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A Florida nurse's complaint has led to a federal probe of potentially unnecessary cardiac procedures at HCA Holdings, the largest for-profit hospital chain in the U.S., according to news reports.
At Lawnwood Regional Medical Center in Fort Pierce, Fla., for example, about 1,200 cardiac catheterizations were deemed to be unnecessary, according to a report in the New York Times.
The nurse, who alerted hospital officials in 2008 and then again in 2010 about unnecessary diagnostic caths and percutaneous coronary interventions, was employed by Lawnwood, but was subsequently fired after he made the first allegations, according to the Times.
The paper also reported there were incidences of injury and near death caused by complications during cardiac procedures performed on patients without significant heart disease.
During a conference call with investors on Monday, HCA said that the civil division of the U.S. attorney's office in Miami is investigating the allegations of unnecessary cardiac procedures.
The federal review will include billing and medical records from 95 HCA hospitals, as well as an inquiry into charges associated with implantable cardioverter defibrillators, the Associated Press reported.
HCA also posted an unsigned letter on its website in anticipation of the New York Times article.
The letter, which was not addressed to anyone, said there are regional variations and even variations within "the same medical staff" regarding the decision to perform minimally invasive diagnostic and interventional cardiac procedures -- and that even outside experts disagree when they review hospital data.
In the letter, HCA said that its volume of diagnostic and interventional cath procedures is in line with the national average, and that the number of these procedures has, in fact, declined over the last decade. The letter contained four graphs to illustrate this last point.
HCA also stressed in the letter that "more than 90% of HCA hospitals are in the top quartile nationally on Core Measures, and more than 80% are in the top 10%."
The Times reported that some of the doctors who performed the procedures in question are still practicing at HCA hospitals. In addition, the Times suggested that HCA was more concerned with its bottom line than with patient safety, citing a Justice Department action against the chain for fraudulent Medicare billing.
HCA had settled that action in 2000 to the tune of $1.7 billion, and signing a Corporate Integrity Agreement that was valid through 2008, according to the Times.
In 2003, HCA suspended the privileges to perform certain cardiac procedures of eight physicians at one Florida hospital because of questions of their medical necessity. Physicians at another Florida HCA hospital, scrutinized around the same time, were found to have performed many unnecessary stenting procedures. Again, the physicians were disciplined and suspended from performing certain procedures.
The privileges of some of these physicians were later reinstated after other reviews indicated they acted within established medical practice, the Times reported.
However, the most recent complaint has not only resulted in a federal probe, but also in HCA extending its review to other Florida hospitals where it found questionable cardiac practices, according to the Times.
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