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Unhealthy Diagnosis
July 27, 2003
FBI agents carry boxes of evidence stemming from an investigation at the
Redding Medical Center, which is owned by the Tenet Healthcare Corporation.
(Photo: AP)
“I feel violated. I feel like a gutted trout almost, from the incision that
was made down my chest ... They cut me in half.â€
Redding Medical Center patient Tom Mitchell.
Dr. Chae Hyun Moon has performed more than 30,000 angiograms and ultrasounds at
Redding Medical Center. (Photo: CBS/60 Minutes)
Jay Bradley, 35, started having chest pains and went to see Moon, who told him
the diagnosis was grim. (Photo: CBS/60 Minutes)
(CBS) With 114 hospitals and $14 billion in yearly revenue, Tenet Health
Systems is this country's second largest healthcare company.
It is also one of the most profitable, having built much of its business on
critical care centers which specialize in expensive high-risk procedures, such
as heart surgery.
But, as Correspondent Ed Bradley first reported in February, Tenet is now
facing allegations that it made some of its profits from overbilling, false
diagnoses, and - in at least one hospital - major surgery performed on patients
who don't need it.
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One of Tenet's most profitable hospitals is Redding Medical Center, located in
the shadow of Mount Shasta in Redding, Calif., a quiet town surrounded by
farmland.
Since 1989, much of that profit has been generated by the hospital's director
of cardiology, Dr. Chae Hyun Moon, who has performed more than 30,000
angiograms and ultrasounds - procedures in which a tube is threaded through a
patient's heart to look for clogged arteries.
Based on those tests, he has sent thousands of patients for coronary bypass
operations. One patient was Jay Bradley, a 35-year-old father of three. Two
years ago, Bradley started having chest pains and went to see Moon. The
diagnosis was grim.
"He put the monitor in front of my face, showed me a little artery on there and
said, 'Well, this is clogged, and this one's the top front of your heart and
there's zero chance of survival.'"
Bradley was checked into the hospital right away, and told he could be called
into the operating room at any minute. But then, something even more alarming
happened.
He says a nurse came in and under her breath said, "Get out!" As Bradley
remembers, the nurse continued and said, "I can get fired for saying this, but
I don't think you need the surgery."
Bradley says she then took another doctor to the ward, who came in with his
head down and told him: "I don't really think you need this. Maybe you should
leave here and go to a big city somewhere."
"At this point, I am going crazy here," says Bradley. "Who's right, who's wrong
here? I went home."
The next day, he had more chest pains and went across town to Redding's only
other hospital, Mercy Medical Center, where he got yet another surprise.
"They called in a cardiologist who looked at my films and my records. He came
up and told me that there was nothing wrong with me at all," says Bradley, who
discovered that he was the third patient in the week who had come in from
Redding Medical Center and had narrowly escaped having bypass surgery.
"We can't find anything wrong with them," Bradley recalled the doctor saying.
After running tests of their own, doctors from Mercy Medical Center finally
diagnosed Bradley with just an irritated nerve or muscle. His chest pain soon
ended and has never happened since.
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But 61-year-old Tom Mitchell wasn't as lucky. Last July, he was at Redding
Medical Center, recovering from an emergency appendectomy when a nurse told him
that they were going to check his heart. The very next person he saw was Moon,
standing at his bedside and telling him he wanted to do an angiogram.
At the time, Mitchell wasn’t even having pains in the chest and had never
suspected that he might be having a heart problem. But he was soon alarmed by
what Moon told him: “He said, ‘See that hanging down right there?’ He
said, 'That's a widow maker.' And he said, 'That could slough off and you would
have a heart attack immediately.'"
"He said, ‘You are here. So why don't we take care of it,’†says
Mitchell, who admits that the pain medication affected his judgment. “I
really was in no shape to reason anything through such as bypass surgery. I was
really sick.â€
Within 24 hours, and only three days after his appendectomy, doctors at Redding
Medical Center were operating on Mitchell’s heart.
But when 60 Minutes presented the same medical records - along with the film
Moon took of his heart - to a group of 11 cardiac specialists, all of them
agreed that Mitchell shouldn’t have had an angiogram, let alone surgery.
Even worse, Mitchell found out later that most coronary bypasses last less than
ten years, which means he may have to have a second heart surgery.
“I feel violated. I feel like a gutted trout almost, from the incision that
was made down my chest,†says Mitchell. “It goes from my Adam's apple to
the bottom of my sternum, completely. They cut me in half.â€
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Kim Schlenker, a critical care nurse who lived in Redding until 1999, says she
has seen a number of cases like Tom Mitchell’s. She remembers working with
other cardiologists when they examined Moon's former patients, and recalls
doctors saying, "My God, they bypassed normal coronaries!â€
"Many complaints were made," says Schlenker. "Letters were written."
