UW Medicine postponing some non-urgent procedures amid rising COVID cases

UW Medicine and other hospitals are starting to postpone non-urgent procedures to free up more space as coronavirus cases surge in Washington state.

SEATTLE — UW Medicine in Seattle is delaying some non-urgent procedures to free up more space in its hospitals for coronavirus patients. 

Hospital staff are identifying non-urgent surgeries that would require hospitalization and postponing them “unless it would cause medical harm to the patient,” said Susan Gregg, spokesperson for UW Medicine on Saturday. 

“We are implementing this process to increase our bed capacity and available personnel based on the current increase of COVID-19 cases in our region and increased hospitalizations,” Gregg said via email. 

UW Medicine isn’t the only hospital choosing to postpone certain procedures. 

During a briefing with state and local health officials earlier this week, Chief Operating Officer at Swedish First Hill, Dr. Elizabeth Wako, said her hospital is reducing elective surgeries to make room for more COVID-19 patients.

The latest data from the Washington State Department of Health (DOH) reported 141,260 confirmed COVID-19 cases in the state, including 2,619 deaths as of Saturday. There are currently 9,765 hospitalizations, according to the DOH. 

In King County, there are 2,930 hospitalizations, in Snohomish County there are 1,041 hospitalizations, and in Pierce County there are 1,192 hospitalizations, according to DOH data that was last updated Saturday afternoon.

Hospitals in western Washington are preparing for what could be a surge in COVID-19 cases following the Thanksgiving holiday if people choose to ignore state and local warnings to not gather with people outside their household. 

A new national survey by the Ohio State University Wexner Medical Center found nearly two in five people report they will likely attend a gathering with more than 10 people for Thanksgiving.

“If you gather with 15 people for Thanksgiving dinner, there will be an 18% chance that one of the individuals will be infected with COVID,” said State Health Officer Dr. Kathy Lofy during a briefing this week.

Deputy Secretary of Health Lacy Fehrenbach added, “There’s risk for further transmission. Those guests who become infected may go on to do other things the following week. They may go to a religious service. Another might work in a nursing home. A child who attended could go to school leading to outbreaks in these locations.”

Source Article

Read more

UW Medicine to reschedule some procedures; hospitals agree to share surge of COVID-19 patients

Responding to a surge in COVID-19 caseloads, UW Medicine has decided to postpone surgeries that are not urgent but would require hospitalization afterward, according to an internal email and confirmed by a spokesperson. 

UW Medicine’s action comes as Washington state’s hospitals earlier this week reached an agreement on how to handle the ongoing rise of COVID-19 patients statewide — committing to one another that “no hospital will go into crisis standards alone.” 

Crisis standards are when hospitals are so overwhelmed they cannot provide the typical standard of care, and they are left to triage resources and decide who will receive treatment and who will be left to die. 

The hospitals’ commitment — which expand on agreements reached before the first surge of COVID-19 in spring — says all of the state’s acute care hospitals will make “concrete plans” to scale back on elective procedures as needed, reserve intensive care units for COVID-19 or emergency cases, and readily accept patient transfers from other parts of the state.

It aims to ensure hospitals will work closely with one another and communicate to prevent individual facilities from becoming overwhelmed when others have capacity.  

“It’s essentially to try to manage — all across the system — the capacity,” said Cassie Sauer, of the Washington State Hospital Association (WSHA), which convened a videoconference Monday for the state’s hospital leaders. “In the places that have gone to crisis standards, those doctors and nurses, I’m not sure their soul will ever be the same.” 

Sauer said hospitals hope to create more slack in the system by collaborating closely together and establishing clear communication. Hospitals must document if they deny the transfer of a patient and inform their chief executive officer if a transfer is denied. 

Statewide, as of 4 p.m. Friday, 78% of acute care beds were occupied, according to WSHA. Nearly 84% of intensive care unit (ICU) beds and almost 75% of the ICU beds in airborne infection isolation rooms were in use — numbers higher than two weeks ago.

Sauer said many Washington hospitals, including UW Medicine and Swedish, are beginning to more aggressively scale back on elective procedures.  

“All non-urgent patients who need to occupy a bed [post-operation] for any length of time will be rescheduled,” wrote UW Medical Center CEO Cindy Hecker and Harborview Medical Center CEO Paul Hayes in a message to colleagues Nov. 19. The rescheduling will begin Nov. 23 and continue through Feb. 1, according to the message.  

Procedures for outpatients and in urgent or emergent cases will continue, Hecker and Hayes wrote. 

UW Medicine spokesperson Susan Gregg said the hospital system is “actively contacting” patients whose surgeries will be postponed. 

“Each individual case is being reviewed based on medical urgency and whether the patient would need to be hospitalized after the surgery,” Gregg said in a statement Friday.  

UW Medicine was caring for 77 COVID-19 patients across its campuses as of Thursday. On Oct. 1, the hospital system was caring for 20.  

