Members of a cardiology trade group say they're worried that people will delay getting medical attention because they're afraid of receiving unnecessary cardiac stents, now that allegations against a Maryland physician have received national attention.
The U.S. Senate Finance Committee released a report last month on stent usage at St. Joseph Medical Center in Towson, where Dr. Mark G. Midei is alleged to have placed the tiny mesh tubes, which prop open clogged arteries, into hundreds of patients who didn't need them.
The Baltimore Sun, The New York Times and The Wall Street Journal ran advance stories on the federal findings, which called the case a "clear example of potential fraud, waste and abuse." The issue was later followed by the Associated Press and publications in Georgia, Massachusetts, Illinois and Washington state.
Now, members of SCAI — the Society for Cardiovascular Angiography and Interventions — are trying to counter the coverage.
"We're very concerned that patients are a bit confused," said Dr. Mark Turco, an interventional cardiologist at Washington Adventist Hospital in Takoma Park. "[Stents are] not bad, and in fact, they can save your life in the setting of a heart attack."
So far, he hasn't seen any evidence of increased hesitance among patients, however.
Turco took about 20 minutes to put a stent into place recently in a 49-year-old man who had chest pains, an abnormal stress test and prior bypass surgery. A small section of the patient's right coronary artery was almost fully blocked with plaque at 10:30 a.m., and by 11 a.m., it was stented and wide open — so much so that it appeared to "embarrass" the rest of the artery, a nurse said.
The procedure is expected to relieve the man's symptoms, though it can't prolong his life or even prevent a heart attack later on.
"In an elective situation, it doesn't save life, but it vastly improves the quality of life," said Dr. Jeffrey Marshall, director of the Cardiac Catheterization Lab at Northeast Georgia Medical Center in Gainesville.
He was in Baltimore in December to meet with Maryland legislators to discuss ways to strengthen the state's physician-regulation system, post-Midei allegations.
"We do feel like we need to have a voice at the table to ensure that it's done right," Marshall said.
SCAI and the American College of Cardiology have submitted draft legislation — called "The Maryland Cardiovascular Patient Safety Act" — that would require outside accreditation of hospital cardiac labs, where stent work is done.
Midei is accused of placing stents in arteries that weren't significantly blocked and falsifying patient records to justify the placements. He has denied the allegations.
SCAI representatives say such inappropriate use, if true, is rare. But some lawyers, physicians and Senate investigators believe otherwise, suggesting that over-stenting could be a national problem that's putting patients at risk.
Stent recipients have an increased risk of blood clots, which could be deadly. That makes their inappropriate placement all the more worrisome, but it shouldn't negate the idea that they're still valuable tools in emergency situations, SCAI says.
"Coverage of controversial practices by one or even a handful of physicians must not be allowed to obscure that fact for people with potentially fatal or devastating symptoms," reads a SCAI statement issued Dec. 6, the same day that the Senate report was released.
Said Marshall: "We don't want people not to go see their doctor."