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Towson cardiologist faces professional charges

Federal lawmakers ask St. Joseph Medical Center to turn over three years of billing records and other documents related to cardiac care, saying they are troubled by reports of unnecessary coronary stents implanted at the Towson hospital and want to investigate for signs of Medicare fraud. Montana Sen. Max Baucus and Iowa Sen. Charles E. Grassley, the top Democrat and senior Republican, respectively, on the Senate Finance Committee, also ask the hospital for records of its financial relationship with manufacturers of the medical devices. They set a March 12 deadline, saying their committee was launching an inquiry as part of its role "to protect taxpayer dollars from waste, fraud and abuse.""In addition to putting patients' lives at risk, unnecessary medical procedures amount to wasteful spending of precious federal health care dollars," the senators wrote in a letter to the hospital, which was sent to CEO Jeffrey K. Norman this week and shared with The Baltimore Sun. St. Joseph officials pledged to cooperate, calling the committee's interest understandable, given the hospital's disclosure that hundreds of patients received expensive and potentially dangerous procedures that they might not have needed. "Transparency and cooperation are in the best interest of the hospital's patients, physicians, employees and community," they said in a statement. The Senate probe was the latest development in an unfolding saga at St. Joseph that has already seen the departure of its top executives, denial of medical privileges to a marquee physician, a drop in the hospital's lucrative cardiac-care practice and a federal fine expected to exceed $5 million. For more than eight years, the hospital's dominant cardiology practice, MidAtlantic Cardiovascular Associates, has fought lawsuits and allegations of inappropriate collusion in the process of referring cardiac patients to St. Joseph and other suburban hospitals. In 2008, St. Joseph hired Dr. Mark Midei (pictured), a prominent interventional cardiologist, away from Mid-Atlantic, scuttling a deal the practice had struck to merge with MedStar Health, a competitor of St. Joseph's. Months later, the U.S. Department of Health and Human Services began a fraud investigation that centered on St. Joseph's relationship with MidAtlantic, and three top hospital executives were placed on leave and later resigned. St. Joseph reached a settlement with the federal government in July. Its details, including the amount of financial penalties, are expected to be disclosed soon; court records suggest that the fine will exceed $5 million. Last summer, the hospital began reviewing records of cardiology patients, and in December 2009 it began sending letters to Midei's patients, saying their coronary stent implants might not have been needed.
Federal lawmakers ask St. Joseph Medical Center to turn over three years of billing records and other documents related to cardiac care, saying they are troubled by reports of unnecessary coronary stents implanted at the Towson hospital and want to investigate for signs of Medicare fraud. Montana Sen. Max Baucus and Iowa Sen. Charles E. Grassley, the top Democrat and senior Republican, respectively, on the Senate Finance Committee, also ask the hospital for records of its financial relationship with manufacturers of the medical devices. They set a March 12 deadline, saying their committee was launching an inquiry as part of its role "to protect taxpayer dollars from waste, fraud and abuse.""In addition to putting patients' lives at risk, unnecessary medical procedures amount to wasteful spending of precious federal health care dollars," the senators wrote in a letter to the hospital, which was sent to CEO Jeffrey K. Norman this week and shared with The Baltimore Sun. St. Joseph officials pledged to cooperate, calling the committee's interest understandable, given the hospital's disclosure that hundreds of patients received expensive and potentially dangerous procedures that they might not have needed. "Transparency and cooperation are in the best interest of the hospital's patients, physicians, employees and community," they said in a statement. The Senate probe was the latest development in an unfolding saga at St. Joseph that has already seen the departure of its top executives, denial of medical privileges to a marquee physician, a drop in the hospital's lucrative cardiac-care practice and a federal fine expected to exceed $5 million. For more than eight years, the hospital's dominant cardiology practice, MidAtlantic Cardiovascular Associates, has fought lawsuits and allegations of inappropriate collusion in the process of referring cardiac patients to St. Joseph and other suburban hospitals. In 2008, St. Joseph hired Dr. Mark Midei (pictured), a prominent interventional cardiologist, away from Mid-Atlantic, scuttling a deal the practice had struck to merge with MedStar Health, a competitor of St. Joseph's. Months later, the U.S. Department of Health and Human Services began a fraud investigation that centered on St. Joseph's relationship with MidAtlantic, and three top hospital executives were placed on leave and later resigned. St. Joseph reached a settlement with the federal government in July. Its details, including the amount of financial penalties, are expected to be disclosed soon; court records suggest that the fine will exceed $5 million. Last summer, the hospital began reviewing records of cardiology patients, and in December 2009 it began sending letters to Midei's patients, saying their coronary stent implants might not have been needed. (Baltimore Sun photo by John Makely)

