State accuses cardiac surgeon
By Ryan Sabalow, Record Searchlight
After almost four years of investigation, the state medical board moved Tuesday to revoke or suspend the license of a Redding doctor accused of having performed hundreds of unnecessary heart procedures.
In an accusation filed with California Attorney General Bill Lockyer, Dr. Fidel Realyvasquez Jr. is charged by the Medical Board of California with gross negligence stemming from bypass surgeries he performed on three patients in 2001 and 2002.
According to the accusation, Realyvasquez, the chief cardiac surgeon at what was then Redding Medical Center, operated on the patients -- ages 58, 52 and 76 -- without cause, based solely on diagnoses made by cardiology chief Dr. Chae Hyun Moon.
Moon, who also is under investigation by the state medical board, voluntarily agreed to stop practicing medicine in July 2003.
Moon, 58, is charged by the medical board with dozens of counts of gross negligence, incompetence, dishonesty and corruption, filing false or fraudulent claims, failure to maintain adequate records, and repeated negligent acts.
That investigation is ongoing.
Tuesday's accusation is that Realyvasquez, 57, performed the three coronary bypasses without verifying Moon's diagnoses.
The medical board's accusation reports each of the three surgeries in detail, using words like "failed to," "unnecessary" and "erroneous" to describe Moon's diagnoses and the following surgeries by Realyvasquez.
The accusations identified the patients by initials to protect their privacy.
In the case of the of the 58-year-old patient, identified as "E.G.," Realyvasquez performed a triple bypass coronary graft without checking to see that the patient could have been helped by a less invasive procedure, according to the filing.
In the second case, Moon told a 52-year-old woman in March 2002 she needed a coronary artery bypass graft surgery, the filing says. Moon suggested that if she didn't get one, "her grandchildren might find her dead," according to the accusation.
The accusation calls Moon's diagnosis of heart angiography a "misinterpretation" and says the patient had only "minor, if any, coronary artery disease."
In his examination of the patient, "Dr. Realyvasquez simply restated Dr. Moon's findings ... and obtained the patient's consent for the surgery," according the accusation.
The most serious allegation stems from the 76-year-old woman's surgery.
The accusation says she "suffered a major embolic stroke, from which she has not yet fully recovered" because of a four-vessel bypass Realyvasquez performed based on Moon's diagnosis.
Realyvasquez's Sacramento attorney, Malcolm Segal, said the medical board's claims are unfounded because his client simply was going off of test results given to him by another physician -- something every surgeon does.
"What (the accusation) seems to be saying is that no physician can rely upon any test report prepared by another physician on the case," Segal said. "I question then, does that mean that a surgeon has to repeat and personally do all the blood tests, repeat and personally do all the X-rays, repeat and redo every other test, even when, by training, that's not his responsibility?"
Saying that he had not seen the medical board's accusations, Moon's attorney, Matthew Jacobs of Sacramento, declined to comment on the allegations against Realyvasquez or Segal's statements.
Redding attorney Russell Reiner, who represents 345 patients who sued the doctors in civil court, said the final decision lies with the person holding the scalpel.
"It's the surgeon's ultimate responsibility to determine whether a person proceeds to surgery," Reiner said. "Realyvasquez failed in his responsibility."
Reiner said the medical board's accusation is "long overdue."
The complaint urges that Realyvasquez's license be revoked or suspended, and that he be forced to pay the costs of the investigation, future enforcement and probation.
Tuesday's filing is the latest chapter of the Redding Medical Center saga, which began in October 2002, when federal agents raided the hospital after tips from whistle-blowers.
Federal officials have been hashing out a settlement in that case since Nov. 15, when Moon and Realyvasquez came to a "global settlement" and agreed to pay prosecutors $1.4 million each.
A spokeswoman for the U.S. attorney's office in Sacramento said prosecutors have until June 2 to finalize that deal.
The settlement ended three years of criminal investigation.
