After losing at arbitration, as well as in federal court and partially on appeal, Tenet Healthcare is refusing to comment on whether it will continue to battle two Detroit-area cardiologists whom the hospital corporation fired from leadership positions in 2018.
The cardiologists were awarded $10.6 million from an arbitrator, who found that Detroit Medical Center (DMC) and its parent, Tenet, retaliated against Amir Kaki, MD, and Mahir Elder, MD, when the doctors repeatedly reported concerns about patient safety and potential fraud.
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The award was made public when it was upheld in federal court in February 2021 and was partially upheld on appeal days later by the Sixth Circuit Court of Appeals.
The Sixth Circuit Court of Appeals denied Tenet’s motion to bar Dr. Kaki and Dr. Elder from returning to work with full privileges but said it would continue to consider the overall appeal. Tenet argued that it needed to keep the cardiologists out of DMC because of “behavioral issues.”
Those allegations are “complete nonsense,” said the cardiologists’ attorney, Deborah Gordon, of Bloomfield Hills, Mich. The alleged problems regarding Dr. Kaki and Dr. Elder were examined by an arbitrator, who “found that all of those complaints were unsubstantiated,” Ms. Gordon said in an interview.
In her final ruling, arbitrator Mary Beth Kelly wrote, “Both Kaki and Elder testified credibly regarding the humiliation, the emotional distress and the reputational damage they have suffered to their national reputations.”
A spokesperson for Tenet and DMC said the organizations had no further comment.
Ms. Gordon said she believes it’s unlikely Tenet will prevail in the Sixth Circuit Court of Appeals, noting that the court already had examined the merits of the case to determine whether Dr. Kaki and Dr. Elder could go back to work. In the court’s opinion, shared in an interview, nothing substantive in Tenet’s appeal prevented the doctors from returning to the hospital, she said.
As of now, both cardiologists have 1 year of privileges at the DMC-affiliated hospitals. Only Dr. Kaki has returned to work, said Ms. Gordon. Neither is speaking to the media, she said.
From respected to reviled
Both Dr. Kaki and Dr. Elder were respected at DMC, according to court filings.
Dr. Kaki was recruited from Weill Cornell Medical College by a Detroit mayor because of his expertise in interventional cardiology. He had staff privileges at DMC beginning in 2012 and was a clinical associate professor and assistant program director of the interventional cardiology fellowship program at Wayne State University in Detroit. He became director of the cardiac catheterization services unit at the new DMC Heart Hospital at Harper-Hutzel Hospital in Detroit in 2014, and 4 years later was appointed director of the facility’s anticoagulation clinic. Dr. Kaki was nominated for and completed Tenet’s Leadership Academy.
Dr. Elder was a clinical professor and assistant fellowship director at Wayne State and was a clinical professor of medicine at Michigan State University. Beginning in 2008, he held directorships at DMC’s cardiac care unit, ambulatory services program, cardiac CT angiogram program, PERT program, and carotid stenting program. Dr. Elder was voted Teacher of the Year for 10 consecutive years by DMC cardiology fellows.
The two doctors aimed high when it came to quality of care and ethics, according to legal filings. Over the years, Dr. Kaki and Dr. Elder repeatedly reported what they considered to be egregious violations of patient safety and of Medicare and Medicaid fraud laws. The clinicians complained about unsterile surgical instruments and the removal of a stat laboratory from the cardiac catheterization unit, noting that the removal would cause delays that would endanger lives.
At peer review meetings, as well as with administrators, they flagged colleagues who they said were performing unnecessary or dangerous procedures solely to generate revenue. At least one doctor falsified records of such a procedure after a patient died, alleged Dr. Kaki and Dr. Elder.
Tenet hired outside attorneys in the fall of 2018, telling Dr. Kaki and Dr. Elder that the legal team would investigate their complaints. However, the investigation was a sham: Filings allege that the investigation was used instead to build a case against Dr. Kaki and Dr. Elder and that Tenet leadership used the inquiry to pressure the cardiologists to resign.
They refused, and in October 2018, they were fired from their leadership positions. DMC and Tenet then held a press conference in which they said that Dr. Kaki and Dr. Elder had been dismissed for “violations” of the “Tenet Standards of Conduct.”