Lawnwood Regional Medical Center investigated by Federal government

Possibly performing unnecessary heart procedures

FORT PIERCE — A former registered nurse at Lawnwood Regional Medical Center & Heart Institute said he witnessed a doctor there put an unneeded stent in about half a dozen patients.

The hospital and others in the parent HCA chain are being scrutinized by the Civil Division of the U.S. attorney's office in Miami regarding whether certain interventional cardiology services provided at 10 HCA hospitals were necessary, the company disclosed in a quarterly report filed Monday with the Securities and Exchange Commission.

Registered Nurse C.T. Tomlinson, 60, said he worked at Lawnwood for about eight months from the summer of 2007 to the summer of 2008. There, Tomlinson said he saw Dr. Abdul Shadani insert stents in patients who did not require them. Shadani could not be reached for comment. HCA spokeswoman Nicole Baxter directed comments to HCA's quarterly filing and the company's website.

Tomlinson, who now lives in Santa Clara, Calif., said he has worked in about 15 hospitals and witnessed a couple hundred doctors perform procedures without ever seeing something like what happened at Lawnwood. Tomlinson also said he watched other doctors at Lawnwood who did not put in stents that were not necessary.

"If you really don't need to put a stent in there, you really shouldn't because if you put it in there and you don't need to, you're causing coronary artery disease," Tomlinson said when reached by phone Tuesday. "You're not doing that artery good. You're doing it harm."

Tomlinson said he addressed the matter with his supervisor the day after witnessing Shadani insert a stent into a heart patient where Tomlinson said the heart patient did not have blockage. Tomlinson said the supervisor warned that Tomlinson should forget the matter. Tomlinson said a week later, he then met with the hospital's ethics officer. Less than a month later, Tomlinson's contract was up, and he was not renewed.

"I felt good about what I did," Tomlinson said. "I think I did the right thing."

An internal HCA memo concluded Tomlinson was retaliated against, according to a New York Times report published online late Monday.

HCA is the largest for-profit hospital chain in the nation and has 163 facilities, including Lawnwood. An internal investigation by HCA showed Tomlinson was correct, according to The New York Times report.

"The allegations related to unnecessary procedures in the cath lab are substantiated," according to a confidential memo written by Stephen Johnson, a company ethics officer, The New York Times reported.

The HCA quarterly report stated the U.S. attorney's office in Miami asked for information from the company in July about company reviews done to determine the medical necessity of certain procedures. The company has not completed its review, but thinks such reviews have taken place at about 10 of its hospitals, primarily in Florida.

"At this time, we cannot predict what effect, if any, the request or any resulting claims, including any potential claims under the federal False Claims Act, other statutes, regulations or laws, could have on the company," the filing states.

According to the HCA quarterly report, the company operates in a highly regulated and litigious industry and health care companies are subject to numerous investigations by various governmental agencies.

The U.S. attorney's office declined to comment.

HCA posted a message on its website in response to The New York Times article. The message provides data that the number of cardiac catheterization and percutaneous coronary interventions performed at HCA-affiliated hospitals have declined during the past decade and states there is a lot of debate regarding when to perform certain cardiac procedures.

"Thus, variation and disagreement among physicians indicates the difficulty in determining the medical necessity of these procedures," the message states.

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