Castration: The Goldmine of American Medicine

The following is Sybil Shainwald’s Keynote Speaker address given at the 27th Annual Hysterectomy Conference for Hysterectomy Educational Resources and Services (HERS).

Castration: The Goldmine of Gynecology

Introduction/Statistics

Female castration is the most performed non-obstetric operation in the U.S., at the rate of about 1,643 per day. That is more than one every minute. Sex organs have been removed from more than 22 million U.S. women and over 600,000 hysterectomies are still performed each year without informing women of the consequences of this needless, heedless surgery. In fact, for every 10,000 hysterectomies performed in the United States, 11 women die. You have more of a chance of dying from the operation than of dying from uterine cancer. Our organs are expendable and doctors will continue to commit hysterectomy – a crime against our bodies – until they are stopped by passing laws that will prevent the medical industry from using our bodies as a battlefield.

In an industry worth 17 billion dollars, the castration rate has remained the same as long as I can recall. 400,000 hysterectomies are performed annually for uterine fibroids, a benign condition. 1

Traditionally, a woman’s importance was based on her ability to have children. Consistent with this, the casual way in which many gynecologists remove our organs is attributable to power, greed and sexism. American doctors are doers- actually they are warriors- when it comes to our reproductive organs. Doctors at an Ob/Gyn conference agreed that “no ovary is good enough to leave in and no testicle is bad enough to take out.” If you don’t have testicles, you cannot get testicular cancer, so why not remove testicles and why remove ovaries? Surgical removal of the ovaries is done in about 75% of women who have hysterectomies. The medically correct term for the removal of the uterus and ovaries is castration. When the ovaries are removed, women have a 7 times greater incidence of heart disease.

The medical approval of castration can partly be attributed to power, the needs of hospitals, the profits to doctors, and sexism. There is apparently no sense of personal responsibility for this crime against women.

The actions and inactions taken by doctors, hospitals and pharmaceutical companies have been catastrophic. I dread to think what would have been the consequences if the victims had been MEN rather than women, who seem to be expected to suffer physical and emotional pain simply because you cannot see their sexual organs. Without warning to women, their bodies have been invaded by the millions. If one poor young man were to inflict castration on one woman, without authority or consent, he would be jailed for the rest of his life. But when doctors and hospitals do it, society looks the other way. Castration in males would never happen; castration in women happens every day of the week.

In the U.S., 45.1% or more of women ages 65 and older in the U.S. report having undergone a hysterectomy. Rates vary by state, with New York having the lowest rate, and Mississippi having the highest at 57.1%. Regionally, the South continues to have the highest rate of hysterectomies at 6.2 out of 1,000 women, while the Northeast has the lowest rate at 3.7 out of 1,000. But do women’s reproductive organs differ by geography?

Focusing on Georgia, it has an overall hysterectomy rate of26.4%, which is the 9th highest in the country. This compares with New York’s rate of 13.3% with 3.2% in the 44 and under age group. 16 states have a rate of 50% or more for women over 65. Mississippi has the most with a rate of 57.1% for 65 and over. No wonder hysterectomies are often called “Mississippi appendectomies.” Rates also vary by country, even though our organs are all the same. 38,831 hysterectomies were performed in National Health Service hospitals in England in 2005-2006. Hysterectomies have also been referred to as “hip pocket surgery” because in most cases, they serve only to line the pockets of the surgeons and hospitals that do the surgery.

I suppose these facts alone should astonish you, but you should also know that, conservatively, more than 9 out of 10 hysterectomies are elective procedures. That means that there is no medical imperative that a hysterectomy is done and that if it is not done, nothing dire will happen. In fact, women would be much better off without a hysterectomy and only doctors’ wallets would suffer.

We are inundated with helpful advice on how to fmd good medical care. On closer scrutiny, you’ll find that it’s not helpful at all. Every radio, T.V., newspaper ad and website for hospitals, clinics, and insurance companies appears to have come from the same ad agency, the one that decided that they could sell anything in the world of medicine if they attached the word “caring” to it. It’s as though by saying “we care” or that our doctors, nurses, lab techs, orderlies are all “caring people,” hospitals can avoid having to explain their fees, their procedures for admitting physicians to their staffs, their infection rates, the frequency of surgery in their operating rooms that is not medically indicated, or the level of patient satisfaction with the food, staff, facilities or business office.

