Product Description

A chilling real-life medical thriller, Coronary chronicles the story of two highly respected heart doctors who violated the most sacred principle of their profession: First, do no harm.

In the summer of 2002, fifty-five-year-old John Corapi, a Catholic priest with a colorful background, visited Dr. Chae Hyun Moon, a celebrated cardiologist in Redding, California. Corapi had been suffering from exhaustion and shortness of breath, and although a physical examination and a conventional stress test revealed nothing abnormal, Moon insisted that the calcium level in Corapi's coronary arteries called for a highly invasive diagnostic test: an angiogram. A chain-smoking Korean immigrant known for his gruff bedside manner, Moon performed the procedure briskly and immediately handed down a devastating diagnosis: "I'm sorry; there is nothing I can do for you. You need a triple bypass tomorrow morning." He then abruptly left the room.

Several hours later, however, Moon inexplicably decided the surgery could wait until Corapi returned from a previously scheduled cross-country trip. Unnerved by the dire diagnosis and also by Moon's inconsistent statements, Corapi sought other opinions. To his amazement, a second, third, and fourth doctor found that his heart was perfectly healthy. In fact, for a man his age, Corapi's arteries were remarkably free of disease.

Sensing a cause more disturbing than human error, Corapi took his story to the FBI. As local agent Mike Skeen soon discovered, Corapi was one of a number of people who had suspicions about Moon and Moon's go-to cardiac surgeon, Dr. Fidel Realyvasquez, an equally respected member of the close-knit northern California community. Working at a hospital owned by Tenet Healthcare, Moon would make the diagnoses and Realyvasquez would perform the surgeries. Together, these leaders of the Redding medical establishment put hundreds of healthy people at risk, some of whom never recovered. Soon Skeen launched a major investigation, interviewing numerous doctors and patients, and forty federal agents raided the hospital where the doctors worked.

A timely and provocative dissection of America's medical-industrial complex, Coronary lays bare the financial structures that drive the American healthcare system, and which precipitated Moon's and Realyvasquez's actions. In a scheme that placed the demands of Wall Street above the lives of its patients, Tenet Healthcare rewarded doctors based on how much revenue they generated for the corporation.

A meticulous three-year FBI investigation and hundreds of civil suits culminated in no criminal charges but a series of settlements with Tenet Healthcare and the doctors that totaled more than $450 million and likely put an end to Moon's and Realyvasquez's medical careers. The case's every twist and turn is documented here.

A riveting, character-rich narrative and a masterpiece of long-form journalism, Coronary is as powerful as it is alarming. This is a hair-raising story of the hundreds of men and women who went under the knife, not in the name of medicine, but of profit and prestige. Brilliantly told, Stephen Klaidman's Coronary is a cautionary tale in the age of miracle medicine, and a shocking reminder to always get a second opinion.

Product Details

• Amazon Sales Rank: #436985 in Books
• Published on: 2007-01-09
• Number of items: 1
• Binding: Hardcover
• 320 pages

From Publishers Weekly
Father John Corapi, a former accountant, was urged in 2002 to have immediate triple bypass surgery at Redding Medical Center. In fact, his coronary arteries were normal, and he and a former colleague persuaded the FBI to launch a criminal fraud investigation against the for-profit hospital, a renowned Northern California medical institution, and its two rainmakers, cardiologist Chae Hyun Moon and chief of cardiac surgery Fidel Realyvasquez. It soon became clear that the egotistical, abrasive, chain-smoking Moon and the highly ambitious, self-promoting Realyvasquez were performing numerous unnecessary procedures on gullible patients, with devastating consequences. Among the egregious examples of medical misconduct were unnecessary bypasses performed on Paul Alexandre, who became an invalid at age 36 after his sternum was permanently damaged during surgery, and on Shirley Wooten, a lively golden-ager whose surgery led to a fall that caused a fatal cerebral hemorrhage. Although it suffers from veteran newsman Klaidman's (Saving the Heart) lack of access to Moon and Realyvasquez, this well-researched and ably written account offers solid proof that American medicine is indeed "a mess." Readers may think the same about the legal system after learning that Alexandre and Wooten received only six-figure settlements while the Corapi walked away with millions, and neither doctor was prosecuted for a crime. (Jan.)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From Booklist
If veteran journalist Klaidman wanted to show how to corrupt an already faulty medical system, he couldn't have chosen a better subject than the Redding (California) Medical Center scandal. All it took was a hospital owned by a multibillion-dollar corporation, Tenet Healthcare; two overly ambitious physicians; and thousands of people, including private insurers and Medicare personnel, willing to overlook questionable diagnoses. Millions were paid out for thousands of unnecessary bypass surgeries and other equally unjustifiable procedures. The compensation of cardiologist Chae Hyun Moon and cardiac surgeon Fidel Realyvasquez were directly tied to the profits of the hospital's heart program. And dozens of misdiagnosed patients suffered irreparable damage to their health, including death. Klaidman shows, too, a judicial system that allowed the physicians to walk away--no criminal charges were filed--and awarded cash settlements to victims and their families that, in the end, amounted to little more for the corporation than the cost of doing business. A story that grabs like fiction but frightens like fact. Donna Chavez
Copyright © American Library Association. All rights reserved

