Tenet Under Closer Exam

REDDING -- Chae Hyun Moon might have wanted to be a doctor since he was a little boy, but his staunchest supporters agree with his sharpest critics: He missed the class on bedside manners.

“Oh, my Lord, he gives you a heart attack just talking to you,” said Lee Cook. The retired computer systems analyst still shudders at the memory of Moon shouting at him not to hang onto the bar of the treadmill during a stress test.

Clifford Baker, a Presbyterian missionary, recalls a 1996 hospital stay when he was experiencing congestive heart failure. “You’ve got about three months straight downhill,” Moon told him. Out in the hallway, Moon advised Baker’s wife to make sure the will was in order.

So many patients, so little time for chitchat. In his 23 years as a cardiologist here, Moon has worked on as many as 35,000 people. On some days, he would perform 10 catheterizations, where a thin tube is inserted to open clogged arteries or obtain diagnostic information. Another doctor would consider it a full day’s work to do three.

For a long time, Moon had the respect, if not love, of his patients at Redding Medical Center. Twelve days ago, that image abruptly darkened when the FBI filed an affidavit detailing an investigation of Moon and the center’s chairman of cardiac surgery, Fidel Realyvasquez. The affidavit outlines a conspiracy to commit health-care fraud by allegedly billing Medicare for unnecessary procedures. Forty agents raided the doctors’ offices, carting away boxes of patient records.

No charges have been filed, let alone proved. Yet the claim in the 67-page affidavit that “there is reason to believe that many” Redding Medical patients “have been victims of a scheme” involving “unnecessary invasive coronary procedures” is shaking this city and causing ripples far beyond.

“This is a horror story, at best,” said Gary Oxley, a nurse who works with Moon and believes the allegations are untrue.

Moon, who has told colleagues that everything he did was in the best interests of his patients, did not respond to requests for an interview at the hospital, his office or house here. But conversations with colleagues and former and current patients as well as a review of court documents describe an assertive, often arrogant doctor, one who couldn’t be bothered with pleasantries, hobbies or critics. For better or worse, his patients have been his life.

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A Slew of Lawsuits

For all the advances in technology, cardiac care can still be as much art as science. Redding Medical was home to the best machines and receptive to the latest ideas. To his admirers, and there are still many here, Moon saw further and knew more. He prevented heart attacks, extending the life and health of many patients.

The affidavit presents a far more chilling scenario, which is that Moon violated the ancient medical oath to “first, do no harm.” One case briefly detailed by the FBI: A 59-year-old male received bypass surgery and, four years later, is still too weak to work. A cardiologist who reviewed the man’s records for the FBI “found, at most, evidence of a relatively minor problem,” the affidavit says.

The investigation, which will take months, is roiling the owner of Redding Medical Center, Santa Barbara-based Tenet Healthcare Corp. Tenet, which owns 113 hospitals around the country, last week revealed a federal audit of its Medicare billing practices. Between the Redding investigation and the audit, Tenet’s stock has declined by two-thirds, shaving more than $15 billion off its market capitalization. Analysts have downgraded the stock, saying Tenet’s moneymaking ways are threatened.

In this former logging community turned vacation jump-off point, Moon is a more personal matter. The Redding Medical Center draws patients from the entire northern half of the state, and Moon is its star. Everyone, it seems, knows someone who’s been a patient or who works for the hospital. It’s the most dominant building downtown, except for the jail, and was going to get even bigger. Before the events of the last two weeks, the 238-bed center was to double in size.

In a search for more business, Redding Medical recently mailed out fliers that showed a trim woman with a basketful of healthful groceries.

“After grocery shopping, a few errands and one load of laundry, a 42-year-old woman collapsed of a heart attack,” the flier warns. “And you thought heart disease was just a man’s problem.”

The “lifestyle risk factors” listed are very broad, including “increasing age.”

Such an approach can save lives, but it’s also ripe for abuse. When does aggressive prevention cross over into unnecessary operations? It’s a question many of Moon’s former patients are being forced to ask themselves. Some are emerging with their faith intact. Some are uncertain what to think. And some are filing lawsuits.

Lawyers are running ads in the local paper and on television, trolling for victims. One local firm says it will file more than 100 suits all by itself.

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High Self-Esteem

When Moon plays golf, he does it on Sunday morning. By 10 a.m., he’s at the hospital, still in his golf clothes, bragging about how well he played or joking about a missed shot.

“He’s a workaholic day and night--24/7, 365. He can be there in five minutes at 3 in the morning,” said Robert Hansen, an anesthesiologist. “I don’t think he knows how to take a vacation. If I were him, I would have burnt out a long time ago.”

Moon, 55, was born in Seoul, the son of an orthopedic surgeon and a volunteer for the Korean Red Cross. He studied medicine at Yonsei University, one of the preeminent schools in the country.

His goal was to be a surgeon like his father, he told the Redding Record Searchlight in a lengthy interview in 1994, but back trouble made it impossible to stay on his feet for hours at a time in the operating room. After coming to the U.S. in 1972, he decided to specialize in heart disease, the leading cause of death.

Moon trained in New York, moved to Cleveland and then made a rapid transit of Orange County, working in seven hospitals in little over a year. In 1979, he arrived in Redding, which he said reminded him of Korea: clear skies, mountains, quiet.

He and his wife, Sun, raised two boys and a girl here, all now grown. Moon contributed to the symphony and funded a high school science scholarship. But mostly he worked.

His self-esteem never seems to have been low, but over the years it blossomed.

“How dare you get a second opinion,” an “enraged” Moon is quoted in a wrongful-death lawsuit filed Friday as saying to a 74-year-old patient with no prior history of heart disease. “I built this heart program!”

