Bariatric surgeons hope a bill being considered in the legislature eliminates lifethreatening waits like Shaul's and improves access to a surgical specialty that has seen expansive growth in central Indiana over the past few years. The measure, now in conference committee, is expected to win final approval in the waning days of this year's session.
Senate Bill 266 would trim the minimum wait insurers can impose before they cover the surgery from 18 consecutive months to six. It also adds a host of other bariatric-friendly measures.
"This is sort of a ground-breaking bill in a lot of respects," said Dr. Steven Clark, a local bariatric surgeon.
Clark does most of his work at St. Francis Hospital & Health Centers, one of four Indianapolis hospital networks that have added bariatric programs since 2000. The others are Wishard Health Services, Community Health Network and Clarian Health Partners.
Those providers joined existing programs at St. Vincent Carmel, Johnson Memorial Hospital in Franklin and some smaller local facilities to perform 1,818 bariatric surgeries in 2004, a 115-percent increase over 2000 totals, according to the latest statistics from the Indiana State Department of Health.
Surgeons say they're not sure how much higher the volume will climb if the bill becomes law. But they say the measure definitely will help those who perform and receive the procedure.
Others, however, worry about the financial impact of a bill that makes it easier for people to receive a surgery that can cost more than $26,000.
"Our opposition to that is this is going to do nothing but drive up the cost of health insurance for everyone," said Shawn Gibbons, president-elect of the Indiana State Association of Health Underwriters, which favors the 18-month wait so patients can try less-expensive alternatives first.
Bariatric surgery reduces or restricts the stomach of morbidly obese patients.
Most insurers require a waiting period before a patient can receive the surgery. The length depends on the patient and helps determine whether someone can make the changes in diet and exercise needed for such a life-altering operation, said Andrew Stoner, a spokesman for Indianapolis-based M-Plan Inc., which is Shaul's health insurer.
"The value is making sure you have good candidates for surgery who can be successful," Stoner said.
Dr. Samer Mattar, medical director of the Clarian Bariatric Center said a sixmonth wait is sufficient for that.
People who are more than 100 pounds overweight have little luck with diets and other forms of weight loss, said Dr. Dana Lindsay of the Johnson Memorial Bariatric Center.
"Studies have shown again and again the only thing that works long-term for morbid obesity is surgery," she said.
Lindsay has had patients die from heart attacks or strokes while awaiting insurance coverage for bariatric surgery.
"It's very frustrating. We don't have cardiac patients wait," added Ted Eads, director of the St. Vincent Bariatric Center of Excellence, which performed surgery on 1,500 people last year.
He noted that a lengthy wait can become a roadblock for patients, some of whom can't afford the $1,500 to $3,000 cost of the medically supervised weight loss that accompanies it.
Mattar considers the state bill a "huge victory." He also cites elements beyond the wait reduction.
One amendment would provide confidentiality for doctors when they report complications or adverse events to the state Department of Health, which then makes the data available to the public.
"We were concerned that if surgeons took on these more challenging patients who actually need the operation more than anyone else, then they would be penalized because they have more complications than anyone else," he said.
Another amendment would require doctors to report weight loss and other medical changes in patients after they have the surgery, which makes sense to Lindsay.
"Only reporting the bad doesn't show the tens of thousands of people who get help," she said.
One of those people motivated state Rep. Carolene Mays, D-Indianapolis, to support the bill. She said a constituent of hers had the surgery, has lost 130 pounds so far and recovered from diabetes, highblood pressure and cholesterol problems.
"She's completely healed from everything, just from the loss of weight," Mays said. "I think it's a bill that's going to save lives."
The bill also would require surgeons to explain their operations in detail to patients, including side effects and possible complications. That helps satisfy a concern of state Sen. Patricia Miller, RIndianapolis, who doesn't want people to see bariatric surgery as a "magic bullet" for weight loss.
"Part of this bill is consumer protection, to make sure people understand what they're getting into," said Miller, who wrote the original bill and chairs the Senate's Health and Provider Services committee.
St. Vincent, which runs the largest bariatric program in the state, draws patients from as far as Louisville and Dayton, Ohio. Patient volume growth has flattened over the years, due in part to the start of other programs and the difficulty getting patients approved for the insurance coverage, Eads said.
The bill could increase surgery volume at St. Vincent, he said, but the bottom line is "it's going to benefit the patients."
And there are a lot of potential patients to benefit. Clark estimates that between 5 percent and 8 percent of Indiana's population of more than 6 million people is morbidly obese.
In Indiana and nationwide, there are roughly 10,000 bariatric surgery candidates for every surgeon, he said.