Source: ABC PrimeTime News
Aired: June 10, 1993
Sam Donaldson: Critics say that you do unnecessary eye surgery on cataract eye patients for the money.
Announcer: Primetime, now from Washington, Sam Donaldson.
Sam Donaldson: Good evening and welcome. We begin tonight with the story of a so-called big cutter, Dr. James Desnick. An Illinois eye doctor who specializes in high-volume cataract surgery for the elderly. Nothing wrong with that in principle. Cataract operations are almost always safe. High-volume does not necessarily preclude good care. But in our undercover investigation of the big-cutter you’ll see tonight, we turned up evidence that he may also be a big charger, doing unnecessary cataract surgery for the money. Who’s money? Why yours, of course. The taxpayers split the bill for medicare. Medicare paid out 3.3 billion dollars for cataract operations in 1992. And as you will see, not all cataract operations are really necessary. One every ten minutes, fifty a day. Eleven thousand cataract surgeries a year, at the Desnick eye center.
Surgeon: You did beautifully, surgery went perfect.
Patient 1: I was blessed. The doctors were pleased. Of course, I’m pleased.
Sam Donaldson: This clinic is one of more than a dozen high-volume high-profit mega centers across the country. Set up to do cataract surgery.
Desnick Commercial: I put my name on what I believe to be the finest cataract care center in the Midwest
Sam Donaldson: Dr. James Desnick a 42-year old ophthalmologist is the busiest and one of the most controversial of the so-called big-cutters. He oversees an expanding empire with 25 offices in 4 midwestern states and at 26 the Miami vision surgical center in Florida. This modern building in northwest Chicago is the nerve center for the Desnick empire. This is where the Midwest surgery is performed. Two years ago Dr. Desnick was doing operations himself but his team of surgeons brings in an estimated $120,000 dollars a day from cataract operations everyday they operate. Most of it from medicare and the U.S taxpayer. According to his critics, that’s what drives him, the money.
Patient 2: You go in there, you got three eyes, he’ll get three eyes. He gon’ operate on you, and just like a factory!
Patient 3: That’s a blur right here. My eye, my eye is just nothing but a blur.
Patient 4: It’s not about your welfare. It’s all about money.
Sam Donaldson: A cataract is a natural clouding of the eyes’ lens that occurs in all of us as we grow older. And the clouded lens is removed in the surgery. An artificial lens made of plastic is then installed. It’s an operation that takes only minutes and usually quite safe. But having a cataract doesn’t automatically mean surgery is necessary. Not all cataracts should be removed?
Dr. Michael Lemp: Absolutely true.
Sam Donaldson: Dr. Michael Lemp was formerly head of ophthalmology for nine years at Georgetown University in Washington, D.C.
Dr. Michael Lemp: Visual disability. That’s the thing that triggers the decision to take on a cataract.
Sam Donaldson: If I go to an eye doctor that says, ‘Mr. Donaldson you have cataracts. Therefore, they should come out.’ Without asking me what my visual needs are, I’m not going to the doctor that I should.
Dr. Michael Lemp: I would agree with that
Sam Donaldson: To see for ourselves what happens at Dr. Desnick’s clinic, we recruited seven test patients to go undercover. Six went to this packed office in Kenosha, Wisconsin, seven to this office in Munster, Indiana. More than fifty van loads of patients arrived in the three hours we were there. All our undercover test patients were given a complete battery of exams.
Doctor 1: How about the lighting in that?
Sam Donaldson: The two under sixty-five were told no surgery was necessary and sent home. But, for four of our five patients over sixty-five and thus eligible for medicare payment, the story was different.
Doctor George Simon: You have some cataracts.
Doctor 2: There’s a cataract on the left eye more than the right eye
Person 1 to Doctor George Simon: Would you suggest her having the surgery or?
Doctor George Simon: Oh yeah, definitely. Yeah, I mean, you’d be at a big advantage.
Sam Donaldson: Our fifth test patient was told to come back in a few months. But, Desnick center doctors weren’t the only ones to examine our patients. Primetime paid for each test-patient over sixty-five to be examined by two independent eye surgeons, their own doctor and Dr. Howard Tessler. A professor of ophthalmology at the University of Illinois. Now, federal guidelines say cataract surgery is appropriate when vision is blurred and an eye tests 20/50 or worse, even with correctives like glasses. According to the independent experts, all our test patients had corrected vision well within the federal guidelines. That was certainly true of 79-year old Tony Valaio.
