend to two.
And if the patient did die, Edward could put the cause of death as Pulmonary Embolism and adverse effect of anticoagulants in therapeutic use. Whether that therapeutic use is warranted no one bothers to check. One person made a wrong diagnosis and all others follow. How that medicine could impact the person profoundly no one cares. No one would have bothered to perform repeat CTA on a dead body

A group of three doctors (cardiologist, hematologist and her OB\GYN) visit the patient in turn. To each the patient asks that she feels fine and she has no symptoms. She wants to know how big the clots are. But all she is told by all three that she should be grateful to doctors for saving her life. She feels no symptoms and she would have never known about her PE and died had the doctors not been proactive in saving her life. How lucky for her that her doctors have treated her although there were no symptoms. A girl who is generally logical, confident and smart is exploited in most vulnerable way. Her coherent confident self turns nervous, anxious and scared as she is told that she is unable to feel symptoms of what is going wrong with her body.
Few people hemorrhage fatally and the rest are given several blood transfusions again adding to profit line of Edward. While PE can be a potentially life threatening situation, anti coagulation has its risks as well and can be as life threatening as a PE. Decision to place a patient on long term anticoagulation should be only taken after a definitive diagnosis is evident. I would have thousands more in medical bills for INR testing; any future pregnancy would require prophylactics and again would have cost thousands. An anticoagulated patient is at great risk for bleeding and stroke during day to day activities. A person may simply be denied life insurance because he or she has been on Coumadin.

The number of dispensed outpatient prescriptions for warfarin had increased 45%, from 21 million in 1998 to nearly 31 million in 2004, and that warfarin was among the top 10 drugs with the largest number of serious-adverse-event reports submitted to the FDA during the 1990 and 2000 decades. From US death certificates, they showed that anticoagulants ranked first in 2003 and 2004 in the number of total mentions of deaths for drugs causing “adverse effects in therapeutic use.” In addition, data from hospital emergency departments for 1999 through 2003 indicated that warfarin was associated with about 29 000 visits for bleeding complications per year, and it was among the drugs with the most visits. And yet warfarin is continued uninterrupted at Edward Heart Hospital because of the revenue it generates. All patients require several blood transfusions, INR testing and medical visits all of which are adding to the profit line of Edward. Long term anticoagulation should be clinically correlated and undertaken with definitive diagnosis. The emphasis should be on correct diagnosis and not treatment. The emphasis need not to be on covering other doctors and earning revenue, but on the welfare of the patients.

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