Despite numerous internal reviews that turned up a widespread pattern of unnecessary cardiology procedures being performed at many of its hospitals, the giant HCA corporation did little to rein in the problem or to inform regulators, payers, or patients about the problem, according to an investigative report in the New York Times by Reed Abelson and Julie Creswell. The story was published less than a day after the company disclosed that it was being investigated by the US Attorney’s office in Miami.
The Times recounts numerous instances in which the company discovered a problem at one of its hospitals but then acted to conceal the problem or to prevent its reoccurrence at other hospitals. In one case, a nurse’s contract was not renewed after he reported to the company that unnecessary procedures were being performed at Lawnwood Regional Medical Center in Fort Pierce, Florida, although an internal HCA investigation had substantiated the nurse’s allegations.
The Times gained access to internal HCA reviews which found that, for an extended period from 2002 until 2010, “some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures they were performing” and, “in some cases, the doctors made misleading statements in medical records that made it appear the procedures were necessary.”
At Lawnwood about half of 1,200 cardiac catheterization appeared to have been performed on patients “without significant heart disease,” the Times reported. HCA responded that the Longwood numbers were consistent with the national averages. (The Times doesn’t fully explain the numbers, but it should be noted that a study published in the New England Journal of Medicine from the National Cardiovascular Data Registry (NCDR) reported a low diagnostic yield for diagnostic coronary angiography.)
At the Regional Medical Center Bayonet Point a 44-year-old man with chest pain “suffered a punctured blood vessel and a near-fatal irregular heartbeat after a doctor performed a procedure that an outside expert later suggested might have been unnecessary.” In another case, “a woman with no significant heart disease went into cardiac arrest after a vessel was cut when a Bayonet Point cardiologist inserted a stent.”
An examination of HCA internal documents “reveals that rather than asking whether patients had been harmed or whether regulators needed to be contacted, hospital officials asked for information on how the physicians’ activities affected the hospitals’ bottom line.”
In another episode from 2003, a confidential memo from an HCA cardiac oversight team found that patients at Bayonet Point “were treated for multiple lesions, or blockages, even when ‘the second lesion (or third) did not appear to have significant disease.’ The team went on to note ‘several cases’ in which patients were treated even though their arteries did not have significant blockages.”
A subsequent review by an external company concluded that 43% of angioplasty procedures at the hospital “were outside reasonable and expected medical practice.” In some cases, blockages that had been recorded as 80-90% were later determined by a “more scientific analysis” to have ranged from 33-53%.
Although the hospital suspended 9 physicians after the report, HCA “took steps to withhold details of its conclusions to the media and others, according to internal communications.” The hospital CEO wrote to other HCA executives: “Clearly, we have protected ourselves under the peer review umbrella and have released very little information.”
An outside review found that one cardiologist who worked in the Lawnwood cath lab, Dr. Prasad Chalasani, had been found to be “too quick to perform catheterizations, often without first doing the stress tests necessary to determine whether a patient needed the invasive and costly test.” Nevertheless, he was highlighted in the hospital’s business plan “as being the most profitable doctor at the facility. ‘Our leading EBDITA MD,’ the plan described him.” (EBDITDA is a measure of corporate earnings, the Times duly notes.)
Corruption and cover-up are not new in medicine, as they are not new is all large enterprises where there is much to protect (not only profits)–most recently, the Catholic church, college and pro sports, not to mention the “usual suspects” in politics, Wall St., etc We do respond differently–rightfully, in my view–when the corrupt institutions are those on whose integrity we need most to rely.
I am wondering whether people view these episodes as “average, expectable, inevitable” or whether there is realistically imaginable change within the “system” and culture of medicine as things now stand.
Ditto for ICD’s , TAVI, RFA, Multaq, Pradaxa, Tekturna, the list is 5 miles long and we are all standing at the brink. These HCA cardiologists were the “monsters” and they got found out. The real culprit is how words like “productivity”, “Incentive”, and “bonus” got into our day to day lives as physicians. The damnation here is of course that doctors go on from medical school to do MBA’s. If one takes the MBA training seriously one has to do more of the above.
I am just filing in my dustbin a glossy brochure sent to me by the Cath lab at Mount Sinai in NYC with the picture of a high volume interventionalist on the cover, of course his is strictly evidence based and ethical so this is not about him but it is what leads to the HCA scene that and IBGYBG.
The day is not far when we will be ashamed to describe what we do for a living
Great coverage Larry
Wilbur Larch MD, FACC
I’m struck by the ways polarizations are described in different arenas. In pharma, the scientists tend to blame marketing. MDs blame MD-MBAs. Everyone blames lawyers or FDA or too much regulation or not enough.
Is it sentimental, in the current context, to still think of the responsibility of a profession? Besides invocations, what authentically and realistically supports it? (e.g., I am on a “Committee on Ethics in the Medical Curriculum” at my own university’s M school. The work is far from window-dressing. But there is always the question of the significance of such windows within the rest of the house.)
Those attacking regulation and those supporting it are two sides of a coin, i.e., mutually exclusive. The MD-MBAs, marketting all are on one side of this.
The lawyers is a totally different issue. In 2012 any physician who uses lawyers to justify what they get up to is being less than honest.
I guessed it. HCA’s former CEO was Rick Scott (Current Gov FL) and in the 1990’s I think it was, HCA paid back $ 1.7 Billion in fines to the Fed for fraud. Look up a you tube interview where Rick Sanchez (CNN) grills Rick Scott on this issue and Rick Scott tries to wiggle his way out.
The Health care con man then went on to get the top job is FL. His plan before he resigned in 1997 was to make HCA the MacDonalds in health. It seems they are still trying.
More proof of why health delivery institutions should not be for profit.
Wilbur Larch MD, FACC
I hope these get clear, is not fear for all these petions with or with out Hart problems to go throught now who to belive when you sick. And how far we can continues with all these fraud ? My famili has genetic hart problems and scare me yest to think Doctors go thru anything yest for take money from Ins. HCA is big Co. is not fear for all the people have the oportunities jobs and get now to worrie .
I’m so sorry fir these News, I found out for a friends (phone call).
Very sad.