Maryland physicians’ groups urged legislators to implement more stringent internal and external review of hospitals performing the procedures in the wake of a high-profile series of over-stenting cases in the Old Line State.
In November, cardiologist Dr. Mark McLean was sentenced to 8 years in jail on charges that he implanted as many as 100 unnecessary cardiac stents.
That case spurred a lawsuit accusing senior staff at Peninsula Regional Medical Center of failing to address complaints against McLean, who had a private medical practice with hospital privileges. The lawsuit cost the hospital $1.8 million in August, one month after McLean was convicted.
In November, St. Joseph Medical Center in Baltimore agreed to pay $22 million to settle a federal lawsuit accusing it of bilking Medicare for unnecessary stent implantations, without making an admission of guilt.
And Dr. Mark Midei, a cardiologist at St. Joseph Medical Center in Towson, Md., has been accused of implanting unnecessary stents in as many as 369 patients. The case is under review by the U.S. Dept. of Health & Human Services. Midei, whose medical license was revoked by the Maryland Board of Physicians, has claimed innocence.
Under increasing public pressure, the Maryland Health Commission’s technical advisory board recommended taking authority to regulate stenting in the state as well as conduct ongoing evaluations of hospitals conducting the procedures, MedPage Today reported.
While the Maryland chapter of the American College of Cardiology and the Society of Cardiovascular Angiography & Interventions agreed that oversight was necessary, they rejected the commission’s plans and called for a more stringent system of internal review and external auditing.
"Good hospitals have nothing to hide or fear (bad ones do)," ACC and SCAI chapter presidents Dr. Samuel Goldberg and Dr. Christopher White wrote in a letter to Maryland Health Care Commission acting executive director Ben Steffen.
The groups called MHCC’s recommendations to expand oversight "excessively vague," and called for a task force on peer review practices and more specific terms of the commission’s oversight.
The letter (PDF) also called St. Joseph Medical’s high-profile over-stenting case the result of "inadequate, voluntary, internal review," adding that "the failure of MHCC [technical advisory group] to recommend a degree of standardize oversight ignores the root cause of St Joe’s failure."
"MHCC’s position is that clinical leadership at each hospital can assure compliance with quality and safety standards," the letter stated. "The failure at St Joe’s was that of clinical leadership and a culture of conflict avoidance and deference to the medical hierarchy."
Late last month Union Memorial Hospital cardiologist Dr. John Chung-Yee Wang, a colleague of Midei and a member of the committee charged with monitoring potential over-stenting, was accused of improper stenting in his own practice.
"This is an opportunity for Maryland to set the standard," SCAI president Christopher White told MedPage Today. "We want to see the Maryland legislature do the right thing."
The groups called for a "robust system of oversight and accountability," including a quarterly report of quality and safety to be maintained by a "Cath Lab PI Committee."