Coronary: A True Story of Medicine Gone Awry - Hardcover

Klaidman, Stephen

Hardcover

ISBN 10: 0743267540 ISBN 13: 9780743267540

Publisher: Scribner, 2007

Synopsis

A dramatic report on the rise and fall of two ambitious California heart doctors traces how they performed countless surgeries and generated enormous profits for their hospital's management company before a suspicious patient and the FBI investigated the possibility that they were subjecting healthy patients to unnecessary medical procedures. 35,000 first printing.

About this title

About the Author

Stephen Klaidman is a former editor and reporter for The New York Times, The Washington Post, and The International Herald Tribune. He was a senior research fellow at the Kennedy Institute of Ethics and a senior research associate at the Institute for Health Policy Analysis, Georgetown University. He is also the author of Saving the Heart: The Battle to Conquer Coronary Disease, Health in the Headlines, and The Virtuous Journalist (with Tom Beauchamp). He lives in Bethesda, Maryland.

Excerpt. © Reprinted by permission. All rights reserved.

1

A Historical Precedent

Felix Elizalde's experience in Redding, as unpleasant as it evidently was for him and for his wife, Margaret, did not necessarily have wider implications. It could easily have been a simple case of medical error or just a difference in clinical judgment between two cardiologists. Medical errors occur with much greater frequency than most people are aware or would like to think, even at the best academic medical centers, and variations in clinical judgment are only natural. Cardiology in particular has many gray areas, and good clinicians frequently differ about the most appropriate treatment. The California State Medical Board, like most of its counterparts around the country, requires a pattern of questionable practice to investigate a physician, not just a single complaint, which makes sense. Doctors should not be held to a standard of perfection nor should they be expected to make identical cookbook diagnoses. Malpractice, of course, was not out of the question in Elizalde's case, but neither was it a certainty. And the possibility of fraud had not entered anyone's mind. In retrospect Elizalde had no definitive reason to be suspicious of Redding Medical Center, its owner, National Medical Enterprises, Dr. Realyvasquez, or, to be completely fair, even Dr. Moon.

Yet at the same time there was something potentially relevant to the situation that Elizalde knew nothing about -- a lengthy episode involving National Medical Enterprises that was deeply troubling. In the late 1980s and early 1990s a number of NME-owned psychiatric hospitals had engaged in a cold-blooded scheme that was ongoing at the time of Elizalde's Redding experience and destined to end in criminal convictions. Had Elizalde known about these activities he might have been even more skeptical about his own treatment.

About fifteen months before Moon diagnosed Felix Elizalde with triple-vessel coronary artery disease, late in the afternoon of April 12, 1991, a repainted police car pulled up to Sid and Marianne Harrell's modest ranch house in Live Oak, Texas, a middle-class suburb of San Antonio. The light blue Dodge had a flashing red light on top and the words Sector One painted on the trunk. There was a prisoner cage in the back seat. Marianne and her fourteen-year-old grandson Jeramy watched two bulky, uniformed men get out. One of them told her curtly, "We're Sector One, Mobile Crisis Unit, and we're here to pick up the boy." Marianne thought they meant Jeramy's twelve-year-old brother, Jason, who was undergoing an evaluation at Colonial Hills, a psychiatric hospital in San Antonio owned by a company called Psychiatric Institutes of America. She said, "He isn't here. What did he do?" But one of the men, who introduced himself as "Lieutenant" Joe Saenz, said, "That boy," pointing at Jeramy. She asked again what he'd done, but they wouldn't tell her.

Marianne, Jeramy, Saenz and the other man, whose name was Ulysses Jones, went inside where Sid Harrell, a retired army staff sergeant, was sitting at the kitchen table. Saenz and Jones told the Harrells they were operating under orders from a Dr. Bowlan at Colonial Hills and that if Jeramy didn't go with them they would get a warrant under which he could be held for twenty-eight days. They also indicated that if this happened he would have a police record.

Marianne was both frightened and angry. She called Colonial Hills and was told that the officers were authorized to bring Jeramy to the hospital. When she asked the reason, she was told for substance abuse, truancy, and because he was a victim of child abuse. Sid then called the local police to try to establish whether Saenz and Jones had the authority to take Jeramy. By the time a police officer showed up Jeramy was handcuffed and in the cage in the back of the Sector One car. The officer reviewed the papers the men showed her, which did not include a warrant authorizing Jeramy's detention. Nevertheless, she told the Harrells that Saenz and Jones were licensed security officers and could indeed get a warrant to hold Jeramy for twenty-eight days. If the Harrells let their grandson go with the security officers, she said, they could probably have him released within twenty-four hours. At this point the distraught grandparents gave up and let the two uniformed men take Jeramy away.

