Coronary: A True Story of Medicine Gone Awry

by Stephen Klaidman

Overview

A chilling real-life medical thriller, Coronary chronicles the story of two highly respected heart doctors who violated the most sacred principle of their profession: First, do no harm.

In the summer of 2002, fifty-five-year-old John Corapi, a Catholic priest with a colorful background, visited Dr. Chae Hyun Moon, a celebrated cardiologist in Redding, California. Corapi had been suffering from exhaustion and shortness of breath, and although a physical examination and a conventional stress test revealed nothing abnormal, Moon insisted that the calcium level in Corapi's coronary arteries called for a highly invasive diagnostic test: an angiogram. A chain-smoking Korean immigrant known for his gruff bedside manner, Moon performed the procedure briskly and immediately handed down a devastating diagnosis: "I'm sorry; there is nothing I can do for you. You need a triple bypass tomorrow morning." He then abruptly left the room.

Several hours later, however, Moon inexplicably decided the surgery could wait until Corapi returned from a previously scheduled cross-country trip. Unnerved by the dire diagnosis and also by Moon's inconsistent statements, Corapi sought other opinions. To his amazement, a second, third, and fourth doctor found that his heart was perfectly healthy. In fact, for a man his age, Corapi's arteries were remarkably free of disease.

Sensing a cause more disturbing than human error, Corapi took his story to the FBI. As local agent Mike Skeen soon discovered, Corapi was one of a number of people who had suspicions about Moon and Moon's go-to cardiac surgeon, Dr. Fidel Realyvasquez, an equally respected member of the close-knit northern California community. Working at a hospital owned by Tenet Healthcare, Moon would make the diagnoses and Realyvasquez would perform the surgeries. Together, these leaders of the Redding medical establishment put hundreds of healthy people at risk, some of whom never recovered. Soon Skeen launched a major investigation, interviewing numerous doctors and patients, and forty federal agents raided the hospital where the doctors worked.

A timely and provocative dissection of America's medical-industrial complex, Coronary lays bare the financial structures that drive the American healthcare system, and which precipitated Moon's and Realyvasquez's actions. In a scheme that placed the demands of Wall Street above the lives of its patients, Tenet Healthcare rewarded doctors based on how much revenue they generated for the corporation.

A meticulous three-year FBI investigation and hundreds of civil suits culminated in no criminal charges but a series of settlements with Tenet Healthcare and the doctors that totaled more than $450 million and likely put an end to Moon's and Realyvasquez's medical careers. The case's every twist and turn is documented here.

A riveting, character-rich narrative and a masterpiece of long-form journalism, Coronary is as powerful as it is alarming. This is a hair-raising story of the hundreds of men and women who went under the knife, not in the name of medicine, but of profit and prestige. Brilliantly told, Stephen Klaidman's Coronary is a cautionary tale in the age of miracle medicine, and a shocking reminder to always get a second opinion.

Product Details

ISBN-13:	9780743299053
Publisher:	Scribner
Publication date:	01/09/2007
Sold by:	SIMON & SCHUSTER
Format:	eBook
Pages:	320
Sales rank:	944,773
File size:	385 KB

About the Author

Stephen Klaidman is a former editor and reporter for The New York Times, The Washington Post, and The International Herald Tribune. He was a senior research fellow at the Kennedy Institute of Ethics and a senior research associate at the Institute for Health Policy Analysis, Georgetown University. He is also the author of Saving the Heart: The Battle to Conquer Coronary Disease, Health in the Headlines, and The Virtuous Journalist (with Tom Beauchamp). He lives in Bethesda, Maryland.

Read an Excerpt

Bad Blood

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By Linda A. Fairstein

Center Point Large Print

Copyright © 2007 Linda A. Fairstein
All right reserved.
ISBN: 9781585479313

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Chapter One

I was alone in the courtroom, sitting at counsel's table with a single slim folder opened before me. I had studied the photograph inside it hundreds of times in my office, but this morning I stared at it again for a different purpose.

The overhead shot of Amanda Quillian on a steel gurney had been taken at the morgue, shortly before her autopsy was performed eight months ago. Circular bruises were clustered on her throat, and crescent-shaped abrasions ringed the discolored areas of her skin, outlining the exact place where someone had ended her life by crushing her neck with his hands.

