Second Cardiologist Found Guilty in Federal Court for Performing Unnecessary Cardiac Procedures at St. Joseph London Hospital.

Dr. Anis G. Chalhoub, formerly a cardiologist at KentuckyOne Health’s St. Joseph London Hospital, was indicted in Federal Court in June, 2016 for allegedly performing unnecessary cardiac procedures.  A jury trial concluded last Wednesday with a finding of guilty on all 12 counts.  (United States District Court, Eastern District of Kentucky, London. Criminal Case No. 16-cr-23).  I do not yet have many court documents, but one of the counts must have been related to the civil lawsuit in Laurel County against St. Joseph and Catholic Health Initiatives which awarded a record $21.2 million to a Corbin man for unneeded surgical heart procedures at the London Hospital. (That case is still being appealed.)  Dr. Chalhoub currently holds a valid medical license in Kentucky and practices in Louisville and Southern Indiana.

[Addendum April 17, 2018:  The Department of Justice released today a notice of the conviction with some additional details. The story was also reported this morning in the Lexington Herald.  This latter notice reported that Dr. Chalhoub was convicted on a single count rather than the 12 counts noticed to to me. I will correct this article when I can reference the original court documents.]

Beginning back in 2012, I began to use publicly available medical utilization data as a way to identify regional variations in the provision of medical services.  (That series of articles on Angioplasty-Abuse can be seen here.)  It is well known that very large variations exist in how often a given procedure or medical service is performed geographically, or even among individual physicians.  Much, if not most of this small-area variation cannot easily be unexplained and is often considered to result from simple preference or untested habit.  Since medical utilization expresses itself as financial cost, looking more critically at small-area or inter-professional variation is considered to be a valid way to identify medically unnecessary or overused services.  We should only be paying for services that actually work and are medically indicated– right?  Unfortunately, we are not yet at that place.

I liked the approach to looking at variations in medical practice because– at least in theory– it provides a non-judgmental way to hone in on what works best, based on the collective judgement of all healthcare professionals. Was I a bad doctor because it never occurred to me to prescribe opioids for chronic arthritis?  Being a high utilizer is not intrinsically “worse” than being a low utilizer, but value determinations cannot be made on either end without taking a look at both.  The possible dark side of being a high-end outlier is that too often such individuals or institutions are engaged in medical fraud.  When high-end outliers among Kentucky’s invasive cardiologists were looked at, indictments and convictions of individual physicians; a number of settlements between physicians or hospitals with the Justice Department; and the collapse of two high-flying, highly-rated cardiac programs resulted.  Six years later, the wheels of justice are still grinding.  Somehow this seems too long to me.

Others will have different perspectives on this case and the related ones. One thing that troubles me greatly is that the abuses that were occurring were not secrets in the medical community. Eventually, it was a whistle-blower complaint from other cardiologists that started the legal process. We physicians are proud to consider ourselves professionals, and as such claim the right and obligation to regulate ourselves internally.  I wish I could say that I believe we are doing a good job of it.  We are not.  What I do believe is that when lawmakers, lawyers, and judges have to step in to ensure that appropriate medicine is being practiced, that we have failed our mutual professional responsibility as physicians.

Peter Hasselbacher, MD
Kentucky Health Policy Institute
6:00 pm, April 13, 2018