Health expenditure in US is by far the highest on earth. Life expectancy and health parameters are between the worse in western nations. Great medicine is practiced in major institutions like the Mayo, Hopkins, Cleveland Clinics. So, where is the problem? Possibly it lies within for-profit rural health systems, wealthy corporations created to suck money out of rural communities while rendering a service of dubious value.

Health expenditure in US is by far the highest on earth. Life expectancy and health parameters are between the worse in western nations. Great medicine is practiced in major institutions like the Mayo, Hopkins, Cleveland Clinics. So, where is the problem? Possibly it lies within for-profit rural health systems, wealthy corporations created to suck money out of rural communities while rendering a service of dubious value. Selecting patients on "ability to pay" criteria, pushing for unneeded easy procedures while disregarding major diseases or -at best- referring them elsewhere: these are few of the tactics implemented to create income without improving community health services. As a naive foreign physician, I was involved personally in the following events which support this hypothesis.


HEALTH MAFIA IN WEST LOUISIANA



Dr.Guadalupi is punished for Byrd Hospital (Leesville, La) and CHS,Inc (Brentwood TN) managers' poor and dangerously greedy plan. Dr.Guadalupi is at fault because he assumed that hiring a thoracic/vascular surgeon meant a safe and honest thoracic and vascular practice. Should Dr.Guadalupi have guessed that CHS plan was to build extra income using Byrd Hospital:

§ to perform unsafe thoracic/vascular procedure, lacking necessary structures;

§ to push non standard indications for vascular testing and procedures;

§ to manipulate Tricare referral pattern at BJACH;

§ to crowd surgeons in the Leesville area, to increase the amount of unneeded surgical procedures, done in order to keep practices economically viable.



HOSPITAL ILLEGAL ACTIVITIES were implemented in order to compensate for the lack of adequate services and referral pattern. The fraudulent inducement of a subspecialty surgeon is not an isolated administrative issue. It has severe consequences on the practice of medicine and the care of patients. Dr.Guadalupi can report precisely (name of patients can be tracked) how the inadequacy of the hospital caused unnecessary patient suffering, unneeded procedures and attempt to channel patients illegally from the neighboring Army Hospital.

o Damage to patients:

§ AA: missed pancreatic cancer by CHS-tele-radiologist, referred for carotid endarterectomy. This case demonstrates: the danger of not having a radiology department; administration plan to push for any possible procedure even if not indicated.

§ BB: lung cancer, underwent thoracotomy twice because the non-certified pathologist read "metastatic cancer" a nodule that, after few days, was read as non-cancerous. It demonstrates the danger of performing major surgery in a hospital without adequate services.

§ CC: renal mass in patient with renal insufficiency; pathologist could not tell if was cancerous or not, so Dr.Guadalupi had to do a total nephrectomy (instead than a polar partial nephrectomy preserving renal function). As above.

§ DD: pacemaker inserted by cardiologists, Dr.Guadalupi performed emergency sternotomy for perforated heart. It demonstrates the danger of pushing for low volume high risk procedures in a minor hospital.

§ Details and names to follow. These cases were not a small percentage: for example, BB was one of only three thoracoctomy done in Leesville in 20 months. It was the only lung surgery in which Dr.Guadalupi needed an immediate definite answer from the pathologist, and the answer was wrong.



o Fraud toward patients (fraudulent medical practice): Byrd Hospital administrators advised Dr.Guadalupi to recruit vascular patients by offering free non invasive (Doppler) testing of the lower extremity arteries to elderly asymptomatic population; then to prescribe angiography if the Doppler test was abnormal, and offering surgical revascularization if lesions were confirmed. Screening and revascularization of low extremities asymptomatic lesions is not an accepted standard of care. Mr.Sam Fulton, in this occasion, recommended Dr.Guadalupi "You should do like Dr….. –previous cardiologist in Leesville- who was performing a procedure on almost every patient he was seeing". These type of events reflects the spirit of CHS/Byrd Hospital administration: increase hospital billing without respect of the quality and honesty of care.



o Fraud toward government resources. CHS/Byrd Hospital administrators pressured the Tricare office at Bayne Jones Army Community Hospital (BJACH) to channel patients toward their Leesville facility. Many of these patients would have been better directed :

· To facilities closer to their home;

· To facilities adequate for their complex pathologies;

· To more adequate facilities which were closer to their home as well.

