The case has had wide repercussions. Over the past year, St. Joseph has told
hundreds of Dr. Midei's patients that they did not need the expensive and
potentially dangerous stents that the doctor inserted because their arteries
were not as obstructed as he had claimed. Now, state health officials are
investigating other local cardiologists who inserted a suspiciously high
number of stents, which are tiny wire mesh devices inserted to prop open
clogged arteries in the heart.

After reports about the Midei case and the wider state investigation, the
number of stent procedures performed at St. Joseph and other area hospitals
plunged, raising doubts about the appropriateness of much of the region's
cardiac care.

A landmark 2007 study published in The New England Journal of Medicine
showed that many patients given stents would fare just as well without them.
Dr. Christopher J. White, president-elect of the Society for Cardiovascular
Angiography and Interventions, said that inappropriate stenting was a
problem, but a rare one. The federal Medicare program spent $3.5 billion
last year on stent procedures.

Prosecutors, malpractice lawyers and state medical boards are only now
waking up to the issue. The Texas Medical Board last month accused a widely
known cardiologist in Austin of inserting unnecessary stents. In September,
federal prosecutors accused a cardiologist in Salisbury, Md., of performing
unnecessary stent surgeries, and last year a Louisiana doctor was sentenced
to 10 years in prison for inserting unneeded stents.

J. Stephen Simms, a Baltimore lawyer who successfully pursued a federal
whistle-blower lawsuit involving kickbacks for coronary procedures, said
such cases were "the flavor of the month right now" with federal
prosecutors.

Jay Miller, another Baltimore lawyer, said he was devoting his entire
practice to unnecessary stent cases. "And I don't think this is limited to
just a few Maryland hospitals," Mr. Miller said.

But far from questioning cardiologists who perform an unusually high number
of stent procedures, many hospital executives celebrate these doctors
because of the revenue they bring, which can be more than $10,000 per
procedure.

"Hospital patients expect their care to be based on medical need, not
profits," said Senator Max Baucus, Democrat of Montana and chairman of the
Finance Committee. "Even more disconcerting is that this could be a sign of
a larger national trend of wasteful medical device use."

Dr. Midei's fall was as rapid as it was dramatic. In a June deposition for a
lawsuit against him, he said: "I didn't know what hit me. I was bewildered
by what had happened."

He had been one of the most sought-after clinicians in his region. Trained
at Johns Hopkins University, he was a co-founder of MidAtlantic, a practice
with dozens of cardiologists that controlled much of the cardiac business in
Baltimore's private hospitals. Dr. Midei was one of the practice's stars.
When MidAtlantic negotiated a $25 million merger with Union Hospital in
2007, the deal was contingent on his continued employment.

St. Joseph was so concerned about losing Dr. Midei's business that the
hospital offered a $1.2 million salary if he would leave MidAtlantic and
join the hospital's staff. When Dr. Midei agreed, the merger with Union
collapsed, MidAtlantic sued, and the practice's former chief executive vowed
in a deposition to "spend the rest of my life trying to destroy him
personally and professionally."

In the June deposition, Dr. Midei estimated that in 2005 -- before research
revealed that many stents were unnecessary -- he performed about 800 stent
procedures. Instead of dropping in subsequent years, however, the number of
stents Dr. Midei inserted rose to as many as 1,200 annually, he estimated.
In a 2007 internal document, Abbott Laboratories ranked Dr. Midei's use of
stents behind only five other cardiologists in the Northeast, including
those at hospitals four and five times St. Joseph's size.

That sort of increase in volume was an obvious red flag, said Dr. William E.
Boden, clinical chief of the division of cardiovascular medicine at the
University of Buffalo and an author of the 2007 stent study. "For him to
have this brisk increase over those years is really unusual," Dr. Boden
said.

In stable patients, stents should be used only if X-rays show that most of
the artery is blocked, and the patient has symptoms like frequent chest
pain. Stent procedures can, in rare cases, cause bleeding, stroke or a heart
attack. Once a stent is placed, it can result in a life-threatening clot
that emerges weeks to months later. Stent patients must spend a year or more
taking blood-thinning medications, which have their own risks.

In April 2009, a patient of Dr. Midei's who was also a St. Joseph employee
complained that he had received an unneeded stent and that many other
patients had as well. The hospital engaged a panel of experts who reviewed
1,878 cases from January 2007 to May 2009 and found that 585 patients might
have received unnecessary stents.

When asked to review the cases himself, Dr. Midei found far less blockage
than he had initially, according to the Maryland Board of Physicians. The
hospital suspended his privileges and eventually sent letters to all 585
patients. Hundreds of lawsuits against Dr. Midei and St. Joseph followed,
including from patients treated well before January 2007.

Abbott responded to the controversy by hiring Dr. Midei as a consultant.
"It's the right thing to do because he helped us so many times over the
years," an Abbott executive wrote in a January e-mail cited in the Senate
report.

The company sent Dr. Midei to Japan, but news of the controversy made his
duties impossible, and he flew home. After one particularly critical story
in The Baltimore Sun, David C. Pacitti, an Abbott executive, wrote in an
e-mail, "Someone needs to take this writer out and kick his ass!"

Edward Chaid, 68, a semiretired general contractor from Timonium, Md., is
among those who have sued. Five years ago, Mr. Chaid decided to get his
first physical examination in decades. Just to be safe, his doctor sent him
for a cardiac stress test at MidAtlantic, which revealed a small "squiggle"
of concern, Mr. Chaid said. He was sent to Dr. Midei to get his arteries
X-rayed, and he emerged from the procedure with two stents.

"Dr. Midei said: 'You sure are lucky. You had 90 percent blockage.' And the
nurse said, 'Oh yeah, you were blocked in your widow-maker.' And I said:
'Thank God. I guess I'm really lucky you got it when you did,' " Mr. Chaid
said in an interview.

Five years later, another doctor concluded that Mr. Chaid's blockage had
been minimal. "I was really shocked," Mr. Chaid said. "I'm from a generation
where doctors are thought very highly of."

But Mr. Snyder, Dr. Midei's lawyer, said that his client's care had been
entirely appropriate, that doctors often interpret X-rays differently and
that St. Joseph was using him as a scapegoat. A Web site created by friends
of Dr. Midei lists dozens of testimonials like this one: "Plain and simple,
Dr. Midei saved my life."




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