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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."
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.
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."
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
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.
Copyright 2002 Los Angeles Times
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?"
Copyright 2002 Los Angeles Times