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Dr Veronikis Written evidence to the Committee - Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill

Written evidence from Dr Veronikis - Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill, 24 November 2021

Dear Convenor,
I hope you are well. I am informed that the Scotland’s Health, Social Care and Sport Committee are discussing legislation in relation to mesh removal surgeries and reimbursement of costs for treatment abroad.

My attention has been drawn to your Invitation to Dr. Veronikis which was published on the Committee’s public website.1 I missed this correspondence. May I politely suggest that your staff feel free to resend an email correspondence if I do not respond with confirmation back that the email has been received. I must assume that it has been filtered out and deleted as spam mail. This has been my experience.
In the attached Appendix, I have supplied answers to your questions, to the best of my knowledge.

In closing, I apologize for the unintended delay in the response, but trust this information will still be useful to you. I am content for the Appendix information to be published on the Committee’s public website.

Should the Committee require any other information, please feel free to contact me and I am happy to give evidence in person.

Sincerely,

Dionysios K. Veronikis, MD

Appendix

1. How many individuals from Scotland have travelled to you for mesh removal surgery so far?

Ten.

2. How many individuals from Scotland have already entered into private arrangements with you for future mesh removal surgery?

The current uncertainty around the commencement of the NHS Scotland procurement exercise is putting a strain on patients. Since 2018, I have been contacted by Scotland patients who wish me to perform their surgeries. Naturally many hope that they will be sent under the NHS Scotland public healthcare procurement arrangement. This is the best outcome for them. Their care is not dependent on their means. Currently, almost all put their plans on hold and are waiting for NHS Scotland.

Others are booking their surgeries and financing the costs privately. One patient has surgery on November 26, 2021. They too hope that they will be reimbursed for this expenditure. These patients usually are in so much pain that they do not want to wait any longer for the NHS Scotland arrangement to be operational. An additional concern is that the local MDT will not respect their choice of surgeon. Within this group of patients some can organise how to pay the costs of treatment abroad better than others.

Women are uncertain that even if the Reimbursement legislation becomes law, that the cut-off date would not allow them enough time to arrange their surgery with their chosen surgeon.

In short, it is difficult to estimate how many of the women who have contacted me will enter into private arrangements for future mesh removal surgery. If NHS Scotland will send them to me then they do not need to make these private arrangements. If NHS Scotland will not send them, then their decisions will be influenced by the availability of reimbursement

3. When do you anticipate surgeries to start taking place under the new contract with the NHS?

I have experienced ZERO progress in this matter. NHS Scotland has not indicated any information about when patients will be sent to my care.

4. Can you provide an estimate on how many more individuals will come forward to use your services under the new contract with the NHS?

NHS Scotland has not provided an estimate of the number of patients on its waitlist for removal surgery. My understanding is that, given free choice, many mesh injured women will opt to have surgery under my care. It is difficult to recover the number of women who have contacted the last three plus years but twelve come to mind that have reached out several times.

5. We understand that removal surgery can be different for every individual, but can you provide an average cost for complete mesh removal?

NHS Scotland has been furnished with a cost breakdown for my surgical services, i.e., complete mesh removal. Those costs are outlined as related to the mesh implant types and reflect the average surgical hours needed to remove each implant type. The most common are slings. To remove an entire retropubic (TVT like) and transobturator (TVT-O like) is about $15, 000.00 USD which includes, video consultation and review of records, office consult, surgical removal, surgical operating room costs, recovery room costs, 24 hour hospital stay, pathologic evaluation of the mesh, post op care while in the USA and video follow-up.
Abdominal and rectopexy mesh surgeries have additional costs.

6. (a) Can you give us some indication on what makes the surgery so complex or specialised? (b) In your opinion, is it possible that individuals may require any other physical or mental health treatment related to their transvaginal mesh or mesh removal?

(a) I respectfully refer the Committee to my evidence session from Thursday, 22 October 2020 when I appeared before the Scottish Public Petitions Committee.
https://archive2021.parliament.scot/parliamentarybusiness/report.aspx?r=12894
(b) As 6(a) above. On physical therapy, please refer to my comment on page 12.
Mental health is not my specialist area. NHS Scotland will have its own services and mental health experts.

It is not uncommon for mesh injured patients to be distressed and have unmet mental health needs related to their individual mesh journey. In many cases their mental health improves when their implant is removed, despite whatever after-care is needed.

7. Does the average cost of the surgery also cover the treatment of other conditions or circumstances that arise either prior to, in the course of surgery, or post-operatively?

NHS Scotland set out the scope of the procurement exercise. I have provided costs estimates for the surgeries as detailed in the tender and clearly outlined what is included in those costs. The exact scope of additional surgeries needed in the course of the removal surgery would be considered on a case-to-case basis and agreed.
However, if anything else is needed during the course of the mesh removal during surgery, I simply, take care of the situation.

8. Does the cost cover post-operative care and support, and if so, for how long?
Yes. The first 24 hours, any and all issues while they are in the USA, 24 hour call service for any emergency, direct access to me, weekly FU appointments as long as they are in the USA and FU at weekly intervals via electronic means up to six weeks. I still respond to patients years later with questions.

Sincerely
Dionysios K. Veronikis, MD