Even the most sophisticated Catholic logician of them all, St. Thomas Aquinas, would have a hard time following this one:
St. Joseph Medical Center fired its star cardiologist because he improperly inserted stents in the coronary arteries of hundreds of St. Joseph's patients, ergo the Towson hospital has done nothing wrong.
That's the argument the hospital wants you to buy, as far as we can tell from its words and actions. But you can see that the premise doesn't quite lead to the conclusion.
St. Joseph deserves credit for shutting down Dr. Mark Midei last year when an internal review showed that he was implanting stents in numerous coronary arteries with "insignificant" blockage. Stents are intended to prop open blocked vessels and are considered a serious step because they can also can cause fatal clots and other complications. Given the emotional and financial pain that was sure to result from its discovery, another hospital might have tried to cover it all up.
Now St. Joseph needs to continue to do the right thing and negotiate in good faith with patients who got stents that a state inquiry and the hospital's own probe suggest were unneeded. Turn over the documents the plaintiff lawyers want. Drop the legal bluster, the "generally denies all allegations of liability" stonewalling.
Yep, I understand how tort cases work. Bluster is the language of negotiation. Defendants deny every ounce of liability as long as they can. Defense lawyers hate arguing cases outside the courthouse, especially "in the media."
But enough facts are known to cast heavy doubt on St. Joseph's protests of innocence. This case is already out of the courthouse.
As Tricia Bishop reported in Monday's editions of The Baltimore Sun, St. Joseph's own chief of cardiology, Dr. Stephen H. Pollock, has told at least two Midei patients that their stents were probably unnecessary. Bravo for him. He's following the Hippocratic oath, not memos from lawyers.
After independently reviewing five St. Joseph cases, the Maryland Board of Physicians in June accused Midei of "gross overutilization of health care services" and "willfully making a false report or record in the practice of medicine."
St. Joseph's own investigation, which resulted in nearly 600 patients being told that stents were implanted in vessels with insignificant blockage, amounts to a stipulation that something was very, very wrong.
There is no established medical reason to stent an artery with insignificant blockage. Medicare won't even pay for it.
Perhaps malpractice insurance companies are behind St. Joseph's new militancy. We don't know who will end up paying for whatever settlement plaintiffs might collect. On Monday, a St. Joseph spokeswoman declined to identify the hospital's malpractice insurer, citing "proprietary reasons."
Maybe insurers are adding up the potential liability and drawing a harder line. Maybe both St. Joseph and the insurers worry about evidence reported by The Sun suggesting Midei was implanting unneeded stents farther back than three years ago, the limits of the hospital's review. That could increase the bill.
"Justice is a certain rectitude of mind whereby a man does what he ought to do in the circumstances confronting him," Aquinas wrote in the Summa Theologica.
What St. Joseph ought to do is reach a fair deal with the people who seem to have been harmed inside its walls. The top order of business should be patients who didn't have stents before their first one was implanted in an unblocked artery, sentencing them to a lifetime of anti-clotting blood thinners they might not otherwise have needed.
But even for those patients who already had at least one of the implants and were taking thinner, any unnecessary pieces of wire mesh inserted in the vessels feeding the heart carry risk.
Midei has said he expects to be exonerated. That sounds a little hollow, too, given developments. But perhaps he has nothing to lose by fighting the allegations as hard as he can.
You can't say that about the hospital. St. Joseph dearly wants to put all this behind it. It wants to get on with the business of caring for patients and rebuilding its reputation.
But as long as the hospital resists a settlement, the case of the questionable stents will continue to haunt it.