In December 2004, one of the busiest heart hospitals in the Tampa Bay area made a big splash when it suddenly suspended nine cardiologists — 40 percent of its staff — saying they were doing procedures "that were not always consistent with nationally accepted clinical guidelines."
Administrators at Regional Medical Center Bayonet Point in Hudson sent memos to staff and told reporters the doctors had performed unnecessary procedures, used the wrong stents to prop open clogged arteries and kept incomplete records. Corporate parent HCA even took out a two-page newspaper ad to address the personnel actions, usually a closely kept secret.
"Patient care and safety have always been the number one priority," the ad said.
Here's what HCA never mentioned: All nine doctors continued to perform complicated cardiac procedures at Bayonet Point without apparent added oversight.
Though they could no longer insert stents, they could do diagnostic catheterizations — a technically demanding procedure that involves threading a catheter through a vein in the patient's groin or arm into the heart. Two were even allowed to insert stents in peripheral arteries.
Dr. Sudhir Agarwal, one of the suspended doctors, said he was doing caths at Bayonet Point and at HCA's hospital in New Port Richey the day after his suspension. When the procedure showed the need for a stent, Agarwal said he simply asked another cardiologist to do the insertion. Agarwal said his instructions were never, to his knowledge, reviewed by administrators.
HCA declined to comment on the suspensions, which are the subject of a pending lawsuit by the doctors. But on Thursday, Agarwal, now 55, spoke publicly for the first time of the 2004 disciplinary action.
His motivation? A New York Times article Monday on unnecessary cardiac procedures at HCA that named Agarwal, making what had been a local embarrassment global news. On the same day, the hospital chain issued a news release saying the U.S. Attorney's Office in Miami launched an investigation last month into its cardiac services at 10 hospitals, primarily in Florida. None of the suspended doctors have been contacted by authorities, their lawyer said.
• • •
It has been nearly eight years since Agarwal's public humiliation at Bayonet Point, which he said came without warning after 11 years at the hospital.
By January 2006, his privileges had been fully reinstated after a panel of doctors, selected by hospital administrators, decided there were no grounds for the suspension. A separate panel of the state Board of Medicine also reviewed and dismissed the allegations. The other eight doctors also eventually had their privileges restored.
Drs. Rene Kunhardt, Gopal Chalavarya, Adel Eldin, Mahmoud Nimer, Dipak Parekh and Joseph Idicula currently have privileges at Bayonet Point, according to the hospital website. Dr. Charles Saniour moved to Lebanon, and Dr. Thomas Mathews took a position at HCA's Oak Hill Hospital in Brooksville.
Thursday evening, still wearing his blue scrubs after a day working in the Trinity HCA hospital, Agarwal sat in the nearby office he shares with his wife, an internist. He strongly denied ever doing any unnecessary procedures. He said it wasn't until months after the suspension that he saw the independent evaluator's report that supposedly triggered the punishment.
Though the New York Times said the report found as many as 43 percent of 355 angioplasty cases at the hospital were "outside reasonable and expected medical practice," Agarwal denied that conclusion was in the report. His lawyer, Anthony Leon of Tarpon Springs, declined to release the report, calling on HCA to do so.
Agarwal said he remained head of the catheterization lab at HCA's hospital in New Port Richey throughout the controversy and launched its stent program in 2008. On Thursday he saw a 54-year-old man who had a heart attack three weeks ago. Within a half-hour of his arrival at the hospital, Agarwal inserted two stents, saving his life, he said.
"After so many years of doing procedures again, I thought I'd shown what kind of doctor I am," he said. "But even after that, HCA is not giving clarification of what happened and letting the public know what the truth is."
Agarwal said the suspended doctors, all foreign-born or foreign-trained, were scapegoats, used by HCA to deflect attention from other issues. For years, Bayonet Point was identified for its high number of stents, ranking third in the state in 2003.
HCA was under scrutiny after paying more than $1.7 billion a few years earlier to settle Medicare fraud and overbilling claims. Through 2008, the company operated under a special Corporate Integrity Agreement with the U.S. Justice Department.
Agarwal said the suspended doctors were saving Medicare money because more stents meant fewer heart bypass surgeries. During the suspensions, the number of more costly bypass surgeries rose, he said.
In its response to the New York Times' story, HCA referred generally to overutilization of cardiac procedures saying, "variation and disagreement among physicians indicates the difficulty in determining the medical necessity of these procedures." HCA said the number of cardiac procedures have declined at its facilities over the past decade.
• • •
Agarwal's wife, Usha, recalled hearing a helicopter overhead when she first moved to Pasco County. It carried Dr. R. Vijay, the first physician to do a heart transplant in Florida. Vijay had been wooed by HCA from Tampa General Hospital to Bayonet Point to build its cardiac program. One bonus: transportation from Tampa in a helicopter.
"I thought I must have come to a pretty good place if they gave doctors — Indian doctors — a ride to work in a helicopter," she said Thursday.
But after Vijay sided with the suspended doctors, his own contract was terminated. He has also filed a lawsuit against HCA.
Agarwal said he will fight until his name is cleared. "Every day I have to live with it," he said. He and his wife come from a small village in India, and she said, "Where we come from, you can live poor, but you cannot live without respect."
Filling the wall next to Agarwal's desk is a portrait of the couple and their children in formal Indian dress. The son, now 27 and daughter, 24, both graduated from Harvard. Both once planned to become doctors.
Both chose business careers instead.
Kris Hundley can be reached at firstname.lastname@example.org or (727) 892-2996.