[HSF] Why should Health Purchasers pay for the cost of our complications?

[Hgrmd at aol.com]

Ani,
  I've had 2 sternal wound infections in the last 3 years.  One  was a 64 yo 
lady with lupus who was dying from severe TR.  She got her 3rd  open heart 
procedure consisting of a triple valve.  She eventually died of  sepsis and 
hepatic failure.  The 2nd case was a 62 yo 350 lb diabetic man  who got a mitral 
and tricuspid repair for a severe nonischemic  cardiomyopathy.  I found out 
later that his wife used Nair (a depilatory)  the night before so that he wouldn't 
have to be shaved by strange ladies (I kid  you not).  Fortunately, the 
infection was superficial to the sternum and  responded to temporary I and D 
followed by flap closure.
  The point of all of this is that if this new Medicare rule holds,  I'm 
likely to start turning down cases like this in the future.  I don't  know about 
you, but I've found that severe lupus is a particularly strong marker  for 
subsequent sternal complications.  I base my impression on the  previously 
mentioned case as well as a fatal case of mediastinitis in a 43 yo  woman (MVR) back 
in 1998.  I know 2 cases don't make a compelling argument,  but my overall 
incidence is way less than 1%.
 
Hal



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