Se incrementa el número de cardiólogos acusados por implantación innecesaria de stents. (Idioma Inglés).

Posted at — Mario Hernández Cueto — julio 8th, 2010 — 11:21 under noticias

Probe of cardiologist accused of implanting unneeded stents now expanding to other docs.

Towson, MD – In an ongoing saga that is throwing a spotlight on how hospitals oversee physician medical decision-making, a review of hospital records over a two-year period at St Joseph Medical Center in Towson, MD has revealed that cardiologist Dr Mark Midei may have implanted “unneeded stents” in 585 out of nearly 2000 patients over a two-year period.

Reporters at the Baltimore Sun, who have long been investigating the St Joseph probe, now report that the state official who first called for an inquiry, Del Peter A Hammen, has asked state agencies to expand their investigation to include other doctors who may also have performed “a suspiciously high number of invasive cardiac stent procedures.”

The Sun also cites sources saying that other procedures and specialists may also be targeted in the inquiry. Names of the other doctors under investigation have not yet been released.

The Midei case dates back to April 2009, when a patient complained to hospital officials; it later emerged that this patient was also an employee at St Joseph. Midei lost his position as department chair and his privileges to practice medicine at the Towson hospital after the hospital concluded its investigation. Case reviews suggested that some of Midei’s patients were told they had stenoses in the range of 90%, but a subsequent review indicated stenoses closer to 10%.

Hospital officials sent letters to patients identified in the record reviews, telling them they may have received unnecessary stents, although no “questionable deaths or complications” were ever seen in Midei’s case load that would have raised any concerns, had the patient not come forward, the Sun notes. And while retrospective reviews of diagnostic angiograms at the hospital might have caught cases in which stents were implanted unnecessarily, this process failed because Midei, as chair, could “handpick” which cases of his would be scrutinized by his peers, according to a report from the State Office of Health Care Quality, the Sun subsequently reported.

For and against

According to the Sun, “local malpractice attorneys say they have been approached by hundreds of Midei’s patients, and a handful of lawsuits against him and St Joseph have been filed.” Attorneys have also reputedly been “stunned” that the St Joseph’s review only went back two years.

But former patients and colleagues are also coming out of the woodwork to support Midei, renowned as an excellent clinician and interventionalist. A website set up in February by a friend of Midei’s has amassed more than 150 testimonies of support for Midei and confidence in his character, skills, and professionalism, including patients writing with stories of Midei advising against stent implantation.

Stents are major money-makers for hospitals, the Sun’s coverage repeatedly notes. In the past fiscal year, stents brought in $222 million in business to Maryland hospitals, roughly $10 000 or more per procedure, according to numbers cited by the paper.
The Midei probe is just the latest in a series of cases investigating cardiologists found to be performing more procedures than medically warranted. Last year, Louisiana cardiologist Dr Mehmod Patel was given a 10-year prison sentence after being convicted on 51 counts of billing private and government health insurers for unnecessary medical procedures, as reported by heartwire. He is appealing his sentence. In perhaps the most celebrated cardiology case in recent memory, Drs Chae Moon and Fidel Realyvasquez of Redding Medical Center, CA were convicted for as many as 50% of the procedures conducted by the two physicians (diagnostic catheterization, angioplasty, and CABG procedures) that may not have been medically necessary.

The case against the physicians was ultimately settled out of court for over $50 million.

(Fuente:  heartwire)

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