BUREAUCRATIC KNOW-ALLS HIT A ROCK

They leapt to judgment on the basis of statistics and now find that they haven't even got enough evidence to file charges. Are the Feds going to pay for the huge losses they caused? Not likely

The FBI's case against two prominent Redding physicians, suspected of performing hundreds of unnecessary heart procedures, appears to have stalled. Despite repeated rumors of impending criminal indictments against the doctors the past two years, no fraud charges have been filed by the U.S. attorney's office. The delay has frustrated lawyers whose own legal interests may be affected by the outcome of a federal case.

In late October 2003, the FBI dropped a bombshell on Northern California with its 80-page affidavit detailing the alleged operating room shenanigans of two of Redding's most revered doctors. Over the next 2 1/2 years, the allegations against cardiologist Chae Hyun Moon and cardiac surgeon Fidel Realyvasquez Jr. would divide the Shasta County community, garner national media attention, shutter a lucrative cardiac surgery program and result in more than $400 million in settlement payments for victims of the alleged wrongdoing.

A spokeswoman for the U.S. attorney's office in Sacramento did not respond to inquiries on the delay. But several observers suggested an investigating federal grand jury may be hampered by the complexity of the medical procedures in question and the range of opinion about what constitutes the accepted standard of care. "In today's world, you can find competing experts," said McGeorge School of Law professor Mike Vitiello. "It's difficult to make reasoned decisions about highly technical matters when expert opinions are in stark contrast to one another." Moon, for example, was known to forgo more conventional diagnostic tools, such as the treadmill stress test, to determine a patient's risk for heart attack. Instead, he often used the intravascular ultrasound, or IVUS, a costly and rarely used technology known to produce results only specially trained experts can decipher. Moon claimed the IVUS was superior to the less expensive approaches, but experts consulted early in the investigation said the surgeries Moon recommended based on his IVUS analyses were unnecessary.

According to the FBI affidavit, Realyvasquez and Moon performed excessive numbers of costly and invasive diagnostic procedures and heart surgeries compared with their counterparts in Northern California. Agents said Realyvasquez was ranked No. 1 on a Medicare list of 50 cardiologists paid in Northern California between July 2001 and July 2002. In that 12-month period he billed the federal government more than $3.5 million and was paid $767,600. For his part, Moon billed Medicare $3.9 million and was paid $1.6 million.

To convict the doctors of fraud, federal prosecutors would have to prove that Moon and Realyvasquez intended to deceive the government by knowingly performing unnecessary operations, then billing Medicaid or Medicare for their services. Proving medical malpractice is less complex and the stakes are lower, experts said. "The purpose of the criminal justice system is to take bad people who have done bad things and segregate them from society," said Vitiello. "If a doctor is careless, do we really want to hold over their head the risk of going to prison for that mistake?"

The civil cases against the doctors have moved more quickly. In January, Moon and three other Redding cardiologists settled with hundreds of patients for $24 million. Tenet Healthcare Corp., which owned Redding Medical Center, where the surgeries took place, paid $395 million to patients and $54 million to the federal government.

Realyvasquez and three other surgeons have refused to settle the civil cases, and a trial is scheduled to begin in September. "I have an absolute and firm belief that Doctor Realyvasquez only acted for the benefit of his patients," said Malcolm Segal, one of the surgeon's attorneys. Segal said he hopes the criminal matter is resolved before the civil trial starts in the fall. "It would be much easier to handle the civil litigation if the federal inquiry had concluded without any charges filed," he said.

The surgeon's ability to practice medicine remains tenuous. Although the Medical Board of California never filed a formal accusation against him, Realyvasquez has not practiced medicine since February 2003. "The allegations and the efforts refuting the statements made by others has consumed an enormous amount of his time," Segal said. "It has been extraordinarily expensive for him." Moon, who faces a formal board accusation, agreed to a temporary license suspension in June 2003, and it remains in effect pending the outcome of any criminal proceeding. His attorney did not return telephone calls.

Stephen Boreman, the deputy attorney general in charge of the medical board's case, said that while everyone involved would like to know how the U.S. attorney's office will proceed, he's confident the public is being well-served. "The public is protected because (the doctors) are not practicing medicine," he said. "I don't view this as anything negative for the people of California." [Since loss of highly skilled medical services to a community can only be detrimental, this is nothing more than prejudging the doctors as guilty]

Source




Bad medicine: "History is full of failed experiments in government control of the distribution of goods and services; some are still ongoing (Cuba). The results speak for themselves: wherever free trade and economic rights are stifled, shortages abound. We can even find examples of that here in the US: Nixon's attempts at price and wage controls as well as today's health care 'crisis' caused not by the private practice of medicine but by government's growing influence in this sector."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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