Reality Check is a Herald series holding those in power to account and shining a light on their decisions. Have a suggestion for a future story? Email our journalists at [email protected].
When the University of Miami medical school heralded the hiring of its new chief of cardiothoracic surgery in 2019, it noted the vast number of surgeries performed by Dr. Joseph Lamelas.
“Dr. Lamelas has performed more than 16,000 cardiac surgeries throughout his 28-year career, 7,000 of which have employed a minimally invasive approach,” the second paragraph of UM’s announcement read on Jan. 2, 2019.
And if you divide 16,000 surgeries by 28 years, the math shows that Dr. Lamelas would have performed 571 surgeries in a given year, or roughly 1.5 surgeries every day, seven days a week.
The issue of the number of surgeries Lamelas has performed is at the center of a $15 million settlement struck between Baylor University, where Lamelas previously worked before joining UM, and the Justice Department, which announced the settlement this week.
READ MORE: Top UM heart surgeon at center of $15 million settlement between Baylor and feds
According to medical experts uninvolved in that legal dispute, surgeons don’t do surgeries seven days a week. Rather, the norm is for surgeons to perform surgeries just two to three days a week, giving them time to conduct office visits with patients on the other days.
“It’s an extremely high number of surgeries to do,” said Dr. Alexander Marmureanu, referring to Lamelas’ career average of 571 surgeries a year. Marmureanu is a Los Angeles board-certified cardiothoracic surgeon whose bio says he does more than 400 surgeries a year.
‘Hundreds of simultaneous overlapping surgeries’
This week, Houston-based Baylor St. Luke’s Medical Center, Baylor College of Medicine and Surgical Associates of Texas P.A. have jointly agreed to pay the settlement, which revolved around claims of allowing “unqualified physician trainees” to perform heart surgeries alone in operating rooms while Lamelas and other veteran teaching surgeons were doing surgeries in other operating rooms at the same time. The veteran surgeons attested to being in both rooms for billing purposes.
Lamelas, 63, who also served as chief of cardiac surgery at Mount Sinai Medical Center in Miami Beach, is accused of performing “hundreds of simultaneous overlapping surgeries” during his two-year stint at Baylor, according to court records.
Although physically impossible to be present at the same time during the concurrent surgeries, Lamelas wrote on medical records that he performed the procedures, according to the 2022 lawsuit filed by the feds in Texas, after a whistleblower first filed suit.
He and two other surgeons at Baylor at the time — Dr. David Ott, 71, and Dr. Joseph Coselli, 71, — then submitted false claims to Medicare, which has regulations governing surgeries, for reimbursement for the heart surgeries, the suit alleges. Prosecutors says this happened from June 2013 to December 2020.
“From a Medicare point of view this is unacceptable,” said Marmureanu, also noting that “the surgeon doesn’t just leave the patient by themselves. The residents continue the operation and should be qualified to do so.”
Baylor, in a statement to USA Today, which first reported the settlement, said the settlement “is not an admission of liability” and that it settled the case rather than pay the litigation costs of a trial.
“Baylor College of Medicine did not engage in conduct that violates any applicable federal law or regulation. It is also important to note that no patients were harmed,” Robert Corrigan Jr., general counsel for Baylor College of Medicine, said in the statement.
“From a surgical standpoint, as long as those assisting are well-trained and qualified, it shouldn’t be unsafe,” said Marmureanu.
But federal prosecutors noted in their 2022 suit the surgeons “left unqualified physician trainees (residents and fellows) alone in operating rooms to operate on unwitting patients so the teaching surgeons could run multiple surgeries simultaneously.”
The University of Miami medical school has not commented on the case, telling the Herald the litigation did not involve them. UM’s doctors work at the county-owned teaching hospital, Jackson Memorial, as well as the school’s own hospital near Jackson’s main campus.
Lamelas earned more than $3 million in 2021 at UM, according to the latest University of Miami IRS 990 filing posted on Guidestar, the organization that tracks nonprofits.
Lamelas discusses his surgeries in UM video
Lamelas, widely recognized as a pioneer in minimally invasive cardiac surgery, said in a February 2019 YouTube video — a month after UM hired him — that he normally performs “between three and five operations a day. And the majority of them are these minimally invasive operations.”
But mitral valve repairs, a specialty of Lamelas’, are intricate procedures that include setup time and the actual surgery, said Keith Pelletier, a Connecticut healthcare consultant and former healthcare administrator.
“A straightforward minimally invasive mitral valve surgery without robotic assistance usually takes around four hours, though this can vary,” said Marmureanu.
And while performing two to three minimally invasive surgeries in one day is feasible, it requires significant time for preparation, anesthesia and post-operative care, Marmureanu said.
“If you have a lot of help, you can bypass some of these steps and focus only on the surgical part,” he added.
Complex surgeries
In the Baylor-Justice Department settlement, authorities noted that overall “the heart surgeries at issue are some of the most complicated operations performed at any hospital including coronary artery bypass grafts, valve repairs and aortic repair procedures. These surgeries typically involve opening a patients’ chest and placing the patient on the bypass machine for some portion of time.”
Given the complexity of the surgeries, “the attending surgeon should always be in the room,” Pelletier said. “There are times when I’ve seen surgeons just pop in for the timeout and then leave, which is not acceptable.”
The issues raised in the lawsuit and settlement are sensitive ones in the surgical profession, experts say. Representatives from UCLA and University of Florida medical schools declined to comment for this article, as did Florida hospitals with major cardiac surgery divisions, including Cleveland Clinic Florida, Baptist Health South Florida, Memorial Healthcare System and the Mayo Clinic.
Source Agencies