No criminal charges were filed, and none of the doctors has admitted guilt.
In February, Realyvasquez and two other surgeons, Kent Brusett and Ricardo Javier Moreno-Cabral, were ordered to begin paying a $21 million civil settlement to 760 patients.
Moon and other cardiologists settled separate civil suits for $24 million nearly a year earlier.
Both doctors still live in Redding, their attorneys said.
Segal said his client has been "working on other matters related to medicine, including research."
Reporter Ryan Sabalow can be reached at 225-8344 or at email@example.com .
Doctor, hospital feuded
Mercy attempted to monitor Moon's operating procedures
Chae Hyun Moon
Six years before a federal probe placed cardiologist Chae Hyun Moon under added scrutiny at Redding Medical Center, the supervisory staff at Mercy Medical Center ordered monitoring of all Moon's heart catheterizations.
The hospital's executive committee later reduced to two the cases that would be monitored, but Moon performed no more catheterizations at Mercy.
The order, revealed in records of Moon's two subsequent lawsuits against Mercy, also contained stern warnings.
"You will not jeopardize patient safety," the committee said in a letter to Moon dated Aug. 28, 1996. "Cases of extreme emergency will be closely reviewed for adequate documentation."
The executive committee also demanded Moon's response to a complaint that he left nurses to deal with an unstable stroke patient, "a serious quality of care issue."
"There is no evidence in the patient's chart of adequate pre-evaluation" and "there was no dictated report on the patient's chart," the letter says.
In addition, Moon was informed "monitoring will continue until the executive committee is satisfied that patient and employee safety is no longer compromised."
Moon, 55, RMC's director of cardiology, and RMC's chairman of cardiac surgery, Fidel Realyvasquez Jr., 54, are the subjects of an FBI probe into Medicare fraud. No charges have been filed since the Oct. 30 search of the doctors' offices and RMC records, but a flurry of other investigations and lawsuits followed.
The two doctors may have performed unnecessary invasive heart procedures for profit, FBI investigators have said.
While the investigation continues, Tenet Healthcare Corp., RMC's corporate parent, announced that both doctors' recommendations would be reviewed before procedures are performed.
Copies of letters filed in conjunction with Moon's lawsuits say Moon's performance came under scrutiny after members of Mercy's "cath lab" staff complained to the hospital's medical division subcommittee. The subcommittee is part of the hospital's "Medical Staff," which controls and regulates doctors' staff privileges at the hospital.
Minutes of an Aug. 27, 1996, subcommittee meeting and the subsequent letter to Moon outline the complaints, alleging that Moon was performing a heart catheterization when his patient apparently suffered a stroke.
Moon allegedly left the hospital while the patient was unstable and the patient eventually died, the documents say.
In addition, a nurse complained that she had suffered a needle stick while assisting Moon and he "would not allow the time to inspect and clean the wound, nor was she given time to reglove."
In other court documents, Mercy attorneys said that "Dr. Moon thrust a needle at her while rushing through a procedure, puncturing the nurse's glove."
Though already RMC's director of cardiology in 1996, Moon also performed procedures at Mercy from at least 1992 to 1996, the court documents say.
Those procedures were limited. Court documents say that in 1995, for example, Moon performed 39 of his 1,894 invasive procedures at Mercy and the balance at RMC.
Moon's attorneys did not return calls for comment on his lawsuits and his long-running legal fight with Mercy Medical Center. Spokespersons for Tenet Healthcare Inc. and for RMC did not respond to requests for comment.
Mercy Medical Center issued a statement saying the legal issues were resolved.
"We are not at liberty to discuss the matter pursuant to a confidentiality agreement," the statement says.
Physician disputed claims
But documents filed in U.S. District Court in Sacramento and in Shasta County Superior Court reveal at least part of the story.After receiving the first letter from Mercy, Moon battled back, the court documents show.
