When Bette Albright took an emergency flight to Salt Lake City in August 2025, her family prayed that doctors there would be able to save her life. Albright, 75, had a small tear in her aorta, the site of an unsuccessful heart valve replacement she had undergone weeks earlier at Benefis Health S ystem, a nonprofit hospital with a primary campus in Great Falls and locations throughout central Montana.  In Utah, medical records show that doctors couldn’t determine exactly what had caused the cut. They tried to mend it during an hours-long surgery, but afterward, Albright struggled to recover. Her family ultimately decided to end her life support in late August. She died with one of her daughters at her side.  In the dizzying hours spent in the Utah hospital, leading up to and after Albright’s death, one detail stood out to her daughter, Kimberly Sangray, as strange and particularly concerning. The surgeons in Utah had decided not to retry the valve replacement that Albright had undergone in Great Falls, a procedure called a TAVR.  In Sangray’s recollection, the doctor’s explanation was simple: Her mother didn’t appear to need the device at all. That assessment is also indicated in Albright’s medical records, copies of which were reviewed by Montana Free Press. Among other notes, Utah doctors surmised that parts of Albright’s heart that could have been helped by a TAVR were, in fact, working “well.” In the months after Albright’s death, the family kept revisiting that apparent contradiction. If the device had been meant to help heal their loved one’s heart, why hadn’t another group of doctors considered it critical? Had Albright actually needed the valve replacement in the first place? “We’ve always been such a good advocate for her,” Sangray said in a May interview with MTFP. “But never once did I think about asking, ‘How did she qualify for this?’” The family wasn’t aware that, since 2024, doctors at Benefis had raised concerns about how the hospital selected patients for the same valve procedure Albright had received. In interviews with MTFP, three former Benefis doctors said they had posed questions about patient selection to other doctors and hospital administrators. Some patients did not have the heart condition that the procedure was designed to treat, the providers told MTFP. Others appeared to have mild heart disease conditions, even though TAVR is generally reserved for severe cases.  “I have concerns that there was a pattern of behavior that suggested that Benefis compromised appropriate patient care for multiple patients,” said Dr. Steven Goldberg, a cardiologist who left Benefis last November after one year in Great Falls. Benefis Health System has been expanding its portfolio to include senior housing developments and a healthy aging center. Credit: Matt Hudson/MTFP Goldberg and other doctors told MTFP they didn’t feel their concerns were taken seriously, either by administrators or the cardiologist who led the Benefis TAVR program at the time.  But by the end of 2025, Benefis had stopped performing TAVRs altogether.  In an interview and in emailed statements to MTFP, Benefis administrators defended the practices of the hospital’s TAVR program and dismissed criticisms from former doctors. Hospital executives also reiterated their commitment to the valve replacement program, pledging that Benefis will restart its TAVR program later this year. Administrators confirmed that the TAVR program is just one part of Benefis’ effort to build a competitive cardiology department — one that the hospital hopes could keep patients from having to travel several hours for their care. Making the program sustainable, they acknowledged, requires an active caseload and can be costly to build. To receive Medicare reimbursements for TAVR, hospitals need to perform dozens of procedures annually — a difficult goal in areas with low populations.  The challenge of offering high quality specialty services in sparsely populated areas is one that experts say many rural hospitals face. “If you don’t do enough of them, you don’t do any of them very well,” Gerard Anderson, a health policy and hospital finance researcher at Johns Hopkins University, told MTFP.  Hospitals often see specialty cardiology services as a major opportunity to drive revenue and serve patients who would otherwise have to travel extensively to access care, Anderson said. The next TAVR program after Great Falls is in Missoula, more than 150 miles away. But the true test of a program’s quality comes after years of consistent data about patient outcomes. “It’s looking at these people a little bit as guinea pigs and trying it, which is scary,” said Anderson, referring to patients in any new specialty program. “I probably wouldn’t want to be a guinea pig.”    