One Reader’s Negative View Of Mark Midei Reply

A few months ago I posted a lengthy piece about Mark Midei, the interventional cardiologist from Maryland who had his medical license suspended last year following a lengthy scandal in which he became the poster-boy (or scapegoat, depending on whom you ask) for all that’s wrong with interventional cardiology in the US. Although I was highly critical of Midei in my piece, I also expressed sympathy for his situation. Now a reader– Ohio MD– has written a response on the Forbes CardioBrief feed to my original post, taking me to task for being “entirely too sympathetic” to Midei. More…

Mark Midei Can’t Get a Job Taking Blood Pressure At A Walmart 8

Earlier this year I had the extraordinary experience of spending several hours on the phone with Mark Midei, the poster-boy (or scapegoat, depending on whom you ask) for all that’s wrong with interventional cardiology in the US. I approached the conversation with some trepidation and discomfort. I’d followed his story closely– but not obsessively– and had written harshly about him. I wasn’t sure why he wanted to speak with me. It turns out he wanted to get his side of the story across to cardiologists and others interested in the case. I listened to Midei More…

2011 in Review: Rivaroxaban, Sapien, Mark Midei, Conflicts of Interest, and Much More 4

Here’s a completely personal review of the past year in cardiology. Please write a comment if you strongly agree, disagree, or think something is missing. Drug of the Year: Rivaroxaban (Xarelto)– Despite a highly negative review from FDA reviewers, rivaroxaban gained FDA approval for the coveted stroke prevention in AF indication. The drug was approved earlier in the year for VTE prevention after surgery. The biggest surprise, though, was rivaroxaban’s success in ACS in the ATLAS ACS TIMI 51 trial, which may well have an important impact on the field for years to come. Rivaroxaban (Xarelto) Gains First More…

The Mark Midei Cases: Patient A Reply

The document containing the final decision of the Maryland State Board of Physicians revoking the medical license of Mark Midei includes extensive details about 5 cases (Patients A-E) reviewed by the Administrative Law Judge (ALJ), along with expert testimony about the cases by Midei himself, William O’Neill, Midei’s expert witness, and Matthews Chacko, the state’s expert witness. Due to the great interest in the Midei case, as well as the many important issues raised by the case, CardioBrief will present the key details of these cases, along with the accompanying testimony about these cases, as contained More…

Maryland Revokes Mark Midei’s Medical License 1

Mark Midei’s license to practice medicine has been revoked by the Maryland Board of Physicians. In its Final Decision and Order the Maryland Board found that Midei was guilty of unprofessional conduct, willfully making a false report, gross overutilization of health care services, violating the standard of quality care, and failure to keep adequate medical records. The Maryland board issued its final decision today, following a 7-day evidentiary hearing in which Midei was present (and in which he was represented by 9 attorneys), and a subsequent oral appeal on June 22, 2011. The finding was based on a detailed More…

Mark Midei Gives A Preview Of His Defense Reply

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 More…

Midei’s Business As Usual Defense:”This Is the Way It’s Done” Reply

Mark Midei’s lawyer responded to the sensational reports earlier this week about his client’s relationship to Abbot. In defending his client he gave a preview of Midei’s defense. According to a story by Tricia Bishop in the Baltimore Sun, “it was business as usual for the medical profession.” “All of these events were legal; they were done uniformly by all practitioners,” said lawyer Stephen L. Snyder, adding that “this is the way it’s done” between product sales people and doctors. The really scary thought here is that Snyder may well be right. He may manage to More…

Senate Report on Mark Midei and Abbott: 30 Stents in 1 Day, Pig Roasts, and More 1

[Updated] Mark Midei, the interventional cardiologist who has been accused of implanting hundreds of unnecessary stents at St. Joseph Medical Center in Maryland, was congratulated by Abbott Labs for implanting 30 stents in one day. “I heard thru the grapevine that you had a truly outstanding day with Xience in the labs on Friday, perhaps setting the single day implant record,” wrote an Abbott official. Two days later, Abbott spent $2,159  for a barbecue at Midei’s house that included a whole smoked pig and other fixings. The details of Midei’s relationship with Abbott are contained in a 170-page More…

