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Two doctors who are under investigation for allegedly
performing unnecessary operations at Tenet Healthcare Corp.'s Redding Medical
Center got to keep their licenses Wednesday.
Shasta County Superior Court Judge Monica Marlow ruled that the California
Medical Board's evidence against cardiologist Chae Hyun Moon and heart surgeon
Fidel Realyvasquez was insufficient to stop them from practicing.
"She sent a message that these kinds of proceedings cannot and should not be
based on innuendo, hearsay and double hearsay," said William Warne, Moon's
lawyer.
Realyvasquez lawyer Robert H. Zimmerman said the board "fired a dud."
The board had sought temporary restraining orders in the wake of an FBI
investigation of the doctors' work, which burst into public view two weeks ago
after agents raided Redding Medical and carted away boxes of patient files.
The FBI is probing alleged Medicare fraud, but the Medical Board was seeking
the suspensions solely on public safety grounds.
"The judge didn't like the evidence we had," said Dave Thornton, the board's
chief of enforcement. "But based on the nature of the allegations, and the
potential for more operations that are unnecessary and put patients at risk,
we felt we had to move quickly."
He added that the board would continue its investigation. "We need to
reevaluate what we have and what more we need in order to get some kind of
interim restriction or suspension of these licenses."
The investigation has proved to be a big headache for Santa Barbara-based
Tenet, which also is having its Medicare billing practices audited by the
federal government. Neither the doctors nor Tenet has been charged with any
crime.
It is very rare for the Medical Board to seek either a temporary restraining
order or an interim suspension order, which is a similar proceeding. Only
three restraining orders and 23 suspension orders were granted during the
board's last fiscal year.
To make its case, the Medical Board used the 67-page FBI affidavit as well as
a declaration by Vincent Yap, chief of cardiology for Kaiser Permanente
Medical Group in Richmond.
"It is my strong professional opinion that neither Dr. Moon nor Dr.
Realyvasquez can safely practice medicine, and each poses a threat to
patients," Yap said, adding that both had committed "acts of dishonesty or
corruption."
But Moon's lawyer, Warne, said the affidavit relied on anonymous witnesses.
"We can only guess at what these witnesses would say if they had to swear
under oath to the 'facts' as they know them." He called Yap's declaration
"disingenuous" and "a house of cards" because, except for one patient file
that the doctor independently reviewed, he was basing all his conclusions on
the affidavit.
The judge's rejection of the affidavit means that it is likely to receive
widespread critical examination. Indeed, at least one of the claims in the
affidavit appeared to weaken under a minimal amount of scrutiny.
Moon is quoted as bragging to a reluctant heart patient that he had studied at
Stanford under Dr. Yak, an inventor of an intravascular ultrasound imaging
technique called IVUS. The patient then tells the nurse "that if Moon studied
under Yak," he wanted Yak to review his records.
"A short time later," the affidavit continues, "the nurse returned and said
that he had telephoned Stanford and that they had never heard of a Dr. Yak."
The patient asked the nurse to seek out Moon for clarification. Moon then
changed his statement, telling the nurse that "Yak was not a doctor but
instead was a technician." The patient, understandably, "felt as though Moon
had just lied to him."
The incident is cited as an example of what the FBI and the Medical Board
describe as the doctors' approach to patients. Moon and Realyvasquez "were
able to carry out their scheme by lying and/or misleading and in some cases
scaring patients," the board wrote in its court petition.
But there is a doctor at Stanford named Paul Yock, and he did invent IVUS.
Moon was a pioneer in the use of IVUS, and according to court papers took a
continuing legal education course at Stanford in it. Yock didn't return calls
for comment.
On Wednesday, neither of the doctors was present in court. Warne said that as
of early evening, he hadn't talked to his client. Moon "was busy treating
patients," the lawyer said. "We talked to his wife, who was elated."
Zimmerman said Realyvasquez was "obviously relieved." He noted that the
reaction to the judge's ruling from the doctors' supporters in the courtroom
"was a spontaneous roar of approval, like someone had just scored a touchdown
in the local high school football game."
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http://www.latimes.com/business/la-fi-moon11nov11.story
By David Streitfeld
Times Staff Writer
November 11 2002
REDDING -- Chae Hyun Moon might have wanted to be a doctor since he was a
little boy, but his staunchest supporters agree with his sharpest critics: He
missed the class on bedside manners.
