Stephen Klaidman - Coronary: A True Story of Medicine Gone Awry

F elix Elizaldes mother died when he was six years old, which left him little choice but to follow his migrant-worker father each day into the fields and orchards of the American West. After several years on the trail his father found a job as a construction worker in Stockton, California. Settling down meant that Felix was finally able to attend school regularly. Although he was bright, at first no one noticed. He was treated, in the vernacular of that time and place, like any other dumb Mexican. But because in fact he was smart and persistent he was able to overcome this stereotype. After finishing high school he worked his way through San Jose State University on the graveyard shift at a mental institution, earned a masters degree in broadcasting from San Francisco State University, and achieved professional success as a journalist, government official, and academic administrator.

In July of 1992 Elizalde was sixty-one years old. He was neither rich nor famous, but he was nonetheless living a version of the American Dream. That month he and his wife, Margaret, set out to see several Shakespeare plays at the world-class theater in Ashland, Oregon. To break the six-hour drive from their home in Castro Valley, near San Francisco, they stopped overnight in Redding, a small city in northern California. After checking into a motel they went out to eat at a Mexican restaurant. Later that evening, Elizalde experienced nausea and stomach pain. It seemed like indigestion to him and he wasnt especially worried, but Margaret was concerned and talked him into going to Redding Medical Center, one of two relatively large and modern hospitals in town.

He was met in the emergency room by a stocky, tightly wound, chain-smoking South Korean cardiologist named Chae Hyun Moon, who was several inches shorter than the five-foot five-inch Elizalde. Moon asked him curtly about his symptoms and within minutes, with no cardiac workup, hustled him off to the catheterization laboratory for an angiogram, an invasive test that, in the absence of acute symptoms, is normally preceded by an electrocardiogram and a stress test. Less than half an hour later Moon told Elizalde that he had bad blockages in his coronary arteries, one of which was known in the trade as a widow-maker, and that he needed immediate triple bypass surgery. Elizalde, surprised and upset, but still able to make a rational judgment, said he would prefer to return to the Bay Area and get a second opinion. But Moon, who was imperious and did not much care for niceties such as respecting patients wishes and informed consent, told him bluntly that he would not survive the trip.

A few moments later Moon introduced Elizalde to Fidel Realyvasquez, the chief of cardiac surgery at RMC. Like Elizalde, Realyvasquez was a Mexican-American from a working-class background. He said he would perform the surgery. A nursing supervisor standing nearby tried to soften the blow by assuring Elizalde that the cardiac care at RMC was the best in northern California, an opinion widely held in and around Redding. In fact, National Medical Enterprises, Redding Medical Centers owner, was on the verge of becoming the second-biggest for-profit hospital chain in the United States and RMC was on track to be its most successful hospital.

The nursing supervisor said Elizalde shouldnt worry about a thing and that the hospital would arrange for a comfortable place for Margaret to stay. But Elizalde, who recently had undergone a treadmill stress test that was negative, was more than a little skeptical. Things were moving too fast for his taste. And he was put off by Realyvasquez, whom he found condescending, especially when he spoke to him in Spanish. Although it was the weekend, he succeeded in reaching his cardiologist, David Anderson, and asked his advice. After speaking to both Elizalde and Moon, Anderson had the feeling that what he was hearing didnt sound quite right. Nevertheless, he told Elizalde that he could not second-guess Moon over the phone. He said Elizalde would have to decide for himself whether to have the surgery.

Despite Andersons hesitancy, Elizalde took away a different message. He thought Andersons tone suggested that he probably should have the operation. But after talking it over with Margaret, Elizalde decided against it. Although bypass surgery was done almost half a million times a year in the United States and was considered routine, the operation carried with it the prospect of a long and painful recovery, the possibility of depression, a small chance of a stroke, and perhaps some lingering mental deficit. If at all possible, Elizalde wanted to avoid these potential consequences.

The next morning Elizalde was flown on a gurney to Summit Hospital in Oakland. Anderson met him there, reviewed his records from Redding, and did some additional tests. He was shocked to find that in his judgment Moons diagnosis and treatment recommendation were baseless. Anderson called Moon and angrily told him that what he had done to Elizalde was thoroughly unethical. Moon replied, You had to be there to make the diagnosis, a comment Anderson found incomprehensible because he saw absolutely nothing on Elizaldes angiogram that indicated a need for heart surgery. A week or two after coming home to Castro Valley Elizaldes symptoms returned and he threw up blood. Soon thereafter he was diagnosed with an inflamed gall bladder, which almost certainly was the cause of his nausea and stomach pain in Redding.

Both Anderson and Elizalde wrote to the California Medical Board about the incident. The board sent Elizalde a form letter saying the matter was under review. Four and a half months later the board notified him by mail that it had closed the case without taking any action because the staff could find no violation of the law. In the 199293 fiscal year the board reported to the state legislature that it had received 6,749 complaints and took 149 disciplinary actions. To anyone familiar with the inadequacy of oversight of medical practice around the country these statistics would come as no surprise. Californias medical board, like most others, was underfunded and understaffed. Elizaldes experience and the boards failure to act went virtually unnoticed in Redding, but Anderson recalls worrying that the case might be a harbinger. He was concerned that RMCs relatively new but fast-growing heart program was operating without sufficient oversight.