Britain: Why did Indian doctor miss my daughter's fatal cancer EIGHT times?

The NHS imports a lot of poorly trained doctors from overseas



A young woman died of cervical cancer after her GP failed to spot symptoms during eight visits over four years. Nikki Sams repeatedly complained of stomach pains and bleeding but Dr Navin Shankar never carried out an internal examination, telling told her it was 'nothing serious'. It was only when she was referred to another practice - when Shankar, 59, was suspended for serious misconduct in a case involving a baby - that she was immediately given a smear test. Miss Sams had a hysterectomy the following week and began radiotherapy and chemotherapy but died around a year later aged 26.

The General Medical Council last week upheld a number of complaints against Shankar following the start of a fitness to practise hearing. It has been adjourned while his performance is assessed.

Miss Sams' father Michael, 54, who quit his job as an airport worker to care for his daughter, yesterday accused Shankar of a 'catalogue of unforgivable errors'. He added: 'Nikki was so brave, she never complained or said "Why me?" but she died unnecessarily. 'It is unbelievable that in this day and age a girl can go to her doctor so many times with all these symptoms and be told not to worry. 'The hysterectomy was such a blow for Nikki because she desperately wanted a family, but that was just the start of the nightmare. 'I have a younger daughter and Nikki was her role model. This has torn our family apart.'

Miss Sams' case will raise fresh questions about the age at which women are given smear tests on the NHS. It is only available to over-25s in England, but to over-20s in the rest of the UK.

Miss Sams, a saleswoman from Luton, Bedfordshire, first saw Shankar in 1999 at the Wigmore Lane Health Centre in the town. She was only seen by another GP in 2005 when Shankar, who qualified in India in 1971, was suspended by the GMC for serious professional misconduct after he blamed a nine-day-old boy's life-threatening blood clot on a tight nappy. The GP was later found to have altered his notes. He had told the parents that the baby was fine, despite the fact that his toes were becoming gangrenous.

After Miss Sams' new doctor immediately recommended a smear test, further examinations found a tumour on her cervix. She had treatment at the Mount Vernon Hospital Cancer Centre in Northwood, Middlesex, and was told the cancer was gone. But X-rays taken following a minor car accident in early 2007 revealed it had spread. She died at home six months later, in August 2007.

The GMC hearing on Shankar will be reconvened at a date yet to be set. If his fitness to practise is deemed to be 'impaired' he could receive a warning, have conditions placed on his registration, be suspended or struck off.

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What Singapore Can Teach the White House

Its health care is first class, cheap and market-driven

Critics of this island-nation often have fun referring to it as the "nanny state" for its laws against spitting, littering, or leaving behind an unflushed loo. When it comes to health care, however, Uncle Sam has better claim to the nanny title. From our federal price "negotiations" and state regulations to discrimination in the tax code, government distortions prop up a system that puts key health-care decisions in the hands of everyone but the patient. Each new government intrusion, moreover, begets only higher costs—and a call for more intervention to fix the problem.

In Singapore, by contrast, they already have universal coverage. They also have world-class quality care at world-competitive prices. And in a week when White House chief of staff Rahm Emanuel is meeting behind closed doors with Senate Majority Leader Harry Reid, Singapore's example might have something to teach them about the kind of reform Americans really need.

"When I'm asked to describe the differences between the U.S. and Singapore systems, my one-word answer is 'complexity,'" says Dr. Jason Yap, director of marketing for Raffles Hospital, a leading private care facility in downtown Singapore. "There are so many parties in the American system that do not really contribute to care."

Dr. Yap is referring to the higher costs that come from an American system that depends on regulation and oversight to accomplish what Singapore tries to do with competition and choice. At the Raffles lounge for international patients, he shows me an example of the latter. It's a one-page, easy-to-read list of fees. At the high end of accommodation, a patient can choose the Raffles/Victory suite for about $1,438 per night. That price includes a 24-hour private nurse, a refrigerator stocked with drinks, and an adjoining living room to entertain. At the other end of the scale, a bed in a six-person room goes for just $99. As Dr. Yap points out, the actual care is the same whether a patient decides to stay in a deluxe suite or a dormitory-style room. But the choice is the patient's; the financial incentives encourage the patient to think about those choices; and the low-priced options help keep the overall costs down.