Dr. Elizabeth Wako, chief medical officer at

Read more

Javaid Perwaiz, ob/gyn accused of unnecessary procedures, testifies

“Yes, I knew the 30-day requirement. I just couldn’t say no,” he said from the witness stand Thursday. “I’m an advocate for my patients.”

He said he performed the sterilizations in contradiction to the requirement to benefit his patients. Often, they had discussed sterilization with doctors who referred them. They told him, he testified, that their insurance would run out if he waited or that they could not get a ride or a babysitter on other dates. Asked during cross examination if he could name which of the patients in the indictments told him that their insurance was running out, Perwaiz could not.

Backdating forms is part of three broad categories of charges against Perwaiz. Prosecutors say he altered medical records to justify unnecessary surgery, often scaring women by mentioning the threat of cancer. They allege he changed due dates so he could induce women into labor on the Saturdays he was operating on other patients at Chesapeake Regional Medical Center. And they contend he billed insurers for office medical procedures done with broken equipment.

He is also charged with falsifying his application to health-care providers by omitting a felony conviction for tax fraud in 1996, which resulted in a brief suspension of his license, and failing to admit his loss of privileges at Maryview Hospital in 1983. Perwaiz, 70, has been jailed since his November arrest.

In a full day of testimony, Perwaiz, led by defense lawyer Emily Munn, defended the care he gave to the two dozen patients named in the 61 counts against him. In case after case, she broadcast his medical charts and the form he filed with Chesapeake Regional Medical Center before surgery. The charts were identified by the initials of the women prosecutors charge he operated on unnecessarily — D.B., D.P., A.G., T.D.C., A.F., A.N. S.N., D.B.D — and by their age and the complaints they wrote down, complaints several women who testified previously said were false.

In case after case, Perwaiz explained that the complaints by the women — often pelvic pain, bleeding and cramping — justified his procedures. Often, he said, women asked him to be sterilized. In none of the cases of women named in the indictments, Perwaiz said, did he refer them to other doctors after finding evidence of cancer.

During cross examination by Elizabeth Yusi, an assistant U.S. attorney, Perwaiz said due dates for patients were changed not for his convenience so he would be paid for the deliveries, but because he relied on a “range” of possible dates from several ultrasound examinations. The American College of Obstetricians and Gynecologists and Chesapeake hospital guidelines advise against inducing labor before 39 weeks without a medical reason, saying it leads to health problems for the baby. Chesapeake Regional Medical Center prohibited inducing labor before 39 weeks without a medical reason.

Perwaiz said his own research indicated no reason for that policy. “There is no difference in immediate morbidity and mortality” he told Yusi. “I find it not understandable that we enforce

Read more

Women testify of trust placed in gynecologist who prosecutors say performed unnecessary procedures

The surgeries started that year and ended only in 2015. Each time, her handwritten medical chart reported that she had complained of pelvic and back pain, bad cramps, frequent and long periods, or something growing in her vagina.

The woman was asked whether she had ever suffered those symptoms. “I never said that,” she answered again and again. She was the latest of Perwaiz’s patients to share their experiences with a doctor prosecutors say performed unnecessary procedures over the course of a decade as part of a scam to fund his lavish lifestyle.

Perwaiz faces 61 fraud counts that cover 25 patients, most of whom he saw from 2015 to 2019. Prosecutors have not said how many others were victims. So many women came forward after his arrest in November that the FBI created a website about the case for them.

When the patient asked Perwaiz why she needed surgery, she said he replied that there was an abnormal growth in her uterus that could be cancer. “I was told this lump will keep on growing each time it was removed,” she testified. “If I do not take care of this, then it would spread very rapidly and cause cancer.”

He operated in 2006, 2007, 2010, 2012 and 2015. During the 2012 surgery, he performed a hysterectomy, removing her uterus and left ovary but leaving her right ovary intact. In 2015, according to her testimony, she voiced no complaints during her checkup, but Perwaiz told her she needed another surgery. This time, he removed her remaining ovary.

Each time he told her that surgery was necessary, she believed him. “He’s my doctor,” she told jurors. “I have to trust him.” M.C. was among the patients who testified that they trusted Perwaiz when he told them they needed invasive procedures over the years.

Like patients, health insurers also trusted him.

He billed them hundreds of thousands of dollars for phantom medical procedures, according to his indictment.

He billed for hysteroscopies, a procedure used to view inside a woman’s uterus during examinations, during times when either the scope was broken or he did not have the other materials in his office to perform the procedure, prosecutors allege. They contend he billed for colposcopies, a procedure to view the cervix, and wrote abnormal findings on patients’ charts even though he didn’t use the solution that would allow him to see those abnormalities. And they say he billed for unnecessary hysterectomies.

