March 24, 2002

News 3 Investigators Sight for Sale,
Pt. 1

LAS VEGAS, February 27, 2002Darcy Spears reporting

Can you see clearly without glasses or contact lenses? Many people can't. In fact, more than a million people turn to lasik surgery each year to correct their vision. One of the largest national chains of laser eye surgery centers has a booming business here in Las Vegas, but News 3 investigator Darcy Spears found that this discount center may be pulling the wool over your eyes as they put sight up for sale.Can you put a price on perfect vision? One lasik center puts a very low price on their surgeries, and as the saying goes, you get what you pay for. Our hidden camera investigation exposes what some call a ?money over medicine? philosophy that's leaving patients and former employees seeing red."She basically talked me into it, because it sounded good. Don't have to wear glasses to read or drive," says Gail Kennedy, consumer. Gail Kennedy looked to the Lasik and Laser Vision Institute as freedom from her prison of poor sight. Gail had known people who had successful surgeries there. The problem is, she did not."It's been 11 months since my surgery and my eyes have hurt me every day, every night," says Gail. Gail says she still needs reading glasses and can't really see any better."It?s almost like the nerve endings have been damaged and they're severely dry." Dr. Jon Siems was the staff surgeon at LVI in Las Vegas for almost two years. He and at least five other staff members recently left because of what they call the money over medicine mentality."Salespeople had to meet certain quotas to maintain their jobs or else they'd get released. Optometrists had to see a certain number of patients every day, physicians were supposed to perform a certain number of surgeries a day," says Dr. Siems.Internal records obtained by the News 3 investigators show LVI staff can get commissions depending on how many patients they sign up each week. LVI optometrist Dr. Lesa Davis acknowledges the pressure. "The counselors are the ones under pressure to see as many patients as they can, or have me see as many patients as I can," Dr. Lesa Davis."It presents an issue of conflict of interest, doesn't it? If someone's reimbursement is based upon whether or not you decide to have the surgery or not, there's a potential risk that the counseling role might be tainted by that incentive," Dr. Wayne Bizer of the American Academy of Ophthalmologists.We sent a producer with a hidden camera for the advertised free consultation. Here's what a salesperson, called a patient counselor, told her. Keep in mind, this person has no medical degree. "For this consultation, what did this tell me? That I'm a candidate?" Asked our producer."You're basically a good candidate for the surgery. Obviously I can't determine it without seeing exam results, but based on your prescription and your age alone, yes, you're a very good candidate for the surgery. If you were not a good candidate for the surgery, I wouldn't let you go on," said the consultant. But just to see a physician, patients first have to put down a non-refundable $100 deposit, based on advice from a salesperson."The company's policy is that the only one that can make the decision as to whether or not somebody's a candidate is the physician," says Matthew Zifrony.No one from laser vision institute's corporate offices would go on camera. Their lawyer says the Las Vegas LVI staff was not following procedure."If the company's policies are not being followed and we have reason to believe that, then we will take the appropriate action to see that they are followed," says Zifroni.That's too little, too late for some."I think there's a lot of other people out there like me and I?ve wanted for a very long time for something like this to happen, because I think it needs to be heard," says Gail.Gail Kennedy isn't the only Las Vegas LVI patient who's had problems. You'll meet more in the continuing coverage of this story. LVI's attorney asked us to point out that there are plenty of happy laser vision institute patients. During the last half of 2001, LVI performed procedures on about 1,000 patients. Eighty-one of those, or approximately 8 percent, filled out a patient satisfaction survey and almost all of them thought their treatment was good or excellent.Local experts and ophthalmology surgeons we spoke to say that the industry standard is for patients to get a free eye exam from a doctor to determine candidacy before they start spending money on the lasik process.