Excerpt. © Reprinted by permission. All rights reserved.

Felix Elizalde's experience in Redding, as unpleasant as it evidently was for him and for his wife, Margaret, did not necessarily have wider implications. It could easily have been a simple case of medical error or just a difference in clinical judgment between two cardiologists. Medical errors occur with much greater frequency than most people are aware or would like to think, even at the best academic medical centers, and variations in clinical judgment are only natural. Cardiology in particular has many gray areas, and good clinicians frequently differ about the most appropriate treatment. The California State Medical Board, like most of its counterparts around the country, requires a pattern of questionable practice to investigate a physician, not just a single complaint, which makes sense. Doctors should not be held to a standard of perfection nor should they be expected to make identical cookbook diagnoses. Malpractice, of course, was not out of the question in Elizalde's case, but neither was it a certainty. And the possibility of fraud had not entered anyone's mind. In retrospect Elizalde had no definitive reason to be suspicious of Redding Medical Center, its owner, National Medical Enterprises, Dr. Realyvasquez, or, to be completely fair, even Dr. Moon.

Yet at the same time there was something potentially relevant to the situation that Elizalde knew nothing about -- a lengthy episode involving National Medical Enterprises that was deeply troubling. In the late 1980s and early 1990s a number of NME-owned psychiatric hospitals had engaged in a cold-blooded scheme that was ongoing at the time of Elizalde's Redding experience and destined to end in criminal convictions. Had Elizalde known about these activities he might have been even more skeptical about his own treatment.

About fifteen months before Moon diagnosed Felix Elizalde with triple-vessel coronary artery disease, late in the afternoon of April 12, 1991, a repainted police car pulled up to Sid and Marianne Harrell's modest ranch house in Live Oak, Texas, a middle-class suburb of San Antonio. The light blue Dodge had a flashing red light on top and the words Sector One painted on the trunk. There was a prisoner cage in the back seat. Marianne and her fourteen-year-old grandson Jeramy watched two bulky, uniformed men get out. One of them told her curtly, "We're Sector One, Mobile Crisis Unit, and we're here to pick up the boy." Marianne thought they meant Jeramy's twelve-year-old brother, Jason, who was undergoing an evaluation at Colonial Hills, a psychiatric hospital in San Antonio owned by a company called Psychiatric Institutes of America. She said, "He isn't here. What did he do?" But one of the men, who introduced himself as "Lieutenant" Joe Saenz, said, "That boy," pointing at Jeramy. She asked again what he'd done, but they wouldn't tell her.

Marianne, Jeramy, Saenz and the other man, whose name was Ulysses Jones, went inside where Sid Harrell, a retired army staff sergeant, was sitting at the kitchen table. Saenz and Jones told the Harrells they were operating under orders from a Dr. Bowlan at Colonial Hills and that if Jeramy didn't go with them they would get a warrant under which he could be held for twenty-eight days. They also indicated that if this happened he would have a police record.

Marianne was both frightened and angry. She called Colonial Hills and was told that the officers were authorized to bring Jeramy to the hospital. When she asked the reason, she was told for substance abuse, truancy, and because he was a victim of child abuse. Sid then called the local police to try to establish whether Saenz and Jones had the authority to take Jeramy. By the time a police officer showed up Jeramy was handcuffed and in the cage in the back of the Sector One car. The officer reviewed the papers the men showed her, which did not include a warrant authorizing Jeramy's detention. Nevertheless, she told the Harrells that Saenz and Jones were licensed security officers and could indeed get a warrant to hold Jeramy for twenty-eight days. If the Harrells let their grandson go with the security officers, she said, they could probably have him released within twenty-four hours. At this point the distraught grandparents gave up and let the two uniformed men take Jeramy away.