"Loneliest seat in town. Prosecutor in a domestic standing up before twelve good men and true -- plus a few whacky broads mixed in -- with a wee bit of circumstantial evidence, a snitch with a rap sheet longer than a roll of toilet paper, and no idea who actually squeezed the breath out of the late, lovely Mrs. Quillian."

I looked up at the sound of Mike Chapman's voice. "I didn't hear the door open. Is it unlocked already?"

Mike's smile was readiest at any chance to tease me. He brushed back his dark hair from his broad forehead, even his eyes laughing as he shook his head while reminding me of the uphill struggle that was about tounfold at trial.

"No. Artie Tramm let me in. Said to tell you the judge gave him orders to admit the riffraff at nine fifteen. Get rid of your coffee and say a little prayer to Our Lady of the Perpetually Hopeless Case."

"It gives me such a warm feeling in my gut when the detective who made the arrest lacks conviction before even one of my witnesses is cross-examined."

"Conviction? This may be the last time you get to use that word for a while, Coop."

Mike walked toward the well of the courtroom as I stood and took the last slug of cold coffee. "Three cups should do it," I said, tossing the cardboard container into the trash can. "Three cups and several hundred butterflies floating around inside me."

"You still get 'em?"

"Put me out to pasture if I'm ever trying a major case and tell you I don't."

He looked at the blowup of Amanda Quillian's face. "She talking to you, Coop? That why you slipped up here at eight thirty?"

I didn't answer. Mike Chapman and I had worked together on homicides for more than a decade, well familiar with each other's habits. We were professional partners and close friends. Mike knew that yesterday I had asked Artie, the officer in charge of Part 83 of the Supreme Court of New York County, Criminal Division, for permission to come up early to spend an hour in the courtroom before the day's proceedings began.

The large shopping cart that had become the favorite conveyance for prosecutorial case files over the last twenty years was parked behind my chair. It was loaded with Redwelds, part of every litigator's organizational system, and within them an array of colored folders -- purple for each civilian witness, blue for NYPD cops and detectives, green for medical and forensic experts, and a few yellow ones for the names my adversary had turned over as part of the defendant's case. The lower rack held the dozens of physical exhibits I planned to introduce into evidence, all of which had been pre-marked for identification to save time during the trial.

"Hey, Mike," Artie Tramm called out as he stepped into the back of the room. "You see the game last night? The Yankees were hitting like it was a home-run derby."

"Ms. Cooper had me hand-holding witnesses till ten o'clock. I only caught the last inning. Good thing they can hit 'cause the pitching staff is having a problem finding the plate this year."

"You got a crowd growing out there, Alex," Artie said, pointing in the direction of the door. "I guess that's why they moved you to this part, so there's enough staff to control 'em. Lucky you came up when you did. Need anything?"

"I'm set, Artie. Thanks." I started to arrange my folders and notepads on the table.

"She needs a killer. She needs a stone-cold murderer I can drag in here in handcuffs before she makes her closing argument in three weeks," Mike said. "Do Coop a favor and keep your eyes open for one."

Artie laughed. "I think you got a few possibilities in the peanut gallery."

The long corridors at 100 Centre Street were bookended with oversize courtrooms, and this case had been assigned to one. The Quillian matter had been high-profile since the victim's body was found in her town house in the East Eighties, half a block away from the Metropolitan Museum of Art, and the supervising judge had known from the time of the arraignment that the trial would draw spectators. Murder, money, and marital infidelity brought out the curious, who would fill the benches and choose sides to root for like fans at a wrestling match.

"Too bad you couldn't hear the openings yesterday. They were both good," Artie said to Mike, twisting the ends of his handlebar mustache with his right hand as he walked to the judge's bench. His left thumb was hooked on the waist of his blue serge pants, which drooped below his paunch. "Both real good."

Because Mike would testify as a witness, he was not allowed to be in the courtroom for any other parts of the trial. "Scale of one to ten, how would you rate them?"

