Lessons Learned from Stent Abuse
Performing costly and invasive procedures at the risk of a patient and the benefit of a physician is undeniably wrong, and raises countless ethical questions regarding patient rights. As our firm pursues a similar case against St. Joseph Medical Center for allegedly implanting coronary stents in patients who did not need them, it is important to understand that these problems are rooted in an incredibly complex medical system.
For this reason, the stories gleaned from mounting lawsuits can inform a broader understanding of health care.
How are unnecessary procedures identified?
In the investigation at St. Joseph, experts overseeing reviews of patient records from January 2007 to May 2009 identified over 500 procedures that may have been unnecessary based on a variety of criteria, including levels of coronary artery blockage.
Many procedures performed by one particular doctor, Dr. Mark Midei, showed records with artery blockage at rates lower than 50%, the baseline criteria for stenting during that time. Had any other doctor viewed these patient records, the procedure likely would not have occurred. As further result of the unnecessary stenting, patient records were falsified creating a situation where other physicians would be provided with, and rely upon, inaccurate and untruthful information concerning the patient's level of coronary artery disease.
Studies have concluded that getting a second opinion may be the best route for patients who would voluntarily elect to undergo a stent procedure. Unfortunately, this may not be so simple in emergency situations.
Implanting a stent is still widely-considered a risky and invasive medical procedure, often allowing little room for additional consultations. When a patient undergoes a cardiac catheterization-during which a thin tube is inserted into a blood vessel and travels to the heart-a doctor can perform many of the necessary diagnostic tests to measure a patient's heart functionality and recommend treatment. If a patient's artery blockage (as measured by tests such as a coronary angiography) warrants a stent to increase blood flow, the physician will implant a stent during this procedure.
Patients tend to avoid getting a second opinion because they trust their doctor. Cardiac procedures are typically performed by physicians that are familiar with the patient-and the patient's medical history-thus sponsoring a level of trust in the doctor and our healthcare system. (Dr. Midei is a noted exception. His work excluded clinical care, and he worked solely as a cardiac interventionalist.) These procedures are also risky and expensive, making it far less appealing to get a second opinion after an angiography.
There are no simple answers here-either how or when to get second opinions, or the larger question of how we as consumers interact with the healthcare system. We hope a better understanding of the issues and complexities that govern medical malpractice will help us all make more informed, appropriate decisions about our health. And ultimately lead to fewer unnecessary, risky procedures.