There Will Be Blood and Money
And a lawsuit. And many, many questions about the relationship between a local hospital and the world’s largest medical device company.
In 2008, Minnesota-based Medtronic, the largest medical device company in the world (one of the founders invented the pacemaker), brought to market its first drug-eluting stent, Endeavor. The company’s sales force descended on hospitals around the country, working to persuade doctors to give the device a try.
The cardiac catheterization lab at the Lahey Clinic — commonly known as the cath lab — was among those that agreed to carry Endeavor. For Lahey, the decision promised to bring the latest technology into the hospital. For Medtronic, it meant landing a prestigious and potentially lucrative account. Lahey implants some 2,000 stents a year, a pace rivaled in the state only by UMass Memorial Medical Center.
WHEN DAVID GOSSMAN joined Lahey in 1987, straight off his medical training, the enormous profits and intense fighting of the stent wars were still years away. As a salaried cardiologist at the clinic, Gossman knew he’d make less money than if he joined a private practice, but he also knew his staff position would free him from some of the mundane hassles of running his own business. He’d be able to focus on treating patients, conducting research, and living a semblance of a normal life. “When you choose academic medicine, you don’t choose it thinking, ‘I’m going to make a killing,’” says a former colleague of Gossman’s. “Dave has a lot of different things going on. He changes hobbies like he changes his clothes — fly-fishing, photography. His whole life didn’t focus on the hospital.”
As Gossman was building his career in the early 1990s, the medical landscape in Greater Boston was changing dramatically. In 1994, Massachusetts General Hospital and Brigham and Women’s Hospital merged to become Partners HealthCare, creating an industry juggernaut. To compete, other local hospitals began scooping up private practices in order to broaden their patient base and ensure a steady stream of referrals. Such moves were critical to the survival of hospitals, a reality summed up by a mantra administrators liked to recite to their physicians (if not the public): No margin, no mission. Without paying attention to the bottom line, in other words, there can be no lifesaving research or treatment. A bankrupt hospital can’t help anybody.
During the hospital consolidation craze, Lahey bought out the practice of Thomas Piemonte, a busy and well-respected cardiologist from Needham. Eventually, Piemonte became the director of the clinic’s interventional cardiology department, a promotion that bumped him above Gossman in the clinic’s pecking order. “Dave didn’t step up,” says the former colleague. “He was happy where he was.”
According to one former Lahey cardiologist, Piemonte was not just more willing than Gossman to be a leader, he was also more driven. He pushed himself, and his colleagues, to try new things. “They do a lot of clinical trials at Lahey, and he’s more willing to be on the cutting edge,” this doctor says. “Other doctors are more conservative, but he’s more willing to try it himself if he thinks it will help patients.” Though Gossman was a skilled member of the team, the doctor says, “I’m not sure he ever took the initiative to seek out those trials; he’d go along.”