Stent Abuse Garners Department of Justice AttentionOct 11, 2013
Stenting overuse has drawn the Department of Justice’s attention and is the focus of a number of whistleblower and federal lawsuits, as well as a Justice Department probe.
The potential overuse of cardiac stenting has highlighted related complication issues. Cardiac stenting is a procedure in which a narrowed coronary artery is propped open with a small, metal mesh tube. During emergency surgery, when a patient is suffering a heart attack, stenting can be life-saving; however, research has long revealed that stents are being implanted in patients who do not achieve significant benefits from stent implantation. Some 700,000 stent procedures are conducted nationwide every year.
In just one potential stenting abuse debacle reported by Bloomberg.com, Najam Azmat, a surgeon conducting stent procedures at Satilla Regional Medical Center in Waycross, Georgia, allegedly tore a patient’s aorta, according to documents filed with a U.S. Justice Department civil complaint. During that surgery, the nursing team brought in another surgeon, the second surgeon ultimately warned hospital administrators about Azmat, and one nurse’s notes stated that the hospital received seven similar warnings.
Azmat continued working at the facility and another patient died. In that case, Azmat was accused of puncturing the patient’s right kidney wall during a stent procedure; she died 17 days later over heavy blood loss complications, according to the federal complaint, Bloomberg.com wrote. The Justice Department’s expert report indicated that the procedure “was not medically indicated” and, according to an expert witness for the woman’s family, “People who should have and could have saved” the patient’s “life were too interested in having Dr. Azmat continue to do procedures and make money for the hospital to do the right thing.” The hospital denied wrongdoing, but did agree to pay $840,000 to resolve the complaint that accused the hospital of submitting claims for cath-lab services—some unnecessary—that Azmat was neither qualified nor appropriately credentialed to perform, according to Bloomberg.com.
Numerous interviews, over 1,000 pages of medical records, internal documents, and witness statements made public in 2012, revealed that the situation with Azmat and the Satilla Regional Medical Center is just one example of the ways in which facilities will work to maintain their catheterization clinics, also known as “cath labs,” Bloomberg.com wrote.
In other cases, hospitals allegedly paid millions in kickback fees in which ghost jobs were used; facilities were also revealed to have padded fees, offered debt forgiveness, and discounted office space in efforts to ensure physicians continued conducting stent procedures, wrote Bloomberg.com, referring to allegations in five federal cases and three private whistle blower lawsuits.
David Brown, a cardiologist at Stony Brook University School of Medicine in New York told Bloomberg.com that some seven million heart patients have been implanted with catheters in the past decade and that one-third of those procedures were not necessary. Also, according to Bloomberg.com, 11 hospitals have agreed to settlements with the Justice Department to resolve civil allegations of unnecessary stenting and related issues, to date. Many of the federal cases were filed by whistleblowers and, in information that has been made public in recent years, documents reveal that facilities received financial benefits and, in some cases, ignored or pushed for allegedly inappropriate stent use.
The Department of Justice has been probing interventional cardiology and stenting since 2006 and revealed that at least 11 hospitals have settled federal allegations over claims that they billed public health programs for unnecessary stents and related issues, according to a previous Bloomberg.com report. Investigations are ongoing in five other states.