Benefis administrators said decisions about patient care ultimately rest with individual physicians but denied that the hospital’s processes for selecting patients and responding to doctor feedback were flawed in any way. Former providers saw the situation differently. “It seemed to me that upper administration of Benefis was really pushing to generate numbers, to generate [the] amount of procedures,” said Dr. Miroslaw Sochanski, a cardiologist who practiced at Benefis from 2019 to January 2025. “And anything that was questioning that was considered as obstructive.” The three former Benefis doctors who spoke with MTFP said the health system’s approach to patient selection for its TAVR program was a direct factor in their decisions to seek work elsewhere. When Benefis administrators appeared indifferent to their concerns, the doctors said, they chose to leave the hospital entirely.  All three now practice in other states. ‘WE CAN’T BELIEVE IT WORKS’ Transcatheter aortic valve replacement, or TAVR, is a medical breakthrough roughly two decades old and a less-invasive alternative to open-heart surgery for certain patients. It’s primarily used in older people who face life-threatening heart disease and are risky candidates for open-heart surgery, according to multiple cardiologists who spoke with MTFP. Experts say TAVRs are intended to improve blood flow in patients whose aortic valve has become restricted due to heart disease. Even though it’s an alternative to open heart surgery, the procedure is still highly technical: Physicians make an incision to access an artery at a patient’s waist and maneuver an artificial valve up to the heart. There, the device is secured to the aortic valve to replace the natural valve and restore blood flow. A TAVR device starts in a collapsed form so that physicians can maneuver it up an artery and into the heart. There, the valve is expanded and secured to replace the natural valve. Credit: Courtesy of the U.S. Department of Veteran Affairs. “Even to this day, after doing 2,000 TAVRs, we can’t believe it works,” said Dr. James “Tod” Maddux, a cardiologist at Providence St. Patrick Hospital in Missoula. “Every time we do a TAVR, we’re like, ‘Oh my gosh, that is the most amazing thing I’ve ever seen.’” St. Patrick Hospital started the first Montana-based TAVR program in 2013 and today is the most established program in the state. Billings Clinic also has an active TAVR program. Benefis began its Great Falls TAVR program in 2022.  Because TAVR is relatively new, the federal Centers for Medicare Medicaid Services (CMS) requires a “heart-team” approach, with multiple doctors involved in consulting and performing the procedures. Medicare is the federal health insurance program for people over 65, and because the vast majority of TAVR patients are elderly, it is the primary insurer that reimburses hospitals for eligible procedures. For rural health systems, recruiting doctors and other medical staff to conduct TAVRs is one of the biggest roadblocks to offering the procedure. The heart team required by federal regulators includes both a cardiologist and two surgeons with specialized training in cardiovascular treatments. Dr. Daniel Spoon, a cardiologist and chief medical officer at St. Patrick, said that until TAVR matures into a more established procedure, the requirement to involve multiple care providers helps mitigate risk. “When everything goes according to plan, anyone can do it,” Spoon said. “When something goes not according to plan, that’s where you need the experience, the team, the nurses, the techs that can get things out of trouble.” “It seemed to me that upper administration of Benefis was really pushing to generate numbers, to generate [the] amount of procedures. And anything that was questioning that was considered as obstructive.”Dr. Miroslaw Sochanski Another hurdle rural hospitals face when deciding whether to launch a TAVR program is the number of patients who come through their doors. CMS, the federal agency that includes Medicare, requires hospitals to complete dozens of heart valve procedures each year to be eligible for TAVR reimbursements, a high bar for hospitals in rural states. Spoon and other experts said that, if patients are few and far between, cardiologists won’t get as much practice as they need. “Volume matters,” Spoon said. “You don’t want to do a couple of these.” For hospitals with active TAVR programs, federal regulators require 100 valve replacements every two years. That includes open-heart valve replacements, but 40% of the procedures need to be TAVRs. For a new TAVR program seeking its first reimbursement from Medicare, the federal government just requires that hospitals perform at least 20 “aortic valve-related procedures” over two years.  “The requirement is because quality of care is lower when services are done less frequently,” said Anderson, the Johns Hopkins researcher. Federal regulators, he continued, are attempting to balance quality with access for people who might struggle to travel for special services.  Until a hospital demonstrates that experience, none of its procedures can be reimbursed by Medicare. Kaci Husted, Benefis’ system senior vice president, said hospitals in that situation, including Benefis, accept that they may absorb high costs of offering services for years before they can recoup expenses from Medicare. “It’s an investment in growing our services,” said Husted in a May interview with MTFP. “So if that investment is, we have to do some of these procedures without getting paid for a while to build up a program to get to a level that it can be financially sustainable and have the volumes it needs, that may just be what it is.” Benefis did not respond to subsequent inquiries from MTFP about how many of its TAVR procedures had been reimbursed by Medicare in recent years. But, in the same May interview, Dr. Greg Tierney, Benefis’ executive vice president of system clinical operations, affirmed that the Benefis program steered by Dr. Kimberly Atianzar, a California-based provider who worked at Benefis part-time, had been progressing toward exceeding Medicare thresholds. “When we very first started it, you have to build that up,” Tierney said. “But, yes, she was well on path to do well over 50 TAVRs when she ended her program.” QUESTIONING PROCEDURES, CONFLICTING OPINIONS Dr. Steven Bailey started at Benefis in 2015 and eventually became the hospital’s most experienced heart surgeon. In interviews with MTFP, he said he regarded TAVR as a medical breakthrough and that he advocated for the program’s launch in Great Falls. But he said that he had also been ostracized by Atianzar after he asked for more thorough reviews of TAVR patient outcomes. Benefis administrators then asked him to stop working on TAVR cases, he said. “It was shortly thereafter that, suddenly, I was not suitable to be participating in the TAVR program,” Bailey said. “That seemed to me to be the overall atmosphere that occurred whenever someone questioned the TAVR statistics or questioned patient selection — that it was met with aggression, and it was not an open, collegial discussion. So that part was disappointing to me.” Atianzar did not respond to multiple texts, phone calls and voicemails seeking comment about her tenure at Benefis. Bailey participated in the first Benefis TAVR in 2022. About a year later, Benefis hired two new doctors who eventually took control of the program. The first was Dr. Dimitrios Koudoumas, a vascular surgeon who began sharing TAVR cases with Bailey. The second was Atianzar. Bailey and other former Benefis doctors said that Koudoumas and Atianzar eventually began participating in more TAVR cases. But as Atianzar took responsibility for the program, former doctors said she changed the process of vetting which patients should receive the procedure. Monday morning meetings, where doctors historically discussed patient cases and the best courses of care, became less collaborative, doctors told MTFP. “It was not an open, collegial discussion. So that part was disappointing to me.”Dr. Steven Bailey Sochanski, the cardiologist who now practices in Utah, said those meetings became more of a “monologue” than a discussion under Atianzar. Sochanski said he had questions about whether some TAVR candidates had sufficiently severe symptoms to warrant a TAVR. He said his opinions were dismissed — both by Atianzar and Benefis administrators. “Since I was asking questions, I was kind of pushed aside. If Dr. Bailey was asking questions, he was sidelined,” Sochanski said. “So that was the prevailing theme that, for the moment, the golden children of the program were Dr. Atianzar and Dr. Koudoumas, who had carte blanche to do anything.” Bailey said he had spent a lot of time building his practice at Benefis, even as doctor turnover hammered the cardiology department. He told MTFP that he planned to spend more years working in Great Falls and tending to his farm just outside of town, but it was a tough blow to be shut out of the specialty program he helped to start. “I felt as if the writing was on the wall that my services were no longer going to be required or valued, and I felt somewhat excluded from things,” Bailey said. “And so I thought that I had to voluntarily make the choice to leave.” Bailey left Benefis last December and now practices in Alaska.  