Coronary : A True Story of Medicine Gone Awry

by Stephen Klaidman

• ISBN13: 9780743267540
• ISBN10: 0743267540
• Edition: 1st
• Format: Hardcover
• Copyright: 2007-01-09
• Publisher: Scribner

Summary

(Scribner) Chronicles the story of two highly respected heart doctors who violated the 'do no harm' principle of their profession. Discusses financial structures that drive the American healthcare system and tempted these doctors to perform unnecessary surgeries. Provides a reminder to always get a second opinion before surgery.

Author Biography

Stephen Klaidman is a former editor and reporter for The New York Times, The Washington Post, and The International Herald Tribune.

Table of Contents

Prologue: An Ill Omen	1
1 A Historical Precedent	7
2 The City	18
3 Old-West Medicine	28
4 A Case of Abandonment	39
5 The Outsider	49
6 An Error in Judgment	63
7 The Investigation	83
8 The Investigation II	109
9 Poor Patient Selection	129
10 The Raid	143
11 Bad Outcomes	150
12 Preparing for Battle	169
13 The Company	184
14 The Civil Cases	198
15 The Intensivist	207
16 "Qui Tam"	220
17 The Townspeople and the Fisher Case	226
18 The Doctor, the Priest, and the Accountant	237
19 A Normal Life	248
20 The Endgame	253
21 The Settlement	261
Author's Note	283
Notes	287
Acknowledgments	289
Index	291

Excerpts

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 warran