This expos, Whistleblower Doctor-The Politics and Economics of Pain
and Dying, concerns Dr. David K. Cundiff's efforts over 32 years to
improve the quality of palliative care and hospice services for
cancer and AIDS patients at the LA County + USC Medical Center.
Over a nine year period, he improved the care of terminally ill
cancer and AIDS patients at the LA County + USC Medical Center by
directing a popular "Pain and Palliative Care Consultation
Service." Unfortunately for the financial bottom line of the
hospital, better pain and symptom control of terminally ill
patients led to more patients at home and fewer patients occupying
Medicaid-funded hospital beds. The unintended consequence of
Medicaid's dysfunctional hospital-centric funding system was the
closure of Dr. Cundiff's Consultation Service in 1995. Dr. Cundiff
subsequently blew the whistle by writing 83 incident reports about
patients receiving poor pain and symptom management. He also wrote
an op-ed piece in the LA Times about poor palliative care and
widespread institutionalized inefficiencies due to dysfunctional
Medicaid financial incentives rewarding a higher hospital census.
The hospital retaliated by firing Dr. Cundiff, and the California
Medical Board revoked his medical license, both supposedly over a
single clinical treatment decision. In a patient with alcoholism,
liver failure, and a deep venous thrombosis (DVT, leg vein clot),
Dr. Cundiff stopped anticoagulant medications because of the high
risk of serious bleeding. Unfortunately, the patient later died of
thromboses in his lungs (pulmonary emboli). This reasonable
judgment call was not the real reason the Medical Board revoked Dr.
Cundiff's license. He challenged the institutionalized
inefficiencies in charity hospitals spawned by Medicaid. In
researching the scientific evidence regarding anticoagulant drug
treatment of venous thromboembolism (VTE: deep venous thrombosis
and pulmonary emboli), Dr. Cundiff serendipitously discovered that
these drugs do not reduce the risk of death in these patients. In
fact, they increase the chance of dying due to bleeding and rebound
hypercoagulability (increased clotting after stopping
anticoagulants). Up to 20,000 Americans die unnecessarily each year
due to bleeding and rebound clotting from these drugs for
prophylaxis and treatment of VTE. While many bleed to death or
suffer major nonfatal bleeding, drug companies and medical special
interests earn from $17 - $25 billion per year in the U.S. from
unnecessary and harmful anticoagulation treatments. Dr. Cundiff's
peer-reviewed medical journal publications challenging
anticoagulant treatment of VTE have been ignored by drug company
funded anticoagulant drug researchers. Federal government health
regulators in the FDA and NIH have refused to issue a detailed
transparent, public critique of his challenges to the evidence
basis of anticoagulation for VTE. Drug company financial clout is
killing people.The major goals of this book include: improving the
pain and symptom control of cancer and AIDS patients, stopping the
epidemic of deaths and injuries from the use of anticoagulant
drugs, changing the Medicaid reimbursement system for the LA County
Department of Health Services and other places where it fosters
inefficiencies and poor medical care, and reinstating Dr. Cundiff's
medical license.
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