By Tricia Bishop, The Baltimore Sun
6:27 PM EDT, July 12, 2011
While the Maryland Board of Physicians weighs professional charges against one cardiologist accused of placing heart stents into hundreds of patients who didn't need them, a federal jury in Baltimore is considering criminal charges against another.
The health care fraud trial of Dr. John R. McLean, who practiced at a hospital on the Eastern Shore before surrendering his medical privileges in 2007, opened Tuesday in Baltimore's U.S. District Court.
Prosecutors outlined a set of allegations against him that are startlingly similar to those against Towson cardiologist Mark Midei, who practiced at St. Joseph Medical Center and was charged administratively — not criminally — last year with violating the Medical Practice Act.
Both men are accused of falsifying patient records in order to justify hundreds of medically unnecessary procedures, specifically the placement of coronary stents into relatively healthy arteries, ostensibly to prop them open. And they have presented similar defenses, claiming through attorneys that assessing arterial blockage is more of an art than a science.
The stakes are higher for McLean, however: He faces decades in federal prison if found guilty, while Midei is confronted by the potential loss of his medical license from a professional board. C. Irving Pinder Jr., executive director of the Maryland Board of Physicians, said Tuesday that he expects to announce a "public resolution" to Midei's case, already more than a year old, "within a week."
McLean's criminal trial is expected to last a month. He sat silently at the defense table Tuesday, as Assistant U.S. Attorney Sandra Wilkinson described him as a liar and cheat who performed unnecessary procedures for the money.
"The defendant performed invasive medical procedures for patients that did not need them," Wilkinson told jurors.
At issue is the appropriate use of coronary stents: tiny mesh tubes that, when inserted into a severely clogged artery, can restore blood flow and save the life of someone undergoing a heart attack. They can also relieve symptoms, such as shortness of breath or chest pain, in some patients when done on an elective basis — a much murkier area for making medical decisions than the emergency situation.
Medical guidelines suggest that an artery should be 50 percent blocked with cholesterol plaque before a patient's disease is considered significant, and some say symptoms don't manifest until 70 percent obstruction is reached.
Midei and McLean are accused of vastly — and knowingly — overestimating their patients' arterial blockage, treating insignificant disease with unnecessary procedures that require patients to take blood thinners for a year or more and put them at risk for other complications.
"You're trading one problem for another," Dr. Ian C. Gilchrist, an interventional cardiologist at the Penn State Hershey Heart and Vascular Institute, testified Tuesday during McLean's trial.
A report published last week in the Journal of the American Medical Association showed that half the elective-stent procedures studied in the United States during a 14-month period — more than 72,000 placements — were medically questionable (38 percent) or outright unnecessary (12 percent). Emergency procedures were nearly 100 percent justified, however.
Midei and McLean's so-called suspicious procedures fall into the elective category. Both physicians have strenuously denied the allegations of wrongdoing.
"My medical decisions have been second-guessed years after the fact by critics without access to the medical records of my patients or to the high-quality images I used when determining that a stent was necessary," Midei wrote in a Baltimore Sun opinion article published in April.
McLean's attorney offered a similar argument, saying that the government is trying to "substitute after the fact the opinion of an expert for Dr. McLean's" opinion.
This "is a case that hangs in the balance of whether someone made the right interpretation," defense lawyer Richard Westling said, calling McLean a "good man" and a "good physician … who cared about his patients."
McLean was federally indicted in late August on one count of fraud and six counts of making false statements to insurers and patients from 2003 through 2007, while working out of Peninsula Regional Medical Center in Salisbury. Investigators claim in court documents that he performed more than 200 unnecessary stent procedures in total, however.
In October, the Maryland Board of Physicians also filed professional charges against McLean for "immoral or unprofessional conduct in the practice of medicine."
"He has been on our radar screen a long time," Pinder said Tuesday.
Midei was charged by the board with "gross overutilization of health care services," among other things. Beginning in late 2009, St. Joseph began warning about 600 people that their stents from Midei might not have been needed, and the doctor is being sued by dozens of his former patients. He has also filed a lawsuit against his former employer.
Both men still have active and valid medical licenses, according to the Board of Physicians, though their careers are likely over. McLean, who is also being sued by ex-patients, has retired, while Midei has said he can't find work even abroad.
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