St. Joseph’s London Discontinues Coronary Artery Bypass Surgery.

St. Joseph’s London Hospital has notified the state that it will no longer perform coronary artery bypass graft surgery (CABG), the traditional open-chest cardio-thoracic surgical procedure used to restore blood flow to the heart of people with severe coronary artery atherosclerosis. Before the advent of the the less invasive angioplasty and stenting, CABG was the main surgical approach to re-vascularization of a diseased heart. For certain combinations of coronary artery disease, and in some clinical settings, CABG remains the preferred approach today.

Why fewer invasive procedures?
In Kentucky, the frequency of both angioplasty and CABG have been gradually decreasing, presumably because the effectiveness of aggressive medical therapy is better recognized, and because research showed that the invasive approaches were being used in circumstances where they offered no advantage over non-invasive treatment. Treatment of coronary artery disease is lucrative for hospitals and physicians alike which unfortunately caused some to stretch the envelope beyond what could be justified medically, even to the point of fraud. That bubble is bursting and accounts for a some if not much of the overall decrease in invasive procedures.

Where will patients go?
The new plan in London is to transfer those patients requiring emergency surgery to one of the nearer hospitals capable of treating such a patient, presumably Pikeville, Hazard, Corbin, Asheville, Summerset, or Lexington. (Some of these hospitals perform fewer CABGs than in London!) For non-emergency surgery, patients will be referred to another KentuckyOne hospital– St. Joseph’s Lexington. Angioplasty and stenting will continue to be performed at St. Joseph’s London presumably with safeguards in place to make sure that the most appropriate procedure will be offered for medical reasons and not for convenience. Continue reading “St. Joseph’s London Discontinues Coronary Artery Bypass Surgery.”

The Other Boot Drops for Kings’s Daughters Medical Center.

Hundred’s of plaintiffs and a 70% drop in angioplasties.


We have known for some time that King’s Daughters Medical Center (KDMC) in Ashland Kentucky (Boyd County) has been under investigation by the Federal Department of Justice for the spectacular number of invasive cardiac procedures performed on its premises. In fact, the rate of angioplasties in that small city was one of the very highest in the nation and the highest in Kentucky. When other hospitals in Kentucky and elsewhere with seemingly anomalous high rates were looked at more carefully, it was found that that many, if not a majority of the procedures in some hospitals were not medically necessary or were even performed on normal or near-normal people!

The extent and progress of the federal investigation at KDMC is as yet unknown but it was not a complete surprise when a civil lawsuit was filed last September in Boyd County Circuit Court. It alleged that a medically unnecessary procedure with placement of a stent was performed in the hospital by its principal cardiologist, Dr. Richard E. Paulus, whose practice reportedly had been purchased by the hospital.

New lawsuits against King’s Daughters.
Earlier this week, a pair of related lawsuits listing some 42 pages of plaintiffs was filed against the hospital, Dr. Paulus, and a variety of business entities operating under the umbrella of the Kentucky Heart Institute. Naturally, a lawsuit tells only one side of the story, but given the precedent of essentially identical scenarios at other hospitals, including St. Joseph In Maryland and St. Joseph London here in Kentucky, the story is believable. The complaints themselves can be downloaded below. Continue reading “The Other Boot Drops for Kings’s Daughters Medical Center.”

Saint Joseph Health Care Settles Fraud Allegations: Analysis of Court Documents

Worse than I thought.

I prepared an earlier article about this settlement based on press releases from the U.S. Attorney’s Office and that of the FBI. I had slim hopes that more information would be available any time soon, but once again I was wrong. I subsequently obtained the full text of the Settlement, but also the recently-unsealed qui tam Relator’s Complaint to the court that started it all. The Complaint revealed a staggering degree of malfeasance with a parade of examples of medically unnecessary procedures extending beyond angioplasty alone to major cardiac surgery, and involving more than one St. Joseph Hospital. It also suggests the direction future prosecutions are going. The Settlement does not protect Saint Joseph Health System from future financial or programatic penalty as much as I expected. Both documents can be downloaded using the links provided above or at the end of this article.

Continue reading “Saint Joseph Health Care Settles Fraud Allegations: Analysis of Court Documents”

KentuckyOne Health Hospital Settles Fraud Prosecution for $16.5 million.

Civil allegations of false or fraudulent billing at St. Joseph London Hospital for medically unnecessary heart procedures settled. Criminal investigation ongoing.

In the same week that KentuckyOne Health announced statewide layoffs of its employees, the Federal Prosecutor’s office of Eastern Kentucky announced the second largest settlement in history for its region. One can only speculate if the timing was a coincidence. Although the $16.5 million represents only a small portion of the $217 million target savings that KentuckyOne hopes to achieve, that self-insured institution is also facing hundreds of civil lawsuits. The hospital system and some of its doctors are paying a high price for someone’s bad behavior. Continue reading “KentuckyOne Health Hospital Settles Fraud Prosecution for $16.5 million.”