"Excela Admits More Wrongdoing "

In the June 22, 2011 edition of the Pittsburgh Tribune Review, Excela admitted to more wrongdoing in the stent controversy that has rocked Westmoreland Hospital in Greensburg, Pennsylvania. In a statement issued by Excela CEO Robert Rogalski, Excela, owner of Westmoreland Hospital, admitted that it recently confirmed the identity of 51 patients who received unnecessary coronary stents in 2009 at the hospital. This, when added to the total of 141 patients identified by Excela for the year 2010, brings the total to over 190 patients who received unnecessary coronary stents at Westmoreland Hospital in 2009 and 2010.

As with the patients who received unneeded stents in 2010, the doctors who were involved in the 2009 stent malfeasance were (not surprisingly), Ehab Morcos and George Bou Samra, interventional cardiologists with, at the time, staff privileges at Westmoreland Hospital. Excela has indicated that it will not review 2008 charts.
Stents are tiny expandable mesh tubes inserted into clogged arteries to keep them open. When a patient exhibits certain symptoms suggestive of acute coronary artery disease, a catherization, including a diagnostic test known as an angiogram, is performed. The angiogram helps to determine the existence and precise location of a clog. Generally, any artery that is more than 70% clogged is stented. If an artery is less than 70% clogged a stent is not necessary as the less severe blockage can be addressed with medication. As with any procedure, stents carry a risk of harm and side effects, including the potential for blood clots. This is why doctors do not insert stents unless medically necessary.

The one million dollar question is...WHY? Why did these doctors do it? Why did they expose their patients to unneeded medical risks? Why did Excela not acknowledge it until two or more years after it started? What did the doctors have to gain? What did Excela and Westmoreland Hospital have to gain? When did Excela first learn of it? Was Excela in on it? In the June 22, 2011 article, Excela indicated that it went public with these findings because "we think it is the right thing to do" Really? If it was the right thing to do in March 2011, why wasn't it the right thing to do a year or so earlier? What does "right thing to do" mean? Is it the right thing to do because Excela is trying to prevent a federal investigation? Is it the right thing to do because other doctors who were not in on it threatened to go public or to report Excela to the accreditation agencies?

I am an attorney who represents people who have received unnecessary stents. If you are the recipient of an unnecessary stent please contact me. I am paid exclusively on a contingent fee. There is no charge, ever

Unneeded Stent Update

On March 4, 2011 the Pittsburgh Tribune Review published a story confirming that 141 patients may have received unneeded cardiac stents at its cardiac care lab in 2010.  These stents were placed by Drs Ehab Morcos and George Bousamra, interventional cardiologists with staff privileges at Exhela Health Westmoreland.

Multiple lawsuits on behalf of many of these unfortunate patients have ensued.

Robert Rogalski, CEO of Excela, Westmoreland's Greensburg based parent, issued a public apology.  In so doing, Mr Rogalski, informed Tribune Review staff reporters that an internal investigation into whether any unnecessary stents were placed at Westmoreland Hospital in 2009 was ongoing.  Specifically, The Trib reported that hospital officials indicated that results of the review of their 2009 cases are expected in May.  Well, May has come and gone and yet no results have been divulged. Perhaps  Excela/Westmoreland meant May 2012 !

Coronary stents are appropriate when the percentage of arterial blockage exceeds 70%.  If a particular coronary artery is not at least close to 70% occluded then a stent should not be inserted.  It will not offer any

benefit and carries with it an unnecessary risk of complications such as the risk of blood clots. The fact that this occurred leads to numerous additional questions.

Who knew that this was happening and when did they know?   How much money did the doctors make on the placement of the unneeded stents?    Did the hospital receive a benefit from these unnecessary procedures?  If so, what was the benefit?   Was anyone at Excela supervising these doctors?  How long has this been going on?   Has anyone died unnecessarily?   Did management at Excela ever compare the number of procedures that Drs Morcos and Bousamra  were doing to the number performed by other cardiologists and radiologists at Westmoreland?  Did management compare the number of procedures performed by these doctors against the industry average?  Is medeicaid or medicare money involved?

Has the federal government initiated an investigation?

In order to determine the percentage of blockage an angiogram must be performed.  How do the doctors or the hospital defend the decision to insert stents in situations where an angiogram clearly shows blockage significantly below 70 percent?  Did the doctors misrepresent the percentage of blockage in the medical records?  Were other staff members in on it?

If you believe that you or a family member may have been the recipient of an unneeded stent or that you are the victim of medical malpractice please contact my law office today.

Jefferson Hospital Status???

