The case has had wide repercussions. Over the past year, St. Joseph has told   
   hundreds of Dr. Midei's patients that they did not need the expensive and   
   potentially dangerous stents that the doctor inserted because their arteries   
   were not as obstructed as he had claimed. Now, state health officials are   
   investigating other local cardiologists who inserted a suspiciously high   
   number of stents, which are tiny wire mesh devices inserted to prop open   
   clogged arteries in the heart.   
      
   After reports about the Midei case and the wider state investigation, the   
   number of stent procedures performed at St. Joseph and other area hospitals   
   plunged, raising doubts about the appropriateness of much of the region's   
   cardiac care.   
      
   A landmark 2007 study published in The New England Journal of Medicine   
   showed that many patients given stents would fare just as well without them.   
   Dr. Christopher J. White, president-elect of the Society for Cardiovascular   
   Angiography and Interventions, said that inappropriate stenting was a   
   problem, but a rare one. The federal Medicare program spent $3.5 billion   
   last year on stent procedures.   
      
   Prosecutors, malpractice lawyers and state medical boards are only now   
   waking up to the issue. The Texas Medical Board last month accused a widely   
   known cardiologist in Austin of inserting unnecessary stents. In September,   
   federal prosecutors accused a cardiologist in Salisbury, Md., of performing   
   unnecessary stent surgeries, and last year a Louisiana doctor was sentenced   
   to 10 years in prison for inserting unneeded stents.   
      
   J. Stephen Simms, a Baltimore lawyer who successfully pursued a federal   
   whistle-blower lawsuit involving kickbacks for coronary procedures, said   
   such cases were "the flavor of the month right now" with federal   
   prosecutors.   
      
   Jay Miller, another Baltimore lawyer, said he was devoting his entire   
   practice to unnecessary stent cases. "And I don't think this is limited to   
   just a few Maryland hospitals," Mr. Miller said.   
      
   But far from questioning cardiologists who perform an unusually high number   
   of stent procedures, many hospital executives celebrate these doctors   
   because of the revenue they bring, which can be more than $10,000 per   
   procedure.   
      
   "Hospital patients expect their care to be based on medical need, not   
   profits," said Senator Max Baucus, Democrat of Montana and chairman of the   
   Finance Committee. "Even more disconcerting is that this could be a sign of   
   a larger national trend of wasteful medical device use."   
      
   Dr. Midei's fall was as rapid as it was dramatic. In a June deposition for a   
   lawsuit against him, he said: "I didn't know what hit me. I was bewildered   
   by what had happened."   
      
   He had been one of the most sought-after clinicians in his region. Trained   
   at Johns Hopkins University, he was a co-founder of MidAtlantic, a practice   
   with dozens of cardiologists that controlled much of the cardiac business in   
   Baltimore's private hospitals. Dr. Midei was one of the practice's stars.   
   When MidAtlantic negotiated a $25 million merger with Union Hospital in   
   2007, the deal was contingent on his continued employment.   
      
   St. Joseph was so concerned about losing Dr. Midei's business that the   
   hospital offered a $1.2 million salary if he would leave MidAtlantic and   
   join the hospital's staff. When Dr. Midei agreed, the merger with Union   
   collapsed, MidAtlantic sued, and the practice's former chief executive vowed   
   in a deposition to "spend the rest of my life trying to destroy him   
   personally and professionally."   
      
   In the June deposition, Dr. Midei estimated that in 2005 -- before research   
   revealed that many stents were unnecessary -- he performed about 800 stent   
   procedures. Instead of dropping in subsequent years, however, the number of   
   stents Dr. Midei inserted rose to as many as 1,200 annually, he estimated.   
   In a 2007 internal document, Abbott Laboratories ranked Dr. Midei's use of   
   stents behind only five other cardiologists in the Northeast, including   
   those at hospitals four and five times St. Joseph's size.   
      
   That sort of increase in volume was an obvious red flag, said Dr. William E.   
   Boden, clinical chief of the division of cardiovascular medicine at the   
   University of Buffalo and an author of the 2007 stent study. "For him to   
   have this brisk increase over those years is really unusual," Dr. Boden   
   said.   
      
   In stable patients, stents should be used only if X-rays show that most of   
   the artery is blocked, and the patient has symptoms like frequent chest   
   pain. Stent procedures can, in rare cases, cause bleeding, stroke or a heart   
   attack. Once a stent is placed, it can result in a life-threatening clot   
   that emerges weeks to months later. Stent patients must spend a year or more   
   taking blood-thinning medications, which have their own risks.   
      
   In April 2009, a patient of Dr. Midei's who was also a St. Joseph employee   
   complained that he had received an unneeded stent and that many other   
   patients had as well. The hospital engaged a panel of experts who reviewed   
   1,878 cases from January 2007 to May 2009 and found that 585 patients might   
   have received unnecessary stents.   
      
   When asked to review the cases himself, Dr. Midei found far less blockage   
   than he had initially, according to the Maryland Board of Physicians. The   
   hospital suspended his privileges and eventually sent letters to all 585   
   patients. Hundreds of lawsuits against Dr. Midei and St. Joseph followed,   
   including from patients treated well before January 2007.   
      
   Abbott responded to the controversy by hiring Dr. Midei as a consultant.   
   "It's the right thing to do because he helped us so many times over the   
   years," an Abbott executive wrote in a January e-mail cited in the Senate   
   report.   
      
   The company sent Dr. Midei to Japan, but news of the controversy made his   
   duties impossible, and he flew home. After one particularly critical story   
   in The Baltimore Sun, David C. Pacitti, an Abbott executive, wrote in an   
   e-mail, "Someone needs to take this writer out and kick his ass!"   
      
   Edward Chaid, 68, a semiretired general contractor from Timonium, Md., is   
   among those who have sued. Five years ago, Mr. Chaid decided to get his   
   first physical examination in decades. Just to be safe, his doctor sent him   
   for a cardiac stress test at MidAtlantic, which revealed a small "squiggle"   
   of concern, Mr. Chaid said. He was sent to Dr. Midei to get his arteries   
   X-rayed, and he emerged from the procedure with two stents.   
      
   "Dr. Midei said: 'You sure are lucky. You had 90 percent blockage.' And the   
   nurse said, 'Oh yeah, you were blocked in your widow-maker.' And I said:   
   'Thank God. I guess I'm really lucky you got it when you did,' " Mr. Chaid   
   said in an interview.   
      
   Five years later, another doctor concluded that Mr. Chaid's blockage had   
   been minimal. "I was really shocked," Mr. Chaid said. "I'm from a generation   
   where doctors are thought very highly of."   
      
   But Mr. Snyder, Dr. Midei's lawyer, said that his client's care had been   
   entirely appropriate, that doctors often interpret X-rays differently and   
   that St. Joseph was using him as a scapegoat. A Web site created by friends   
   of Dr. Midei lists dozens of testimonials like this one: "Plain and simple,   
   Dr. Midei saved my life."   
      
      
      
      
   Jeff Snyder, SysOp - Armageddon BBS  Visit us at endtimeprophecy.org port 23   
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