Doctor said to strike patient at hospital

Doctor said to strike patient at hospital

Federal probe targets cardiologist, Scripps
By Cheryl Clark
UNION-TRIBUNE STAFF WRITER

September 8, 2007

LA JOLLA - Dr. Maurice Buchbinder, a prominent cardiologist, and Scripps Memorial in La Jolla are under federal investigation because he allegedly hit a patient several times during a procedure at the hospital, physicians and health officials have confirmed.

On Tuesday, Buchbinder was suspended indefinitely from practicing at any Scripps facility in the county.

"I can confirm the suspension, and that there is an investigation under way," Scripps spokesman Don Stanziano said.

The probe was launched after several lab technicians who saw the alleged abuse filed a complaint with state licensing officials.

Their complaint accuses Buchbinder of violating standards of care established by the federal Centers for Medicare and Medicaid Services, which reimburses hospitals for treating Medicare patients.

A team of investigators for Medicare and the state visited Scripps Memorial on Tuesday.

"The complaint investigation . . . is not yet concluded," said Diane Greif, a manager for the agency in San Francisco.

Two physicians and other officials connected with heart care at Scripps independently told TheSan Diego Union-Tribune the same story. They spoke on condition of anonymity.

None of them saw the incident, but they said they were informed of the details.

They said the complaint concerns a patient who underwent a procedure in Scripps Memorial's catheterization lab Aug. 31.

The procedure involves threading a tube through coronary arteries to detect and unblock various obstructions. It is normally conducted while patients are awake, and mild sedatives are often administered to keep them calm.

Nevertheless, some patients become unruly and combative, either from fear or because of unintended effects from the medications.

In those rare cases, it is common for health professionals to use arm or leg restraints or additional drugs to keep the patients from hurting themselves or others.

Sources said those measures should have been standard protocol during the procedure involving Buchbinder.

Instead, they said Buchbinder was seen hitting the patient repeatedly over different parts of the body in an effort to keep the patient from moving. They described Buchbinder's actions as "abuse" or "assault."

Buchbinder, 54, did not respond to several requests for comment.

A woman who answered Buchbinder's home phone Thursday identified herself as his wife and said he "has not been a hazard to the community."

"The patient is absolutely fine. This is not a medical ethical issue," she said. "This is going to be a legal matter. . . . There's a lot more to the story."

The woman said her husband "has had a stellar performance in the medical world. (Now) he's guilty until proven innocent."

In a statement issued yesterday, Scripps officials said they had launched an internal investigation.

"We take all complaints involving patient safety seriously," the statement said.

Scripps performs more heart procedures than any other hospital system in the county. Besides the patients in its own network, Scripps has a contract to handle most cardiac services for members of Kaiser Permanente in the San Diego region.

A year ago, heart doctors at two fiercely competitive Scripps facilities - Green Hospital and Scripps Memorial - announced they would set aside their turf and ego battles. The amalgamation was meant to pave the way for a unified Scripps Cardiovascular Institute, a $360 million building still being planned.

At the time, Buchbinder was described as the institute's co-director along with Dr. Paul Teirstein. This week, however, Stanziano said Buchbinder never officially received that title.

It is not the first time Buchbinder's name has been associated with controversy.

In 1991, Buchbinder, then practicing at UCSD Medical Center, helped test a device called the Rotablator. The rotating tool has a tiny diamond head mounted on the end of a shaft. When inserted into a clogged artery, the device was said to remove fatty obstructions in about 95 percent of cases.

In 1994, a federal audit faulted Buchbinder's use of the Rotablator in patients before it received government approval.

The audit also found that:

Important follow-up exams of coronary vessels were not done for 280 patients who were treated with the device.

The Rotablator was used in some people even though their heart disease had become severe.

Problems experienced by certain patients weren't reported properly.

UC San Diego subsequently blocked Buchbinder from using the device on an experimental basis.

It was then reported that Buchbinder owned about $10 million worth of stock in Heart Technology Inc., the company that made the Rotablator, at the same time that he coordinated Rotablator research at about a dozen hospitals nationwide.

As the audit was under way, Buchbinder quietly sold a large portion of his shares.

He is currently testing the Watchman, a device resembling a small parachute, as part of a study. It is designed for people with atrial fibrillation, a heart condition that raises a person's risk of suffering a stroke by five times.

The mini-parachute is placed near the left atrial appendage of the heart, with the goal of stopping blood clots from leaving the heart and traveling to the brain.

A spokesman for the Watchman's manufacturer, Atritech Inc., said Buchbinder was the only cardiologist in San Diego using the device. He had enrolled 26 patients as of April, the spokesman said.