Review of Stephen Klaidman, Coronary (New York: Scribner, 2007)

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

My rating: 5 of 5 stars


One of the worst violations of medical ethics in the last twenty years occurred in 2002 at a hospital in California. Two doctors -- one a cardiologist who did the angiograms and other testing and referrals to surgery and a cardiac surgeon were doing bypass surgery on patients who did not need it. Some had complications; some died. Klaidman's book tells the story of this sordid case that reveals in detail the problems still haunting American medicine.

Although the evidence was overwhelming, many physicians were reluctant to testify against other physicians, and a few even defended them. The company that owned the hospital, which had put pressure on the doctors to gain more cardiac cases for money, paid out around $500,000,000 in fines, which it was allowed to do in increments. The doctors were never prosecuted, and while the cardiologist lost his license, the cardiac surgeon did not. Luckily he did not want to continue practicing medicine anyway. Justice was not done despite a major FBI raid and investigation. The U.S. Attorney did not prosecute the case because of the difficulty of proving conspiracy, but indictments may have been an incentive for other doctors to come forth and testify. The hospital had earlier kept its accredited status despite a known lack of peer review of its heart procedures because the agency that accredits hospitals teaches them, for a fee, how to pass their inspections.

This is a story of failed justice, of moral cowardliness, of moral courage shown by a few good people, and of the failure of American doctors to police themselves. Doctors, like other professionals such as lawyers, police themselves since they have the technical knowledge to make good judgments. However, there is a "thin white line" which forbids doctors to turn in other doctors. If the medical profession cannot police itself, what recourse to patients have to trust their physicians?

This book would be a valuable supplemental text to medical ethics courses and is worth reading by the general public as well. I highly recommend it.



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