The regulatory board responsible for licensing doctors in Maryland has filed administrative charges against a Towson cardiologist accused of performing hundreds of unnecessary procedures, beginning a process that could strip him of the authority to practice medicine in the state.

In a 19-page document made public Friday morning, the Maryland Board of Physicians accuses Dr. Mark G. Midei of "gross overutilization of health care services" and "willfully making a false report or record in the practice of medicine," among other violations of state law.

Midei, who ran the cardiac catheterization lab at St. Joseph Medical Center until last year, is alleged to have put stents in the arteries of patients who did not need them. He is also accused of falsifying medical records to make it appear that the patients were candidates for the expensive — and sometimes dangerous — procedure.

If the board's charges are upheld, Midei could be fined and lose his medical license. Board members have scheduled a conference Aug. 4 to discuss the case with Midei at their Baltimore offices.

A statement e-mailed Friday afternoon to The Baltimore Sun by Midei's spokesman said: "We have just received the letter from the Maryland Board of Physicians and we are in the process of reviewing it. We continue to stand by our prior statements that Dr. Mark Midei's care was appropriate. We look forward to future discussions with the board."

The board charges, lodged after a lengthy investigation of patient records, provide the first independent verification of complaints made more than a year ago to board members and to the staff at St. Joseph, which revoked Midei's hospital privileges last summer after its own investigation.

The Towson hospital has sent letters to 585 of Midei's patients — out of 2,000 cases it reviewed — warning them that their stent procedures might have been unwarranted, needlessly exposing them to the risk of death from blood clots and the effects of a lifetime of taking blood-thinning drugs.

Midei, who is also being investigated by a separate state committee and is a subject in at least two federal inquiries, has said that he expects to be exonerated. Court papers filed on his behalf in response to a malpractice lawsuit suggest that the allegations against him have been inflated by attorneys.

Some supporters have contended in letters to The Sun that Midei is being framed by a former colleague; others credit him with saving their lives.

"I asked for and felt very fortunate to have my procedures done by Dr. Midei," wrote Bill Gavin, who received a stent in 2004, in an e-mail to The Sun. "I would ask for him again without any hesitation."

According to the Board of Physician's charging document, signed June 7, Midei regularly overestimated the level of narrowing, or "stenosis," patients had in their arteries.

"He expressed a little bit of surprise" when told by a St. Joseph review committee that he had an "established pattern of overestimating," the document states.

In a statement e-mailed to The Sun on Friday morning, St. Joseph said it has cooperated in the Board of Physicians' investigation, but declined to comment further.

The board's investigation included detailed reviews of five of Midei's cases. In each, Midei wrote in the patient's records that they suffered from an 80 percent blockage of a coronary artery, which needed to be propped open with a stent. But a subsequent review of X-ray images showed less than 50 percent blockage.

Clinical guidelines generally suggest that an artery be at least 70 percent blocked before a stent is placed, and St. Joseph's rules consider anything less than a 50 percent blockage to be "insignificant."

Midei explained the discrepancy by saying that he routinely used certain percentages — 70, 80, 90 percent — as shorthand to signify mild, moderate or significant blockage, the document says. But he conceded after reviewing his cases that there were "significantly lower percentages of stenosis than he had initially dictated at the time of the procedure."

