Lawyers see St. Joseph's stent claims growing

Hospital notified 585 patients of unnecessary procedures, but still more are coming forward

May 22, 2010|By Robert Little, The Baltimore Sun

The story Frank Ward tells about his medical history would sound familiar to just about any malpractice attorney in Baltimore.

He went to St. Joseph Medical Center for a heart procedure, Dr. Mark Midei put a stent in his artery after finding a blockage, and now another doctor says the blockage was insignificant and the stent wasn't necessary. A total of 585 patients have received letters from St. Joseph describing similar scenarios, after the Towson hospital reviewed the last two years of Midei's cases.

"I feel betrayed," said Ward, a 50-year-old courtroom constable from Perry Hall.

But similarities aside, Ward's case also represents a whole new category of potential problems for St. Joseph, and it suggests that the hospital could be facing legal claims from many more of its former patients.

Ward's cardiac procedure was performed five years ago, outside the two-year window the hospital chose to investigate. And he didn't learn of the doubts about his procedure in a letter from the hospital; he had his medical records reviewed on his own, through his attorney.

Midei denies any wrongdoing, and his lawyers argue in court papers that the news media and fee-hungry attorneys have inflated the issue beyond reason. Still, local malpractice lawyers already have a term for Ward's type of claim against St. Joseph — "non-letter cases" — and say they expect to see many more.

"If there were 600 cases over the last two years, how many have there been over the last five? Or since Dr. Midei started working at St. Joe's?" asked attorney Briggs Bedigian, who represents Ward and several other St. Joseph patients. "There could be thousands."

"When I heard that St. Joe's had concluded its review, I was kind of stunned. There's no logic to stopping at two years, or three years," said attorney Andrew G. Slutkin, who represents several patients who did not receive letters. "If it were me, I would want to know if I had a stent that wasn't necessary, no matter how long it had been."

St. Joseph's officials, who began investigating Midei's records after receiving a complaint in April last year, say they quickly sent letters to patients alerting them of the investigation's findings so they could contact their doctors. Cases reviewed by The Baltimore Sun all followed the same pattern: A patient's medical records described significant blockage of an artery before a stent was placed — 90 percent, for instance — but the subsequent review found insignificant blockage — perhaps 20 percent.

The two-year time span of the review came at the recommendation of independent medical experts hired to conduct the investigation, hospital officials said.

"If there were going to be any complication, it would have manifested itself within that two-year period," the hospital said in a statement released Friday to The Sun.

Some patients who weren't included in the hospital's review, however, say potential medical complications are only part of the problem.

One of Slutkin's clients, a 68-year-old Parkton man who asked that his name not be used because he did not want to discuss his medical issues publicly, said the two stents he received from Midei in 2005 were the only cardiac treatment he's ever received. For five years he believed he was at risk of heart failure. But a specialist who reviewed his records recently said the 90-percent arterial blockage recorded in his records at St. Joseph was actually a 20 percent to 30 percent blockage, and not appropriate for treatment with a stent.

"How many people out there are just like me, and spent years thinking something was wrong with them that wasn't?" he said. "They should be looking at all their records."

Ward, who received a total of seven stents before having bypass surgery in 2006, had his records reviewed by Dr. Jeffrey Breall, the head of interventional cardiology at Indiana University. After looking at a video taken at St. Joseph of Ward's arteries, and reviewing written records from Midei, Breall concluded that one artery initially described as 70 percent blocked was actually 30 percent blocked — not a candidate for a stent.

"I thought about [my heart troubles] every day. It's the kind of thing that changes your life," said Ward.

"The first time I went away after I got the stents, I remember feeling scared, thinking I was too far away from St. Joe's," said Ward. "And that was just in Ocean City."

Intracoronary stents are mesh tubes that can be threaded into clogged arteries to prop them open. They offer an alternative to open-chest surgery, but they can also cause clotting or other damage.

St. Joseph patients treated outside the two-year window who think they have a case face several legal hurdles, including a statute of limitations that bars claims more than five years old. Under state law, to be successful with an older case the patient would have to prove that fraud was committed.

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