The Good, The Bad, And The Ugly: Stents In The News Reply

Three big stent stories were in the news today. You’d never know that all 3 were about the same topic.   The Ugly   The ugly side of stents is emphasized in David Armstrong’s Bloomberg News story on Mehmood Patel, the Louisiana interventional cardiologist serving a 10-year prison sentence for Medicare fraud. These days Patel “leads health-conscious inmates on a morning walk, then cracks open one of the medical journals on his prison-approved reading list. Counseling fellow convicts to keep their blood pressure down is about the extent of the doctoring done by the man who once boasted he More…

400 Patients Sue Kentucky Hospital and 11 Cardiologists Over Unnecessary Procedures Reply

After undergoing more than two dozen cardiac procedures over a period of twenty years at St. Joseph Hospital in London, Kentucky, a patient was told by an outside cardiologist in Lexington that a recent procedure had been performed unnecessarily on an artery that was barely blocked. “I would have not carried out this procedure,” the cardiologist, Michael R. Jones, wrote in a letter to the patient. The story is recounted  in an article published on Sunday in USA Today and the Louisville Courier-Journal, about the latest and perhaps the biggest case yet to surface over unnecessary cardiac procedures. More…

2012 In Review: A Bad Year For Conventional Wisdom 3

This was a really grim year for anyone who thought we had things pretty well figured out. Time and again conventional wisdom was thrown out the window. 2012 forced the cardiology community to reconsider what it thought it knew about HDL cholesterol, platelet function tests, aspirin resistance, triple therapy, IABP, and more. One device company, with a lot of help, did just about everything right when it introduced a radical, highly disruptive new technology. Another device company did just about everything wrong in handling a series of crises. The new generation oral anticoagulants continued to More…

Why HCA Is Like Barclays And JP Morgan 3

Earlier this week the New York Times reported on a pattern of seriously deficient cardiac care at a number of hospitals owned by HCA. Understandably, the most common reaction is simple disgust over more bad cardiology behavior. After the Mark Midei case, after subsequent and even worse cases in Maryland, Pennsylvania, and elsewhere, the easy thing is to say that many cardiologists, and especially interventional cardiologists, are corrupt and greedy. But the larger significance of the HCA story has not been generally understood. The real problem at HCA wasn’t so simple. Yes, some interventional cardiologists may have been acting like teenagers More…

Prominent Interventionalists Attack Appropriate Use Criteria For PCI 5

A group of leading interventional cardiologists has launched an attack on the growing role of appropriate use criteria (AUC) for PCI in the US. They argue that severe flaws in current guidelines render unreliable current attempts to assess the rate of appropriate procedures. In a paper published in  JACC: Cardiovascular Interventions, Steven Marso and colleagues (Paul Teirstein, Dean Kereiakes, Jeffrey Moses, John Lasala, and J Aaron Grantham) criticize a study in JAMA published last year from the National Cardiovascular Data Registry (NCDR) that found a large degree of inappropriate or uncertain PCI procedures, as well as a wide range of More…

Whistleblower Lawsuit Filed Against 5 Cardiologists in Pennsylvania Reply

The US government has joined a cardiologist in a whistleblower lawsuit against Hamot Medical Center  in western Pennsylvania  and a group of cardiologists with whom he once practiced, Ed Palattella reports in the Erie Times-News. Cardiologist Tullio Emanuele, who now practices in Kentucky, has accused five former colleagues, members of Medicor Associates Inc. and its affiliate, Flagship Cardiac, Vascular and Thoracic Surgery of Erie, of billing Medicare for unnecessary angioplasty and other procedures. Hamot Medical Center  is now affiliated with the University of Pittsburgh Medical Center. The lawsuit, according to the Times-News, alleges that the contracts the cardiologists had More…

Significant Declines Observed in Cardiovascular Procedures Performed in Hospitals Reply

More evidence is starting to emerge that the overall volume of cardiovascular procedures in US hospitals is in decline. The trend should come as no surprise to those who have been following news about cardiovascular medicine in recent years, as the field has been repeatedly struck by debate, scandal and controversy related to the potential overuse of expensive and invasive therapies. A monthly report from Wells Fargo that tracks hospital volume found a 9.37% drop in inpatient cardiovascular surgeries and procedures in July 2011 compared to July 2010. This continues a trend of similar monthly declines More…