In a six-page letter hand-delivered to the Mercy doctors Sept. 30, 1996, Moon contends that the patient, identified elsewhere in the documents as Charles Kenneth Brown, 67, of Anderson, knew the risks of the procedure and decided to go ahead with it.
Brown suffered from a number of other medical problems, Moon says in the letter, and was recovering from the stroke suffered during the cardiac procedure when he "had a sudden death out on the floor which the etiology is unclear."
According to his death certificate, Brown died Aug. 9, 1996, of cardiac arrest, due to cardiac arrhythmia, due to renal failure, due to a reaction to contrast dye.
Contrast dye is used in some heart procedures, including catheterization.
Moon's letter says Brown was taken to another unit in the hospital for treatment. Moon said he told the staff he was going to his office and asked the Mercy staff to call about test results. Once at the office, Moon called Brown's other doctors to alert them to the problems and finally called Mercy's Cardiac Care Unit and was told others had taken over his case, his letter says.
Moon also wrote that he had been told the person who complained about him was a former RMC employee "who had a personal encounter with me" at RMC and that the Mercy committee had "totally disregarded that possibility of personal vendetta."
He went on to request more information about the alleged needle stick, complaining that Dr. Nena Perry, who chaired the executive committee, had "refused to provide the name of the individual and the incidence itself, whether it was an emergency or elective."
Perry is out of town and could not be reached for comment.
Moon said he would normally give a scrub tech time to change gloves after a needle stick, but added: "A needle stick is a needle stick, once you have felt the needle how much can you examine yourself and worry about it, and it does not merit to stop the procedure."
Committee discussed case
Moon called the committee's decision to place him on monitoring status "unthinkable," noting that he had not had a single procedure-related death in his five years at Mercy.He also threatened to sue "taking the case to court from my point of view with the unfair treatment by your committee and pain and suffering I am going through."
A month later, on Nov. 26, Moon appeared before the committee and continued to passionately plead his case. He was identified in the meeting transcript as "Phys. 261."
"My interpretation is that there is something personal against me," he told the committee board, according to a transcript of the meeting. "You don't do anything about the other cardiac complications. Shame on you people for putting me on monitoring."
A committee member told Moon that the "abandonment" of the patient was likely a "non-issue after hearing your description of the events," the redacted transcript says. The committee member again declined to name the needle-stuck nurse.
Assurances that the abandonment issue was apparently about to be dropped did little to calm Moon.
"I can't believe this accusation, it's unbelievable," Moon retorted. "This is a trivial thing. How would you feel as a physician if you got this kind of letter?
"Why didn't I have the right for rebuttal before you took action? I'm not killing anyone. I did 1,900 procedures last year, no deaths, no strokes. This year one. . . . Compare my data with other cardiologists in town to see if I'm falling out of the norm."
After Moon's appearance the unidentified committee members discussed the case further, deciding that "we have a problem here because most nurses came from RMC and part of the reason they came is because Phys. 261 was difficult to work with . . ."
But they eventually concluded "it would be inappropriate not to allow Phys. 261 to operate in the cath lab."
The committee agreed that Moon's monitoring would be limited to two cases and would receive a follow-up letter "expressing concerns of cath lab personnel and put the letter in his file."
That letter was sent to Moon on Dec. 30, 1996.
"The executive committee wishes to reiterate that the reason for the monitoring is to investigate the concern expressed by the cath lab personnel."
Federal lawsuit filed
But Moon never did go back to Mercy.On Sunday, Feb. 2, 1997, a four-column advertisement appeared in the Record Searchlight.
"To all of my patients from Chae H. Moon, M.D.," the ad read. "This announcement is to notify all of my patients that I will be limiting my practice to Redding Medical Center and my office."
Moon also sent letters to patients advising them that he had chosen to stop practicing at Mercy for "political reasons," the court documents say.
Moon's federal suit was filed Dec. 18, 1997, against Mercy, Mercy Healthcare North, Catholic Healthcare West, the medical staff, Perry and hospital administrator George Govier.