Dr. Mark Bowlan's "diagnosis" of drug abuse and the allegation that Jeramy was an abused child had been based solely on Bowlan's interview with Jeramy's twelve-year-old brother Jason. Bowlan, a psychiatrist who at the time had a temporary, limited medical license, which he would lose that summer for falsifying letters of recommendation, waited four days before seeing Jeramy, even though he had asserted that the boy was so dangerous that he had to be brought in by a pair of professional bounty hunters and admitted to Colonial Hills on an emergency basis. After six days, during which time his grandparents, who were his legal guardians, were not allowed to see him, Jeramy was released on a writ of habeas corpus obtained by state senator Frank Tejada. The senator went to the hospital himself and threatened to kick the door down if they didn't let the fourteen-year-old go. A bill for $11,000 followed. Jeramy's younger brother Jason was kept in the hospital for two weeks. His bill was $15,000. Both bills were paid by CHAMPUS (Civilian Health and Medical Program of the Uniformed Services), the U.S. government's health insurance program for members of the military.

Jeramy Harrell's experience of being forcibly taken from his home and being incarcerated in a mental hospital was not unique in the annals of the Psychiatric Institutes of America, a subsidiary of National Medical Enterprises. And, as bad as the Harrell case was, it was far from the most egregious in the company's history. Nor would it be the last. Something seemed to be awry in the corporate DNA.

At least as far back as 1984, some Texas psychiatrists knew what was going on at the Psychiatric Institutes of America hospitals, and some were benefiting from it handsomely. Dr. Charles S. Arnold, a San Antonio psychiatrist, tape-recorded a conversation on June 12 of that year with the administrator of Colonial Hills, the hospital to which Harrell would be taken. Arnold said he recorded the conversation "because of what I had already learned about the hospital." The administrator told him that if he went along with the program, the hospital would make him rich, as it had done for other psychiatrists who had cooperated. The administrator then cited a Houston physician as an example: "They called [name deleted] and said 'Look, you want to be rich? You let us set up this program the way we want to set it up. All you do is be the admitting psychiatrist and we'll make you rich.' We made him rich."

The administrator who contacted Dr. Arnold was executing a key part of the company's business plan -- to identify and admit patients with good insurance coverage. Harvey Friedman, the psychiatric unit's vice president for program services, said that Ron Bernstein, the chief operating officer, had issued a directive to "Fill the beds at any cost. Hire sleazeballs. These are his words. Anything it takes. That was his philosophy." A year after NME's approach to Arnold, Norm Zober, president and CEO of its Specialty Hospital Group, which included the psychiatric facilities, scribbled the following hand-written note at a planning meeting: "Kinds of doctors we are looking for? Guys that will admit." At a similar meeting thirteen months later, Zober wrote that the "incentive" contracts that were being discussed were "Deals to sew up M.D.'s."

The doctors were the linchpins of this scheme. And because what they were being asked to do -- accept bribes for referrals among other things -- was illegal, NME cooked up ways to disguise these bribes. The company relied on the doctors to do what was expected of them and in return rewarded them with titles that required no work and paid handsomely. At the psychiatric hospitals, cooperating doctors were usually given contracts as chiefs of treatment units. Peter Alexis, who was regional vice president of Psychiatric Institutes of America for Texas, explained that the doctors were paid salaries ostensibly for providing services expected of someone holding the title they had been given. Alexis also said the size of a doctor's salary was directly linked to the number of his referrals.

Mark Bowlan, the psychiatrist who admitted Jeramy Harrell and eventually pled guilty to charges of making false claims, theft of public money, and forgery, said he received $250,000 from NME his first year under contract, $400,000 in his second year, and was offered $750,000 for a third year. He later told the Houston Chronicle that "Doctors became addicted to the money, whether in terms of lifestyle, financial obligations or recreation." Dr. Arturo Torres of Laurelwood Hospital charged $125 for each patient visit. He averaged twenty-four patients in the hospital and billed for five visits a week per patient, from which he grossed $780,000 in one year. The visits, when they occurred at all, were cursory. Hi, how are you feeling today? Fine, that's good. Bye.

