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Medicare pays less than private insurance - the payment varies by state - but it is still lucrative.
Before turning 65, many people are uninsured or have insurance that does not cover shock. Once someone qualifies for Medicare, the chance of getting shock therapy soars - as the 360% increase in Texas shows.
Stephen Rachlin, retired chairman of psychiatry at Nassau County (N.Y.) Medical Center, believes shock therapy is useful treatment. But he worries that financial rewards may influence its use.
"The rate of reimbursement by insurance is higher than anything else a psychiatrist can do in 30 minutes," he says. "I'd hate to think it's done solely for financial reasons." Psychiatrist Conrad Swartz, co-owner with Abrams of Somatics Inc., the shock equipment manufacturer, defends the financial rewards.
"Psychiatrists don't make much money, and by practicing ECT they can bring their income almost up to the level of the family practitioner or internist," says Swartz, who performs shock himself.
According to the American Medical Association, psychiatrists earned an average of $131,300 in 1993.
A doctor says 'no'
Michael Chavin, an anesthesiologist from Baytown, Texas, participated in 3,000 shock sessions before he stopped two years ago, worried he was hurting elderly patients.
"I began to get very disturbed by what I was seeing," he says. "We had many elderly patients getting repeated shocks, 10 or 12 in a series, getting more disoriented each time. What they needed was not an electroshock to the brain, but proper medical care for cardiovascular problems, chronic pain and other problems." In Chavin's view, when the cardiovascular system is dramatically stressed in the elderly, doctors risk triggering a fatal decline.
"As an anesthesiologist, what I do for three to five minutes can have serious consequences later," Chavin says. "But psychiatrists cannot bring themselves to admit any harm from ECT unless the patient gets electrocuted to death on the table while being videotaped and observed by a United Nations task force.
"These deaths are telling us something. Psychiatrists don't want to hear it." Chavin, then chief of anesthesiology at Baycoast Medical Center, stopped doing shock in 1993, reducing his income by $75,000 a year.
He says he feels ashamed that his waterfront home and pool were partially financed by what he considers to be "dirty money." In spite of his growing doubts, Chavin didn't quit doing shock right away. "It was hard to give up the income," he says.
First, Chavin turned away patients. "I'd tell the psychiatrist: 'This 85-year-old woman with high blood pressure and angina is not a good candidate for repeated anesthesia.' " Then, to confront his doubts, he began looking at the research on shock therapy. "I found it was done by psychiatrists who do electroshock for a living," Chavin says.
He finally quit doing shock and another anesthesiologist took over. Two months later, on July 25, 1993, a patient named Roberto Ardizzone died from respiratory complications that began as he received shock therapy.
The hospital stopped doing shock altogether.
By Dennis Cauchon, USA TODAY
next: Shock Treatment Therapy
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