Nearly 1 in 5 women who undergo hysterectomy may not need the procedure
JANUARY 06, 2015
Media Contact: Beata Mostafavi 734-764-2220

Study: Hysterectomies are declining overall but alternatives to hysterectomy are still being underutilized.

ANN ARBOR, Mich. —  A University of Michigan-led study of nearly 3,400 women in Michigan shows that one in five who underwent a hysterectomy for benign conditions may not have needed it.

The findings, which appear in the American Journal of Obstetrics and Gynecology, indicate that alternatives to hysterectomy are being underused and that treatment guidelines are often not followed.

An estimated one in three women in the U.S. will have had a hysterectomy by the age of 60.  Researchers found that although the numbers of hysterectomies are decreasing, nearly 18 percent of hysterectomies that were done for benign indications were unnecessary, and a pathology analysis for nearly two in five (38 %) of women under 40 did not support undergoing a hysterectomy.

“Over the past decade, there has been a substantial decline in the number of hysterectomies performed annually in the United States,” says senior author Daniel M. Morgan, M.D., associate professor in the Department of Obstetrics and Gynecology at the U-M Medical School.

“An earlier study found a 36.4% decrease in number of hysterectomies performed in the U.S. in 2010 compared to 2002. However, despite the decrease in numbers of hysterectomies in the U.S., appropriateness of hysterectomy is still an area of concern and it continues to be a target for quality improvement.”

More than 400,000 hysterectomies are performed in the U.S. each year. About 68% of surgeries for benign conditions are done because of abnormal uterine bleeding, uterine leiomyomata (fibroids), and endometriosis. The American Congress of Obstetricians and Gynecologists recommends alternatives to hysterectomy, including hormonal management, a minimally invasive gynecological procedure called operative hysteroscopy, endometrial ablation (a procedure that destroys the uterine lining) and use of an intrauterine device as primary management of these conditions in many cases.

Researchers set out to assess how often alternatives to hysterectomy are being recommended to women with benign gynecologic disease before performing hysterectomy and how often the pathologic findings from the hysterectomy supported an indication for surgery. They examined the medical records of 3,397 women who underwent hysterectomies for benign conditions in Michigan. Data were collected over a ten-month period in 2013 from 51 hospitals participating in the Michigan Surgery Quality Collaborative (MSQC). Indications for surgery included uterine fibroids, abnormal uterine bleeding, endometriosis, or pelvic pain.

Nearly 40% of women did not have documentation of alternative treatment before their hysterectomy. Fewer than 30% received medical therapy, while 24% underwent other minor surgical procedures before the hysterectomy. Alternative treatment was more likely to be considered among women under 40 years old and among women with larger uteri. About 68% of women under 40 received alternative treatment compared with 62% of those aged 40-50 and 56% of those aged 50 or above.

Nearly two in five women under 40 (38%) had pathologic findings that did not support undergoing a hysterectomy versus those aged 40-50 (12%) and over 50 years (7.5%). The frequency of unsupportive pathology was highest among women with endometriosis or chronic pain.

“This study provides evidence that alternatives to hysterectomy are underutilized in women undergoing hysterectomy for abnormal uterine bleeding, uterine fibroids, endometriosis, or pelvic pain,” Morgan says.

Additional Authors: Lauren Elizabeth Corona, of Wayne State University; and Carolyn W Swenson, M.D.; Kyle H Sheetz; Gwendolyn Shelby, R.N.; Mitchell B. Berger, M.D.; Mark D. Pearlman, M.D.; John O DeLancey, M.D., all of U-M. Darrell A. Campbell, Jr., U-M’s former chief medical officer. Pearlman and Morgan are also members of the U-M Institute for Healthcare Policy and Innovation. 

Funding: The MSQC is funded by the Blue Cross and Blue Shield of Michigan/ Blue Care Network.

