Edward Marshall, at his London, Ky. home on Feb. 8, 2013, became the first of nearly 400 people to sue a local hospital and 11 cardiologists, claiming they conspired to perform unnecessary, risky and often painful heart procedures to unjustly enrich themselves.(Photo: James Crisp, The (Louisville, Ky.) Courier-Journal)
Andrew Wolfson, The (Louisville, Ky.) Courier-Journal
LONDON, Ky. -- After enduring at least two-dozen heart procedures over two decades, disabled former meat cutter Edward Marshall decided in September 2010 that he'd been treated long enough by cardiologists at St. Joseph London hospital.
So he saw a specialist in Lexington, who told him some disturbing news: An artery treated just months earlier was barely blocked, and there had been no need for Dr. Sandesh "Sam" Patil to enlarge it with a balloon angioplasty, then prop it open with a stent.
"I would have not carried out this procedure," the Lexington cardiologist, Dr. Michael R. Jones, told Marshall in a letter that is included in the court record.
Marshall, 67, who lives in London, became the first of nearly 400 people to sue the London hospital and 11 cardiologists, including Patil, claiming they conspired to perform unnecessary, risky and often painful heart procedures to unjustly enrich themselves.
The suits, which also name the hospital's parent company, Catholic Health Initiatives, allege that two patients died and that the others will be required to take dangerous blood-thinning medications for life and are at risk of other potentially fatal complications.
The hospital and other physicians named as defendants deny the allegations.
"These were very sick people who needed the interventions, and got them," said the hospital's lead lawyer, Todd Thompson, who calls the conspiracy allegations "Alice in Wonderland stuff."
But records show the plaintiffs aren't the only ones who have Patil and the London hospital in their sights:
-- The U.S. attorney's office in Lexington is investigating the medical necessity of cardiac procedures performed there, and the financial relationship between the St. Joseph system and Patil's cardiology group, according to a disclosure in CHI's most recent annual report.
-- Patil is the subject of a federal criminal health care fraud investigation, his lawyer disclosed last month when Patil refused to answer 109 questions at a deposition in Marshall's suit, declining even to say whether he is a doctor.
-- The Kentucky Medical Licensure Board last month found that Patil provided substandard care to four of five patients whose records it examined, placing stents without justification in three of them.
Mirroring claims in the lawsuits, the board's consulting doctor found that Patil showed a "consistent inappropriate rush to invasive testing" in one patient and an "inexplicable plan" to place stents in an unobstructed artery in another. Still, the board allowed Patil to continue to practice, with monitoring and remedial education.
-- The Centers for Medicare and Medicaid in 2011 cited the hospital for failing to review the medical necessity of 3,367 cardiac catheterizations performed there the year before. In those procedures, a wire is inserted through an artery in the groin into the heart.
The citation said a doctor on the hospital's "quality assurance committee" had never reviewed any medical records regarding the procedures and that one patient had them annually -- 20 in all -- even though he had no symptoms of heart disease. The hospital agreed to take corrective measures.
-- In research conducted for his Kentucky Health Policy Institute blog, University of Louisville professor emeritus Peter Hasselbacher found that in 2008 and 2009, St. Joseph London did more angioplasties with stents than either of the state's two major teaching hospitals.
Hasselbacher, an internist, also found that after lawsuits were filed -- when St. Joseph London came under the spotlight -- the number of invasive procedures dropped by one-third, which he called "the most persuasive evidence that too many cardiac catheterizations with placement of stents might have been performed."
Barbara Mackovic, a spokeswoman for KentuckyOne Health, which operates the St. Joseph system and Jewish Hospital HealthCare Service for CHI, declined to comment on Hasselbacher's analysis, the citation from the Centers for Medicare and Medicaid, or the Kentucky Board of Medical Licensure findings.
She also declined to comment on the lawsuits, citing a corporate policy against discussing pending litigation.
In a statement, she said St. Joseph London hospital is cooperating with the U.S. attorney office's investigation. She also said Patil has not had privileges at the London hospital since December 2010 and has not practiced there since.
Neither Patil, who now works for Appalachian Regional Healthcare in Whitesburg, Ky., nor his lawyers, responded to requests for comment.
U.S. Attorney Kerry Harvey, citing Justice Department policy, said he could neither confirm nor deny that the hospital and Patil are under investigation.