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Cardiologist sues Cape Cod Hospital, alleging he was dismissed for raising ethical, safety concerns

Dr. Richard Zelman was medical director of the hospital’s Heart and Vascular Institute.

Former Cape Cod Hospital cardiologist Dr. Richard ZelmanDebee Tlumacki for the Boston Globe

A former Cape Cod Hospital cardiologist says he was dismissed and defamed after raising concerns about botched surgeries and poor ethical practices at the hospital.

In a lawsuit filed in Barnstable Superior Court on Tuesday against the hospital and its CEO, Dr. Richard Zelman alleged that the hospital prioritized profits over patient safety and public health.

According to the lawsuit, Cape Cod Hospital CEO Michael Lauf tried to limit the use of a medical device to patients whose insurance reimbursed at higher rates. Additionally, Zelman said Lauf and others retaliated against him after he reported what he saw as “grievously dangerous care” by the hospital’s cardiac surgeons, who were employed by Brigham and Women’s Hospital.

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In a statement, Cape Cod Hospital noted that Zelman was no longer employed there and denied the claims Zelman made in the complaint, in particular that the physician had experienced retaliation for raising patient safety issues and that the hospital didn’t take action to improve cardiac care at the facility.

“Indeed, our patient safety record is stellar and has never been compromised for any reason,” a hospital spokesman said in a statement. “We will not allow the good work of our dedicated physicians, nurses and other valued staff members to be undermined by specious allegations spurred on by an individual with personal objectives whose goal had been to gain leverage in employment contract negotiations. This tactic failed and we look forward to sharing the complete story, including Dr. Zelman’s own role in it.”

The hospital noted that Zelman has retained full medical staff privileges at the hospital and has continued to perform cardiac procedures there. However, a panel of hospital medical staff held a hearing on Wednesday that could lead to those privileges being revoked, Zelman said through a representative.

Zelman is seeking an undisclosed amount in damages, including for back pay, lost benefits, physical harm, and emotional distress.

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An interventional cardiologist, Zelman began working at Cape Cod Hospital in 1990 while in private practice and accepted full-time employment there in 2006. He also contributed to the system’s founding of a Heart and Vascular Institute, becoming its medical director in 2018.

According to hospital tax documents, Zelman was the health system’s highest earner in 2020, the most recent year for which data is available. He out-earned the CEO with a $1.78 million total compensation package.

However problems started in 2019, when Zelman claims Lauf, the hospital’s CEO, limited the use of a device designed to filter out stroke-causing debris during certain procedures to patients whose insurance reimbursed at higher rates.

Zelman alleges that he raised the concerns not only with Lauf but with a previous chairman of the hospital’s Board of Trustees, who raised it with the current chair. Though the hospital subsequently changed its ways and allowed the devices to be used in all high-risk patients, hospital executives allegedly retaliated against Zelman, including investigating his performance, and stripping him of oversight duties.

According to the complaint, Zelman raised concerns again in 2021, reporting to Lauf and other hospital officials about what Zelman believed were several preventable patient deaths following procedures performed by the hospital’s two cardiac surgeons. All the patients, according to Zelman, were at low risk for complications.

Zelman also alleged that cardiac surgeons left the hospital during scheduled procedures, when they were expected to be on the premises.

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In response, Lauf allegedly agreed that the cardiac surgeons’ mortality rate was “unacceptable,” but told Zelman that the supervision of cardiac surgeons was the responsibility of Brigham and Women’s Hospital, which employed the physicians, rather than Cape Cod Hospital, where the surgeons worked under a contractual agreement with the Brigham.

In a statement, Brigham and Women’s Hospital said they were still reviewing the complaint, and that “patient safety is our first priority and we regularly review our care to ensure it meets the highest quality standards.”

Both surgeons continued to work at the hospital, which Zelman alleged was because their procedures brought in a lot of revenue. One surgeon was ultimately removed from the hospital after he brought an automatic rifle to work.

In October 2021, Zelman elevated his concerns to Dr. Raphael Bueno, the chief of thoracic and cardiac surgery at Brigham and Women’s Hospital. Bueno, according to the lawsuit, promised to send experienced surgeons to oversee the cardiac surgeons. But less than two weeks later, Zelman reported to Bueno that “catastrophic surgical outcomes” had occurred despite active supervision by the Brigham’s attending staff.

The surgical team at Cape Cod has since changed, and the hospital has switched its affiliation from the Brigham to Beth Israel Lahey Health.

Tensions escalated when the Brigham self-reported to the Centers for Medicare & Medicaid Services potential problems with how its Cape cardiac surgeons had documented valve replacement procedures. According to the lawsuit, an attorney for Cape Cod Hospital told Zelman the self-report was triggered by the Brigham’s fears that Zelman “‘would become a whistleblower,’ or words to that effect.” Ultimately, Brigham and Women’s issued a refund to CMS for all revenue it had derived from the procedures performed at Cape Cod over the prior six years. Cape Cod feared CMS would ask it, too, for a refund, putting millions of dollars in reimbursements at risk. It was unclear if Cape Cod ever refunded the revenue.

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By January, Zelman claims in the complaint that Cape Cod Hospital leadership repudiated an agreed-upon contract extension. Though Zelman said he was not responsible for the way the procedures were billed, hospital leadership cited the billing concerns in its decision.

Lauf additionally launched an investigation into Zelman about allegedly deficient clinical patient care. The investigation then pivoted to focus on alleged regulatory and compliance concerns. By June the investigation was completed, but the report was never given to Zelman, according to the lawsuit.

Zelman said the hospital offered to let him keep his job, provided he issue a written statement that endorsed the quality and safety of all the hospital’s cardiac related programs, and specifically the cardiac surgery program. Zelman refused and, according to the suit, was ultimately terminated from the hospital at the end of September.


Jessica Bartlett can be reached at jessica.bartlett@globe.com. Follow her on Twitter @ByJessBartlett.