Mark Midei Gives A Preview Of His Defense

Mark Midei, the embattled Maryland interventional cardiologist, has finally spoken. After more than a year of intense controversy and criticism, Midei has presented a preview of his defense in a commentary published by the Baltimore Sun.

Midei writes that he will soon appear before the Maryland Board of Physicians where “I will have the long-awaited opportunity to meet with my peers and make the case for retaining my license to practice medicine. In the meantime, I take the opportunity now to address some important points about the charges leveled against me in connection with my work with cardiac stents at St. Joseph Medical Center in Towson, Maryland.”

Midei claims that the accusations against him served to deflect attention away from a federal investigation into St. Joseph’s and its owner, Catholic Health Initiatives, for misconduct between them and MidAtlantic Cardiovascular Associates. “As my troubles became front-page news, St. Joseph Medical Center moved to the back page.”

My obvious role as a decoy did not merely help St. Joseph Medical Center and CHI in their public relations; my role as a decoy helped St. Joseph Medical Center and CHI survive. Other hospitals facing similar accusations of kickbacks and illegal payments have paid recent fines of $100 million or more and have been threatened with exclusion from the Medicare program — a fatal blow to any hospital. St. Joseph Medical Center paid a paltry $22 million fine.

In response to claims that he manipulated the peer review process, Midei claims that he “shared responsibility for a weekly teaching conference at which heart doctors evaluated difficult cases, a practice consistent with other national, and Baltimore heart centers.” Midei denies allegations by St. Joseph’s that he “acted alone in the peer review process.”

Midei also claims that he was never compensated based on his productivity. Before joining St. Joseph’s he worked at MidAtlantic Cardiovascular Associates, where “all members were compensated equally.” At St. Joseph’s he “had a guaranteed contract; the number of procedures I performed had absolutely no bearing on what I was paid.” [Editor’s note: it should be pointed out that it was widely assumed that Midei was lured from MidAtlantic by the promise of a considerable increase in compensation by St. Joseph’s. Further, Midei’s move to St. Joseph’s from MidAtlantic played a role in the bad blood between the two organizations.]

Midei also denies receiving any gifts or other rewards from stent manufacturers.:

I did not receive personal enrichment from manufacturers during my practice of clinical medicine. Even small honoraria were donated to hospitals or foundations providing free care or medications to indigent patients.

But Midei doesn’t address one of the most sensational stories related to the case, as revealed in a US Senate report, in which Midei implanted 30 Xience stents in one day and was later given a pig roast at his home by the stent’s manufacturer, Abbott.

Midei concludes:

My medical decisions have been second-guessed years after the fact by critics without access to the medical records of my patients or to the high quality images I used when determining that a stent was necessary. I recognize that best practices in cardiology continue to change rapidly, and that physicians are practicing far more conservatively today due to changes in medical knowledge and other factors. I do not pretend that I have been perfect in my practice of medicine; no doctor can make that claim.

But I can say unequivocally that my decisions as a doctor have been motivated by one thing only: The well-being of my patients.

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