Спасибо, С. А. На мой взгляд, как раз идея-то хорошая. Изначальное недоумение было вызвано следующей формой подачи материала: "целенаправленно окклюзировали рабочий шунт, зачем?"
Прошу прощения, а нельзя ли выложить ангиограммы, хотябы одного из случаев, которые обсуждались на форуме... Интересно посмотреть самому, по описаниям и комментариям - кое-какое представление формируется, но все же...
Все познается в сравнении, отечественные "герои" современной стентологии выглядят просто ангелами. Представляю нового кумира для любителей крайностей - Samuel DeMaio. Полная статья [Ссылки доступны только зарегистрированным пользователям ]
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Patient C's death
The board's complaint says one man it identifies only as Patient C died after he came to DeMaio in November 2007 with a history of chest pain and a previous bypass surgery. Over the next eight months, DeMaio put at least 21 stents into the man, causing him to suffer from in-stent stenosis — a re-narrowing or blocking of the artery after a stent was placed, according to the complaint.
The patient returned to DeMaio in July 2008 with a total blockage of one main artery and decreased heart pumping capacity, the complaint says. Unnecessary stents were put in "areas of mild and diffuse disease ... and exposed Patient C to serious complications ... and ultimately his death," the complaint says.
DeMaio implanted a defibrillator, which the board's complaint said the patient was not a candidate for given his condition, and six days later, "Patient C began to experience an irregular heart beat and the AICD (automatic implantable cardioverter defibrillator) began to discharge."
The defibrillator continued shocking the patient into the next day, according to the complaint. Lisa Jones, a nurse who worked with DeMaio for 7½ years, said the patient's screams could be heard throughout the Westlake hospital.
"It affected everyone. You didn't have to be on the staff; you just had to be in the building to hear the guy screaming," Jones said. "It was very traumatic to hear him screaming, and to see the family and to know how much he was suffering."
DeMaio did all he could, said Jones, who coordinated DeMaio's research for medical companies, mainly on stents. She said that she believes his treatment of the patient was proper and added that DeMaio "was very demanding about how he wanted his patients treated and passionate about his work."
As the shocks continued into the second day, DeMaio conferred with the family, gave the patient two doses of the anesthetic propofol and put a magnet over the defibrillator to stop it from discharging, the board's complaint says. The patient went into cardiac arrest and stopped breathing. The propofol doses were not documented as board rules require, the complaint says.
DeMaio said that the patient was beyond all treatment and once he put the magnet over the patient's skin, death would be imminent because the defibrillator could no longer shock the heart back to a normal rhythm. The patient and his family were crying, so the propofol was to calm the patient, DeMaio said.
DeMaio said it was the nurse's responsibility to document the propofol because it was "during a code situation" — a medical emergency.
The patient was first treated by a colleague who put in some of the stents, DeMaio said. DeMaio said he placed the other stents "over a period of years," not the eight months the complaint says. He added that the defibrillator was necessary and questioned the qualifications of the unnamed experts the board consulted to review DeMaio's records.
"I don't get to know who their experts are," DeMaio said. "I don't get to know who is making the accusation."
A spokeswoman for the Medical Board said that as a matter of policy, its lawyers don't comment on cases.
The patient's family has not filed a lawsuit.
The man with 32 stents
Four of the five patients who filed malpractice suits against DeMaio either declined to comment or did not return calls after their lawyer, Jay Winckler of Austin, advised them not to talk. The fifth could not be reached.
"I don't see it as helping my clients," Winckler said.
Donald Spann of Landrum, S.C., who is in his early 80s, is among the five. His lawsuit alleges that DeMaio inserted as many as 32 stents in his arteries over 13 months.
Dr. Jeffrey Rade, an associate professor at Johns Hopkins University and a cardiologist hired by Winckler as an expert to review four of the cases, wrote in a report accompanying Spann's lawsuit that "this gratuitous and egregious placement of (more than 2 feet of) stents ... subjected Mr. Spann to the pain and risks of unnecessary procedures including exposure to ionizing radiation ... death, myocardial infarction (heart attack), stroke, bleeding, vascular injury and kidney damage." He added that Spann was at risk for stent thrombosis, which is a blood clot that forms on the stent, "a potentially catastrophic complication associated with a ~50% mortality rate."
In Spann's and several of the other lawsuits, Rade wrote that DeMaio overestimated the severity of the patients' illness, overused stents and put them at risk for severe medical problems.
DeMaio denies those allegations.
He said he recommended that the patient with the 32 stents, whom he declined to name so as not to breach patient confidentiality, have bypass surgery, but the patient refused. But rather than abandon the patient, DeMaio said, he chose to help him by inserting stents and monitoring him.
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Dr. Rodney Davenport, a dentist in Greenville, has been seeing DeMaio since 1996 when he was diagnosed with congestive heart failure at age 51. DeMaio recommended he have a bypass, but his veins weren't good enough, and he's since had about 15 stents placed by DeMaio and "probably 20 angiograms," Davenport said.
Now 66, Davenport said he has followed DeMaio to Austin and now to El Paso to remain his patient.
So has Fred Fernandez, 60, of Fort Worth, who said he has 54 or 55 stents and an unknown number of angioplasties. All but two of the stents were placed by DeMaio, he said.
Federal report linking Dr Mark Midei and Abbott finds "potential fraud, waste, and abuse"
DECEMBER 6, 2010 | Shelley Wood
Baltimore, MD - Embattled interventionalist Dr Mark Midei is back in the news this morning after the release of a Senate Finance Committee report investigating ties between Midei and Abbott Laboratories [1].
The report, published on the Finance Committee website, calls the Midei imbroglio "a clear example of potential fraud, waste, and abuse."