Part 2

LAS VEGAS, February 27, 2002Darcy Spears reporting

What happens when corporations try to control medical care? A local surgeon says it becomes a ?money over medicine? mentality. That's something that's thriving here in Las Vegas at discount surgery center, Laser Vision Institute. Who would you want telling you whether you were a candidate for laser eye surgery? A salesperson? A corporate business executive? Probably a doctor. But we found that may not be the case at one center, where sight is for sale.Having an eye operation is serious business. You want to make sure your doctor is in complete control.But lack of control is one of the reasons Dr. Jon Siems says he left Laser Vision Institute after almost two years. "Really my primary concern that I had, as well as many other physicians that were associated with this institute, was an excessive amount of pressure that we treat all patients that came in--and really patients that I deem not even proper candidates for the lasik procedure. They were trying to pressure me into treating those patients," says Dr. Siems. We decided to put that pressure to the test with our hidden camera. We start by having this News 3 reporter examined by local ophthalmology surgeon Dr. Paul Hiss."Amy has several reasons why she would not be a good candidate for a refractive procedure, especially lasik. Number one, she has extremely dry eyes. And she has very large pupils, which would increase her probability of getting a lot of glare from lights at night. But the most compelling reason is that she has warpage of the cornea," says Dr. Hiss. Something he and a second expert diagnose as a degenerative eye disease."There isn't a surgery that can help her see any better," says Dr. Hiss.Armed with that information, she heads to Laser Vision Institute."With your prescription, I?m sure you know you're extremely high with a pretty high astigmatism. You do fit the parameters for the surgery," says the patient counselor, Jill.The patient counselor passes her on to the next step. Amy has to pay $100 to secure her exam time and $200 more on exam day, where she spends two hours and sees three different people, including optometrist Dr. Lesa Davis. "You?ve got a lot of astigmatism, you've got a lot of nearsightedness, you've got every strike against you for the surgery as far as the laser vision institute goes with prices," says Davis. Price seems to be the only problem dr. Davis diagnoses. "You happen to be in luck because you have thick corneas," says Dr. Davis. Remember what our expert said?"Operating on a cornea that already has instability would only add to more instability," says our expert, Dr. Hiss.But according to LVI, "you're a good candidate for the surgery. You're chances of needing an enhancement are fairly high due to your prescription though, so it may take two surgeries to get you to see perfect," says Davis on our hidden camera.There's no mention of Amy?s condition or any medical concern at all. We sat down with Dr. Davis to ask why she approved Amy for surgery."She actually wasn't approved for surgery," says Davis in our interview.What about this?"You?re ok to schedule for surgery, so follow me," the hidden camera footage says. Her explanation? They actually weren't done with Amy."Was she scheduled for a re-check prior to surgery?" Asked reporter Darcy Spears."She should have been," says Davis. She wasn't. She was sent to the desk to pay her $200 exam fee and schedule surgery."As soon as a patient gets to the front desk, I have no call," says Davis. This was the call she made at the front desk. Dr. Davis to front desk on hidden cam: "She's ok to schedule for surgery."Dr. Davis maintains Amy?s condition would have been caught."Are you saying that after buying the medications, going through the prep, being out of her contacts, coming in the morning of her surgery, that day, someone would have said, ?I?m sorry, we can't operate on you??" Asked Spears."Absolutely," says Davis."Isn?t that too easy to say in hindsight?" "You can always say that, but there has not been one patient who has slipped through who shouldn't have had the surgery under my care," says Dr. Davis.LVI corporate attorney Matthew Zifrony says Dr. Davis doesn't have the authority to decide who should have the surgery. Zifrony says that whether a patient qualifies for lasik or not is up to the surgeon, who patients typically don't meet until the day of their surgery."Up until that time, the patient would not have been told or should not have been told that they are a candidate by anybody, because the company does not give anybody the authority to tell the patient that they are qualified other than the physician," says Zifrony.That physician is Seattle-based surgeon Dr. Joseph King. In a memo just sent to News 3, he agrees that Amy should have been re-checked even though he never examined her. He says he may have decided to cancel Amy?s procedure the morning of her scheduled surgery. Dr. Siems says the doctors didn't have the last word. That, he says, came from the corporate office."If they looked through the charts and saw that they felt they thought this was a candidate, they would call us up and inform us, or at least ask us why this patient had not been treated because they felt they were candidates," says Siems."To my knowledge that has never happened and to my knowledge that will never happen because the company's interest is to keep the patient's well-being paramount to everything else. It is not to put the company's interests first and foremost," says Zifrony.Dr. Lesa Davis has only been licensed in Nevada for one year. She has a clean record with the state. There's LVI doctor who we found operating on the wrong side of the law. We'll uncover that as our investigation continues on Friday. LVI's parent company has been in trouble with the Nevada attorney general for their advertising. On Friday, Darcy will also look at what the ads offer, versus what they deliver.

