Thursday, September 5, 2013

On the horrific story of a Texas neurosurgeon and why it could happen again

If you are interested in patient safety and medical errors and haven't read the story in the Texas Observer about a spectacularly incompetent neurosurgeon, you should. It is long but worth it. As I tweeted last week, it will make you cringe.

The story includes many details about operations done poorly and patients suffering paralysis and death at the hands of Dr. Christopher D. Duntsch.

The Texas Medical Board is over-worked, slow to act and apparently toothless when it comes to disciplining doctors. Despite many complaints, it took them more than a year before it temporarily suspended his license on June 26, 2013.

However, the author of the piece, some Dallas area lawyers and at least one blogger are mistaken when they blame the malpractice monetary cap in Texas for contributing to the delay.

Yes, Texas has a cap on non-economic damages. Is that really the problem? Or is it what I and many others have written, that average duration of a malpractice suit is well over 4 years, with many cases lasting much longer than that?

If the only way this doctor could have been stopped was by malpractice litigation, he would still be operating today.

This dreadful situation was created by a number of factors.

As background, note that Dr. Duntsch has a remarkable curriculum vitae in that he graduated from medical school summa cum laude and was inducted into Alpha Omega Alpha, the med school equivalent of Phi Beta Kappa.

In addition to an MD degree, he also received a PhD and did two research fellowships and a minimally invasive spine fellowship. However, according to the website of the American Board of Neurological Surgery, Dr. Duntsch was not board-certified.

In the Observer article, a general surgeon who assisted him on his first operation in Texas immediately recognized that Dr. Duntsch did not have good technical skills. The general surgeon said, “His performance was pathetic . . . He was functioning at a first- or second-year neurosurgical resident level but had no apparent insight into how bad his technique was.”

After another disaster, his operating privileges were suspended for 30 days after which time he was to have been supervised by another neurosurgeon at every procedure.

But the hospital Duntsch worked in, Baylor Plano, did not enforce that sanction and he continued to operate until he finally caused the death of a patient from bleeding.

He resigned from that staff and obtained privileges at Dallas Medical Center, which claimed that Baylor Plano said there were no issues with Duntsch's performance. Of course, there were issues. And resigning from a medical staff while under restriction of privileges or even under investigation mandated a report, which apparently was not sent, from Baylor Plano to the National Practitioner Databank.

At Dallas Medical Center, two of his first three cases ended badly. One patient died, and the other suffered a major complication.

A surgeon who was brought in to reoperate on the patient with the complication could not believe what he found and called the Medical Board himself. He was told it would take time to process the information and investigate.

Although Dallas Medical Center "fired" Duntsch, he still was operating at two other hospitals. How he obtained privileges at those two was not explained.

At one, a patient woke up with both vocal cords paralyzed after a cervical spine fusion, and at the second one, the OR team had to "physically restrain" Duntsch from continuing a procedure that was going badly.

After another more detailed complaint by the general surgeon who had helped Duntsch with his first case, the Medical Board finally suspended his license.

There were four chances to have stopped this doctor sooner.

One, as many commenters on Reddit wondered, how was this surgeon allowed to graduate from his residency program? It is unlikely that he suddenly became a terrible surgeon after completing his training, although the medical board did find that he was impaired by drugs or alcohol.

Two, the doctors who knew of the bad cases could have been more vocal in opposing his applications for staff privileges at the area hospitals. They may have held back because of fear that they would be sued for libel or slander.

Three, the hospitals in the Dallas area could have been more diligent in investigating his past record, but neurosurgeons are cash cows so maybe his problems were glossed over.

Four, the Texas Medical Board could have been more proactive in the face of such serious allegations against the doctor.

All four of the above would have been much quicker and more efficient than any malpractice suit. The fact is that while too late to help several patients, the Medical Board suspension occurred in well under 2 years, still faster than any lawsuit would have been resolved.

This is key, "Every year the board is overseeing many more doctors and bringing in more money. But it doesn’t get to keep much of it: In fiscal year 2013, the board sent almost $40 million to the state’s General Revenue fund, of which it got about $11 million back. (Like other state licensing agencies—the Pharmacy Board, the Nurse Practitioner Board—the Medical Board operates at a surplus for the state.)"

As is true in many states, medical licensing fees are essentially a tax on doctors. Instead of going for better policing of the profession, the states use the money for other things. The doctors who assist with Medical Board investigations are unpaid volunteers.

Here's a very telling passage from the Observer article. "Why does it take so long to investigate a doctor? The process for resolving complaints is slow and painstaking, set up in statute to guarantee doctors the maximum legal protection."

And who writes the statutes? The majority of legislators are lawyers, certainly not doctors.

Regarding the investigators, the article says, "They know if they try to discipline a doctor, the burden of proof will be on them. A poorly put-together case can mean months or years of expensive litigation. So the board members tend to act conservatively."

I would wager that even a well put together case could mean months or years of expensive litigation too.

So the lawyers, who will tell you that they are the champions of patient safety and the salvation of mankind, are also the biggest stumbling block to rapid resolution of the problem of disciplining bad doctors.

