A True Story of Medicine Gone Awry
By Stephen Klaidman
Scribner; 303pp; $25
The Good A gripping medical mystery--and a shocking tale of corporate greed.
The Bad Unfortunately, the end of the story is a bit of a letdown.
The Bottom Line Casts a beacon on the all-too-frequent association of medicine and the pursuit of profit.
In 2002 a Catholic priest named John Corapi had his heart checked out by Dr. Chae Hyun Moon. The celebrated cardiologist, who practiced at a Redding (Calif.) hospital owned by giant for-profit Tenet Healthcare Corp. (THC ), responded to Corapi's symptoms of exhaustion and shortness of breath with five of the scariest words in the English language: "You need a triple bypass."
Thus begins the tale of the priest, the doctor, and the multibillion-dollar hospital chain, recounted in penetrating detail in Coronary: A True Story of Medicine Gone Awry. Fortunately, as author Stephen Klaidman reports, Corapi then got opinions from three other doctors, all of whom said no surgery was needed since his arteries were completely healthy. The priest went to the FBI. An ensuing investigation and a raft of civil lawsuits turned up more than 600 patients who were allegedly subjected to unnecessary heart procedures by Moon and a colleague, Dr. Fidel Realyvasquez. The scandal, along with simultaneous revelations that Tenet may have improperly billed Medicare by as much as $760 million a year, brought what was the nation's second-largest hospital chain to its knees. And it provided forceful evidence that the drive for profits can put patients in mortal danger.
Klaidman, an ex-reporter at The New York Times and The Washington Post and a former health-policy researcher, deftly intertwines elements of a medical mystery story with disturbing details about corporate greed. So profit-focused was Tenet, Klaidman discovered, that it required each hospital CFO to submit monthly reports on individual doctors' contributions to the bottom line. Redding Medical Center (RMC), home base to Moon and Realyvasquez, was a cash cow, generating $3,181 in revenue per patient per day, or twice Tenet's average. What's more, in 2002 its pretax income soared 31%, to $93.6 million. Drawing on medical records, depositions, FBI files, and interviews, Klaidman brings this culture to life, offering vivid dialogue and scene-setting.
A novelist would be hard-pressed to invent more outsize characters. Colleagues and other doctors portray Moon and Realyvasquez as egomaniacs who battled with each other and didn't win many friends among their patients, either. Realyvasquez was so foul-mouthed that RMC's CEO felt compelled to report him to Tenet's top brass. And more than once, a nurse recalled, Moon rattled his terrified patients by remarking: "I'm going to save your life. This is your lucky day." Then there's the whistleblowing priest, whose story provides one of the book's most fascinating chapters. A former accountant and real estate broker, Corapi got caught up in the Los Angeles drug scene in the 1970s, even attending the party where comedian John Belushi was on the night he died. Homeless and strung out on cocaine, Corapi decided to turn his life around and entered the priesthood at age 37.
Equally compelling are Klaidman's stories of patients who weren't so lucky. There was the ex-railroad worker who had lost part of one leg in a boxcar accident and had to have a vein taken from his good leg for a quadruple bypass. Then there was the grandmother who suffered debilitating strokes after her heart surgery. Later, physicians hired by a personal-injury lawyer determined that both patients' procedures were unnecessary.
In the midst of such gripping drama, Klaidman never forgets that, at its core, this is a tale of a company that seems to have cracked under pressure from Wall Street to continually boost profits. Just one day before the FBI raided RMC to collect evidence on Moon and Realyvasquez, an analyst reported that Tenet had been raising prices in order to benefit from the extra fees Medicare paid for "outliers"—patients who have extraordinarily expensive procedures such as those performed by RMC's cardiac unit. The coincidence is not lost on Klaidman: He says RMC was near the top of the list of outlier abusers, generating 59% of its pretax income from the fees.
Coronary's only failing may be the ending of its story. After hearing so many shocking tales, we expect the hand of justice to crush Moon and Realyvasquez. In fact, the U.S. Justice Dept. did not bring criminal charges against the pair. They and Tenet settled the civil cases for $450 million. Moon and Realyvasquez left medicine. Tenet also paid the U.S. government $900 million to settle claims regarding alleged improper financial activities. The company, now a shadow of its former self, "has taken many steps to improve clinical quality and compliance oversight," says a Tenet spokesman.
Klaidman succeeds at casting a light on the all-too-frequent association of medicine and profit-mongering. And he leaves readers with a stark and enduring lesson: Never underestimate the importance of a second opinion.
By Arlene Weintraub