Customer Reviews

Coronary: A True Story of Medicine Gone Awry

5 star:		(12)
4 star:		(28)
3 star:		(6)
2 star:		(3)
1 star:		(0)

 

 

This book reads easily, is full of suspense and intrigue like a novel. It is so amazing that this could have gone on! Being an RN myself, I can't imagine the total lack of peer review that apparently was the norm at RMC. My mother is also an RN who worked there with Moon and says the author's account of him rings absolutely true to her. This book needs to be read by more of the public to help them understand the mess the healthcare industry is and how important it is to be knowledgeable healthcare consumers. A big thanks to Klaidman for laying out this convoluted story in such a readable way!

This was a relatively fair telling of the RMC scandal that hit our community a few years back. Klaidman tries to present a complete picture of the main players to the readers and for those who are familiar with the story and the area, it is fascinating. I don't think he was fair, however, in saying that the local public was oblivious to what was going on. Many of us were quite aware of the overdiagnosis and excessive sugery but were only able to steer those we knew away from Moon and RV. We felt pretty powerless to stop a huge corporation and it's power-hungry minions.

How much faith do have in your doctor? How do you really know if his or her recommendations are sound? Are the currently-popular health care and physician rating systems effective? Is the health care system appropriately monitored? These are just a few of the questions explored in "Coronary", written by Stephen Klaidman. In this book, Klaidman tells a detailed, dramatic, and shocking account of Redding Medical Center and the 2002 medical scandal that harmed over 700 patients in the name of profits. Redding Medical Center, a well-known, highly acclaimed cardiac hospital, housed two of the "nation's best" heart specialists. Together, they boasted some of the highest volumes of cardiac procedures in the nation, mainly because they were performing completely unnecessary surgeries on completely healthy patients, employing the opinion that "there's no money in the cure, there's only money in the treatment" (p.128).

Klaidman describes the story in detail, including the sting operation that ended in relatively unsubstantial monetary settlements for the victims and lenient disciplinary actions against the doctors. Unfortunately, the long descriptions used to describe everything in the story, from the history of Redding to the personal accounts of the lawyers involved detracted from his desired impact on the reader and made it a boring read in parts.

Personally, I found the psychological aspects of the book the most shocking. Many of the patients put blind faith in Dr. Moon, and those who sought second opinions lived in fear and doubt of their medical status, wondering if they were sick long after getting multiple clean bills of health. Additionally, it seemed as though both doctors actually believed they were practicing ethical medicine. This story, in book form or in the shorter version of news archives, is recommended to any person that has ever contemplated the value of a second opinion or questioned the integrity of health care in America.

This story of medical malfeasance at one of the nation's most celebrated hospital centers is an exhaustively researched page turner with a vibrant cast of characters and a plot that begs for an "Erin Brockovich"-type transformation to the big screen. There are doctors with out-of-control God-complexes and an array of medical practitioners who enable them; there are corporate scoundrels without conscience, whistle-blowers who are themselves something less than saints, and a dogged lawman who never gives up his pursuit of justice. And there are, of course, the patients & their families - the victims whose anguish is almost beyond reckoning. But "Coronary" merits five stars not just for what you'll find within its pages but also for what you will not find. Most importantly, there is no manipulation of facts or context to fit a preconceived theory on the part of the writer; there is no exploitation of human suffering for the sake of juicing up the drama, and there is no promiscuous use of quotation marks to reconstruct fading conversations -- a flaw that unfortunately, debases so much of contemporary non-fiction. Even leaving aside the likelihood that "Coronary" may well help to prevent future medical catastrophes like the one that is its subject, this book exemplifies investigative journalism at its best.

Very scary story well-presented in human terms. I appreciated challenges the author faced knowing how the story has no clear-cut or satisfactory ending. But that's reality. In terms of personal impact, I found its telling both cautionary and heart-rending: an indictment of profit-motivated, unregulated big medicine run amok. I recommend Coronary and have been sharing my copy with friends and relatives.

In October 2002 Tenet Healthcare headquarters was stunned to learn that 600 FBI agents had just raided one of their hospitals in Northern CA, seizing documents, computers and other information for a whistleblower lawsuit that accused two highly-respected cardiac physicians of performing thousands of unnecessary, highly invasive surgeries on relatively healthy people in order to drive up the hospital's revenue. This book is a blow-by-blow description of those events.