Shawn Albright holds a photo of her mother Bette Albright with family members while her sister Kim Sangray looks on, April 22, 2026, in Great Falls. Bette Albright died from complications after undergoing several heart procedures, including at Benefis Health System. Credit: Lauren Miller, Montana Free Press, CatchLight Local/Report for America Two weeks after Albright’s death, in the fall of 2025, Goldberg emailed Benefis administrators to share concerns about a different patient whom Atianzar selected for the procedure. Goldberg said the patient’s profile included several indications that they didn’t appear to need the procedure. Among other considerations, Golderberg pointed out, the patient appeared to have a mild form of heart disease, and there didn’t seem to be enough hard calcium in the valve to affix an artificial device. Goldberg first appealed to Atianzar about her decisions. When that went nowhere, Goldberg alerted Benefis leadership. “I did raise those concerns,” Goldberg told MTFP in February. “Not only were they not taken seriously, but I was publicly ridiculed in the meeting and received emails from hospital administration that I should apologize to the interventional cardiologist for having insulted them by challenging them.” In emails that Goldberg shared with MTFP, hospital administrators appeared to deflect Goldberg. In one, Benefis Chief Operating Officer Amy Linder suggested he apologize to Atianzar for raising questions about TAVR patients in a meeting. In another, the hospital acknowledged that an “outside entity” was reviewing multiple TAVR cases. But later, administrators refused to share any details with Goldberg when he asked about the outcome of that probe, according to emails reviewed by MTFP. The hospital also declined to answer additional questions from MTFP about the findings of that external review, citing the confidentiality of doctors’ performance reviews. Frustrated by his experience, Goldberg left Benefis last November and now practices in California. All three former Benefis doctors who spoke with MTFP regarding the TAVR program in Great Falls declined to discuss specific patient cases, including Albright’s, citing patient confidentiality. Tierney, Benefis’ head of system clinical operations, characterized the team’s vetting of TAVR candidates as an open dialogue between doctors with varying levels of experience, training and willingness to be aggressive in a course of treatment. He said the concerns of other doctors amounted to differing opinions. “At the end of the day, the decision on who to care for the patient is the patients’ physicians,” he said. “I can listen to your opinion, but I certainly don’t have to accept it.” But the criticism levied against Atianzar came from doctors with widely recognized professional qualifications. Goldberg, Sochanski and Bailey each had specialty certifications and experience that met or exceeded those of Atianzar and Koudoumas. Goldberg said that he had performed more than 100 TAVRs and launched a TAVR program in California prior to joining Benefis. Tierney said he had full confidence in Atianzar’s qualifications, even though she wasn’t board-certified in interventional cardiology, a specialty that involves treatments such as stents, angioplasty and TAVR. “Some people are grandfathered in based on their experiences,” he said. “She had taught in other different places. She had set up programs in other places. She was extraordinarily well-trained and had a wealth of experience.” Tierney emphasized that, while individual physicians are ultimately responsible for evaluating which patients could benefit from a TAVR, he saw no issues with how the TAVR program was run and indicated that Atianzar left the hospital on good terms. Addressing the decision to halt the TAVR program at the end of 2025, Tierney said the pause was necessary to hire more full-time physicians based in Great Falls. Earlier this year, the hospital announced that it had hired a new heart surgeon and interventional cardiologist. Koudoumas still practices as a cardiothoracic surgeon at Benefis.  “[Benefis leaders] believe strongly that the best program and the best way that we support that program is with permanent doctors,” Tierney said. “When they live in the community, they have ownership.” ‘I DIDN’T DO THIS’ Bette Albright consulted with Atianzar about TAVR in the summer of 2025, after she came to the hospital with shortness of breath.  Atianzar had operated on Albright earlier that year to repair a leaky heart valve. Family members said that Albright loved “Dr. A,” who was personable and earned Albright’s trust. When Atianzar began raising the possibility of a TAVR procedure to address her strained breathing, Albright’s two daughters in Great Falls and son-in-law said the family understood it to be their best route to avoid a much more invasive open-heart surgery. The condition that TAVR is federally approved to treat, severe aortic stenosis, occurs when blood flow through the aortic valve is restricted. The U.S. Food and Drug Administration has approved nearly all TAVR devices, including the one used on Albright, for aortic stenosis.  