"Oh, my Lord, he gives you a heart attack just talking to you," said Lee Cook.
The retired computer systems analyst still shudders at the memory of Moon
shouting at him not to hang onto the bar of the treadmill during a stress
test.
Clifford Baker, a Presbyterian missionary, recalls a 1996 hospital stay when
he was experiencing congestive heart failure. "You've got about three months
straight downhill," Moon told him. Out in the hallway, Moon advised Baker's
wife to make sure the will was in order.
So many patients, so little time for chitchat. In his 23 years as a
cardiologist here, Moon has worked on as many as 35,000 people. On some days,
he would perform 10 catheterizations, where a thin tube is inserted to open
clogged arteries or obtain diagnostic information. Another doctor would
consider it a full day's work to do three.
For a long time, Moon had the respect, if not love, of his patients at Redding
Medical Center. Twelve days ago, that image abruptly darkened when the FBI
filed an affidavit detailing an investigation of Moon and the center's
chairman of cardiac surgery, Fidel Realyvasquez. The affidavit outlines a
conspiracy to commit health-care fraud by allegedly billing Medicare for
unnecessary procedures. Forty agents raided the doctors' offices, carting away
boxes of patient records.
No charges have been filed, let alone proved. Yet the claim in the 67-page
affidavit that "there is reason to believe that many" Redding Medical patients
"have been victims of a scheme" involving "unnecessary invasive coronary
procedures" is shaking this city and causing ripples far beyond.
"This is a horror story, at best," said Gary Oxley, a nurse who works with
Moon and believes the allegations are untrue.
Moon, who has told colleagues that everything he did was in the best interests
of his patients, did not respond to requests for an interview at the hospital,
his office or house here. But conversations with colleagues and former and
current patients as well as a review of court documents describe an assertive,
often arrogant doctor, one who couldn't be bothered with pleasantries, hobbies
or critics. For better or worse, his patients have been his life.
A Slew of Lawsuits
For all the advances in technology, cardiac care can still be as much art as
science. Redding Medical was home to the best machines and receptive to the
latest ideas. To his admirers, and there are still many here, Moon saw further
and knew more. He prevented heart attacks, extending the life and health of
many patients.
The affidavit presents a far more chilling scenario, which is
that Moon violated the ancient medical oath to "first, do no harm." One case
briefly detailed by the FBI: A 59-year-old male received bypass surgery and,
four years later, is still too weak to work. A cardiologist who reviewed the
man's records for the FBI "found, at most, evidence of a relatively minor
problem," the affidavit says.
The investigation, which will take months, is roiling the owner of Redding
Medical Center, Santa Barbara-based Tenet Healthcare Corp.
Tenet, which owns 113 hospitals around the country, last week revealed a
federal audit of its Medicare billing practices. Between the Redding
investigation and the audit, Tenet's stock has declined by two-thirds, shaving
more than $15 billion off its market capitalization. Analysts have downgraded
the stock, saying Tenet's moneymaking ways are threatened.
In this former logging community turned vacation jump-off point, Moon is a
more personal matter. The Redding Medical Center draws patients from the
entire northern half of the state, and Moon is its star. Everyone, it seems,
knows someone who's been a patient or who works for the hospital. It's the
most dominant building downtown, except for the jail, and was going to get
even bigger. Before the events of the last two weeks, the 238-bed center was
to double in size.
In a search for more business, Redding Medical recently mailed out fliers that
showed a trim woman with a basketful of healthful groceries.
"After grocery shopping, a few errands and one load of laundry, a 42-year-old
woman collapsed of a heart attack," the flier warns. "And you thought heart
disease was just a man's problem."
The "lifestyle risk factors" listed are very broad, including "increasing
age."
Such an approach can save lives, but it's also ripe for abuse. When does
aggressive prevention cross over into unnecessary operations? It's a question
many of Moon's former patients are being forced to ask themselves. Some are
emerging with their faith intact. Some are uncertain what to think. And some
are filing lawsuits.
Lawyers are running ads in the local paper and on television, trolling for
victims. One local firm says it will file more than 100 suits all by itself.
High Self-Esteem
When Moon plays golf, he does it on Sunday morning. By 10 a.m., he's at the
hospital, still in his golf clothes, bragging about how well he played or
joking about a missed shot.
