A Reputation Built By Success

Kentucky Hospital Conspires With Cardiologists in Medical Malpractice

A London, Kentucky hospital and 11 cardiologists performed over 3,000 unnecessary cardiac catheterization surgeries and countless other heart procedures on healthy patients. These unfortunate victims of medical malpractice will now be required to take dangerous blood-thinning medications for the rest of their lives. The US attorney’s office and other governmental offices are currently investigating the hospital and doctors. USA Today brought the story to us:

Hundreds sue Ky. hospital over heart procedure

USA Today, February 17, 2013, by Andrew Wolfson, The (Louisville, Ky.) Courier-Journal

LONDON, Ky. – After enduring at least two-dozen heart procedures over two decades, disabled former meat cutter Edward Marshall decided in September 2010 that he’d been treated long enough by cardiologists at St. Joseph London hospital.

So he saw a specialist in Lexington, who told him some disturbing news: An artery treated just months earlier was barely blocked, and there had been no need for Dr. Sandesh “Sam” Patil to enlarge it with a balloon angioplasty, then prop it open with a stent.

“I would have not carried out this procedure,” the Lexington cardiologist, Dr. Michael R. Jones, told Marshall in a letter that is included in the court record.

Marshall, 67, who lives in London, became the first of nearly 400 people to sue the London hospital and 11 cardiologists, including Patil, claiming they conspired to perform unnecessary, risky and often painful heart procedures to unjustly enrich themselves.

The suits, which also name the hospital’s parent company, Catholic Health Initiatives, allege that two patients died and that the others will be required to take dangerous blood-thinning medications for life and are at risk of other potentially fatal complications.

The hospital and other physicians named as defendants deny the allegations.

“These were very sick people who needed the interventions, and got them,” said the hospital’s lead lawyer, Todd Thompson, who calls the conspiracy allegations “Alice in Wonderland stuff.”

But records show the plaintiffs aren’t the only ones who have Patil and the London hospital in their sights:

– The U.S. attorney’s office in Lexington is investigating the medical necessity of cardiac procedures performed there, and the financial relationship between the St. Joseph system and Patil’s cardiology group, according to a disclosure in CHI’s most recent annual report.

– Patil is the subject of a federal criminal health care fraud investigation, his lawyer disclosed last month when Patil refused to answer 109 questions at a deposition in Marshall’s suit, declining even to say whether he is a doctor.

– The Kentucky Medical Licensure Board last month found that Patil provided substandard care to four of five patients whose records it examined, placing stents without justification in three of them.

Mirroring claims in the lawsuits, the board’s consulting doctor found that Patil showed a “consistent inappropriate rush to invasive testing” in one patient and an “inexplicable plan” to place stents in an unobstructed artery in another. Still, the board allowed Patil to continue to practice, with monitoring and remedial education.

– The Centers for Medicare and Medicaid in 2011 cited the hospital for failing to review the medical necessity of 3,367 cardiac catheterizations performed there the year before. In those procedures, a wire is inserted through an artery in the groin into the heart.

The citation said a doctor on the hospital’s “quality assurance committee” had never reviewed any medical records regarding the procedures and that one patient had them annually – 20 in all – even though he had no symptoms of heart disease. The hospital agreed to take corrective measures.

– In research conducted for his Kentucky Health Policy Institute blog, University of Louisville professor emeritus Peter Hasselbacher found that in 2008 and 2009, St. Joseph London did more angioplasties with stents than either of the state’s two major teaching hospitals.

Hasselbacher, an internist, also found that after lawsuits were filed – when St. Joseph London came under the spotlight – the number of invasive procedures dropped by one-third, which he called “the most persuasive evidence that too many cardiac catheterizations with placement of stents might have been performed.”

Barbara Mackovic, a spokeswoman for KentuckyOne Health, which operates the St. Joseph system and Jewish Hospital HealthCare Service for CHI, declined to comment on Hasselbacher’s analysis, the citation from the Centers for Medicare and Medicaid, or the Kentucky Board of Medical Licensure findings.

