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Lap-band patients operate in the dark

Willie Brooks Jr. was a 35-year-old substitute custodial worker for the Pomona school district when he decided to do something about his weight last year.

The 6-foot-6 Brooks tipped the scale at nearly 300 pounds. He thought he would be in line for a permanent position if he lost a few pounds. So when he noticed the advertising campaign suggesting he find out about weight loss surgery by calling 1-800-GET-SLIM, he followed up.


FOR THE RECORD:
Lap-Band doctor: A column by Michael Hiltzik in the April 18 Business section incorrectly stated that Dr. Michael Omidi, who has been associated with Top Surgeons, the promoter of Lap-Band weight-loss surgery, was placed on probation by the California Medical Board for such acts of “gross negligence” as allowing medical assistants to operate on patients. Although the board did make such accusations, Omidi settled the case by stipulating to having violated state law by performing surgeries on three patients at an unaccredited surgical facility. The board revoked his license but stayed that action for a three-year probationary period. —


Brooks had surgery to implant a lap-band -- a silicone ring fitted around the upper stomach to suppress appetite -- last June 5 at a surgical facility in Beverly Hills operated by Top Surgeons, the sponsor of those 1-800-GET-THIN and 1-800-GET-SLIM billboards that have become as inescapable on Southern California freeways as smog in summer. He was sent home to Perris with a prescription for oxycodone painkiller and instructions to return in a week.

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Three days later, Brooks was dead. At the autopsy, a Riverside County coroner found stomach contents leaking around the edges of the lap-band and more than a liter of pus in his abdomen. On her report she listed the cause of death as “peritonitis due to lap-band procedure due to obesity.”


FOR THE RECORD:
Lap-Band surgery: Michael Hiltzik’s column in Sunday’s Business section said that Willie Brooks, who died after weight-loss surgery at a clinic in Beverly Hills, was 6 feet 6 and nearly 300 pounds when he died. He was 5 feet 6. —


I was thinking about the Brooks family the other day while driving past one of the new billboards Top Surgeons has been rolling out in the Southland.

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The new billboards state, “We only work with pre-screened, fully-inspected and accredited facilities.” They display a huge gold seal reading: “We are committed to PATIENT SAFETY at the highest level!”

These billboards seem to be a response to my previous columns about this hard-sell, high-volume medical enterprise and the people behind it, the brothers Julian and Michael Omidi.

As I’ve reported, the California Medical Board revoked Julian Omidi’s medical license last year after finding that he had been intentionally deceitful about his past on his license application. The board also has placed Michael Omidi on probation for such acts of “gross negligence” as allowing unlicensed medical assistants to operate on patients.

As for “fully-inspected and accredited facilities,” the accreditation of the clinic at 9001 Wilshire Blvd. in Beverly Hills where Brooks had his surgery was revoked in April 2009 by the American Assn. for the Accreditation of Ambulatory Surgery Facilities (AAAASF), one of the four accreditation agencies recognized by the state of California. The federal government terminated the clinic from Medicare and Medicaid after inspectors produced 22 pages of health violations.

In a lawsuit filed last month in Los Angeles County Superior Court, Willie Brooks’ family says he would never have consented to have surgery at the facility or with Top Surgeons personnel had he known about some of these issues.

It’s plain that Brooks’ passing has left a vacuum in the lives of his widow, Okema, and their six children, ages 14 to 20.

“He was the glue that held the family together,” she told me. “Camping, family vacations, sports.” The last family fishing trip was the day before his surgery.

What the family’s lawsuit underscores is that the state needs to get information about physicians’ and facilities’ disciplinary histories to their patients a lot faster. Much of that information is public, but it hides in plain sight because few patients know how to find it.

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The medical board is taking a step in that direction by requiring doctors’ offices to post a large sign directing patients to its website,

www.medbd.ca.gov, where they can find disciplinary records on every doctor in the state. The regulation will go into effect at the end of June, says the board’s interim executive director, Linda Whitney.

The Legislature is also moving, if slowly, to close the holes in state regulation of independent surgical clinics. The regulatory fabric was ripped apart by a 2007 state court ruling that voided the Department of Public Health’s oversight of clinics owned by a doctor.

But no other agency has been given legal authority to step into the void. A bill sponsored by Sen. Gloria Negrete McLeod (D-Chino) may help. “We’re trying to close those holes so no one can sneak through,” she told me last week.

A similar bill was vetoed last year by Gov. Arnold Schwarzenegger, who said its improvements to consumer protection were only “marginal.”

Negrete McLeod says her bill, SB 1150, would end another regulatory shortcoming identified by my reporting: the inconsistencies in the clinic accreditation process.

State law says that (with certain minor exceptions) an outpatient facility performing major surgery such as a lap-band operation must be accredited by one of four nongovernmental agencies recognized by the California Medical Board. But this system offers clinics a lot of wiggle room.

