The corruption investigation into cardiologists in the Zwolle hospital Isala focuses on expensive, implantable electronic heart devices. Since the autumn of 2020, the Public Prosecution Service has been investigating payments from a German seller of ICDs and pacemakers. Justice suspects that manufacturer Biotronik has paid millions in bribes to medical specialists. This is evident from research by NRC in collaboration with the German weekly Der Spiegel.
Most implantable defibrillators (ICDs) in the Netherlands are placed in the Zwolle hospital. It is regarded as a center of expertise, but within the professional group the high number of implants in Zwolle leads to discussion. Patients in Zwolle are heavier and older and have a device in their body as a preventive measure more often than average.
Also read the research story: Heart devices from German company pivot in corruption investigation
Supervisors, the Ministry of Health, Welfare and Sport and health insurers have been wondering for some time whether cardiologists do not decide to implant too quickly. According to critics, the health risks are underestimated.
There are major financial interests involved. Every year around 6,000 ICDs are installed nationwide, with the equipment alone costing 130 million euros. After an implant, patient support should be available 24/7.
Only a few manufacturers supply the ICDs, which stabilize the heart rhythm like a defibrillator with electric shocks. Health insurers appear to have no insight into the cost differences of the brands and do not know which devices Dutch doctors choose. That’s because hospitals declare the devices as part of a general surgical treatment.
Repossessed on houses
Biotronik, a German family business with a subsidiary in Nijmegen, has previously been discredited by bribe payments to cardiologists. In the US, it has more often made arrangements to bribe cardiologists, through luxury trips and large sums of money for fake workouts, meaningless fictitious consultant positions and lectures at conferences. The last million settlement dates from July this year.
The Public Prosecution Service has seized the homes of at least five medical specialists, three of whom are electrophysiologists with experience in implanting pacemakers and ICDs. The cardiologists are suspected of having collected 3.2 million euros in unfairly obtained benefits. The payments would have been made over several years through foreign entities. The OM suspects cardiologist Peter Paul D. of having benefited most from bribes. He would have wrongly received 1,013,559 euros privately.
In the annual report, the Dutch subsidiary of Biotronik states that the Public Prosecution Service has been investigating “several payments” in the past since the end of 2020. Biotronik does not respond to questions. Isala says that she herself is “possibly disadvantaged” by “the possible fraud”.
Freedom for doctor
Physicians have a lot of freedom to decide about having an ICD placed. Implantation has grown rapidly since the turn of the century, particularly in patients who have never experienced cardiac arrest before. Currently, more than half of the devices are implanted preventively.
As early as 2010, cardiologists warned that financial motives could play a role in the increase. Hospitals and medical specialists can earn good money from it. At the same time, an implantable defibrillator poses a risk to the patient. A large study shows that 8 percent of patients develop serious complications, such as inflammation and bleeding, within 2.5 years. Hospitals do not mention this percentage in patient brochures. Wearing an ICD also has major consequences for daily life. Sometimes the device delivers shocks inappropriately.
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A version of this article also appeared in the newspaper of October 17, 2022