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.

UNNEEDED HEART STENTS MAKE BIG MONEY FOR DOCTORS

It is becoming increasingly apparent that many doctors are making big money from placing unneeded heart stents.  Interventional cardiologists around the country have been prosecuted and sued for placing heart stents into the arteries of patients who did not need them.  These doctors make big profits in placing the unneeded stents into unsuspecting patients. 

The extent of the problem is difficult to ascertain.  Some interventional cardiologists have indicated that it is prevalent. However, coworkers who most assuredly must know the identities of the individuals engaging in this substandard, if not criminal behavior, are typically tight-lipped. Presumably, these coworkers are reluctant to step forward for fear that it could jeopardize their livelihoods. Hospitals with whom these cardiologists have staff privileges very rarely acknowledge any problem.  Not only is unneeded angioplasty profitable for the hospital, but public acknowledgment could lead to many lawsuits, which could have significant financial repercussions. 

Last year, the United States Senate Committee on Finance conducted an investigation into this problem.  The Committee initiated the inquiry based on reports that cardiologist Mark Midei, M.D. from St. Joseph Medical Center in Towson, Maryland implanted approximately 600 stents that were not medically necessary.

The Committee discussed the profits derived by Dr. Midei in connection with each procedure, as well as the concomitant financial benefit to the hospital.

The Committee found that St. Joseph billed public and private insurers more than $6.6 million for the 585 unnecessary stent procedures performed by Dr. Midei between 2007 and 2009.  This translates to over $11,000 per unnecessary procedure.  Although the report does not indicate whether there was a separate charge by Dr. Midei or whether his fee was incorporated, it is evident that these procedures were profitable.

On November 9, 2010, St. Joseph Hospital reached a settlement with the federal government agreeing to pay 22 million dollars to settle federal claims that it engaged in a decade-long kickback scheme with Dr. Midei’s cardiology group. 

In addition to the doctors and hospitals, the medical device companies have a major financial incentive in their stents being used.  In the Midei case, many of the stents were manufactured or supplied by Abbott Laboratories.

The Committee found that it is common practice for medical device companies to collaborate with physicians and to cultivate top volume cardiologists.  In fact, after Dr. Midei was barred from practicing at St. Joseph due to implanting patients with unnecessary stents, Abbott began paying Midei consulting fees.

If you believe that you are the victim of a doctor implanting unnecessary cardiac stents, call Attorney Mark Haak.

Officials Hesitant in Examining Stent Procedures

Officials nationwide are hesitant in examining the the placement of unneeded stents by interventional cardiologists. 

Stents are tiny metal cages that are inserted into plaque filled arteries to push the plaque to the walls of the arteries and allow for the free flow of blood.  In determining whether stents should be used, cardiologists may rely on a variety of tests to determine the percentage of plaque build-up.  Typically cardiologists do not recommend stenting unless at least 70% or more of the subject artery is clogged with plaque.

Over the last few years a number of doctors around the country have been investigated, prosecuted and/or sued over the placement of stents that were not medically necessary.  Doctors placing the unneeded stents appear to be motivated by  high medicare and insurance reimbursement rates, contracts with stent manufacturers and, in some instances, kick backs from hospitals where the procedures are performed. 

A number of instances of unnecessary stenting have been reported around the country.  Two California cardiologists were discovered engaging in this reprehensible conduct in 2002. 

In December 2009, after six days of deliberation following a three month trial, Mehmood Patel MD,  a Louisiana cardiologist, was convicted of 51 counts of health care fraud as a result of placing stents in patients who did not need them.   

In November, 2010, the Texas Medical Board accused Texas cardiologist Samuel DeMaio MD, of performing unnecessary heart stent and defibrillator implementation procedures.

Likewise, in 2010, a Salisbury, Maryland cardiologist, John McLean MD, was indicted by a federal grand jury on charges associated with unnecessary stent procedures on patients.

In perhaps the most prolific example of unnecessary stenting yet to surface, Towson, Maryland cardiologist Mark Midei MD, was accused , in 2010, of placing stents in almost 600 patients who did not need them.

Most recently, Excela Health, owner of Westmoreland Hospital in Greensburg, Pennsylvania, recently identified two cardiologists, Ehab Morcos MD, and George Bousramos MD, of placing stents in over 140 patients who did not require them.