By the way, If you google Dr. Duntsch, you will see that he still has many outstanding ratings from various websites, including 4½ stars of a possible 5 from HealthGrades.

And check out the first couple of minutes of this video from March of this year produced by his public relations people for the "Best Docs Network."

Among the many interests listed in Dr. Duntsch's LinkedIn profile are "Mentoring the Next Generation of Scientists" and "Medicolegal." In the future, I'm sure he will get few chances to do the former but many for the latter.

I feel for the patients and families who were harmed by this surgeon.

Texas is no different than most other states. This could happen again just about anywhere in this country.

UPDATE 12/18/2013

On 12/6/2013, Dr. Duntsch agreed to give up his Texas medical license and further disciplinary proceedings were dropped.


Anonymous said...

This is extraordinarily sad on all levels.

It makes me angry that hospitals that knew how horrible he was did not report him to the NPDB as they are legally obligated to do.

Not that it has bearing on your post, but med mal caps do affect patients, as fewer attorneys are willing to take on malpractice cases when they know their expenses likely will not be covered by the amount recovered in court. I feel this is unfair to patients who are grievously injured, but I know there are strong opinions on both sides of the issue.

I am just tired of incompetent doctors and other medical professionals being shuffled around and protected. A surgical tech in NH was shuffled around and protected and because of it, he ended up giving a LOT of patients hepatitis C and stealing their pain meds, thereby leaving them in pain (

I just do not understand how people who cover this sort of thing up can live with themselves. They are directly responsible for people dying. It's so immoral that it is beyond comprehension for me. It makes me so angry and disgusted that I have trouble putting it into words.

Anonymous said...

As a lawyer who defends healthcare professionals in Texas (not physicians . . . yet) before the administrative agencies, I found this post very interesting. You are quite correct is stating that the tort reform had nothing to do with this doctor skirting discipline for so long. It is a process, and if you were to ever fall into the process through no fault of your own (since complaints are confidential by statute, anyone can file a complain over any frivolous matter and if it strikes the Board as something they should investigate, they will. Which can be quite eye opening to the licensee), you would be glad the process is there to protect your license.

I looked at the Texas Observer story and tried to figure out when the first complaint came to the Medical Board - it looks like the first complaint came about one year prior to the suspension action, in the summer of 2012. The Texas Observer story states that they can't start an investigation without a complaint - which is true - but they try to equate that to a police department not investigating crimes they see in front of them. That is a poor analogy - the Medical Board is not omniscient, they can't see the errors that are occurring. I don't know of any healthcare regulatory agency at the state level that has the capability to do that . . . in any state.

One thing I have found is that the Board's (all of the healthcare boards) are reticent to use their authority to temporarily suspend a license - as the Observer piece notes. I've represented a client who was in prison (for a non-healthcare related matter, but still in prison) and the licensing agency knew about it. And they didn't act to suspend or revoke the license until almost two years after release from prison. This person had stellar employer reviews after release (and before - the criminal charges were about as unrelated to healthcare as possible), but the agencies have clear authority to revoke the license when a licensee goes to prison (it is actually mandatory by statute and it relates to the date of imprisonment). They just won't pull that trigger . . . unless there are prior Board orders for drug use and there are positive tests (at least the Nursing Board does those type of temporary suspension).

And finally, the Board's investigators overstate their burden to some extent. They don't have to prove matters beyond a reasonable doubt (the 95% criminal standard). It is not even clear and convincing evidence (a 75% standard) in most cases, though that is the standard for temporary suspensions - because the Board has to prove a clear and imminent threat to public safety. But for final disciplinary actions, that standard is preponderance of the evidence, or more likely than not, which is the 51% standard.

I concur with you that there are really 5 avenues to stop doctors who are dangers to patients. But to expect the Medical Board to bear the brunt of blame in this matter, especially when the legislators in Austin obviously don't care to fund the Board appropriately, seems to be a bit of a stretch. I don't expect a state agency, even one with responsibility to eventually deal with bad docs, to be the first line of defense against malpractice. I lay that at the feet of those who you note also could have stopped this guy: the medical schools, the facilities and his fellow professionals.

And you are definitely right about the last point - Texas isn't really all that different than other states in this matter.

Unknown said...

I can explain it perfectly because I was a surgeon who turned in a colleague and how it went was why more docs remain silent. I'd gladly fill you in but not here.

Anonymous said...

May I ask a hypothetical question? If you and this doctor worked at the same hospital, and you knew of his in-house reputation, then one of your patients mentioned or asked about possible surgery with this doctor, how would/should you have responded.


Skeptical Scalpel said...

First Anon, thanks for commenting. It is very sad and infuriating.

Second Anon, I appreciate your comments and your affirmation of most of what I said.

Jack, why don't you email me at SkepticalScalpel(at)

Third Anon: As a former surgical chairman, I have been in that postion many times. I tell the patient to find another doctor. And I tried to get the incompetent doctor off the staff. That is no easy task, because the same legal issues arise as occurred in the Texas case. Plus there may be medical staff by-laws that virtually guarantee that short of a felony, a bad doctor will never have his privileges revoked.

