As reported in the Baltimore Sun last week, Catholic Health Initiatives (CHI) agreed to pay up to $37 million to settle civil claims of unnecessary coronary artery stenting at its St. Joseph Hospital in Towson, Maryland. The class action suit by some 273 patients was one of several federal and civil lawsuits against the hospital for the placement of, or billing for medically unnecessary invasive cardiac procedures beginning years before 2010. The settlement still needs the approval of court officials and an agreement of at least 60% of other plaintiffs to join the case. These and apparently other plaintiffs have the option not to join the settlement. The books are not obviously closed on the case. The Hospital’s principal invasive cardiologist, Mark G. Midei, is named in other open actions, but not this case.
Cost of doing business? Slap on the hand? Fair outcome?
Although this sounds like a lot of money, it amounts only up to $134,000 per patient before plaintiff’s attorneys take 40% and repayments are made to Medicare, Medicaid, and private insurance companies who paid for the “allegedly” unnecessary medical procedures. Frankly, I anticipated a higher penalty given my understanding of the severity of the “alleged” deeds. Naturally, as we have come to see in these cases, CHI admits no wrongdoing, presumably knuckling under to an alternative interpretation of heavy-handed litigation and to avoid further uncertainty and legal expense.
CHI settled earlier with the Federal Government for $22 million for illegal kickbacks. In May 2013, the Hospital settled confidentially with another 200 or so patients for unknown sums. CHI sold its unfortunately but inevitably-tainted hospital (but not its tort liabilities) to the University of Maryland in 2012. In my opinion, and based on what I have read from independent examination of the facts, including a US Senate investigation, I would not personally have visited the hospital for services. Regretfully, when all the facts in cases like this are kept from the public, confidence and trust can be lost for a long time. No one is served well, save perhaps attorneys for the plaintiffs.
Earlier legal actions in this saga have had surprising twists and turns. A jury found Dr. Midei guilty, but a judge vacated the verdict which cannot be retried. Many medical malpractice suits against Midei remain open. His medical license was revoked in 2011 following professional review of his actions. It is not clear to me how many suits against the hospital remain open other than the class-action referred to above.
Is there any relevance to our angioplasty-abuse cases here in Kentucky, or for that matter all the other places where the money-engine of angioplasty-abuse was ignored for so long? The circumstances seem depressingly similar. No one can be certain, but settlement without full resolution of the facts already has a precedent in Kentucky in the federal settlement with CHI’s St. Joseph London hospital. The terms of a reported federal settlement with King’s Daughters Hospital in Ashland have not yet been made public. The civil suits for those two institutions remain a long way from being resolved. A Kentucky doctor is in prison and others may still be under investigation. Hospitals may yet be closed or sold. Clearly these hospital systems would like to put these matters behind them. I doubt it will be quick or inexpensive to do so. I do wish I had a much better understanding of just what has happened instead of what in my opinion amounts to a face-saving procedural coverup that leaves the public in the dark.
As usual, If I am incorrect in my facts or there is an better interpretation, please let us know.
Peter Hasselbacher, MD
Emeritus Professor of Medicine, UofL
April 14, 2014