She also declined to comment on the lawsuits, citing a corporate policy against discussing pending litigation.

In a statement, she said St. Joseph London hospital is cooperating with the U.S. attorney office’s investigation. She also said Patil has not had privileges at the London hospital since December 2010 and has not practiced there since.

Neither Patil, who now works for Appalachian Regional Healthcare in Whitesburg, Ky., nor his lawyers, responded to requests for comment.

U.S. Attorney Kerry Harvey, citing Justice Department policy, said he could neither confirm nor deny that the hospital and Patil are under investigation.

A focus on hearts

CHI operates 73 hospitals in 19 states and in November, KentuckyOne Health began taking over management of most of the operations of University Hospital in Louisville.

St. Joseph London has touted its cardiology services and the fact that in 2008 it was named one of the top 100 cardiac hospitals in the country by Thomson Reuters, an information company.

The hospital has said it decided to focus on cardiac care in part because of its location in “coronary valley,” an area in southeast Kentucky with a high rate of heart disease.

But Louisville lawyer Hans Poppe, the lead counsel for the plaintiffs, says in the suits that unnecessary stents – which allow health care providers to generate revenue from health insurance companies, the government and patients – have become a pervasive problem, with cases in Texas, Tennessee, Maryland and Pennsylvania.

CHI agreed to pay $22 million to the federal government in 2010 to settle allegations that its hospital in Towson, Md., made improper payments to a cardiology group that included a doctor who was later stripped of his license. The government had alleged that doctors were regularly performing unnecessary procedures.

Marshall filed his suit in London in September 2011. His lawyers then placed ads in the London Sentinel Echo seeking other potential plaintiffs.

Since then, about 40 additional suits have been filed, including one that names 280 plaintiffs. No trial dates have been set.

The hospital’s attorneys say it has turned over as many as a half-million medical records, but Poppe said the hospital has refused to disclose an internal investigation it submitted to the U.S. attorney’s office, or the portion of doctors’ contracts that Poppe says will show they were “incentivized” for performing additional procedures.

Depositions have been taken of just two of Poppe’s clients, Marshall and Rhonda McClure.

McClure, 54, a retired trucking company dispatcher and bookkeeper who lives in London, alleges that she went into the hospital for shingles in 2007 and ended up having unnecessary bypass surgery.

Dr. Paula W. Hollingsworth, a Lexington cardiologist who examined McClure’s records, said in a letter produced in the lawsuit that McClure did not need the bypass.

McClure acknowledged during her statement that she has multiple medical problems and needed at least some of the cardiac care she received.

A question of care

Marshall said in a deposition that he had the first of five heart attacks in 1992 and started seeing one of Patil’s partners in 1996.

His suit says that over the ensuing years Patil and other doctors unnecessarily implanted a pacemaker and stents and did unneeded angioplasties and catheterizations.

He said in an interview that he had the procedures so routinely that nurses in Patil’s practice would joke about seeing him for the next one. He said in his deposition that when he started to question Patil about the need for the procedures, he would change the subject.

Marshall said he became more suspicious on Aug. 2, 2010, when Patil was doing a angioplasty and announced that he’d found no blockage in the artery but was going to insert a stent anyway.

Marshall then went to Jones, the Lexington cardiologist, who reviewed his records and said in an Oct. 2, 2010, letter that the artery that Patil stented was only “25 percent blocked” and that “in cardiology, we almost never treat … a narrowing of less than 70 percent.”

Thompson, the hospital’s lawyer, notes that Jones practiced at a competing hospital, Central Baptist.

Marshall said the revelation destroyed his faith in doctors.

“It made me mad,” he said in his deposition. “I think I had a few curse words.”

Asked why St. Joseph London should be held responsible, he said: “I just think that the hospital should know what the doctors are doing in their building. And if they don’t know, they should.”

Marshall, who has three daughters and nine grandchildren, said the procedures scared his family unnecessarily.

“It is serious business when someone is fooling with your heart,” he said in an interview. “It is just not right what they put people through.”