Bad and getting worse– but not without precedent
The matter of “Angioplasty Abuse” at St. Joseph London Hospital has now truly gained national attention. I have been reporting on the lawsuit against the hospital and some of its physicians and analyzing medical utilization data in this Policy Blog since last December. It was alleged that for several years that doctors at the hospital were performing invasive cardiac procedures on patients who had no need for them, and that the hospital should have known this. On Sunday, Courier-Journal reporter Andrew Wolfson published an in-depth, front-page article that was reprinted by USA Today and further commented upon in Forbes.com. Other news outlets are now also following the story more closely– a story that gets worse as it grows.
Courier-Journal article goes national.
Mr. Wolfson reported that some 400 people had already sued the hospital, its parent company Catholic Health Initiatives (CHI), and 11 of its cardiologists for performing medically unnecessary and potentially dangerous heart procedures. This is no longer simply the claim of a bunch of plaintiffs and their attorneys, or jealous rival cardiologists. The Kentucky Medical Licensure Board released its public agreement with Dr. Sandesh Patil, the principal physician involved. Read it and judge for yourself if the interests of Kentuckians are being appropriately protected. The agreement includes excerpts from the Board’s consultant review of five patient records. The comments were, in my opinion, devastating. You don’t have to be a cardiologist, or for that matter or even a physician to see that there were fundamental problems of patient care. Nevertheless, the Board allowed him to keep his medical license and has been allowing him to practice elsewhere in the state. Various commenters on the USA Today article were surprised at this– as am I.
Mr. Wolfson’s article also highlighted a number of items new to me. The Hospital was cited in 2011 by the Centers for Medicare and Medicaid for failing to review the medical necessity of 3367 cardiac catheterizations performed in the year before. (This is a number the hospital brags about on its homepage.) The hospital’s “quality assurance committee” had apparently never reviewed any medical records regarding the procedures. A spokesperson for KentuckyOne Health, which runs St. Joseph London (and now Jewish and University Hospitals here in Louisville), refused to comment. Most of the internal documentation is similarly shrouded behind the multiple ongoing civil and criminal legal processes.
Deja Vue all over again!
What a mess! Nonetheless, it’s hard for me to have much sympathy for the hospital because its CHI owners had seen essentially the same situation at a sister hospital in Towson, Maryland which ironically is also named St. Joseph. That matter was ugly enough that it prompted a special report from US Senate Finance Committee. You can read it for yourself here. I warn you, it will make you angry, depressed, or both. It’s hard to avoid forming the opinion that we are seeing an instant-replay here in Kentucky. Both the hospital, and the maker of the coronary artery stents (Abbott) took very good care of the doctor involved. Read the first few pages and decide for yourself how corrupt the medical industrial complex has become. Read and decide for yourself how serious was the threat by an executive of Abbott to intimidate or physically harm the reporter who publicized the scandal. The Finance Committee did not dismiss it.
The peer review committee at St. Josephs Towson also failed. It didn’t seem to bother anybody that one physician would put in 30 stents in a single day. One subsequent review found that less than half of the stents placed over a long period were absolutely medically necessary, more than half were optional, and a huge number were “inappropriate.” Another review by the Board of Medical Licensure found that one third of cases did not meet medical standards. I believe it’s telling that once the lawsuit and criminal investigations began, the frequency of stent placements throughout the greater Baltimore area diminished considerably, just as it did here in Kentucky. The medical licensure Board of Maryland did not hesitate to pull the physician’s license, but Abbott worked to find him a job out of the country. Why does it have to take a complaint by a patient to get the remedial ball rolling?
Can anyone protect us?
Maryland state regulators must have been embarrassed by what was happening under their noses. They were able to identify other hospitals where excessive angioplasties might have been being performed. However, they were apparently unable to do much about it because of limited financial and manpower resources as well as statutory restrictions on the ability of the state’s investigative agencies to cooperate. (Think Kentucky prescription abuse.) A state task force came up with a number of recommendations.
1. Strengthen and changed the focus of hospital peer review standards.
2. Broaden the reporting requirements under state patient safety regulations.
3. Increase permissible sharing of information among investigatory agencies.
4. Give the regulatory agencies the ability to protect the integrity of the process by granting them Medical Review Committee Status in shared investigations. (This protects good doctors and patient confidentiality.)
I have no knowledge of whether any of their recommendations came to fruition. I rather have my doubts that it could happen in Kentucky.
St Joseph, and presumably its owners, promised to put in place a remedial plan so that this sort of thing would never happen again. It remains to be seen if that plan was disseminated to other hospitals in the organizations. So far, in my opinion, the lesson seems not to have taken. I predict that this is going to be an embarrassing, prolonged, and expensive few years for St Joseph London and KentuckyOne Health. Other “Heart Hospitals” should take notice.
As always, I invite any comments offering alternative interpretations or corrections.
Peter Hasselbacher, M.D.
Emeritus Professor, UofL
Feb 20, 2013