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It’s the state and national medical story that not only won’t go away, but is expanding in scope.

When is a cardiologist justified in recommending and performing invasive surgeries to insert mesh tubes, called coronary stents, in blocked arteries to relieve restricted blood flow?

The basic rule of thumb is that an artery should have at least 70 percentage blockage before a procedure is required. The question is, are doctors who claim they are erring on the side of caution actually erring on the side of greed?

Unnecessary stints result in unnecessary surgery risks to patients who get them, but also subsequent health issues, including a lifetime of prescriptions for blood-thinning medications.

Physicans say they’re justified in inserting stints long before patients reach that level of circulation restriction.

But local and national media and health care bloggers are covering increasing allegations that Catholic Health Initiatives is indulging in what Louisville-based health care policy expert Dr. Peter Hasselbacher has coined “angioplasty abuse.”

Patients allege that for several years, CHI doctors at St. Joseph London Hospital in London, Ky. performed invasive coronary procedures on patients who weren’t anywhere near that 70-percent blockage and didn’t need them.

It was Hasselbacher, president of the Kentucky Health Policy Institute, who first started covering the story back in September. In December, he outlined why the trend could be really important to Louisville in an in-depth December entry, “Kentucky Health Policy Institute Blog| Serious Accusations of Medical Overtreatment Made Against Responders to UofL’s Partner Search.”

An excerpt from that post:

“If the allegations against St. Joseph London prove to be true, then there are hundreds, if not thousands of patients with a potential claim for damages from that one facility. I suspect that KentuckyOne Health self-insures its hospitals. It is quite possible that claims such as these can bring KentuckyOne Health to its financial knees and therefore limit the payments to the University of Louisville that the public was promised. The University promised many things to convince the Governor and other state officials to accept what appears to me to be the same deal it offered one long year ago. I hope the University did not promise things over which it had no control.”

Three months later, that focus is expanding, with attorneys telling Insider Louisville they believe CHI doctors practiced angioplasty abuse at other facilities.

Texas-based attorneys Mikal C. Watts and Ryan L. Thompson, with Watts, Guerra, Craft LLP, have created a new website to  reach patients, or their surviving family members, who may have received unnecessary medical procedures performed at King’s Daughters Medical Center in Ashland, Ky. since 2000. The firm created the website after the Daily Independent, Ashland’s newspaper, refused to let them advertise.

Louisville-based lawyer Hanse Poppe, who is affiliated with Watts, Guerra, Craft LLP,  is the lead counsel representing about 400 people who are already suing 11 cardiologists, St. Joseph London and CHI, the hospital’s parent. St. Joseph London is operated by KentuckyOne Health, Kentucky’s largest health system, formed after CHI acquired Jewish Hospital & St. Mary’s HealthCare in January, 2012.

Calls to CHI’s spokeswoman in Kentucky were not returned.

After Hasselbacher began posting about the allegations, Courier-Journal’s Andrew Wolfson followed with a comprehensive piece  in February on the allegedly unnecessary heart procedures at St. Joseph London.

Wolfson’s story was syndicated in USA Today with the headline: “Hundreds sue Ky. hospital over heart procedures.”

 Larry Huston of Forbes also has covered he angioplasty abuse story, curating information from Hasselbacher and Wolfson.

From that coverage, we know:

• St. Joseph London was cited in 2011 by the Centers for Medicare and Medicaid for failing to review the medical necessity of 3,367 cardiac catheterizations performed there the year before.

• St. Joseph London did more angioplasties with stents in 2008 and 2009 than either the University of Louisville Hospital or the University of Kentucky Albert B. Chandler Hospital, according to Hasselbacher, who is professor emeritus at the University of Louisville.

• Dr. Sandesh “Sam” Patil, one of the cardiologists named in lawsuits, is under investigation by the U.S. Attorney’s office. Patil also is the subject of a federal healthcare fraud investigation.

• There’s been a decrease in angioplasties performed at St. Joseph London since Patil left St. Joseph London in 2010.

After Wolfson’s piece went national, Hasselbacher posted:

“…it’s hard for me to have much sympathy for the hospital because its CHI owners had seen essentially the same situation at a sister hospital in Towson, Maryland which ironically is also named St. Joseph. That matter was ugly enough that it prompted a special report from U.S. Senate Finance Committee.”