These examples suggest that oversight is lacking.  Is it not reasonable to conclude that unnecessary stent procedures are taking place in other places not yet identified?  How can any patient know that his doctor did not misrepresent the percentage of blockage?  Why should patients who are ostensibly experiencing serious health concerns have to worry if their own doctor is preying upon them?  What steps have hospitals, regulatory and accrediting agencies taken to investigate past practices and to ensure that this cannot continue?  Will hospitals who, through internal investigation, discover unscrupulous doctors performing unnecessary stenting, acknowledge it publicly or simply try to sweep it under the rug?  Should we rely on hospitals to conduct their own investigations when it may be that these very hospitals are complicit?

What is Status of the Jefferson Regional Medical Center Investigation?

Recently, the Pittsburgh Business Times confirmed that Jefferson Regional Medical Center, located approximately 15 miles south of Pittsburgh, was conducting an investigation into cardiac stent procedures performed at the Heart Institute affiliated with the medical center. Dr. Sang Park, a cardiothoracic surgeon and the medical director at the Heart Institute, confirmed his concern that an internal investigation was needed. Dr. Park stated that at most institutions there is little or no oversight to determine the necessity of the procedure.

Explaining that there is no peer review process to judge whether a doctor is doing "right or wrong", Dr. Park expressed his belief that for years cardiologists have been abusing the system in performing unnecessary stents.

Last month Excela Health announced, following an investigation by independent outside cardiologists, that in 2010 there were 141 patients who received unneeded heart stents at Westmoreland Hospital in Greensburg, Pennsylvania. By comparison, Jefferson, apparently is conducting its investigation "in house". At this juncture no word of the outcome of the Jefferson investigation has been forthcoming.

Christopher Mallavarapu,M.D., a cardiologist in Louisiana,compared the placement of unnecessary stents to incest because, "nobody wants to talk about it". In December, 2010 the N.Y.Times quoted Steven Nissen,M.D.,chief of cardiovascular medicine at the Cleveland Clinic, as stating that he, "routinely treats patients who have been given multiple unneeded stents." He further complained that we are spending a fortune on procedures that are not needed. In discussing the extent of the problem Dr Nissen expressed his opinion that the use of unnecessary stents is happening right now in every city in the country.

Thus far doctors and hospitals in California, Texas, Louisiana, Maryland and Pennsylvania have been investigated for heart stent abuse. State medical boards are starting to appreciate the extent and gravity of the problem.

If you believe that you may have been the victim of a negligent cardiologist, contact Attorney Mark Haak today for a free evaluation of your case.

Are Unneeded Stents a Growing Problem?

Are unneeded stents a growing problem?  Recently officials at Excela Health in Westmoreland County, Pennsylvania announced that over 140 patients received unnecessary stent procedures performed by two interventional cardiologists with staff privileges at Westmoreland Regional Hospital. According to hospital representatives, Drs Ehab Morcos and George Bousamra performed coronary stent procedures on patients in 2010 that "may not have been medically necessary".  Excela  representatives have hired two seperate teams of independent, interventional cardiologists to conduct formal reviews of cardiac coronary stent procedures performed at Westmoreland Hospital's cardiac catheterization laboratory.  While patients who received unneeded stents in 2010 have been notified, cases of patients receiving stents in 2009 are still under review.

 

Jefferson Regional Medical Center outside of Pittsburgh, Pennsylvania recently announced that it, likewise, is conducting an internal investigation of its catheterization laboratory.  This results from this investigation have yet to be released.

 

The performance of unneeded stent procedures is neither new nor limited to the Pittsburgh area.

 

In 2010, it was revealed that Dr Mark Midei, a cardiologist with staff priviliges at St Joseph's Hospital in Towson, Maryland, performed almost 600 unnecessary stent procedures between 2007 and 2010. 

 

In 2006, it was discovered that cardiologist Mehmood Patel was performing vast amounts of these unnecessary heart procedures at Our Lady of Lourdes Regional Medical Center in Layfayette, Louisiana. 

 

In 2002, it was revealed that two california cardiologists were likewise performing stent procedures that were not required.  Drs Chae Hyun Moon and Fidel Realyvasquez performed an extraordinary amount of unnecessary procedures at Shasta Regional Medical Center in Redding, California.  Before their practice was made public, the hospital pampered them with chairmanships and perks.

 

These incidents beg the question: are these unnecessary heart procedures simply isolated examples of  "doctors gone bad", or are they the tip of a yet to be discovered iceberg?  This question is especially troublesome given the likelihood that the hospitals involved had to have known.