The suit alleged violation of federal antitrust statutes, violations of the Business and Professions Code, interference with Moon's right to pursue his medical profession, defamation and interference with prospective economic advantages and loss of business opportunity.
Moon claimed he had been denied a right to a fair hearing and subjected to "contempt, ridicule and obloquy (verbal abuse and disgrace)."
But on Aug. 23, 1999, after years of depositions and motions, U.S. District Court Judge David F. Levi granted the Mercy lawyers' request for a summary judgment — effectively throwing the case out of court. The case was dismissed Sept. 16, 1999.
Even before the federal case was dismissed, Moon's attorneys filed a similar suit in Shasta County Superior Court on Sept. 10, 1999.
This time Moon accused the defendants of unfair business practices and said they had interfered with his right to "practice his calling."
Ongoing ridicule and defamation had never stopped, Moon complained.
The only other entries in the Shasta County case file are a Dec. 21,
1999, request for dismissal from Moon's attorneys and a notice of dismissal
six days later.
Reporter Maline Hazle can be reached at 225-8266 or at firstname.lastname@example.org
Sunday, January 5, 2003
© Copyright 2003 Record Searchlight. All Rights Reserved.
Judge pressures doctors to pay
By Ryan Sabalow, Record Searchlight
Three doctors accused of performing unnecessary heart surgeries at Redding Medical Center have until next Friday to begin paying a $21 million settlement, or they’ll be charged 10 percent interest, a Shasta County superior court judge has tentatively ruled.
In a written ruling filed late Wednesday, retired Shasta County Superior Court Judge Jack Halpin wrote that there were merits to claims made by hundreds of the doctors’ former patients that the physicians had wrongfully withheld settlement money they’d agreed to pay in November.
Halpin set a hearing to discuss his tentative ruling at 10 a.m. Tuesday in Department 4 of the Shasta County Superior Court.
Halpin also wrote that the doctors must either agree to settle the case on Tuesday or be prepared to face a jury trial for the first of many patients listed in the settlement.
There are more than 760 people waiting to receive a portion of the money.
In papers filed with the court, attorneys for heart surgeon Fidel Realyvasquez Jr. and two other surgeons, Kent Brusett and Ricardo Javier Moreno-Cabral, had argued that their clients weren’t required to begin paying the $21 million because they have yet to finalize a settlement with federal investigators.
Lawyers for the patients argued against that claim, saying "the evidence (was) overwhelming" that the payments were "not dependent on anything the federal government did or did not do," according to court documents.
In his tentative ruling, Halpin wrote that waiting for the finalized federal deal before paying the patients was not stated "explicitly or implicitly" in the settlement.
On Nov. 15, doctors with Redding Medical Center avoided criminal charges by reaching a "global settlement" with patients on whom they had allegedly performed unnecessary heart surgeries.
As part of their deal with the federal government, Realyvasquez, Brusett and Moreno-Cabral authorized their insurance companies to pay the patients their portion of the $21 million settlement.
But the doctors’ attorneys last month announced that they would not pay because the federal deal has yet to be finalized.
U.S. Attorney McGregor W. Scott said in an e-mail from his Sacramento office that federal attorneys are diligently working to sign off on the deal with the doctors. But he also suggested that he agrees with the arguments lodged by the patients’ attorneys.
"The resolution of the individuals’ cases in state court in Redding against the involved physicians is not dependent on the completion of the written settlement of the cases in federal court," Scott said.
The settlement in November ended three years of criminal investigation that revolved primarily around Realyvasquez and cardiologist Chae Hyun Moon.
Moon and other cardiologists settled separate civil suits for $24 million nearly a year ago.
None of the doctors involved in the lawsuits has admitted guilt.
Reporter Ryan Sabalow can be reached at 225-8344 or at email@example.com
Three Strikes Legal - Index