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Cardiologist Charged With Performing Unnecessary Stent Procedures – Whistle Blower Reported Exaggerated Blockage Percentag

Posted Jun 12 2010 10:18am

In addition to the surgical procedures, authorities are questioning if and how medical record information was either entered inaccurately or changed to indicate a higher percentage of blockage with the patients who underwent surgery.  When a comparison was run against other doctors performing the same surgical procedures, they found the doctor was averaging twice the number of procedures.   image

The information provided by the whistle blower in this case, a reported hospital employee is going to be a key part of the entire investigation as well.  A board reviewed the cases and found that the actual numbers with the x-rays showed less than 50% blockage with a board examination.  The doctor is also looking at some malpractice suits and the the case has also gained the attention of the Senate.  Now the state is reviewing other physicians with questionable stent rates and the FBI is investigating another doctor in the DC area showing a high rate of stent procedures.

Clinical guidelines state that a 70% or better blockage is the number used to determine if a patient should require a stent, so this is where the investigation primarily lies to determine how many were actually at  70% or above.  The doctor himself somewhat agreed that some of the cases were lower than 70% when he originally dictated his notes.  The doctor stated there was also other clinical symptoms that were assessed with each patient too, but the review board stated they didn’t find anything in the charts to substantiate.  This will be an interesting case to follow as review boards can be a bit slanted as some of the physicians on the boards may have something reported in their cases too that they may not want revealed or any attention brought about, and the article states that normally random cases are reviewed, but I would guess in this case, random would not be the choice here, or at least I would hope not. 

One thing for sure that all of us can learn just from this article is to read up on the internet if you are a patient in this situation and ask questions, what is your reported blockage rate, at least ask that question and ask if there are other things going on with your body that may have an impact here too.  This case borders on fraud accusations with generating money for these procedures and I can tell you having experienced a case with my own senior mother, there are some of these folks out there that recommend and do procedures that are not needed. 

One other potential area here to think about too are the manufacturers who make the stent, this is a huge marketing war here and just to throw in another potential area, was there any influence from the companies that could have been involved here too? 

There’s a lot of money spent in legal wars over stent patents here and again, it’s not completely out of the question to ponder if there could have been some outside influence here too, but again maybe not but something to give some thought to for a potential side line.  BD 

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. image

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.

"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

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.

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