But Albright’s medical records, reviewed by MTFP, show that she was experiencing aortic regurgitation, a type of valve leak, rather than aortic stenosis. Experts say TAVRs can be used to treat aortic regurgitation in severe cases or in patients with multiple issues, but the two conditions have meaningful differences. Patients with stenosis often have a buildup of hard calcium in the valve, which is how doctors secure a TAVR device. The lack of calcium, more common with aortic regurgitation, poses a risk during TAVR procedures. Sisters Shawn Albright and Kim Sangray laugh while talking about their mom, Bette Albright, on April 22, 2026, in Great Falls. Bette Albright died from complications after undergoing several heart procedures, including at Benefis Health System. Credit: Lauren Miller, Montana Free Press, CatchLight Local/Report for America Sangray, Albright’s daughter, said the family was never told about the risks of low calcium deposits when speaking with Benefis staff about a possible TAVR. The family agreed to proceed with the TAVR in July 2025. Atianzar and Koudoumas were the primary physicians, according to Albright’s medical records. The two made several attempts to place the valve. None were successful. Afterward, Atianzar informed Albright and her family that the procedure had failed.  The failure, Atianzar told the family, was specifically due to a lack of calcium. “She told us it was because there wasn’t enough calcium, is why it didn’t take,” Sangray said during an April interview. “That’s the first time I’ve ever heard about calcium.” Within days of the aborted procedure, Albright’s daughters realized their mother wasn’t recovering. She described pain all through the left side of her chest and rib cage, Sangray recalled. The normally upbeat mother and grandmother, who loved cooking and caring for family members, couldn’t get around the house. “She had pain,” recalled Shawn Albright. “She would cook dinner, and she’d be like, ‘I’m sorry,’ and she’d have to lay down. The pain was horrendous.” When Albright returned to the Benefis emergency department in mid-August, her medical records show that staff identified a tear in her aorta. The condition was critical enough that local staff discussed transferring Albright to a larger medical center.  Ultimately, Albright and her family decided to transfer her to the University of Utah Hospital in Salt Lake City. Before they boarded the flight, Sangray’s phone rang. Atianzar was on the other end.  “And the first thing she said to me was, ‘I didn’t do this. This is not because of me,'” Sangray said. Atianzar also made multiple offers to fly to Salt Lake City to meet the family while Albright was there, Sangray said, something that struck Albright’s family as exceedingly strange.  “As soon as she hung up the phone, I told her, I said, ‘That’s why she called. To cover her ass,’” said Jeff Sangray, Kimberly’s husband and Albright’s son-in-law, in an April interview. Albright and Sangray flew to Salt Lake City for emergency surgery. According to Sangray, the effort to repair Albright’s heart took 11 hours. While Albright’s tear was at the site of the TAVR procedure, ultimately, Utah medical staff said in her medical records that the cause was “clinically undetermined.” ‘THAT FULL COMPLEMENT OF SERVICES’ Benefis administrators told MTFP that bringing a specialty care program such as TAVR to a Montana hospital is intended to provide competitive care to local patients. But in a rural setting where a hospital’s market is geographically vast, specialty care is also a critical tool to keep patients from seeking services elsewhere. “Ultimately, the big hospitals in the state for any of the more specialized programs are kind of direct competitors with each other, especially for someone who lives in, let’s say, a Lewistown that’s right in between here and Billings,” said Husted, Benefis’ senior vice president. “I mean, they are going to go to one place or another.” Tierney, the Benefis administrator, said that revenue from specialty services like TAVR doesn’t exist in a vacuum, either. With every procedure done at Benefis, a patient will also have required labs, scans and other “spin-off” tests that can also generate revenue for the facility, Tierney explained. If Benefis has to send a patient to Missoula for a specialty service, Tierney added, it’s highly unlikely that the patient will come back to Benefis for any of their related or follow-up care — a domino effect of lost revenue. “Benefis maintains a comprehensive compliance program and takes all concerns regarding patient safety and regulatory compliance seriously. All concerns are thoroughly reviewed, and when appropriate, Benefis takes prompt