Part 3

LAS VEGAS, March 1, 2002
Darcy Spears reporting

Marketing medical procedures is controversial, but low-ball ads for laser eye surgery are everywhere. In her continuing coverage, News 3 investigator Darcy Spears exposes some lasik ads promising more than they deliver.
Experts in the eyecare community say that one laser surgery chain that provides low-cost care is compromising medical ethics. They say selling sight like a commodity diminishes the entire role of professional healthcare.
The ads are eye-catching. $499 an eye, $299 an eye, no interest, no payments till August 2002!
"It should not be like buying an appliance or a car," says Dr. Hiss.
The ads are for lasik eye surgery and they help the Laser Vision Institute bring plenty of potential patients in the door.
"Makes me wonder how they can afford to provide quality care at such a low price," says Dr. Wayne Bizer of the American Academy of Ophthalmologists.
Former LVI surgeon Dr. Jon Siems says it's because almost no one gets that price.
"The $299 once again is kinda the bait and switch model that very few people actually qualify for and really the attempt is to just lure you in for the $299 and then get the price up to a higher level," says Dr. Siems.
"The advertisements are very clear that the price that's being advertised is limited to a qualified patient. It's not deceptive in any way," says LVI's corporate attorney Matthew Zifrony.
We couldn't find any patients who qualified for the advertised prices, from Las Vegas.
"Instead of costing $1000, it cost me $1800," says Doreen Gore, customer.
"I said, ?hey you can't charge me $1,800! You have it advertised in the newspaper for $995!? I said, ?what seems to be the deal here??" says Florida customer, Richard Bennetti.
Richard Bennetti's deal was finally done after some haggling, for $1200 an eye.
We even sent one of our producers to see if she qualified, after having her checked by a local expert, ophthalmology surgeon Dr. Paul Hiss.
"She has ideal eyes for refractive surgery. She has good curvature, good thickness, she has a relatively low prescription," says our expert, Dr. Hiss.
But would it be low enough?
"Your prescription's a little bit higher than what they require for $299," the patient counselor tells our undercover producer.
He tells her that if she pays more, she'll get better follow-up care.
In fact, once they get you in the door and sign you up for much more than the advertised price, they sell you on something else that drives the price even higher.
"If anything happened and we needed what they call enhancement, for $300 extra any enhancements that we needed for a lifetime would be included in that policy," says Doreen Gore.
"A lifetime guarantee is almost meaningless because the chance that the center is gonna be around in 20 years is almost zero probably," says Dr. Siems.
Doreen Gore says she tried for six months, but couldn't get LVI to schedule her enhancement. Her eyes just kept getting worse.
"It?s based on availability and nothing more. The policy of the company is to honor that lifetime guarantee with every patient," says LVI attorney, Matthew Ziffrony.
"I think that they don't care once they had my money. I don't think that it was important to them whether or not they did the follow-ups on me," says Doreen.
The American Academy of Ophthalmologists says there's another problem with the lowball pricing, called co-management. That's where a patient sees an optometrist for exams, but doesn't get to meet the surgeon until the actual day of surgery. The current and former LVI surgeons don't even live in Nevada.
"I have concern about the low end of patients giving up the opportunity of being with their ophthalmologist, with their surgeon. Of having met the surgeon before the procedure; having straight and direct access to the surgeon, and a surgeon being there, in town and available now, next week, next year in part of an ongoing practice," says Dr. Bizer.
Gayle Kennedy says she's had nothing but problems since her surgery, from severe dry eyes, to difficulty driving, to major discomfort.
"I still can't read any better than I did before. My eyesight has tested about the same as before the surgery so I?ve seen no improvement. I'm just very unhappy with it," says Gayle.
She thinks that if she'd met the surgeon beforehand, she might not have had the procedure at all. "It should have been done differently and I?m gonna pay," says Gayle.
"My judgment is there's a big problem with that. And that is that your doctor's not available for you if you have a problem. Laser vision correction is a wonderful procedure but there are complications that occur. The only doctors who don't have complications are the ones that never see their patients again, or people who just frankly lie," says Dr. Bizer.
Things can indeed go very wrong when patients don't see their surgeons until the day of surgery.
The Las Vegas Review Journal carries the Laser Vision Institute's ads almost every Sunday. The RJ display ad department says each one of these ads cost nearly $10,000.

