The Final Boss of Our Medical Misery -- The American Prospect

[erronis]

Some health care problems, like Luigi Mangione’s excruciating back pain, are complex and mysterious. But the ultimate villain is pretty straightforward.[/blockquote]

https://prospect.org/health/2024-12-13-final-boss-of-our-medical-misery/

About three years ago, a UnitedHealth medical director for utilization management (we’ll call him KW) began to suspect that a popular spine surgeon was misrepresenting patient MRIs to make the case that they needed unnecessary spinal fusion surgery in lieu of a less invasive discectomy procedure. Specifically, KW, a board-certified orthopedic surgeon, believed the surgeon was misdiagnosing degenerative disc disease as spondylolisthesis, the much rarer condition believed to have afflicted Luigi Mangione, the 26-year-old engineer accused of assassinating UnitedHealthcare CEO Brian Thompson following a long phase of societal withdrawal, triggered by a flare-up of his unbearable back pain.

But when KW brought up the topic in a one-on-one peer review consultation in early 2022, the surgeon grew combative. If UnitedHealth did not approve spinal fusion surgery and forced him to perform a routine discectomy, the surgeon promised he would intentionally botch the discectomy, ultimately causing the patient to require spinal fusion anyway. “It would be cheaper,” the surgeon reasoned, for UnitedHealth to just approve the spinal fusion off the bat, according to a 2022 lawsuit.

KW, who had come to develop a deep skepticism of the merits of spinal surgery, was shocked, and reminded the surgeon he was being recorded. The surgeon did not back down, and repeated his threat to literally injure his patient in retaliation for being denied the go-ahead to perform a costlier surgery. But when KW shared his recording with the insurer’s fraud, waste, and abuse committee, he was punished and forced to submit to remedial training on how to “de-escalate” adversarial physician interactions, while the surgeon was given nary a warning.

A very in-depth article with lots of disturbing aspects.

[Dennis Donovan]

1. From the article:

The notion of care denial as a humanitarian exploit might sound preposterous, especially to the multitudes of back pain sufferers currently sharing stories online of debilitating pain prolonged by excruciating rounds of denials and appeals with the nation’s largest health insurer. But at the time of his dispute with the spine surgeon, KW had spent the better part of a decade working as an expert witness for a quixotic lawyer litigating some 580 malpractice lawsuits against Atiq Durrani, a surgeon accused of performing—and almost as often as not, botching—unnecessary spine surgeries on hundreds of patients in Kentucky and Ohio. Durrani had been a “rainmaker” surgeon at numerous Cincinnati-area hospitals whose penchant for over-operating, often after telling patients they would soon be paralyzed if they didn’t go under the knife, was an open secret in the physician community.

Dr Durrani is a real villain in this story. There's a website dedicated to him called: https://www.butcherofpakistan.com/