Lawyer files malpractice claims in cardiac cases

A Towson attorney filed a foot-high stack of claims in a state arbitration office Tuesday on behalf of 101 patients alleging conspiracy, negligence and fraud against St. Joseph Medical Center and its former star cardiologist, Dr. Mark G. Midei, who's accused of performing hundreds of unnecessary cardiac procedures.

The arbitration filings, required before court action, came after settlement talks between the hospital and medical malpractice attorney Jay D. Miller broke down. They represent the first significant wave of litigation involving Midei, who has already been sued in a handful of court filings this year. But more legal action is expected to follow, encompassing doctors at other hospitals.

"I think [the problem is] nationwide," said Miller, who is also looking into potential claims against at least one cardiologist at Union Memorial Hospital in Baltimore.

A state committee revealed last month that a doctor at an unnamed Maryland hospital is currently under investigation and that an inquiry at a third hospital is likely. St. Joseph, Union and Washington Adventist Hospital in Takoma Park have the highest rates of stent placements in Maryland, according to a Baltimore Sun analysis.

Both Union and Washington said in statements to The Sun that they haven't been contacted about any state investigation and that quality care is their chief concern. Union declined to address Miller's claims directly, but said that its doctors perform procedures "according to best practices within the cardiology profession."

Midei is accused of falsifying medical records to make it appear that patients had clogged arteries, then inserting mesh stents into their healthy veins — an unwarranted treatment.

St. Joseph removed him from duty last year, shortly after it learned of the allegations. And a physician oversight board filed professional charges against Midei this summer, alleging "gross overutilization of health care services" among other violations of state law.

That case has yet to be resolved, and no criminal charges have been filed against him, though a U.S. Senate Committee is investigating whether Midei's alleged actions involved Medicare fraud. Last year, a Louisiana cardiologist was sentenced to 10 years in federal prison for similar allegations of procedure overuse, and a Salisbury cardiologist was indicted for it this summer.

Several lawsuits were filed earlier this year in Baltimore County, and one in the city seeking class-actions status. Miller, who says he represents nearly 200 patients, said he wants each of his clients to pursue their own claims.

"I want each person to have his or her day in court," Miller said Monday. "Each case is different. Everybody's damages are different. … We're talking about fraud here."

Miller filed the claims in Maryland's Health Care Alternative Dispute Resolution Office, which arbitrates malpractice cases. Representatives can begin further talks, and either side can appeal in court if it finds the board's decision unsatisfactory. If all sides agree to forgo further talks, the cases can be moved to court without additional meditation.

St. Joseph sent letters to nearly 600 of Midei's former patients, warning them that their stents may have been unnecessary. And the hospital has said it wants to work with patients to settle legitimate claims.

Miller would not discuss specifics regarding his confidential talks with St. Joseph officials, but he said the breakdown occurred over how much money each side thought his clients deserved. He said the hospital offered no more than "out-of-pocket expenses" for medication and follow-up visits to doctors not covered by insurance.

The attorney said the patients deserve more. Depending on individual insurance plans, he said, his clients could be out between $20,000 and $50,000 over the course of their remaining years, in part because the procedure requires they take medications with dangerous side-effects.

In a statement, St. Joseph's said it could not comment on claims that have yet to be filed. But they did confirm they're seeking to talk with patients and their lawyers to try to settle any potential claims. The hospital says that not all patients who received letters had an unwarranted procedure.

The hospital, the statement says, "will take responsibility when patients demonstrate that inappropriate care has caused them an injury. … SJMC has invited all the plaintiffs' attorneys to submit supporting medical information so that it can properly and fairly evaluate each claim. SJMC has only received that information in a few cases."

The statement adds that the hospital "respects that some patients want to explore their legal options as a result of receiving a letter regarding their procedure. SJMC had hoped to find common ground with Mr. Miller that would allow for an expedited process to appropriately settle all legitimate claims in a fair manner. Unfortunately, efforts thus far have been unsuccessful."

Midei's attorney, Stephen L. Snyder, said the inability of St. Joseph's to satisfy its patients further harms his client, who denies any wrongdoing.

"The hospital took unprecedented and decisive action in tarnishing and forever destroying Dr. Midei's fine reputation," Snyder said in a statement. "Yet when it comes time to defend these matters, the hospital's conduct frustrates and disappoints these plaintiff's lawyers who are led to believe that the only issue to resolve is how much. It is not."

Miller said the lawsuits will give him a chance to depose key hospital officials and learn more about how Midei allegedly escaped scrutiny. Regulatory documents reported on by The Baltimore Sun in May show that the doctor avoided peer review because, as a department head, he chose which cases would be scrutinized.

State regulators discovered, for example, that in five cases, Midei wrote that patients had 80 percent blockages of coronary arteries, which required stents. But the board found that the arteries were blocked only 50 percent.

Miller, who sought out clients by placing newspaper ads after the letters were sent out, questioned whether St. Joseph officials did all they could to uncover the problem and alleges that the hospital and Midei conspired to perform unnecessary procedures.

"The hospital had to have been aware of what Dr. Midei was doing and they just looked the other way," Miller said. All 104 of his clients filing claims Tuesday received letters from the hospital warning them that they might not have needed the procedure, Miller said.

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