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Cardiologist sues hospital over stent allegations

Cardiologist Mark G. Midei, accused of performing unnecessary heart procedures on patients at St. Joseph Medical Center in Towson, filed a fraud lawsuit Thursday against the hospital and its parent organization, Catholic Health Initiatives, alleging they inflicted "irreparable damage" to his career through a "campaign of corporate deception, trickery and fraud."

It's Midei's first public pushback since he was removed from duty last year. Since then, dozens of legal claims have been filed against him, and a physician oversight board has filed professional charges that could revoke his medical license.

But Midei, who helped build St. Joseph's reputation as a top heart center, says the allegations are unfounded and false. He was made into a "decoy," the lawsuit alleges, by administrators desperate to deflect the attention of federal regulators investigating the hospital's relationship with Midei's former employer.

The four-count lawsuit seeks $60 million in compensatory damages and could ask for up to $540 million in punitive damages.

"For the past eighteen months, SJMC has been affirmatively, yet falsely, reporting to the public and Dr. Midei's patients that Dr. Midei surgically inserted unnecessary stents," states the 50-page document, filed in Baltimore City Circuit Court. "This lawsuit will set the record straight. Dr. Midei is not the villain as portrayed by SJMC."

St. Joseph officials said they could not "address the specifics" of the lawsuit, but that the hospital plans to "vigorously defend itself." Representatives have previously said that hospital actions were appropriate and based on a review of Midei's clinical practice, which was spurred by a patient complaint.

Midei's harshly worded lawsuit, filed by Pikesville lawyer Stephen L. Snyder, tells another side of the story, alleging corporate greed, backstabbing and revenge.

At its core are nearly 600 letters that St. Joseph sent to Midei's former patients after a limited review of patient records. The letters warned that the patients may not have needed the tiny tubular stents that Midei, 53, placed in their arteries to improve blood flow.

St. Joseph officials said Thursday that the medical center was "guided by a belief that it had a moral and ethical responsibility to put patients' interests first." They've previously said that the letters were sent for "clinical reasons" and were not to be taken as a "definitive determination that a stent was unnecessary."

But the damage is done, according to the lawsuit. Those letters ruined Midei, it claims, and stripped the medical community of a skilled cardiologist.

Snyder and Midei, his wife at his side, held a news conference Thursday morning to announce the lawsuit.

"I can promise every one of my patients that what I did [in treating them] was what I would want for myself, for anybody in my family," Midei said. "They were treated appropriately and with the highest regard for their well-being, and I'm confident in everything that I've done, every decision that I've made."

He said that the past year and a half had been "very difficult and very challenging" for him and his family, and that he hopes to practice medicine again, though he doesn't know if it will be possible.

"This has followed me around the globe," Midei said, referring to the allegations.

Stents and related heart procedures earned an average of $81 million annually for St. Joseph, which aggressively recruited Midei as a full-time employee with a seven-figure salary two years ago.

He had already worked in the hospital for years on a contract basis through MidAtlantic Cardiovascular Associates, which he helped found in the early 1990s. That business grew into the region's premier cardiology practice, with members providing services at hospitals throughout Maryland, including St. Joseph, where Midei ran the cardiac catheterization lab.

The MidAtlantic practice controlled 70 percent of the business at St. Joseph's Heart Institute, according to an unrelated court filing, and Midei was one of its stars. His work helped attract the interest of MedStar Health, which owns Union Memorial Hospital in Baltimore, a major competitor for St. Joseph.

MedStar proposed a $25 million merger with MidAtlantic contingent on Midei's employment. But St. Joseph hired him and another doctor, who's now their chief of cardiology, before the deal could be done.

The move scuttled the MedStar deal and prompted a lawsuit against Midei and St. Joseph by MidAtlantic, whose former chief executive also vowed to "spend the rest of [his] life trying to destroy [Midei] personally and professionally."

The executive later expressed regret for those comments in a deposition, and the lawsuit was dismissed last year. By then, however, federal regulators had begun investigating MidAtlantic's relationship with St. Joseph.

The association between the hospital and MidAtlantic has at times been contentious, spawning allegations in lawsuits that patient care was improperly guided by financial connections. The federal Department of Health and Human Services, which investigates Medicare fraud and other health law violations, issued subpoenas to both organizations in 2008.

That investigation eventually led to a management shake-up at St. Joseph and also raised "questions about Dr. Midei's high utilization rate" of stent placements, hospital officials have said. About the same time, in April 2009, a patient complained that Midei was placing stents that weren't medically necessary.

When Midei was a St. Joseph employee, cardiology guidelines recommended that stents be placed only in people with artery blockages above 50 percent, which is typically determined from an catheterization X-ray image combined with analysis of clinical symptoms.

But Midei, the complainant said, was allegedly putting stents into arteries with insignificant blockage. St. Joseph removed him from duty in May 2009. His rights to practice at the hospital were suspended in July last year, around the same time that the hospital reached an undisclosed — and as yet unapproved — "agreement in principle" with the federal government to settle the investigation.

The hospital said it hired external experts to review records from multiple physicians and only Dr. Midei's showed patients who "may have received stents that were not supported by their catheterization films."

Midei's lawsuit says the hospital "chose to trump up false charges to make Dr. Midei the fall guy for both the federal government and for the public focus."

Said Midei: "It's been very disappointing to see reviews of my work conducted three or four years — in some instances five years — later, after the procedure was done, where I'm having to make a judgment on the fly at a patient's bedside."

He's accused of purposely exaggerating the level of blockage in patients' arteries to justify stent placement. St. Joseph reviewers — and Midei himself — found significantly lower blockage when they looked at the records than Midei had noted, according to the Maryland Board of Physicians, which oversees doctor discipline and licensing.

"One person looking at the same film twice at two different times may find significant variances in the way that they interpret them," Midei said Thursday. "When two observers look at them, that's even multiplied, and so I don't find it surprising that there is a disparity."

He also said the notion that a precise, percentage-level measurement occurs is faulty. "We do this visually," he said. "It's an estimate, and estimates are prone to discrepancies."

Midei's lawsuit says administrators disregarded favorable testimony from multiple co-workers, along with a recommendation by a colleague that he be reinstated. They also ignored analysis from other cardiologists who said Midei's choices were within recognized standards of care, the suit claims.

The hospital asked him to resign in November and, according to the lawsuit, offered to help Midei find work elsewhere. But soon after, the hospital began sending out the patient letters, initiating a "national publicity event," according to Midei's attorney.

Midei's court filing claims that the mailings violated confidentiality provisions by disseminating the review results, which were faulty because they were based on only a portion of the patient files.

St. Joseph has acknowledged that it "focused only on a single element: the percentage of blockage of the vessel" and "did not undertake a full medical review," which is required to "reach a conclusion that the stent was or was not necessary."

Snyder questioned why the hospital didn't go the extra step of doing a complete review, particularly when so much was at stake. St. Joseph declined to provide an answer to The Baltimore Sun.

"This hospital threw one of its own under the bus, knowing full well that there's variability in the review of these [records], and, even more importantly, without the full picture," Snyder said.

After it suspended Midei, St. Joseph also notified the Maryland Board of Physicians that Midei "displayed a repeated pattern of placing stents in patients based on [his] overestimation of the degree of [arterial blockage]," according to a board document.

The Board of Physicians conducted its own review and this summer charged Midei with violating the state's Medical Practice Act. A hearing was held in August to discuss the charges, though no resolution has been announced.

As of today, Midei's license is in good standing.

tricia.bishop@baltsun.com

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