Rhode Island Lawyer, David Slepkow

In a move that has sparked some controversy, it was discovered that Senator Rand Paul of Kentucky will be seeking treatment for a hernia across the border in Canada. The news emerged in a civil suit that is currently pending in court as Paul is seeking reimbursement for the procedure from the defendant. However, many have accused Paul of making a health care choice at fundamental odds with his long-held views about the free market as it applies to medicine.

RAND PAUL’S INJURY

Paul’s hernia resulted from an incident in which he was attacked by his next door neighbor while mowing his grass. Paul suffered numerous injuries in the attack, including five broken ribs and severe bruises to his lungs. He has been suffering pain daily ever since the incident, which occurred in late 2017. The attack resulted from a landscaping disagreement between the two neighbors as Paul’s neighbor accused the senator of depositing his leaves on the neighbor’s lawn. Paul’s neighbor was charged with assaulting a member of Congress and was sentenced to 30 days in prison. The senator is currently suing his neighbor for damages that resulted from the incident. This particular surgery was listed in the court filings, and the pleadings were available to the public.

THE SHOULDICE HERNIA HOSPITAL

Senator Paul has elected to have his surgery performed at the Shouldice Hernia Hospital. This facility is located in Markham, Ontario and performs nothing but hernia surgeries. It is a private hospital and is one of the few non-public hospitals that are allowed to operate in Canada since it was in business prior to Canada’s modern health care laws. As a result, it was grandfathered and allowed to continue to operate as private. This hospital does not accept insurance, and patients that are using their services must pay out-of-pocket for any procedures. Paul’s surgery is estimated to cost between $5,000 and $8,000, and he will be the footing the bill at his own expense. Since Paul is already suing his neighbor for damages arising from the attack, he has added this bill onto the amount that he is seeking in the lawsuit as damages.

HERNIA SURGERIES WITHOUT MESHES

The Shouldice Hernia Hospital does not use hernia mesh in any of its surgeries. Instead, it uses its own natural tissue procedure without hernia mesh. There are high rates of complications that are associated with the use of hernia mesh. In many cases, the mesh either becomes infected or moves out of place. This leads to adverse side effects. In some instances, it requires another surgery to remove the mesh and either implant new mesh, or fix the hernia without mesh. One of the biggest issues with mesh hernia repair is that there is a higher rate of recurrence. Up to 20 percent of hernia procedures that are done with hernia mesh require further follow-up surgery. As a result, many patients have filed lawsuits against the manufacturers of hernia mesh. Shouldice claims that its patients only require surgery for recurrence in one percent of their hernia procedures.

NATURAL HERNIA SURGERIES

Shouldice’s procedure relies upon a patient’s own natural tissue to repair the hernia as opposed to using a mesh to cover the affected area. The hospital’s operating theory is only to use mesh as a last possible resort in the rare instance where the patient’s surrounding tissue is not strong enough to support fixing the hernia. In only a handful of cases, the patient’s tissue is heavily damaged or weakened or the hernia is simply too large to fix without mesh. The hospital will also consider the use of the mesh to repair hernia that have recurred several times. However, Shouldice operates from the premise that mesh is not the first option for the best possible surgical outcome given the problems that have arisen from the use of hernia mesh. In fact, Shouldice’s founding occurred over 10 years before hernia mesh began to be used, and they never adopted the practice. Shouldice will not use mesh in a direct inguinal hernia or an indirect inguinal hernia repair. The hospital will almost always administer patients a full IV during surgery in order for patients to be as comfortable as possible during the procedure.

SHOULDICE’S UNIQUE PROCESS

The hospital also uses a unique setup to help patients recover after their surgery. The rooms at the hospital have no televisions. This is consciously done in order to encourage patients to get up and walk around. Early exercise leads to quicker healing and less of a chance of a recurrence of the hernia. This is a more natural type of hernia repair than those that use hernia mesh and have a higher likelihood of long-term success.

THE CONTROVERSY

Senator Paul holds views that can be characterized as free-market libertarian views. He claims that his decision to have his surgery in Canada originated with his free-markets theory. According to Senator Paul, the best option for his surgery existed in Canada so he was simply choosing the most viable option. Paul argues that patients who have the ability to pay for their treatment in cash should be allowed to go wherever they want for surgery. Paul says that his choice to have surgery in Canada reflects his belief in a capitalist health care system.

Some of the controversy surrounding Senator Paul’s decision revolves around an inconsistency with his ardent views. While Paul claims that his choice is capitalist in nature, Canada’s health care system is the antithesis of Paul’s beliefs. Paul has spent a career railing against socialized medicine and state-run health care, and Canada’s system is exactly what Paul reviles. Paul has even go so far as to compare the single-payer system, which Canada’s health care is based on, to slavery. In addition, Paul is one of the leading advocates of repealing the Affordable Care Act, claiming that it represents a government overreach into the area of health care.

The truth is likely somewhere between Senator Paul’s belief and that of his critics. Shouldice Hospital is a private hospital that does not accept insurance and thus, is not a part of the single-payer health care system that Paul loathes. It is a private business that Paul can most certainly patronize. At the same time, Paul is also paying for the procedure out of his own pocket and is not receiving any kind of insurance benefits. However, there is also the perception of hypocrisy, since Paul is travelling to Canada to have a surgical procedure in a country with a health care system that he has criticized. Coming in tandem with his opposition to the current health care laws in this country, it may not put Paul in the most favorable light. The appearance is that Paul is traveling to Canada to pick the most favorable procedure. In addition, while he may receive damages from his assailant, he also has access to better health care than the average American since he is a doctor and a Member of Congress.

What is likely to be certain is that Paul will not be one of the hernia recipients that suffer from the complications associated with hernia meshes. He will likely not have any recurrence of the hernia nor will he suffer from an infection since the hernia procedures performed by Shouldice Hospital will not leave him with a polypropylene implant in his abdomen.