Tuesday, August 27, 2013

Surgeons behaving badly

An orthopedic surgeon from New York reportedly has 261 malpractice suits against him. He has been accused of performing "phantom" and unnecessary operations. In one case, he supposedly performed a knee reconstruction, and the patient died of a pulmonary embolism the same day. A post-mortem examination allegedly showed no evidence of a reconstructed knee.

There is also said to be evidence showing that in one day he was doing as many as 22 cases, some apparently lasting less than 8 minutes. Details can be found in a lengthy story in the Poughkeepsie Journal.

If you've been following my blog, you know that I am not a big fan of lawyers. But I have to admit that one lawyer's questions about what the hospital knew about all this and why the surgeon wasn't scrutinized sooner are good ones.

Surely the operating room staffs of the two hospitals he worked in must have had a hint that something was wrong. If he said he reconstructed a knee and didn't really do it, wouldn't the OR nurses, techs and anesthesiologists have noticed? Were there no quality assurance or risk management policies in place?

And what about the other orthopedists in town or members of his multispecialty group? They must have seen some of his patients who were dissatisfied. How could they not have spoken up?

What about the company providing his malpractice insurance. How do you get to 261 cases? I once sat on a committee of a malpractice insurance company run by a state medical society. We interviewed a surgeon who had about 10 active or closed suits against him.

When we spoke to him, he could not explain why he had so many suits other than that he had a high-volume practice. His record keeping was poor and his communication skills were lacking.

We terminated his policy on the spot. No other company would insure him. Without malpractice insurance, he could not work.

The orthopedist in question has surrendered his New York medical license as of September 2, 2013 but still has a license to practice medicine in Virginia. Another Poughkeepsie Journal article describes his work history since he left Poughkeepsie, a non-medical incident in Virginia and the transfer of assets to his wife's name. By the way, that might not work since it was probably done after the problems surfaced.

Of note is the fact that he has excellent patient satisfaction scores. Based on 51 responses, he gets 4½ of 5 stars from HealthGrades.    

A spine surgeon in Ohio has been indicted by a federal grand jury on 10 counts of performing unnecessary spine surgery, 5 of which involve health care fraud.

He is said to have told some patients that surgery was urgently needed, including that their heads would fall off if they were in an automobile accident "because there was almost nothing attaching the head to the patient's body."

A lawyer filed a malpractice suit against the surgeon claiming he did unnecessary operations on over 100 patients.

Although he apparently has no current hospital privileges, he still can operate at a surgical center that he owns.

His HealthGrades scores are a bit more modest at 3 stars.

I realize that only one side of both of these stories has been told. These are allegations. Nothing has been judged in court yet.

Finally, we go from the serious to the silly. A New York City eye surgeon has gone public with an offer to trade his services as rewards for dates with women. He has exacting standards however.

According to the New York Post, he went to three Ivy League schools (Dartmouth, Columbia and Harvard), Emory and has an MBA from NYU. "He wants a woman with a graduate degree or Ivy League undergraduate degree."

Police have been stationed outside his office to control the hordes of Ivy League women who are queuing up.

These are isolated stories and not representative of all surgeons. But they are disturbing to me.

What do you think?


Anonymous said...

I don't care for lawyers either (ok, I have 3 to 4 that are ethical, none of that group includes a "risk manager"). However, it comes down to this:

how can we get doctors, hospitals, support staff, patients, state medical boards, to join together to really stop doctors like the above?

I mean real discipline. If we have discipline, meaningful discipline, or forced education on subjects, communication classes, documentation classes, wouldn't part of this go away?

If we got the "sue you to be rich" patients who wouldn't win cases, wouldn't pretty much the other half gone away?

I'm not happy with 2 sides: those who want to sue, those who don't stop the problems from occuring.

The other option I would like to see: docs who are honest enough to apologize. Fix things. I've had a couple in my lifetime. Apologize to me and tell me how you'll do better. I've had some boo boo's in my life and I'm here to tell you I only get cranky and spread the word about docs who aren't honest and only looking out for #1 and leaving me in a pile of #2.

Anonymous said...

My response to the eye surgeon, "Ew, SICK!"

Anonymous said...

