By Robert Little, The Baltimore Sun
6:06 PM EDT, May 22, 2010
The story Frank Ward tells about his medical history would sound familiar to just about any malpractice attorney in Baltimore.
He went to St. Joseph Medical Center for a heart procedure, Dr. Mark Midei put a stent in his artery after finding a blockage, and now another doctor says the blockage was insignificant and the stent wasn't necessary. A total of 585 patients have received letters from St. Joseph describing similar scenarios, after the Towson hospital reviewed the last two years of Midei's cases.
"I feel betrayed," said Ward, a 50-year-old courtroom constable from Perry Hall.
But similarities aside, Ward's case also represents a whole new category of potential problems for St. Joseph, and it suggests that the hospital could be facing legal claims from many more of its former patients.
Ward's cardiac procedure was performed five years ago, outside the two-year window the hospital chose to investigate. And he didn't learn of the doubts about his procedure in a letter from the hospital; he had his medical records reviewed on his own, through his attorney.
Midei denies any wrongdoing, and his lawyers argue in court papers that the news media and fee-hungry attorneys have inflated the issue beyond reason. Still, local malpractice lawyers already have a term for Ward's type of claim against St. Joseph — "non-letter cases" — and say they expect to see many more.
"If there were 600 cases over the last two years, how many have there been over the last five? Or since Dr. Midei started working at St. Joe's?" asked attorney Briggs Bedigian, who represents Ward and several other St. Joseph patients. "There could be thousands."
"When I heard that St. Joe's had concluded its review, I was kind of stunned. There's no logic to stopping at two years, or three years," said attorney Andrew G. Slutkin, who represents several patients who did not receive letters. "If it were me, I would want to know if I had a stent that wasn't necessary, no matter how long it had been."
St. Joseph's officials, who began investigating Midei's records after receiving a complaint in April last year, say they quickly sent letters to patients alerting them of the investigation's findings so they could contact their doctors. Cases reviewed by The Baltimore Sun all followed the same pattern: A patient's medical records described significant blockage of an artery before a stent was placed — 90 percent, for instance — but the subsequent review found insignificant blockage — perhaps 20 percent.
The two-year time span of the review came at the recommendation of independent medical experts hired to conduct the investigation, hospital officials said.
"If there were going to be any complication, it would have manifested itself within that two-year period," the hospital said in a statement released Friday to The Sun.
Some patients who weren't included in the hospital's review, however, say potential medical complications are only part of the problem.
One of Slutkin's clients, a 68-year-old Parkton man who asked that his name not be used because he did not want to discuss his medical issues publicly, said the two stents he received from Midei in 2005 were the only cardiac treatment he's ever received. For five years he believed he was at risk of heart failure. But a specialist who reviewed his records recently said the 90-percent arterial blockage recorded in his records at St. Joseph was actually a 20 percent to 30 percent blockage, and not appropriate for treatment with a stent.
"How many people out there are just like me, and spent years thinking something was wrong with them that wasn't?" he said. "They should be looking at all their records."
Ward, who received a total of seven stents before having bypass surgery in 2006, had his records reviewed by Dr. Jeffrey Breall, the head of interventional cardiology at Indiana University. After looking at a video taken at St. Joseph of Ward's arteries, and reviewing written records from Midei, Breall concluded that one artery initially described as 70 percent blocked was actually 30 percent blocked — not a candidate for a stent.
"I thought about [my heart troubles] every day. It's the kind of thing that changes your life," said Ward.
"The first time I went away after I got the stents, I remember feeling scared, thinking I was too far away from St. Joe's," said Ward. "And that was just in Ocean City."
Intracoronary stents are mesh tubes that can be threaded into clogged arteries to prop them open. They offer an alternative to open-chest surgery, but they can also cause clotting or other damage.
St. Joseph patients treated outside the two-year window who think they have a case face several legal hurdles, including a statute of limitations that bars claims more than five years old. Under state law, to be successful with an older case the patient would have to prove that fraud was committed.
If the allegations against Dr. Midei are upheld in court — that he purposely wrote false information into patient medical records to make it appear that a stent was needed — arguing fraud would not be a stretch, both Slutkin and Bedigian said. Midei's own attorneys acknowledge, in motions filed with the state's Health Care Alternative Dispute Resolution office, that the allegations against him could lead to criminal charges.
Even patients still within the five years face the obstacle of having to prove they received a stent that wasn't needed, Slutkin added. Those who received a letter from the hospital essentially have an admission of liability. But those who didn't must request their medical records — typically for a fee, if the request comes from an attorney — and have them reviewed by a specialist, which can cost several hundred dollars more.
Midei, who maintains his innocence, has released a statement saying that he expects to be vindicated. Once one of St. Joseph's star physicians, who performed hundreds of procedures annually and helped the hospital reach the milestone of implanting its 100,000th stent last year, Midei lost his medical privileges at the hospital in May 2009.
He could not be reached to comment further, but he still has a following of supporters and patients who don't believe he has done anything wrong. A website set up by a personal friend of Midei's has attracted at least 130 comments of support, many from patients who say he saved their lives. Documents filed by attorneys on his behalf also suggest that the matter has been inflated by malpractice lawyers and the press.
"This media frenzy has resulted in inquiries from persons who never even received stents," one document read.
"The potential exposure of the stent litigation as a whole, as evidenced by the aggressive attorney solicitation of clients and the endless media attention, is substantial," read another.
In marketing brochures, St. Joseph has called itself the busiest heart catheterization center in Maryland, and it is regarded as one of the main cardiac care facilities in the region. The hospital performs about 6,500 cardiac procedures a year — an average of 18 a day.
When St. Joseph began its review of Midei's cases, federal investigators were already exploring the hospital's relationship with MidAtlantic Cardiovascular Associates, the region's dominant cardiology practice. Midei was a co-founder of MidAtlantic in 1995 and was a member of the practice even as he served as head of St. Joseph's cardiac catheterization lab. His hiring by St. Joseph in 2008 scuttled MidAtlantic's proposed $25 million merger with MedStar Health, owner of the rival Union Memorial Hospital.
In July 2009, St. Joseph reached an undisclosed agreement with the federal government to settle any potential claims related to its dealings with MidAtlantic. Hospital officials declined to elaborate Friday on the settlement, which has not been made public, but called it an agreement with the U.S. Department of Justice.
St. Joseph said it has implemented several new safeguards in its cardiac catheterization program for the future, including random peer-review of cases, rotating reviews of three physicians each month, and an annual review of 5 percent of the cases of the hospital's highest-volume physicians.
Malpractice lawyers, meanwhile, say they expect claims and lawsuits to keep surfacing from the hospital's past.
"Dr. Midei has been doing these procedures for years — thousands of them," said attorney Robert Weltchek, who represent five patients, including one who did not get a letter.
"I think people began to question, if he was doing this two years ago, was he doing it three years ago? Four years ago? How long?"
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