Dr. Howard Tessler: Your eyes look healthy and um, with your old glasses you see about 20/30. I made a small change in the prescription, 20/25.
Sam Donaldson: But, that wasn’t what Valaio heard at the Desnick eye center.
Doctor George Simon: I think your vision is, is beginning to deteriorate
Test Patient 1: How much will that cost?
Doctor George Simon: Won’t cost you anything because medicare will pay for it.
Sam Donaldson: Doctor George Simon didn’t ask Valaio if he had any vision problems.Valaio hadn’t complained of any. Valaio was simply told he did. Was encouraged to have surgery on both eyes.
Person 2 to Doctor George Simon: Would you recommend him to go through the procedure?
Doctor George Simon: Oh yeah, absolutely.
Person 2: Okay.
Sam Donaldson to Doctor Howard Tessler: Doctor, are you certain this patient doesn’t need surgery now for cataracts?
Doctor Howard Tessler: I think it would be near malpractice to do surgery on him.
Sam Donaldson: But it can be very lucrative to do cataract surgery on elderly patients. Medicare pays $2,400 for each operation. That’s $2,400 an eye. Dr. Desnick’s clinic generates millions of dollars in income each year. How lucrative can it be for a surgeon there? Dr. Dan Ritaka was offered a job last year by Dr. Desnick. He observed there for a few weeks and was told he would be expected to perform a lot of cataract operations.
Doctor Dan Ritaka: Anywhere from 35 and if uh-if he could push me to 40-50, the limit.
Sam Donaldson: And, if you had joined him, you could’ve made as much as half a million dollars a year. Why didn’t you?
Doctor Dan Ritaka: I wasn’t able to screen who I was going to operate on.
Sam Donaldson: Doctor Ritaka talked with the clinic’s chief surgeon. And he says, who eventually got so fed up he left and complained to the FBI’s state medical board.
Doctor Dan Ritaka: I watched this doctor leaving, examine the patients and start putting up a fight with the nurses that were pushing them into the rooms. And he would reject the patient. And I said, doctor, you’re rejecting the patient. That’s good, that’s ethical. I could do the same thing. And he says, ‘no because as soon as I reject them they’re going in the next room to get surgery.
Sam Donaldson to Doctor Ritaka: You felt that if you worked there you would be doing something that was unethical.
Doctor Dan Ritaka: Right. I felt that I’d have a hard time getting sleep at night.
Sam Donaldson: Doctor Desnick opened his clinic to us to watch surgery. The Desnick eye clinic is an impressive state of the art facility. And the way it is kept filled with patients is also impressive, and controversial. Desnick makes cold telephone calls to recruit new patients. Runs a daily barrage of TV and newspaper ads. But critics complain that his telemarketing and some of his advertising is misleading or unethical. Complaints he dismisses as unfounded. Dr. Desnick told us he focuses his recruiting in poor areas in order to help people who don’t have easy access to eye care. Along with cataract screening, he hands out free chicken lunches and gifts. But, some former employees say he concentrates on poorer patients because they almost always don’t have easy access to second opinions.
Former Employee 1: The Black community and Hispanic community were specifically targeted.
Sam Donaldson: This former Desnick marketing executive asked us to disguise her identity.
Former Employee 1: People who had Alzheimer’s, people who did not know what planet they were on. People who’s quality of life wouldn’t change by having cataract surgery.
Sam Donaldson: And, doctor Desnick took full advantage of their vulnerability.
Former Employee 1: Absolutely. Very often those people got surgeries the same day they had just come in for an initial exam.
Sam Donaldson: We assembled a group of former patients who feel that the Desnick Eye Center’s high-volume approach resulted in poor care. This is John Portman. He went in complaining that he couldn’t see well. Not knowing that he was suffering from a deadly melanoma cancer. When the Desnick people examined you, did they find the melanoma?
John Portman: They didn’t find nothing.
