St. Joseph Medical Center has repeatedly said it wants to do right by its coronary stent patients.
After a complaint last year that star cardiologist Mark Midei was placing stents in the arteries of patients who didn't need them, the Towson hospital removed him from duty, reviewed thousands of medical records and sent letters to nearly 600 people whose stents appeared unnecessary, telling them to go see a doctor.
But now that the lawyers have arrived, bearing the threat of hundreds of lawsuits, some say the message has changed. Even as some St. Joseph employees continue to suggest wrongdoing — including its chief of cardiology, who has told at least two patients that his former colleague falsified their records — the hospital's attorneys appear to be girding for a fight.
In its legal filings, the hospital said it "generally denies all allegations of liability." And medical malpractice attorneys preparing cases against St. Joseph say hospital lawyers are gathering experts to argue that Midei did nothing improper, despite the hospital having revoked his practice privileges.
"While still acting under the guise of doing the 'right thing,' SJMC and its attorneys are not only categorically denying any wrongdoing by Dr. Midei (and fighting damages in every aspect), they are also employing tactics to delay and obstruct [evidence] discovery at every possible turn," declares a document filed last week in the state's health care arbitration office by Baltimore lawyer H. Briggs Bedigian, who represents more than a dozen of Midei's former patients.
"If they're going to [now] stand by [Midei's] care and say what he did is not negligent and what he did is justified," Bedigian said in an interview, Midei should "be looking for an employment lawyer."
In a statement to The Baltimore Sun, St. Joseph said that it is not "involved in the defense of Dr. Midei," who denies any impropriety. But it also is unwilling to concede that every patient who got a letter also had an unwarranted procedure that caused them harm, and is thus entitled to a payment for damages.
"The notification that SJMC sent to patients was not a definitive conclusion that the stent was unnecessary," St. Joseph said, adding that hospital officials did not conduct a full medical review before sending the letters.
After complaints about Midei were lodged by a patient early last year, reviewers for the hospital looked at X-ray images from the medical files of his stent patients to determine if their arteries had enough blockage — generally at least 70 percent — to justify the procedure. In many cases, they concluded that Midei had recorded significantly more blockage in written records than was revealed in the films, leading officials to send those patients letters.
The letters were not an admission of liability, hospital officials say. "Upon a full medical review by outside experts, it is possible that the stents may be deemed appropriate," St. Joseph said in the statement.
Hospital officials added that they are willing to "accept financial responsibility where the individual claim has been fully assessed and determined to have merits" and that their "door is open to productive, reasonable, and serious discussions" with attorneys and patients.
But medical malpractice lawyer Jay D. Miller, who represents 190 of Midei's former patients, said he's been in talks with the hospital for weeks, and that the offers have been far from what he considers fair.
"I was consistently told 'we know we're wrong, and we intend to be fair to your people, don't file suit, give us a chance to sit down with you," Miller said. "When I sat down with them, it was now defense lawyers and everything changed."
Miller wouldn't divulge the figures discussed during the confidential negotiations, though he described them as "barely" covering the $2,800 annual cost of the blood-thinning drugs that many patients with stents are required to take.
"They're forcing my hand," Miller said. "I'm going to file 190 lawsuits."
Sources familiar with the settlement discussions say the hospital is offering, on average, less than $100,000 per patient, while attorneys are sometimes asking for three times that amount or more.
For some of Midei's patients, even unnecessary stents might have improved their quality of life, at least for a time, by taking away heart pain caused by blockage that didn't meet the 70 percent threshold, cardiac specialists say. But those patients also must live with an increased risk of sudden clotting and other complications, the need to take drugs they otherwise wouldn't, and a general fear that something could go wrong at any point.
That makes each case hard to put a dollar figure on.