Cardiologists Lose License, should be in Prison

This story is from the Redding, CA Record Searchlight

by Ryan Sabalow

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 rsabalow@redding.com.

CABG - Legal Assault with a Deadly Weapon.

If a patient is told by a cardiologist that his or her heart is in "GREAT SHAPE," but he or she needs a CABG or he could drop dead at any time, and the doctor hands the patient a pen with which to sign the permission to perform the surgery, he should be arrested and charged with conspiracy to commit assault. If this patient, with the heart in "GREAT SHAPE," indeed has the surgery, the cardio-thoracic surgeon and all of his assistants, including the cardiologist who referred the patient should be arrested for assault with a deadly weapon. And if, this patient whose heart was in "GREAT SHAPE" before the surgery happens to die on the table or of later complications, that entire group of conspirators should be charged with murder.

Two years ago, after seeking a second opinion from a noninvasive cardiologist, I opted for treatment with medication for my unstable angina instead of a quintuple bypass. Ten days ago, my friend underwent a triple CABG and he is miserable. He is afraid to go to sleep at night for fear that he won't wake up. He is not allowed to lift anything heavier than his shoes for several months. He can't walk more than 1/2 hour a day for 3 months. He feels like his guts are going to fall out.

Granted, a year from today, if he is lucky, he'll say to me, "I feel great, I am so glad I had that surgery last May." But I am equally convinced I'll be able to say, "I've felt great for three years and didn't have the CABG." He may then say, but you must take all kinds of medicine every day for the rest of your life." And my response shall be, "Well, don't you as well."

Before you let a cardiologist talk you into this major surgery that you probably don't need, please, get a second opinion from a noninvasive cardiologist. If your current heart doctor says, "Oh, you are a walking time bomb, you haven't time for that," or "Dr. Cutter is a cardio-thoracic surgeon, he's your second opinion," RUN, don't walk to a noninvasive cardiologist because chances are those other two guys are lying to you.

Some Disturbing Facts

The fact that most patients with Coronary Artery Disease (CAD) can be safely and medically treated instead of with invasive and surgical solutions such as angioplasty and Coronary Bypass Arterial Grafts (CABG) has been known for over ten years. C. Pepini, writing in the Journal of Myocardial Ischemia in 1995 said this in his paper titled "Management of Myocardial Ischemia: A Time to Re-evaluate." In 1997, in their paper Evidence-Based Coronary Care," in a 1997 Annals of Internal Medicine , Braunwald and Antman reaffirmed Pepini's findings.

My own noninvasive cardiologist, Howard Wayne, MD (www.heartprotect.com) says in more than 22 years of treating his CAD patients with medication, only 11 of them had to have a CABG because they stopped responding to his medical regimen. During the same period, mortality in his patients from CAD and incidences of heart attacks has been less than one percent a year.

Finally, Dr. Thomas Preston, MD, a Professor of Medicine at the University of Washington School of Medicine and Chief of Cardiology at Pacific Medical Center in Seattle, said, "CABG is overused, frequently ineffective, and absurdly expensive. It is the epitome of modern medical technology, yet, as it is now practiced, its net effect on the nation's health is probably negative." Strong words from a cardiologist, but no stronger than those Howard Wayne has been saying for years.

In his editorial, "Marketing an Operation," Preston states the following:

• CABG consumes more medical money than any other treatment of procedure.
• Although performed less frequently than most common abdominal and gynecological operations, it is the leader in terms of equipment and personnel, hospital space, and assorted resources.
• CABG does not cure CAD, is scandalously overused, and its high costs drains resources from other areas of need.
• Fully half (Wayne says 95%) of the CABGs done in the United States are unnecessary surgeries that do not save lives or even prevent heart attacks.
• Among sufferers of CAD, those treated without surgery enjoy the same survival rate as those who do.

These are the words of a respected Professor of Medicine and a chief of Cardiology for a major medical center. They are the words of a noted noninvasive cardiologist who has been treating CAD patients primarily with medication for over 22 years. There has been reams of papers published in medical journals for more than a decade that expose the Coronary Artery Bypass Graft as unnecessary, expensive and dangerous. They stop your heart when they perform this surgery for crying out loud. Listen to the wisdom of a few upstanding cardiologists who are desperately trying to stop the gross over-prescribing of CABGs.

Why do cardiologists insist on performing this surgery instead of treating their CAD patients? There can only be two answers to this question. They either do not know any better or it is a matter of they put their own financial well-being ahead of the health of their patients.

This message is being sent out in emails and placed on message boards and forums around the Internet. Administrators of these sights have a choice. They can continue deleting these posts and demonstrate they are part of the problem, or they can prominently display and promote this discussion. Let's see what side of the issue they are really on.

It is high time for an update

Hey, Dr. Corey, I'm still alive and kicking. In fact, two years after refusing to have my chest cracked open by a cardio-thoracic surgeon at Indiana Heart Hospital, I am feeling better than ever! This despite the scare tactics you and he used to try to get me on the operating room table. It turns out I was not the walking time bomb you said I was.

In fact, I am alive and well, working on an offshore drilling rig in Nigeria, West Africa. I am sitting on that rig this very moment, typing this post to the blog that I have not posted on in nearly a year. I just got off the phone with my lovely wife, Rebecca (YES! I've gotten married since my last post! -- and she's 16 years younger than I) and she gave me the sad news that a friend of ours is trying to be talked into a triple cardiac artery bypass graft.

It seems our friend has symptoms that are similar to mine and a story that practically mirrors mine. He has angina. His doctors tell him that his coronary arteries are badly blocked -- but his heart is in good shape. Well people!! If the heart is in great shape, it must be getting oxygen, that's what keeps the heart in great shape! If the oxygen isn't getting through the clogged coronary arteries, it must be bypassing them in some way, right?

The body is a miraculous entity. It has the capability to heal itself. When arteries get blocked, the ingenious body builds natural bypasses to replace the clogged ones. There is a doctor in San Diego named Howard Wayne. He taught me this fact and has been treating me for two years with medication. MEDICATION!!! Not surgery. I didn't get cut open. I didn't have my heart stopped, I didn't have a long post-op recovery period and an even longer period of physical therapy AND, I didn't put a lot of money in my surgeon's pocket!

Dr. Wayne is a board certified cardiologist, among other certifications he can boast. He is not a quack. He costs about 10 percent what bypass surgery charges insurance companies. He is not trying to pay for his Mercedes Benz 500 or the new olympic swimming pool in his backyard. He is trying to show the 80,000 Americans doctors scare into bypass surgery every year that for most of them, not only is the surgery unnecessary, it reduces your life expectancy! You could do nothing at allfor your angina and still live longer than many bypass victims.

Yes, I wrote "VICTIMS." Most patients who undergo bypass surgery are victims of scare tactics made by cardiologists who either do not know what they are talking about, or worse, are purposely misleading their patients to get them to have unnecessary but very expensive surgery.

I am going to call my friend this afternoon at 3 pm Nigeria time (10 am Indianapolis time) and ask him to please read my blog. I'll ask him to go to the archives and start at the beginning. I also want to encourage him to call Dr. Wayne in San Diego. I have an appointment on June 6 to see him for my second annual check up.

Wake up America! Your cardiologist is more interested in his financial well being than your health.