"Mike, please don't -- "

"Go about your business, Ms. Cooper. Ignore us. Don't tell me you didn't read your own reviews in this morning's papers?" Mike grinned at me, running his fingers through his shock of black hair.

Artie was taking the judge's water pitcher to be filled. "Trust me. She was a lot better than that columnist said in the Daily News. I mean, it's not exactly like they're criticizing Alex. It's the facts that don't seem so strong. I'd give Alex a nine, but I'd give her case a three," Artie said to Mike. Then he seemed to remember that I was also there. "I hope you're saving some surprises for us."

"And Howell?"

"Ten. A perfect ten. He's so smooth. I tell you, Mike, I ever get the urge to kill somebody? Lem Howell's my mouthpiece." The door swung closed behind Artie Tramm.

"I didn't mean to stir the pot, Coop."

"Artie's right."

"About our case?"

"About Lem Howell. Did Laura give you the list of calls to make this morning?"

"She wasn't in yet when I got to your office." Mike was dressed in his trademark navy blazer and charcoal gray slacks. His pale blue shirt was unbuttoned at the collar and his rep tie unknotted and casually crisscrossed under the jacket. Both of us -- Mike, taller than six feet, and me, five ten without my heels -- seemed swallowed up by the large, empty courtroom.

"It's on her desk." I liked the flow of a trial to be seamless. Witnesses were lined up days ahead of time, placed on standby, and asked to juggle busy professional schedules to appear as needed. Most jurors became annoyed when unnecessary delays extended the length of their service. There would be things none of us could control -- the juror whose subway train gets stuck or whose babysitter doesn't show or who claims his cat swallowed a hair ball and has to go to the vet -- but Mike and my paralegal, Maxine, would monitor the lineup I had organized to keep my presentation tight.

"Anything else I -- "

"See you at one."

"Don't get short with me, kid. I'm with you on this. You just got to be realistic about our chances. I'm sorry if I broke your concentration."

"That's not all you're trying to break."

I put Amanda Quillian's photograph back in the folder and replaced it on the cart.

"So you got up here early to avoid running the gauntlet into the courtroom, you brought all the exhibits with you -- and I guess you've made your peace with Amanda."

It was something I did at the beginning of every murder trial, just my own quiet way of getting ready to go into battle. Within the hour, every aspect of this woman's personal life would be exposed to the jury -- and to the public. The most intimate details of her daily affairs would be offered up for dissection -- by me as well as by the defense -- most of them things she had talked about, if at all, only with people she trusted and loved.

As soon as the doors were unlocked, the first two rows behind me, on both sides of the aisle, would be crammed with reporters from each of the city's newspapers, and the television and radio stations, as well as stringers for the national media. The bench after that one was reserved for the victim's family -- her elderly mother, two sisters, and several of her closest friends. The rest of the audience would be a mix of locals who braved the intense heat of the June day, some who were courthouse regulars who liked the show -- no matter what the crime -- and others because cameras aren't allowed in New York State trials, meaning no gavel-to-gavel coverage of the case on Court TV. And, of course, also attending would be the young Legal Aid lawyers and my colleagues from the Manhattan District Attorney's Office, slipping in between their own calendar calls to study Lem Howell's style or lend me moral support.

I knew my case cold. I knew its weaknesses and more of its strong points than the twelve jurors and four alternates would ever hear. Some of the state's evidence had been suppressed by the judge in pretrial hearings as inadmissible or potentially prejudicial, and Howell would do his best to limit me even further with every application I made. I had already prepared for the testimony that would be elicited today. I didn't need this time to do any work.

I had used the last half hour to think about Amanda Quillian. Mike was right -- she had talked to me, over and over, through the various forms of evidence he and I had gathered in the months after her death.

I looked at the morgue photograph to remind myself of how eloquently she had told her story, from the outset, by the horrific damage done to her strong, healthy body. I looked at it to remind me of the outrage I had felt when Mike Chapman had first called to ask me to meet him at the medical examiner's office to see his victim -- one of three homicides that had occurred in Manhattan on that cool fall afternoon. I looked at it to remind me that I had been invested with the trust of those who'd loved her to seek some kind of justice for the killer -- the killers -- of Amanda Quillian.

