Print

Email story

Comment

Letter to the editor

Hospital acted on surgery questions

Nine cardiologists at Bayonet Point were suspended when procedures are questioned.

By COLLINS CONNER
Published December 10, 2004

HUDSON - Questions about surgeries and use of medicines led to the suspension this week of nine cardiologists from Regional Medical Center Bayonet Point.

Those were the findings of an independent panel of heart experts, according to Dr. R. Vijay, medical director of Regional's heart institute.

The findings said that in some cases the cardiologists:

--Performed angioplasties on arteries that were not significantly clogged with plaque.

--Propped open clogged arteries with stents of the wrong size or type.

--Used incorrect or inadequate medicines to treat coronary artery disease.

--Kept incomplete medical records.

The findings led the hospital's board of trustees to immediately stop the nine doctors from performing further interventional heart procedures and may trigger an examination of Regional's heart center by the state Agency for Health Care Administration.

The unusual suspension of so many doctors also thrusts Regional Medical Center into a nationwide controversy over the commonplace use of angioplasty to treat clogged arteries.

Increasingly, some experts say, the procedures are overused and often unhelpful, but they add enormously to doctor and hospital revenues.

It has been evident for years that Regional's high-volume heart center outpaces most similar centers in both the number of angioplasties performed and the amount of revenue they generate.

In the Dartmouth Atlas of Cardiovascular Health Care, a 1999 study of hospital treatments provided to heart patients nationwide, Medicare patients at Regional underwent more angioplasties than those in any other region in Florida and most regions across the country.

More recent state hospital data also shows more heart procedures performed at Regional than in even much larger Florida heart centers.

Vijay, the medical director of Regional's heart center and former chairman of the Florida Board of Medicine, cautioned that the findings are only a preliminary assessment of the records. The hospital's peer review committee also will hear the physicians' description of the cases.

Medicine is "not a very exact science," said Vijay. "There is a judgmental issue here."

Professional treatment guidelines used nationwide lay out how coronary artery disease should be treated in its early stages, when arteries begin to become clogged with sticky plaque. The guidelines also pinpoint when the plaque blockage has grown large enough to warrant surgical interventions, such as balloon angioplasty to push open the clogged artery and stenting to hold the plaque in place.

But some physicians believe angioplasty and stenting is used too soon and too often when patients would do as well or better with heart medicines, diet and exercise.

Regional officials refused Thursday to name the nine suspended doctors, citing the required confidentiality of the peer-review process. It is not known if patients were harmed by any of the questioned treatments.

But throughout the day patients called Regional and the St. Petersburg Times, expressing dismay at the suspensions and the secrecy.

Dr. Wayne Taylor, chairman of Regional's board of trustees, said he sympathized with the patients but said the confidentiality was necessary.

"It can't be done in the public right now," he said. "I know the public wants to know details and eventually everything becomes known. But we have to go through the peer review process."

Wednesday's suspension of so many doctors - more than a third of the heart center's cardiology staff - may be unprecedented, but Taylor said the action was appropriate.

"We had the study, we saw the results and acted in good faith," he said.

The suspensions also disturbed the medical community.

"It ... raises the issue of performance caliber and that is a big blow to any physician," said Brooksville cardiologist M.P.R. Nathan.

The Agency for Health Care Administration, which oversees hospitals in Florida, has not received a report of the events from Regional, said agency spokesman Jonathan Burns.

But AHCA doesn't need a report of problems to trigger a hospital review, Burns said. "We can any time, without notice, send surveyors in to check anything we want to check," he said. "Health care quality is our top priority, and we are going to take whatever steps needed to ensure that's happening."

As for Regional, he said, the agency "is taking all appropriate steps to ensure patient safety at Bayonet Point as it does with all other hospitals."

[Last modified December 11, 2004, 19:18:41]