Anonymous said...


Thanks so much for recognizing things like this. It is things like this, a lot of patients have lost their faith & trust in the medical profession because of events like this. No one wins.

I've seen a number of complaints on medical boards. I've complained one time only, about a nurse who gave me the incorrect dosage of allergy medication. She signed & dated my sheet, and I saw the dosage, half of what it was supposed to be, and said hey here is what happened, could you just give me the other half of the dose? I can't imagine that wouldn't be ok. She blew up at me and chewed me out. I got up and left. I overheard a doctor telling her, 'you can't talk that way to a patient'. I complained to the doctors' office admin & the medical board. The medical board called me up and I said if she had apologized & just given me the other half of the dose, I'd been fine with that. Her attitude said that if she made another mistake (and everyone does), she would NOT be looking out for the patients' best interest in fixing the mistake. That's a person who shouldn't be in the medical profession. The medical board said she was cleared.

Would any one trust a medical board after that? Med boards are seen as protecting bad docs. Until they start taking teeth in the matter, its only going to get worse. Whether or not the boards are paid, part and parcel of being a doctor is that you DO have a higher standard of ethics and morality that is expected, demanded, of the profession. Until that duty is taken seriously, and the medical profession police itself a lot better, I suspect things will get worse.

Anonymous said...

That there are "medical staff by-laws that virtually guarantee that short of a felony, a bad doctor will never have his/her privileges revoked" is horrible. What lobby is responsible for the existence of this type of bylaw, if any? The AMA? Is there any hope of this ever changing?

As a patient, I feel so unsafe when I read this type of thing. I can only hope and pray that my personal doctors would protect me and steer me in a different direction if I were about to see a bad doctor.

Carolyn Thomas said...

What seems to be missing in this post, plus in most of the comments, is focus on the PATIENT - the ultimate victim of what amounts to criminal behaviour.

This surgeon's incompetence was well-documented in a clearly horrifying way BY HIS PEERS (including physical restraint to remove him from an O.R?!) It's impossible to believe (neurosurgery being a small world) that hospitals involved were somehow unaware of his track record. As you say in this remarkable understatement: "...the hospitals in the Dallas area could have been more diligent in investigating his past record."

I'm reminded of the sickening way that a gutless Catholic Church spent decades knowingly transferring its predator priests from one unwitting parish to the next despite fully knowing the irreparable harm these criminals were inflicting upon innocent victims - with the church's corrupt assistance.

We rush to blame the criminal, but those who look the other way are equally culpable.

Where is the outrage from other surgeons who watch public trust erode with yet another scandal? Where is the patient safety mechanism in place for both reporting and acting upon complaints - even when they are lodged loud and clear?

And where is the will to protect the patient?

In a similarly grim case, a study reported in JAMA a few years ago investigated how reluctant docs are to report their own even when they are fully aware of peers who are deemed "impaired or incompetent to practice medicine":

Skeptical Scalpel said...

Carolyn, thanks for commenting.

In my defense, I did say near the end that I felt for the patients and their families. It's the longest post I ever wrote, and I did not want to go on too much longer.

Your post about the JAMA article was excellent.

I would point out that it was the comments of the neurosurgeon's peers that finally got the attention of the Texas Medical Board.

Anonymous said...

Very scary.

One minor point, however. I don't think it is worth pointing out that he was not board certified. The ABNS certification process takes a few years after completion of training (have to submit practice data from first few years of independent practice, etc.). Therefore, even the best neurosurgeon probably would not be board certified this very early point in his career.

Anonymous said...


Thanks for having the honesty and respect to post this. Its just that these things are so hard to take - and I'm sure not just for us patients, but for those in the profession who also take the loss of trust/faith personally.

here's a few other things I saw that make me upset: "Being a doc is a terrific thing. I'm not one of those who goes around saying 'medicine is in trouble in the future, you should look into something else,' but medicine, because of the payout structure and a variety of other things, is losing the chance to really make a killing anymore. There used to be cardiac surgeons with seven-figure incomes. Such is not the case anymore."

Making a killing? Its things like that that scream money over patients.

The other are complaints about not getting paid enough but "Most of you eat dinner with your families three or more nights per week, but still feel you don't have enough personal time;" when a good number of us have dinner together less than that for working late.

I've also seen comments regarding 30% figures of kids of "medical families" in medical school. If you don't know what life is like for us (and trust me I've had a few that don't), then what is the point of saying you are there for the patient? I had docs pick the treatment that I couldn't afford then complain I was non compliant when I said something about them.

How can we address these things?

Skeptical Scalpel said...

First Anon, point well-taken about the board-certification.

Second Anon, I agree that making a killing isn't the point of going to med school. If that's your goal, be a hedge fund manager.

I don't know how you would address those things you mentioned. It is beyond me.

artiger said...

