The North Shore-LIJ Health System Chief Medical Officer Lawrence Smith, MD, today issued the following statement in regards to an independent report about the Department of Neurosurgery’s Chiari Institute produced by James I. Ausman, Professor of Neurosurgery at UCLA, and former chairman of neurosurgery at the Henry Ford Hospital and University of Illinois in Chicago:

Over the past year, the North Shore-LIJ Health System’s Chiari Institute has been the focus of considerable scrutiny, most of it fueled by lawsuits initiated by a single attorney representing patients – many of whom had undergone previous surgeries at other hospitals -- who say they did not benefit from surgeries performed at North Shore University Hospital.

As we occasionally do as part of our ongoing quality review process in all clinical areas, the North Shore-LIJ Health System voluntarily hired a nationally recognized expert to conduct an independent analysis of the Chiari program and its surgical practices. The expert, James I. Ausman, MD, PhD, who received his medical degree from Johns Hopkins School of Medicine, is a Professor of Neurosurgery at UCLA, and the former Chairman of the Department of Neurosurgery at the Henry Ford Hospital and University of Illinois in Chicago. Among other tasks, Dr. Ausman was asked to evaluate the propriety of “occult tethered cord” surgeries performed on some Chiari patients, the criteria used by the Chiari Institute to select patients for surgery, and whether the indications that the Chiari team relied on to determine whether to perform surgeries were reasonable and consistently applied.

Although not requested, the health system shared the full report with the New York State Department of Health (DOH). Based on the findings, the North Shore-LIJ Health System reaffirms its support of the Chiari Institute and its plans to continue and expand the program under the existing model.

Importantly, this decision and review are fully supported by the New York State DOH.

Below is a summary of some of Dr. Ausman’s findings:

• The Chiari Institute (TCI) is the largest center in the world devoted exclusively to studying and treating of Chiari Malformations, which are structural defects in the cerebellum, the part of the brain that controls balance.

• Patients who come to the Chiari Institute are “extensively screened and studied” by a multidisciplinary team of neurosurgeons, neurologists and nurse practitioners to select the appropriate medical or surgical therapy for their problems.

• The patients’ cases and records are evaluated at weekly multidisciplinary meetings, and treatment decisions are made “according to strict protocols and criteria established by the Chiari Institute.”

• Less than 30 percent of patients evaluated at the Chiari Institute actually undergo surgery. As a result, there is no valid argument that TCI attracts patients in order to generate income.

• More than 80 percent of patients at the Chiari Institute improve after treatment.

• The Chiari Institute’s retired director emeritus, Thomas Milhorat, MD, who presently is continuing his research at North Shore-LIJ’s Feinstein Institute for Medical Research, has published more Chiari-related research studies than any neurosurgeon in the world.

• The Chiari Institute used published literature and its own research to improve patient outcomes – an approach called “evidence-based medicine” that is the basis for many medical advances over the years.

• The Chiari Institute relies on “established treatments used by others around the world.”

North Shore-LIJ was especially interested in Dr. Ausman’s impression of the Chiari Institute’s process for evaluating and selecting patients, considering the allegations by some plaintiffs and their lawyer that patients were pressured to have surgery. After observing that only 30 percent of the patients who came to the Chiari Institute were operated on, Dr. Ausman wrote, “In my opinion, this is an outstanding example of a comprehensive, multidisciplinary approach being used in medicine combined with translational research information to achieve the best possible decisions and care for patients. It is a model for other areas in medicine. Those selected for surgery have an extensive discussion with the physician and nurse practitioner about the reasons for (the Chiari Institute’s treatment approach), along with a detailed explanation of the risks and benefits of the surgery… In my experience, this is the most comprehensive explanation of the risks and benefits of a treatment, particularly surgery that I have ever seen professionally. Surgery is performed based on strict criteria for selection. These criteria are continuously improved by added knowledge from (Chiari Institute) doctors and reported studies.”

In regards to surgical outcomes, Dr. Ausman wrote, “Over 80 percent of the patients are improved after treatment, leaving the rest the same or worse. One cannot reasonably expect that a treatment of any medical condition has a 100 percent good outcome, particularly the Chiari Malformation family of disorders in which the diagnosis and treatment course are so complex and variable. It is remarkable that 50 percent of those patients seen at (the Chiari Institute), who have failed previous therapy, are improved after treatment there.”

In conclusion, Dr. Ausman wrote that the Institute “has a high volume of experience in treating Chiari Malformations, excellent results, low complication rates and interdisciplinary care, all consistent with that expected from a world-class medical center. This center is a model for the care and treatment of any disease entity… It is the finest center of its kind in the world treating Chiari deformities.”

Contact:Terry Lynam
516-465-2640/2600
tlynam@nshs.edu