There is a real product behind all this talk about “caring.” But when advertisers stop talking about the actual benefits of a product and begin to talk in vague positive catchwords, you know there must be little of merit beneath those words. How long would we listen to say, IBM telling us only that they’re “nice” before we asked for some cost, quality and service data?

How does someone get the reputation of being one of the “best” doctors in a particular specialty or in a particular locale? Most often doctors come by their reputations by telling people that they are good, or by having themselves represented as such by an interested party such as a hospital, their partner, their spouse, their office manager, their car dealer, anyone who benefits from that doctor’s business doing well.

It’s rare to hear information about how bad a doctor is, except from former patients, and they don’t often have a large audience. It’s much more common today to hear, in a hospital’s advertisements for instance, that their staff physicians are all terrific, well-trained, caring and attentive. The only source of their revenue is getting patients to go to their staff doctors, because patients cannot be admitted to a hospital without their doctor being an admitting physician.

There is little incentive for surgeons to abandon their favorite surgical procedure if they are rewarded for it, and the consequences to women are NOT publicized, except by HERS.

New York Times article “Medicare Won’t Pay for Medical Errors”:

On October 1, 2008, an article in the New York Times revealed that Medicare will no longer provide coverage for certain “reasonably preventable” conditions, including infections developed afier certain surgeries. These “conditions” are injuries caused by the hospital and medical personnel, which, although Medicare considers them “preventable” do actual harm to patients. On the list are operations to retrieve a surgical sponge left behind from a previous surgery, incompatible blood transfusions, serious bed sores, injuries from falls, and urinary tract infections caused by catheters. All of these are injures that women could suffer after a hysterectomy, but why pay for the initial surgery? The article states “officials believe that the regulations could apply to several hundred thousand hospital stays of the 12.5 million covered annually by Medicare. The policy will also prevent hospitals from billing patients directly for costs generated by medical errors.”

In addition, the article states, “because Medicare is the largest insurer in the country, its decision to refuse payment for preventable conditions has already influenced others – public and private – to set similar criteria. Over the last year, 4 state Medicaid programs have announced they will not pay for as many as 28 “never events” (so called because they are never supposed to happen). So have some of the country’s largest commercial insurers, including WellPoint, Aetna, Cigna and Blue Cross Blue Shield plans in 7 states.”

“The Congressionally mandated Medicare measure is not projected to yield large savings- $21 million a year, compared with $110 billion spent on inpatient care in 2007. But it carries great symbolism in the effort to revamp the country’s medical payment system, which has long been criticized as driving up costs through perverse incentives that reward the quantity of care more than the promotion of health.”

Why not save the $7 billion spent on hysterectomies?

The article continues, “the real money, many health economists believe, may come from reorienting the payment system to encourage prevention and chronic disease management and to discourage unnecessary procedures.” Now, Medicare won’t even pay for doctors’ and hospitals’ errors, but will pay for unnecessary hysterectomies.

The rate of reimbursement for treatments for uterinefibroids in 2006 from Medicare and

Medicaid were as follows:

a. total hysterectomy $5,200

b. vaginal hysterectomy, including removal of fallopian tubes and/or ovaries $5,140

c. abdominal myomectemy $5,132

d. vaginal hysterectomy $5,051

e. vaginal myomectemy $1,746

As evident from these statistics, the more body parts that are removed, the more money goes to the hospitals and doctors from Medicare and Medicaid. How much of an incentive exists for hospitals or doctors to change their ways? ZERO.

We all know that 90% of the time, or more, there is NO reason for doing a hysterectomy – removal of your sex organs – usually, the result is castrating women even just for uterine fibroids.

Our scars are the goldmine of American medicine. We should all remember that Dr. Robert Mendelsolm said, “medicine never gave up an operation when it didn’t have another to replace it.”

The Experience of Women in the System – Misinformation

In the 1970’s, Diana Scully observed Ob/Gyn residency programs and found that doctors were taught to “think of the uterus as a cradle. After you’ve had all your babies there’s no reason to keep the cradle. And removing your uterus will save you from the risk of developing cancer in later life.” As we can see from the CDC statistics, this is not true.

