San Antonio Express-News (Sunday)
Surgeon accuses Methodist of career sabotage
Over a nearly 50-year career as a cardiothoracic surgeon, J. Marvin Smith III earned a reputation as the go-to guy for complex heart surgeries in San Antonio.
Smith would take on difficult cases, such as ruptured aortic aneurysms, where the risk of death is high, according to fellow physician John Holcomb, a pulmonary and critical care specialist.
Smith also has held various prestigious posts, including chief of staff at Methodist Texsan Hospital, chairman and president of the Bexar County Medical Society, and on the Society of Thoracic Surgeons’ committee for standards and ethics.
Yet Smith now alleges “vindictive leaders” at Methodist Healthcare System of San Antonio are ruining his career by waging a “smear campaign” against him — first by saying his patients had excessive, or “unacceptable,” mortality rates for certain surgeries, and then by asserting he has a medical condition that prevents him from safely practicing medicine.
Methodist has “totally” blocked Smith’s ability to practice cardiothoracic surgery “despite no evidence or findings that he poses any danger to patients whatsoever,” he has said in litigation unfolding in state District Court in San Antonio.
Smith said Methodist took action against him because of his refusal to practice “corporate medicine.” It wants to force him out of his practice in favor of surgeons “who happily comport with (its) plans to increase profits by acquiescing to mandatory (but medically unnecessary) secondary consults for every patient,” the lawsuit added.
“The malicious actions of Methodist Hospital tarnished and destroyed my medical career because I refused to place the hospital’s interests ahead of the interests of my patients,” Smith said in a statement provided by his attorney, Eric Pullen, who declined to make the doctor available for an interview.
Smith seeks at least $5 million in damages from Methodist for what he said was “false and disparaging” information about him and for interfering with his business relationships.
A Methodist spokeswoman declined to comment on the lawsuit.
In a brief answer to Smith’s lawsuit, Methodist provided a general denial to the allegations. It said Smith failed to exhaust his remedies through the hospital system’s administrative process before filing the lawsuit. It wants the lawsuit stayed until those proceedings are resolved.
Methodist is jointly owned by HCA Healthcare Inc., a publicly traded company based in Nashville, Tenn., and nonprofit Methodist Healthcare Ministries.
Methodist Healthcare paid about $76 million to acquire TexSan Heart Hospital at 6700 Interstate 10 W. from MedCath Corp. and a group of San Antonio physicians in early 2011. Smith said he helped design and staff
the cardiothoracic facilities at the hospital.
Hundreds of surgeries
Smith has performed hundreds of surgeries at Methodist Texsan, maintaining a “high degree of competence and care with a correspondingly low (patient) mortality rate throughout his career,” according to his lawsuit.
“Out of the blue, in November 2018,” the lawsuit added, Methodist provided “Dr. Smith with ‘statistical information’ indicating his (patients’) mortality rate with coronary artery surgery was excessive.” The rate for aortic surgery he performed was deemed “unacceptable.”
Smith later turned to Holcomb to review Methodist’s findings. Holcomb recalled Smith was presented with only a handful of cases, which he considered a small sample size. Two of those cases resulted in patient deaths, Holcomb said, but those patients had an aortic root replacement.
“You have to risk-adjust those patients because there’s probably a 50 percent mortality rate as they come through the door,” said Holcomb, who was previously employed by Methodist but is not involved in the litigation.
“My sense is, in the general environment today, that a lot of doctors are afraid to do high-risk cases, but Marvin is not,” Pullen said. “A lot of the cases he did were high-risk. He was the guy people sent cases to when they were tough.”
Kerrville cardiologist J. Nat Sanderson said he’s referred cases to Smith and never found him to have an issue with high mortality rates.
“I think he’s proven that,” Sanderson said. “I’ve had good results over the years with Marvin.” Sanderson’s practice is owned by HCA.
Before it began a peer review process of Smith, Pullen said, Methodist already had shared the mortality rate with members of its medical staff. That marked the start of the Methodist’s misinformation campaign, he added.
Methodist asked Smith to consult with physicians who treat patients in intensive care — known as intensivists — on his postoperative patients. He also was asked to consult with the hospital’s “Heart Team” on all preoperative, valve and aortic cases pending Methodist’s review of the surgical cases it identified as “concerning,” the complaint stated.
Smith has maintained that such consults provided “no meaningful benefit,” but he agreed with Methodist’s demands rather than face discipline or revocation of his hospital privileges.
In March 2019, Smith received a report from Methodist regarding his practice performance from January to August 2018. The report stated “all of the data are within expected parameters of performance,” according to the lawsuit.
Pullen called the conflicting evaluations “unexplainable.”
“Methodist wants to have it both ways,” he said.
Medical condition
After the mortality data was shown to be incorrect, Methodist requested that Smith submit to third-party evaluations of “his medical condition and his surgical competency,” according to the lawsuit.
Methodist has alleged that Smith suffers from a “cognitive impairment” that affects his ability to practice and perform surgery, Pullen said, though the attorney didn’t know the precise medical diagnosis. Smith has disputed the allegation.
“IF Dr. Smith actually had the medical condition alleged, it could impact his ability to practice if it was not properly treated,” Pullen said in an email. “However, Dr. Smith does not have it.”
Methodist presented Smith with options to undergo competency evaluations through two programs. One of the programs provides assessments and education for doctors who have perceived needs or want to return to practice.
The lawsuit said, however, that the evaluation process was “re