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Doctor sues Lahey, says stent issue led to firing

Cites pressure to use Medtronic product

By Liz Kowalczyk
Globe Staff / November 12, 2009

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A cardiologist at Lahey Clinic said he was fired for resisting pressure from two top physicians at the hospital to use stents made by device giant Medtronic Inc., even though the company’s stents might not have been best for some patients.

Dr. David Gossman, who worked at Lahey for more than 20 years, alleged in a lawsuit filed last month that Dr. Richard Nesto and Dr. Thomas Piemonte pressed him and other cardiologists to use Medtronic stents, because they believed if the hospital increased its use of the product, Medtronic would let Lahey participate in clinical trials for a new heart valve. Trials of the CoreValve are scheduled to begin next summer. Testing medications and devices can help hospitals and physicians attract patients.

Gossman, who lives in Westford, also said in the lawsuit - filed against the hospital and the two doctors in Massachusetts Superior Court - that Piemonte has financial ties to Medtronic. Piemonte is director of interventional cardiology and sits on Lahey’s “inventory committee’’ for the catheterization lab, which chooses products and approves contracts with companies.

Lahey spokesman Steve Danehy said yesterday the hospital’s corporate compliance department investigated the allegations and found them to be “totally groundless.’’ Gossman, he said, was dismissed for “misconduct’’ that occurred months before he said he was pressured to use Medtronic stents.

“We obviously feel pretty badly about the allegations made against these physicians,’’ Danehy said. “We see them as physicians with unimpeachable integrity.’’

Danehy would not elaborate on the alleged misconduct. Gossman’s attorney, Patricia Washienko, said she and her client “wholly disagree with Lahey’s characterization of the reasons for Dr. Gossman’s termination and are confident not only that the evidence will support his claims but that he will be vindicated for what is clearly a wrongful termination.’’

Danehy said Piemonte is a member of Medtronic’s speakers bureau - he receives payments from the company to lecture to other physicians about their products - and that the wives of both Piemonte and Nesto own stock in Medtronic. Piemonte’s wife is a sales representative for the company and sells pacemakers and defibrillators but does not do business at Lahey, Danehy said.

He said these financial ties to the company have not influenced care and the physicians make “decisions that are in the best interest of patients.’’ Danehy said Piemonte has recused himself from voting on purchases of Medtronic stents or other products by the inventory committee, because of his family’s relationship with the company.

Piemonte did not return a telephone call to his office. Nesto said he could not comment on the allegations, because the hospital public relations department was handling all statements about the situation.

In a written statement, Medtronic also said it could not comment on the allegations.

“Medtronic’s process to select potential clinical research sites for the US CoreValve transcatheter valve clinical study was designed to be fair, objective, and independent of commercial interests [such as a hospital’s purchasing patterns],’’ the company said. “We’ve recently been made aware of allegations about that process [arising out of an employment dispute] and are looking into them.’’

In his lawsuit, Gossman, who was assistant director of the catheterization lab, said that by firing him, Lahey violated Massachusetts law that protects whistleblowers in hospitals, among other violations.

Gossman said a Medtronic sales representative approached Piemonte this past summer and offered Lahey access to CoreValve trials, predicated on the hospital’s purchase and increased use of other Medtronic products. This alleged bargain was discussed in the department.

Gossman said that in July, Nesto and Piemonte told one doctor that her low use of Medtronic stents was jeopardizing Lahey’s access to CoreValve.

Gossman said he encouraged his colleagues to resist pressure to use Medtronic stents, and then, during a lecture attended by cardiology fellows on Aug. 27, publicly expressed concerns about the situation.

Two weeks later, Gossman said, Nesto and Piemonte fired him and a security officer escorted him from the hospital.

Gossman did not explain in his lawsuit why he objected to using more Medtronic stents. But in a letter he wrote after his dismissal to a member of the hospital’s research review board, he said that “many in the field believe’’ the stents are “suboptimal’’ and that the conflicts of interest surrounding the product “compromise patient care.’’

Minneapolis-based Medtronic has been embroiled in ethics scandals in the past several years. In 2006, the company reached a $40 million settlement with the federal government over accusations it paid illegal kickbacks to doctors for using its spinal devices.

And earlier this year, a doctor who was a consultant to the company published a study that made false claims about a Medtronic bone-growth product, saying it had much higher success in healing the shattered legs of wounded soldiers at Walter Reed Army Medical Center than other doctors there had experienced, according to Army investigators.

Liz Kowalczyk can be reached at kowalczyk@globe.com.