Friday, October 26, 2012

To stent or not to stent: that is the question

To stent or not to stent: that is the question


Recently a Towson Maryland law firm filed medical malpractice cases against 8 physicians alleging inappropriate implantation of stents into the hearts of 39 patients. According to the case filings these procedures were performed at Saint Joseph’s Hospital, the same facility where cardiologist Dr. Mark Midei had similar accusations thrown his way. Since 2009 over two hundred claims have been filed for misuse of stents echoing the most recent filings. To add to the fray another law firm has now come forward with additional claims which are being processed as this article takes form. Collectively these three hundred cases have several elements in common, quasi science and hired guns to support the contentions of the filers. In an attempt to prove that the art of medicine is an exact science lawyers have gone to the extreme making representations of a very specious nature. Stenting is an inexact science. Decisions to stent are made by highly trained individuals who make determinations based on a complex set of variables. Food and Drug Administration (FDA) has approved stents for blockages greater than 70% of an arterial occlusion. Physicians unlike those who file legal cases for sport realize that heart attacks can occur without blockages, with partial arterial blockage or at the threshold established by the FDA. To accuse a physician of hyper-inflating the occlusion size to stent an artery borders on the absurd.


Reviewing dozens of studies concerning the appropriate use of stent technology, one notes major variations in their application throughout the United States. Patients presenting with chest pain who are found to have a coronary artery blockage of less than seventy percent are difficult prospects to treat based on current recommendations. At this point many factors converge in a physician’s mind to arrive at the appropriate decision for that specific patient. Many physicians will take the conservative route never stenting unless the FDA’s artificial numbers are realized. This style of practice may keep a physician outside the courtroom but end up expediting the demise of the patient.  Physicians who are more aggressive save lives but risk the hammer of a judicial system designed to destroy their careers. Three hundred patients each with a set of symptoms specific to themselves sought medical help when they felt their lives were threatened. Once cured, these former patients jumped on the proverbial bandwagon to assault those who managed their medical care hoping to cash in on the rush to judgment.  In fairness to these healers each and every case should be examined separately from the larger group. In the event that anyone or all of these legal filings are fraudulent the lawyer and the patient should both be held up for sanctions. Alternatively, if there is “solid evidence” that medical practice was inadequate a reasonable compensation should be allocated. Mark Davis, MD President of Healthnets Review Services.  

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