Sam Donaldson: The cancer, easily visible, was finally spotted on a chance visit to Portman’s family doctor. I guess you feel you may have escaped something?
John Portman: I think I escaped dying. Because if they wouldn’t have gotten that cancer out of there then so long Charlie.
Sam Donaldson: And there’s Pauline Jackson, a victim she says, of unnecessary surgery. Her eye ruptured during the first of two cataract removals recommended by doctor Desnick.
Pauline Jackson: Eye balls sees red and it kept running puss, stuff like that. So I had to go to another doctor.
Sam Donaldson: A review of Mrs. Jackson’s medical records show she may not have needed cataract surgery. According to a hand-writing analyst, Dr. Desnick changed her chart. An acceptable 20/25 to an unacceptable 20/50. In another case, he changed the record from 20/30 to 20/80. Dr. Desnick said he changes the records only to correct mistakes by his technicians. Still, when he got sued, he settled the two cases out of court for a total of $265,000 without admitting liability. According to some former employee, he had an unwritten policy that everyone use the same color pens, blue. So making changes easier to do. We talked to one former employee who fears reprisals if she is identified.
Former Employee 2: One time he took a pen that was a black pen and started writing on the record then realized and threw the black pen across the room and said, ‘I don’t allow black pens. I only want blue pens’. And, of course, we all realized because he was trying to make a change on the record at that time.
Sam Donaldson: You saw him make these changes?
Former Employee 2: Oh yes. He used to do it in front of employees all the time.
Sam Donaldson: Dr. Desnick says criticism of him has been done by disgruntled former employees and by jealous colleagues afraid of the competition from his expanding business. He says his clinic has treated tens of thousands of patients with only a small percentage of complaints. He arranged for us to interview two satisfied patients, Leonard and Joan Bayer.
Leonard Bayer: The eye care, I don’t think could be any better than it is.
Joan Bayer: Everything is perfect. It’s real good.” Sam Donaldson: “But, consider what happened to test patient John Buck who is 74. Dr. Mark Blazer, the center’s medical director, recommended cataract surgery on both eyes.
Doctor Mark Blazer: If I could switch seats with you, I’d have it done.
Sam Donaldson: On his right eye, our experts say, has vision well within the guidelines and also on his left eye. The left eye? Buck’s left eye has inoperable optic nerve damage. A cataract operation would be like replacing the lens on a hopelessly damaged camera, according to Doctor Howard Tessler. He did have a small cataract in his left eye.
Doctor Howard Tessler: Correct.
Sam Donaldson: But the optic nerve has been damaged.
Doctor Howard Tessler: Correct.
Sam Donaldson: So cataract surgery would accomplish what?
Doctor Howard Tessler: Next to nothing
Sam Donaldson: So how was surgery justified for John Buck?
Doctor 3: You know you’re getting a glare. I would say we could do significantly better.
Sam Donaldson: Dr. Desnick’s chief surgeon wrote us a letter insisting that surgery was indicated for Buck and in everyone of our test cases because they each have significant objective glare disability. Now glare can occur in some cataract sufferers. Normal nighttime lights can start to look like this. And, the federal guidelines do say that if a patient complains about glare, surgery can be recommended. But none of our test patients when they were even asked complained about glare.
Doctor George Simon: Do you ever notice any glare or blurriness when you drive? Any difficulty with the signs?
Test Patient 2: No.
Test Patient 3: It’s not much because my um glasses are tinted.
Sam Donaldson: But the guidelines notwithstanding, the Desnick center uses a very interesting machine called an auto refractor to determine whether there are glare problems. The test looks convincing we thought we’d try it.
Doctor 4: Sam, you’ve got perfect vision, it’s 20/20.” Sam Donaldson: “This is the machine that measures glare. It’s accuracy depends on it’s adjustment. Patti Haley is an optometrist who says that when he worked at the Desnick clinic from 1997-1990, the machine was regularly rigged. He says he watched the technician tamper with the machine. This way.
Doctor 4: By putting the tape on the bulb. The tape covers the bulb and we’ll use a marker to change the contrast on the bulb. Haley then inserted the tampered bulb back in the machine. Now ready for a customer.
Sam Donaldson: This is what it now looked like on the machine screen.
Doctor 4: Based on the test you have cataract on your left eye.
