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PUBLIC DECLARATION REGARDING
SCRIPPS CLINIC, GREEN
HOSPITAL, LA JOLLA, CALIFORNIA
Laura Walther Nathanson M.D., F. A. A. P.
PACKAGE 3:
“See how this happened to Chuck, here.”
P. 2, #2, second bullet. Specialists outside of area of expertise.
012C - 015
SUMMARY:
There are three problems that fall in the category of “Specialists
practicing outside their area of expertise.”
First, there is the individual physician, who sees a patient
requiring specialty care—and the physician is not Board Certified in that
specialty.
Second, there is the individual physician who is stymied by a
patient with a difficult, rare, possibly dire diagnosis—and who refuses to
authorize a second opinion.
Third, there is a physician, a department, or an institution that
encounters a patient whose rare condition requires highly specialized treatment.
The patient’s best hope is to be transferred to a physician, department,
or institution focused upon the rare condition and the specialized treatment,
rather than to stay in a facility that almost never confronts these challenges.
But the physician, department, or institution decides to keep the patient in its
care, whether from ego, or the hope of gaining useful medical experience, or the
financial implications to the Institution of authorizing
care “out of network.”
In Chuck’s case, all three problems arose.
1. Individual physician without Board Specialty.
Document
012C consists of Dr. Miller’s credential report from the
American Board
of Medical Specialists.
Hematology is the study of diseases of the blood, such as aplastic
anemia and iron deficiency anemia. Cancers of the blood also occur, such as
leukemia and multiple myeloma.
Hematologists also study cancers of the blood. Here (b.) is a page of web
definitions of “Hematologist.”
Oncology is the study of cancer, and is often restricted to the
study of solid tumors.
Physicians may become Board Certified in any of these three
specialties:
2. Failure to
authorize a second opinion:
The Hopkins/Miller document above makes no mention of a second opinion, nor does
it demonstrate any uncertainty in its “Diagnosis of Exclusion,” see Package 4.
3. Failure to transfer care. The Hopkins/Miller diagnosis
was Cancer of Unknown Primary Site, which occurs in only about 3% of all cancer
patients. Moreover, unlike other cancers, each case of CUPS is unique to the
individual patient and requires access to cutting-edge, even experimental,
treatment.
Dr. Miller himself stated that he could offer no treatment, much
less cure, and refused to offer us a return visit, because it would be “a waste
of time.” referral to a Cancer Center (meaning a Center designated as such, and
closely monitored by the
National Cancer Institute) Dr. Miller refused, saying “We are a cancer
center.”
Echoing this attitude, an obituary in the San Diego Union Tribune
earlier this year nudged me to
write to its reporter, document 013. I
have blocked out the name of both reporter and the young man who had died at the
age of 21, after being treated at Scripps Clinic for a rare, life-threatening
disease:
severe aplastic anemia, in which the bone marrow stops making red blood
cells, document 013A.
I was distressed to read that he had been hospitalized at Scripps
Clinic from February, 2007 to to May, 2007, while waiting for a compatible bone
marrow donor transplant. Bone
Marrow Transplant, in which bone marrow is obtained from a donor, or from
umbilical cord stem cells, is
the only effective treatment for severe aplastic anemia. For a transplant to
“take,” it is important that the patient does not build up immunity to red blood
cells before the transplant. That means that the patient should be given as few
blood transfusions as possible, ideally none at all, before the transplant.
Since the young man had to be
hospitalized so long before a transplant became available, it seems
probable that he underwent one or more blood transfusion.
Moreover, some experts feel strongly that a young person in good
general health “deserves” an umbilical cord stem cell transplant, rather than a
bone marrow transplant from an unrelated donor, to decrease chances of
rejection. Scripps Clinic, according to the National Bone Marrow Transplant
records, does not perform umbilical cord stem cell transplants. MD Anderson does
perform them.
When it comes to donor bone marrow transplant:
According to the National Bone Marrow Transplant Program records,
Scripps
Clinic Cancer Center performed only three (3) donor bone marrow transplants
during the five years ending in 2005 (014).
As a comparison (015),
MD Anderson Cancer Center performed over 400 in the same period.
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