On March 4, 2011 the Pittsburgh Business Times reported that Doctors at Jefferson Regional Medical Center had formed a committee to review the use of cardiac stents and that this committee was formed months before disclosures at Excela Westmoreland Hospital regarding the unnecessary implementation of cardiac stents by doctors with staff privileges at Westmoreland.

 

Richard Collins, vice president and chief medical officer of Jefferson, indicated the decision was based on the nationwide inappropriate use of stents.  According to Collins, the committee "will" randomly audit patient records to identify problematic patterns.

 

While the patient records audited at Westmoreland were performed by an outside independent group, the records to be audited at Jefferson were to be done in house.   What is the status of the investigation at Jefferson?  If the committee was formed long before the Excela/Westmoreland scandal arose what is the committee doing?   Has the committee received the results?   If not, why not?   What is taking so long?   If Jefferson has received the results why have the results not been made public? 

 

According to Dr. Sang Park, cardiothoracic surgeon and medical director at Jefferson's Heart Institute, approximately 800 cardiac catherizations were performed at Jefferson in 2010.  Has the hospital randomly selected a statistically significant sample to test?  The key diagnostic test to determine if a stent should be implanted is an angiogram.  An angiogram allows doctors to determine the extent of blockage in arteries.  Stenting is generally considered unwarranted if the percentage of blockage is less than 70%.  In determining that unnecessary stenting may have occurred at Excela/Westmoreland, the outside auditors gave the cardiologists the benefit of the doubt and only red tagged patient files where stents were placed in situations where blockage was 50% or less.

 

How long can it take Jefferson to analyze a randomly selected, statistically significant number of angiograms to see if there is a problem? 

Is "Fee for Service " at Fault in Unneeded Stents

"Fee for Service" appears to be at fault for unneeded stents being placed in the arteries of  patients in hospitals all over the country.

 

Multiple instances of unneeded stents being placed in the arteries of unsuspecting heart patients have been reported.  The most recent is Westmoreland Regional Hospital in Greensburg, Pennsylvania.  Like many hospitals, Westmoreland is owned by a separate corporate entity, Excela Health, that in turn owns other hospitals. On March 3, 2011, Excela sent letters to 141 patients of Drs Morcos and Bousramos informing them that they may have received unnecessary stents.  The stents were all placed in 2010 at Westmoreland Regional Hospital.

 

How could this have happened?  According to Dr Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic, the insertion of unneeded stents by interventional cardiologists is going on in every city in America.  But why would a trusted doctor perform an unnecessary invasive procedure?

 

Perhaps the answer is "fee for service".  Our system does not pay clinicians or device manufacturers to keep us healthy.  There is no money in that.  How do you measure health?  Our system pays doctors and hospitals to do tests, sell devices and perform procedures. Hospitals compete for market share and more and more have adopted standard marketing and sales techniques by branding various sub specialties and driving herds of patients.  Certain hospitals market themselves as "heart centers" or "cancer centers".  Why?   Perhaps because that is where the money is.   When is the last time you saw a "rheumatology center" marketed? 

 

In a December 2010 staff report on cardiac stent usage, the United States Senate Committee on Finance noted that the Medicare system pays hospitals a set free for each diagnosis, regardless of how much the individual patient actually costs the hospital.  Is it any surprise that professional business managers and hospital administrators have found a way to achieve profits by focusing on those procedures and specialties the are most profitable? 

Excela Admits More Mistakes

On Saturday April 23, 2011, Excela Health, owner of Westmoreland Regional Hospital in Greensburg, Pennsylvania admitted to more mistakes in the stent controversy.  According to the Pittsburgh Tribune Review, Excela acknowledged that at least six of the 141 patients whom Excela previously notified as having been the recipients of medically unnecessary stents did not get stents at all. 

Jerome Granato, M.D., a cardiologist and chief medical officer at Excela informed the Trib that at least six of the unneeded stent patients did not get the stents that they did not need.  This is not to say, however, that these patients were treated appropriately. Dr Granato suggested as much when he stated, "They had a procedure on a minimally diseased vessel..."

Therefore, as the matter presently stands, the scorecard at Excela reads as follows:

-At least 135 patients receiving unnecessary stents in 2010;

-At least 6 patients receiving unnecessary non-stent heart procedures in 2010;

-Excela acknowledging that in May it will inform the unlucky recipients of the unneeded stents implanted in 2009.

Interventional cardiologists recommend stenting when artery blockage exceeds 70%.  According to Excela, all patients who received unneeded stents in 2010 had blockages of less than 50%.  Hospital officials have purportedly notified the Office of the Inspector General at the Department of Health and Human Services.

