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Scrutiny of cardiac care at Pasco HCA hospital latest in long saga

Published Aug. 8, 2012

HUDSON — A Pasco County hospital that touts its heart care is getting national attention for the work of its cardiologists — though not the kind it might want.

On Monday, the New York Times reported that Regional Medical Center Bayonet Point is one of 10 Florida hospitals in the HCA chain that is under scrutiny for possibly performing unnecessary cardiac procedures.

But at Bayonet Point, where the procedures in question happened back in 2003, this is only the latest twist in a saga that covers years of lawsuits and newspaper headlines, and is nowhere near its conclusion.

After HCA leaders grew concerned at the large number of cardiac stenting procedures at Bayonet Point, the hospital suspended nine doctors in 2004 — more than a third of its cardiac staff.

Today, seven of them have privileges at Bayonet Point, and all nine have sued HCA for defamation.

And a prominent physician who pioneered heart transplantation in Tampa Bay has also sued, saying the hospital revoked his privileges after he supported his colleagues.

The doctors could not be reached for comment Tuesday, but one of their attorneys said they are still "devastated'' by their 2004 suspensions.

"These doctors, prior to the allegations, were pillars in the medical community," Anthony Leon said. "They suffer daily because you can never take away the stigma that was placed on them by HCA and Bayonet Point Hospital."

Hospital officials declined to comment.

• • •

With 290 beds, Bayonet Point is Pasco County's largest hospital. Its Heart Institute, founded in 1989, has won accolades from the American Heart Association.

Questions about surgeries arose in late 2003, when officials at HCA's Nashville headquarters thought Bayonet Point doctors seemed to be inserting lots of cardiac stents, a device threaded through a catheter into the artery to open clogs.

The value of stents has been debated for years. They are less invasive than heart bypass surgery, but studies have also shown that for many patients, medication, along with healthy diet and exercise, can alleviate clogging effectively.

HCA officials worried that Bayonet Point doctors were inserting unnecessary stents, an allegation the Tampa Bay Times reported in 2004 when the suspensions were announced.

According to the New York Times' report this week, a consultant hired by HCA studied medical charts in 2004 and reported that 43 percent of the hospital's stent insertions were "outside reasonable and expected medical practice.''

That was worrisome because four years earlier, HCA had accepted a $1.7 billion fine from the government to avoid formal charges of Medicare fraud that stemmed from the time Rick Scott, now governor of Florida, led the company. Any further hint of wrongdoing could cost the company dearly.

HCA has never publicly released the 2004 consultant study, but Bayonet Point quickly revoked the nine doctor's hospital privileges.

Then things turned uglier.

• • •

In 2006, the doctors sued alleging that the hospital defamed their characters, cost them income and never gave them a peer review hearing with a chance to answer the allegations, as state law requires.

The suit, which the doctors hope goes to trial next year, suggests that — far from concern over the cost of stents — Bayonet Point was upset that stents were replacing more expensive bypass surgeries. The doctors also alleged in a federal suit that Bayonet Point singled them out because of their race. Six are of Indian descent, three are Arabs and one is Hispanic. They have dropped that suit.

Stent numbers at Bayonet Point were high compared with other hospitals, but "these cardiologists practice in a high elderly populations with a high need for medical intervention,'' said Palm Harbor lawyer Wil Florin, who represents seven of the doctors in their defamation suits.

None of the doctors has been disciplined by state health officials, though records indicate that one of them, Dr. Rene Kunhardt of Hudson, settled a malpractice suit for $250,000 after a patient died during a 2004 stent insertion at Bayonet Point.

Two years after the doctors' suspensions, a hospital peer review showed that they all conformed to acceptable standards of care, Leon said.

Kunhardt, as well as Drs. Sudhir Agarwal, Gopal Chalavarya, Adel Eldin, Mahmoud Nimer, Dipak Parekh and Joseph Idicula still 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, Leon said.

The controversy over stents also involved Dr. R. Vijay, who has chaired the Florida Board of Medicine and performed the first heart transplant at Tampa General Hospital. He was director of Bayonet Point's Heart Institute when the 2004 consultant study was completed. According to his lawsuit against HCA and Bayonet Point, he disagreed with the suspensions and said so.

In April 2005, HCA removed him as the Heart Institute's director. His suit alleges that the consultant study had determined that three of his stents were unnecessary, but a corporate official told him that the finding "would never see the light of day'' if he resigned from the Bayonet Point staff. So he did.

The New York Times reported that the Justice Department is looking into HCA's practices. A primary focus is surgeries at South Florida hospitals, some performed as recently as 2008. The story quotes liberally from the 2004 consultant study and internal HCA documents.

The Bayonet Point doctors are still trying to get a copy of that study and have asked a Pinellas Circuit Court judge to order HCA to release it, Florin said. The doctors have never seen details of the allegations against them, he said.

Times staff writer Letitia Stein contributed to this report, which contains information from the New York Times and Associated Press.

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