Moon also has clashed with the other hospital in town, Mercy Medical, suing it in December 1997 for violating federal anti-trust statutes. In September 1999 the suit was dismissed, but Moon continued to rag on the competition a few blocks away.

“Those boys at Mercy don’t even know” what the latest heart technology is, he is quoted telling one patient in the FBI affidavit. “They have an 8% mortality rate; we have 2%.”

Mercy declines to talk about Moon, issuing a blanket statement: “We have no information to offer, and feel it would be inappropriate to comment.” The statement adds that Mercy did not request the FBI investigation, which many of Moon’s supporters claim.

“He has a terrible, terrible personality,” said Betty Cook, who now believes that Moon’s insertion of a stent to widen her husband Lee’s artery was unnecessary. “He doesn’t talk like you and I are talking. He shouts and yells and demands.”

Yet Cook also remembers approaching Moon after the operation and saying, “I’m sure happy we have a cardiologist like you in Redding. It makes us feel better, to know we’re in good hands.”

And Moon, not gruff for once, said, “That means the world to me to hear you say that. You’ve made my day.”

The brusqueness has cultural roots, one nurse said. The American tradition of analyzing everything, making sure the patient is comfortable, isn’t necessarily the way medicine is practiced overseas.

So too with Moon’s worst habit, smoking. He didn’t try to hide it, and even laughed about it. “Koreans,” he would say, “don’t get heart disease.”

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Former Patients

Some former patients, even now, have a benign view of Moon.

“We hope he gets vindicated,” said 67-year-old Ruben Martinez, a print-shop owner who lives in nearby Weaverville. Two years ago, Martinez had chest pains. His doctor checked him out and was worried enough to helicopter the patient 40 miles to Redding Medical.

“They were doing the work-up on me when I started having pains. Dr. Moon walked in. He wasn’t even supposed to be there that day. He came in and said, ‘This man is having a heart attack,’ ” Martinez said. “I was lucky he wasn’t out buying shoes like he intended to do that day.”

The FBI affidavit speculates that at least half of Redding Medical’s patients really did need surgery, and another quarter fell into a gray area of having a minor amount of heart disease. As for the rest, “there existed no indication of any heart disease that would warrant surgical intervention of any kind.”

That means thousands of patients are wondering about their own cases. One of them is Larry Clifford, an electrical engineer who saw Moon because of his tendency to fall asleep at odd times.

“I felt I was in good hands,” Clifford said. “He was very arrogant, always saying, ‘I’m the best.’ He said he was one of the best cardiologists in the United States. He had a pretty bad beside manner, but that was OK. Zing-zing and he’s gone.”

Clifford ended up having a five-way bypass. “When I was leaving there, they convinced me I was a ... lucky person that they happened to find this. And maybe that’s the case. But I don’t know.”

No one is likely to be sure for months, if not years, if ever.

“I believe in innocent until proven guilty,” said Terry Zeller, a nurse who has worked with Moon. “But he’ll never be completely exonerated from this in the court of public opinion. There will always be a question.”

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A Good Life

If Moon, as his supporters assert, was good for Redding, Redding was also good to Moon. He and Sun, a sculptor, live on the far outskirts of town. White pillars and a black gate, decorated with two “private property” signs, keep the unwanted world at bay.

“No comment, please,” a woman says over the intercom. ‘You can contact our lawyers.” The lawyer, John Reese Jr., didn’t return calls.

The driveway winds up the hill and out of sight. According to tax records, the unseen house was built in 1991 and has 6,180 square feet. Its assessed value is $835,756. A neighbor -- he lives practically next door but has never met the doctor -- says Moon built a painting studio in the back.

Moon’s abstract canvases are the most unusual thing about him, colleagues say; such a contemplative activity doesn’t seem to fit in with his type-A personality. But Moon’s interest in art is long-held. His sister, his parents-in-law and other relatives are artists. He recently sponsored an art show here, one friend said.

Since the raid, Moon has been trying to carry on. Baker, the Presbyterian missionary who was given a death sentence by Moon six years ago, had an appointment last Wednesday. “The office was jammed,” he reports.

Baker was getting his pacemaker tested. Unexpectedly, Moon came in.

“It’s a rotten thing,” Baker said to him.

Moon replied he was being “crucified” in the Redding paper. He said he’d heard there had been close to a thousand letters in his support sent to the editor, but none had been published.

Tom King, editor of the Record Searchlight, said the paper has received about “20 or 30” letters, a few signed by multiple people, in support of the doctors. He added that the paper has received an equal number of letters detailing unverified allegations against them. None of the letters from either group has been published.

The faithful have had no trouble making their feelings known on an immense banner outside the hospital’s catheter lab.

“We Support Our Doctors,” it proclaims. By Saturday, there was no space left to add comments. Some were grammatically suspect, but the meaning was always clear. “Dr. Moon your great.” “Thank you for saving the life of my father-in-law and my wife.” “Your #1.” “Keep the faith. This too shall pass.” “I trust you. You saved me.”

When Moon first saw it, one witness said, he broke down in tears, sobbing uncontrollably, saying he couldn’t believe what was happening. Two colleagues had to hold him.

The state medical board has petitioned for a temporary restraining order to stop Moon and Realyvasquez from practicing.

As part of the petition, there was a declaration from Vincent Yap, chief of cardiology at Kaiser Richmond Medical Center. “It is my strong professional opinion that neither Dr. Moon nor Dr. Realyvasquez can safely practice medicine, and each poses a threat to patients,” he wrote.

A hearing is scheduled for Tuesday.