Reference: “Use of Other Treatments before Hysterectomy for Benign Conditions in a Statewide Hospital Collaborative,” American Journal of Obstetrics & Gynecology, January, 2015.

I am beside myself…

Bend Doctor Responds to License Threat
Tami Sawyer’s Former Physician May File Appeal
By Barney Lerten, KTVZ.COM
POSTED: 5:13 pm PDT October 29, 2010
UPDATED: 4:22 pm PDT October 30, 2010

BEND, Ore. — A Bend gynecologist facing state Medical Baord disciplinary action over involvement with now-indicted real estate broker (and former patient) Tami Sawyer said Saturday his license is still valid and he’ll be back to work Monday.

Dr. David Redwine, who won a still-unpaid, hefty judgment against a company run by Tami and Kevin Sawyer, faces possible suspension or revocation of his medical license over state findings of “unprofessional or dishonorable conduct” and “gross or repeated acts of negligence” involving Tami Sawyer.

“The board has not diminished my license at all. I’ll be seeing patients Monday and I’m scheduled to operate Tuesday,” said Redwine, who has less than two weeks to seek an appeal hearing or face as-yet undetermined consequences that could range from revocation or suspension of his license to practice medicine, to a fine or reprimand.

Redwine told KTVZ.COM he is out of town visiting family and “will be talking with my attorney about filing an appeal hearing.”

The physician said he could not speak to the issues until he discusses matters further with his attorney, but added, “We need to let the process take its course.”

The Oregon Medical Board issued a complaint and notice of proposed disciplinary action Oct. 21 against Redwine, a physician and surgeon specializing in endometriosis and gynecology.

The state’s findings come nearly a year after Tami Sawyer filed a malpractice lawsuit against him, accusing him of a consensual sexual relationship with her when she was a patient and improperly prescribing medicines to her and her family members.

The state findings detail much of the same claims, showing that Redwine disputes Sawyer’s claim of how long the relationship lasted.

Sawyer claimed this week that no judge in the area would hear the malpractice case and had recused themselves.

Last week, Tami and Kevin Sawyer were indicted on 21 federal charges of fraud, conspiracy and money-laundering charges. They are due for arraignment in Eugene Nov. 8.

Tami Sawyer agreed in March 2009 to a judgment on behalf of their company, Starboard LLC, in a lawsuit filed by Redwine and wife Laurie against the Sawyers’ company, Starboard LLC, for more than $800,000 invested in the company that they never got back.

Sawyer almost went to jail on contempt of court charges a year ago, for refusing to divulge details of the company’s finances, but the Oregon Court of Appeals stayed that order, saying she was likely to prevail on appeal. The judgment has not been paid.

The state Medical Board complaint says Redwine first provided obstetric and gynecological care for Sawyer, identified as “Patient A,” in the late 1980s and they also began business transactions in the late ‘90s, including Redwine making loans to Sawyer for real estate investments.

According to Sawyer, the two “entered into a sexual relationship beginning in 1999 and culminating in the fall of 2007,” the complaint said, while Redwine recalled “a shorter time span” of “a sporadic sexual relationship beginning in late 2004 and extended into 2005.”

The state complaint says Redwine “wrote various prescriptions” for the patient between 2004 and 2007, and also “wrote occasional prescriptions for (Sawyer’s) family members at her request, without the benefit of conducting an examination or maintaining a chart.”

In 2005, the complaint says Redwine “performed a breast examination on (Sawyer) in a social setting that was witnessed by a family member and friend.” It says Redwine terminated their doctor-patient relationship in an April 2008 letter.

Greta Matus, an investigator with the Oregon Medical Board, said Friday the nature of the disciplinary action against Redwine has not been decided. If Redwine does not seek a contested case hearing, the complaint said that will result in a dfault order by the board as it “deems appropriate.”

Sawyer told KTVZ.COM on Friday, “It’s very sad it’s come to this.”

“Why David’s attorney … deposed me about David and (my) past relationship is still a mystery to me,” she wrote.

