BARNSTABLE — A prominent cardiologist says he was fired by Cape Cod Hospital after reporting his concerns about poorly done heart surgeries and cost-saving practices that compromised patients’ health.
Dr. Richard Zelman, who was medical director of the hospital’s Heart and Vascular Unit for the last four years, has filed suit in Barnstable Superior Court claiming he was unlawfully fired by officials of Cape Cod Healthcare, the nonprofit that operates both Cape Cod and Falmouth hospitals. Zelman says he should have been protected by the health care whistleblower statute.
A cardiac interventionist who performs procedures like angioplasty and stenting but not surgery, Zelman seeks damages for lost wages and benefits, physical harm, and emotional distress in his Dec. 6 filing. He requested a jury trial.
In a written statement to the Independent, Zelman said that during his long career he has been instrumental in bringing advanced cardiac care to Cape Cod and has been dedicated to providing the same high-quality outcomes and safety that patients expect to receive in Boston.
“Unfortunately over the past five years, there has been inadequate oversight by the hospital administration, and problems have occurred that in my opinion have led to serious patient consequences,” Zelman said in the statement. His concerns were ignored, he said, and resulted in retaliation against him.
Zelman has sued Cape Cod Hospital, Cape Cod Healthcare Inc., and Michael Lauf, the company’s president and CEO.
Under Lauf’s leadership, Zelman argues, the organization “placed profit above all else, including prioritizing revenue generation over patient safety and public health, and frequently retaliated against health care whistleblowers,” according to court documents.
Cape Cod Healthcare issued a statement denying the claims made in Zelman’s complaint “and in particular denies any allegations of retaliation against him for raising patient safety issues or that the hospital failed to take action, when appropriate to continue to improve the quality of the hospital’s cardiac care and services.”
Court documents show that trouble between Zelman and Lauf started in 2019, when the CEO acquired a limited number of cardiac sentinel devices, used in some valve replacements to filter out stroke-causing debris. Lauf prohibited the use of the devices on “managed care” patients such as those on Medicare and Medicaid, preferring patients whose insurance reimbursed at higher amounts, says Zelman in his suit.
Zelman says he believed Lauf’s actions violated professional standards of practice and expressed his concern to the CEO, who he said “angrily castigated” him and threw him out of his office.
Zelman then brought his concern, he says, to a former chairman of Cape Cod Healthcare’s board of trustees, who in turn raised the issue with the board’s current chair who then met with Zelman. Lauf then agreed to acquire devices for use on all high-risk patients, including those on managed care, according to the suit — but he retaliated against Zelman.
At Lauf’s direction, Zelman claims, hospital officials attempted to intimidate him, “threatening to destroy his career and reputation for bringing patient safety concerns to the Board.”
Lauf chastised Zelman in a group meeting for whistleblowing to the board and told him he would be fired if he did it again, according to Zelman’s complaint.
Then, in 2021, Zelman reported to Lauf and other hospital officials what he believed were dangerous practices by the two cardiac surgeons at the hospital. His concern was based on three postoperative deaths and a fourth patient being placed on extended life support following bypass surgery. All the patients had been considered low risk and were expected to have uncomplicated surgeries.
Zelman also cited two failed valve repairs in young patients and the death of a young patient being transferred to another hospital on life support when a tube, sutured in place by one of the cardiac surgeons, fell out en route.
In his response to Zelman, Lauf reminded him that supervision of cardiac surgeons was not Cape Cod Hospital’s responsibility because they were hired by Brigham and Women’s Hospital under a contractual relationship with Cape Cod Healthcare.
Lauf and hospital officials refused to remove the two surgeons, “citing the potential of substantial lost revenue,” according to the court documents. Promises to improve oversight of the two were not honored, Zelman argues.
In October 2021, Zelman took his concerns to Dr. Ralph Bueno, Brigham and Women’s chief of thoracic and cardiac surgery, who promised to send more experienced surgeons to oversee the surgeons at Cape Cod Hospital. Zelman reported to Bueno a few weeks later that “cardiac surgical outcomes appear to have deteriorated,” and he and his fellow cardiac intervention doctors had become “largely reluctant to refer cases directly to either surgeon.”
Ultimately one of the two surgeons was fired for showing up at the hospital with an automatic rifle.
Brigham and Women’s no longer has a contract with Cape Cod Healthcare. Cape Cod Hospital is now affiliated with Beth Israel Lahey Health.
Contacted by the Independent, a Brigham and Women’s spokesperson said the hospital was aware of the suit. “We are reviewing what was filed and evaluating the merits of the connection to Brigham and Women’s Hospital that were made by this individual,” said communications specialist Aaron Sanborn in an email.
Tensions escalated further in November 2021 when Brigham and Women’s reported billing irregularities to the Centers for Medicare and Medicaid Services, arising from the failure of its cardiac surgeons at Cape Cod Hospital to properly document valve replacement procedures. Such deficiencies can result in mandatory refunds of federal reimbursements.
In June 2022, the Brigham issued a full refund to the Centers for Medicare and Medicaid Services for reimbursements related to valve replacement procedures at Cape Cod Hospital for the previous six years. The Boston hospital’s refund “increased the risk that CMS would require Cape Cod Healthcare to issue a similar refund,” says Zelman’s suit. According to court documents, a hospital attorney told Zelman that the Brigham’s decision to self-report the irregularities was based on a fear that “Zelman would become a whistleblower or words to that effect.”
On June 13, Lauf notified Zelman that his employment would end in September, at the expiration of his contract.
According to the documents, Lauf was willing to continue Zelman’s employment if Zelman provided a written statement endorsing the quality of cardiac programs at the hospital. While it represented a million-dollar contract, “no amount of money was going to buy my silence,” said Zelman in his statement to the Independent.
While Zelman is no longer employed by Cape Cod Hospital, he continues to hold medical staff privileges and can perform cardiac procedures as a private practitioner, according to a hospital spokesman. But Zelman maintains in his suit that he continues to experience harassment.
Brian O’Malley, a retired doctor who lives in Provincetown, said of Zelman, “He is someone I trust and has one of the best records in the country.” He added that there are “good people” on both sides of the case.
“I don’t put it personally on Mike Lauf,” O’Malley said. “It’s the way the system is structured these days. It’s a business, and hospitals are treated as independent competitors in the marketplace.”
The steep drop in elective procedures due to Covid has strained hospital finances, said O’Malley. Emergency rooms are meanwhile overwhelmed with patients with mental health and substance use disorder issues, he said.