"Westmoreland Regional Hospital Admits Drs. Morcos and Bousamra in the Wrong"

Recently Westmoreland Regional Hospital Admitted that Drs Morcos and Bousamra were in the wrong in inserting unneeded heart stents in over 140 heart patients in 2010. These procedures were performed at Westmoreland Regional Hospital.
Westmoreland Regional Hospital in Greensburg, Pennsylvania, owned by Excela Health, operates a cardiac catherization center. Drs. Morcos and Bousamra were two of the interventional cardiologists who had staff privileges to perform catherization procedures during the year 2010.
On March 3, 2010, Excela Health's CEO Robert Rogalski, publicly apologized in a news conference stating, "We would like to apologize to the patients who received coronary stents that may not have been necessary." In a subsequent Pittsburgh Tribune Review article Mr. Rogalski acknowledged: "This should never have happened. There's no excuse for it." In a letter sent to patients that same day, Jerome Granato, M.D., Chief Medical Officer of Excela informed patients that Drs, Morcos and Bousamra performed coronary stent procedures that, "may not have been medically necessary", indicating that the "perceived"blockage in these patients arteries may not have justified the placement of a coronary stent.
While multiple lawsuits have been launched against these doctors, their practice group, Westmoreland County Cardiology, Inc., as well as Excela, many questions remain unanswered, including, For how many years has this been going on? How many other patients are involved? What are the injuries to these patients, both long and short term? How much money did Excela make over the years from patient admissions related to these unnecessary procedures? Why did Excela come out in a very public way and acknowledge this problem? Why now? Were other cardiologists threatening to sound the alarm? Who manufactured and supplied the stents and what was their relationship to Drs. Morcos and Bousamra? Are other hospitals experiencing similar situations? Are these unnecessary medical procedures limited to stents?
According to a 2010 report published by the United States Senate Committee on Finance investigating unneeded stent procedures, between 2004 and 2009 Medicare Part A paid approximately $26 billion dollars for approximately 2 million inpatient stays where the patient's principal diagnosis was heart-related and the patient received a cardiac stent. This does not count the amount of money paid by private insurers. According to the Committee from the Centers for Medicare and Medicaid Services (CMS), the Medicare DRG system (diagnosis related groups) pays hospitals a set fee for each diagnosis, regardless of how much the individual patient actually costs the hospital. One can easily see how hospital stays related to stent procedures can be big business for hospitals and medical device manufacturers.

Are Stent Procedures Overused?

Some medical research suggests that stent procedures have been overused for years.  According to the journal, Circulation, although there has been a dramatic rise in stent placement in order to prevent heart attacks, the rate of heart attacks has remained relatively stable.  Thomas Graboys, M.D. a medical professor at Harvard Medical School has opined that stent placements are virtually useless in stopping the disease itself.  Many doctors believe that most people do well on medication. However, medication does not give the quick fix in relieving chest pain like that typically caused by angina.

Stents are tiny metal cages used to prop open arteries clogged with plaque. They are used in 85% to 90% of all coronary interventions performed in the United States.  Manufacturer's argue that they prevent the need for a more invasive bypass procedure.

The problem is that it appears that stent procedures are performed on far more people than are necessary.  Typically doctors use the standard of at least a 70% blockage to determine if stents are appropriate. However the same cardiologist who determines the percentage blockage typically performs the stent procedure itself.  Given the fact that the cardiologist is compensated at a far higher rate for placing the stent, it is easy to understand why this situation is rife with conflict of interest. Moreover, many of these doctors no doubt believe that the complication rate will be low because they are performing the procedure on someone who is not sick enough to require the procedure to begin with.

Nevertheless, the placement of stents carries risks and when in placed in patients who do not need them, these risks are unnecessary. Risks such as blood clots, unnecessary need for reintervention, infection, and coronary artery aneurysm are but a few of these unnecessary risks.  Additionally, should a patient need another unrelated procedure within the next year, many doctors will refuse to operate for fear of complications.

Hospitals obviously know that stent placements have increased without a corresponding significant health benefit to patients.  Why have they not come forward?  Perhaps because these procedures are not only profitable to the cardiologists involved but are also extremely lucrative for the hospitals.  Many hospitals have sought to attract interventional cardiologists to build up their high margin growth areas.