St. Joseph/Midei Stent Fiasco gets predictably worse. Chief of division faces licensing charges.

This post was authored by Brian Nash and posted to The Eye Opener on June 11th, 2010.

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Early this afternoon, the Baltimore Sun reported that the Maryland Board of Physicians, the state’s regulatory agency for licensing doctors, filed charges against the cardiologist, Dr Mark Midei, who was the head of the cardiac catheterization lab at St. Joseph Medical Center. Essentially the 19 page charging document alleges that Midei was guilty of “gross overutilization of health care services” and “willfully making a false report on record in the practice of medicine.” (emphasis added) Efforts are underway by our firm to obtain a copy of this complaint filed against Midei by the Board. We contacted the Board of Medicine and were told that the person who handles these requests was ‘not in today.’ Since the Sun was able to obtain a copy of the charging document – notwithstanding the alleged absence of the Board’s employee – we contacted the Sun. They declined to provide it with the understandable position that they “don’t share our material beyond what we publish for everybody.” At least they were kind enough to reply to our inquiry in very timely fashion. Hey, it was worth a shot.

The Sun reports:

Midei, who ran the cardiac catheterization lab at St. Joseph Medical Center until last year, is alleged to have put stents in the arteries of patients who did not need them. He’s also accused of falsifying medical records to make it appear that the patients were candidates for the expensive — and sometimes dangerous — procedures.

These charges are referred to as the “first independent verification of complaints made more than a year ago to board members and to the staff at St. Joseph.” The first public awareness of ‘complaints against Midei’ did not occur until St. Joseph Medical Center sent letters to patients around mid-December, 2009. As you will learn later in this blog, the first complaint to the Board of Medicine was made ostensibly by a whistle-blower employee of the hospital in November 2008. What in the world took the hospital thirteen months to investigate? The agreement reached with the federal government on the Medicare fraud investigation is reported to have happened in July 2009 5 months before the letters were sent. Midei is reported to have been terminated by St. Joseph Medical Center in the summer of 2009. How long does it take to write a letter to patients and their doctors?! I guess they had to meet with their lawyers for 5 t0 13 months to ‘get it right.’

The ‘typical’ letter, written by the Head of the Department of Medicine, Daniel Hardesty, M.D.,  reads in pertinent part:

I am writing to let you know that a subsequent review [i.e. after the sent had been placed months before] of your cardiac catheterization report was different than the original reports and may be relevant to your ongoing care and treatment.

What is perhaps even more telling is the letter written by Dr. Hardesty to the treating physician for the patients who received unnecessary stents. In relevant part, they read:

You are identified as the referring cardiologist. A subsequent clinical review of this patient’s catheterization report and images were at variance with the previously reported findings. In the opinion of the reviewer, the amount of stenosis in the [coronary artery stented] was insignificant. (emphasis added). Please refer to the Clinical Guidelines attached.

Somewhat fascinating is the fact that from all currently available information it is believed that the determinations made of these 585 patients who received the letters were made by a panel of reviewers, not one reviewer, and that the panel had to agree unanimously that the stents placed by Midei were “unnecessary.” Discovery in the class action lawsuit we are involved in against St. Joseph Medical Center will let us all know just how many were involved in this process of ‘review.’

In a follow-up blog a few hours ago by the Sun’s financial columnist, Jay Hancock, we get the following information from the charging document:

– The board received its initial complaint about Midei in November 2008. An anonymous person describing him/herself as a St. Joseph employee detailed 36 cases in which stents had supposedly been improperly placed. The board received another, similar complaint in April 2009. But it didn’t launch the investigation until it was notified on July 19, 2009, that St. Joseph had revoked Midei’s privileges.

– The board charging document includes the first bits of explanation from Midei to be made public. To wit:

Midei explained the discrepancy by saying he routinely used certain percentages — 70, 80, 90 — as shorthand to signify mild, moderate or significant blockage, the document claims. But he conceded, after reviewing his cases, that there was “significantly lower percentages of stenosis than he had initially dictated at the time of the procedure.”Midei also told hospital staff that he considered other clinical symptoms aside from test results when determining whether to place a stent, according to the charging document. (emphasis added)

Wonder which defense lawyer dreamed-up the ‘shorthand’ defense? Why did I know we were also going to hear about how he used his clinical judgment to justify his conduct of putting in totally unnecessary stents. I suspect many of you don’t do medical malpractice litigation, but the legal equivalent to “the dog did it” is “I used my clinical judgment” to justify what I did.

To bring today’s news full circle, be aware that apparently the Maryland Board of Physicians was notified thirteen (13) months before the letters went to patients. Jay Hancock’s blog posting tell us the following:

– The board received its initial complaint about Midei in November 2008. An anonymous person describing him/herself as a St. Joseph employee detailed 36 cases in which stents had supposedly been improperly placed. The board received another, similar complaint in April 2009. But it didn’t launch the investigation until it was notified on July 19, 2009, that St. Joseph had revoked Midei’s privileges.

I ask again – what took so long?! How many patients were subjected to unnecessary stents by Midei while the Board was “investigating.”  How long does it take to look at a medical record that says the heart’s blood vessel was stenosed (narrowed) 90% and look at a film study and see that it’s not even 20%? Did you know that the Board of Medicine can take emergency action against a physician who poses a risk of harm to the public?

As we continue to say – if you have any questions or need additional information, please contact: The Murphy Firm’s Lisa Bennett, 410-951-8811 or 410-940-8590 Lisa.Bennett@murphypa.com

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