This is no accident. Like ours, Singapore's system is a mix of public and private care and financing. Unlike ours, Singapore's system is anchored, as the Ministry of Health puts it, "on the twin philosophies of individual responsibility and affordable health care for all."

"Individual responsibility" is not just a buzzword. All but the abjectly poor have to pay for some of their care, another downward pressure on prices. Perhaps most important, almost all working Singaporeans are required to put money in a medical savings account that they use for out of pocket expenses. It's their money, and they control it. As a result, they are careful about spending it. "In Singapore almost everyone has to pay something for their care," says Dr. Yap. "When it's your money, you really ask yourself: Do I really need this?"

It seems to be working. According to a Raffles Hospital official, a knee replacement surgery runs between U.S. $12,000 and $14,000. Spinal fusion runs between $10,500 and $14,000, and a heart bypass (coronary artery bypass graft) from $23,000 to $26,500. Conservatively speaking, these prices are less than a third of what the same procedure would cost in the U.S.—that is, when you can even get the price.

As any American who has ever tried to make sense of a hospital bill or haggled with his insurance company over a payment can tell you, even for those who have decent coverage our system can be a bureaucratic nightmare. Singapore's system isn't perfect. It does suggest, however, that the Average Joe stands more to gain from a system where hospitals and doctors compete for patients, where patients have different price options for their hospital stays and appointments, and where they pay for some of it out of pocket.

Yes, a city-state with three million citizens has some advantages over a nation of more than 300 million people in 50 states. Yes, health care in Singapore is hardly the laissez-faire ideal. Still, there's intervention and there's intervention: What makes Singapore's health care work is that it is designed to swim with the market and not against it.

In macro terms, that means Singaporeans spend only about 4% of GDP on health care—against 17% for the United States. At the same time, Singapore scores better than the U.S. on life expectancy, infant mortality, and other key international measures.

In his address to Congress last month, President Obama complained that "we spend one and a half times more per person on health care than any other country, but we aren't any healthier for it." That's a good point. And the lessons Singapore has to offer suggests that what Americans need most in Washington today are fewer closed-door meetings and more open minds.

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Government AIDS healthcare in DC a disaster of waste

In a city ravaged by the highest rate of AIDS cases in the nation, the D.C. Health Department paid millions to nonprofit groups that delivered substandard services or failed to account for any work at all, even as sick people searched for care or died waiting.

More than $1 million in AIDS money went to a housing group whose ailing boarders sometimes struggled without electricity, gas or food. A supervisor said she was ordered to create records for ghost employees.

About $400,000 was paid to a nonprofit organization, launched by a man who once ran one of the District's largest cocaine rings, for a promised job-training center that has never opened.

More than $500,000 was earmarked for a housing program whose executive director had a string of convictions for theft, drugs and forgery. After the D.C. Inspector General's Office could find no evidence that he was operating an AIDS nonprofit group, the city terminated the grant but never sought repayment.

All told, the Health Department's HIV/AIDS Administration awarded more than $25 million from 2004 to 2008 to nonprofit agencies marked by questionable spending, a lack of clients, or lapses in record-keeping and care, a 10-month Washington Post investigation found. Many of the groups have since closed or are no longer providing AIDS services.

Across the city, the sick are suffering. Renee Paige, 50, once threw birthday parties for her two daughters in her apartment in Southeast Washington, where she'd cook beef stew for elderly neighbors and always had bus fare for a friend. But AIDS and two bouts of pneumonia had left her weak, homeless and unable to care for herself. She came to a community meeting in April after spending the night on a park bench in heavy rain, with no place to go. "I have AIDS," she told the group, "and I am soaking wet." Weeks later, she died alone, on the bench, one mile from the HIV/AIDS Administration and within two miles of a dozen nonprofit groups that help people with AIDS.

"I couldn't understand," said Keena Stewart, who had known Paige for 15 years. "How could she die like that?" More than 15,000 people have HIV or AIDS in the District, 3 percent of the population older than 12. For black men, the rate is more than double, at 6.5 percent -- one of every 15 people.

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Budget tricks rife in health reform effort

Advocates of health care reform are relying on budget manipulations to stick with President Obama's pledge to overhaul the system without adding to the deficit, critics on and off Capitol Hill say. Both independent budget analysts and Republicans say a Senate vote expected this week on a 10-year, nearly $250 billion Medicare reimbursement bill is the perfect example. They say it was sliced out of the reform plans because it would send the cost of Mr. Obama's top legislative priority over $1 trillion.