"He's a workaholic day and night--24/7, 365. He can be there in five minutes
at 3 in the morning," said Robert Hansen, an anesthesiologist. "I don't think
he knows how to take a vacation. If I were him, I would have burnt out a long
time ago."
Moon, 55, was born in Seoul, the son of an orthopedic surgeon and a volunteer
for the Korean Red Cross. He studied medicine at Yonsei University, one of the
preeminent schools in the country.
His goal was to be a surgeon like his father, he told the Redding Record
Searchlight in a lengthy interview in 1994, but back trouble made it
impossible to stay on his feet for hours at a time in the operating room.
After coming to the U.S. in 1972, he decided to specialize in heart disease,
the leading cause of death.
Moon trained in New York, moved to Cleveland and then made a rapid transit of
Orange County, working in seven hospitals in little over a year. In 1979, he
arrived in Redding, which he said reminded him of Korea: clear skies,
mountains, quiet.
He and his wife, Sun, raised two boys and a girl here, all now grown. Moon
contributed to the symphony and funded a high school science scholarship. But
mostly he worked.
His self-esteem never seems to have been low, but over the years it blossomed.
"How dare you get a second opinion," an "enraged" Moon is quoted in a
wrongful-death lawsuit filed Friday as saying to a 74-year-old patient with no
prior history of heart disease. "I built this heart program!"
Moon also has clashed with the other hospital in town, Mercy Medical, suing it
in December 1997 for violating federal anti-trust statutes. In September 1999
the suit was dismissed, but Moon continued to rag on the competition a few
blocks away.
"Those boys at Mercy don't even know" what the latest heart technology is, he
is quoted telling one patient in the FBI affidavit. "They have an 8% mortality
rate; we have 2%."
Mercy declines to talk about Moon, issuing a blanket statement: "We have no
information to offer, and feel it would be inappropriate to comment." The
statement adds that Mercy did not request the FBI investigation, which many of
Moon's supporters claim.
"He has a terrible, terrible personality," said Betty Cook, who now believes
that Moon's insertion of a stent to widen her husband Lee's artery was
unnecessary. "He doesn't talk like you and I are talking. He shouts and yells
and demands."
Yet Cook also remembers approaching Moon after the operation and saying, "I'm
sure happy we have a cardiologist like you in Redding. It makes us feel
better, to know we're in good hands."
And Moon, not gruff for once, said, "That means the world to me to hear you
say that. You've made my day."
The brusqueness has cultural roots, one nurse said. The American tradition of
analyzing everything, making sure the patient is comfortable, isn't
necessarily the way medicine is practiced overseas.
So too with Moon's worst habit, smoking. He didn't try to hide it, and even
laughed about it. "Koreans," he would say, "don't get heart disease."
Former Patients
Some former patients, even now, have a benign view of Moon.
"We hope he gets vindicated," said 67-year-old Ruben Martinez, a print-shop
owner who lives in nearby Weaverville. Two years ago, Martinez had chest
pains. His doctor checked him out and was worried enough to helicopter the
patient 40 miles to Redding Medical.
"They were doing the work-up on me when I started having pains. Dr. Moon
walked in. He wasn't even supposed to be there that day. He came in and said,
'This man is having a heart attack,' " Martinez said. "I was lucky he wasn't
out buying shoes like he intended to do that day."
The FBI affidavit speculates that at least half of Redding Medical's patients
really did need surgery, and another quarter fell into a gray area of having a
minor amount of heart disease. As for the rest, "there existed no indication
of any heart disease that would warrant surgical intervention of any kind."
That means thousands of patients are wondering about their own cases. One of
them is Larry Clifford, an electrical engineer who saw Moon because of his
tendency to fall asleep at odd times.
"I felt I was in good hands," Clifford said. "He was very arrogant, always
saying, 'I'm the best.' He said he was one of the best cardiologists in the
United States. He had a pretty bad beside manner, but that was OK. Zing-zing
and he's gone."
Clifford ended up having a five-way bypass. "When I was leaving there, they
convinced me I was a ... lucky person that they happened to find this. And
maybe that's the case. But I don't know."
No one is likely to be sure for months, if not years, if ever.
"I believe in innocent until proven guilty," said Terry Zeller, a nurse who
has worked with Moon. "But he'll never be completely exonerated from this in
the court of public opinion. There will always be a question."