Each hospital's business was driven by extremely ambitious bottom-line requirements that effectively ruled out acceptable patient care. Marketing was everything. James Hutchison, an executive at Baywood Hospital, told an investigative committee of the Texas Senate and the Select Committee on Children, Youth and Families of the U.S. House of Representatives that "every employee, from groundskeeper to program director, from office secretary to nurse, was obliged to conduct weekly marketing calls." Russell Durrett, controller of Psychiatric Institutes of America's Twin Lakes Hospital in Denton, Texas, from November 1988 to July 1989 told the House Select Committee in 1992 that at the Twin Lakes program those with the rank of director and above were given a weekly quota of contacts -- his was five -- and received prizes for referrals. He testified that, "We had an insurance remaining report that we comple...

Customer Reviews

"Spinning the story"
As a local from Redding, I can tell you that some of the "heros" in the book put quite a spin on their involvement. Specifically, when objections were raised about the CV program prior to the FBI raid, those objecting were told that the cardiologist and surgeons were saviors and, furthermore, "they really refer a lot of patients to me" ('so please be quiet about your concerns'). These sentiments were issued by some of the directors of departments in the hospital. Imagine my surprise to find one of these individuals lionized in the book rather than indicted himself! Oh well, this made the reading extra riveting for me!

Appalling....
Appalling would have been a more appropriate name for this book; appalling that these actions occurred in this current era of medicine and regulatory compliance. Every new twist in this well-chronicled story can be described as appalling.

The reader is drawn to the charm of Redding, California, but then the evident ethical disconnects of the townsfolk become apparent. As the story implies, the fact that something was not quite right at Redding Medical Center was well known in the community, yet it was spoken of only in whispers and never with any conviction. Because Dr. Moon and Dr. Realyvasquez were revered in the community, one can only wonder whether the townsfolk were devoid of ethics and chose to ignore the whispers or whether their loyalty to their neighbors blinded them to the truth. Or, perhaps, as one Redding resident wrote in a review of this book, "We felt pretty powerless to stop a huge corporation and its power-hungry minions."

Even more inexcusable than the act of fraud by Moon and RV is Tenet's apparent disregard for the practice, all in the name of profit. What principles did corporate executives lack that they allowed these things to happen and to continue without any intervention. This question becomes more significant when we consider that, in addition to settling this lawsuit for $54M, Tenet settled claims in January and July 2006 worth $215M and $900M, respectively.

This is a well-researched and well-narrated book that exposes the reader to the realities of healthcare. Those of us who work in healthcare and believe in its merits cannot deny that fraud and abuse occur. We, as healthcare workers, have a duty to our patients, employers, and community to recognize and report these practices.

Troubling
Coronary by Stephen Klaidman is a shocking compilation of facts outlining a scandal that rocked the town of Redding California. For deception of this proportion to occur so recently is almost incomprehensible. As a healthcare worker the first 3 or 4 chapters are unbelievable. This story of true life facts reiterates the trust the American people has in their physicians and how easily they can be deceived. The need to question and understand the care you are receiving and to keep your best interests in mind is a clear message.
It is one thing to ask and act on the recommendations of your waitress at the local diner when contemplating ordering that night's special as opposed to your favorite dish. A lapse in judgment is acceptable and can be remedied the next time out; it is on a completely different level when you take the word of your physician as being the absolute truth when you request their recommendation. Physicians are the individuals you trust not with a meal decision with but a life decision. Patients were told that if they did not have these surgeries they would die. The choice they were given was life or death. Extraordinary that an entire community of physicians as well as the patients within that community would harbor the uneasy feelings and gut tugs for so many years prior to the truth finally being exposed by a priest who sought out a second opinion.
Has this episode of events solidified the fact that there is not a sufficient system of checks and balances in healthcare to properly monitor physicians that provide care to the insured patients, whether it is private or government that keep the doors of the hospitals open? It is imperative that every person that seeks medic al treatment regardless of the level of acuity or capacity of the facility through which they get their care question the treatment received; the only person looking out for you is YOU. Inquire when you see something that doesn't `seem' right; ask more questions when you know something isn't right, change will proceed. I would encourage all healthcare professionals to read this book as a reminder of the danger of losing your voice when it comes to communicating concerns of unethical behaviors.