More than 30 years later, this “cradle” analogy continues to be used. A New York Department of Health pamphlet, which doctors and hospitals must give to women told they need a hysterectomy, is one of the reasons New York State has the lowest rate in the country. The pamphlet was published as a result of legislation requiring a “standardized written summary” be given to all women considering a hysterectomy.2 It informs women about other treatment options, not just castration. However, it still claims that the only function of the uterus is to “cradle and nourish a fetus from conception to birth, and aid in the delivery of the baby. It also produces the monthly menstrual flow, or period.” There is no further information about the uterus itself, and no other function of the uterus is mentioned.

In order for women to truly be informed before deciding to follow through with this surgery, this pamphlet must be given to every woman who is told that hysterectomy is an option for her. The pamphlet at least provides women facing the prospect of castration with a list of 17 questions to discuss with her doctor. Still, it fails to explain that removal of the uterus and ovaries is castration – something most women would like to know before undergoing the surgery and it does not explain that sex will never be the same, in addition to all of the other consequences, such as personality change, difficulty with social interaction, memory loss, pain, loss of energy, and even suicidal thoughts.

Hospital Websites

Sources, including the internet and media, which should, and in the case of doctors and hospitals, are required to give accurate information to patients to conform with statutes and laws requiring informed consent. are instead rife with misinformation. Women scouring the web for information on hysterectomies want to find out the answers to questions such as “What are the consequences of a hysterectomy? What are the side­ effects?” Women in Atlanta and this area who are anxious for answers to these questions click on the Emory University Hospital website.

Emory

Introduction

As with most hospital websites, supposedly intended to enable a woman to make an informed decision, Emory’s website provides little information, but rather gross misinformation on hysterectomies, treatment options and consequences of a
hysterectomy. The site and the links it provides deprive women of crucial information on the well-documented consequences and risks of hysterectomies.

It is an empty claim for Emory, an educational institution, to make, but it is typical of hospital websites throughout the country. What is shocking about Emory’s website is the extent to which it promotes hysterectomies while directing women to look elsewhere for information on the surgery.

Conducting a Search

If your doctor tells you that you need a hysterectomy, you want to be an informed consumer, so you go look at Emory’s website. If you search for the term “hysterectomy,” you are taken to a page with a long list of press releases and articles. A press release dated June 2, 2004 goes into great detail about how “vaginal hysterectomies are more advantageous” than abdominal hysterectomies, without any reference to the consequences of removing your organs. The articles discuss uterine artery embolization, endometriosis and gynecological services, but none of them discusses the well­ documented consequences of hysterectomy. What Emory does not tell you is that most of the most devastating adverse effects are the same no matter how the uterus is removed. Either way, your organs are removed and you are castrated!

Shockingly, there are even advertisements on the site for the “donation” (really sale) of women’s eggs. They appear on the same page, under the section entitled Women’s Health, where women would be searching to find information about hysterectomies.

Emory tells visitors to the site, “‘symptomatic uterine fibroids trigger approximately 150,000 hysterectomies each year.’ In fact, it’s the fear that doctors instill in women regarding benign conditions such as fibroids, along with misinformation about treatment options, that ‘triggers’ hysterectomies. Fibroids can’t pull the ‘trigger’ on hysterectomies. Only doctors can pull that trigger.”

Links on Emory’s website

If you then go to the Department of Obstetrics and Gynecology page on Emory’s website, it tells visitors that it “is dedicated to providing health information and education to women in the Atlanta community, the region and the nation” but there are NO hysterectomy materials to educate women about the consequences of hysterectomy. If you click on the link to the Patient Education page, you are given three additional links to rev1ew:

1. The American College of Obstetricians and Gynecologists website

2. The Universe of Women’s Health

3. A phone number at Emory. Let’s look at these options one by one.

ACOG

If you go to the American College of Obstetricians and Gynecologists’ website, there is a section called “Hysterectomy.” Under that section is a paragraph called “Risks,” which reads as follows “the risk of problems related to hysterectomy is among the lowest for any major surgery.” In fact, sex will never be the same, in addition to all of the other consequences, such as personality change, difficulty with social interaction, memory loss, pain, loss of energy, and even suicidal thoughts. Under “Physical Effects,” there is no information on effects that occur when ovaries are removed, only when they are left intact. Under “Sexual Effects,” the website states, “some women feel more sexual pleasure after hysterectomy. This may be because they no longer have to worry about getting pregnant. It also may be because they no longer have the discomfort or heavy bleeding caused by the problem leading to hysterectomy.”

