One of the unanswered questions in the case of Dr. Mark Midei and St. Joseph Medical Center, in which Midei is alleged to have placed more than 500 coronary artery stents in patients who may not have needed them, is: Who initially called attention to Midei?
So far the hospital has said only that it received a complaint from a patient. In gathering documents for a column on stents for this Sunday's paper, however, I received a state report that says the complaint came from "a patient who was also employed by the hospital, which prompted the hospital to initiate a review..."
So the patient was also a St. Joe employee. The way compliance and quality-assurance were set up at St. Joe, maybe the only people who could have been alert to unneeded stents were insiders. Before the hospital made reforms, there was a lack of accountability in its official procedures, at least in terms of identifying successfully implanted but unnecessary hardware. Certainly the patients never could have figured out they had unneeded stents, if that's what happened. (The story hasn't been fully told, and Midei has said he expects to be exonerated.) But docs and hospital officials have told me that, generally in catheterization labs, techs and nurses are often in a position to see the angiogram results and interpret them. And they talk to other employees. (St. Joe hasn't identified the employee/patient who complained about Midei.)
The lack of safeguards against unnecessary implants seems to be widespread. To get a good sense of how inadequate hospital protocols are at catching potential unnecessary stents, check out this post from Wachter's World, the blog of Dr. Bob Wachter, the chief of medicine at the University of California San Francisco Medical Center, in which he ruminates on the St. Joe situation.
I quoted Wachter in this March column on likelihood of stent abuse at other hospitals. I'm the "Baltimore reporter," mentioned in his post, who asked him the question that he says "threw me back on my heels."