Daily Independent (Ashland, KY)

October 10, 2013

KDMC, Paulus subjects of suit

Man claims unnecessary procedures caused long-term damage

Kenneth Hart
The Independent

CATLETTSBURG — An Ohio man and his wife have filed a civil lawsuit against King’s Daughters Medical Center and a recently retired heart surgeon who practiced there, alleging the doctor caused long-term damage to the man’s health by performing cardiac stenting procedures he knew were unnecessary.

In the 17-page complaint, filed Sept. 30 in Boyd Circuit Court, Robert and Jana Huron of Chesapeake allege the defendants in the case — the hospital, Kentucky Heart Institute Inc. and Dr. Richard E. Paulus — “routinely overstated the extent of the disease in coronary arteries of patients in order to justify PCTA (percutaneous transluminal coronary angioplasty) with placement of a stent — a small mesh wire cylinder — into the arteries of a patient’s heart.”

According to the suit, PCTA with stenting is only medically appropriate when the artery has stenosis, or narrowing, of at least 70 percent. But overstating the severity of the disease “allows the defendant healthcare providers to bill health insurance companies, federal and state governments and the patients themselves for hundreds of unnecessary procedures,” the suit states.

KDMC has been under investigation for approximately two years by the U.S. Department of Justice for alleged overstenting. KDMC has been among the nation’s leaders in stent procedures. Bloomberg.com reported that Ashland ranked fourth out of 1,768 U.S. regions in the number of stent-related procedures per 1,000 Medicare enrollees in 2010, according to an analysis by researchers affiliated with Dartmouth College in Hanover, N.H. KDMC is Ashland’s only cardiac-stenting facility.

The civil suit states between 2006 and 2011, KDMC performed more stenting procedures than any other hospital in Kentucky. But in 2012, after the launch of the DOJ investigation, the number of stentings done at KDMC had decreased by 70 percent. However, KDMC still performed more of the procedures than all but one Kentucky hospital that year, according to the suit.

KDMC is one of a number of hospitals that have been investigated by the DOJ over interventional cardiac procedures. According to Bloomberg, at least 11 hospitals have settled federal allegations that they billed public health programs for needless stents and related misdeeds. Federal investigations continue in five states.

In an August speech to the Ashland Rotary Club, KDMC CEO Fred Jackson acknowledged the existence of the DOJ probe, but said investigators had found nothing amiss. He also said “rumors in the community” concerning the investigation had been a major factor in driving patients away from the hospital and thus contributing to its financial losses over the past two years.

Those losses, Jackson said, were the principal factor in the hospital’s recent decision to lay off about 150 of its employees. However, unlike other mass layoffs KDMC has had over the past several years, the most recent round of cuts failed to restore the hospital to profitability, he said.

KDMC on Wednesday released the following written statement by Dr. Phil Fioret, the hospital’s chief medical officer:

“KDMC has been transparent in its communications with its patients, its medical staff and the community about the ongoing investigation by the U.S. Department of Justice into cardiac stent procedures performed by physicians at KDMC. We take this matter very seriously, and since 2011, much of KDMC’s financial resources have gone to its efforts to cooperate with the government’s investigation. While the government’s review is continuing, it is not surprising that civil lawsuits would be filed related to these same issues. As with any investigation and litigation matters, KDMC cannot comment on the specifics of any of these matters no matter how much we would like to.

“KDMC is here for patient care and service to the community. We are working hard to keep focused on this fact while the legal issues are being addressed. The safety of our patients and the provision of exceptional care to our community will always be our first priorities. To that end, KDMC has been working with Dr. Bonnie Weiner at the Accreditation of Cardiac Excellence, a nationally recognized peer review organization of cardiac catheterization services. ACE has worked with us to proactively provide enhanced oversight of our cardiac services as well as to facilitate implementation of state of the art processes. As a physician, I am confident in the cardiology services that our hospital continues to provide and I believe KDMC has taken every necessary measure to ensure outstanding quality patient care.”

In the lawsuit, Robert Huron, 50, alleges Paulus gave him multiple stents between 2006 and 2011 that were medically unnecessary. As a result, the suit states, Huron is allergic to the polymers in the stents and will “now and in the future continue to suffer from allergic reactions to the polymers and is in a constant state of anaphylaxis.”

Huron also will be “indefinitely required to take medication that carries life threatening risks, is subject to life-threatening allergic reactions, is now and will always be at risk for future stent thrombosis as well as stent re-stenosis,” the suit states.

Claims made in civil lawsuits state only one side of an issue. Neither KDMC nor Paulus had responded to the civil suit as of Thursday. Under Kentucky law, the defendants have 20 days from the dates they are served to do so.

The Hurons are represented in the suit by attorneys Hans Poppe of Louisville and William H. Wilhoit of Grayson.

Paulus’ Washington D.C.-based attorney, Robert S. Bennett, who represented President Bill Clinton in the Monica Lewinsky affair, told Bloomberg his client had done nothing wrong and would “vigorously contest” any and all allegations against him.

“We have thoroughly investigated this case and are convinced Dr. Paulus always acted in the best interest of his patients and never inserted a stent that was not medically appropriate,” Bennett said.

Bennett also told Bloomberg the reason Paulus performed so many stentings was that KDMC became a regional hub for the procedure.

Paulus, 66, retired in August after 21 years of practicing at KDMC. He said at the time that his retirement “was the confluence of a lot of events,” and that he wanted to spend more time doing charitable work and with his family.

KDMC’s Heart & Vascular Center bears Paulus’ name — the Richard E. Paulus M.D. Pavilion.

KENNETH HART can be reached at khart@dailyindependent.com or (606) 326-2654.