Certainly subjective in its approach - telling all from the side of the doctors, patients, the FBI and the pile of plaintiff attorneys - it's nevertheless a compelling look at how the business of healthcare - and it is a business - has to walk a very fine line between the need to operate that business profitably and the obligation to provide quality, ethical healthcare at the same time. It's also a rather scary look at just how significantly members of the medical community differ from one another when it comes to diagnosis, treatment, and the clinical environment.

Years later, the community of Redding and the healthcare community at large are still sharply divided over what all really happened at this hospital, and there's so much we'll never know. There are some reviewers on Amazon (notably, two of the main doctor's relatives, so not exactly objective) who claim that the book is basically a work of fiction, about people making hysteria-driven accusations that were soon fueled even further by the fat pot of financial awards, but it's not quite that simple. I found the author's style slightly sensational, but not overly so and I expected that going in. This was a very broad and complicated series of events and he really only had one side of the story.

Book Report
By authoring the book Coronary, former New York Times reporter Stephen Klaidman is attempting to expose a major "systemic flaw" (Klaidman, 2007, p.284) in American medicine; one he inadvertently became aware of after reading of the FBI raid on Redding Medical Center. Criminal fraud by practioners and the various entities that house and facilitate medical practice became a subject that Klaidman knew he could pen a book about and "enlighten" the public. (Klaidman, p.285). By chronicling the medical and surgical practice of a cardiologist, surgeon, and their minions in performing hundreds of unnecessary cardiac caths and bypasses, Klaidman has exposed the soft underbelly of why the American medical system appears to produce so much dissatisfaction. The reason is defined in the succinct observation of Mike Skeen, the FBI agent in charge of the investigation, "At some point, Skeen was convinced, a transition was made from human beings to numbers." (Klaidman, p.257).
Klaidman painstakingly researched the medical scandal in Redding and wrote a book that is factual in its observation, presentation and conclusions. He attempts to be fair and balanced in presenting the doctors' motives and actions. he does not judge their motives accept to quote others regarding g their motives, and quotes the doctors themselves. He is however, scathing in his undeniable exposure of real physical harm done to patients by performing unnecessary surgeries and procedures, and the reluctance of the United States attorney to prosecute a criminal case against the defendants, the top executives of Tenet Healthcare Corporation, who were already embroiled in the civil cases. (Klaidman, 2007, p.281). Klaidman's ability to translate complicated legal maneuverings into a form that is both suspenseful and intelligible to laymen is particularly commendable.
This book should be recommended reading to all who work within the American medical system in any capacity, from the financial and other miscellaneous administrators of medical corporate entities to the caregivers in clinics, laboratories and hospitals. Furthermore, any individual who has an interest in medical care, whether for themselves or another should read this book. This book poses the question of whether the American capitalist system of profit and loss can be successfully applied to medical care without the patient being sacrificed to the end goal of the" bottom line." As Klaidman paraphrases Mike Skeen the FBI agent in charge, "To them these weren't patients, these weren't people; they were revenue generators."(Klaidman, 2007, p.257)

The situation described in "Coronary" was extremely complicated. Actions of the main characters were described as being, or potentially being, in violation of laws at a variety of governmental levels, and some were criminal violations while others were civil. The descriptions of events were heavily dependent on the dialogue among the main characters.

In the last page of the book of the section following the concluding chapter, in the section titled, " Author's Note", Stephen Klaidman writes, " To make the book as readable as possible, I have sometimes reconstructed conversations and used quotation marks. I did this when one or more parties to the conversation had a clear and consistent memory of it and when no other participant credibly denied that the conversation had taken place essentially as I had recorded it. I also used quotation marks when the conversation was part of a sworn statement such as a deposition or FBI affidavit. When one party to a conversation said he or she did not remember what was said, I made a personal judgment based on my assessment of the credibility of the parties."
In the presentation of such a complicated situation, the wide latitude of the author in his exercise of judgment as to how facts within dialogue would be presented has a great impact on the reader's interpretation of fact. An objective reading of the book does not lead to an automatic agreement with the obvious conclusions of the author.

The reader may decide to be automatically outraged by the information described by the author, but how much of the information is true and not a matter of interpretation? What is seriously disturbing is the fact that it is entirely possible that for profit healthcare organizations might benefit from the unethical behavior described by the author and that physicians associated with those organizations could be enticed to support or to ignore their transgressions.