A Good Life
If Moon, as his supporters assert, was good for Redding, Redding was also good
to Moon. He and Sun, a sculptor, live on the far outskirts of town. White
pillars and a black gate, decorated with two "private property" signs, keep
the unwanted world at bay.
"No comment, please," a woman says over the intercom. 'You can contact our
lawyers." The lawyer, John Reese Jr., didn't return calls.
The driveway winds up the hill and out of sight. According to tax records, the
unseen house was built in 1991 and has 6,180 square feet. Its assessed value
is $835,756. A neighbor -- he lives practically next door but has never met
the doctor -- says Moon built a painting studio in the back.
Moon's abstract canvases are the most unusual thing about him, colleagues say;
such a contemplative activity doesn't seem to fit in with his type-A
personality. But Moon's interest in art is long-held. His sister, his
parents-in-law and other relatives are artists. He recently sponsored an art
show here, one friend said.
Since the raid, Moon has been trying to carry on. Baker, the Presbyterian
missionary who was given a death sentence by Moon six years ago, had an
appointment last Wednesday. "The office was jammed," he reports.
Baker was getting his pacemaker tested. Unexpectedly, Moon came in.
"It's a rotten thing," Baker said to him.
Moon replied he was being "crucified" in the Redding paper. He said he'd heard
there had been close to a thousand letters in his support sent to the editor,
but none had been published.
Tom King, editor of the Record Searchlight, said the paper has received about
"20 or 30" letters, a few signed by multiple people, in support of the
doctors. He added that the paper has received an equal number of letters
detailing unverified allegations against them. None of the letters from either
group has been published.
The faithful have had no trouble making their feelings known on an immense
banner outside the hospital's catheter lab.
"We Support Our Doctors," it proclaims. By Saturday, there was no space left
to add comments. Some were grammatically suspect, but the meaning was always
clear. "Dr. Moon your great." "Thank you for saving the life of my
father-in-law and my wife." "Your #1." "Keep the faith. This too shall pass."
"I trust you. You saved me."
When Moon first saw it, one witness said, he broke down in tears, sobbing
uncontrollably, saying he couldn't believe what was happening. Two colleagues
had to hold him.
The state medical board has petitioned for a temporary restraining order to
stop Moon and Realyvasquez from practicing.
As part of the petition, there was a declaration from Vincent Yap, chief of
cardiology at Kaiser Richmond Medical Center. "It is my strong professional
opinion that neither Dr. Moon nor Dr. Realyvasquez can safely practice
medicine, and each poses a threat to patients," he wrote.
A hearing is scheduled for Tuesday.
'He has a terrible, terrible personality .... He shouts and yells and
demands.'
Betty Cook, who now believes that Moon's insertion of a stent to widen her
husband Lee's artery was unnecessary
|
Copyright 2002 Los Angeles Times |
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http://www.latimes.com/news/opinion/editorials/la-ed-tenet9nov09.story
November 9 2002
Patients want to trust their
doctors. Few demand a second opinion, even if they ought to, when a specialist
says a surgical procedure is necessary to head off an imminent heart attack.
That's what adds such a chill to the stories out of Northern California about
cardiologists being investigated for performing risky but possibly unnecessary
heart procedures that effectively bolstered their paychecks. So do the
questions about whether hospital administrators could have turned a blind eye
to possible medical wrongdoing in the name of profits.
The FBI, which is conducting an investigation, has filed no charges against
the doctors, Chae H. Moon and Fidel Realyvasquez Jr. Their employers, Redding
Medical Center and its parent, Santa-Barbara-based Tenet Healthcare, have not
been named targets of investigation. But it's the sort of tale that resonates
with patients because of the intense cost and profit pressures on managed-care
companies.
The investigation into the coronary-care unit and Medicare payments it
generates for the Redding hospital is just part of the story. Red flags
appeared late in October after a Wall Street health-care analyst questioned
the overall heavy reliance on Medicare payments at Tenet, one of the nation's
largest hospital companies.
The federal Department of Health and Human Services then said it would audit
Tenet's receipt nationwide of special Medicare payments that are designed to
help hospitals defray financial losses from difficult and invasive procedures.
Worried investors quickly fled, Tenet's share price took an abrupt nose dive
and the company's chief operating and chief financial officers unexpectedly
resigned.
