Collateral Damage

I once heard Don Berwick say, shortly after taking over as Director for CMS, that he originally thought quality and safety where the biggest challenges facing healthcare today. But after spending time in the district, he quickly came to realize he was wrong. It was fraud that was the biggest challenge.

Collateral DamageHis message came to mind after recently reading a book given to me by Rosemary Gibson, entitled “Collateral Damage”, written by Dan Walter. I can honestly say that after reading the book, I felt embarrassed to be working in healthcare.

In the book, Mr. Walter shares the story of his wife, Pam, who underwent a cardiac catheter ablation procedure for an abnormal heart rhythm known as atrial fibrillation. He describes what went wrong during Pam’s procedure, and then details the pain, suffering, lack of transparency and denial of accountability that followed for both he and his wife. The procedure was performed at what is considered to be one of the best hospitals in the country, which makes the reader wonder what is going on at the “not so great” hospitals across the country, as well as who is defining what makes a hospital “great”. His aim in writing the book was to, “accurately portray what happened to my wife…without detracting from the skill, kindness and compassion of the majority of the people who work there…and to prove to Pam that she does matter, and to tell her that despite what the leadership of that hospital says, her life is important – and her story is important – and it deserves to be honestly told”.

The book is Mr. Walter’s account of the facts related to his wife’s care, so it is only his side of the story. However, it is remarkably well written, and gives a deeply researched account of the cardiac catheter ablation “business”. He includes information:

  • Taken from numerous publicly available FDA transcripts and testimonies on how unsafe these catheters were thought to be.
  • Promotional materials from companies making these catheters who were trying to get them through the FDA approval process hyping the wonderful results being seen in patients who were the first to be “experimented” on.
  • Transcripts from advisory panels and cardiology meetings where leading experts acknowledged the lack of evidence that these catheters even worked.
  • Conclusions from peer-reviewed journals showing complication rates much higher than what was being shared with patients.
  • Medical records highlighting a lack of real informed consent related to the risks and benefits of these procedures.

Mr. Walter also shares numerous other patient stories and holds nothing back. Not only does he name names, but he includes pictures of physicians and others who he and Pam encountered along their journey.

In one section of the book, the author shares thoughts on the difference between a “witness” and an “accomplice”, a witness being one who sees wrong and reports it.  He raises the question that if we as caregivers witness something wrong and don’t report it, aren’t we really accomplices to the wrong when we turn our back and walk away?  His statement caused me to reflect back on my career. As an anesthesiologist, I remember days when I was assigned to provide anesthesia for a catheter ablation case. Although I spoke with the patient about anesthesia related risks and benefits – I never thought of questioning the merits of the procedure I was to be a witness to. It was challenging enough keeping up with all the new findings in my specialty let alone comprehend everything being published in the numerous specialties anesthesiologists support. But after reading Pam’s story, I felt that I too may have been an “accomplice” to possible wrong doing.

I applaud Mr. Walter for sharing Pam’s story. I also struggle to understand why this book has not received similar attention, or the same hype experienced by authors of recent books published on medical error. Collateral Damage goes much deeper in highlighting problems facing healthcare today…a reason why I believe this book should be required reading for all resident physicians and health science students entering the field.

As quality and safety leaders and educators, our daily efforts are built around things like standard work processes, shared best practices, care bundles, checklists and universal protocols–“things” we do in the best interest of our patients. The bigger picture, as Don Berwick alluded to, requires that we overcome the personal, political, legal and financial agendas inherent within many high-level stakeholders. Otherwise, I sometimes feel we are just moving chairs around the deck of the Titanic.

For those interested, Dan’s book is available free on Amazon Kindle as of June 12th

14 Comments on “Collateral Damage”

  1. Over the past 8 years I have never met a provider who didn’t understand exactly what is wrong with our Healthcare System. Sadly. I have met precious few who have the courage to stand up for what is right. You have joined the ranks of those precious few. Take the next step and work with Dan to stop clinical chaos.

    • Robin Karr says:

      Thank you for having the courage to write this post! In September 2007, I was knocked out against my will by a CRNA and surgery I didn’t need or consent to was performed on me. Six healthy organs were removed. Nobody said a word. I love your Titanic analogy. I also like the distinction you make between a ‘witness’ and an ‘accomplice’. You’ve helped restore my faith in medicine. My story and substantiating documentation are posted on my web site here

  2. Dave, after reading your post I went and read this book. Couldn’t agree with you more. It is my sincere hope that this insightful and arresting addition to the growing body of literature in this space will rise to the top of reading lists in hospitals across the country. Thanks for pointing this work out in you post.

    • Dave,
      Thanks for the reply. Glad you had a chance to read Collateral Damage. I hope more people read Dan’s story about his wife Pat. Rosemary Gibson shared Dan’s book with me. My wife and I both read it over a weekend – couldn’t put it down. Made me realize even more all the forces that are in play when striving for safe, high quality care. This year we are bringing about 100 health science students and resident physicians to our Telluride Patient Safety Summer Camp where we focus on open and honest communication. The Summer Camps are June 10th – 19th in Telluride and August 1st – 4th in DC. This year, Dan’s book is one of two books all students and residents are required to read before heading to CO or DC.