"Detective Michael Patrick Chapman, Second Grade, Manhattan North Homicide Squad, do you swear to tell the truth, the whole truth, and nothing but the truth -- so help you God?" The powerful voice of my adversary boomed from the doorway that one of the court officers had unlocked for him.

"Lemuel Howell the Third. My very favorite black panther," Mike said, swinging open the gate that separated the well of the courtroom from the gallery. His reference described Howell's lean, elegant frame and his skin color, not his politics.

"Alexandra, my friend, good morning." Lem rested his monogrammed leather briefcase on the floor beside his chair, then stepped over to shake hands with Mike. He reached out his arm to grasp my elbow, leaning over to kiss me on the cheek. Lem had always been a toucher -- the arm-stroking, back-rubbing, hand-grasping contact kind, all the while locking eyes and willing you to engage with him.

"Hi, Lem."

"Looking cool, collected, and with a faint scent of jasmine in that perfume today," he said, lifting his nose to sniff the air near my ear.

"Lavender, actually. But thanks."

"You might find this a bit of useful information for your off-duty life, Detective. Coco Chanel believed that women ought to dab perfume on themselves wherever they might like to be kissed," Lem said, pinching my arm before he let it go.

"Then you should be sniffing a little closer to Coop's ass than her ear," Mike said, as Lem winked at me -- tapping his long fingers on my pile of folders before returning to his table. "You're looking mighty fine yourself, Counselor. Guess it's that razzle-dazzle moment for the jury."

Lem was as strong on substance as he was on style. He had been one of my first supervisors when I'd arrived in the office as a rookie prosecutor, before he left for a lucrative partnership in the litigation department of a midtown law firm.

Lemuel Howell III had the eloquence of the great black preachers, the brain and wit of a superb trial lawyer, and the looks of a leading man in a 1940s noir film -- his wavy hair pomaded into place, straight back without a part. By the end of voir dire -- in this matter a four-day exercise weeding through 182 prospective jurors -- he had most of them ready to eat out of his hand before they'd heard the first prosecution witness.

He opened the brass locks on the briefcase and placed a sheaf of papers on his desk before removing a thick, gold fountain pen from his breast pocket. Then he smoothed the front of his beige suit.

"And you, Michael Patrick? You've detected, deduced, and done Alexandra's bidding for the better part of a year, and still no perpetrator?"

"If only your client would loosen up and let me know who he paid to do the kill, maybe I could twist Coop's arm to cut him a deal."

"He can't tell you what he doesn't know, can he?"

"Save that line of bull for the jury." Mike slapped Lem on the back as Artie Tramm returned with the water pitcher and told us that he was ready to open the doors. "And go easy on her, Mr. Triplicate, you know how Coop hates to lose."

Triplicate was what the courthouse reporters called Lem Howell, not for the Roman numeral III in his name, but for his habit of phrasing his descriptions in threesomes. Yesterday, in his opening remarks, Amanda's death was "admittedly savage, barbaric, and the cowardly work of a dangerous madman"; his client was "innocent, falsely accused, and horribly distraught by his wife's untimely demise"; and the People's case was "dreadfully flimsy, paper-thin, a gossamer web of fabrications."

"Both sides ready?" Artie Tramm asked.

I nodded while Lem gave him a firm "Yes, sir."

Tramm opened the door on the far side of the judge's bench, which led to the small barred holding pen to which Brendan Quillian had been delivered earlier this morning from his cell in the Tombs. I watched as one of the officers removed Quillian's handcuffs and walked behind him into the courtroom, to place him next to Howell so jurors would not know he had been incarcerated pending trial.

The defendant was dressed in one of his elegant Brioni suits, probably for the first time since the day of his arrest. He was as tall as Mike Chapman but with a beefier build, and his brown hair was showing streaks of gray, despite the fact that he had just turned thirty-five. He fixed on me with an icy look as he crossed behind his table, a glare made all the more sinister by the cast of his right eye. Brendan Quillian had been blinded in that eye by a childhood accident, and I swiveled away from its glassy, dead stare as he squinted at me.

"Smart move," Mike whispered, oblivious to the quick exchange. "Howell's the perfect lawyer for this case."

Quillian and Howell were animatedly talking to each other.