Scalpel, about the Texas Medical Board being it because of a marked influx of new physicians? Proponents point to tort reform as being the reason for that, others disagree. I've read of applying for a Texas license to be a long process (time wise, that is). Any Texas license holders out there have any insight?

Emm-Null said...

I feel like there's a lot that's been said already about the operations of the medical board and the responsibility of the surgeon's colleagues in this case. They seem to have done about as well as can be expected of them with the tools they're given. Or, if they could have done better, they don't seem primarily responsible.

The question I have here is: where does the responsibility of the hospital begin and end? From my understanding of the article, one of the most damning and tragic patient deaths occurred when Baylor Plano failed to fulfill their punitive action against Duntsch and observe all his surgeries.

By this point, Baylor Plano has an extensive record of Duntsch's incompetence that they suspend him (only for 30 days?), but for some reason consider him magically reformed and let him perform surgery unsupervised.

So the hospital, in addition to what at least seems like softballing Duntsch's punishment, lets up on their own patient safety measures for no readily apparent reason. Then someone dies under his watch and the hospital doesn't stand in the way of him getting a new job and seeing more patients (at least, as far as we can tell with what we know).

I know almost nothing of hospital administration, but this seems almost unforgivably negligent. Is it normal for hospitals to have such little care for who they hire?

Anonymous said...


Most hospitals don't hire the physicians who work there. (In fact, here in CA it is illegal for non-governmental entities to employ doctors.)

Hospitals do credential physicians thru their medical staff, but most of the gate-keeping occurs with the initial process. It is tough to get rid of a referring doctor once he is in.

Also, I suspect that it is much more unlikely for a surgeon to lose his privileges than a hospitalist or anesthesiologist. Spine procedures are highly lucrative for everyone involved, and hospitals would be reluctant to forgo the income by letting go a busy surgeon.

Skeptical Scalpel said...

Artiger, the board's staff is overworked because there are not enough of them. Could it be that they should get more of the $40 million that licensing fees bring in?

Yes, hospitals do not necessarily hire docs. I put "fired" in quotes because the story in the Observer used that term. To the best of my knowledge, Duntsch was not an employee of any of the hospitals.

The story (and I) should have said his privileges were rescinded. There is a tendency for hospitals to be less than candid when asked for references. Again, this is in a large part due to the legal ramifications of saying something negative about a doctor.

Anonymous said...

I think many physicians think "there but for the grace of Someone go I...", and are reluctant to complain officially about colleagues.

Also, at what point does incompetence become reportable? Some recent surgical examples from my experience:

Laparoscopic insertion of dialysis catheter, unrecognized bleed (3 liters at autopsy), patient dies post-op. Surgeon is smart, usually very good technically, and chief of the medical staff.

20-hour robotic surgery to remove cancerous bladder and create diversion pouch. Patient has cerebral edema.

Gynecologist with obviously poor laparoscopic skills got disciplined by the medical board for a 5-hr. hysterectomy, but maintains privileges. Does she even know that her surgical skills are poor?

Neurosurgeon spends 10 hours for a routine spinal fusion.

AFAIK, none of these cases made it out of departmental review.

Emm-Null said...

Anon, Skeptical, thanks for the clarification. That makes much more sense. I was confused by the terminology in the article as to what actually was happening.

Still, it seems odd from a common sense standpoint that the hospital would be so...disinterested in keeping things like this in check.

Skeptical Scalpel said...

Anon, you make a very good point. All of those cases are certainly eyebrow raisers. The only thing I can say is that there are one-time problems and then there are patterns. I'd say that anyone, no matter how good, can make a mistake. If one does it frequently, then it's a pattern.

Anonymous said...

And what about the Houston orthopedic surgeon, who as written up in Texas monthly, Who had so many complications that the board took away his license twice. Both times he took the board to court and twice the lawyers and the legal system restored his license despite the objections of the Board of Medicine

Skeptical Scalpel said...

I am not familiar with the story of the Houston orthopedist, but that fact that he got his license back twice via legal action is not surprising. That's the American way.

Anonymous said...

Sometimes Hospitals have partnerships with outside groups, even helping them set up their practice so they will do cases at their institution. Wondering if this was the case here as he came fresh out of fellowship and started a "spine institute" on his own. Not to defend anything here, but I am a surgeon and I think what this is highlighting is the poor training that is going on in our residencies and fellowships. Attendings are too busy to let residents fully do cases. Medicolegally it is tough to allow a resident to do major portions of cases. Attendings no longer 'take a resident' through the case; they need to get the case done expeditiously and move on to the next case or office hours. Also, when a resident or fellow is labeled as being poor with their hands they are often just set aside to squander with no one helping them out. If a 5th yr chief resident is obviously not good surgically and a danger, then they should not be allowed to graduate however residency programs do not want this to happen as it reflects poorly to their Residency review committee and could put their program at risk, and they do not want to lose the residency spots. The problem is when we all graduate from our residency as surgeons we are not fully competent, we need to get our there and do it ourselves. As my partner in spine surgery told me, that is why is is called a "practice" because we need to practice. Their should also be a push amongst ourselves to mentor or younger docs just coming out. These difficult cases should be done with a partner at first, someone with many years experience, just operate as co surgeons you each get paid 62 percent of the fee, and I think 62 percent with a patient doing awesome is better than 100 percent and bad complications; who needs it!