Part 4
LAS VEGAS, March 1, 2002Darcy Spears reporting

When you have surgery you expect follow up care, but News 3 investigator Darcy Spears found that if you have problems after lasik surgery at one local center, your doctor probably won't be just a phone call away.Out of town surgeons fly in and do surgeries and exams for a few days, then fly out. It's a corporate medicine concept used by the Laser Vision Institute. They say it guarantees patients the best care, but we found that care isn't always coming from a properly licensed doctor when sight is for sale. When it comes to doctors, Laser Vision Institute's doors have been opening and closing almost constantly. The company is now on its third doctor in just five months.Just who are LVI's surgeons? Dr. Jon Siems was one of them, but he recently left. One of his concerns was the company's advertising. LVI's ads say their doctors are among the most experienced lasik surgeons in the country. Dr. Siems says something else. "When I was originally associated with this corporation, I trained the majority of the physicians who ended up treating for laser vision institute. And even though it says we only employ the most experienced physicians with regards to their lasik history, my experience was that most of the physicians had very little if any experience with lasik in their past," says Dr. Siems. With Dr. Siems gone, LVI is advertising new surgeons. Their most recent ads list Dr. Joseph King, a Seattle-based surgeon. Before him, Dr. Robert Selkin whose home was near Dallas, Texas. Dr. King checks out just fine with our state board. But Dr. Selkin?"Dr. Selkin's not here right now. He's supposed to be. He had some family medical emergencies and Dr. King's sort of filling in for him," says an LVI patient counselor. That's not true, according to LVI's attorney."The company immediately stopped using Dr. Selkin's services," says Matthew Zifrony, LVI's corporate attorney. When LVI was touting Dr. Selkin's expert surgery skills, the state board of medical examiners shows that Dr. Selkin was not legally allowed to practice medicine in Nevada. "This is not only unethical, this is illegal. It should be of grave concern to everybody that this is occurring. Now whether that occurred because the corporation was negligent of looking into the background, or simply acknowledged it and simply sent the person up here, either way, that is a grave decision to be making and should not have been done," says Dr. Siems. "As soon as the company learned that it had been missed, the company immediately took corrective procedures to prevent Dr. Selkin continuing to practice performing surgeries for the company given that the company learned that Dr. Selkin was not properly licensed," say Zifrony.The problem is that Dr. Selkin operated on Las Vegas patients without an active Nevada license. Optometrist Dr. Lesa davis worked with Dr. Selkin. "I know he's an excellent surgeon. A piece of paper is not gonna determine whether he's gonna give good patient care or not," says LVI doctor Lesa Davis. Whether those who work for LVI give good patient care has been questioned in the past at centers across the country. And not just at LVI. The three brothers who own Laser Vision Institute also own the chain Eyeglass World. They were recently fined half a million dollars after the Florida attorney general accused them of:- Pressuring optometrists to issue unnecessary prescriptions- Selling outdated, used and non-sterile contact lenses- Intentionally misquoting prices over the phone- Bait and switch advertising- And failing to have a licensed optician on premises at all times.Nevada's attorney general has sent two cease and desist letters to a Las Vegas Eyeglass World store because employees misrepresented themselves as licensed opticians. Dr. Selkin isn't the only doctor who illegally practiced at the Las Vegas LVI. Another surgeon based in Washington D.C. performed lasik surgery here while not actively licensed to practice medicine in Nevada. If you want to check out the lasik industry from all sides, you can visit the website of a watchdog group called surgical eyes.