Opinion ID: 2258942
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Heading: Staff reporter

Text: BRANDYWINE HUNDRED  Pamela Kane feels the hysterectomy urged on her by a gynecologist she trusted would have been unnecessary, and she believes her story should be a warning to other women. Kane, 45, has filed a complaint with the New Castle County Medical Society against Dr. Margo Kanaga of Wilmington, charging her with recommending unnecessary and inappropriate surgery and failing to perform proper diagnostic tests or exploring more conservative alternative treatments before scheduling surgery. Kanaga did not respond to a reporter's telephone calls or a registered letter seeking comments. She has told the medical society she would withhold public comment on the case until the society issues its finding, expected in August. Kane said that in March, Kanaga told her she should have an abdominal hysterectomy  the removal of her uterus, as well as her ovaries and fallopian tubes, through an incision in her belly  because she had a prolapsed uterine fibroid, a benign muscle tumor protruding through her cervix. The procedure would be followed by three days in the hospital and six weeks recuperation at her Brandywine Hundred home. But when Kanaga called Kane in April to schedule the surgery, Kane decided to test Kanaga. Kane did not tell Kanaga that a few days earlier, another gynecologist had removed the tumor during a simple pelvic exam, with a twist of his hand. That easy solution proved to Kane that surgery would have been unnecessary. Instead of spending several days in the hospital, several weeks recovering and several thousand dollars  whether out of my pocket or paid by my insurance company  for totally unnecessary surgery, ... I was hardly the worse for wear, Kane said. And I felt better the next day than I had in weeks. I believe, Kane wrote in her complaint, Dr. Kanaga has committed a serious breach of the standard of care a patient has the right to expect and the duty of care required of a physician. Kane's problems began in March, when she had an extremely heavy menstrual period and called Kanaga's office. The receptionist speculated Kane needed a dilation and curettage, a diagnostic procedure in which the lining of the uterus, shed in menstruation, is scraped out for laboratory analysis. The procedure itself may resolve heavy bleeding. But when Kanaga examined Kane April 2, she told Kane she had a protruding fibroid that would block a D & C. I'll have to do a hysterectomy, Kane recalls Kanaga saying. Kanaga asked if Kane's insurance company required a second opinion. Kane didn't know, so Kanaga told her to check. Kanaga suggested that Kane not pay much attention to a second opinion as alternatives that might be mentioned were just experimental. Kane recalls asking if Kanaga could remove the fibroid and leave the uterus. Kanaga told her no. Kane made appointments with two gynecologists, for second and third opinions. She began to have second thoughts about a hysterectomy. With children at home and a computer software business to run, she was not anxious to be laid up for six weeks. She remembered reading about newer, less-invasive procedures that could sometimes prevent hysterectomy. She did some research, she said, learning that ovarian cancer is rare and that hysterectomy can cause long-term physiological and psychological problems extending far beyond the post-operative recovery. ... I was not informed of any of those risks by Dr. Kanaga though she did explain the risks of surgery to me and the need for estrogen replacement therapy afterward. --------------------- She learned that ovarian cancer is rare and that hysterectomy can cause long-term problems. -------------------- Before Kane could get a second opinion, she began to menstruate heavily. The night of April 19, she went to St. Francis Hospital's emergency room. There, Kane recalled, a gynecologist grasped the fibroid with forceps and said, I'm just going to give it a twist to see how it's attached. He immediately held up a lime-size piece of red tissue and said, Here's your tumor. It had been attached to her uterus by a slender stem. The doctor did a D & C, told her everything seemed fine and asked her to visit his office in a couple of weeks. Does this mean I don't need a hysterectomy? she recalls asking. A what? he asked incredulously. My previous gynecologist said I needed a hysterectomy, Kane said. No, you don't need one, he said. At home, Kane began to fume. I wondered how many women are getting unnecessary hysterectomies, she recalled. On April 29 she called Kanaga's office, planning to tell her what had happened. But before she could, she was asked by an office worker if she'd had the second opinion. She said yes. The office worker said insurance would only pay 80 percent, so Kanaga would need Kane's share, $500, before surgery. The staffer asked when Kane would like to have surgery, and told her to call Kanaga the next day at noon. But at 7:40 the next morning, Kanaga called Kane's house. When Kane called her back, Kanaga asked who she'd seen for the second opinion. No one local, Kane fibbed. Good, said Kanaga. Why `good?' Kane questioned. Unbiased, said Kanaga. What did they say? What you said, that I had a protruding fibroid tumor. When did you want to schedule surgery? Kanaga asked. They selected a date in May. A few days later, Kane contacted Kanaga's office, said she was having second thoughts, and asked if they could refer her to a surgeon who would just remove the tumor. The office gave Kane the number of a doctor-referral service. A few days later, Kane received a certified letter from Kanaga dismissing her from her practice in the interest of patient care. On May 11, Kane visited the gynecologist she'd seen at St. Francis. He said everything was normal. I can only conclude, Kane wrote in her complaint to the medical society, that Dr. Kanaga, fully aware because of my age and presenting condition [heavy bleeding] I was in a `gray area' where the proposed surgery might be defensible ... chose the treatment plan that was most profitable for her with no concern for me. ... The News Journal September 2, 1992 Medical unit backs doctor on treatment By JANE HARRIMAN Staff reporter WILMINGTON  The New Castle County Medical Society has decided that a hysterectomy would have been appropriate treatment for a woman of 45, although Pamela Kane's problem was easily resolved subsequently without surgery. ... Medicine is not an exact science, Dr. Richard Winkelmayer, chairman of the society's Professional Conduct Committee, wrote in an Aug. 27 letter to Kane, a Brandywine Hundred resident. For most medical conditions there are usually a number of different treatment alternatives depending on the individual patient and the physician's training, experience and philosophy. Doctors who studied Kane's case felt hysterectomy was one of several appropriate therapies for someone in your age group, Winkelmayer wrote. In her complaint this spring, Kane said Dr. Margo Kanaga, a Wilmington gynecologist, urged her to have her ovaries and uterus removed because she had a prolapsed uterine fibroid, a benign muscle tumor protruding through her cervix. The operation would have caused surgical menopause, and Kane would have had to take estrogen. Before Kane could get a second opinion required by health insurance, she went to the hospital emergency room with severe bleeding. A gynecologist removed the tumor, the cause of the bleeding, with a twist of the wrist during a regular pelvic exam. A dilation and curettage (a diagnostic procedure that scrapes out the lining of the uterus for laboratory examination) then showed Kane did not need a hysterectomy. Kane felt Kanaga had been recommending unnecessary and inappropriate surgery and failing to perform proper diagnostic tests or exploring more conservative alternative treatments before scheduling surgery. Over the past 50 years, doctors have often recommended hysterectomy for women who no longer can, or want, to bear children. But the procedure is expensive, and involves a hospital stay of three to four days, with a recovery period of up to six weeks. Kane said Tuesday, The only question they [the medical society] answered was one I didn't ask: Whether or not I am in a gray area ... It was not very responsive ... the whole thing is very backward. Kanaga did not respond to The News Journal's request for comment. Many gynecologists are doing less radical surgery for some fibroids. When a fibroid is small and accessible, a trained surgeon can use laparoscopic techniques (tiny incisions and pencil-sized instruments) to remove only the tumor, sparing the uterus and ovaries. The woman goes home the next day and is back at work in a day or two. Kane feels Kanaga should have advised her the new procedure was available.