Patients can't help worrying about collisions between medicine and profit,
because their very lives are at stake.
It's bad enough to think of doctors performing unnecessary procedures for
their own gain. It's even worse if the push for profits could combine with a
poorly designed and badly monitored Medicare payment program to create an
environment that encourages fraud or gaming the system.
Medicare administrators, state regulators and law enforcement have to find out
quickly what, if anything, went wrong at Tenet. They also should analyze
similar payments to other companies and, if necessary, tighten oversight.
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Copyright 2002 Los Angeles Times |
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http://www.latimes.com/business/la-fi-hag6nov06,0,2787973.story
By Rick Wartzman
Times Staff Writer
November 6 2002
Country music legend Merle
Haggard knows a thing or two about cheatin' hearts. Cheating on heart
surgeries, however, is a whole different matter.
The 65-year-old recording artist, who is currently on tour, came home to
Redding the other day to find the town in an uproar over allegations that a
couple of doctors at the local medical center may have been pushing patients
to undergo heart surgeries they haven't really needed. Haggard, it turns out,
had a pair of heart stents put in by one of the doctors, Chae Moon, about five
years ago.
Now, Haggard said, he's convinced that the fear he has long harbored in the
back of his mind is completely warranted. "I suspected when it was done to me
that I didn't need" an operation, he said. "There's a very good chance I may
be a prime example of what Dr. Moon did. The whole thing has made me mad. I'm
just waiting here for the FBI to contact me."
The FBI raided Redding Medical Center, which is owned by Tenet Healthcare
Corp., last week. Agents also searched Moon's offices, as well as those of his
colleague, Dr. Fidel Realyvasquez. No one has been charged.
Moon didn't return a phone call Tuesday seeking comment. Neither did his
lawyer. A Tenet spokesman said that whether Haggard's surgery was proper is "a
question for Dr. Moon to answer.... We have limited ability to judge medical
necessity. That's not a question for us."
Haggard -- whose hits include "I'm Gonna Break Every Heart I Can" -- said that
in 1995, he had an angioplasty procedure performed in Nashville to help pry
open his clogged arteries. Afterward, he felt terrific and was given a clean
bill of health. "They told me everything looked good," Haggard recalled.
So it was surprising, he said, when he went to Redding Medical Center in the
summer of 1997 for a checkup and was told by Moon that his heart was failing.
Moon recommended that he immediately operate on Haggard to put in stents,
small tubes that are inserted in heart valves or arteries to keep them from
collapsing. Haggard said he had emergency surgery that same day -- but always
had doubts about whether the operation was truly necessary.
"It just didn't hit me right," said Haggard, who moved to a ranch just outside
Redding from his native Bakersfield in the late 1970s.
He said his misgivings were heightened when the drummer in his band, the
Strangers, also checked into Redding Medical Center about three years ago.
Biff Adam was back from the road, feeling a little weak and complaining of
some chest pain, when he went to see Moon.
After some tests, Adam remembered in an interview Monday, the doctor delivered
the bad news: The left muscle in his heart was badly damaged. Moon "went up to
my wife and said, 'Your husband needs a heart transplant,' " Adam recounted.
"She almost passed out."
Adam said his family doctor in Redding, Morris Ballard, suggested that he get
a second opinion. He did, from Dr. Robert Pick, who wound up treating Adam not
with surgery but with a drug called Coreg, which lowers blood pressure. "That
straightened me out," Adam said. "I didn't need a heart transplant -- that's
for damn sure."
Both Pick and Ballard were traveling Tuesday and couldn't be reached.
Haggard's '97 surgery wasn't his only experience with Moon. On another
occasion, he said, he took a treadmill test at Redding Medical Center, after
which Moon informed him that he needed to be put on a blood-thinning
medication. Haggard said Moon also made clear that "I'd be a candidate for
open-heart surgery in five years."
That time, Haggard said he ignored Moon's advice, declining to take the
medication. He doesn't figure he'll be going in for any more heart surgery,
either -- at least not with Moon.
"You have to wonder," said Haggard, "did he tell me the truth at any time?"
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Copyright 2002 Los Angeles Times |
This is the Karl Loren Happiness On Line Web Site Karl Promises To Answer Any Personal Message, Personally.
Medical Board fails to win the suspension of two heart physicians at a
Tenet Healthcare facility.