Reference no: EM133181734

Stents in the Cardiac Cath Lab? As the Chief Medical Office at Merciful Medical Center (MMC) in Omaha, Nebraska, you have been informed that Dr. Knowitall has just been sued for inappropriate use of cardiac stents. Once the story breaks in the news media, you are certain your institution will also be involved. Your predication comes true. Over the next several weeks, multiple patients join a lawsuit, which now names MMC, as well as Dr. Knowitall. You meet with the head of the Quality Assurance Committee (QA Committee) and begin an investigation to the indications for Dr. Knowitall's cardiac stent implementation. The Chair of the QA Committee informs you that Dr. Dr. Knowitall is the busiest invasive cardiologist in the city. He is regarded as the most skilled cardiologist in the area, especially with regards to placing stents in hearts. Many physicians, their families and friends have been treated by Dr. Knowitall. Despite their high regard for his skills, the QA Committee and two external cardiology consultants who have no ties to MMC, review several hundred of Dr. Knowitall's cases. Upon review of his records and procedures, using current standards of care to guide their assessment, the members of the QA Committee and the outside consultants determine a large number of the stents placed by Dr. Knowitall were not indicated. Compared to their expert readings of the lab tests, the reviewers find Dr. Knowitall had a pattern of over-reading or misreading many of the test for the cardiac catheterization. In many of the tests, Dr. Dr. Knowitall reported 70% occlusions, whereas the expert reviewers find occlusions of 50% or less. These findings lead the reviewers to believe Dr. Knowitall has purposely fabricated data. While the QA Committee and external experts are viewing the cases at MMC, the media has ensured this matter has top billing on the television, radio, and Internet news. The malpractice lawyers in the area are having a feeding frenzy and are making sure their advertisements now include, "If you've had a cardiac stent ..." in addition to their usual lists. In addition, the state medical board is investigating Dr. Knowitall. These investigations take some time. And while they are in progress, you decide, based on your internal investigations, that Dr. Knowitall should not be performing cardiac catheterizations and stents at your instruction. While he is being investigated, it becomes quite apparent he lives in a luxurious home in an expensive area. He has 2 children that attend private schools, he belongs to a country club, and own expensive cars, boats, and a second home in Arizona. His wife is not employed outside the home. Mrs. Knowitall spends most of her time pursuing her dream of becoming a state jousting champion. She has a live-in nanny, a live-in housekeeper, and a full-time groomsman for her horses. In other words, Dr. Knowitall has a lifestyle well beyond the means of even the busiest invasive cardiologist. He has been providing multiple talks for the stent company and this firm has sponsored several lavish events, including one at this home. Dr. Knowitall claims that he has no conflict of interest and is not being incentivized by the medical device firm. The data you are able to gather at this point is inconclusive with respect to his other sources of income. At the conclusion of the MMC and state investigations, Dr. Knowitall surrenders his medical license and stops practicing medicine in your state.

• Present a background statement on the case study identifying the problems and secondary issues particular to the quality of care.
• What role would, or could, information technology play in the identification and/or monitoring of cardiac catheterizations and ensuring the quality of care is delivered at MMC?
• Identify and discuss any compliance and/or regulatory issues that would be relevant in this case that as an administrator, you would/should be concerned about.