Maryland investigation targets second hospital

Allegations of inappropriate stents at St. Joseph lead to new probe. Regulators won't name the target hospital

September 22, 2010|By Tricia Bishop, The Baltimore Sun

State health regulators have launched an investigation into a second Maryland hospital suspected of performing unnecessary medical procedures like those alleged at St. Joseph Medical Center in Towson, according to a report released Wednesday.

The report concludes, however, that regulators are largely powerless to prevent medical fraud even when they suspect it.

The latest investigation began after regulators reviewed data that shows how frequently Maryland hospitals use cardiac stents to treat heart patients. Dr. Mark Midei, former head of the cardiac lab at St. Joseph, is accused of placing stents in hundreds patients who did not need them, and the data shows the Towson hospital is among the top stent-placement centers in the state.

The report did not name the second targeted hospital, and officials declined to elaborate.

Government officials want to investigate still more hospitals, and found data that suggests a "detailed clinical investigation is warranted," the report says. It also says additional probes have been prevented by "unanticipated difficulties" in their ability to gather information.

"State regulatory agencies alone are not currently equipped, either with sufficient resources or with sufficient scope of authority, to prevent this type of problem from recurring at other hospitals," says the report, signed by state Health Secretary John M. Colmers.

An earlier Baltimore Sun analysis of data from the state's Health Services Cost Review Commission showed that St. Joseph and two other hospitals — Union Memorial in Baltimore and Washington Adventist Hospital in Takoma Park — consistently outpaced all other Maryland facilities in the use of stents, exceeding the state average by 20 percent to 30 percent over the past five years.

Representatives from Union Memorial and Washington Adventist issued statements to The Sun this week, in preparation for the report's release, saying they are focused on patient health and that neither has been contacted in connection with any state investigation.

"All of our procedures, including the stent procedures, are performed according to best practices within the cardiology profession," the statement from Union Memorial said.

Washington Adventist representatives said they "continuously monitor, review and evaluate our procedures to validate the quality and medical necessity of stent placement."

The report's findings are the product of a seven-month investigation into unnecessary medical procedures at Maryland hospitals, spurred by Midei's case. It was produced by several state agencies — including the Office of the Inspector General, the Physicians' Board, the Maryland Health Care Commission and the cost review commission — and calls for several procedural and legislative changes that could enhance the agencies' powers.

Among them is a recommendation to increase information-sharing. Current state laws prevent the disclosure of doctors' names in certain types of investigations to all but a select few agencies – rules that have hindered efforts to regulate medical care, the report says.

It also recommends revamping hospital "peer review" practices to ensure that clinical reviews are conducted whenever suspicious circumstances like a high volume of procedures are encountered, not simply in cases where an error or injury is reported.

"There's lots of room for improvement in patient safety and outcomes in our health care system," Colmers said in an interview, calling the review and subsequent report a first step in restoring confidence in the state's health care system.

"We had hoped that we would be a little bit further along in some of the data analysis work," Colmers said.

Maryland Del. Peter A. Hammen, who chairs the House of Delegates' Health and Government Operations Committee, ordered the state inquiry after reading about Midei in The Sun. The U.S. Senate Finance Committee ordered a similar investigation, which is continuing.

Hammen said he plans to assemble a public working group over the next month to review the recommendations.

"Expect some legislation to come out of this next session," he said, adding that "these are very complex issues."

Midei is one of several physicians in Maryland and around the country accused of overusing stents, which are inserted into blood vessels to bypass blockages.

Earlier this month, a Salisbury cardiologist was indicted on charges of federal health care fraud for billing patients thousands of dollars for hundreds of allegedly unwarranted procedures, including stent placements. Last year, a Louisiana cardiologist was sentenced to 10 years in prison in a similar case.

"Maryland is just the tip of the iceberg," said medical malpractice attorney Jay Miller, who says he represents more than 190 of Midei's stent patients. "This [will turn out to be] a national problem."

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