St. Joseph acts to put stent crisis behind it

Hospital looking ahead despite lingering problems

St. Joseph Medical Center in Towson is caring for fewer heart patients these days, and CEO Jeffrey K. Norman acknowledges that some are avoiding the hospital where a top physician has been accused of implanting unnecessary coronary stents.

After a monthslong internal review, the hospital disclosed in January that 369 patients of cardiologist Mark G. Midei do not appear to have needed the stents they received.

The allegation has been a blow to St. Joseph, ranked by research firm Thomson Reuters among the top 100 heart hospitals in the country. Cardiac care is a key plank of the hospital's business plan. And the drop in admissions in the hospital's specialty follows several years in which the number of admissions overall has been flat at St. Joseph, located in a region with some of the world's best medical facilities.

Norman arrived in the middle of the firestorm, taking over in November after an executive shake-up. The hospital brought in a crisis-management team and mobilized what it has characterized as a swift and comprehensive response.

After outside experts pored over files, Norman and administrators notified affected patients, talked publicly about the problem and tightened oversight of heart cases. Midei stopped practicing and lost his privileges at the hospital last summer and officially resigned in November.

"We want everybody to judge us by our actions," Norman said in an interview at the hospital, a nonprofit founded 146 years ago by Franciscan nuns. "We had a patient complaint, we took action, we did the right thing. ... We'll continue to do that."

Still, the aftereffects of the accusations about unneeded stents are likely to linger.

Last week, Sens. Max Baucus of Montana and Charles E. Grassley of Iowa, the Democratic chairman and senior Republican, respectively, on the Senate Finance Committee, demanded stent billing records and other documents from the hospital, saying that their panel was launching an inquiry as part of its role "to protect taxpayer dollars from waste, fraud and abuse." And lawsuits have been filed on behalf of patients.

St. Joseph also has been the focus of a separate, long-running federal health care fraud investigation into its relationship with MidAtlantic Cardiovascular Associates, the hospital's dominant cardiology practice. Norman said the hospital and federal government came to an "agreement in principle" last year and that he expects to "have that all settled and behind us" shortly. Court records indicate that the hospital will pay a fine expected to exceed $5 million.

But the crisis over cardiology care strikes at the core of what St. Joseph does. Cardiac surgery is St. Joseph's top inpatient service, with more than 3,900 cases in fiscal year 2009, according to Maryland's Health Services Cost Review Commission. Cardiology is No. 2. Doctors there have inserted more than 100,000 coronary stents since 1980.

But now the hospital is seeing a 10 percent drop in the number of people admitted for cardiac care, Norman said. Inpatient and outpatient cardiac procedures - a category that includes stent placement - have dropped 30 percent.

Norman attributes much of that decline to the departure last summer of Midei, the only person implicated by the St. Joseph review. Norman said he senses a "tentativeness" about St. Joseph care among heart patients and cardiologists since the hospital's announcement of its findings.

"Patients are taking a pause; maybe their physicians referring patients are taking a pause," Norman said. "I think we'll regain that trust and we'll regain that volume, but it'll take some time."

Midei was a star physician hired by St. Joseph in 2008 after he had performed surgeries there for years while on the MidAtlantic staff. In 2003, he told The Baltimore Sun that he was performing 1,000 stent procedures a year. Through a spokesman, he declined to comment for this article. He has said previously that he expects to be exonerated.

Stent implantation is a fairly routine procedure, often performed while patients are conscious. But stents - which open arteries blocked by plaque - come with risks of complications. They can't be taken out once put in. And they are expensive.

The patient complaint that prompted the internal review was made a year ago, according to Norman, about the same time that federal investigators delving into St. Joseph's relationship with MidAtlantic Cardiovascular asked the hospital to look into its peer-review process in cardiology.

Since then, the hospital has decided to randomly review all cardiology cases - a change recommended by outside cardiologists recruited to suggest improvements. Random reviews might also be extended to other specialties at the hospital, Norman said.