番茄社区

A long-time Cape Cod interventional cardiologist is , alleging that he was retaliated against and defamed, and that the terms of his employment contract were breached, all as the result of sounding the alarm on profits being placed before patient care.

Richard Zelman, MD, against Cape Cod Hospital and its president and CEO, Michael K. Lauf, as well as its parent health system, Cape Cod Healthcare, in Barnstable County Superior Court earlier this week.

Zelman first became affiliated with the hospital in 1990, accepted full-time employment in 2006, and previously served as medical director of its newly created Heart and Vascular Center since 2018.

In his complaint, he stated that, "when he raised patient safety concerns that impeded revenue generation or otherwise adversely affected the bottom-line, the defendants retaliated against [him], including by threatening his career and reputation and unlawfully terminating his employment with the hospital," which Cape Cod Hospital adamantly denied.

Zelman pointed to alleged occurrences that began in 2019, such as when he objected to Lauf refusing to acquire certain devices to filter out stroke-causing debris for use in all transcatheter aortic valve replacement (TAVR) procedures on patients deemed to be at high risk. While Lauf eventually acquired a limited number of these devices, he prohibited their use in Medicare Advantage or Medicaid managed care patients, preferring they be used for patients whose insurance reimbursed at higher amounts.

Zelman alleged that when he "objected to this prohibition in accordance with his contractual and ethical obligations to ensure treatment of patients without regard to their ability to pay," and brought his concerns to Lauf directly, the CEO "responded harshly" and with "attacks that grew deeply personal."

After Zelman next brought his concerns to the most recent past chairman of the health system's board and met with the current chairman, the CEO agreed to acquire devices for use in all high-risk patients.

However, Zelman alleged that the retaliation that followed was "swift and persistent," including threats of publicizing "false allegations of deficient performance" and immediate termination if whistleblowing to the board ever happened again.

In 2021, Zelman said that he observed and reported what he believed to be "grievously dangerous care" by two cardiac surgeons working at the hospital, which did not employ its own cardiac surgeons. According to the complaint, in response to Zelman's reports, Lauf reminded him that the supervision of cardiac surgeons was not his responsibility, but rather the responsibility of their employer, Brigham and Women's Hospital in Boston.

While Zelman said that he reported his concerns to numerous health system officials, the complaint stated that the defendants "failed to take the steps necessary to protect patients and, instead, retaliated against [him] for his whistleblowing activity."

The defendants didn't dispute the allegations regarding the cardiac surgeons' care, but "citing the potential for substantial lost revenue, the defendants refused to remove either cardiac surgeon from the surgical staff or to shut-down the cardiac surgical program until a patient-safe alternative could be implemented," the complaint added.

Patient safety concerns were allegedly escalated by Zelman directly to Brigham and Women's Hospital, after which members of Cape Cod Hospital leadership informed Zelman that Brigham and Women's had self-reported TAVR-related billing irregularities to CMS in fear that Zelman would become a whistleblower "or words to that effect," according to the complaint. Because of Brigham and Women's report to CMS of its own billing irregularities spurred by Zelman's whistleblowing activity, the defendants faced losing millions of dollars.

At the beginning of this year, Zelman alleged that Lauf repudiated an agreed-upon extension of his employment agreement, citing the potential reputational and financial losses to Cape Cod Hospital from Brigham and Women's Hospital's reporting. After Zelman in turn expressed concerns about retaliation for whistleblowing, the defendants launched a "trumped-up investigation" of him, the complaint stated.

In May, the defendants learned that Brigham and Women's Hospital would be issuing a full refund to CMS for all TAVR procedures performed at Cape Cod Hospital over the previous 6 years. The following month, Lauf notified Zelman that his employment would end at the end of September.

Among the other allegations, Zelman noted that Cape Cod Hospital had been willing to continue his employment provided that he agree to issue a written statement that endorsed the quality and safety of the hospital's cardiac programs. However, Zelman allegedly refused, giving up a "multi-million dollar contract," the complaint noted.

Zelman is seeking damages of an unspecified amount.

In an emailed statement, Zelman wrote, "Over the past 25 years, I have been instrumental in bringing advanced cardiac care to Cape Cod. My commitment has always been to delivering the same quality, outcomes, and safety as the academic centers in Boston. Unfortunately, over the past 5 years, there has been inadequate oversight by the hospital administration and problems have occurred that in my opinion have led to serious patient consequences. I have voiced concerns over several years and they have been ignored."

"Cape Cod Hospital offered me a million-dollar contract as long as I agreed to immediately issue a written statement endorsing the quality and safety of the cardiac surgical program that no longer exists," Zelman added. "No amount of money was going to buy my silence."

In an email to 番茄社区, Cape Cod Hospital provided the following response: "While Dr. Zelman is no longer employed by Cape Cod Hospital, he continues to hold full medical staff privileges at the hospital and perform cardiac procedures as a private practitioner. The hospital denies the claims set out in his complaint, and in particular denies any allegations of retaliation against him for raising patient safety issues or that the hospital has failed to take action, when appropriate, to continue to improve the quality of the hospital's cardiac care and services."

"We value and support the many dedicated physicians, nurses, and other staff members who care for our cardiology patients every day. This litigation is unfortunate and the allegations are a disservice to the hard work of these professionals. We will vigorously defend this case, but it would be inappropriate for us to offer further comment at this time," the hospital added.

Meanwhile, Brigham and Women's Hospital sent their own email, stating, "We have been made aware of Wednesday's court filing and are reviewing its contents. As healthcare providers, patient safety is our first priority and we regularly review our care to ensure it meets the highest quality standards."

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