Skeptical Scalpel said...

Anon, thanks for commenting. I agree that a lot has changed about the way residents are trained. I have written about it. In general surgery, at least 25-30% of residents may be under-prepared to work independently buy their own admission. Mentoring is good but hard to accomplish in some settings.

Also, you will recall from the article in the Texas Observer, this guy thought he was the best neurosurgeon in the area. It's like alcoholism. The first step is admitting you have a problem.

artiger said...

I'll just echo Anon. I finished in 1997, and went out to the wolves. I would have benefitted from some help from my senior partners for sure, but golf seemed to get in the way a lot. Oh well, it did teach me to learn my limitations, which really helped when I moved to the sticks.

Anonymous said...

This man is a monster. He operated on my mother.

As for the Best Docs, don't believe a word that was said. It's a PR firm. The paitents are real but the story is not complete.

Skeptical Scalpel said...

I am sorry. I hope your mother is OK.

a loving and caring mother said...

There is nothing I can possibly say to describe the pain and misery my son has been and is continuing to be subjected to, due to the botched surgery performed on him by Christopher Duntsch. The surgery was supposed to be a minimally invasive surgery with the patient going home the next day. Instead, after being hospitalized for months and to this day, still requiring continued surgeries performed by various doctors, my son is living in pure "hell" from the pain and disabilities which occur every second of every minute of every hour of every day of every week of every month, since the surgery. He continues to wait for the original surgery needed to heal his neck and back. I watched my son lay in the intensive care unit for over 28 hours without seeing Mr. Duntsch (I refuse to call Duntsch doctor, since he apparently doesn't know what a doctor is or does). In my personal opinion, I feel that Christopher Duntsch should go to prison for the entirety of his remaining life for the personal injuries and deaths he has caused during his lifetime as a butcher.

a loving and caring mother said...

Several months ago, my son was supposed to have minimally invasive surgery performed by Christopher Duntsch. Instead of going home the day after the surgery was performed, my son continued to lay in an intensive care ward in horrible, horrible pain. Duntsch did not visit my son in the ICU ward for 2 days. At first, the family was in the dark about what had happened. Then we were advised that a tumor had been found and due to bleeding, the surgery could not be performed. Then later, we were advised that the tumor was benign. As a mother, I felt hopeless as I watched my son lay in agonizing pain. The botched surgery was performed on Monday morning, and on Thursday, another surgeon from a different hospital, was asked to come to the hospital and attend my son. Friday, my son was moved via ambulance to a different hospital under the care of several surgeons and physicians. After 2 1/2 months, my son was released from the hospital to return home. He continued to have IV's and feeding tube (to this day, he is still unable to swallow food and remains on feeding tube). He returns to the hospital weekly to have a procedure performed on his esophagus in order for him to be able to swallow. My son has not been advised when it will be possible to have the original surgery that was supposed to have been performed by Duntsch. I watch my son live in agonizing pain every second of every moment of every hour, of every day, of every week, of every month. I personally think that Christopher Duntsch (I refuse to call Duntsch a doctor, much less, a surgeon) should spend the entirety of his life in prison as a murderer and a butcher. He shows no remorse for any botched surgeries he has performed, even those that ended in deaths.

Skeptical Scalpel said...

Loving and caring mother, I appreciate your taking the time to comment. It is very sad that this happened. I think the entire medical profession is remiss here, but particularly the hospitals that permitted this to go on as long as it did and of course, the Texas Medical Board.

I hope your son gets better. I wish you and him all the best.

Anonymous said...

unforunatly highly connected docs are protected by either hospitals and or in connection with medical Board members.if those doc has poor reputation or done huge mistaks usually are forgiven. in contrast if the doc is not a player and he is cares about your patient, the medical community will perceive him as a threat to the medical community harmony . and he will be kicked out in a blink of an eye immediatly under the name of hospital By law not for any harm to even one patient. leaving a good ethical hard effiecient MD out of practicing after 10 years with no error or neglect ., leaving pt sudennly stranded without their doc who has been treating them for years with no complain. It is all about connection who should we keep or who is goinig to be a thread to the one who play the game .is about survival in the market. it is so sad to come to the point either you play the game on not , the patient suffer in both situations

Skeptical Scalpel said...

Interesting comment. You might want to read the post of mine about a doctor who fought the establishment at his hospital.

Anonymous said...

Skeptical Scalpel said...

Anon's link to to an update on the story. It's worth a look if you have been following it. The doctor denies all allegations.

Anonymous said...

Thank you for posting the video link update that I sent. I'm one of the patients severely injured by this Godless man. I can't give anymore details. Thank you.

Skeptical Scalpel said...

Anon, thanks for sending me the link. I am so sorry that you have been injured by this surgeon. I hope you feel better son. Good luck.

Anonymous said...