"He's the perfect lawyer for any case."

"Your middle-class white jurors won't want to think Quillian did it -- don't understand domestic violence when it happens outside the ghetto. Your upper-class white women will think he's too handsome to be guilty, and your upper-class white men -- "

"When's the last time you saw an upper-class white man on a Manhattan jury?" I asked. "They use every excuse in the book to avoid service."

"And your blacks -- dammit, I guess everybody in the room -- will fall under the spell of the silver tongue of Lem Howell."

"I'm ready to open the doors, Mike," Artie said.

"My money's on you, kid. Make 'em believe, okay?" Mike said, slapping the table and heading to the courtroom door. "See you at the break."

He walked out against the flow of incoming traffic, while I seated myself at the table with my back to the benches. The first five reporters made a beeline for Howell. The district attorney, Paul Battaglia, had firm rules that forbade each of us from talking to the press while a case was pending. Lem Howell, however, would leak like a sieve from now until the moment of the verdict, feeding the media tidbits helpful to his client that the jury would never be allowed to hear. So I sucked it up and sat quietly in place while the officers filled the rows with curious onlookers and tried to keep order in the court.

"Put your newspapers under your seats," Tramm roared at the two hundred spectators. "No reading materials, no food or beverages, no cell phones, no talking among yourselves.

"All rise," Tramm continued, "the Honorable Frederick Gertz presiding."

The door from his robing room opened and the stern-faced Gertz, five foot six, strode into the well and climbed the three steps to his bench.

"Good morning, Ms. Cooper, Mr. Howell."

"Good morning, Your Honor," we both answered.

Jonetta Purvis, the court clerk, was standing at her desk close to the defense table.

"The defendant and his lawyer are present, the assistant district attorney is present. Shall we bring in the jurors, Your Honor?"

"You both ready to go forward? Any housekeeping to attend to?"

"Ready," I said. I pushed the indictment aside -- the written instrument that charged Brendan Quillian with "Murder in the Second Degree and Conspiracy to Commit the Crime of Murder in the Second Degree" -- and reached for the thick purple folder beneath it.

Artie stood by the door next to the judge's bench and opened it. "Jurors entering."

The group of sixteen -- the first twelve chosen and four alternates -- filed in, taking their seats in the two rows closest to my desk. They fidgeted as they settled down, some staring at Quillian and Howell, others focusing on me and the full shopping cart behind me.

It was impossible to imagine how jurors had been able to obey the judge's instructions not to listen to television accounts or read stories about the case. I stifled my desire to scan the group to see what reading materials each had brought along. Last evening's news had led with a summary of the opening-day arguments, and this morning's New York Post banner -- dial m for mogul: hubby hires hitman -- would have been visible on every subway and bus route that carried these folks downtown.

I lifted the flap of the folder and squinted at the bright yellow Post-it note stuck to my punch list of questions. It was in Lem's handwriting, slipped onto the file when he had stepped over to greet me minutes ago. Alex -- take your best shot. If you remembered half of what I taught you, you wouldn't be leading off with Kate. Beneath the warning he had scrawled another word: SHOWTIME.

Gertz's eyes swept the courtroom, making sure he had everyone's attention before he pointed his gavel in my direction. "Call your first witness, Miss Cooper."

My voice caught in my throat as I stood, and I coughed to clear it as I started the People's case. I didn't need to look over at Lem to let him know he had scored his first hit.

Copyright © 2007 by Fairstein Enterprises, LLC

Continues...

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Excerpted from Bad Blood by Linda A. Fairstein Copyright © 2007 by Linda A. Fairstein. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Prologue: An Ill Omen

1 A Historical Precedent

2 The City

3 Old-West Medicine

4 A Case of Abandonment

5 The Outsider

6 An Error in Judgment

7 The Investigation

8 The Investigation II

9 Poor Patient Selection

10 The Raid

11 Bad Outcomes

12 Preparing for Battle

13 The Company

14 The Civil Cases

15 The Intensivist

16 "Qui Tam"

17 The Townspeople and the Fisher Case

18 The Doctor, the Priest, and the Accountant

19 A Normal Life

20 The Endgame

21 The Settlement

Author's Note

Notes

Acknowledgments

Index

Editorial Reviews

By nearly every standard except ethics, Chae Hyun Moon and Fidal Realyvasquez were superb retailers. These Redding Medical Center cardiologists tirelessly drummed up business where there was no need, convincing more than 1,000 patients to undergo completely unnecessary heart procedures. Stephen Klaidman's Coronary is a jarring real-life medical-legal thriller, complete with an eccentric hero (a former accountant turned Catholic priest), masterful FBI investigators, and exciting courtroom scenes. Stranger than fiction; best not read in doctors' waiting rooms.