“He had to know that when all of my attorneys read it, there would be further investigation surrounding that fact,” Sawyer said.

“Lives and careers have been ruined,” she added. “It’s just incredibly sad to me.”

I just want to scream, “How dare you be rotten like so many others out there! You were supposed to be one of the good ones!”

There just aren’t enough good endometriosis surgeons out there as it is, and he is ranked as one of the rock stars out there. I have recommended him for years. To fall from grace like that – who loses? The patients lose.

No one has (yet) accused him of butchery like some of the other former rock star surgeons out there have been accused, but his disciplinary action is still a tragedy because he used very poor judgement while emotionally and sexually involved with a patient, and emotionally involved with her family.

Even if his medical license does not get revoked, I will never see him now, and I will not recommend him.

You ought to be ashamed of yourself, Mr. Redwine. I am heartbroken.

Judge asked to lower award
Government questioning future costs
Saturday, Dec. 13, 2008
BY JIM SUHR – Associated Press

EAST ST. LOUIS — The U.S. government is asking a federal judge to trim an $8.6 million judgment over an Air Force base doctor’s mistreatment of a case of flesh-eating bacteria that cost a woman use of an arm.

Federal prosecutors this week asked federal Magistrate Judge Philip Frazier to reconsider his ruling favoring Jean Phillips, an Air Force captain’s former wife, who the judge concluded was left with a right arm that’s been “withered, lifeless and useless” since 2002.

Frazier, after an August bench trial, found that Dr. Dan MacAlpine was stationed at Scott Air Force Base just east of St. Louis when he failed to notice or heed Phillips’ rash on her right arm in 2002, assuming she was an addict looking for prescription drugs. MacAlpine told her to go home and take Motrin, a popular over-the-counter pain medication.

But the rash turned out to be necrotizing fasciitis, commonly known as flesh-eating bacteria, that Frazier says eventually cost Phillips use of her right arm.

“This is a sad story,” Frazier wrote in his 13-page ruling Nov. 25. With a useless arm that causes her continuous, extreme pain and likely hooked on prescription drugs, the judge added, the now-divorced Phillips “faces the future with no reason to be optimistic that things will improve.”

Frazier awarded $2.5 million each for future pain and suffering and for future disability, as well as $1.5 million for past pain and suffering. The judge also said Phillips should get $500,000 apiece for past disability and disfigurement, $495,169 for past and future lost earnings, $421,581 for past medical costs and $215,040 for future ones.

Frazier credited the government for $110,748 in medical services already rendered.

“Granted, there are more dramatic injuries out there involving multiple amputations and the like,” Frazier wrote. “But (Phillips’) situation is about as bad as it gets when one considers the impact on her work and personal life.”

The judge acknowledged Phillips’ life already “was on a downward arc” when she contracted the flesh-eating bacteria, noting she had poor health including issues with abnormal uterine tissue growth called endometriosis, hypothyroidism, insomnia, headaches and anxiety. Frazier said she also had emotional troubles and perhaps drug addiction.

But “she had one other thing that she does not have today. She had a chance,” the judge wrote. “The cruel reality is that her life would probably improve if the arm were taken” — amputated to make way for a prosthetic arm she actually could use.

In its motion Wednesday, the U.S. government, which operates Scott Air Force Base through the Defense Department, asked Frazier to lower the damages he assessed for Phillips’ past and future medical expenses and her lost wages. Those damages total $1,131,790.

According to the government, Phillips’ future medical expenses beyond 10 years from now required speculation, perhaps making her eligible for $48,000 — not $215,040 as Frazier ruled. And “there is simply no evidence in the record that (Phillips) was willing or able to work even prior to her necrotizing fasciitis,” Wednesday’s motion read in questioning the woman’s eligibility for lost earnings.

Phillips’ attorney, Thomas Keefe Jr., was out of the office Friday and unavailable until next week, according to his office, which declined to disclose where Phillips now lives. A published telephone listing could not be found.