Dr. Mark Bowlan's "diagnosis" of drug abuse and the allegation that Jeramy was an abused child had been based solely on Bowlan's interview with Jeramy's twelve-year-old brother Jason. Bowlan, a psychiatrist who at the time had a temporary, limited medical license, which he would lose that summer for falsifying letters of recommendation, waited four days before seeing Jeramy, even though he had asserted that the boy was so dangerous that he had to be brought in by a pair of professional bounty hunters and admitted to Colonial Hills on an emergency basis. After six days, during which time his grandparents, who were his legal guardians, were not allowed to see him, Jeramy was released on a writ of habeas corpus obtained by state senator Frank Tejada. The senator went to the hospital himself and threatened to kick the door down if they didn't let the fourteen-year-old go. A bill for $11,000 followed. Jeramy's younger brother Jason was kept in the hospital for two weeks. His bill was $15,000. Both bills were paid by CHAMPUS (Civilian Health and Medical Program of the Uniformed Services), the U.S. government's health insurance program for members of the military.

Jeramy Harrell's experience of being forcibly taken from his home and being incarcerated in a mental hospital was not unique in the annals of the Psychiatric Institutes of America, a subsidiary of National Medical Enterprises. And, as bad as the Harrell case was, it was far from the most egregious in the company's history. Nor would it be the last. Something seemed to be awry in the corporate DNA.

At least as far back as 1984, some Texas psychiatrists knew what was going on at the Psychiatric Institutes of America hospitals, and some were benefiting from it handsomely. Dr. Charles S. Arnold, a San Antonio psychiatrist, tape-recorded a conversation on June 12 of that year with the administrator of Colonial Hills, the hospital to which Harrell would be taken. Arnold said he recorded the conversation "because of what I had already learned about the hospital." The administrator told him that if he went along with the program, the hospital would make him rich, as it had done for other psychiatrists who had cooperated. The administrator then cited a Houston physician as an example: "They called [name deleted] and said 'Look, you want to be rich? You let us set up this program the way we want to set it up. All you do is be the admitting psychiatrist and we'll make you rich.' We made him rich."

The administrator who contacted Dr. Arnold was executing a key part of the company's business plan -- to identify and admit patients with good insurance coverage. Harvey Friedman, the psychiatric unit's vice president for program services, said that Ron Bernstein, the chief operating officer, had issued a directive to "Fill the beds at any cost. Hire sleazeballs. These are his words. Anything it takes. That was his philosophy." A year after NME's approach to Arnold, Norm Zober, president and CEO of its Specialty Hospital Group, which included the psychiatric facilities, scribbled the following hand-written note at a planning meeting: "Kinds of doctors we are looking for? Guys that will admit." At a similar meeting thirteen months later, Zober wrote that the "incentive" contracts that were being discussed were "Deals to sew up M.D.'s."

The doctors were the linchpins of this scheme. And because what they were being asked to do -- accept bribes for referrals among other things -- was illegal, NME cooked up ways to disguise these bribes. The company relied on the doctors to do what was expected of them and in return rewarded them with titles that required no work and paid handsomely. At the psychiatric hospitals, cooperating doctors were usually given contracts as chiefs of treatment units. Peter Alexis, who was regional vice president of Psychiatric Institutes of America for Texas, explained that the doctors were paid salaries ostensibly for providing services expected of someone holding the title they had been given. Alexis also said the size of a doctor's salary was directly linked to the number of his referrals.

Mark Bowlan, the psychiatrist who admitted Jeramy Harrell and eventually pled guilty to charges of making false claims, theft of public money, and forgery, said he received $250,000 from NME his first year under contract, $400,000 in his second year, and was offered $750,000 for a third year. He later told the Houston Chronicle that "Doctors became addicted to the money, whether in terms of lifestyle, financial obligations or recreation." Dr. Arturo Torres of Laurelwood Hospital charged $125 for each patient visit. He averaged twenty-four patients in the hospital and billed for five visits a week per patient, from which he grossed $780,000 in one year. The visits, when they occurred at all, were cursory. Hi, how are you feeling today? Fine, that's good. Bye.

Each hospital's business was driven by extremely ambitious bottom-line requirements that effectively ruled out acceptable patient care. Marketing was everything. James Hutchison, an executive at Baywood Hospital, told an investigative committee of the Texas Senate and the Select Committee on Children, Youth and Families of the U.S. House of Representatives that "every employee, from groundskeeper to program director, from office secretary to nurse, was obliged to conduct weekly marketing calls." Russell Durrett, controller of Psychiatric Institutes of America's Twin Lakes Hospital in Denton, Texas, from November 1988 to July 1989 told the House Select Committee in 1992 that at the Twin Lakes program those with the rank of director and above were given a weekly quota of contacts -- his was five -- and received prizes for referrals. He testified that, "We had an in...

Edition details

• Publisher: Scribner
• Publication date: 2007
• ISBN 10: 0743267540
• ISBN 13: 9780743267540
• Binding: Hardcover
• Language: English
• Edition number: 1
• Number of pages: 320