Universe of Women’s Health

If you click the link to Universe of Women’s Health, the only function of the uterus mentioned is to carry a fetus. It doesn’t mention that the uterus is a hormone-responsive sex organ that supports the bladder and the bowel, or that women who experienced uterine orgasm before the surgery won’t experience it after the uterus is removed.

Emorv nurses’ phone line

After finding misleading information on these websites, you would try calling the Emory nurses’ phone line, like Nora did. The Emory website’s invitation to visitors to speak with live nurses via a call-in number was an informational dead end on the subject of hysterectomy risks. The nurse who answered the phone at Emory seemed confused by simple questions. The best that Emory nurses could do was define an abdominal hysterectomy and then read verbatim from Wikipedia – an unreliable, unprofessional source which can be changed by anyone. It is by no means reliable. You would think that an academic institution such as Emory Hospital which has tremendous credibility due to its academic standing in the world would not rely on Wikipedia as a source. Even Wikipedia’s own officials advise against quoting Wikipedia as an authoritative source. Women who call Emory are ostensibly very likely to get information that is no more reliable than an online encyclopedia written by volunteers from around the world who may or may not know what they’re talking about.

A second call to the patient education website’s phone number got the same results: the nurse who answered seemed confused, and unprepared to field the most basic questions about hysterectomy. The nurse said ‘Tm going to ask you exactly what you would like.” Nora said, “I would like to know what the effects of hysterectomy are.” Instead of Nora, the caller of course could have been any woman faced with the decision of whether or not to have surgery. The fact that the nurse asked Nora what she would like to know is baffling. After all, how does the patient know what they need to know? It’s like a woman asking a doctor, “would you please tell me what the consequences of hysterectomy are?” and the doctor responding, “Okay, what would you like to know?” What’s obvious from these calls is that women need to know the answers to their questions before they ask them, which renders Emory’s “patient education” meaningless at best…and potentially very harmful.

The 3rd time Nora called the same patient education phone number, the nurse saidthat it was actually a doctor referral line. Later, the nurse admitted that this supposed “patient education” resource is run by a marketing department, and the nurses report to a marketing director.

Grady Health System

Grady’s website

A review of Grady Memorial Hospital Health System website provides even less information. Emory University School of Medicine and Morehouse School of Medicine provide all the staff at Grady Memorial Hospital. Emory University website’s joint Emory University and Grady Hospital page boasts that Grady is “one of the largest public hospitals in the Southeast. ..[and] an internationally recognized teaching hospital with a historic commitment to the health needs of the most vulnerable.” Yet a trip to “Extraordinary Grady’s” website not only fails to provide women with information on hysterectomies, it does not even provide links to other websites — including the Emory University website. After clicking on the English link on the page Entitled Women’s Health Services – with a picture of two babies-you are sent to a page claiming that Grady provides a “full range of services for women of all ages, including:

Primary care

Gynecological Services

Obstetrics

Family Planning

Teen Services

Breast Health Initiatives

Nutrition Counseling, WIC

Social Services

Comprehensive Education Programs

Women’s Urgent Care Center

Rape Crisis Center

Convenient Neighborhood Health Centers”

However, when I attempted to click on a link entitled Gynecological Services, I found that no such link existed. In fact, the only live link is for Obstetrics and the Family Birth Center.

Additionally, on a page entitled “Patient Safety,” the Grady website details what it calls the “You Speak…We Listen…” Program. This “program” states that Grady staff “listens…when you have questions about equipment, tests and procedures,” but when I called to ask about hysterectomies, I was sent to media relations and the staff refused to answer questions about the procedure.

Grady’s phone line

I made a call to Grady Hospital using a phone number I found on its website for the Women’s and Children’s Pavilion. The staff stated that Grady is a “full service hospital” and that it performs hysterectomies. However, the staff members would not tell me the number of hysterectomies performed at the hospital each year. I was transferred several times, and eventually to media relations. The media relations representative informed me that Grady “does not release information like that to the public” and when asked if there was anything on the website about it, or any other way to obtain that information, the staff member stated I could look at the website ourselves, but that they would not tell me the statistic.

