Justice suspects that the medical specialists have been paid for years by a supplier of medical equipment, who would have received preferential treatment from the cardiologists in exchange for millions of euros.
The tax investigation service FIOD carried out house searches in Germany and Curaçao last week and seized real estate, says an FIOD spokesperson. Searches were also made at, among others, the medical company Diagram bv in Zwolle.
Real estate seized
The two suspected cardiologists are involved in Diagram as medical director and commissioner. This company conducts scientific research worldwide and provides IT services to hospitals. Diagram is closely associated with Isala hospital.
A Diagram spokesperson declined to comment on the raids, saying the investigation has nothing to do with the company itself, but focuses on the two cardiologists. The FIOD does not want to say whether the company itself is also the subject of investigation.
Justice this week seized the property of the two suspended cardiologists worth 1 million euros and more than 843 thousand euros respectively. This includes their homes in Zwolle and an apartment in Amsterdam, according to data from the Land Registry.
Concerns about lack of transparency among medical specialists
The suspension causes ‘a lot of uncertainty’ and the waiting time for patients is increasing, according to an anonymous person involved in the department. The Isala says it will attract extra capacity from outside. ‘We will ensure that the absence of the two cardiologists will cause as little inconvenience as possible for individual patients.’
The government and the House of Representatives have been concerned for some time about the lack of transparency regarding the income of medical specialists who are not employed by the hospital, but are hired as a specialist medical company (MSB).
Members of MSBs, so-called ‘independent doctors’, have a lot of autonomy; clarity about their financial interests in other companies is usually lacking. The government wants MSBs to improve within two years. If this does not happen, regulations will be introduced that make it compulsory for medical specialists to be employed.
Cardiology is characterized by favoritism and possible self-enrichment
Isala’s cardiology department has been plagued by conflict for some time. The heart center, which is known as one of the best in the Netherlands, was discredited last year because of a sick working atmosphere. From internal reports that de Volkskrant has realized that there was a case of favoritism and an unsafe working climate. Employees of other departments, among others, complained to the hospital board about the cardiology department.
The hospital board placed the department under guardianship and appointed two interim directors. The cardiologists did not accept this and asked the judge to reverse that decision. At the end of last year, the judge ruled that the hospital had acted correctly.
Possible self-enrichment and conflicts of interest of cardiologists have also been a topic of discussion within the hospital for some time. An internal, confidential report prepared by Isala about Diagram last summer points to ambiguities and potential conflicts of interest surrounding the company.
Confidential Report Out Of Concerns About Mixing Functions
The company was born 25 years ago from research activities of the Isala and conducts non-commercial and commercial cardiovascular studies. Nine cardiologists from the hospital jointly own a 40.5 percent stake in the company.
The report shows that this mixing leads to suspicion in the workplace. ‘There is insufficient insight into the interests of cardiologists from their various positions and tasks within Isala and at Diagram’, the report concluded last summer. The result: several employees ‘distrust the actions’ of some cardiologists who work for Isala ‘but also have (financial) interests in Diagram’.
In the report, one of the suspects is explicitly associated with the risk of a conflict of interest. ‘We see a mix of functions in the medical director of Diagram, who is responsible for capacity planning within Isala Hartcentrum and is a member of purchasing teams.’
Diagram is partly dependent on commercial clients for conducting scientific research. The often loss-making scientific studies were partly financed with the proceeds of the commercial studies. That caused tension, according to the report. Cardiologists also have an interest in conducting and obtaining scientific studies for the development of their field and position, the report notes. ‘Maintaining a good relationship with suppliers as sponsors of these scientific studies is important in this regard.’
Heart center purchased services from a company in which cardiologists had an interest
At the request of the hospital, consultancy firm EY also investigated possible conflicts of interest among cardiologists in Zwolle. EY looked at their involvement in companies that have a relationship with the hospital. This included HC@Home, a company that has developed a program that enables remote heart care via a smartphone. The heart center purchased services from this company, while a number of cardiologists had an interest in it.
Several employees told EY’s investigators that they “experienced pressure” to deploy HC@Home’s products, especially when the company ran into financial difficulties. HC@Home went bankrupt last year after Isala filed for bankruptcy. The hospital had paid 167 thousand euros too much, but the company was unable to pay it back.