$15K Surgery Shakedown? Med School Dean's Twitter Snafu; Lethal Injection 'Expert'

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Pay $15,000 or Lose Twin Pregnancy

Sara Walsh, a Florida woman pregnant with twins, would have to pay $15,000 up front before a surgeon would perform an operation that could potentially save her life as well as that of her babies, according to KFF Health News.

Walsh had "twin-to-twin transfusion syndrome, a rare complication that occurs when fetuses share blood unevenly through the same placenta," the article stated.

Ruben Quintero, MD, of the Fetal Institute in Coral Gables, was the nearest surgeon who could perform the procedure, known as fetoscopic laser surgery, which only about 30 to 40 hospitals nationwide can perform.

Walsh's mother agreed to give her the money, and her insurer said she could apply for a waiver to reclassify the care as in-network, so she went ahead with the procedure. She and her mother paid up in hopes that her insurer, Blue Cross Blue Shield (BCBS), would reimburse them.

Ultimately, Quintero's office billed about $18,600 for two follow-up appointments and the surgery. BCBS paid about $5,500 and said Walsh was on the hook for the rest.

Last fall, the Fetal Institute sent Walsh a check for about $1,282, which it said corrected an overpayment on the full charges. She has received no other reimbursement.

Five weeks after surgery, Walsh gave birth to premature twin girls who were otherwise healthy.

"No parent should face the choice of 'How much money can I raise in the next 12 hours and is it enough to save the lives of my children?'" she told KFF Health News.

Med School Dean's Twitter Controversy

The president of Thomas Jefferson University in Philadelphia who is also dean of its medical school has a history of liking tweets on controversial topics and from unreliable sources, according to the Philadelphia Inquirer.

Though he doesn't tweet much himself, Mark Tykocinski, MD, has liked more than 70 alarming tweets, including some by Alex Berenson who the Atlantic dubbed "the pandemic's wrongest man" for his consistently incorrect analysis of the COVID pandemic.

Tykocinski also liked a tweet from former President Donald Trump that has become a dog whistle for transphobia: the alleged story of a 13-year-old who got gender reassignment surgery and was fundraising to sue doctors.

Tykocinski has claimed that his likes don't reflect his personal views or the institutional priorities of the university. But the transphobia, anti-science, and anti-diversity sentiments expressed in the tweets has made the university community uneasy, according to the news outlet.

"Some of the views he endorses on his account call into question the university's commitment to diversity and inclusion and would be hurtful to Jefferson's trans-identifying students and students of color," an anonymous Thomas Jefferson employee told the Inquirer.

In response to the criticism, Tykocinski told the Inquirer: "I regret my lack of understanding of how 'liking' a tweet is an implied endorsement." He said he liked the tweets to bookmark them, "to learn more about the subject matter or the particular viewpoint."

Expertise of Lethal Injection Witness Questioned

A Florida pharmacist has testified extensively on behalf of state governments in support of their lethal injection regimens, but a ProPublica and Type Investigations report raises questions about his expertise.

Since 2015, Daniel Buffington has "testified for seven states, which collectively paid him at least $354,541 for his services." But the report alleged that throughout his testimony, Buffington "seemed to be exaggerating or misrepresenting the scope of what he could legally do as a licensed pharmacist."

Notably, the report stated, he has testified several times that he has prescribed midazolam, but Florida and Georgia -- where Buffington is licensed -- do not permit pharmacists to prescribe controlled substances. Midazolam is one of the drugs commonly used in lethal injection cocktails.

Buffington has also vehemently denied the possibility that midazolam has a ceiling effect in order to argue that any concern that a prisoner would feel pain would be "fundamentally defective," according to the report. However, other state experts say such an effect could exist. In addition, Buffington has never induced or maintained anesthesia, nor has he witnessed an execution, the report stated.

Oklahoma death row inmate Richard Glossip is set to die in just over 2 weeks, in part because of Buffington's testimony as a state expert witness. According to the investigation, Glossip has been scheduled to be executed so many times that staff have recommended he switch up his last meal this time. Glossip was the lead plaintiff on a case challenging the Oklahoma law. He's lost hope this time, instead wondering, "What if it goes wrong?"

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