Cleveland/Clinic.org website

Compared to the Emory, Grady and other websites, the Cleveland Clinic gives more information on alternatives to hysterectomy for treating various conditions. Under “what is a hysterectomy,” the site states, “it’s important to be fully informed of your options and the risks and benefits of the surgery before making a decision.” However, treatments listed include especially hormone medications, the side effects of which are not discussed on the page. Cleveland is similar to the other sites in that while discussing “options,” it focuses on women who want to have children. Instead of simply stating all women, the site says “women who want to have children should consider alternatives to hysterectomy” and “personal factors, such as your desire to have children in the future, will also affect the treatment options that are available to you.” While it is true that the desire for children will affect the decision, every patient should be encouraged and instructed to find out about all the possible treatments or non-treatments.

Misinformation from the Federal Government

Even women who search government websites are misinformed. For example, the Department of Health and Human Services’ National Women’s Health Information Center tells us, “most women do not have problems during or after” hysterectomies. After stating this, the page goes on to list a few “risks” of a hysterectomy:

• “Heavy blood loss that requires blood transfusion,

• Bowel injury,

• Bladder injury,

• Anesthesia problems (such as breathing or heart problems),

• Need to change to abdominal incision during surgery,

• Wound pulling open.”

This is on a Frequently Asked Questions webpage designed to inform women, but instead it is misleading them. This page is published by the U.S. Dep’t of Health and Human Services. There is a list of “options other than hysterectomy” on this page, but you can imagine that a woman who reads that “most women do not have problems” may not read the rest of the answers because she is not aware that she should be at all concerned about the consequences of being castrated. Further, the “other options” section, appears after most of the hysterectomy information, instead of being prominently and conspicuously placed at the top of the list. Finally, I doubt anyone here would consider any of the “risks” listed as a minor risk or not a problem.

Solutions

Complete and correct information to women

1 in 3 women in this room will have a hysterectomy by age 60. There is a simple and inexpensive solution to the castration of women. It is information; accurate and complete information about when a hysterectomy is actually medically necessary (as we have seen, almost never) and about the rates of hysterectomies in the local population. More than 2 decades ago, the method of using a mass media campaign was studied in Switzerland, and it worked a mere 2 months after the start of the campaign. In the areas where the message was broadcast, the rate of hysterectomies performed within a 9-month period decreased by a staggering 25.8% across all age groups. The decrease among ages 35-49 was even higher, at 1/3 less. Comparatively, the rates remained unchanged in regions without the media campaign.

This shows us that something as simple as giving accurate information about the necessity (or not) of hysterectomies is an effective solution to this terrible unnecessary castration of women.

Legislation must be passed that will not add to our budget deficit, but will add to our health, and save money and lives. It is absolutely vital that healthcare providers be mandated to show the video “Female Anatomy- the Functions of the Female Organs” to every woman who is told she needs a hysterectomy. A 17-year study by HERS found that 99.7% of women who were told they needed a hysterectomy were NOT informed about the functions of the female organs or the consequences of their removal.

These women said they would NOT have gone through with the surgery if they had had that information. This is NOT the informed consent the law requires. Once women know the full consequences of this needless, heedless operation, they will refuse to have it. Doctors must give this opportunity to women if there is to be real informed consent.

Informed Consent

Every competent adult is the final judge or should be – of whether or not to have a procedure done.

Although the Georgia legislature codified the Georgia Medical Consent Law 3, it was the last state to adopt the doctrine of informed consent which provides that physicians have a duty to inform patients of the risks of a proposed treatment or procedure and to inform them of available treatment alternatives.

Most states follow the reasonably prudent physician standard, while Georgia now follows the reasonably prudent patient standard. Under the physician standard, a doctor
is required to disclose those risks which a reasonable and prudent medical practitioner would disclose under same or similar circumstances. Under the patient standard, the doctor must disclose material risks generally recognized and accepted by reasonably prudent physicians, which, if disclosed to a reasonably prudent person in patient’s position, could reasonably be expected to cause that person to decline proposed treatment or procedure because of risk of injury that could result.”