Midei also told hospital staff that he considered other clinical symptoms aside from test results when determining whether to place a stent, according to the charging document. But a St. Joseph review committee found that, in some cases, there were no "sufficient clinical indications to support the need."

The first hint of trouble came in November 2008, when the board received an anonymous complaint from someone claiming to be a St. Joseph employee and accusing Midei of "medical fraud," the charging document says. The person gave the board a list of 36 stent procedures that were supposedly unnecessary, performed between July and November of that year. The accuser reiterated the allegations in late April 2009, in a letter that purported to list 41 other unwarranted stent procedures.

Board Executive Director C. Irving Pinder Jr. said members receive about 2,000 complaints per year and follow up on all of them. A formal investigation by a board-selected peer-review group began in mid-2009, according to the charging documents, after St. Joseph alerted the board that it had suspended Midei's privileges to practice at the hospital.

"Quality-of-care cases take months," Pinder said. "It's a long process to do."

Typically in such investigations, 10 to 12 cases are selected for a random review conducted by a peer group, in this case two doctors in the cardiology field. They reviewed records that were independent from a federal investigation and the internal examination done at St. Joseph, Pinder said.

"We decided that we wanted to do our own" inquiry, he said.

The board, which is responsible for licensing and disciplining state physicians, charged Midei with violating the Maryland Medical Practice Act through unprofessional conduct, false reports, overusing health care services, failing to maintain proper records and providing substandard quality of care.

"This is quite a unique case; it's an anomaly," Pinder said. "These are all very serious accusations."

Last year, the board opened 200 full investigations. It filed administrative charges against 75 doctors out of the roughly 26,000 licensed to practice in the state. In 2009, 72 doctors lost their practice privileges for some period through suspension or revocation.

Midei will have a chance to defend himself before an administrative law judge at a formal hearing if the case is not settled. If the charges are sustained, the board can invoke a range of penalties, from probation to license revocation.

In the meantime, Midei faces a handful of malpractice lawsuits from former patients, along with a U.S. Senate investigation and a state examination, which recently found that he performed twice as many stent procedures as the typical Maryland cardiologist.

Several other doctors appear to have questionable stent rates, according to the state's data analysis, suggesting that improper stent placement might not be an isolated problem.

The FBI is in the early stages of investigating a Washington cardiologist, an agent told The Sun.

And fresh lawsuits have recently been filed in state and federal courts against John R. McLean, a Salisbury doctor who was accused in 2007 of performing about two dozen unnecessary stent procedures. McLean retired without public sanction from the Board of Physicians, according to the oversight agency's website.

Midei graduated from Northeastern Ohio University College of Medicine, according to the board's site, and completed postgraduate training at the Johns Hopkins University. He was licensed to practice medicine in Maryland in 1983.

In 1995, he co-founded the region's dominant cardiology practice, MidAtlantic Cardiovascular Associates, and earned a reputation as a highly skilled cardiologist.

His hiring by St. Joseph in 2008 was considered something of a coup. Midei's departure from MidAtlantic ended a proposed $25 million merger with a company owned by a St. Joseph rival, Union Memorial Hospital. That led at least one MidAtlantic colleague, former Chief Executive Hank Yurow, to vow revenge, according to Midei.

In a court affidavit, filed after he was sued by MidAtlantic, Midei alleges that Yurow said: "I will spend the rest of my life trying to destroy you personally and professionally. … I will sue you back to the Stone Age."

In a deposition, Yurow acknowledged having made the statements and said he was "still embarrassed about that."

Federal investigators who handle Medicare fraud were examining the close business relationship between MidAtlantic and St. Joseph when the allegations surfaced about Midei.

Details of that investigation have not been disclosed, though St. Joseph agreed to a proposed settlement with the federal government based on the investigation more than a year ago.

tricia.bishop@baltsun.com

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