MacAlpine now lives in Iowa, where a woman who answered his home telephone Friday said the 39-year-old doctor had no comment. The AP left a message.

Randy Massey, a spokesman for Southern Illinois’ U.S. attorney’s office representing the federal government in the case, declined comment Friday.

Scarring caused by surgical gel spray
Women are being hurt by a surgical treatment
LANE NICHOLS – The Dominion Post | Monday, 11 February 2008

A surgical gel – containing a drug untested on humans – has caused excruciating internal scarring in dozens of women that could lead to infertility, claims a leading gynaecologist.

Many of the endometriosis patients have already forked out thousands of dollars for repeat surgery. Some are now pursuing compensation from ACC.

Endometriosis is a condition where abnormal growths develop in pelvic organs, causing inflammatory reactions leading to scarring and pain. It affects millions of women worldwide.

Though some gynaecologists have stopped using the anti-scarring gel because of concerns about its safety and effectiveness, others still use the treatment, Wellington specialist Hanifa Koya said.

Medsafe, the Government agency that approves medicines, has told the American manufacturer to add additional precautions to the instruction pamphlet. But it maintains the product is safe, and refuses to ban its sale without conclusive evidence of harm – even though the gel is considered high risk under proposed legislation.

Dr Koya – who first raised concerns in December 2005 – was disillusioned at the response of health agencies, which she claimed had let Confluent SprayGel be used internally on thousands of Kiwi women since about 2002 without adequate clinical testing or ongoing monitoring of its effects.

She had spoken out because of concern for her patients and to highlight the need for immediate law changes to protect people.

“Confluent SprayGel is a product sprayed inside human beings and contains a section 29 drug (methylene blue) which has not been tested on human beings, and this product was allowed to be used … [with] no quality assurance in terms of monitoring,” she wrote to Medsafe in December.

“It’s quite amazing – we’re using it inside human beings,” she told The Dominion Post. “I would have expected … that they would have said, `Let’s put this product on hold or start asking some questions’, but that didn’t happen.”

Dr Koya began using the gel in October 2002, but stopped in April 2006 after her rate of repeat laparoscopies – keyhole operations – jumped from less than 2 per cent to around 10 per cent.

Women who would usually have made swift recoveries developed severe pain or discomfort after their initial operations. Dozens of the many hundred women she treated with the gel needed repeat surgery to remove scarring – which could cause infertility – even though their endometriosis had not returned. “It’s only where I’ve sprayed the SprayGel. It’s like sheets of scarring which I’ve never seen in my practice.”

Dr Koya said she had not repeated any laparoscopies since using an alternative product.

She complained to American manufacturer Confluent Surgical and has written repeatedly to MedSafe and the Health Ministry asking them to investigate, but felt her concerns had been ignored.

New Zealand distributor Covidien Tyco did not return calls.

Medsafe interim manager Stewart Jessamine said SprayGel was classed as a device under the Medicines Act, not a medicine. No clinical assessment was required before its sale, though manufacturers had to ensure the device was safe. Medical practitioners had the ultimate responsibility for its use on patients.

After a review, it it concluded the gel was safe “when used as intended”.

There had been no other complaints and there were no plans to restrict its supply, it said.

DESIGNED TO HELP HEALING

What is Confluent SprayGel?

• Marketed as a synthetic, absorbable barrier to prevent tissue sticking together and forming scarring after abdominal pelvic surgery.
• A gel-based product containing methylene blue – a dye substance which is added to make it visible.
• Medsafe says methylene blue is already used widely in humans but is not approved for general supply as a medicine.
• The gel is in clinical trials in the United States but not approved for sale there.
• Approved for use in Australia and Europe.
• Sprayed on internal tissue. Usually absorbed within a week then excreted.
• Distributed in New Zealand till last month by Intermed Medical but now by Covidien Tyco.