"This report sets forth alarming evidence that patients at St Joseph Medical Center received unnecessary and potentially harmful stent implants time and again—a pattern that is shocking, disturbing, and shameful," Senate Finance Committee chair Max Baucus (D-Mont) said in a press statement. "Doctors should not be performing invasive medical procedures patients don't need, and taxpayers certainly shouldn't be paying for these wasteful and improper implantations."
According to the Senate Finance investigation, St Joseph billed government and private insurers more than $6.6 million for the procedures performed by Midei; more than half of this amount was paid by Medicare.
As previously reported by heartwire, Midei is alleged to have implanted hundreds of unneeded stents when he worked at St Joseph Medical Center in Towson, MD. The Maryland Medical Board is also investigating Midei, saying he repeatedly overestimated the severity of stenosis and used stents that weren't needed; the medical board proceedings have not yet concluded.
Midei has told heartwire that he stands by his work, although it's "possible" that faced with the same case today, he might "approach it potentially differently." After losing his privileges at St Joseph, Midei worked at the Prince Salman Heart Center, in Saudi Arabia, the report notes.
Other physicians who have reviewed the cases for St Joseph's or Midei's legal team have reached different conclusions as to whether the stents were medically necessary.
"A clear example of potential fraud"
According to the Finance Committee senators, who obtained thousands of internal documents, letters, and emails from both Abbott and St Joseph, Abbott had long been in the practice of rewarding Midei for being a high-volume user of its stents—a practice that continued "despite the ethical and legal questions surrounding Dr Midei."
A 2007 Abbott report titled "Project Victory," obtained by the committee, notes that Midei was one of the highest users of Abbott's stent in the US Northeast. Back in August 2008, just two days after Midei implanted 30 Abbott stents in a single day, Abbott paid for an "appreciation" pig roast for St Joseph's cardiac staff held in Midei's backyard; at least $1925 total was spent by Abbott on more than one occasion for "crab and barbecue dinners" at Midei's house. "Abbott employees attended the events during the period that Dr Midei implanted stents without clinical indication and consequently may have been medically unnecessary," the report notes.
In all, Abbott paid more than $30 000 to Midei to help market its drug-eluting stent, including paying for a trip to Asia geared toward "getting the word out in China/Japan." When Midei lost his privileges to practice at St Joseph over the unnecessary-stenting allegations, Abbott swooped in to help, offering him consulting work. "It's the right thing to do because he helped us so many times over the years," an email obtained by the Finance Committee notes.
Other emails are also telling. Following some of the initial stories about Midei in the Baltimore Sun, an Abbott executive said in an email: "Someone needs to take this writer out and kick his ass! Do I need to send in the Philly mob?"
Guilt, innocence, and opinion
The Midei case is a high-profile example of what may become a more common phenomenon: state and federal checks on individual physician and hospital use of stents and other devices. As reported by heartwire, another "unnecessary-stenting" case is currently playing out in Texas, where the medical board there alleges that Dr Samuel J DeMaio failed to meet the standard of care in his treatment of nine patients, placing multiple stents in areas of insignificant or moderate disease, among other charges. In one case, DeMaio placed more than 30 stents in a single patient, albeit over a number of years.
Quoted in a New York Times article about the Senate investigation [3], Dr Steven Nissen (Cleveland Clinic, OH) observed, "What was going on in Baltimore is going on right now in every city in America," Nissen says. "We're spending a fortune as a country on procedures that people don't need."
But Dr William O'Neill (University of Miami Miller School of Medicine, FL), one of the physicians who reviewed patient records and scans for Midei's legal team, told heartwire that Midei is being treated as "guilty until proven innocent."
"Where does Dr Midei go to get his reputation back when he is exonerated? I have seen nothing in my review of records that suggests that he was negligent or dishonest or fraudulent in treating his patients. . . . It is irresponsible of Dr Nissen to comment on this case without ever having seen charts or cines or been involved with medical supervision of this cardiologist."
In response, Nissen told heartwire: "I wasn't commenting on the specifics of the Midei case, although it seems astonishing that a single cardiologist could place 1200 stents in a single year. The excessive use of stents in stable-angina patients in America is readily apparent to most observers. I frequently see patients with multiple stents that were initially placed for atypical symptoms in the absence of severe stenoses and without evidence of documented reversible ischemia. Our payment system incentivizes aggressive use of invasive procedures, and that's often what we get, quantity rather than quality."
Abbott spokesperson Jonathon Hamilton told heartwire that the consulting arrangements between Midei and Abbott had concluded earlier this year, although he could not provide a reason. He called Midei a "highly regarded physician in this field."
He also noted that Abbott has internal policies on interactions with healthcare providers that conform to industry codes. The specific emails quoted in the Senate report are being reviewed, and Hamilton acknowledged that there appear to have been "some inappropriate individual communications. These matters are being addressed internally."
Midei did not respond to requests from heartwire for comments on the Finance Committee report.
Last month, St Joseph Medical Center signed a settlement agreement with the federal government, resolving "an ongoing civil investigation involving its past financial relationship with MidAtlantic Cardiovascular Associates and certain stent procedures performed by Dr Mark Midei while employed by [St Joseph Medical Center]." Midei was previously a partner at MidAtlantic. "The medical center reached the agreement without admitting liability to avoid the expense and uncertainty of litigation and to allow the medical center to move forward," a November statement from St Joseph, sent to heartwire, reads.
A new statement, issued to heartwire on Monday, notes that St Joseph Medical Center "fully cooperated" with the committee's requests for information and that staff there have not yet reviewed the report in depth.
Да вот таков дикий капитализм, нам компании барбекю, крабов и путешествия не оплачивают, поэтому советский ангелографер-стентер - самый честный во всем мире.
19.11.2010, 19:25
Линейный вид