Further, they argue that the health care overhaul bill has been front-loaded with revenue and backloaded with spending to make it look less expensive that it actually is. The reforms price tag will play a major role in the looming debates in Congress and across America. "It's a gimmick that is designed to allow the president and the Democrat majority to say our health care reform bill is deficit-neutral," said Sen. John Thune, South Dakota Republican. "And well, sure, if you take $250 billion and back it out, it's easy to say it's deficit-neutral."

The Medicare bill, offered by Sen. Debbie Stabenow, Michigan Democrat, would repair what physicians say is a flawed formula that underpays them for treating Medicare patients. Nearly every year, the math calls for them to face a double-digit cut unless Congress overturns it. "The very act of separately passing the 10-year physician-payment patch, without paying for it, before passing health care reform undermines [the Democrats'] credibility and the confidence that they will make the hard choices necessary to make sure that reform is fiscally responsible," said Maya MacGuineas, president of the bipartisan Committee for a Responsible Federal Budget.

But Senate Majority Leader Harry Reid, Nevada Democrat, says the move is simply to address an annual problem that must be fixed to ensure doctors can treat senior citizens. "Physicians, you know, they go into medicine to take care of people, and when they are faced with a situation where if they see a Medicare patient, they can't even pay their overhead, that doesn't speak well for our Medicare system," Mr. Reid said.

Both the American Medical Association and the AARP are lobbying hard in support of the measure. "Those who are concerned about waiving budget requirements should recognize that the past practice of 'temporary band-aids' on the [rates] has only served to increase both the size of future cuts and the cost of subsequent interventions. That is neither responsible budget policy nor in keeping with our obligations to provide access, choice and quality care," the groups said in a letter to Congress.

While there is near-universal agreement on Capitol Hill to fix the formula somehow, Republicans and some moderate Democrats warn that it's irresponsible to cut the fix out of health care reform and not pay for it.

"The physicians issue has to be addressed but it has to be addressed in a way that doesn't increase the deficit by $245 billion," Sen. Evan Bayh, Indiana Democrat, said last week. "That's just not responsible. ... If we're going to honor the president's promise to make this fiscally responsible, that's an issue that ought to be addressed."

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How Much Obamacare Costs the Average Family

Whether or not you now have health insurance, Obama’s health care bill will cost you dearly

If you don’t have insurance, you will be required to buy it. The legislation specifies how much you will have to pay for the coverage before any subsidy kicks in. All during the campaign, Obama kept speaking about affordable coverage. Now it appears that his definition of “affordable” might be a bit elastic.

If your household income is $66,000 a year, slightly above the national average, Obama’s health care bill will require you to spend 12 percent of your income -- about $8,000 a year or almost $700 a month -- to buy health insurance before you get any federal subsidy.

Even those making less will have to reach deep into their meager resources to satisfy Obama’s statutory requirement. Families scraping by on only $44,0000 a year will have to pay 7 percent of their income (about $3,000) on insurance. Even those making just $33,000 will have to ante up 4.5 percent of their income (about $1,500) for health insurance. The required payments reach so far down the scale that those who are living at the federal poverty level of $22,000 will have to shell out 2 percent of their totally inadequate incomes ($440) for insurance.

That Obama is charging premiums to those living at or on the border of poverty is absolutely incredible! And this from a candidate who pledged that he would not tax the middle class! If you have insurance, you will get hit by his proposed 40 percent tax on insurance premiums.

When the tax -- and the legislation -- takes effect in 2013, all families making about $120,000 or more in combined household income (14 percent of all families or one in seven) will have to pay the tax. By the next year, 2014, the tax will hit every family making more than $100,000 (about 18 percent of all families or one in six). By 2019, 10 years hence, the tax will reach down to affect every family making more than $75,000 a year (31 percent of families or one in three). The tax will take 40 percent of all premiums above $21,000.

So if you don’t have insurance, you will be socked with a mandate to buy coverage and pay a hefty proportion of your income to do it; and if you have insurance, you will be hit with an excise tax on the coverage. (In theory, it is the insurance companies that have to pay the tax, but the Senate Finance Committee “assumes” that they will pass the tax along to their policyholders).

