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After a nearly year-long investigation, the Senate Finance Committee, which oversees Medicare, released a report yesterday concluding that Baltimore cardiologist Mark Midei appears to have surgically implanted cardiac stents into hundreds of patients who didn’t need them.
It’s not that Dr. Midei was incompetent. In fact, he was one of the most sought-after cardiologists in his region. From the Senate’s report, it appears that Midei’s motive was profit. Implanting cardiac stents is highly profitable for cardiologists and hospitals, and Midei was also given perks by stent manufacturer Abbott Labs. When cardiologists perform such procedures regardless of patient benefit, it constitutes cardiology malpractice.
“Hospital patients expect their care to be based on medical need, not profits,” said Montana Senator Max Baucus. “Even more disconcerting is that this could be a sign of a larger national trend of wasteful medical device use.”
Should Doctor’s High Volume of Cardiac Stent Implantations Have Been a Red Flag?
Implanting a cardiac or vascular stent is a major surgery that carries the risk of complications both during the operation and up to a year afterward. Although these stents do save lives, they should only be used on patients with substantial arterial blockage and symptoms such as frequent chest pain.
According to medical records, Midei performed approximately 800 stent procedures in 2005, then increased his volume to an average of 1,200 procedures annually over the next few years. A 2007 internal document from Abbott Labs ranked Midei’s procedure volume behind only five other cardiologists in the Northeast, including those at hospitals several times the size of the hospital he was associated with.
That sharp increase in volume should have been a red flag, according to Dr. William E. Boden, clinical chief of cardiovascular medicine at the University of Buffalo, who authored a 2007 study on the overall effectiveness of cardiac stent therapy.
“For him to have this brisk increase over those years is really unusual,” Dr. Boden told the New York Times.
In April 2009, a cardiac patient of Midei’s raised that red flag, complaining that he had received an unnecessary stent. St. Joseph Medical Center, in Towson, Maryland, where Midei performed most of his surgeries, ordered a review of 1,878 cases from January 2007 to May 2009. The panel found that 585 of the cardiac stents Midei implanted may have been unnecessary. St. Joseph suspended Midei’s privileges, and hundreds of medical malpractice and hospital negligence lawsuits were filed against both Dr. Midei and St. Joseph.
Since cardiac stent implantations can bring in more than $10,000 of revenue per procedure, there is a strong financial incentive for hospitals to encourage them. St. Joseph was willing to pay Midei a $1.2 million annual salary to leave private practice and work for the hospital.
Last month, St. Joseph settled charges that it had paid illegal kickbacks to Midei’s practice in exchange for patient referrals. Although it admitted no wrongdoing, it paid a $22 million fine.
Some doctors say the Midei/St. Joseph case is not isolated, but reveals a degree of inappropriate care at hospitals that is all too common.
Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic, routinely treats patients who have received unneeded stents.
“What was going on in Baltimore is going on right now in every city in America,” Nissen told the New York Times. “We’re spending a fortune as a country on procedures that people don’t need.”
Source: The New York Times, “Doctor Faces Suits Over Cardiac Stents,” Gardiner Harris, December 5, 2010