The NY Times reports that HCA Holdings Inc. had uncovered evidence as far back as 2002 and as recently as late 2010 showing that cardiologists at several of its hospitals in Florida performed procedures that they cannot justify. HCA is the largest for-profit hospital chain in the US, with 163 hospitals and 110 surgery centers across the country, including twenty facilities in Virginia. Several doctors made misleading statements in medical records making it appear that the procedures were necessary. A confidential review from 2010 reveals that half of the cardiac catherizations, invasive diagnostic tests, performed at HCA’s Lawnwood Hospital were on patients without significant heart disease – 1,200 unnecessary invasive procedures. Furthermore, in 2003 a report from an outside consulting group hired by HCA raised “questions regarding the medical necessity of some of the procedures.”
The US Attorney in Miami asked HCA to provide reports investigating the medical necessity of cardiac procedures. There have been medical necessity reviews for certain “cardiology services” for ten HCA hospitals, primarily hospitals located in Florida, writes the LA Times. According to Med Page Today, HCA is also under federal review, which will include billing and medical records from 95 HCA hospitals and an investigation of charges associated with implantable cardioverter defibrillators.
Bloomberg reports that interventional cardiology procedures such as implantation of metal stents or balloons to open clogged arteries and tests for heart disorders are among the biggest revenue sources for HCA.
In late 2003, a confidential memo mentioned incidents at Bayonet Point hospital where patients were “treated for multiple lesions, or blockages, even when ‘the second lesion (or third) did not appear to have significant disease.’” The memo continued to cite “several cases” where patients were treated even though their arteries did not have significant blockages. Later, in a transcript of confidential hearings, Dr. Martin I. Kalish, a physician who served as an outside lawyer for HCA, stated the “style of clinical practice leads to unnecessary procedures and unnecessary complications.”
At HCA’s Bayonet Point Hospital, a 44-year old man came to the ER with chest pain. A doctor performed a procedure that was later deemed unnecessary, causing a punctured blood vessel and near fatal irregular heart beat. They had to revive him in the ER. Luckily, he was shocked twice and they “got him back.”
In December 2004: A confidential memo concluded that as many as 43% of 355 angioplasty cases, an invasive procedure where a doctor opens up a patient’s arteries, “were outside reasonable and expected medical practice.” Furthermore, the investigation showed that some physicians had written that patients had blockages of 80% to 90% when in fact, analysis of sampling cases, proved that blockages actually ranged from 33% to 53%. According to Dr. Rita Redberg, a prominent cardiologist at the University of California, San Francisco, cardiologists generally do not operate on any blockages less than 70%. Thus the significant disparities between the blockage cited in medical reports by doctors at Bayonet Point and the CardioQual review “raises real concerns that this wasn’t just error, but it was intent.”
C. T. Tomlinson was a traveling nurse working at HCA’s Lawnwood hospital in the late spring of 2008. He witnessed a doctor insert a stent on a heart patient who had no apparent blockage in his artery. When he asked the doctor what they were going in to fix, the doctor asked the nurse if he did not see the 90% blockage in the artery. Mr. Tomlinson reported his concerns to hospital officials, only to be informed shortly after that his contract would not be renewed. That summer the hospital opened an investigation, concluding that there were problems with 13 of the 17 cases preformed by that same doctor, including unwarranted cardiac catherizations and patients who were needlessly subjected to multiple procedures.
HCA declined to show that it had ever notified patients who might have been entitled to compensation from their hospitals for any harm. Moreover, reviews of confidential correspondence between HCA executives reveal that rather than asking whether patients had been harmed or whether regulators needed to be contacted, hospital officials asked for information on how the physicians’ activities affected the hospital’s bottom line.
Some doctors accused in the reviews of performing unnecessary procedures are still practicing at HCA hospitals.