These costs make a mockery of Obama’s oft-repeated pledge to avoid any tax increase that would impact those making under $250,000 a year. He finances about half of his health care plan on the backs of the elderly by cutting Medicare and inducing scarcity and the other half by premium taxes and insurance purchasing mandates on the middle and lower middle class.

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What's In and What's Out of Health Care Legislation

As liberals rush Obamacare through Congress, let's review the disparity between promises and text. Joe Wilson's declaration "You lie!" is ringing truer with each passing day.

Barack Obama promised "transparency" and to give the public five days to read the bill, but Sen. Jim Bunning's amendment to require the bill, along with a final Congressional Budget Office score, to be posted online 72 hours before the vote was defeated. Reps. Brian Baird, D-Wash., and Greg Walden, R-Ore., have been trying to get the House to agree to post the bill 72 hours before the vote. Most Republicans have signed on, but the Nancy Pelosi leadership is unwilling.

The Democrats still hope to rush the bill through unread. The 1,100-page stimulus bill was posted online only 13 hours before the vote, and the 1,200-page cap-and-trade bill was posted only 15 hours before the vote.

Obama promised that the health care bill would not cover illegal aliens, but Sen. Chuck Grassley's amendment to require immigrants to prove their identities with photo IDs was rejected.

Obama promised that if you like your current health insurance, you won't have to change it, but Sen. John Cornyn's amendment to assure present insurance owners that they wouldn't have to change their coverage and that they could keep the coverage they have with their current employers without government driving up cost was defeated.

Obama's appointment of 34 czars includes a health care czar, but Sen. John Ensign's amendment to require any health care czar to be subject to the constitutional Senate confirmation process was defeated. Obama's new regulatory czar, Cass Sunstein, defends removing organs from terminally ill patients and from deceased people, even when they did not consent to be organ donors.

Obama promised that under his plan, "no federal dollars will be used to fund abortions," and his press secretary, Robert Gibbs, tried to divert attention from this bold lie by obfuscating the Hyde Amendment. But the Hyde Amendment is not a law; it's a one-year-at-a-time rider that applies only to current Medicaid programs, and it would not apply to the health care law.

The Democrats five times (twice in Senate committees, three times in House committees) defeated amendments to prohibit the health care plan from spending federal money or requiring health insurance plans to cover abortions. They also defeated Sen. Orrin Hatch's amendment to respect the conscience rights of health care workers who do not want to perform abortions because of moral or religious objections.

One amendment that did pass was Sen. Maria Cantwell's amendment, which would give the secretary of health and human services the power to define cost-effective care for each medical condition and to punish doctors who treat high-cost patients with complex conditions. That has been Obama's goal from the beginning and inevitably will lead to the "death panels" Sarah Palin warned about.

Former Sen. Tom Daschle, who was scheduled to be health and human services secretary or health care czar until he had to bow out, said that the law should be written in generalities so the bureaucrats can fill in the details. Dr. Ezekiel Emanuel, brother of chief of staff Rahm Emanuel and a key Obama health care adviser, may be behind the stimulus legislation that will send "embedded clinical-decision support" to doctors via computer to warn them about what is "appropriate" and "cost-effective," backed up by the threat to impose financial penalties on doctors who are not "meaningful users."

The Democrats' health care "reform" would carry a trillion-dollar price tag, vastly increase the national debt hanging over our children and grandchildren, impose socialist control over one-sixth of our economy, and force us to obey totalitarian dictates. The mandate on employers to provide health insurance would result in lower wages and fewer jobs.

The mandate on individuals to buy health insurance or pay a penalty, even threatening jail for those who fail to conform, amounts to a massive tax increase on individuals and families whose health insurance may lack all the new federally specified requirements.

Obama's "spread the wealth around" policy is evident in the big expansion of Medicaid combined with large cuts in Medicare. Former Health and Human Services Secretary Michael Leavitt says that the combination of mandates to buy insurance, guaranteed issue, and community rating amounts to massive income distribution that is hidden from public view and not even debated.

Finally, we are subject to the deviousness of what House Minority Leader John Boehner calls the 70 phantom amendments, which were added in secret after the bill was voted out by the committee. The bill may be even worse than we think.

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