"Coronary: A True Story of Medicine Gone Awry" by Stephen Klaidman; Scribner; 320 pages; $25
It's easy to understand when medical centers in major cities, like Houston or New York, become renowned for pioneering heart surgery or cancer treatment, drawing patients from far and wide.
But when a hospital in Redding, Calif., population 80,000, is reported to have the highest heart-bypass surgery rate in the country, it might trigger some head scratching among casual observers.
From the mid-1990s to the early part of this decade, two doctors at Redding Medical Center - Chae Hyun Moon and Fidel Realyvasquez (known as Dr. RV) - became known throughout Northern California and beyond as among the best cardiac specialists in the business.
Drs. Moon and RV, also known for their coarse bedside manners and disdain to keep proper postoperative charts, cracked chests at remarkable rates, according to Stephen Klaidman's exhaustively researched book. It appeared that almost any patient with chest pain, shortness of breath or numbness in extremities was quickly diagnosed with life-threatening blockages and whisked into surgery, he writes. This did not go unnoticed. A standing joke was that if you had a flat tire in front of the Redding Medical Center you'd wind up with a zipper-scar down your chest.
In addition to handsome compensation packages and almost universal reverence among staff, Moon and RV enjoyed perks like golf junkets in corporate jets. That's because they generated a fortune for the corporation that owned RMC: Tenet Healthcare.
Tenet knew how to make money.
The markup on drugs at its 115 hospitals in 2002 was twice the national average, Klaidman reports. At $1,125, RMC was first in California for net income per adjusted patient day.
A spectacular surge in cardiac procedures at the 238-bed Redding hospital between 1997 and 2002 translated into a similar surge in income. RMC's pretax net income went from $40 million in 1998 to $93 million in 2002.
By comparison, the slightly larger, nonprofit Mercy Hospital across town netted $5 million in that year. And the Washington Hospital Center - a 900-bed, nonprofit facility with a nationally renowned heart program in the nation's capital - earned $14.2 million in 2004.
Klaidman writes that through double-billing and grossly inflated charges, RMC proved to be a main engine in the fantastic rise of Tenet stock. Tax dollars provided the lion's share of the profit through billings to Medicare.
Moon and Realyvasquez were golden gooses.
But even in the notoriously inept, secretive, corrupt and poorly policed U.S. health care system, a pair of doctors who routinely perform bypass surgeries and other invasive - and expensive - procedures on patients who do not need them are ultimately exposed.
Klaidman, a former writer and editor for The New York Times and Washington Post, has spent years researching and writing about medical triumphs and the failures of health care in America. Here, he chronicles a shocking saga of surgeons, hospital administrators and corporate officers blinded by greed, their chief concern not the welfare of patients but enrichment of the bottom line.
"There is no way to quantify how many died as a direct result of having unnecessary surgery," Klaidman writes, "but there is virtually no doubt that some did."
Fate and the truth took an excruciatingly long time to catch up with Moon and Realyvasquez. When they did, the exposure followed twin paths.
Suspicious doctors and other health care professionals in Redding surreptitiously began keeping track of evidence that the cardiac specialists were operating on people without coronary disease. As patients who resisted surgery made formal complaints, backed by second opinions from reputable physicians, a tipping point was finally reached.
The FBI launched an investigation culminating in a massive raid of RMC offices and records that made national headlines. The criminal case spawned hundreds of civil lawsuits as patients realized they had undergone unnecessary surgeries with drastic ramifications.
Though some in Redding remained steadfast supporters of the two doctors, the cardiologists' reputations were ruined. Many patients, however, were left unsatisfied in the end.
Hundreds of lawsuits were settled by Tenet and the cardiologists' malpractice insurers for sums exceeding $400 million; Tenet further reimbursed the federal government $900 million for overcharges through the years; the doctors could no longer practice medicine and saw their personal wealth severely dwindle. But they were never prosecuted criminally and would spend no time in jail, much to the disappointment of many former patients, attorneys and law-enforcement officers who felt shortchanged by the justice system.
Klaidman's reporting skills, unfortunately, far exceed his writing ability. What should be a smooth, spellbinding narrative too often reads more like a thorough reporter emptying his notebook. It's a report that is far too dry and sometimes jangled, with not enough pure storytelling.
Yet readers willing to endure the ride will be rewarded with a jarring journey thorough the shadows of what passes for a health care system in this country.