In the exciting ninth Alexandra Cooper legal thriller from bestseller Fairstein (after Death Dance), the Manhattan prosecutor is confronted with the trial lawyer's greatest fear-a witness who's destroyed on the stand. When the defense attorney shows that Kate Meade, the lead witness in Cooper's circumstantial case against Brendan Quillian for the murder of his wife, Amanda, has concealed her affair with the defendant, this revelation of Meade's potential bias has a devastating effect on the prosecution's case. As Cooper struggles to recover, the case takes a whole new twist when a fatal explosion in New York City's third water tunnel, which is under construction, suggests that Amanda's death is connected with other violent acts in the Quillian family's past. While Cooper may engage in a few too many action sequences for legal purists, the crisp writing and Fairstein's enviable capacity to translate her own experience as a prosecutor into an accessible plot puts this series a cut above most entries in this crowded subgenre. (Jan.) Copyright 2006 Reed Business Information.

Publishers Weekly

Formerly a Washington Post editor and a research fellow at the Kennedy Institute of Ethics, Klaidman (Saving the Heart: The Battle To Conquer Coronary Disease) has a long-standing interest in examining problems with the American medical system. In his latest work, he uses medical records, depositions, and interviews to follow the investigation of two doctors who allegedly performed unnecessary cardiac surgery on a large number of patients at a small California hospital. Klaidman's description of events is highly personalized-he shows the case through the eyes of the victims, the FBI, healthcare administrators, doctors, and lawyers-and raises many questions. Was this simple malpractice or actual medical fraud? Did the healthcare administration know what was going on? Was the settlement fair to the victims and to the doctors under attack? Klaidman hopes this look at a single case specifically illustrating some of the flaws in our medical system and their consequences will generate interest and discussion. Exceptionally readable and enlightening; recommended for all public libraries.-Tina Neville, Univ. of South Florida at St. Petersburg Lib. Copyright 2006 Reed Business Information.

Library Journal

An explosion far beneath Manhattan's surface turns prosecutor Alexandra Cooper's ninth case (Death Dance, 2006, etc.) into a free-for-all with roots sunk deep in the bedrock of the past. Did Brendan Quillian strangle his wealthy wife, Amanda, who'd been making serious noises about leaving him, so that he could keep her money and his management job with her late father's real-estate empire? Lemuel Howell III, Brendan's silky attorney, insists that his client will be vindicated, and his cross-examination of Alex's first few witnesses certainly seems to justify his confidence. But the case is rocked by a blast in Water Tunnel #3, a construction project 60 stories underground designed to bring water to an increasingly thirsty New York-a blast that kills Brendan's brother Duke, a sandhog who worked there. Alex, who had never given Brendan's family of working-class Irish immigrants a second thought, is suddenly wrapped up in their dirty laundry. There's news from Brendan's sister Trish of a long-simmering feud between the Quillians and the Hassetts, who toiled alongside them in Tunnel #3. There's the revelation that 20 years ago, Bex Hassett, Trisha's best friend, was strangled in Pelham Bay Park during Brendan and Amanda's honeymoon. And a macabre new detail has surfaced: Somebody cut off Duke's finger before the explosion finished him. Before Alex can fit Amanda's murder into this decades-long pattern of violence and hatred, a courtroom surprise sends the case hurtling off in still another direction, and the only certainty is that it'll end deep in the bowels of New York's tunnel system. Fairstein's latest is as generously plotted as ever, with a series of fascinatingly grim locales that suither gifts perfectly-even if she can't resist whispering historical sidelights into your ear with every change of scene.

Kirkus Reviews