An oncologist who has been treating patients in Great Bend has come under scrutiny, triggered by a complaint to the Kansas Board of Healing Arts from a Reno County patient, according to an investigation conducted by the Wichita Eagle.
Abbyville’s Marian Rank, 70, was diagnosed with a tumor, and said she avoided being treated with chemotherapy, only after she sought additional medical evaluations, according to the story.
Rank had undergone radiation treatment and is taking an anti-hormone pill. Radiation treatment is a concentrated dose that attacks a tumor.
She said her original consultation was done at the Hutchinson Clinic with Dr. Mark Fesen, an oncologist who treats patients full-time at the Heartland Cancer Center in Great Bend.
Fesen has no record of medical malpractice lawsuits or disciplinary action by the Kansas State Board of Healing Arts.
Oncologist Shaker Dakhil, president of the Wichita Cancer Center of  Kansas, advised Rank that the best practice for cancer patients such as her who meet certain criteria is a genetic test called the Oncotype DX, that helps determine whether chemotherapy is necessary.
“If you accept the science and believe that only people who need chemo should be offered chemo, then you should offer the test to the patient.,” Dakhil said.
Rank said she avoided chemotherapy after she took a Oncotype DX test that helps predict the chance of metastasis — when cancer spreads to other organs — for some breast cancers. It tests a sample of the tumor for a group of 21 genes. Along with other prognostic and diagnostic factors, the results of the Oncotype DX test can be used to tailor treatment plans.
If the test shows a low risk of metastasis, the use of hormone therapy alone may be considered. In this way, Oncotype DX helps people avoid chemotherapy and its side effects. If the test shows a person has a higher risk of metastasis, a treatment plan that includes hormone therapy and chemotherapy may be advised.
Rank said she was discouraged by Dr. Fesen from taking the Oncotype DX test, and she didn’t want to be treated with chemotherapy, which Dr. Fesen had recommended.
“Taking the test was the most important thing in my life because it kept me from doing chemo,” said Rank, who said the test revealed chemotherapy would not help her.
Chemotherapy’s side effects include fatigue, nausea, vomiting, hair loss, infection, memory impairment, swelling and pain.
“I’m better off not having chemo, which has lasting effects. Chemo is as scary as cancer,” Rank said. “It kills so much of you in order to kill the cancer.”
Rank said the hardest part was having the courage to question a doctor’s suggested treatment and forge ahead with another medical opinion.
“It was very important to me to seek another medical opinion,” she said. “The hardest thing is to question a doctor. But my children insisted I do that.”
Patients should question their doctors, Dakhil said.
“Cancer patients should have complete trust in their cancer physician,” Dakhil said.
She filed the complaint in 2011 through a letter to the Kansas Board of Healing Arts because she wanted to prevent her treatment prognosis from happening to someone else.
Rank said she recently received a letter from the board saying the investigation had been completed. Results are reviewed by the appropriate profession’s review committee and a disciplinary panel. The investigation  is either closed or allowed to proceed for action by the  Kansas State Board of Healing Arts.
The article confirmed that other patients had good experiences with Dr. Fesen.
“His decisions and practices demonstrated to me that he always had the best interests of his patients and his staff in mind,” wrote Jo Murphy, a nurse who was a patient of Fesen’s.  “We respected and trusted him and he respected and trusted us.”
The Heartland Cancer Center is a joint venture between Central Care Cancer Center and Centura Health. Central Care is a comprehensive oncology group that has served the Heartland Cancer Center for the last decade; Centura is the umbrella organization for St. Rose Ambulatory & Surgery Center and St. Catherine Hospital in Garden City.
The Central Care oncologists who treat patients at HCC are  radiation oncologists Claudia Perez-Tamayo, M.D., and Thomas Hegarty, M.D.; and medical oncologists Mark Fesen, M.D., and Greg Nanney, M.D.
“He’s (Fesen) a great doctor. He’s practicing perfectly well,” said Claudia Perez-Tamayo to the Eagle.  “We have zero knowledge or understanding of what Hutchinson Clinic is going through. There’s really nothing that has impacted us.”
Perez-Tamayo told the Eagle that Fesen is a full-time doctor who sees patients insured through Medicare and Blue Cross Blue Shield.
The Eagle reports that the Hutchinson Clinic began investigating Fesen’s practice in 2010 in an independent audit that was not related to Rank’s complaint.
The internal audits in 2010 and 2011 stated that Fesen treated some patients for cancer who apparently didn’t have that diagnosis and “unnecessarily” and “inappropriately” treated others.  Fesen practiced at the Hutchinson Clinic from 1993 to 2011.
The auditor reviewed 108 of Fesen’s cases that were randomly selected.  The audits stated there were compliance issues with the National Comprehensive Cancer Network guidelines, which are generally accepted as the basis for the treatments physicians prescribe.
The audit also reviewed records of the clinic’s other oncologist, Fadi Estephan, and identified no compliance issues.
The auditor questioned Fesen’s means of treating some cancers.
• He did not follow established national cancer-treatment guidelines in about 40 percent of the patient cases reviewed.
• He treated some patients with lymphoma and cancers of the blood “unnecessarily” and “often too early, too much and too long.” The auditor suggested that Fesen should either not be allowed to treat those patients or be required to get board certification in that area.
•  He split doses of chemotherapy and other drugs, without documenting why.
•  He overprescribed support IV therapies, such as minerals and antibiotics, and gave patients with blood cancer an excess number of bone marrow tests. The auditor questioned whether an external insurance audit would find documentation to justify the treatments.
Both audits mentioned the extended use of the drug Rituxan, in some cases for as long as six to eight years. Extended usage can cause kidney, heart, stomach and bowel problems and serious infections that can lead to death.
Fesen told the Eagle that he was prevented by law from confirming or denying claims because doing so would go to the heart of protecting patients’ confidential medical information.
Fesen’s email to the Eagle stated, “My whole professional life has been dedicated to providing the utmost in quality, compassionate, consistent care to my patients, and I categorically and vehemently deny ever doing anything other than that. If someone works harder or longer to care for cancer patients, or to stay abreast of the latest and best medical advances to do so, or to consult with experts nationwide when necessary, I don’t know who that is.
“I am passionate that my patients — no matter what their demographic, geographic or economic situation – have access to the best care I can provide. That is not just what I do, that is who I am.”
Since leaving Hutchinson, Fesen has practiced at Central Care Cancer Center in Wichita. Fesen has hospital affiliations with Wichita’s Via Christi Hospitals, Coldwater’s Comanche County Hospital, Beloit’s Mitchell County Hospital, Scott County Hospital and Garden City’s St. Catherine Hospital in Garden City, according to Medicare’s website.
The 15-member Kansas State Board of Healing Arts  serves as the licensing and regulatory agency for medical doctors and other health care providers.
The Eagle reported that the board received more than 11,000 complaints in the past five years. There were 542 open investigations.  In 2013, the board took about 240 actions against providers.