Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.
Physician Discipline Lenient, Secretive
In November 2018, members of Kentucky's Board of Medical Licensure allowed Michael Heilig, MD, an orthopedic surgeon who had battled substance use disorder, to return to medical practice. Six months earlier, Heilig had failed a hospital drug screening after a nurse raised concerns that he was under the influence while operating on a patient.
Critics say Heilig's case exemplifies the problems with disciplinary programs for doctors battling addiction. These programs often lack transparency, leaving patients and the public in the dark about inappropriate behavior by their physicians, according to an .
When the nurse reported Heilig in May 2018, she told investigators that the surgeon "almost fell" and was "talking a little weird" during his first surgery of the day. During the second surgery, he was "not acting like himself," she added.
By the time his third surgery began, Heilig was "stumbling with his eyes closed and mumbling," the nurse told investigators. He was so confused about the task at hand that they had to stop the procedure, she stated.
Heilig was self-prescribing Ambien and had been diagnosed with two substance use disorders, which landed him in a program designed to help doctors battling addiction. However, Heilig's license was never suspended or revoked, according to WKYT. After the incident, the surgeon agreed that he would not practice medicine again until he was sober for at least 90 days.
According to critics, the issue with disciplinary programs lies in the lack of transparency. Addiction issues with physicians are typically handled first by confidential Physician Health Programs, or PHPs, which give doctors another avenue to battle addiction without facing disciplinary action. These programs keep the identities of physicians private.
"Medicine is a field that relies almost completely on trust. When we don't have transparency about reasons that trust might not be deserved, we have a problem," Art Caplan, PhD, head of medical ethics at the NYU Grossman School of Medicine, told WKYT.
Patients Sue Hospitals for Sending Data to Meta
Months after a news investigation revealed that a few dozen hospitals were using a tracking tool that sent patient data to Meta, several large health systems including UPMC, Advocate Aurora, and Duke Health are battling patient lawsuits, according to a .
In June, STAT and The Markup co-published an investigation that found a third of Newsweek's top 100 U.S. hospitals used a tracker called Meta Pixel, which sent a patient's sensitive health information to Meta (formerly known as Facebook) every time they scheduled a doctor's visit. This data included information on medical conditions, prescriptions, and appointments.
This week, a federal judge allowed one of these lawsuits against UPMC to come out of the court system and into arbitration. The case, which is now closed, was filed by a patient named Malinda Smidga, who alleged in the lawsuit that she entered sensitive health data on an appointment scheduling page that was later linked to her Facebook account.
"Both Meta and UPMC recklessly disregarded patient privacy in order to maximize their own profits," Smidga said in a class action complaint.
UPMC won its arbitration motion by providing evidence that Smidga had agreed to updated terms and conditions before entering the patient portal, including a provision that required arbitration and waiving her right to a jury trial.
Nicholson Price, JD, PhD, a professor of law at the University of Michigan who specializes in health law and big data, told STAT that it's difficult for patients to win lawsuits over privacy protections. "Frankly speaking, the mere fact that something is horrifying having to do with patient data is not enough on its own to be a successful lawsuit," Price told STAT.
Following this investigation, 28 of the 33 hospitals have removed Meta Pixel from its booking platforms, or stopped the tracking tool from sending data to Meta.
Questionable Hospice Referrals
In her many years of selling hospice care, Marsha Farmer developed a knack for identifying potential patients who needed end-of-life care. But as her employer at AseraCare pushed her to enroll more patients that weren't always appropriate for hospice, Farmer decided she needed a way out.
In order to qualify for hospice care, patients must agree to waive curative care and be certified by a doctor as having less than 6 months to live. But at AseraCare, Farmer was encouraged to recruit clients for hospice care regardless of whether they were imminently going to die. The company, Farmer said, sought out people who were uneducated or poor, "because you are able to provide something to them and meet a need."
Once a potential patient expressed interest, a nurse would then assess whether their conditions qualified -- or could be interpreted to qualify -- as a fatal illness. Conditions such as shortness of breath might look appropriate for hospice care on paper, Farmer said.
The lucrative nature of the hospice industry as well as the lack of federal oversight has produced a healthcare industry rife with exploitation, and without any legal consequences, according to an .
Companies in the hospice business can expect some of the biggest returns for the least amount of effort in healthcare, the report stated. Medicare pays providers a set per-diem rate, most care takes place in the home, and nurses are not required to visit more than twice a month, allowing a steady cash flow while keeping costs low. The way Medicare has designed hospice care has also incentivized providers to recruit patients who aren't on the brink of death, the investigation found, as longer hospital stays were more lucrative and stable patients required less resources.
Farmer and a co-worker, Dawn Richardson, filed a whistleblower lawsuit accusing AseraCare of Medicare fraud, claiming that the company enrolled patients who were ineligible for hospice care. The company decided to fight those allegations. In a 2015 trial, a jury found AseraCare guilty of enrolling ineligible patients in hospice, but then a judge allowed the company's request for a new trial due to an error. Ultimately, the lawsuit was settled.
"Nobody really cared," Farmer told ProPublica. "The government didn't care, the judge didn't care, and all of these people's money was wasted."