Complaint Review: Mayo Clinic Rochester - General Surgery & General Internal Medicine

John B. Bundrick - Mayo Clinic Rochester General Internal Medicine - writes the Clinical Pearls Series for The Mayo Clinic Proceedings - an excellent review series of articles, but the case studies are stereotypical, and the 'management' not what really happens = the generic patient with the no human mistakes scenario (never happens). 

In the January 2011 issue, case #3, Dr. Bundrick details the "Mayo Clinic treatment" of chronic abdominal wall pain due to superficial nerve inflammations - a 2% lidocaine trigger point injection & reassurance after a positive Carnett's test.  [What is a Carnett's test being the problem for most Mayo Staff - ask one what Carnett's test is today - and send the answer to the Mayo Clinic Board of Trustees, or the CEO & President of one of the Mayo Clinics - they need to know.  Ask any surgeon and you won't get much of an answer except silence.]  The Legal Department at Mayo Clinic, Jill Beed-Smith, thinks it a Chico's earring design. 

These abdominal wall nerve inflammations are all-to-common sequelae of abdominal laparoscopic procedures, other surgical procedures including appendectomy, vascular (Dr. Warner Andrew Oldenburg misses this in Jacksonville), & ob-gyn (Pfannenstiel incisions & portholes), and sports injuries (football, soccer or treadmill).  Any patient that moves can get an abdominal wall nerve inflammation, and it occurs in peds (in the Peds Surgical Literature): J Pediatr Surg. 2011 Apr;46(4):699-703. doi: 10.1016/j.jpedsurg.2010.08.054. Surgery for refractory anterior cutaneous nerve entrapment syndrome (ACNES) in children. Scheltinga MR, Boelens OB, Tjon A Ten WE, Roumen RM.  (Surgery for REFRACTORY being what to note.) 

This diagnostic problem represents the most common cause of abdominal wall pain.  The anterior cutaneous nerve entrapment inflammation syndrome is acronymed out as ACNES for the Google searcher - not that anyone at Mayo Clinic cares.  Dr. Michael Sarr, and other surgeons at the AZ, FL & MN Mayo Clinics, haven't a clue about what a Carnett's test is - it's never on the workups, never on the Rounds talks, and everyone wants to CUT - Medicine is a cutting game at Mayo Clinic. 

This John Bundrick MD article hides a 'dirty' subtext of mismanagement of this problem at Mayo Clinic - a subtext story that The Mayo Clinic Proceedings Editorial Staff is well aware of.  Most abdominal wall pain nerve inflammations don't survive more than 48 hours at Mayo Clinic (never make it to the General Internal Medicine Clinic 'refractory' area) - they are turfed to surgery, and used as a surgical quota procedure for the Surgical Staff & Chiefs.  [You have to have so many procedures/year to remain on Mayo Staff & still lecture, travel, ski, and be a big-hyped deal.]  

You can do a whole menu of these 'neurectomy' procedures, and still be on the last-flight-out of Rochester on Friday to the Bahamas, Mexico, South America, LA, Idaho or Colorado for skiing.  It's a butcher job ghoulish procedure, but pays well as the insurances, and The Medical Board of Minnesota, haven't caught on as to what a 'neurectomy' at Mayo Clinic really means - the soundbite hides the reality.  The Medical Boad of Minnesota should have stopped these neurectomies decades ago. 

Except for Dr. Josef Mengele's repopularization of the procedure for inmate torture at Auschwitz, these abdominal wall neurectomies have been considered by most to be unnecessary over-doing-it for the money - since 1926.  Interestingly it's the Jewish surgeons, like Dr. Michael Sarr, who like & popularize this surgery - the main problem being that the surgery does not 'treat' the abdominal nerve inflammation - they make the anatomy & pain worse.  A procedure is ok if it doesn anything for the problem - which neurectomies don't.  Kapeesh?

These abdominal neurectomies are surgeries that guarantee life-long pain problems, and a need for multiple surgical revisions - which the stupid surgeon wouldn't realize - or maybe they do, and don't care.  At least 2-4 more procedures will be needed to correct the abdominal wall deformity left by the Mayo Surgical Staff - the black student who couldn't hold a retractor or close except with spit, the intern who couldn't use a scalpel, and Dr. Sarr still coming awake from last night's wine-and-dine of whoever for the 'glory of the Mayo Clinic.'  No one doesn't drink on before-surgery night at Mayo Clinic.  This is a hierarchy of stupid medical students, uncaring residents, multi-tasking surgeons, and the clueless anesthesia guy/woman - top to bottom vacuum of stupidity. 

What's worse is that John Bundrick MD knows the reality of the situation - that neurectomy makes things worse & does not treat the nerve entrapment - and he hasn't informed Jill Beed-Smith in the Legal Department, or the Board of Trustees at Mayo Clinic of this. 

The trigger-point injection of the nerve serves two purposes: to relieve pain and to reduce herniation of the neurovascular bundle through the fibrous ring - the injection is the only treatment that has a POSSIBILITY of working: The Permanente Journal/ Summer 2002/ Volume 6 No. 3, WV Applegate.  So why would any Mayo Clinic surgeon EVER do a neurectomy?  And this won't be written as an Editorial Comment in The Mayo Clinic Proceedings for obvious reasons - they've hung up on the messenger(s).  Mayo Clinic makes too much money ripping out 'normal' abdominal nerves for the Pathology Department - they don't care about treatments, they care about money.  They don't care that neurectomies don't work - EVER.   

Probably only 1 in 20, or 1 in 200 patients make it to the General Internal Medicine Service for a Carnett's test & trigger-point injection treatment - most are siphoned off to be instantly neurectomized by the General Surgery Services.  They are place on the Surgery Schedule as 'neuroma' - the surgery creates a neuroma - and there's no consent form.  And John B. Bundrick MD is responsible for this in 2013 - his 'code of silence,' his looking the other way. 