As an RN I am deeply touched by this story. I feel that the nurses on duty should have made a better effort to stop this phisician from harming others. As a nurse in Texas, and a nurse that has had problems, personally, with a doctor, I would have fought to protect my patients. If the doctor had been a nurse the system would have worked much more quickly. I would like for you to contact me concerning doctors that take advantage of patients and nurses that could be considered malpractice. It is a personal matter that I would rather not discuss on your blog. I have been impressed by what I have read so far and believe that you are here to help others.

Anonymous said...

Agree with previous comments about onus on the university where this physician was allowed to graduate from. Also I am unclear how can a physician be allowed to have hospital privileges doing a specialty where they are not board certified in?

Skeptical Scalpel said...

I agree that the nurses should have been more vocal.

Every hospital that I know of will allow new graduates of residency training to practice while they are preparing for and taking board exams. Most specialties allow three chances to pass the boards, both written and oral (if they require oral exams). A doctor could take several years to complete the process. Also, some docs can pass exams easily but when confronted with a living patient, things go wrong.

Anonymous said...

Why isn't this being investigated as a criminal matter? This man should be prosecuted for various crimes, including, at the least manslaughter. For him to insist that he be able to continue his assaults, it is premeditated.

Skeptical Scalpel said...

Anon, I can't answer that. I do know that his Texas license has been revoked, but I read that he can apply for reinstatement in a year.

Anonymous said...

Skeptical Scalpel said...

Thanks for the link. The hospital certainly has some explaining to do.

Unknown said...

As simple random drug test of this person could have also stopped him. Random, routine drug test are standard in many other industries where safety is a concern (food manufacturing, trucking, airlines, etc) I have been and employer and I am a RN. In conversations with a hospital CEO and Chief Risk Officer about why health care does not randomly and routinely drug test everyone who has an employment role the risk manager always sites "privacy". I have been in pharmaceutical manufacturing plants as a sub contractor. They are so stringent you don't get further into the building with out giving a urine sample with a negative result. Healthcare has lessons to learn from other industries and their examples of safety.

Skeptical Scalpel said...

You have a point. Drug testing would have to be for all healthcare workers--nurses, pharmacists, techs, etc--not just doctors.

Anonymous said...

As more information is finally coming out due only to the litigation process, the picture is becoming more and more disturbing. Here is an audio from one of Duntsch's fellowship program directors:

Here in Texas, it took only 3-days to take away the license of a veterinarian who was abusing dogs. The medical board took about 18-months to do the first action against Duntsch's license after the first phone call to them from a surgeon who said "He is going to kill somebody."

Skeptical Scalpel said...

Anon, thanks for the link to that rather chilling audio.

As I said in the post, "One, as many commenters on Reddit wondered, how was this surgeon allowed to graduate from his residency program? It is unlikely that he suddenly became a terrible surgeon after completing his training, although the medical board did find that he was impaired by drugs or alcohol."

There's another long story about the litigation in the Texas Observer. here's the link

This really is a horrific case and it's getting worse.

Anonymous said...

Found an email Duntsch wrote that you might be interested in:

It left me speechless.

Skeptical Scalpel said...

Anon, speechless indeed. It is unbelievable.

Anonymous said...

Inside Edition - Videos - Coming Up On The Next Inside Edition on Wednesday, 5-21

Anonymous said...

Skeptical Scalpel said...

Thanks for the links. It should be worth watching.

Fat Bastardo said...

This is just the tip of the medical holocaust iceberg. His other corporate coke buddies knew for years what a dangerous menace he was and did a Sergeant Schultz... is see nothing I know know thing,

Duntsch is a junkie that's his excuse, what's the medical board's excuse?

The fact is, the medical industry kills 1 million Americans each year. Don't believe me? Google "Death By Medicine"

US health care is nearly 20% of the US GDP

1/3 of every dollar Americans spend in health care goes to cover waste and fraud. Now you know why this butcher was allowed to keep his license. That represent 750 BILLION which is more than the US spends on national defense.

FACT: Because of medical blunders there are 116 MILLION extra medical visits. The medical industry is the only industry where careless incompetence is more profitable that care and diligence.

Skeptical Scalpel said...

Fat, please provide references or links to support your statements that the medical industry is killing 1 million Americans each year, that 1/3 of every dollar covers waste and fraud, and that blunders lead to 116 million extra medical visits.

Anonymous said...

Anonymous said...

Skeptical Scalpel said...

Anon, I 'm afraid I can't accept two articles from Mercola, one rehashing the other, as proof of anything. You will have to do better than that. Sorry.

Anonymous said...

Is your doctor stoned? Physicians with substance abuse problems continue to work - News -

Skeptical Scalpel said...

The story just keeps getting worse. Thanks for the link.

Anonymous said...

Forgive me if this has bee brought up already, but in my opinion, the hospital thay failed to report him to the NPDB as they should have bears responsibility for failing to do so, and it should not be acceptable. Also, the hospital that provided a letter of recommendation despite the seriousness of the events that led up to his dismissal beara some responsibility in subsequent events involving the doctor. I understand that they would have had to be careful about what information thry passed along but they could have simply not provided a letter of recommendation.

