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On The Mend

On The Mend
by Susan R. Miller

Less than five hours after hernia surgery, Miami entertainment lawyer Ira Abrams was having lunch with a colleague.  Five days later, he was back in his office, looking forward to resuming his regular exercise routine the following week.

“My recovery … feels almost miraculous.  It happened in quantum leaps,” Abram says.

Workers’ compensation insurers and employers long have looked for ways to cut the $3 billion a year cost incurred from hernias, a rip in abdominal muscles that each year sends 750,000 people, mostly men, to the operating room.

Dr. Arthur Gilbert, a South Miami surgeon, may have found a way.

Traditionally, the tears were sewn up, subjecting people to possible new tears in areas, weakened by pulling together the muscle and to additional costs for workers’ care.  The price of hernia surgery ranges between $4,000 and $4,500, but it is higher when a second surgery is needed.

But Abrams was treated with a new technique designed to eliminate the need for second surgeries.  Developed in a year-and-a-half by Gilbert, the procedure has workers’ compensation insurers and employers saying it can save them thousands of dollars per employee.  For its inventor, the “Gilbert patch” procedure has brought renown in medical circles but has resulted in no great payoff for the low margin work. He neglected to patent it.

Meshed together

Marketed by Ethicon, a division of health care giant Johnson & Johnson, the double-sided piece of polypropylene mesh acts as a plug.  Unlike traditional hernia surgery that uses stitches to hold together the abdominal wall, this patch provides tension-free support both above and below the tear, thus reducing the risk of a second tear in the weakened area.

“It’s like jumping out of a plane and wearing two parachutes, if one fails I have the other.  The thing applies to this mesh,” says Gilbert, who is president and surgical director of the Hernia Institute of Florida Inc. on the campus of South Miami Hospital.

Though other companies have developed similar patches, Gilbert claims none is double-sided or covers as large as area as the mesh he helped design.

He began using mesh materials in his hernia surgeries in 1984.  Fifteen years later, he performs about 20 surgeries each week and about 1,000 a year using his newest design.

Although a few other centers specialize in hernia repair, the Hernia Institute is the largest in Florida and performs the most surgeries each year.  The institute is a private company that doesn’t release revenue figures.

Patients come from across the country and abroad to undergo the surgery using the “Gilbert  patch,” which is marketed by Ethicon as the Prolene Hernia System.

Guarded Condition

Ethicon is more cautious than Gilbert when it comes to espousing the product’s benefits.  Lorie Gawreluk, Ethicon’s manager of public relations, says the company only recently initiated a study to determine whether the product saves people from second surgeries.

“One of the challenges is the recurrence rate, and our hope is that we will prove over time that the Prolene Hernia System, because of it’s double-wall construction, may reduce the rate of recurrence,” Gawreluk says.

The Ethicon study will track 10,000 hernia surgery patients over 10 years.

Getting Ethicon on board was a challenge for Gilbert, who said he was turned down by the company at least three times.  It wasn’t until a competitor came up with a similar mesh the Ethicon asked for his help, he says.

Pricey Alternative

On the market now for 18 months, the mesh has its detractors.  Some doctors suggest that price tag – about $165 – is high compared with other products that produce similar results.

“I don’t use his system for the reason Ethicon charges to much for it,” says Tampa hernia surgeon Dr. Bill Welch.  He says another treatment kit marketed by Ethicon, which includes everything from the mesh to the bandage to be applied after surgery, costs only $47.

Welch says when it comes to performing hernia surgery, the profit margins are extremely narrow.  “We are down to squeaky bones,” he says.

But Gilbert and those who use his services defend the cost, saying the ultimate savings gained by getting people back on their feet makes it worth the extra money spent up-front.

“Workers’ compensation insurance works best when the employees are able to have their injuries treated in the most effective and speedy way possible,” says Gregory Quinn, media relations coordinator for the Boca Raton-based National Council on Compensation Insurance (NCCI), an industry organization that gathers and analyses workers’ comp data.  “Anything that speed up the healing process is good for everybody.”

Traditional surgeries have a 12 to 15 percent failure rate and keep patients out of work for as long as two months.  Gilbert claims his rate of recurrence is less than one-half of 1 percent and his patients are back on the job within two weeks.

Getting workers back on the job more quickly can save employers thousands, said Bill Tuttle, a workers’ compensation supervisor for Crawford & Co., a third-party insurance administrator in Fort Lauderdale that sends many of its hernia patient to Gilbert.

“It saves about $3,600 to $4,100,” Tuttle says.  “Some general practitioners keep their [hernia surgery] patients out four to six weeks, while patients who go to the Hernia Institute are usually back to work within a week..”

Gilbert’s clients include several large Florida companies such as Publix and numerous municipalities.  The Miami-Dade County School Board sends most of its workers’ compensation hernia patients to Gilbert.

Scott Clark, executive director of the school board office of risk and benefits management, said Gilbert and the other two doctors there charge the board a “global fee” starting at $4,100 per procedure.  If the cost exceeds that amount, the institute eats the additional charges.

No patent for Gilbert

Though he makes money on the surgery, Gilbert doesn’t make any money on his invention.  He said that while the patch was his design, he didn’t think to patent it.

“When people told me I was folding my mesh a certain way and asked why I don’t patent it, I though they were kidding me,” Gilbert says.  “I didn’t realize you could take wire, fold it three times, patent it and call it a paper clip.”

Instead, Gilbert makes money as a paid consultant for Ethicon.  He travels extensively teaching doctors how to perform the surgery using his patch.  He is so confident that the surgery will work, Gilbert gives his patients a one-year guarantee.

“We tell them that if our repair doesn’t hold up, we are prepared to do this for them at our own expense,” he says


The “Gilbert patch” (left and middle) is a double-sided piece of mesh that acts as a plug over the hernia. Miami lawyer Ira Abrams, right, called his recovery ‘miraculous’.
Susan R. Miller – Miami Daily Business Review, Thursday, July 8, 1999 – Vol. 74, No. 20


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