In today's Baltimore Sun, reporter Tricia Bishoplooks at the use of stents and the risks they bring. According to the article, until recently, use of cardiac stents to open blocked arteries has been all the rage and was seen as a relatively safe procedure when compared to open heart coronary bypass surgery. Since the 1990s, stents have been increasingly used and have generated more than $1 billion of revenue for Maryland's hospitals.
In the wake of close to 600 claims against Mark Midei, M.D.- the once preeminent interventional cardiologist at St. Joseph's Medical Center in Towson, Maryland -- for unnecessary stenting of patients with little or no artery blockage, the health care community is now taking a hard look at the risks and benefits of cardiac stents and is now trending away from using them in favor of medications or bypass surgery. According to statistics from the state Health Services Cost Review Commission, stenting procedures in Maryland will drop by 25% this year (from 14,255 to 10,650).
Some of the comments and opinions expressed by those interviewed are rather remarkable. Most striking are the comments of Dr. William O'Neill, executive dean of clinical affairs at the University of Miami's Miller School of Medicine. Dr. O'Neill, who was hired by St. Joe's to review Dr. Midei's patient charts, claims that he found "no unwarranted stents."
With all due respect to Dr. O'Neill, our firm and many others have hired top flight interventional cardiologists to review Dr. Midei's charts and in many instances, there was absolutely no blockages whatsoever. Many patients' own cardiologists have also reviewed Dr. Midei's films and reports and cannot reconcile the reported findings against the films. Thereferring cardiologists have reviewed the data at the request of theirpatients who received the now well known yet cryptic letter from St. Joe's warning patients to consult with their physicians about possible harm. In more than a few cases, patients report that the treating doctors have simply shrugged their shoulders in dismay and have offered apologiesfor referring them to Dr. Midei.
Dr. O'Neill is also quoted as suggesting that physicians who perform stenting on borderline patients, i.e., those with close to 70% blockage, will now "be afraid that some angry patient or angry attorney or disgruntled colleague or competitor is going to turn him in for doing unnecessary procedures." Once again, when the goings get tough, the defensive medicine argument rears its ugly head. Dr. O'Neill further justifies unnecessary stenting by stating that "[f]or some of these doctors, it was like, 'I'm here, so let me go ahead and put a stent in.'"
One must wonder whetherDr. O'Neill intends to offer the same opinions in court as he has in today's article in the Baltimore Sun.
At least four studies over the last four years have found that stenting generally is not without some significant risks, even with the most recent development of the drug-alluding stent that was hailed a few years ago by Dr. Midei as the "hottest thing in cardiology in years."
The Baltimore Sun should be commended for its ongoing effort to bring to light the continuing issues related to the actions and possible harm caused by Dr. Midei. Many in the community are understandably perplexed and disappointed that a physician could invade his patients' rights and expose them to such unnecessary risks. Dr. Midei has many supporters, but he has many injured and very concerned patients as well.