Prosecutors also contend that Perwaiz often induced labor for pregnant patients before they were due on Saturdays at Chesapeake Regional Medical Center, where he scheduled surgeries, so he could earn money making deliveries.

Between 2010 and 2019, Perwaiz billed insurance companies more than $2.3 million for gynecological care partially justified by diagnostic procedures he never performed, prosecutors allege in the indictment. In testimony earlier in the trial, an investigator for Anthem Blue Cross Blue Shield said that, over a decade, more than 41 percent of Perwaiz’s patients had surgical procedures compared with 7.6

Read more

7 Procedures Not Covered By Medicare


2. Hearing aids

Medicare covers ear-related medical conditions, but original Medicare and Medigap plans don’t pay for routine hearing tests or hearing aids. 

Solution: If you are in a Medicare Advantage plan, check your policy to see if it covers hearing-related needs. If it doesn’t, or if you have original Medicare, consider buying insurance or a membership in a discount plan that helps cover the cost of such hearing devices. Also, some programs help people with lower incomes to get needed hearing support. Or you can pay as you go. Congress passed legislation in 2017 that allows some hearing aids to be sold over the counter without a prescription. The Food and Drug Administration has until August to issue proposed guidelines for the sale of these devices.

3. Dental work

Original Medicare and Medigap policies do not cover dental care such as routine checkups or big-ticket items, including dentures and root canals.

Solution: Some Medicare Advantage plans offer dental coverage. If yours does not, or if you opt for original Medicare, consider buying an individual dental insurance plan or a dental discount plan.

4. Overseas care

Original Medicare and most Medicare Advantage plans offer virtually no coverage for medical costs incurred outside the U.S. 

Solution: Some Medigap policies cover certain overseas medical costs. If you travel frequently, you might want such an option. In addition, some travel insurance policies provide basic health care coverage — so check the fine print. Finally, consider medical evacuation (aka medevac) insurance for your adventures abroad. It’s a low-cost policy that will transport you to a nearby medical facility or back home to the U.S. in case of emergency. 

Source Article

Read more

Before undergoing aesthetic medicine procedures, make sure to verify these details

The unfortunate death of a young woman allegedly following a liposuction procedure in a beauty centre has been widely discussed among the public and aesthetic practitioners alike. It prompted me to write in to share some information concerning medical aesthetic practice in Malaysia.

The category of aesthetic medicine is relatively new. In 2013, the Health Ministry defined aesthetic medicine as “An area of medical practice which embraces multidisciplinary modalities dedicated to creating a harmonious physical and psychological balance through noninvasive, minimally invasive and invasive treatment modalities which are evidence-based. These modalities focus on the anatomy, physiology of the skin and its underlying structures to modify an otherwise ‘normal’ (nonpathological) appearance in order to satisfy the goals of the patient and are carried out by registered medical practitioners”.

There are many ways to classify aesthetic medicine procedures. It depends on the applicability of the procedure to the patient. The Health Ministry’s Aesthetic Medical Practice Committee classifies aesthetic procedures into three categories.

The first is noninvasive. “This is defined as external applications or treatment procedures that are carried out without creating a break in the skin or penetration of the integument. They target the epidermis only.”

Second is minimally invasive procedures. “This is defined as treatment procedures that induce minimal damage to the tissues at the point of entry of instruments. These procedures involve penetration or transgression of the integument but are limited to the subdermis and subcutaneous fat, not extending beyond the superficial musculoaponeurotic layer of the face and neck, or beyond the superficial fascial layer of the torso and limbs.”

Lastly, invasive procedures. “This is defined as treatment procedures that penetrate or break the skin through either perforation, incision or transgression of integument, subcutaneous and/or deeper tissues, often with extensive tissue involvement in both vertical and horizontal planes by various means, such as the use of knife, diathermy, ablative lasers, radiofrequency, ultrasound, cannula, and needles.”

In other words, the noninvasive procedures only target outer layers of the skin, such as a superficial chemical peel, intense pulsed light, and microdermabrasion. Minimally invasive procedures targets deeper skin layers and muscles and include treatments such as botulinum toxin or dermal fillers. Invasive procedures are all the surgical procedures that need cutting and perforating the inner layer of the human body and require specialised expertise for procedures such as such as nasoplasty or liposuction.

Who can perform medical aesthetic procedures?

According to the Private Healthcare Facilities And Services Act 1998, and the Aesthetic Medical Practice Guidelines 2013, aesthetic medicine procedures can only be performed by registered medical practitioners (doctors) with letters of credentialing and privileging in licensed premises. The regulations stipulate that all medical professionals need to follow very stringent rules before performing procedures to safeguard public health. The service provider’s (doctor/clinic/medical centre/hospital) obligation is to display all the certificates or documentation correctly for the patient to see.

In summary, before you agree to undergo aesthetic medicine procedures, make sure to verify:

> That the premises has its license displayed (clinic license from the

Read more