Profits Override Skill in Hip Replacement Choices, Patient Says
By William Dotinga
6-26-2013 21:26:00

    LOS ANGELES (CN) – A man claims Kaiser Permanente—focusing on profits rather than skill—lacked the necessary expertise and botched his hip replacement surgery.
     Denny Hernandez and his wife Sabina sued Kaiser Foundation Health Plan and four of its subsidiaries, as well as Drs. Gurbir Chhabra, Mohammad Namazian, Christopher Sherman, Richard Rose and Sumera Panhwar in LA County Superior Court. The couple alleges a litany of actions against the healthcare giant, including medical malpractice, reckless misconduct, negligent hiring and fraud.
     Hernandez claims that Kaiser doctors determined that he needed a total hip replacement in 2008 because of an advanced case of osteoarthritis. Because Hernandez was only 48 years old at the time, defendant Dr. Chhabra recommended two procedures—the total hip arthroplasty, or THA, and the new Birmingham Hip Resurfacing (BHR).
     Doctors developed the BHR as an alternative to full hip replacement for younger patients. When the FDA approved the procedure in 2006, the agency required doctors to undergo extensive training before performing their first BHR, and required a specialist to be in attendance during a surgeon’s first 10 BHRs.
     “This was due in large part to the fact that that the successful outcome of hip resurfacing is strongly dependent on the experience of the surgeon and the hospital performing the procedure. The results of subsequent studies published in the Association of Bone and Joint Surgeons also confirmed that surgeon experience plays a significant role in the successful outcome of resurfacing procedures, with complication rates being six times higher for the first 25 procedures than the second 25 procedures, and that proper implant positioning required significantly more experience—between 75 and 100 procedures. Additionally, the literature for the BHR system warns physicians of the importance of having sufficient training with both the recommended instruments and the surgical technique before performing the procedure,” Hernandez says in the complaint.
     After several consultations, Dr. Chhabra recommended the BHR despite knowing that he lacked the necessary training and tools to perform the procedure, according to the complaint.
     “Dr. Chhabra represented to plaintiffs that he had the requisite knowledge, skill, training, experience, tools and equipment to properly perform the BHR procedure when, in reality, Mr. Hernandez was going to be Dr. Chhabra’s guinea pig,” the complaint says.
     It took six months for Hernandez to receive the necessary clearances for the procedure. Two weeks before the scheduled BHR, x-rays revealed that Hernandez’s hip degeneration had worsened—but the surgery was performed as scheduled nonetheless.
     “Despite the manufacturer’s warnings that only physicians who have sufficient training in the BHR system should perform the procedure and that the recommended instruments and surgical approach are crucial to the success of the procedure, defendants ignored each and every one—including the warning that a posterior surgical approach be utilized. On or about Sept. 29, 2009, the day after undergoing the BHR procedure, Mr. Hernandez was visited by Dr. Chhabra who, believing the surgery was a success, revealed to plaintiff that he had only performed the BHR procedure once before,” the complaint states.
     A few days after the procedure, Hernandez says he experienced “an unusual excruciating pain in his right hip.” Although he’d been instructed to report anything unusual post-surgery, Kaiser doctors prescribed a painkiller and advised him to take it easy, according to the complaint.
     Hernandez says that he complained of pain and stiffness in his hip, thigh and buttocks—as well as “clicking and crunching sounds” during his November 2009 post-op visit. Dr. Chhabra advised him to continue home exercises and prescribed preventative antibiotics.
     By January 2010, Hernandez says his hip began giving out randomly.
     “Some episodes were worse than others and sometimes, if plaintiff was lucky, he was able to grab onto something before falling to the ground. On or about Feb. 24, 2010, after one of plaintiff’s episodes, Mr. Hernandez returned to Kaiser when he couldn’t tolerate the pain. Kaiser administered intravenous painkillers to plaintiff, making the pain tolerable so that Kaiser could obtain x-rays of plaintiff’s right hip. After reviewing the x-rays, Kaiser assured plaintiff that nothing was wrong and that he could go home,” Hernandez says in the complaint.
     His right hip continued to give out, and each subsequent episode caused pain, swelling and stiffness, according to the complaint. Once again, Kaiser doctors took x-rays, confirmed the prosthesis appeared aligned and sent him home.
     On Nov. 5, 2010—more than a year after the BHR procedure—Hernandez says he heard a loud popping noise coming from his right hip, followed by crippling pain. Sabina Hernandez took her husband back to Kaiser, where doctors told her privately that they believed Hernandez was faking the pain to get more painkillers.
     “Armed with this information, Mrs. Hernandez decided that she was going to take possession of plaintiff’s pain medicine, so that he would no longer have unfettered access to it and that he would have to ask her for it so that she could monitor his intake. Naturally, arguments ensued and conflict arose as suspicions were aroused. Plaintiff frequently endured severe pain in order to avoid an argument with either Mrs. Hernandez or their adult son. However, all of this took quite an emotional toll on plaintiff,” Hernandez says in the complaint.
     He continues: “On or about Feb. 3, 2011, after enduring months of severe pain with less than adequate amounts of pain medicine to treat the pain, plaintiff asked his wife for a little more pain medicine to help manage the stiffness and deep throbbing pain he had been experiencing in his hip, thigh and buttocks for the past few days. Plaintiff’s son immediately objected and a verbal argument ensued. No matter what plaintiff said, it wasn’t enough to undo the damage Kaiser caused; not even his family believed him anymore. Not wanting to endure the pain any longer, especially alone, plaintiff reached for a loaded gun, which fortunately Mrs. Hernandez intercepted. Mrs. Hernandez immediately transported Mr. Hernandez to Kaiser, where he stayed for several days for observation,” Hernandez says in the complaint.
     (Please see the next story for part II)