At Redding Medical Center, at least one doctor has told federal authorities
that he repeatedly warned Tenet’s administrators there about doing “heart
procedures ... that may not have been medically necessary.â€
Other cardiologists in Redding have also told authorities they spoke to
Tenet’s administrators about “unnecessary heart procedures and surgeriesâ€
being performed there. And in 1999, doctors at another hospital alerted Redding
Medical Center of their “concern ... that Dr. Moon is unsafe,†after
several nurses, including Schlenker, had complained about him.
“I thought he was a dangerous man and that he doesn't regard the lives of the
patients he is working on,†Schlenker says she wrote in her letter.
But Tenet’s administrators in Redding not only ignored the warnings about
Moon, they built their heart center around his practice — making him director
of cardiology, featuring him in their ads and flying him to outlying clinics so
he could see even more patients.
By 2001, Moon was doing about five times the number of angiograms performed by
most cardiologists. He made Tenet millions of dollars a year, billing $20,000
or more for each procedure.
But it wasn't a doctor or a nurse who finally did something about what was
going on at Redding Medical Center. It was a priest, Father John Corapi.
Last June, after Moon informed Corapi that he had a fatal heart condition and
needed bypass surgery, he went to a lawyer to prepare a will. He went to
confession and then he went to another hospital where he had close friends for
the surgery.
“The cardiologist said, ‘Excuse me, but what are we bypassing? You're
bypassing something when you do a bypass surgery,’" recalls Corapi. "He said,
'I don’t see anything.’â€
After a series of tests showed that his heart was normal, Corapi called a
meeting with Tenet’s administrators at Redding Medical Center. He asked them
to investigate the case and said “there is something that’s not quite
right.†But the hospital refused. Instead, they told Corapi that he was in a
life-threatening situation and that they concurred with Moon's recommendations.
Tenet’s administrators also assured him that another anonymous cardiologist
had also confirmed Moon's opinion. Meanwhile, Corapi consulted seven other
cardiac specialists, who agreed his heart was healthy.
He then called the Redding Medical Center one last time. “It just sticks out
in my memory,†says Corapi. “Hal Chilton, the CEO, said over the phone,
‘We like our position. Seek counsel if you like.’â€
Father Corapi did more than seek counsel. He called the FBI, who eventually
sent more than 40 agents to raid Redding Medical Center, Moon’s office and
the office of the hospital’s director of cardiac surgery. They confiscated
thousands of files, including those of at least 167 patients who died after
surgery ordered by Moon.
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The news of the raid could not have come at a worse time for Tenet Health
Systems. All around the country, a number of Tenet hospitals have recently been
subjects of federal actions - from patient endangerment in Florida to evidence
of illegal kickbacks to physicians in California. Even government officials in
Washington, D.C., have recently filed a lawsuit against Tenet, claiming the
company has systematically defrauded taxpayers.
The company’s executives sent 60 Minutes a letter stating in part: “We
expect to demonstrate in the weeks and months ahead that our internal systems
and processes work effectively whenever we became aware of anything that fails
to meet the law or our own high standards.â€
Concerning Dr. Moon and Redding’s Chief of Cardiac Surgery, who are both
under investigation by the FBI and had declined a request from 60 Minutes for
an interview, they wrote: “We were as surprised as everyone by this
investigation. The two doctors have practiced in the Redding area for decades
and their reputation for providing good care, so far as we know, was impeccable
until last October.â€
But for some, who have been in the health care business for years, Tenet’s
arguments are very hard to believe.
“When they are running ads for this person, when they have documented charges
by people who have called his practice to their attention, time and time again,
when their own nurses were complaining, when other physicians were complaining,
it is pretty hard for somebody to say, ‘Gee, I didn’t know,’†says Rep.
Pete Stark, a 30-year veteran on health care issues.
The California Democrat has followed Tenet since 1994, when the company paid an
unprecedented $379 million to settle fraud claims brought by 28 states and the
federal government. Tenet also pled guilty to charges of criminal conspiracy
and giving illegal kickbacks to physicians.
“You have people who are willing to break the law and have a record of doing
that. These guys are the poster children for unethical business practices,â€
says Stark.
But Tenet executives have said that the doctors under investigation had only
what they called a "a loose connection" with the hospital’s administrators
and doctors.
“That seems to me to be an outright lie. They were providing clerical and
medical assistance to Dr. Moon at no cost,†says Stark.
"They could suspend his privileges and not make him chief of cardiology."
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Since 60 Minutes first aired this story in February, Dr. Moon has lost his
malpractice insurance and stopped practicing.
In addition, lawsuits have been filed against Tenet, Redding Medical Center,
Dr. Moon and several of the hospital’s cardiac surgeons. The federal
government has also expanded its investigations of Tenet Healthcare Corporation
nationwide, and the company’s chief executive officer, Jeffrey Barbakow, has
resigned.