Neurectomy for this entity went out in 1926, with the publication of Carnett's original article: Carnett JB (1926) Intercostal neuralgia as a cause of abdominal pain and tenderness. J. Surg. Gynecol. Obstet. 42:625-632.  Why the medical insurances are still wanting to pay for this procedure is a true enigma - why would anyone want to pay for a surgery that doesn't work - that the literature has pegged as not working for 87 years?  No one at Mayo Clinic, except perhaps John Bundrick MD, reads the literature that he references.  So hire someone that does read the literature - that appears to be a Human Resources loophole at Mayo Clinic.  The Carnett's chip is cut out when the person is hired for Mayo Clinic.     

Clinical Pearls in Internal Medicine is a Mayo Clinic Proceedings article that probably most of Mayo Clinic anywhere hasn't read - because most staff at Mayo Clinic haven't a clue what a Carnett's test is (before or after 2011).  Neurectomy surgery is much more profitable, and fun for the learning curve of would-be surgeons.  This is a con, dupe, a fraud - that Dr. Bundrick is party to - the General Medicine Services haven't objected, and the number of neurectomies haven't decreased for the last 20 years.  Case #3 is the showcase version, the neurectomy surgery story is much darker.

Abdominal wall neurectomy at Mayo Clinic:  First the exam by the surgeon is succinct, no Carnett's test, and the patient is scheduled for next-day surgery to fill the vacant OR spots (just like Mengele did in Auschwitz to fill the crematoriums & gas chambers with the daily transports - no consent there either).  This is no US/MRI scan done as a prerequisite for surgery, no blood work is really needed (nothing like Dr. Bundrick's case study), and no medical consultation except with a FMG 'girl Friday' of Dr. Sarr's - who clears everything as she's on the phone with her kids & husband, and in-between doing her Board Review studying.  She's a plant - in the literal and real sense.

The Anesthesia Service never formally consults, and they haven't caught on that a trigger-point injection should be on the Surgical Checklist, and would be billable service for them - if they had a brain.  It's like the Yellow Brick Road at Mayo Clinic - going nowhere with staff minus something - the Carnett's chip - and no Wizard of Oz in sight - certainly not Dr. Bundrick. 

The surgery, Dr. Sarr lets a 3-month intern cut her surgical chops on the abdomen, the abdominal muscle fascias are cut to the periteum for the 'peritoneal peak,' and the nerve is removed in the nerve foramen without trying to inject to see if the pain is relieved - the patient is drugged by Anesthesia per Dr. Sarr's instructions - women patients don't get a consent option.  The muscle below the nerve is cut in a coup d'etat for another $100 to the charge.  There isn't a reason in hell for this last 'move.' 

The muscle fascias are then closed with a deforming, painful, and mutilating for the abdominal wall muscles, closure: common mass closure.  To save the suture pack counts - it only takes one to sew everything together in a home ec mess of a seam.  Common mass closure on clothing would flunk you in Home Economics 101.  But no Mayo Clinic Surgeon ever really takes a sewing class. 

Common mass closures all rupture within 3-5- years, no one follows them past a day, and then the patient needs mesh as most procedures can't be repaired with an abdominal wall layered closure.  The patient in 1999, objected and asked that Mayo Clinic undo to a layered closure - the Mayo Clinic refused - this would have been possible right after the procedure - before the muscles 'melt' together.  

Jill Beed-Smith Esq. has no intention of authorizing any repairs, any settlements, or any sense - and has stated this over and over to women patients - who never consented - requesting undoing.  Still many of these closures could be repaired, but most surgeons outside of Mayo Clinic don't want to be blamed for the less-than-perfect abdominal wall outcome.  Mayo Clinic removes a nerve unnecessarily, without a trial of conservative medical management, and then does the worst closure ever conceived - a closure that the jury is still out on - an unproved closure except in the short-term.  Mayo Clinic Plastics needs to get on it: there a queue of patients waiting for a layered closure repair.     

Abdominal wall neurectomies at Mayo Clinic are unconsented for procedures - no women would consent in an informed way to this mutilation, no next of kin consents, and no patient is given the chance.  Per Jill Beed-Smith - it doesn't matter that Dr. Michael Sarr & the Surgical Services never got consent, and never discussed the options - this is Mayo Clinic.   

The General Medicine Service (John Bundrick MD), The Legal Department (Chief Counsel: Jill Beed-Smith Esq), The Editorial Staff of The Mayo Clinic Proceedings, and the State Medical Board of Minnesota are aware of the problem - but letting it continue - which is irresponsible, unethical, cruel, crazy, and a tragedy. 

Dr. Michael Sarr, Chief of General Surgery, and his intern assistant, were reported to the State Medical Board of Minnesota in 1999 for doing this neurectomy procedure, without consent, on a woman patient (case #1) who never got to Medicine, never had a Carnett's test, and was never offered a trigger-point injection - she sent articles on this abdominal wall pain syndrome problem - and the correct treatment - to Dr. Sarr and was administratively bounced from the Mayo Clinic email system.  She requested a surgical revision of the closure - and was denied.  The neurectomy was done even knowing in 1999, that it was the wrong treatment and would not treat the condition.  It was for the money.  Other patients have requested repairs, revisions, and a change in the policy of Mayo Clinic to keep allowing a deforming procedure that does nothing to treat the problem. 

This neurectomy scam at Mayo Clinic needs to stop.  If the staff can't read about Carnett's on Wikipedia, they surely have access to John Bundrick MD and Mayo Clinic Proceedings - and they all have ipads and tweet pictures of neurectomy scars.