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December 03, 2004

Beware Bogus Botox!

My first guess was that this particular treatment is targeted at those who happen to be both extraordinarily vain as well as phenomenally cheap.

Investigators are looking at an unapproved wrinkle treatment as the culprit that hospitalized 4 people with suspected botulism poisoning after they received injections at an Oakland Park, FL clinic, 3 officials close to the investigation said
....
The physician and his girlfriend remain on ventilators but are in stable condition at Bayonne Medical Center in NJ.
...
Officials said they found letters from Toxin Research International, a Tucson pharmaceutical distributor that sells a product called Botulinum Neurotoxin type A.
...
The manufacturer of Botox, Allergan Inc. of Irvine, Calif., has complained to the USA that TRI's product is illegal and cannot be sold in this country, said company spokeswoman Stephanie Fagan.

But on second thought--Want to bet the doc giving the injections was charging her patients full price for the treatment, even though she was using the cheap and tainted stuff? From the looks of the case, she may have been doing so for quite a while.

A physician working at an Oakland Park clinic under investigation for giving anti-wrinkle shots that may have sickened four people has been forbidden from prescribing medication since 2002, after officials found she was giving substandard drugs to her patients.

Why in god's name is Shelly Wolland still allowed to practice medicine?* Isn't the repeated, purposeful practice of treating one's patients with substandard drugs a violation of the Hippocratic oath? Given her history, why would any reputable clinic hire her?

Update: How...interesting.

Doctors who prescribed the costliest volumes of drugs have some of the shakiest practice records. And doctors who prescribe the largest amounts of OxyContin, an often-abused painkiller, have the highest rate of disciplinary problems.

Guess who was one of the top ten Florida Medicaid prescribers for controlled drugs during 2000-2002? That's right, Dr. Shelly, though there's reason to think that she didn't prescribe all those drugs to actual patients.

The discovery prompted authorities to look into Sunshine's billing practices. It was discovered that between January and December 2001, Wolland submitted more than 2,000 claims to Medicaid for procedures that were never performed and drugs that were never distributed to patients, according to the attorney general's office.

I wonder what might have happened to all those extra prescriptions...

Dr. Shelley Wolland, Floral Park's chief physician, scoots around on a wheeled stool in the clinic's infusion room. Patient charts are balanced on her lap. Her strawberry blond hair is braided and beaded, and multiple earrings adorn her pierced lobes. About five clients, resting on black vinyl recliners, are hooked up to intravenous blood compounds. Others wait to be seen in a lavender painted examining room. On busy days the large infusion room is clogged with nurses filling out charts and hooking up IVs; patients trying to maneuver around tables, recliners, chairs, and wheelchairs while grabbing sandwiches and drinks from a refrigerator; everyone arguing, napping, gossiping. On the walls Wolland has tacked snapshots of many of her patients when they first came to her. Most are grimly skeletal, black blotches marring their skin. They have visibly improved, some in just a few months, and they all praise Wolland for saving their lives.

"When I first come here I had the attitude, 'Just give me some medicine so I can sell it,'" says one man, speaking slow and thick, his eyes moist. "I ain't with that anymore. Dr. Wolland here, she made me see I have some hope." But when the man leaves, an acquaintance quietly asserts that he's still selling his meds. That may or may not be true, since the acquaintance might simply be expert at spinning yarns, or may himself have gone back to smoking crack.

One new patient, Ray, a young, fine featured man who has been leaning back in a recliner, nods and lifts his upper back from the sticky vinyl of the chair. "I need the money from selling meds because my disability check isn't but $565," Ray announces. He seems vigorous and healthy, though the pants and shirt he's wearing look old and threadbare in places. "But if I do that, I'll get sicker. That's what I keep telling my roommate. I knew he was selling his AIDS drugs but I just found out there's this whole network they've got. I come home one night and there's this guy sitting in the living room Doctor K. He the man. You beep him, he'll come to your house and buy what you got."

Recently, after the boyfriend of a clinic patient was observed trying to find a buyer for some Epogen he was carrying in a paper bag, Dr. Wolland told her nurses and the police officers to banish the man from the clinic. "I can tell what's going on," Wolland says, "when somebody asks me for a certain medicine that he never had before. It's got to be a street thing. They come in and say, 'I need my Neupogen and Epogen.' I look in their file and see their blood work and I know they haven't been taking it and aren't suffering from a condition those medicines can help , and I know someone's been offering them money for it."

*In Florida, Wolland is still allowed to practice medicine because there are no state rules barring her from medical practice.

A South Florida Sun-Sentinel investigation found dozens of doctors allowed to continue freely prescribing dangerous drugs at state expense, even after multiple patients have died of an overdose, and even in extreme cases where they have been charged with drug crimes or serious misconduct. The state has no system that monitors, sounds an alarm or stops doctors who abuse the system.

More Update: Damn. Has Dr. Shelly/Shelley ever been out of hot water?

When Yolanda Mack discovered she was three months pregnant in August '98, she sought prenatal care at a Northwest 54th Street clinic. Despite three troubling ultrasounds warning that her baby would be born with ''grotesque deformities,'' no one told her -- until it was ''too late to legally terminate the pregnancy,'' she says in a negligence lawsuit.

Mack, a 19-year-old single mom, gave birth Feb. 11, 1999 to Jason Daquan West at Jackson Memorial Hospital. Diagnosis: encephalocele. Translation: the brain protruded through a hole in the skull, almost like a bubble.

The baby lived for eight months. ''The mother bonded with the child,'' says attorney Robert Bryan. ''Even though he was deformed, she loved him.'' And when he died Oct. 19, ``she had a funeral, she buried him, and she grieved.''

The defendants: Dr. Shelley Wolland, an osteopath; Floral Park Health Care Centers; gynecologist Dr. Ramon Hechavarria; radiologists Dr. Robert J. Hyman and Martin S. Goldstein, and Spectrum Medical Services, which did the ultrasounds. Someone dropped the ball, says attorney Lance Stelzer, Bryan's co-counsel.

From an August '98 ultrasound report: ''The possibility of a deformity involving the fetal head is raised.'' In November '98: ''The fetal head appears deformed.'' In Jan. '99: ''There is apparent malformation of the fetal skull.'' But Mack says she wasn't informed -- until she was in her last month. Says Stelzer: ``Everybody is pointing the finger at everybody else.''

Lawyers for Wolland and Goldstein did not return calls for comment. Floral Park attorney Chris Mancini says the clinic did nothing wrong, and ''it's no longer in business anyway.''

Anybody want to spend $7.95 on her Physician Quality Report? I bet it's chock full of interesting reading--and if it's not, well, that's pretty interesting in its own right.

Posted by Bigwig at December 3, 2004 01:43 PM | TrackBack
Postscript:
First time visitor to House Hraka? Wondering if everything we produce could possibly be as brilliant/stupid/evil/pedantic/insipid/inspired as the post you just read? Check out the Hraka Essentials, the (mostly) reader-selected guide to Hraka's best posts, and decide for yourself.
Comments

The back alley "botox" phenomena is pretty widespread. Lionel Richie's wife was arrested for participating in a scheme involving the stuff. It's even made it into one of the TV dramas we watch.

Posted by: Les Jones at December 4, 2004 12:11 PM

Hippocratic Oath -- Classical Version

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.


Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.

as posted at http://www.pbs.org/wgbh/nova/doctors/oath_classical.html

Posted by: Paris at December 5, 2004 06:21 PM
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