(In 2010, CHI agreed to pay $22 million to the federal government to settle the charges alleged about improper payments to doctors who regularly performed unnecessary procedures.)

To be sure, CHI isn’t the only hospital group facing a crisis caused by heart surgery patients who received allegedly unnecessary heart procedures.

Nashville-based HCA Healthcare, which operates 163 hospitals and 110 freestanding surgery centers, was the subject of a story by the Tampa Bay Times’ Kris Hundley in “Little is clear-cut on HCA’s high rates of lucrative heart procedures.” In that story, Hundley documented the U.S. attorney’s office in Miami had “launched an investigation into the medical necessity of cardiac procedures at 10 of its hospitals, including several in Florida.”

In September 2011, WHAS11’s Adam Walser interviewed Poppe, lead counsel for the plaintiffs in the London suits, and the Edward Marshall, who was at the time Poppe’s sole plaintiff against St. Joseph London et al:

http://www.youtube.com/watch?v=Z8_5KBcwCmo&feature=player_embedded#!

While suits are filed against larger hospital systems, Poppe told Insider Louisville no lawsuits have been filed yet against smaller, instate hospital systems. But that could change, Poppe said.

Here’s Insider’s Q&A with Poppe:

Insider Louisville: Do you have any reasons to believe unnecessary heart procedures like those that took place a St. Joseph’s took place at other Kentucky hospitals?

Poppe: Yes, we have very good reasons to believe significant numbers of unnecessary medical procedures were being performed at King’s Daughters (Medical Center.)

IL: Have you recently filed any “unnecessary procedure” lawsuits against hospitals in Kentucky, other than St. Joseph London?

Poppe: We have not filed any cases other than London, but will be very shortly.

IL: I was surprised to see that you went from one plaintiff to nearly 400 with ads in The London Sentinel Echo. Did you place ads anywhere else?

Poppe: In London, we placed a few ads in some of the smaller papers in the surrounding counties.  In Ashland, the newspaper refused to run our ads.  I suspect (King’s Daughter) had something to do with that.

IL: Have additional plaintiffs surfaced since Andrew Wolfson’s C-J/ USA Today piece? Are you over 400 yet?

Poppe: The CJ article did not generate many new London cases; we were already at a critical mass.

IL: Any word on trial date, or a guess at when they’ll be on the timeline?

Poppe: There is no trial date set, and when we get one will depend on how the judge decided to handle these cases.  Depending on whether he tries them individually or in large groups will have a lot to do with it.

We wondered if a doctor were performing multiple unneeded surgeries on patients, at the same location, with the same nurses and staff, whether staff would notice and speak out?

A couple days before Wolfson’s piece hit USA Today, Barry Meier published an analysis in the New York Times headlined “Doctors Who Don’t Speak Out,” about how doctors who speak out, or report problems with products or drugs, often suffer consequences.

While Meier’s story focused on whistleblowers on defective artificial hips, it suggests bottom lines for hospitals and physicians appear to be blurring the line between what’s in the best interest of patients and what generates the most revenue for doctors:

For a consultant, breaking those ties can carry a cost. For example, when Dr. Lawrence D. Dorr, an orthopedic specialist, warned fellow surgeons in an open letter in 2008 that a hip implant made by Zimmer Holdings was flawed, he became the subject of a whisper campaign that questioned his skills as a surgeon. “The first thing that a company does is to put out a campaign that a surgeon does not know how to operate,” said Dr. Dorr, who was a consultant to Zimmer when he wrote the letter. “It hurt my practice for a year.”

Finally, the question becomes,what’s in this for plaintif’s attorneys?

Per Watts Guerra Craft LLP’s online ‘eSign-able’ contract, the attorneys keeps 33 1/3 percent of the settlements if they’re settled before they’re tried, or 45 percent if they’re settled afterward. The fee-sharing agreement amongst all the attorneys involved breaks down as follows: Watts Guerra Craft LLP: 28.33 percent, Tom Rhodes Law, P.C.: 28.34 percent, The Poppe Law Firm: 28.33 percent, and Wilhoit Law Offices: 15 percent..

And of course, lawsuits give only give only one side of the dispute.

Curtis Morrison, a former Insider contributor, is now a Whittier Law School J.D. candidate (expected graduation May 2016).