The facility where Brooks got his lap-band was originally accredited as Almont Ambulatory Surgery Center by the Accreditation Assn. for Ambulatory Health Care (AAAHC). That approval ended February 2009 for reasons the association won’t disclose. The clinic then received accreditation from a different body, the AAAASF. After that group revoked its accreditation on April 27, 2009, the clinic applied to the San Francisco-based Institute for Medical Quality, but the IMQ rejected its application in May.

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For those of you keeping score at home, that’s three out of four accreditation agencies. The fourth, which is known as the Joint Commission, last September accredited the facility, which by then was operating under a new corporate name, Beverly Hills Surgery Center. The facility still holds that accreditation.

Interestingly the JC, unlike IMQ and the AAAASF, doesn’t examine a facility’s prior accreditation history as part of its approval process.

Incidentally, Top Surgeons was claiming on one of its websites as recently as April 6 that its facilities were still accredited by AAAHC, though that hadn’t been true for some 13 months. They removed the claim April 7 -- the day after I asked them about it.

Negrete McLeod is concerned that the system allows a facility with quality issues to go accreditation-shopping. Under her bill, the suspension or revocation of a facility’s approval by one agency would be binding on the other three. “If somebody refuses or denies or revokes accreditation, you’re not going to be allowed to look for another,” she said.

Another provision under consideration is making sure that reports of clinics’ health violations get publicly disseminated.

In their lawsuit alleging medical malpractice and wrongful death, Brooks’ widow, Okema, and six children note that the flunked inspection of the Top Surgeons clinic and its termination by Medicare and Medicaid occurred before his surgery. The lawsuit says Top Surgeons and the clinic didn’t meet the proper standard of medical care in treating Brooks, which it calls negligence, and that by not disclosing its regulatory history to him it committed fraud.

The lawsuit also says Top Surgeons knew that Brooks’ surgeon, George Tashjian, was under investigation for gross misconduct.

Indeed, the California Medical Board began formal proceedings Nov. 3 to revoke Tashjian’s medical license, accusing him of grossly negligent treatment of three patients, two of whom died. Those cases occurred in 2006 at Glendale Memorial Hospital and Health Center. The board contends that, among other things, Tashjian failed to respond promptly to signs that the patients were suffering from infections or other complications.

Tashjian faces a July 21 administrative hearing. In an e-mail to me he called it “an unverified and unproven accusation to which I have valid defenses.”

Although the board’s formal accusations are posted on its website, Brooks would not have learned about the case against Tashjian even if he checked because the accusation was not filed until more than four months after his surgery. But the accusation concerns cases dating back to 2006, which suggests that the board’s disciplinary cases should move faster and that some way should be found to alert patients when an investigation is under way.

According to the family members’ lawsuit, Brooks experienced virtually nonstop pain and nausea in the days following his operation. They claim they placed five calls to Top Surgeons but no one there told him to come in for examination or to go to the hospital. Their lawsuit also claims they were never able to reach Tashjian.

None of the defendants, including Top Surgeons, has filed a formal answer to the lawsuit. But attorney Stephen J. Goldberg, who says he represents Michael Omidi and the Almont facility, said that nothing in the lawsuit suggests that the condition of the clinic had anything to do with Brooks’ death. Goldberg contends that any gastric tear discovered by the coroner might have happened post-operatively, perhaps during a bout of vomiting, and says there were no evident complications when Brooks was sent home.

In an e-mail to me, Tashjian noted the coroner’s observation that Brooks resisted his wife’s entreaties to go to the hospital. “We were not given a chance to intervene and possibly prevent this outcome,” he wrote.

Of course, if Willie Brooks had access before his operation to everything that has surfaced since then about the clinic and his doctor, perhaps no intervention would have been necessary, because he would have gone elsewhere for surgery.

Top Surgeons wants you to believe that things have changed at the surgical facility since Brooks’ operation. Atul Madan, who became its medical director on Oct. 1, told me by e-mail last week that he had “established formal protocols” for patient care and instituted “in-service education of all staff,” among other improvements. He said the facility had passed several inspections, a sign that it’s “clean, safe, and professional.”

For weeks, Madan has refused my requests for an interview. Among the questions I’d hope to ask him is why his facility’s accreditation by the AAAHC was misrepresented on the Top Surgeons website on his watch. I’d also ask how he feels about Top Surgeons marketing major surgery as a “safe, 1-hour” procedure, especially to patients whose health is typically compromised by a high risk of “diabetes, hypertension, heart disease, stroke and arthritis” (his words).

If Sacramento achieves anything this year, it should close the regulatory loopholes enjoyed by outpatient surgical clinics and require greater disclosure of problems. As long as there are billboards and TV jingles to advertise can’t-miss surgical remedies for serious medical problems like obesity, people will respond to them. But how many more cases like Willie Brooks’ do we want to see filed?

Michael Hiltzik’s column appears Sundays and Wednesdays. Reach him

at mhiltzik@latimes.com, read past columns at www.latimes.com/hiltzik, and follow @latimeshiltzik on Twitter.


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