Skeptical Scalpel said...

Anon, I agree that the hospitals could have done a lot more than they did to stop this guy from operating. It occurs to me that lawyers are responsible for preventing employers from speaking candidly about departing employees, yet employers can also be sued for not being candid.

Unknown said...

These continuances of bad practices is often the case as many institutions are self regulated in spite of regulations. It is common practice in Arizona for similar horrors, and the patient gets buried and the records are altered to cover the reality. Common business in places like Bullhead City, and Kingman, Az. If you think otherwise your ignorant to the way of medicine in this part of the world.

Skeptical Scalpel said...

Mind, I am sorry to hear that.

Alex Wade said...

Skeptical Scalpel and all other readers -
I read the email from Duntsch to his office assistant and I have to say that a person who would write and send such an email has a mental illness. It is absolutely terrible that so many people were harmed by him, and there is no way to ever repair the damage he did.
I truly believe that when a 90 year old man drives his car into a Farmers Market and kills a dozen people, the family, the doctor who approved the license, and the driver himself all bear a certain responsibility. It is shared.
We have become a society that chooses to elevate individuals in the hope that we will one day be that lucky individual - think Kardashian - and in exchange we then try to place blame on individuals instead of looking deeper at the systemic problem that allows a mentally ill person into medical school, allows him to graduate and be a doctor, allows him to participate in the care of patients during training, allows him to finish training and a fellowship and obtain privileges in hospitals...
But ask yourself what the alternative is?
Do we build asylums, and park the mentally ill people in the asylums, like we used to do? Have we, in the case of C. Duntsch, come to realize that allowing mentally ill people to walk free in society means that every now and then one will become a surgeon? An airline pilot? A school / theater / mall shooter?
Can we as a society agree to a level of mental illness that disqualifies you from participating? And if so, what do we do with them? Brand their forehead?
Someone, somewhere had an uneasy feeling about this guy and was afraid to speak up. We need to find a way to make it okay to ruin a person's life (ie the dreams of C. Duntsch when he was in medical school) so he doesn't ruin the lives of innocent people.
And if someone walks in to a gun shop, or orders online, a weapon that you would want only a bona fide good guy to have, and you don't know for 100% sure they are a bona fide good guy, please don't sell it to them. They may be as mentally ill as C. Duntsch is.

Skeptical Scalpel said...

Alex, thanks for the comments. It's a sad story all around. Wasted talent. Wasted place in med school. Wasted residency. Wasted lives of the victims. No one spoke up. Tragic.

Chris said...

The more I read about Duntsch's case (especially the truly chilling email linked above, rife with delusions of grandeur and paranoia), the more I wonder if the man had a psychotic break sometime during his training, but remained high-functioning enough to go undetected for several years. I am not a psychiatrist, and more to the point am not his psychiatrist (hopefully he has one) but it is hard for me to imagine a more plausible explanation for this bizarre and tragic string of events.

Even if done out of pure malice or hunger for money, I would expect things to have been carried out more competently. In Duntsch's case, most of the events are really inexplicable in terms of rational behavior.

Skeptical Scalpel said...

Chris, the Duntsch affair is truly puzzling. How can someone go off the rails so far?

Chris said...

The lack of rationality is what makes me suspect mental illness. I have seen firsthand spine surgeons who operate with their own interests ($$$) in mind, but at least they perform competent procedures, even if unnecessary ones.

Also it's worth noting this is not even the first time such a bizarre case has occurred, even in Texas. Anyone who was practicing medicine in the Houston region in the 1990's or 2000's has probably heard the sordid, and eerily similar, tale of "Erik the Red":

Skeptical Scalpel said...

Chris, thank you for the link to the story of Erik the Red. It is quite similar to the Duntsch case except it's worse because it went on for so long.

Anonymous said...

To your point about Dr Duntsch should have been stopped prior to graduating, I was an adjunct professor of nursing at a university and failed a student in her last semester before graduating. She literally could not make simple drug dosage calculations without paper, pencil, and drawings of vials, among other deficiencies. I was called into the Dean's office and asked why I was failing her and did not allow her to make up clinical time and tutor her more individually. (She was the only student I would have labeled a true danger to patients in my career as a fulltime professor at another university). I explained that I tried to work with her to no avail. It was determined that I was to blame and was never offered another contract with that university again.

Skeptical Scalpel said...

That is quite a story. It's a little different with residency program directors who don't generally get fired over personnel decisions. The problem is that people like Duntsch and your nursing student who couldn't calculate drug doses need to be weeded out much earlier than at the end of their final year. My anecdotal experience is that firing residents during their last year of training will often result in a lawsuit that the hospital and the training program will not win.

This is one of the many reasons that I don't miss being a residency program director.

Lili said...

I have been in the medical field for a long time and about to go in for orthopedic surgery for the first time. So I asked a surgery tech for referral and the only doctor in my insurance that he knew was given low rating by a physical therapist. So how do go about researching the doctors when everything online still give the cases you mentioned 4 and 5 stars?