      Thanks also for the great work you are doing in helping make care safer.
      Best regards,

  3. Dear Dave,
    Thank you for your post. Pam Walter’s experience is a strong reminder that as physicians, it is our responsibility to prioritize compassion, the sincere commitment to strive to alleviate the suffering of others.

  4. Rory McDonagh says:

    I agree.
    I’m a Gynecologist. Hysterectomy is one of (if not the) most commonly performed surgeries worldwide. Many are unnecessary and are booked so that the Surgeon will be able to “fill” his/her block of surgical time.
    Yes, a hysterectomy will likely remedy the patient’s concerns; but in many settings it is an entirely unnecessary and extremely aggressive approach to a patient’s concern. I am aware of some colleagues who’s wait-list for hysterectomy is 6 months. What could that possibly mean? What gynecologic problem (ostensibly who’s only remedy is hysterectomy) could wait 6 months for surgery? Doesn’t this seem to imply a want for a legitimate surgical indication?
    Physician autonomy is a lauded element of our profession, yet it demands an integrity that many seem not to posses.

    • Robin Karr says:

      I applaud the gynecologist who has been so honest about hysterectomy abuse in his own profession. I am a victim of that abuse and my life has been altered forever. I wish more doctors would have the courage to step up to the plate and call it like it is. Over half a million women undergo hysterectomy every year in the U.S. 74% of those hysterectomies include castration. 90% of them are considered to be medically unnecessary. I’m working on an article now regarding the ethics of female castration and informed consent. If more gynecologists had the integrity of Dr. McDonagh, I don’t think there would be a need for me to write about this issue.

  5. Salwa Beheiry says:

    I am well aware of Pam’s story and I felt so very sorry for what happened at the time. It was very unfortunate. I do not work in the same institution but I work in the same field. I just want to say that, having a procedure done in a great institution does not mean that everyone in that institution is specifically skilled or experienced to perform all procedures. Often times I am amazed, how in this day and age and with all the information available online, some of the patients do not take the time to thoroughly research the facts about the various doctors, their experience, the number of procedures performed, procedure outcomes and so on.
    AF ablation is very safe and very effective in the hands of experienced operators. AF ablation restores quality of life to thousands of patients debilitated by this arrhythmia.

    • Tracy Granzyk MS says:

      Thanks so much for taking the time to comment. You raise a great point! I know that those of us who work in healthcare sometimes take for granted how hard it is for patients to find the information they need, most often at a time they are also dealing with illness. It would be even better if all health systems made those numbers readily available so patients did not have to go searching for the data. It’s still very hard to get the big picture of an individual physician’s outcomes by procedure, even from within healthcare. If you know of a great resource, please share with our readers!

    • Dan Walter says:

      Salwa’s voice is widely respected in the aifb patient community — and deservedly so.

      I would take issue, however, with the statement that “I am amazed, how in this day and age and with all the information available online, some of the patients do not take the time to thoroughly research the facts about the various doctors, their experience, the number of procedures performed, procedure outcomes and so on.”

      Firstly, we have come to a sad pass in medicine when you can’t trust that your doctor is looking out for your best interest. So it’s caveat emptor.

      Fair enough.

      But when a newly diagnosed person goes online to get information on a proposed ablation procedure, they will find at first glance a flood of corporate-drive PR masquerading as news
      that a safe and effective minimally invasive “cure” is at hand at the local hospital ( — which is very far from the truth.

      This remains a very technically challenging and risky procedure of dubious efficacy.
      ( ) ( )

      And anyone would be hard pressed to find reliable rates of success or complications of any particular doctor. There is only one Andrea Natale.

      Catheter ablation for afib is a risky procedure that is palliative at best — and it may be the right choice for some people.

      But to promote it as a safe and effective, minimally invasive “cure” for afib is just wrong.

      • Kelly G. says:

        I have not read the book yet and was linked here from another site. I’m a female and in April of 2010 I had an ablation done after an svt event where my heart was beating 224 beats per minute. The only other time I had experienced this was one episode 17 years prior. I was told that the procedure was my only choice and had it done 5 days later. Since then the racing has become more frequent. Over the last 4 months I’ve had approximately 12-15 episodes of racing. I’m currently wearing a 30 day monitor and the cardiologist wants to do the procedure again. This time I’m really questioning his recommendation. My question is what are the options if this procedure is not all they claim for it to be? Is medication the only option or is there an alternative medicine approach? There are things that seem to trigger it (never had ONE episode that was not premenstrual) so can managing triggers be an option or is the risk to great to leave it to that alone?

  6. FYI Dan’s book will be available free for Amazon Kindle on Wednesday, June 12th:

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