As one the state’s most successful medical malpractice attorneys, Stephen L. Snyder faced off with 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 agreement, hospital officials decided he had gone too far. They went to the FBI.

In an opening statement Wednesday for his federal trial on charges of attempted extortion, Snyder, who is representing himself, said the Baltimore hospital wanted to prevent him from exposing problems in their organ transplant program. He said they entrapped him by indicating they were open to such a deal while federal agents secretly recorded him.

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

He went on: “They Snydered me in a dishonest way.”

Federal prosecutors told jurors that Snyder crossed the line between aggressively advocating for a client to shaking down the University of Maryland Medical System to enrich himself.

“‘Pay me, or I’ll 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 payment at the urging of his client, and that he conferred with attorneys to ensure the agreement was ethical. Prosecutors say those attorneys were kept in the dark about key aspects of what Snyder was seeking, and that Snyder was acting counter to the client’s hopes that the hospital would be exposed and reformed.

Snyder was recorded surreptitiously saying he would help the hospital keep the problems he believed he had unearthed quiet, shelving a threatened media blitz and advertising campaign that would ruin the hospital’s reputation. Instead, he offered, he could work as a consultant, as much or as little as they wanted him to. He said he could work as a janitor to fulfill the terms of the multimillion-dollar payment.

“In every case I’m saying, you have to pay X or you’re going to be exposed. That’s every case. Is that extortion?” Snyder asked in court.

“But you’re asking for $25 million,” responded Dr. Depriest Whye, chief executive officer of Maryland Medicine Comprehensive Insurance Program, which handles malpractice claims against UMMS.

The Snyder case provides a rare window into what happens when someone alleges serious lack of judgment or other error in the nation’s hospitals, something that John Hopkins University researchers once estimated is so significant that it may be the third leading cause of death in the nation.

Snyder asked for a payment after he said he discovered that the UMMS organ transplant program was giving patients high-risk kidneys at by far the highest rate in the country. The hospital paid out a total of $13.5 million to settle claims from two of Snyder’s organ transplant clients.

UMMS has acknowledged and even promoted that it made greater use of high-risk kidneys than other facilities, saying it did so in the interest of helping people who might otherwise not 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 decreased “due to our refined waitlisting criteria and donor organ selection.” And data shows the percentage of high-risk kidneys being used has decreased. The hospital said its patient outcomes have improved “significantly” and that they have “more insights and resources available to guide us in these decisions.”

Jurors saw clips from a video produced by Snyder and presented to UMMS officials in which he compared problems with the hospital’s kidney transplants to a scandal at Baylor St. Luke’s Medical Center that resulted in its heart transplant program briefly shutting down.

Whye said Snyder referred to UMMS’s situation as “Baylor on steroids.”

“We were concerned about damage to reputation, damage to revenue,” Whye said of the threats, adding that hospital officials said allegations against the program lacked context and that they worried they wouldn’t be able to efficiently counter them to the public.

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

In his opening statement, Snyder repeatedly told jurors of his prowess and sterling reputation as an attorney. He even expressed disappointment that during jury selection they were apparently unfamiliar with him.

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

Snyder said the case has taken a toll on him and his family, “tanked my reputation and affected my ability to earn money.”

“Zero has happened to [UMMS], and I’ve been destroyed,” he said. “It hurts. It hurts bad.”

He vowed to go hard in his cross-examination of the hospital officials whom he says have wronged him. He said he hoped jurors wouldn’t hold it against him.

“I have to,” he said. “My life’s at stake.”

By the end of the day, Snyder was wearing on the patience of U.S. District Judge Deborah Boardman. Snyder, who spent nearly all of his career as a civil attorney, has struggled to comply with court directives or grasp federal criminal procedure, and kept bringing up topics he had been warned not to touch. Boardman said he appeared to be trying to testify through his meandering cross examination of the first witness, and that it could not continue.

Boardman warned at the close of the first day that Snyder had a right to represent himself. But “that is not an absolute right,” she said, saying she could revoke it.