The association between the hospital and MidAtlantic has at times been contentious, spawning allegations in lawsuits that patient care was improperly guided by financial connections. The federal Department of Health and Human Services, which investigates Medicare fraud and other health law violations, issued subpoenas to both organizations in 2008.
That investigation eventually led to a management shake-up at St. Joseph and also raised "questions about Dr. Midei's high utilization rate" of stent placements, hospital officials have said. About the same time, in April 2009, a patient complained that Midei was placing stents that weren't medically necessary.
When Midei was a St. Joseph employee, cardiology guidelines recommended that stents be placed only in people with artery blockages above 50 percent, which is typically determined from an catheterization X-ray image combined with analysis of clinical symptoms.
But Midei, the complainant said, was allegedly putting stents into arteries with insignificant blockage. St. Joseph removed him from duty in May 2009. His rights to practice at the hospital were suspended in July last year, around the same time that the hospital reached an undisclosed — and as yet unapproved — "agreement in principle" with the federal government to settle the investigation.
The hospital said it hired external experts to review records from multiple physicians and only Dr. Midei's showed patients who "may have received stents that were not supported by their catheterization films."
Midei's lawsuit says the hospital "chose to trump up false charges to make Dr. Midei the fall guy for both the federal government and for the public focus."
Said Midei: "It's been very disappointing to see reviews of my work conducted three or four years — in some instances five years — later, after the procedure was done, where I'm having to make a judgment on the fly at a patient's bedside."
He's accused of purposely exaggerating the level of blockage in patients' arteries to justify stent placement. St. Joseph reviewers — and Midei himself — found significantly lower blockage when they looked at the records than Midei had noted, according to the Maryland Board of Physicians, which oversees doctor discipline and licensing.
"One person looking at the same film twice at two different times may find significant variances in the way that they interpret them," Midei said Thursday. "When two observers look at them, that's even multiplied, and so I don't find it surprising that there is a disparity."
He also said the notion that a precise, percentage-level measurement occurs is faulty. "We do this visually," he said. "It's an estimate, and estimates are prone to discrepancies."
Midei's lawsuit says administrators disregarded favorable testimony from multiple co-workers, along with a recommendation by a colleague that he be reinstated. They also ignored analysis from other cardiologists who said Midei's choices were within recognized standards of care, the suit claims.
The hospital asked him to resign in November and, according to the lawsuit, offered to help Midei find work elsewhere. But soon after, the hospital began sending out the patient letters, initiating a "national publicity event," according to Midei's attorney.
Midei's court filing claims that the mailings violated confidentiality provisions by disseminating the review results, which were faulty because they were based on only a portion of the patient files.
St. Joseph has acknowledged that it "focused only on a single element: the percentage of blockage of the vessel" and "did not undertake a full medical review," which is required to "reach a conclusion that the stent was or was not necessary."
Snyder questioned why the hospital didn't go the extra step of doing a complete review, particularly when so much was at stake. St. Joseph declined to provide an answer to The Baltimore Sun.
"This hospital threw one of its own under the bus, knowing full well that there's variability in the review of these [records], and, even more importantly, without the full picture," Snyder said.
After it suspended Midei, St. Joseph also notified the Maryland Board of Physicians that Midei "displayed a repeated pattern of placing stents in patients based on [his] overestimation of the degree of [arterial blockage]," according to a board document.
The Board of Physicians conducted its own review and this summer charged Midei with violating the state's Medical Practice Act. A hearing was held in August to discuss the charges, though no resolution has been announced.
As of today, Midei's license is in good standing.