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The Remissionary Position

I wrote a column in late January called “Daze of Christmas Past,” in which I recounted how I got diagnosed with cancer — large B-cell non-Hodgkins lymphoma — a couple weeks before Christmas. It was a really not-fun holiday surprise. As a bonus, since the tumor was attached to the front of my spinal column, I had to undergo a reconstruction of my upper spine to stabilize it prior to cancer treatment.

By the time I got home from the hospital, on Christmas Day, no less, I was stiff, sore, using a walker, and breathing from an oxygen tank at night. I felt like I was 95 years old. It will get better, the doctor said. Be patient. Or a patient. I can’t remember which. I didn’t move around much for a couple of weeks, but I began keeping a daily journal that I cleverly called “Cancer Diary.” I was scheduled to begin chemotherapy in late January. The odds of a cure, they told me, were 70 percent. Not so bad.

I watched on television as Congressman Jamie Raskin announced that he’d been diagnosed with the same cancer I had. He was about a month ahead of me in treatment, it appeared, so I decided to keep an eye on his progress. He was wearing a kerchief to cover his newly bald head — not a great look.

I read a lot about various natural cancer-fighting foods and decided to begin each day with a bowl of Cheerios and fresh berries, and with liquid mushroom extracts — lion’s mane, turkey tail, and reishi — on the highly scientific theory that it couldn’t hurt.

On January 24th, I began the first of six chemo treatments — one every three weeks — at West Clinic in Midtown. After I arrived and had some blood taken, I was escorted into the chemo area, a large room with 20 or so matching reclining chairs, each next to a rolling stand holding medical drip bags. There was a wall of windows facing Union Avenue, the cars filled with people who, like me, had probably never noticed this building or had any idea what happened inside. A Wendy’s was across the street.

I was taking the “R-CHOP” protocol, a well-established treatment for large B-cell lymphoma. It’s a regimen of cyclophosphamide, doxorubicin, prednisone, rituximab, and vincristine. So there. Mmmm.

The process began with three 40-minute drips: Tylenol, Benadryl, and an anti-nausea medication. The heavy stuff was to come a couple hours later. I was to be there “all day,” the nurse said. Two of my fellow drippees chattered ceaselessly on their phones. Others slept or listened to music through headphones. I guessed they were old hands at this. Six hours later, and I was no longer a chemo virgin.

Thus began the next five months of my life. I never had the horrible reactions to chemo that many people get — headaches, nausea, and other gastric thrills — but I got three or four days of extreme fatigue about halfway through each three-week cycle. My hair fell out in mid-February. I tried wearing various theoretically cool-looking toppers but decided finally to just roll with a chrome dome. Once my facial hair was gone, my head looked like a thumb.

I started writing my column again in late January and only missed a couple of weeks. I read voraciously on the Kindle my son bought me. It’s light and easy to hold in bed. My mother-in-law came from Spain to stay with us and help out until I “got better,” and she was a delight.

I had a couple of setbacks that led to visits to the ER and hospital stays, but I weathered the storms. The scans I took showed the tumor was shrinking — from an egg, to a walnut, to a grape, over the course of three months. Then, in late April, Congressman Raskin announced that “chemotherapy has extinguished the cancer cells.” I took this as a good sign. In the meantime, I was starting to feel pretty “normal.”

After my last chemo on June 5th, I got another PET scan. Three days later I got an email from my oncologist. “Scan showed remission,” it said. “More details when we meet.” Details, schmetails. I still have some follow-up treatments to get through, but apparently “chemotherapy has extinguished the cancer cells,” and I count myself a lucky man.

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DOJ Sues Methodist, West Clinic on Kickback Allegations

Methodist Le Bonheur Healthcare (MLH) paid for unlawful kickbacks from the West Clinic for patient referrals, according to a lawsuit filed Tuesday by the U.S. Department of Justice (DOJ), but the Memphis companies say the allegations “mischaracterize” the relationship.  

The DOJ began investigating the claims in 2017, after Jeffrey H. Liebman, the former president of Methodist University Hospital, came forward as a whistleblower. He was joined in the whistleblower suit in 2019 by Dr. David M. Stern, M.D., who served in leadership roles at Methodist, West Clinic, and the University of Tennessee Health Science Center (UTHSC).

In 2012, Methodist announced a “partnership” between the healthcare system and West Clinic. At the time, Methodist lacked a comprehensive cancer treatment service. The deal would allow West’s patients to get treatment at Methodist-owned facilities.  

The news release issued at the time said it was not a “sale” but a “novel partnership.” The two were “joining forces with Methodist to create a comprehensive, fully integrated cancer service for the benefit of Mid-South residents.” But, the DOJ said, Methodist “purchased substantially all of [West’s] outpatient locations.” This deal allowed Methodist to get more Medicare reimbursements, or more payments from the federal government for caring for Medicare patients. 

At the same time, Methodist made a $7 million investment in ACORN Research, a business in which West and its medical director, Dr. Lee Schwartzberg, had a personal financial interest, the DOJ said. This gave the parties involved the mechanism to move the kickback funds during the seven years of the agreement. The payments were “expressly” for services that were supposed to be — but were not — provided in the agreement. 

The DOJ said the entire “sophisticated business integration” helped to disguise the “unlawful kickbacks.”  The department said, “Methodist knowingly agreed to pay West millions of dollars in kickbacks for the revenues Methodist expected to, and ultimately did, realize from West’s referrals.”

The agreement lasted from January 1st, 2012 through December 31st, 2018 and continued even after Methodist knew the allegations were being investigated by federal agencies.     

“Methodist knowingly agreed to pay West millions of dollars in kickbacks for the revenues Methodist expected to, and ultimately did, realize from West’s referrals.”

U.S. Department of Justice

“As a result of the transaction, Methodist, which prior to the deal had no outpatient cancer treatment, was able to establish a new stream of income in the reimbursements for outpatient treatment that previously went to West,” the DOJ said in a news release issued Tuesday. “Methodist also realized a huge increase in referrals for inpatient services from West, which previously referred the bulk of its patients to Methodist’s competitors, including Baptist Memorial Hospital.

“By purchasing West’s outpatient locations, Methodist was able to bill Medicare not only for the facility and professional components of outpatient treatment but also for the chemotherapy and other drugs provided, for which Methodist could recoup a staggering discount in costs through the 340B Discount Drug Program, resulting in $50 million in profits to Methodist in one year alone.”

But Methodist officials rebutted the allegations Tuesday. the deal structure was created by “respected outside experts” who said the agreement reflected fair market value for the services. It will fight the government’s “allegations in detail in the appropriate legal forum.”

A statement from Methodist said, “Our payments were appropriate, and MLH received the services due under affiliation agreements. The government’s belated decision to intervene in the suit two years after it declined to do so has changed nothing about the case.

“We are proud that our partnership with West succeeded in creating an integrated cancer diagnosis treatment and surgical service that not only improved cancer care, but provided care where it was needed most, reduced health disparities and led to better patient outcomes for the Memphis and Mid-South communities.”

The matter is being investigated by the U.S. Department of Health and Human Services, Office of Inspector General.