Multiple lawsuits have been filed by unneeded stent recipients.  It is unclear whether any suits have been filed by patients who received unnecessary non-stent procedures.  

All of the procedures were performed by either Drs. Morcos or Bousramos, interventional cardiologists who formerly had staff privileges at Westmoreland Hospital. Combined, these two physicians performed at total of 753 stent procedures in 2010. These doctors resigned from Westmoreland hospital On January 12, 2011, after having been notified of the results of an investigation conducted by outside contractors into the necessity of many of their stent procedures. Morcos and Bousramos were quickly granted temporary privileges at Forbes Regional Hospital.  It is unclear how many stent procedures were performed by these doctors at Forbes or even whether Forbes plans to look into it. 

Will Local Hospitals Divulge Unneeded Stents?

On March 3, 2011 Westmoreland Hospital in Greensburg, Pennsylvania publicly acknowledged that in 2010 over 140 patients of Drs. Morcos and Bousramos received unneeded cardiac stents in connection with angioplasty that was performed by these physicians at Westmoreland Hospital.   The unneeded stents were discovered by an independent team of cardiologists invited into the hospital to evaluate the unusually high volume of stents placed by Morcos and Bousramos.  Morcos and Bousramos are interventional cardiologists who specialize in angioplasty.

A few days later, Jefferson Regional Medical Center, located approximately 15 miles south of Pittsburgh, announced that it, likewise, was conducting an investigation to ascertain whether it had a problem with staff interventional cardiologists placing unnecessary cardiac stenting.  Unlike Westmoreland, Jefferson's audit was to be conducted internally rather than through outside independent cardiologists.

Westmoreland has indicated that it will evaluate patient records for the year 2009 to determine if the unnecessary procedures extended beyond 2010 and that it will release the results in May.  Jefferson has not indicated when its investigation will be completed or whether it will publicly acknowledge the results.  Many cardiac patients of both of these institutions are fearful that they may have been victims of unnecessary intrusive procedures and, perhaps, more importantly, that they have been mislead by their cardiologists into believing their condition is worse than it is.

Stents are tiny metal cages used to prop open arteries that are clogged with plaque. The procedure in which the stents are inserted is called angioplasty.  The procedure is performed by a cardiologist who weaves a catheter with a deflated balloon and stent to the location in the artery that is partially filled with plaque.  When the correct location is identified, the balloon is inflated and the stent expands to push the plaque to the interior walls of the artery so as to once again allow the free flow of blood to the heart.  An angiogram is the diagnostic test used to determine if stenting is appropriate.  Typically, cardiologists require the artery to be at least 70% obstructed before stenting is considered medically necessary.  In the cases recently identified by Westmoreland Hospital, all of the patients who received stents had arteries that were less than 70% occluded, sometimes significantly less.  

Two More Stent Suits Filed Against Westmoreland Hospital

Two more stent suits were filed against Westmoreland Hospital and Drs. Morcos and Bousramos in Westmoreland County this week according to the Pittsburgh Tribune Review.  

On March 3, 2011, Excela Health, owner of Westmoreland Hospital, sent letters to 141 seperate patients advising them that they may have been recipients of unnecessary heart stents placed by Drs. Morcos and Bousramos in 2010.  Morcos and Bousramos are interventional cardiologists who, until January this year, had staff privileges at Westmoreland Hospital.   The number of complaints now filed totals 21.    

Officials at Excela have indicated that they have retained an outside consulting group to review cardiology cases and expect results of their 2009 cases to be issue in May.  This information comes on the heels of announcements last year in Maryland, Texas and  Louisiana of  unnecessary stent procedures performed by various doctors at hospitals in those states.

According to the the Pittsburgh Tribune Review, Drs. Morcos and Bousramos performed more than 750 of the 2,000 heart stent procedures done at Westmoreland Hospital in 2010.   According to the December 2010 investigatory report of the United States Senate Committee on Finance, nationwide, balloon-expandable stents were being implanted in more than 90% of all interventional coronary procedures.  Assuming the accuracy of these figures, it would appear that a patient receiving interventional coronary care by Drs.Morcos and Bousramos at Westmoreland Hospital in 2010 had a better than 15% chance of receiving an unnecessary heart procedure.  One has to wonder how these doctors decided upon whom to prey.

One problem may be the lack of peer review.   Doctors at other hospitals have indicated that at some facilities the cardiologist who performs the diagnostic test to ascertain the extent of the blockage is the same doctor who interprets the test and ultimately inserts the stents. One can easily see how this might lead to a "fox in the hen house" type scenario.  It  is not yet known whether this lack of oversight existed at Westmoreland Hospital.