Improper referral of Tricare patients produced unfair gain by:

· performing tests and procedures (example: cardiac catheterization) that needed to be repeated later in adequate hospitals;

· performing procedures without critical objective indications (example: joint replacement);

· performing major procedures (vascular, thoracic, oncological surgery) without a full range of services, increasing the immediate gain of the hospital but also increasing the overall cost of care;

· indirectly, increasing patients’ difficulties in the utilization of appropriate medical care.

· statistics of patient referred from the Army Hospital can prove the trend skewed in favor of Byrd Hospital respect to other major hospitals (1998-2003 for example).

Dr.Guadalupi was involved directly in the Army Hospital connection in two occasions:

· Mr.Roger LeDoux and Mr.Sam Fulton organized a meeting between him and Col.Noel Habib, commander at Bayne Jones Army Hospital, to organize a collaboration "as the collaboration already in place between Army orthopedics and Dr.DeLapp", according to Byrd Hospital CEO Mr Roger LeDoux.

· Mr.Roger LeDoux and Mr.Sam Fulton recommended Dr.Guadalupi to take privileges at the Army Hospital through Spectrum Healthcare in order to do surgical clinic and calls at the Army Hospital. They instructed him about referring major surgery outside the Army Hospital, but not to himself (which was illegal). The case should have gone first to Byrd Hospital cardiologists (vascular cases) or pulmonologist (lung cases), which would have completed the work-up and then re-referred the patient back to Dr.Guadalupi for surgery.

· After a first meeting with Col.Habib and having taken privileges with Spectrum Healthcare, Dr.Guadalupi dropped this deceiving plan.



o Fraudulent inducement to have a thoracic/cardiovascular surgeon sign a Recruitment Agreement (Mr Don Henderson, Mr Sam Fulton).

o Disregard for Immigration Rules: Mr.Don Henderson and other CHS Inc executives induced Dr.Guadalupi to sign a Recruitment Agreement while Dr.Guadalupi was living abroad without any US Immigration VISA.

o Criminal conspiracy and legal harrassment: Byrd Hospital and its connections at the local 30th District Court (see attachment) conspired and persecuted Dr.Guadalupi, not respecting the rules of service abroad and international conventions, denying a convenient venue and systematically rejecting all Dr.Guadalupi’s reasonable objections and requests for fair mediation. This conspiracy includes also cover up of Byrd Hospital/CHS Inc attempted fraud and punishment for Dr.Guadalupi’s whistleblowing.

o Disrespect for Dr.Guadalupi’s condition. Abuse of corporate power. Dr.Guadalupi is a person with high moral values, dedicated to his work and his family. Dr.Guadalupi is a human being –not a corporation- who cannot afford the economical and psychological stress of fighting legal persecution, while the dishonest CHS Inc executives are using unlimited resources. Dr.Guadalupi may not be able to continue practicing under stress, so may not be able to defend himself any further. Dr.Guadalupi asks that CHS Inc/Byrd Hospitals executives are made individually liable for any economical, physical and moral distress suffered by himself and his family now and in the future.

Dishonest persons:
o Don Henderson, CHS Inc Brentwood TN, former CEO, Byrd Regional Hospital
o Roger Ledoux, CEO, Byrd Regional Hospital

o Sam Fulton, Byrd Regional Hospital

o Wayne T.Smith, CEO, CHS Inc, Brentwood, TN

o Brian Peoples, CHS Inc, Brentwood TN

o Alva Wolfe, CHS Inc, Brentwood TN

o John Ford, Judge, 30th District Court

Trackable (proof):

o Name of damaged patients.

o Visit to BJACH Cmdr Habib, Spectrum Healthcare privileges.

o Referral records from BJACH to Byrd and other Hospitals, 1997-2002.

o Patients who had cardiac cath at Byrd Hosp and then test repeated elsewhere .

Pietro Guadalupi, MD, FACS
pguadalupi@earthlink.net