Sam Donaldson: But because you tampered with the bulb.
Doctor 4: Correct.
Sam Donaldson: Now is that what happened at Dr. Desnick’s clinics?
Doctor 4: This happened routinely with all the patients that came in for eye exams.
Sam Donaldson: Doctor Desnick claims Haley is just biased. Indeed, the two have been locked in court actions against each other for two years. Haley’s filed a two million dollar whistle blower lawsuit against Desnick claiming medicare fraud. The courts threw it out. Desnick counter sued and because Haley was a day late in filing his response court judgment has been entered against him pending further proceedings on Desnick’s charge that Haley’s defamed him. But Haley’s just not the only one to tell us the machine may have been rigged. Prime talked to four other former Desnick employees who say almost everyone failed the glare test. Now all patients recommended for surgery do sign a waiver. Which, like the video they are shown at the Desnick center, makes the point that cataract surgery is elective. But what four of our five elderly test patients heard from the doctor was a recommendation for surgery and no discussion of alternatives or risks. All told, seven cataract operations were recommended, $16,800 in medicare money. We’ve gone through the five patients that we brought you. You looked at all of them and tell us you don’t recommend cataract surgery for any one of them.
Doctor Howard Tessler: No.
Sam Donaldson: Could this just be an honest difference of opinion between professionals?
Doctor Howard Tessler: Not in these particular five cases, I doubt it.
Sam Donaldson: We informed Doctor Desnick of our undercover results and provided him with the medical releases for our test patients. We repeatedly requested an on camera interview, but he refused. Because, he said we had conducted a witch-hunt, using deceptive and unethical tactics and had lied to him. He said he might consider for an un-recorded background interview, from which, he could not be quoted. Doctor Desnick sent a letter calling our test patients ‘shills’ who lied about their symptoms. He claimed they all met the federal and state criteria for elective surgery. But we still wanted to talk to him about it directly. Dr. Desnick I am Sam Donaldson of ABC PrimeTime. May I speak with you a moment about your clinic? We tried to get him on the record one day at Chicago’s O’hare airport. Your critics say you do unnecessary eye surgery of cataract eye patients for the money.
Doctor Desnick: I am not here to respond to that
Sam Donaldson: Is it true doctor that you changed medical records to show less vision than your patients actually had? We’ve been told, Doctor, that you’ve changed the glare machine so that you have a different reading. Is that correct? Doctor, why won’t you respond to the questions? As the complaints against doctor Desnick bounded, the American Academy of Ophthalmology launched a disciplinary investigation. Doctor Desnick resigned his membership. Leaving the academy no choice but to close the inquiry. Medicare has cited Doctor Desnick for numerous infractions. In one instance he paid $100,000 as a settlement. But, he’s still allowed to participate in the program. We showed our undercover video to congressman Pete Stark, who oversees the medicare program in the House.
Congressman Pete Stark: What you have seen here has shown me is a guy who’s hussy. Unfortunately, we stay out of the doctor’s decision.
Sam Donaldson: But isn’t this the taxpayers decision?
Congressman Pete Stark: It’s their money and you’re right, those people ought to be put out of business. But what I’m further telling you is that they’re probably right inside the law.
Sam Donaldson: Doctor Desnick is now expanding rapidly. He just bought this Chicago Hospital catered to medicare and Medicaid patients. But many of his past patients who feel they’ve been injured are still struggling with their anger.
Patient 5: If you couldn’t do me no good, why do me harm?
Patient 3: I’m gonna be 73 years old and I’m not gonna back off.
Patient 6: And for one thing I’m sorry, that they can’t take his license away from him.
Sam Donaldson: As a matter of fact, the state of Illinois medical board has begun a proceeding which could result in Doctor Desnick losing his license. The court has charged him with 18 violations. Among them, deceptive or misleading advertising, misleading malpractice, taking unfair advantage of patients’ vulnerability. Doctor Desnick is fighting the charges, which he says are without merit. Finally, we want to make the point that what we discovered at Doctor Desnick’s clinics does not mean that elderly patients should shunt cataract surgery or ignore the recommendations of their ophthalmologists. In the proper hands, surgery is a safe operation which can do much to improve vision.