Midei: I acted in the patients' best interests

In the near future, I will appear before the Maryland Board of Physicians where I will have the long-awaited opportunity to meet with my peers and make the case for retaining my license to practice medicine. In the meantime, I take the opportunity now to address some important points about the charges leveled against me in connection with my work with cardiac stents at St. Joseph Medical Center in Towson, Maryland.

First, and perhaps foremost, is the timing of the hospital's accusations that I implanted stents in patients who did not need them. These charges, which originated from someone within the hospital community, conveniently surfaced as St. Joseph Medical Center and its Denver-based owner Catholic Health Initiatives (CHI) was entangled in a federal investigation of misconduct between them and MidAtlantic Cardiovascular Associates. As my troubles became front-page news, St. Joseph Medical Center moved to the back page.

My obvious role as a decoy did not merely help St. Joseph Medical Center and CHI in their public relations; my role as a decoy helped St. Joseph Medical Center and CHI survive. Other hospitals facing similar accusations of kickbacks and illegal payments have paid recent fines of $100 million or more and have been threatened with exclusion from the Medicare program — a fatal blow to any hospital. St. Joseph Medical Center paid a paltry $22 million fine.

State regulators have accused me of manipulating St. Joseph Medical Center's peer review process. I did not. I shared responsibility for a weekly teaching conference at which heart doctors evaluated difficult cases, a practice consistent with other national and Baltimore heart centers. I shared the choice of which cases to review. We reviewed all cases involving patient complications, regardless of the severity of these complications. Any doctor, nurse, technologist or physician assistant could suggest additional cases for review. St. Joseph Medical Center has perpetrated the myth that I acted alone in the peer review process. In fact, I reported directly to St. Joseph Medical Center physicians and administrators who supervised this process and were apprised of it on a weekly basis.

One of the ironies of my story is that it has been used to portray the perils of the fee-for-service medical system, when in fact I have never been compensated based on productivity. At MidAtlantic Cardiovascular Associates, where I worked before moving to St. Joseph Medical Center, all members were compensated equally. At St. Joseph Medical Center, I had a guaranteed contract; the number of procedures I performed had absolutely no bearing on what I was paid. I have advocated for health care reform and I have supported this cause financially.

Much also has been made of my relationship with stent manufacturers. To set the record straight, while "VIP" tours of manufacturing facilities may have been offered to me, I did not accept such gifts or offers. Various manufacturers have been said to have "rewarded" me for the use of their products. This is untrue. I did not receive personal enrichment from manufacturers during my practice of clinical medicine. Even small honoraria were donated to hospitals or foundations providing free care or medications to indigent patients.

My medical decisions have been second-guessed years after the fact by critics without access to the medical records of my patients or to the high quality images I used when determining that a stent was necessary. I recognize that best practices in cardiology continue to change rapidly, and that physicians are practicing far more conservatively today due to changes in medical knowledge and other factors. I do not pretend that I have been perfect in my practice of medicine; no doctor can make that claim.

But I can say unequivocally that my decisions as a doctor have been motivated by one thing only: The well-being of my patients.

Dr. Mark G. Midei of Monkton is facing private lawsuits and the possible loss of his medical license amid accusations that he placed unnecessary stents in patients at St. Joseph Medical Center. He has filed a counter-suit against the hospital alleging it had fraudulently damaged his career. His licensure case is scheduled to be heard by Maryland Board of Physicians on Wednesday.