corrective action and makes necessary changes to its practices.”Kaci Husted, Benefis’ system senior vice president “Because once you’ve sent them away, you’ve lost that patient,” Tierney said. “So in order to maintain our heart program and our heart volumes, you have to have that full complement of services.” Experts say staying competitive in rural health care can require a significant up-front investment, particularly for TAVR. The valve devices used in a TAVR can cost tens of thousands of dollars, and the operations tie up multiple physicians and other hospital staff. Anderson, of Johns Hopkins, said rural hospitals serving the same state or region might benefit from dividing certain types of specialty services, such as cancer care or cardiology, to avoid direct competition for a limited pool of patients. But he said the finances of individual hospitals often take precedence, with each one looking to expand revenue where possible.  “They’re competing against each other, and if somebody’s making money, they’re not going to give it up,” Anderson said. After meeting with MTFP for one interview, Benefis declined to answer additional follow-up questions about its TAVR program or its financial viability, citing MTFP’s interviews with critical former employees. In a June statement, Husted reiterated the hospital’s commitment to offering high-quality services. “Benefis maintains a comprehensive compliance program and takes all concerns regarding patient safety and regulatory compliance seriously,” she wrote in an email. “All concerns are thoroughly reviewed, and when appropriate, Benefis takes prompt corrective action and makes necessary changes to its practices.” ‘OUR OPTIONS WERE HERE’ Albright struggled after surgery in Salt Lake City. After multiple procedures and being placed on a ventilator for more than a week, her family concluded that she would not recover. Shawn Albright and Kimberly Sangray acknowledged that their mother had been dealing with serious health complications for a long time. But both sisters expressed distress and grief at the idea that Albright might not have been a strong candidate for a TAVR in the first place — the procedure that appeared to set her on a downward spiral, rather than make her healthier.  In hindsight, the sisters wondered if they should have sought out a second opinion, despite the geographic barriers. Kim Sangray says she plans to get “Love, Mom” tattooed in her mother’s handwriting. The phrase is meant to mimick how Bette Albright signed her cards, shown here on April 22, 2026, in Great Falls. Bette Albright died from complications after undergoing several heart procedures, including at Benefis Health System. Credit: Lauren Miller, Montana Free Press, CatchLight Local/Report for America “Traveling to Missoula, you know, it hurt her back. We talked about going to Billings. She just didn’t want to travel,” Sangray said. “So our options were here, and that’s what we went with.” The family signed a legal release to allow Benefis to discuss Albright’s medical care with MTFP, including whether Albright’s condition was actually severe enough to warrant a TAVR and whether complications from that procedure contributed to Albright’s death. Benefis declined to comment, saying in an email that the hospital did not “have anyone available for an interview who was directly involved [in] Bette Albright’s care, nor would it be overly productive for us to try to piece together different parties’ recollections of the verbal conversations that occurred as part of her care.” The doctors who spoke to MTFP said they believe that the patients in the Great Falls region, including much of north central Montana, deserve access to high-quality specialty services. They acknowledged that the promise of building up those programs was part of what initially drew them to practice at Benefis.  But the doctors said they left Great Falls disappointed, wishing that Benefis had supported the rigorous, collegial discussion that they felt should take place around clinical decision-making. The resulting turnover of medical professionals impacts patient care, they said, and threatens the competitive edge that Benefis hopes to gain in Montana. “Great Falls is ripe for a strong cardiology program, and strong cardiology leadership at Benefis would be a great position if it weren’t for all of the negativity that’s surrounding it,” Goldberg said. “I think that what happens is that everybody comes in — including myself, by the way — and says, ‘This could be great, but I don’t think I want to go through the pain of dealing with the toxicity that is a part of that program right now.'” The post A Montana hospital tried to build a cutting-edge heart program. It drove doctors away. appeared first on Montana Free Press. ...read more read less