Sunday, October 18, 2015

A Small Indiana Town Scarred by a Trusted Doctor - The New York Times

MUNSTER, Ind. — On a spring evening last year, Debra Davidson flipped on the television to watch the local news. When an item came on about her longtime physician, she perked up and leaned forward. Then she screamed. Her husband rushed into the living room to see if everything was O.K.

Everything was not O.K. The report said that her cardiologist, Dr. Arvind Gandhi, had been sued by two former patients who accused him of performing unnecessary operations.

Mrs. Davidson had been treated by Dr. Gandhi for more than three decades. She first saw him for an irregular heartbeat when she was 27. For years, she took the medication he prescribed. When Dr. Gandhi said she needed open-heart surgery in 2011, she scheduled it immediately. When he subsequently inserted mesh stents three times to remove blockages from her arteries, she never questioned the procedures.

Only last year did she resist one of Dr. Gandhi's recommendations: to implant a pacemaker. Instead, he inserted a heart monitor under her skin but asked her to reconsider her resistance to a pacemaker.

Mrs. Davidson is now one of 293 patients around Munster, Ind., who have filed lawsuits against Dr. Gandhi and two other doctors in his practice claiming that they performed needless procedures.

The Indiana state Medicaid program has started an investigation, and one doctor not named in the litigation said he had received a subpoena from the United States attorney's office and provided the medical charts of several former patients of Dr. Gandhi and his colleagues that he has since treated. Lawyers for Dr. Gandhi and his practice, Cardiology Associates of Northwest Indiana, said they had not received any subpoenas, and the doctors denied any wrongdoing.

In recent years, federal officials have brought several prominent cases against cardiologists and hospitals, accusing them of performing unnecessary procedures like inserting stents into coronary arteries. While medical professionals say there is no indication that cardiology has more unnecessary procedures than, say, orthopedics, they do note that the specialty has come under increased scrutiny by regulators because the procedures tend to be reimbursed by Medicare and private insurance at significantly higher levels than those in many other specialties.

"Cardiology, whether we like it or not, is generally a big moneymaker for hospitals," said Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic and the former president of the American College of Cardiology. "We are still a fee-for-service system, and that creates, in my view, misaligned incentives among some physicians to do more procedures and among some institutions, particularly in areas where there is not tight medical supervision, to turn a blind eye and enjoy the high revenue stream."

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