Doctor Fired After Revealing Testing Flaws

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MILWAUKEE -- A cardiologist whose research at a national medical meeting revealed that other doctors at her hospital were misreading a substantial number of diagnostic echocardiograms has been fired by that hospital, the Journal Sentinel and MedPage Today have learned.

The fired physician, Dr. Kiran Sagar, said she was called into a meeting with Aurora St. Luke's Medical Center officials at the end of August -- two months after the results of her study were presented at the American Society of Echocardiography meeting -- and told that her contract was being terminated.

Sagar said she was told she would be paid until the end of November, but she had to leave her hospital office immediately.

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"They said, 'Don't worry, we'll pack up your office,'" Sagar said.

In an interview, she said she was never told why she was being let go. She said she suspects it was because of her research on the misread echocardiograms and the publicity it generated.

"The cardiologists weren't happy," she said. "I think behind the scenes they were saying, 'How can you expose our dirty laundry?'"

In an e-mail, an Aurora spokesman said Sagar's firing was not related to her presentation.

"Dr. Sagar's contract was terminated for a number of reasons, none related to her study," spokesman Adam Beeson said in the statement. "This was in no way a retaliatory action. As a matter of fact, the study supported our quality improvement initiatives and has resulted in heightened standards in the echo lab."

Sagar, 65, who has trained dozens of doctors in echocardiography over the years, is one of the first female cardiologists to practice in Wisconsin.

She came to Aurora in 2003 after leaving a tenured position at the Medical College of Wisconsin.

"Is she a good doctor?" said Dr. Alfred Tector, a long-time St. Luke's heart surgeon. "Yes, she is. She has a very good reputation."

However, Sagar said she now is unable to practice medicine in the area because of a noncompete clause in her contract that prohibits her from working as a doctor within 20 miles for two years.

"I'm a physician and I have no options," she said. "What can I do? I have to move."

Exposing Errors

The study reported at the ASE meeting involved a review of 235 echocardiograms done at St. Luke's from August 2007 to October 2008.

All physicians who interpret heart ultrasounds are required to have a minimum of six months of training during their fellowship; the highest level of training, Level 3, requires a minimum of 12 months of cardiac ultrasound training in an accredited fellowship.

Of the 35 physicians who performed clinical readings of the echocardiograms reviewed in the study, only three were Level 3 specialists within cardiology.

Sagar's analysis revealed that 68 of the 235 imaging studies, or 29 percent, were misread.

In at least five of those cases, patients actually went into the operating room with a faulty diagnosis, although the problem was discovered before surgery was done.

In addition, 18 patients were subjected to more invasive echocardiography in which a probe was inserted down the throat and 19 underwent invasive coronary angiography. The misreadings also resulted in increased healthcare costs for the patients.

Initially, Sagar said, the study was done as an internal quality assurance project for St. Luke's. However, she said she felt the problem needed to be presented to other doctors around the country to help improve medical care nationwide.

Indeed, other doctors familiar with her work say it is precisely that kind of internal analysis that is needed to reduce health costs and improve patient care in America.

However, Dr. Sanjiv Kaul, president of the ASE, said that if Sagar was fired because of her presentation, it could stymie other doctors looking to improve care at their hospitals.

"It could have a chilling effect," said Kaul who has known Sagar since they both practiced in Virginia in the 1980s. "It's ridiculous, after all those years in Milwaukee. She's a fantastic scientist. More of this kind of work needs to be done."

However, the problem found by Sagar can cost hospitals and other doctors money because, ultimately, it can lead to doing fewer expensive diagnostic tests, said Kaul, head of the cardiovascular medicine at Oregon Health & Science University in Portland.

Nationwide Problem

At the time of the Sagar's presentation in June, other experts in echocardiography said the problem likely was occurring all over the country.

"There are an awful lot of people out there interpreting echocardiograms who really shouldn't be," Dr. Judy Mangion, a cardiologist and assistant professor at Harvard Medical School said back in June.

Mangion said that many community-based cardiologists have only Level 2 status, meaning they have just six months training interpreting cardiac ultrasound studies.

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