Less May Be More, But Stents Are Neither Good Nor Bad 4

A few days ago the distinguished healthcare writer Shannon Brownlee wrote a provocative blog post  about the overuse of stents. A key piece of evidence that she used was a paper co-authored by Grace Lin and Rita Redberg in which focus groups of cardiologists cheerfully admitted that they would give stents to hypothetical patients who were, according to the current guidelines, not eligible for stents. Here’s a paragraph from her post: The really unsettling part of Lin and Redberg’s paper? The conversation they quote among the cardiologists from one of the focus groups that suggests that once a More…

ProPublica: Cardiac Society Draws Bulk of Funding From Stent Makers 1

Editor’s note: The following post is reprinted with permission from ProPublica. It is the latest installment in ProPublica’s Dollars for Doctors: How Industry Money Reaches Physicians, an ongoing investigation. Cardiac Society Draws Bulk of Funding From Stent Makers by Charles Ornstein, ProPublica, May 13, 2011, 1:27 p.m. A Pittsburgh hospital informed 141 patients [1] earlier this year that they may have received unneeded angioplasties and stents [2], the tiny mesh tubes inserted to keep arteries open. A Towson, Md., cardiologist faces a hearing on the fate of his medical license [3] after being accused of implanting stents More…

Pennsylvania Hospital At Center of Controversy Had Very High Stent Volume Reply

Westmoreland Hospital, the Pennsylvania Hospital where 2 cardiologists have been accused of implanting  stents in patients who did not need them, had an exceptionally high volume of stent procedures, according to an article in the Pittsburgh Tribune-Review by Luis Fabregas. The hospital, with only 364 beds, implanted 1,297 stents in fiscal year 2010,  the fourth-highest number  in the state of Pennsylvania. The hospital’s volume was greater than the volume at several much larger major  hospitals in Pennsylvania. Dr. Jerome Granato, the chief medical officer of the hospital’s parent company told the paper: “The pattern is More…

Pennsylvania Hospital: 141 Patients Received Unnecessary Stents Reply

A hospital in western Pennsylvania says that at least 141 heart patients received coronary stents that weren’t needed, according to an article by Luis Fabregas in the Pittsburgh Tribune-Review. Westmoreland Hospital in Greensburg, PA has informed the patients and the 2 interventional cardiologists who performed the procedures have resigned. The hospital  says that it will cooperate with the Office of the Inspector General. The episode had its origins early in 2010 when “several unidentified physicians alerted hospital officials about a pattern of excessive stent use in the cardiac catheterization laboratory,” according to the news report. The hospital then More…

The ACC Wants You To Know That Nothing Is Rotten In The State Of Maryland Reply

For more than a year now, as most CardioBrief readers undoubtedly know, a scandal in Maryland has raised troubling questions about hundreds of stent patients treated by Mark Midei– previously considered one of the top interventional cardiologists in the state. In the wake of the scandal, some have questioned whether other interventional cardiologists, in Maryland and elsewhere, may also have routinely performed unnecessary procedures. Of course, no one knows the true extent of the problem. But clearly something is, or was, rotten in the state of Maryland, and perhaps other states as well. (It would More…

Heart Rhythm Society Advising DOJ in Investigation of ICD Implants 5

The Heart Rhythm Society has informed its members that it is “aware of an ongoing US Department of Justice (DOJ) civil investigation of Implantable Cardioverter Defibrillator (ICD) implants” and that it has “agreed to assist in an advisory role to lend expertise concerning proper guidelines for clinical decision making.” HRS explained that its role involved “reviewing information that does not include either identifiable patient or facility level data. Rather, we are providing insight on the field of electrophysiology to the DOJ.”

Investigators in Maryland expand investigation of unnecessary stenting Reply

The investigation of interventional cardiologist Mark Midei has now turned up similar suspicious practices by other Maryland physicians, the Baltimore Sun reports. “Several cardiologists in the state have performed a suspiciously high number of the same invasive cardiac stent procedures that Dr. Mark G. Midei is accused of over-performing at St. Joseph Medical Center,” writes Tricia Bishop.

Even more people may have received unnecessary stents at St Joseph’s 1

There may be more people who received unnecessary stents at Maryland’s St Joseph’s Medical Center than previously thought, according to a front page story in the Baltimore Sun by Robert Little. As previously reported, St Joseph Medical Center in Towson, MD had previously informed hundreds of patients who received stents implanted by Mark Midei that they may have undergone an unnecessary procedure. The notifications were based on a review of cases that occurred within a two-year time frame. But patients (and their lawyers) who were treated outside that time window are now claiming that they were also More…