Coronary: A True Story of Medicine Gone Awry, by Stephen Klaidman, is a story of greed, ego, and intimidation in healthcare. It serves as a cautionary tale to patients, healthcare administrators, and healthcare professionals. The book itself does not inspire, but it does provide information and a level of transparency desperately needed in healthcare.

Klaidman is a former editor and reporter for The New York Times, The Washington Post, and The International Herald Tribune. His interest in systemic flaws in medicine led him to write numerous articles and several books, including Saving the Heart: The Battle to Conquer Coronary Disease, Health in the Headlines, and The Virtuous Journalist. His background of being a senior research fellow at the Kennedy Institute of Ethics likely helped peak his interest when he learned that FBI agents had raided a hospital and two physician offices in Redding, California, in October 2002. The FBI was investigating allegations that hundreds of unnecessary procedures had been performed at the Redding Medical Center (RMC), some resulting in death. RMC is a hospital which, at that time, was well-known for its cardiac program and was a part of the Tenent Healthcare system. This, however, was not the first time that Tenent, known previously as National Medical Enterprises, had been involved in scandal.

The book documents the rise of two physicians, Dr. Chae Hyun Moon, chief cardiologist, and Dr. Fidel Realyvasquez Jr., cardiac surgeon, who became immensely powerful in RMC due to the tremendous growth in volumes and revenue, for which they were responsible. As Tenent pushed for higher profits, the need for continued growth and success of the cardiac section resulted in Moon and Realyvasquez operating without appropriate oversight and the unwillingness of administrators and staff, as well as other physicians, to question them in any manner. Additionally, as the reputation of RMC grew as the "place to go" for cardiac care, so did the fortunes of some of those surrounding Moon and Realyvasquez. In 2002, Father John Corapi, a respected priest, and his friends, Joe Zerga and Tamra, realized that Corapi had narrowly escaped unnecessary surgery. Through tenacious investigation and questioning and through contacts they had and made, authorities finally became interested in the allegations.

While Klaidman obviously spent a tremendous amount of time with a multitude of players and documents in this devastating drama, he fails to truly emotionally engage the reader or gain the reader's full trust. The book fails as both a novel and a documentary as it apparently tries to straddle both worlds. Long, involved descriptions meaning to convey a setting or bring a person to life only results in boredom and a desire to skim the book. Klaidman's self-proclaimed use of quotation marks in reconstructed conversations based on participant's memories (p. 285) is questionable. He provides instances himself, such as on page 110, where Corapi, whom Klaidman states has "an almost verbatim memory of conversations" (p. 109) misstates or omits facts. Klaidman disregards that a person recounting something multiple times is not proof that the person's recollection is necessarily accurate. In addition to lack of cooperation from the two physicians, Moon and Realyvasquez, who were accused of performing hundreds of unnecessary procedures for profit, Klaidman does not rise above his own bias, thus destroying any balance that could have been had.

However, despite the above-mentioned shortcomings and lack of sufficient identification of documents and other proof, Klaidman presents a compelling story. Anyone who reads this book will never again have a procedure without seeking a second, or even third, opinion. As shown in Coronary, the patriarchal and hierarchical structure in healthcare can result in intimidation of patients, professionals, administrators, and staff to the point where organizational and personal ethics are no longer in play.

While this book is interesting and does give a good overview, background, and interesting facts in the case, it is not a particularly good read as a novel and readers interested in just the facts would do better to look for other sources.

"Coronary" is a pretty quick and interesting read. The story is really scary, kind of like COMA (25th Anniversary Edition) in real life.

What will really interest lay readers but is not particularly news to those of us who are attorney who represent malpractice victims is this: the extent of "turning a blind eye" or outright cover up that some in the medical profession will choose to do rather than turn in a politically powerful doctor who is not just hurting, but in some cases, killing people.

It's not until the civil lawyers get involved, frankly, that this house of cards (the massive amount of unnecessary procedures being done which seemed to financially support not only the hospital where they were taking place but the local country club as well)falls apart.

Folks, this is simply not all that unusual in the real world. This book would also be a good gift for anyone who thinks that we ought to limit damages in malpractice cases. California's silly arbitrary limit on damages nearly kept all of the civil lawyers out of the case completely, because the financial risk to the lawyers was too great compared to California's measly recovery limits for malpractice victims.