Georgia’s standard is similar to New Jersey’s. As the New Jersey Supreme Court said, “the strongest consideration that influences our decision in favor of the ‘prudent patient’ standard lies in the notion that the physician’s duty of disclosure ‘arises from phenomena apart from medical custom and practice: the patient’s right of self-determination. The foundation for the physician’s duty to disclose in the first place is found in the idea that ‘it is the prerogative of the patient, not the physician, to determine for himself the direction in which his interests seem to lie.’ ill contrast, the arguments for the ‘professional standard’ smack of an anachronistic paternalism that is at odds with any strong conception of a patient’s right of self-determination.”4

In Ketchup v. Howard, 247 Ga. App. 54 (2000),5 the Georgia Court of Appeals found that all persons have a liberty interest protected by the Georgia Constitution to make all decisions regarding their medical care so long as they are legally competent. This right, the Court concluded, includes the right to refuse all medical treatments, even when it is necessary to save the patient’s life. In determining which standard Georgia should follow, the Court found that a greater number of states in this country follow the reasonable physician standard, although many states have begun to base their law on what a reasonably prudent patient, rather than physician, would do. The Court decided to follow the minority and adopted the patient standard. Thus, doctors must inform patients of the material risks of a proposed treatment or procedure which are or should be known, as well as available alternatives to the proposed procedure or treatment.

A review of Georgia case law discussing “informed consent and hysterectomies” turned up only one relevant case and that case predates the current Georgia Informed Consent statute.6 In that case, the patient was bound by a consent form in spite of her failure to read it. In a recent New York case, Policari v. Dottino,7 the plaintiff alleged that her physician NEVER informed her of the alternatives to a hysterectomy and NEVER advised her of the sexual side effects of the surgery. The New York court held that the law contained no requirement of a special informed consent for before performing a hysterectomy.8

Omitting the rudimentary information needed for hysterectomy informed consent leaves a woman with no way to make an informed choice about one of the most important medical decisions of her life: whether or not she should risk a hysterectomy. We know that most women would never choose to undergo this elective surgery if they were truly given the information on how a hysterectomy will change their bodies both physically and mentally as well as impact their relationships with their partners, children, friends, and coworkers. So, how are we in a situation where women simply are not told the real truth? And how do we let over 600,000 women be castrated each year?

Malpractice

If you have an unnecessary hysterectomy you suffer from a doctor-induced injury. Your malpractice suit is important, because so few are brought and so few are won. The doctrine of informed consent is a substantive area of the law and “a surgeon who performs [surgery] without her patient’s consent…is liable in damages.” Doctors view this as the Sword of Damocles over their heads, but few lawyers will take them on, unless you are within child-bearing years. Prevention is much better than the cure.

Your lawyer must be careful to bring your lawsuit with the applicable statute of limitations (time within which you can sue). Medical malpractice affects all of us and the damage to an injured woman cannot ever be fully measured. For the rest of us, there are increased costs whether they be to health care providers, insurers or consumers. Malpractice is often denounced as an atrocity visited upon doctors by the legal system, but immunity breeds irresponsibility. We need to know about the quality of health care we receive.

Other solutions that would help reduce or eliminate unnecessary hysterectomies include:

1. increase doctor discipline- there are less actions taken against doctors than against other health professionals

2. increase the licensing fee for doctors and use the extra money to fund programs to prevent malpractice

3. require state licensing boards and professional peer review groups to take aggressive actions to identify, discipline, or remove from practice doctors who do not deliver an acceptable quality of medical care

4. require lawyers, insurance companies and peer review organizations which obtained information about doctors after patients prevailed in malpractice suits to submit all relevant data on those doctors to the state licensing board

5. eliminate settlement secrecy agreements

6. require doctors to be periodically re-certified

7. repeal the insurance industry’s exemption from the anti-trust laws

8. rate doctors by experience in their field to target the “bad doctors”

9. Establish national data banks for hospital and doctor performance, and allow public access to this data

10. increase penalties for truly frivolous lawsuits and for raising frivolous defenses

11. increase arbitration of small claims

12. Improve state regulation of the insurance industry be requiring prior approval of any rate increases, by experience rating, and by increasing staffs and budgets of the often ineffective state insurance offices

13. enact federal disclosure legislation requiring the insurance industry to submit annual data on claims, premiums and investment income to a new Federal Insurance Office

14. American Association for Justice Litigation Group on hysterectomies

Conclusion

What I have just described are all ways we can demand that the medical profession and the government to fulfill their responsibility of giving women all the information to which they must have access to make an informed decision. However, even more important are ways you the patient can make absolutely sure you have the information you need to make the right decision for yourself, your body and your future.

First, if your doctor tells you that you need a hysterectomy, don’t run home and pack your overnight bag. Call HERS and Nora Coffey instead. Get the information that is essential to your decision. Ask the doctor if there is an alternative treatment for your condition, and get a second, third opinion.

