Qui Tam


“This is the best of times and the worst of times” for medicine since its very success has significantly and directly contributed to the unalterable attendant rise in the cost of health care a consequence of the logarithmic advancement of scientific, pharmaceutical and biomedical advances in the modern age.  There are other contributing and ancillary reasons why medical care now monopolizes 18-19% of GDP to include the unhealthy aspects of a diet manifested with many nutritional inadequacies and excesses and a sedentary lifestyle.  Irrespective of whether congress is able to pass any meaningful health care reform, we know that costs will continue to inexorably rise pushing more and more people into the precarious categories of either insurance with large deductibles and co-payments or no coverage.  It is not too sanguine to say that the survival of this country’s economic health depends on getting our fiscal house in order which requires prudent policies that curtail rising medical costs.  Many doctors practice their specialties not primarily motivated by the bottom line but know of physicians and hospitals who unfortunately make treatment recommendations that tend to predominantly favor more expensive procedures.  Dr. Atul Gawande wrote a brilliant article about health care in the border valley region of Texas.  It was titled, “The Cost Conundrum” and investigated the reason that McAllen and Edinburg are one of the most expensive health care markets in the United States.  What he found was gross unwarranted over utilization reflected in the stark comment of one cardiac surgeon that stated the area resembled a pig trough.

There are no easy answers to controlling health care costs.  But it is essential that any physician who recognizes or suspects that a systematic pattern of treatment has gained dominance primarily due to the rich rewards of doing more costly procedures when other less expensive but effective alternatives are available should be disturbed.  The partiality of a physician’s clinical acumen can be easily justified sometime under the weight of conflicting studies and opinions.  But no matter the motivation for supporting a more expensively invasive approach, a doctor can never completely absolve himself of the consequences of such a promotion.  Medical care operates under an umbrella of many competing treatment plans some controversial, and though physicians may favor one particular option, they still have an obligation to explain the various choices in a substantive and thorough manner.  This common situation has played out with Avandia.  There has been a continual conflict between various doctors and organizations to include the drug company about the increased possibility of a heart attack or heart failure after Dr. Steve Nissen of the Cleveland Clinic raised an alarm.  Many patients who took this drug and may have remained on it even after being informed about the potential risk would have wanted to know about the suspected complications.

One area that seems out of balance is the overuse of stents and angioplasty when treating cardiovascular disease.  Clearly, hospitals and cardiologists make more money by managing heart disease with a more aggressive interventional approach.  There are many patients who are not offered a purely medical option when the data strongly suggest that it would be as efficacious and therapeutic.  Why does this procedure dominated attitude prevail?  It would appear that sometimes there is an overt attempt to influence such actions by reinforcing the more flattering articles and studies.  Other times there is tacit approval since doctors who wish to discuss a more balanced agenda are hesitant to be overly critical in light of the hegemonic
power hospitals wield through their ability to use peer review in an illegitimate and biased manner.  It is better to go along and not make waves instead of confronting your colleagues or administrators.  As the Avandia controversy shows there is always room for opposing views and dissimilar perspectives to exist supported by volumes of incompatible literature.  The waters are further muddied by researchers who indicated that the use of medicated stents and angioplasty procedures days after a heart attack expose patients to substantial risks without providing any benefits.

If you witness a hospital, organization or medical group that is inordinately performing too many stents and angioplasties while unduly persuading you to not deviate from this scheme or intimidating you to not pursue any action to limit the frequency of these procedures then feel free to discuss it with an experienced Qui Tam attorney.  Unless dedicated doctors confront such egregious abuses, eventually there will be no choice but to institute draconian measures to control health care costs.  One only has to remember the flagrant situation at Tenet’s Redding Medical Center where hundreds of unnecessary angiograms and coronary bypass surgeries were performed under the grateful and watchful eye of the administration and aided by the failure of many doctors to raise any objections.