Dr Mark Midei因给患者植入不必要的支架而被吊销行医执照

Dr Mark Midei因给患者植入不必要的支架而被吊销行医执照

7月13日，马里兰州医学委员会经过审查决定吊销Dr Mark Midei的行医执照，认为其医疗行为违反职业操守，且情节严重。委员会至少2年不会接受Dr Mark Midei的复职申请，之后委员会再考虑是否恢复其执照。Dr Mark Midei曾故意夸大患者的症状和冠脉狭窄程度，从而为多名患者植入不必要的支架，其行为违反职业道德，给患者造成严重伤害。

支架滥用在国内已不是什么新闻，有些医生任意扩大支架使用的范围，临床上看到有很多狭窄程度低于30%的血管也被植入支架，还有的病人被放了5-10个支架，这都是明显的过度医疗。

胡大一教授曾经指出，要改变过度医疗，首先要改革医学教育内容和医疗服务模式，加强医护人员的人文教育。还要改革医疗体制，建立不合理医疗行为的问责机制。比如，在新加坡，患者如做3个以上心脏支架，医生必须书面说明理由。如理由不合理，或植入后效果不理想，他的行医资格会受到质疑。政府可能拒付医保费用，并吊销该医生行医资格。而我国，在这一领域还没有相关政策。

相关链接：
美国心血管影像贺岁片《让支架飞》
经皮冠状动脉介入治疗指南2009

Dr Mark Midei's medical license revoked
July 13, 2011 | Shelley Wood

Baltimore, MD (updated) - The Maryland Medical Board has concluded its review of Dr Mark Midei, deciding to revoke his license, calling his violations of the Medical Practice Act"repeated and serious."

The disciplinary actions alert published on the board's website today notes that the board will not accept any application for reinstatement by Midei for at least two years. At that time, it is up to the board whether it will consider reinstatement of his license.

As previously reported by heartwire, Midei is alleged to have implanted hundreds of unneeded stents when he worked at St Joseph Medical Center in Towson, MD. The imbroglio was ultimately taken up by the US Senate Finance Committee, which issued a damning report back in December 2010.

For years, however, watchers have been waiting to hear what the Maryland Board of Physicians concluded, having charged Midei with violating the Medical Practice Act back in July 2010, focusing specifically on five patients it was alleged may have received stents unnecessarily. A subsequent seven-day hearing before an administrative law judge (ALJ) led to her issuing a 77-page "proposed decision" that Midei have his license revoked for having violated five provisions of the act, specifically those prohibiting:
Unprofessional conduct in the practice of medicine.Willfully *** a false report or record in the practice of medicine.Gross overutilization of health care services.Violations of the standard of quality care.Failure to keep adequate records.In its "findings of fact," the board concluded that Midei implanted six cardiac stents unnecessarily in four out of the five cases reviewed and noted in his charts that the extent of the stenosis was 80%, when in fact it was lower "and in most cases much lower." In three cases he falsely reported that patients had unstable angina, when in fact they didn't, and in all five patients he failed to obtain the active coagulation time and instead administered heparin while inserting the catheter. In one of the patients, Midei "also failed to look at or disregarded the hospital's note that the patient had already been given an anticoagulant and should not be given another."

In June, Midei filed exceptions with the board in an oral hearing, which was considered in advance of today's announcement. Those included a request by Midei that the board reverse the judge's opinion on which expert reviewer to believe. The ALJ had used Dr Matthews Chacko (Johns Hopkins Hospital, Baltimore, MD) as expert reviewer, whereas Midei's primary expert witness was Dr William O'Neill (University of Miami, FL). The board's "consideration of exceptions" notes that all of the experts were "qualified" but that the ALJ "made her determination based on the consistency of Dr Chacko's testimony and his clear presentation and demeanor" as well as her consideration of professional publications. By contrast, the ALJ "noted some inconsistencies or equivocations in the testimony" of O'Neill. Also at issue was the fact that Chacko was paid $1400 for his report and expert testimony—something Midei raised as problematic. The board report notes that O'Neill, Midei's expert, was "paid more than 20 times that much."

Asked to comment, O'Neill emailed heartwire to say: "I think it's a tragedy that a fine doctor's reputation and livelihood are ruined when there was never a single shred of proof that he harmed any patient. I stand by my [previous] comment that after reviewing all the records and films personally, I would have no problem letting Dr Midei treat me or a family member. I pity any interventional cardiologist practicing in Maryland today; if Dr Midei can lose his license, any of them could."

The board agreed with the ALJ's conclusions and, "using its own expertise," agreed that Chacko's testimony "represents an accurate statement of the standard of quality care." The board clearly took exception to Midei's suggestion that he sometimes wrote "80%" as a form of shorthand for blockages that in fact were less than 50%, calling that "a justification for a blatant falsehood that resulted in patients receiving unneeded stents as well as the creation of false records."

The board also questioned the believability of Midei's testimony that his decision to stent certain patients was on the basis of "remembered" symptoms not recorded in patients' medical records. "The ALJ found it not credible that Dr Midei could remember these unrecorded symptoms in the cases of patients who were among thousands that he saw only once, for very brief period of time (from 20 to 37 minutes) three years previously."

As reported by heartwire, Midei, who is being sued by hundreds of former patients believing they received unnecessary devices, is himself suing his former hospital, St Joseph, alleging in part that he was a scapegoat in "an epic campaign of corporate deception, trickery, and fraud" relating to past business deals and a federal investigation. In his medical-board hearing, Midei was permitted to present evidence to support this claim; the board, ultimately, agreed with the ALJ that "nothing St Joseph Medical Center did or failed to do is relevant to the issues of this case."
The final decision and order, signed by board chair Dr Paul T Elder, contains a number of scalding conclusions about Midei's conduct, stating that he failed to deal honestly with patients and colleagues and that his reports intentionally and nonaccidentally "exaggerated" patient symptoms and degree of stenosis.

"Dr Midei's violations were repeated and serious. They unnecessarily exposed his patients to the risk of harm," the decisions states. "They increased the cost of the patients' medical care. Dr Midei's willful creation of false percentage numbers for the degree of occlusion of coronary arteries is indefensible and amounts to a deliberate and willful fabrication of medical records."

Requests for a reaction from Midei's lawyers have not been returned. Midei has 30 days to ask for a judicial review of the decision.