Second, if you must have the surgery – unlikely – get a copy of the hospital consent form before you are admitted. Review it. If it says myomectomy or hysterectomy, cross out what you do not want. Be sure to delete any sections of any consent form you do not agree with. Ask the doctor how many hysterectomies s/he has performed. Find out the hospital’s rate of hysterectomies and the mortality rate. If the doctor objects, cross out the doctor! Find another doctor. Adequate informed consent protects you and the doctor.

What we need to do is use the information to educate our sisters and to force the medical schools to change, the legal profession to recognize our wrongs, the insurance companies to stop paying for unnecessary surgery, the hospital to discipline their ranks, the doctors to break their code of silence. We need to force our legislators to act, our medical society to suspend licenses, our work-places to have ombudswomen to tell us our rights and to accompany us. We need to walk out of the doctors’ doors and if we are wronged, we need to sue.

No one cares about your life as much as you do – not doctors, not lawyers. Every unnecessary hysterectomy is a doctor-induced injury. With Nora Coffey at our side, we must stop the needless suffering, the mutilation, the ruination of our health. The medical approval of elective hysterectomies can be attributed to profit motivation, the needs of teaching hospitals, power and sexism.

As we can see, modem medicine is dangerous to women’s health. The best advice anyone can give you to preserve your reproductive organs is to stay out of the gynecologist’s office – and then you will be able to stay out of the lawyer’s office.

Footnote 1. Many websites that I reviewed stated that uterine fibroids that grow larger may have to be treated with a hysterectomy,but not one of these websites said that the fibroids usually decrease in size on their own upon menopause. Furthermore, none of the websites specifically stated that treatments can and should take age or time until the onset of menopause into account.back

Footnote 2. NEW YORK PUBLIC HEALTH CODE§ 2496 (2495•2499)back

Footnote 3. The Georgia Medical Consent Law, 31-9-6(d) provides in pertinent part: A consent to surgical or medical treatment which discloses in general terms of the treatment or course of treatment in connection with which it is given and which is duly evident in writing and signed by the patient or other person or person authorized to consent pursuant to the terms of this Chapter shall be conclusively presumed to be a valid consent in the absence fraudulent misrepresentations of material facts in obtaining the same.back

Footnote 4. Largey et al. v. Rothman. NJ Sup. Ct., No 1-52 (1988) back

Footnote 5. In Ketchup, Dr. Howard, a dentist, examined Ketchup and informed him that he needed a root canal on one of his molars. Ketchup returned to the office at a later date for the procedure, which Dr. Howard performed without informing Ketchup of any risks involved with the procedure or any alternative treatment. After the root canal, Ketchup experienced continuous numbness in his lower lip, chin, and gum on the side where the root canal was performed. Other doctors determined that Ketchup had permanent dental neuropathy caused by damage to a nerve during the root canal procedure. As a result, Ketchup sued Dr. Howard for dental malpractice alleging that Dr. Howard (I) negligently injected anesthetic agents while performing the root canal; (2) used improper materials to perform the root canal; and (3) failed to inform Ketchup of the risk of nerve damage resulting from the root canal. back

Footnote 6. In Winfrey v. Citizens & Amp. Southern National Bank, 149 Ga. App. 488 (1979), the plaintiffs estate alleged that her doctor had failed to obtain her informed consent before performing a complete hysterectomy. The Winfrey court concluded that the plaintiff had voluntarily signed consent form after reading her physician’s name, her name, and the words “laparoscopy, possible laparotomy” and because no legally sufficient excuse appeared, she was bound by the consent form in spite of her failure to read it. back

Footnote 7. Policari v. Dottino. No. 121095/01,2005 WL 6035257 (Jun. 16,2005 N.Y. Sup. Ct. N.Y. Cty). back

Footnote 8. Although Plaintiff maintained that was presented with an informed consent form to sign, she argued that it was only a standard hospital consent form, not the special hysterectomy form that New York State law required. The Policari court considered N.Y. Public Health Law Section 2805-d which provides that Jack of informed consent “means the failure of the person providing the professional treatment or diagnosis to disclose to the patient such alternatives thereto and the reasonably foreseeable risks and benefits involved.” The statute further requires a plaintiff to establish that a reasonably prudent person in the patient’s position “would not have undergone the treatment or diagnosis” upon being or having been fully informed. It found that the plaintiff, because she signed the general consent form, had been properly informed of the risks, complications, and limitations of surgery. back