As one of the state’s most successful medical malpractice attorneys, Stephen L. Snyder has faced the University of Maryland Medical System many times and walked away with millions of dollars for his clients and large legal fees for himself.

But when he sought a $25 million payday in 2018 under the auspices of a consulting deal, hospital officials decided he had gone too far. They went to the FBI.

In an opening statement Wednesday in his federal racketeering trial, Snyder, which represents itselfsaid the Baltimore hospital wanted to prevent him from exposing problems in their organ transplant program. He said they trapped him by indicating they were open to such a deal while federal agents secretly recorded him.

“We did Snyder people in an honorable way,” Snyder told jurors, alluding to his law firm’s slogan: “Don’t sue them. Snyder’s.”

He continued: “They beat me in a foul way.”

Federal prosecutors told jurors that Snyder crossed the line between aggressively advocating for a client and shaking down the University of Maryland’s medical system to enrich himself.

“‘Pay me or I will destroy you,'” Assistant U.S. Attorney Matthew Phelps told jurors in his opening statement. “That’s what Mr. Snyder did to the University of Maryland Medical System.”

Snyder and prosecutors disagree on two key points: Snyder said he sought the consultant’s payment at his client’s urging and that he consulted with lawyers to make sure the deal was ethical. Prosecutors say those lawyers were kept in the dark about key aspects of what Snyder was seeking and that Snyder acted contrary to the client’s hopes that the hospital would be exposed and reformed.

Snyder was on record saying he would help the hospital keep quiet the problems he believed he had uncovered, eliminating a threatened media blitz and publicity campaign that would damage the hospital’s reputation. Instead, he offered, he could work as a consultant, as much or as little as they wanted. He said he might work as a caretaker to meet the terms of the million-dollar payout.

The Snyder case provides a rare window into what happens when someone alleges gross lapses in judgment or other error in the nation’s hospitalswhich researchers at John Hopkins University once estimated is so significant that it could be the third leading cause of death in the country.

Snyder requested payment after he said he discovered the UMMS organ transplant program was providing high-risk patients with kidneys at the highest rate in the country.

UMMS admitted and even advertised that it used more high-risk kidneys than other facilities, saying it did so in the interest of helping people who might not otherwise receive a transplant.

In the years since Snyder approached hospital officials, UMMS told The Baltimore Banner in a statement, the overall number of kidney transplants has declined “due to our refined waiting criteria and selection of donor organs.” And the data show that the percentage of high-risk kidneys being used has declined. The hospital said patient outcomes had improved “significantly” and they had “more information and resources available to guide us in these decisions”.

Phelps told jurors that Snyder exaggerated or misrepresented criticism of the hospital’s performance. Snyder, meanwhile, found experts prepared to testify that UMMS was an outlier and had worse results. He said their program was “obvious”.

In his opening statement, Snyder repeatedly told jurors about his skill and excellent reputation as a lawyer. He even expressed his disappointment that during jury selection they apparently didn’t know him.

“I was a force to be reckoned with and I was honest,” Snyder said.

Snyder said the case affected him and his family, “it affected my reputation and it affected my ability to make money.”

“Zero happened with (UMMS) and I was devastated,” he said. “It hurts. It hurts bad.”

He vowed to go hard in his questioning of hospital officials who he says wronged him. He said he hopes jurors don’t hold that against him.

“You have to,” he said. “My life is at stake.”