St. Joseph tells 169 more patients they may have had unneeded surgery

Number of patients in stent case reaches 538

hospital could be fined millions

March 10, 2010|By Robert Little | Baltimore Sun reporter

St. Joseph Medical Center in Towson, facing lawsuits and a pair of federal investigations related to its cardiac care business, has informed another 169 heart patients that they received expensive and potentially dangerous treatments they might not have needed.

The additional cases, announced Tuesday, bring to 538 the number of patients notified by St. Joseph that coronary stent implants they received at the hospital might have been unnecessary. Hospital officials also said an internal review of patient records is continuing, and that more questionable procedures could be uncovered.

The St. Joseph's announcement was the latest flare-up in an issue that has already spawned a class action lawsuit, prompted the removal of a prominent physician and elicited the interest of the U.S. Senate. It also could result in a multimillion-dollar fine for the hospital, according to court records.

The hospital began investigating its heart catheterization practices after receiving warnings from a patient and from federal investigators last year, and quickly focused on stents implanted by Dr. Mark Midei, a leading cardiologist and one of the hospital's senior physicians.

Stents, mesh tubes that are threaded into damaged arteries to prop them open, are generally considered appropriate when vessels have at least a 70 percent blockage. But hospital officials say their review uncovered stents implanted by Midei in patients with insignificant blockage. And attorneys representing some patients say the amount of blockage was often overstated in their medical records.

"Leaders of [St. Joseph] felt it was their ethical responsibility to notify these patients to allow them to determine if medical follow-up was appropriate," the hospital said in a statement Tuesday. St. Joseph officials reiterated that Midei, who no longer works at the hospital, is the only physician under investigation.

A spokesman for Midei declined to comment. He reiterated a statement the doctor issued in January, which read: "I am confident that I have always acted in the best interest of my patients, and when all the facts are presented, I will continue providing quality medical care to my patients."

A former employee of MidAtlantic Cardiovascular Associates, the dominant cardiology practice in suburban Baltimore, Midei was recruited to lead the cardiac catheterization laboratory at St. Joseph in 2008. His departure helped scuttle a deal MidAtlantic had to merge with St. Joseph rival Medstar Health, and prompted the practice's chief executive to tell Midei: "I will spend the rest of my life trying to destroy you personally and professionally," according to court records.

The troubles at St. Joseph began soon thereafter. Federal investigators subpoenaed business records from St. Joseph and MidAtlantic in mid-2008, beginning a Medicare fraud investigation that the hospital settled last year. Details of the settlement, including a fine estimated in court records to exceed $5 million, are expected to be announced soon.

The hospital says it enlisted a group of outside cardiology specialists to review records from stent patients, and they quickly focused on Midei. The hospital sent 369 letters to patients late last year notifying them their stents might have been inappropriate and encouraging them to call their doctors. Several lawsuits have since been filed on behalf of patients.

Last month, two senior members of the U.S. Senate Finance Committee called on St. Joseph to turn over records of its financial relationships with stent manufacturers, including records of how the $10,000 procedures were billed to federal and private insurers.

"In addition to putting patients' lives at risk, unnecessary medical procedures amount to wasteful spending of precious federal health care dollars," they wrote in a letter to the hospital.

Since Midei's problems began, many of his patients have surfaced to speak out in his defense. The Web site, which says it was started by friends without Midei's knowledge or assistance, has numerous posts from patients and colleagues describing lifesaving procedures he performed, and decrying the lawsuits and legal advertisements that use his name.

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