My concern is how can we know that HealthGrade scores are reliable/accurate? It seems like the only verification of identity is an email address, and given the easy availability of free email services, an unscrupulous physician, group, or practice could easily inflate scores, similar to Amazon (http://www.wikihow.com/Spot-a-Fake-Review-on-Amazon.Com). Not to mention that HealthGrade itself may have deals with rated physicians to elevate positive reviews and/or bury negative reviews dependent on subscriptions or other arrangements, similar to Yelp (http://www.totalvac.com/blog/yelp-the-mafia-of-the-web/).

Note that these websites were yielded from a quick internet search, and are not necessarily authoritative.

Skeptical Scalpel said...

HealthGrades scores are neither reliable nor accurate. I have written about this in the past. See http://skepticalscalpel.blogspot.com/2011/03/americas-top-50-hospitals-says-who.html and search "HealthGrades" in the search field of my blog (upper right).

Anonymous said...

Obviously doctors need tort reform and litigation caps, and obviously there will always be crappy doctors who do bad things or practice bad medicine. I usually get angry and defensive when patients (usually the dumber ones) allude to suing the hospital because of this or that. But truthfully, there is no other recourse that patients have in our adversarial system than litigation. I wish we could set up an independant board for medical malpractice, with judges that are astute in medical and medicolegal matters, and a fund to protect livelihoods of patients without damning the physician. In the world of vaccines, the National Vaccine Injury Compensation Program did exactly that, to fund lost cases against the vaccine industry thereby mitigating their effect and incentivizing continual vaccine production. But I guess our version of this is malpractice insurance...

Skeptical Scalpel said...

There will never be a board for medical malpractice. The lawyers for both plaintiffs and malpractice insurance companies, both of whom are riding the gravy train that is paid for by us, will never let it happen. Don't forget, most legislators are lawyers.

Anonymous said...

I read somewhere once, that the psychopath diagnosis was highest for police officers and surgeons . . . amongst a few others - but there ya go!

Skeptical Scalpel said...

I also read that so-called "research" alleging that surgeons were psychopaths. Better look it up again. It's some guy's opinion based on conjecture.

CEOs and lawyers placed ahead of surgeons and clergy were in the top 10 (http://jobs.aol.com/articles/2013/01/02/the-jobs-with-the-most-psychopaths/).

artiger said...

Re: that NY eye surgeon...a good candidate for "This Weeks Sign that the Apocalypse is upon Us".

State universities are much more fun than Ivy League schools anyway.

Anonymous said...

This guy is obviously a fraud, and an incompetent. But the case brings up a few uncomfortable truths about common practices.

In many private practice settings, a "fast" surgeon gets 2 rooms whereby he can start operating on the 2nd patient while the 1st is being sewn up by the PA or nurse first-assistant. This is especially prevalent for orthopods.

The other clinicians in the room prob. had some idea about what was going on, but most people would be unwilling to jeopardize their livelihood in this setting unless the surgeon was immediately killing patients. With his caseload, he would have been beloved by the hospital admins, and any complainers better beware.

Skeptical Scalpel said...

Artiger and Anon, I agree with both of you.

arizona eye doctor said...

My gosh, this is surprising. I never thought that someone could actually do that! 261 medical malpractice reports?? The authorities has to do something about this.

Prof. E.Browne said...

The biggest problem we have our side of the Pond in UK is the increasing number of non-english speaking doctors moonlighting from Europe who can get temp work in our overcrowded underfunded health service. By the time a malpractice suit is filed they are long gone :-(

Skeptical Scalpel said...

That's an interesting issue. Who then is left holding the bag? Here in the US, the hospital and any other doctors involved would potentially have to pay whatever damages the missing physician was responsible for.

Connie McLennan said...

This is a bit off-topic, but for the record, I think Health Grades is next to useless in tracking malpractice. I have found doctors with sanctions and/or administrative actions against them in the CA Medical Board database, yet Health Grades' "Background Check" listed NO sanctions history or board actions. An email to them, with a specific example, received no response, and the example's "background" information never changed. I have yet to find any Health Grades profile that lists any malpractice actions.

Skeptical Scalpel said...

It's off topic but pertinent. I agree about Healthgrades and have blogged about the shortcomings of its ratings several times. The fact is, there are about 600,000 doctors in the US. There is no way they can track the license statuses and sanctions of every doctor in a timely way. They would be better off just telling consumers to check with their state's medical board.

artiger said...

But Scalpel, there's no money to be made by telling people to check with their state's medical board.

U.S. Health Care is like one giant cookie jar, always with room for one more hand.

Skeptical Scalpel said...

I guess not.

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