St. Joseph Medical Center has repeatedly said it wants to do right by its coronary stent patients.
After a complaint last year that star cardiologist Mark Midei was placing stents in the arteries of patients who didn't need them, the Towson hospital removed him from duty, reviewed thousands of medical records and sent letters to nearly 600 people whose stents appeared unnecessary, telling them to go see a doctor.
When asked if the hospital bore any legal liability, CEO Jeffrey K. Norman replied: "I suppose we do."
But now that the lawyers have arrived, bearing the threat of hundreds of lawsuits, some say the message has changed. Even as some St. Joseph employees continue to suggest wrongdoing — including its chief of cardiology, who has told at least two patients that his former colleague falsified their records — the hospital's attorneys appear to be girding for a fight.
In its legal filings, the hospital said it "generally denies all allegations of liability." And medical malpractice attorneys preparing cases against St. Joseph say hospital lawyers are gathering experts to argue that Midei did nothing improper, despite the hospital having revoked his practice privileges.
"While still acting under the guise of doing the 'right thing,' SJMC and its attorneys are not only categorically denying any wrongdoing by Dr. Midei (and fighting damages in every aspect), they are also employing tactics to delay and obstruct [evidence] discovery at every possible turn," declares a document filed last week in the state's health care arbitration office by Baltimore lawyer H. Briggs Bedigian, who represents more than a dozen of Midei's former patients.
"If they're going to [now] stand by [Midei's] care and say what he did is not negligent and what he did is justified," Bedigian said in an interview, Midei should "be looking for an employment lawyer."
In a statement to The Baltimore Sun, St. Joseph said that it is not "involved in the defense of Dr. Midei," who denies any impropriety. But it also is unwilling to concede that every patient who got a letter also had an unwarranted procedure that caused them harm, and is thus entitled to a payment for damages.
"The notification that SJMC sent to patients was not a definitive conclusion that the stent was unnecessary," St. Joseph said, adding that hospital officials did not conduct a full medical review before sending the letters.
After complaints about Midei were lodged by a patient early last year, reviewers for the hospital looked at X-ray images from the medical files of his stent patients to determine if their arteries had enough blockage — generally at least 70 percent — to justify the procedure. In many cases, they concluded that Midei had recorded significantly more blockage in written records than was revealed in the films, leading officials to send those patients letters.
The letters were not an admission of liability, hospital officials say. "Upon a full medical review by outside experts, it is possible that the stents may be deemed appropriate," St. Joseph said in the statement.
Hospital officials added that they are willing to "accept financial responsibility where the individual claim has been fully assessed and determined to have merits" and that their "door is open to productive, reasonable, and serious discussions" with attorneys and patients.
But medical malpractice lawyer Jay D. Miller, who represents 190 of Midei's former patients, said he's been in talks with the hospital for weeks, and that the offers have been far from what he considers fair.
"I was consistently told 'we know we're wrong, and we intend to be fair to your people, don't file suit, give us a chance to sit down with you," Miller said. "When I sat down with them, it was now defense lawyers and everything changed."
Miller wouldn't divulge the figures discussed during the confidential negotiations, though he described them as "barely" covering the $2,800 annual cost of the blood-thinning drugs that many patients with stents are required to take.
"They're forcing my hand," Miller said. "I'm going to file 190 lawsuits."
Sources familiar with the settlement discussions say the hospital is offering, on average, less than $100,000 per patient, while attorneys are sometimes asking for three times that amount or more.
For some of Midei's patients, even unnecessary stents might have improved their quality of life, at least for a time, by taking away heart pain caused by blockage that didn't meet the 70 percent threshold, cardiac specialists say. But those patients also must live with an increased risk of sudden clotting and other complications, the need to take drugs they otherwise wouldn't, and a general fear that something could go wrong at any point.
That makes each case hard to put a dollar figure on.
"Right now, it's a game of chicken, because everybody is, I think, afraid to commit and make that first step," said Baltimore lawyer Andrew G. Slutkin, who represents about a dozen Midei patients.
Slutkin says plaintiffs' attorneys are hesitant to settle, because to them, the amount becomes a psychological ceiling that defines what the cases are worth. And the hospital is likely to hold out, because they see the figure as a floor — the bare minimum that will have to be paid every time.
Slutkin has one case filed in Baltimore County Circuit Court, and the others are in earlier stages. He said his experience so far with the hospital has been good, however.
"I haven't had any problem with any of the defendants in the cases that I'm pursuing," he said.
One of Slutkin's clients has a note from Dr. Stephen H. Pollock, St. Joseph's chief of cardiology, in his medical file, saying Midei likely misrepresented the man's artery blockage. Midei, who earned $1.3 million in fiscal year 2009, said it was 80 percent blocked, while Pollock said the records show at most a 40 percent obstruction.
Pollock declined to be interviewed, but said in an e-mailed statement that he "felt an obligation to meet with" patients, discuss the issues and answer their questions.
Pollock and Midei were both founding members of MidAtlantic Cardiovascular Associates, the region's dominant cardiology practice. And both earned the group's ire when they jumped to St. Joseph in early 2008, with Pollock taking over there as head of cardiology and Midei running the cardiac catheterization suite.
Pollock frequently referred his own patients to Midei, a skilled interventional cardiologist, for more invasive assessment and treatment. And when the Midei allegations surfaced, Pollock began pulling patient records to do his own review.
He even reached out to one patient, Frank Ward, after reading about him in a Sun story about unnecessary stents.
Ward never got a letter from the hospital, which only contacted patients who received stents going back two years. But he had an outsider review his records, at the urging of his attorney, and concluded that two of his stents, placed in 2005 by Midei, were unwarranted.
Pollock reviewed the man's file, eventually writing a note dated June 28, 2010, saying he "agreed with the assessment of the experts of Mr. Ward's lawyer that in the second procedure two of the three stents were unnecessary."
Ward released the note, which will likely become part of his Baltimore County court case against Midei and the hospital, to The Sun.
Bedigian, Ward's lawyer, has so far filed the most stent cases in Baltimore County Circuit Court, though he has others being prepared or reviewed within the state's Health Care Alternative Dispute Resolution Office, the first stop for most medical claims.
Thomas Chaffee's case alleging unnecessary stents was filed there in January, and Bedigian argued in a legal document filed Tuesday that its progress is being stonewalled by the defendants' lawyers, who are not turning over required documents. Lawyers for St. Joseph did not respond to requests for comment.
Bedigian's legal filing asks the arbitration office to compel the hospital to produce a log documenting what information it wants to withhold, and why.
"If they're going to do the right thing," Bedigian said, "let's see what [they've] got."