A nurse who alleges she was fired from an Iowa hospital after reporting questionable patient deaths, fraudulent billing, and the manipulation of patient-outcome statistics is now suing the hospital for retaliation.

Cynthia Tener is suing MercyOne Siouxland Medical Center, Mercy Health Services-Iowa Corp. and Trinity Health Corp. in federal court for alleged retaliation in violation of public policy and the federal False Claims Act.

When asked about the lawsuit, MercyOne provided a written statement that said, “MercyOne stands by our cardiac services program, and our commitment to safe, quality care is steadfast. We are dedicated to the fair and valued treatment of our colleagues, physicians and providers as this is central to our values at MercyOne. As this is now an active legal matter, we are unable to provide further comment.”

The physician at the center of lawsuit, Dr. Giovanni Ciuffo, said he was unaware of the lawsuit and could not comment on the matter until he looked into it. The Iowa Board of Medicine has no record of any public disciplinary action against Ciuffo.

Tener is a registered nurse who was employed by MercyOne Siouxland Medical Center as the director of the cardiovascular service line until she was fired last fall. As part of her job, she provided supervision and coaching for the cardiovascular nurses and clinic leaders as part of her job.

In her lawsuit, she alleges that in November 2020, she requested a meeting with Ciuffo, a cardiothoracic surgeon, as well as Dr. Stilanos Efstratiadis, Dr. Glynne Edwards, and the medical center’s chief operating officer, Timothy Daugherty, to discuss Ciuffo’s actions in a recent surgical case.

According to the lawsuit, Ciuffo “had cut open a patient in the operating room without the other treating physicians present and then failed to follow the surgical plan to which he, the other physicians, and the patient had previously agreed.” The patient died shortly after surgery.

When Tener voiced concerns in the meeting about Ciuffo’s actions, the doctor allegedly became angry and demeaning, talking down to Tener and referring to her as “this little girl” and “this woman.”

Ciuffo was never disciplined for his conduct towards Tener in the meeting. Shortly thereafter, two other employees, Chad Brady and Kevin Christiansen, allegedly confided in Tener that they had concerns about Ciuffo performing unsafe add-on procedures during surgeries and lying to patients about their expected outcomes.

Lawsuit: Patients kept alive to improve stats

In February 2021, Efstratiadis allegedly informed Tener he was concerned that Ciuffo was not getting proper informed consent from patients, that he was operating on patients whose risk levels were too high, that his volume of add-on procedures was excessive, and that his patient mortality rate was abnormally high.

Efstratiadis allegedly told Tener that even when patients had little to no chance for recovery, Ciuffo would keep them alive via mechanical means such as ventilators, heart pumps and feeding tubes for at least 30 days after surgery in order to protect his patient-outcome statistics as reported to a national database.

Once the 30 days had passed, the lawsuit alleges, Ciuffo would “withdraw those artificial life-sustaining measures” and allow the patients to die naturally so their deaths would not be recorded as adverse outcomes in the database. For at least some of those patients, Mercy allegedly billed Medicare for “these futile artificial preservation treatments and equipment,” the lawsuit claims.

The lawsuit characterizes the database as a national registry of cardiovascular surgical outcomes that is maintained by the Society of Thoracic Surgeons. The database tracks a number of adverse surgical outcomes, including death, but only those that occur in the first 30 days after surgery. Health care facilities, including MercyOne, receive quality ratings based on their database statistics, the lawsuit alleges.

Following her conversation with Efstratiadis, Tener reported the concerns regarding Ciuffo to Daugherty and to MercyOne’s chief medical officer, Dr. Larry Volz, her lawsuit claims. MercyOne then gave a sample of Ciuffo’s case files to another physician for an evaluation.

According to the lawsuit, this physician-evaluator disagreed with Ciuffo’s course of action in all but one of the cases reviewed and found that Ciuffo’s use of add-on procedures was medically inappropriate.

Mortality rates and billing questioned

In May 2021, Tener asked for a meeting with Daugherty, Volz and others to discuss her ongoing concerns. At that meeting, Tener allegedly presented documents showing that the expected mortality rate for a coronary artery bypass graft was 3.1 percent and explained that from July 2019 through April 2021, Ciuffo had a patient mortality rate of 13 percent.

Around that time, MercyOne allegedly imposed restrictions on Ciuffo’s practice, limiting him to surgeries on patients with low risk levels, and subjecting his planned surgeries to prior review by Volz. The lawsuit claims Volz canceled at least two of the surgeries Ciuffo had planned to perform, citing excessive risk. In one case, Volz attempted to stop the surgery, but Ciuffo allegedly went ahead with it and the patient ultimately died.

Shortly thereafter, Tener allegedly emailed Volz and Daugherty, expressing concerns about the manipulation of risk data and other issues. Neither Daugherty nor Volz responded, the lawsuit claims.

About that time, a cardiology nurse practitioner met with a patient and determined he was too high risk for a procedure contemplated by Ciuffo. The nurse practitioner referred the man elsewhere for further care, but Ciuffo allegedly met with the man and obtained his consent for the procedure. The lawsuit alleges Ciuffo failed to fully inform the patient of the risks and did not tell the patient about the multiple heart valves he planned to replace. After Tener reported the situation to the medical center’s ethics committee, a committee member allegedly informed Ciuffo of the complaint and the fact that Tener was the complainant.

When Tener next met with Ciuffo, the doctor “loudly screamed at her” and got to within a few inches of her face and yelled that she was “nothing but a nurse,” the lawsuit alleges. When Tener complained to Daugherty, the COO allegedly told her she needed to work harder on building a relationship with Ciuffo.

In September 2021, Tener learned that physicians at MercyOne in Iowa were reading and interpreting results for cardiac tests conducted in Nebraska and South Dakota, without being properly licensed in those states. Mercy was billing Medicare for the Iowa physicians’ professional fees in reading and interpreting those test results in violation of Medicare billing rules, the lawsuit claims. When Tener informed Daugherty of the issue, he reportedly responded, “I know it’s a problem.”

In October 2021, two nurses allegedly filed an internal complaint against Ciuffo, claiming he falsely documented having provided lidocaine to a patient during a painful wound treatment. When informed of the matter, Ciuffo allegedly complained to Daugherty, who reportedly responded that it was “no big deal” because when he receives complaints, he simply marks them as unfounded.

Tener was later investigated by the hospital for having created “a toxic work environment,” and she was placed on suspension on Nov. 3, 2021. Days later, she was fired.

Her lawsuit, alleging retaliatory discharge that is not in the public interest, seeks unspecified damages from MercyOne and its affiliates. The defendants have yet to file a response in the case.