Skeptical Scalpel said...

Lili, that is a good question. If you've been in the medical field for a long time, don't you know any other people you could ask? Also you have one positive and one negative opinion about the orthopedist in question. How do you know which one of those is right?

What about your primary care physician? Doesn't she refer patients to orthopedists?

Anonymous said...

Skeptical Scalpel,
D (Dallas) magazine just posted a new article on Duntsch in the Nov 2016 issue:

Skeptical Scalpel said...

Thanks. It adds even more fuel to the fire and confirms what I wrote back in 2013. As I suspected, he had some problems as a resident.

Janet said...

Para. #3 tells me that the man has always had a serious and dangerous personality defect. Sociopath or psychopath, take your pick.
High intellectual performance is at odds with gross 'practical' incompetence.

Or should we go back to basics, return surgery to those who *demonstrate* excellent scalpel & sewing skills.
- You know, the folk who advertised their sharp razors, with a red and white striped pole. ;)

Skeptical Scalpel said...

Going back to barber surgeons would not guarantee Psychpaths would be excluded. [Reference: Sweeney Todd]

Unknown said...

I have been in pain since August 24, 2016. I am in to much pain and don't have enough mobjty left to text all of this. For almost 3 years now have been trying to bring some kind of attention to this doctor and his practice. I sW a pa, never saw the doctor, was scared with paralysis if I fell wrong because of a part of my spinal cord being compressed in my neck. The pa assured me that They would be going in through the front of my neck, small incision and that I would only be in surgery for a few hours and only in the hospital overnight, so they could stabilize it to what I thought was to repair it or fix it somehow. Any risks or dangers or losses were never even mentioned, made it sound like an overnight simple thing.
I never spoke with the doctor before the surgery but because he had done a prior surgery on me in 2010 for a pinched nerve in my lower back turned out ok, I trusted him. It had taken me months to get the MRI's done because I wasn't in pain. The pa jad me scheduled for surgery in 9 days because he said if I were to fall and do any damage that he wouldn't be able to fix it. Scared me to death.
I didn't know what c3-c7 meant, just letters and numbers to me.
I went for the pre-0p on 8-18-16 and the receptionist handed me a bunch of papers and told me to read them and sign them. After reading what I could, Went back to the receptionist and told her that I couldn't sign them because I didn't understand them. I was to see the pa for the pre-op a d she said he would explain it to me. I didn't know what to ask and couldn't pronounce most of that stuff. The pa was explaining a brace to meander I was having trouble with that but that paralysis stuck in the back of my head and my fear of it. I am very idependent and have no family, so was important to me not to become paralyzed. I was 67 years old with severe Osteoperosis and a smoker and had been on corticosteroids for over 20 years. His pa sets up these surgeries and doesn't even talk to me to see if I was "candidate" or not. I didn't know about being a candidate for nothing! He took my life and I just want to STOP him from doing this to anyone else. Since something broke loose in my neck in April of 2017, I have been getting worse. They increased my pain medication but had it put back down because I couldn't stay awake. Both the ps and the surgeon said that I just didn't heal right, both gave me the same answer. The pa offered me another surgery, some kind of a REVISION surgery but since I don't trust them, I refused.
I went back to my primary care provider and asked for a referral to another nuerosurgeon.

Unknown said...

A friend told me to read about this Dr. Death case in Plano,TX because whT this doctor did reminded her of what I am going through. I would have rather not woke up from that surgery! I have no quality of life!
I was referred to another nuerosurgeon and he asked if the risks versus the benefits had been explained to me? I said n, I was only going to be in the hospital overnight. I now have incomplete paralysis, have lack of mobility, can't feel the bottoms of my feet, severe pain and muscle spasms in my back and all of my limbs and feet. I am getting worse everyday. I'm so scared because I can't get medical care here. I kept going back to this new nuerosurgeon and he had done another MRI on me and.he explained that these screws had protruded through the disc space and into the spinal cord. I have had to piece all of this together little by little. I am now having trouble breathing, don't know if it's due to anxiety or what but can't get medical care irregardless.
I asked the new nuerosurgeon if he could take all of that stuff out of my neck, he told me he couldn't. I asked him doesn't anyone know how to take it out, he said we all do but no one wants to touch that mess, you are what's known as a complication. What's that? Someone with a field surgery and the only one that will touch i, the one that did the surgery..I just cried
I was also told that the doctor that did this to me was well known for these aggressive surgeries. I was horrified and still am.
This nuerosurgeon called the doctor's office that did this and told them that the doctor needed to see me himself. They called me and made me an appointment and I had my roommate take me. The first thing this doctor said to me was "if I hadn't done that, if you fell wrong, you could be paralyzed from the neck down". Then he proceeded to say "I would never" and I cut him off because that is exactly what his pa told me. They both told me the same thing in the same exact words. He then proceeded to tell me that going through my bones was like going through drywall and that maybe I wasn't a very good candidate. I sId and you kept going? None of this conversation got into the medical records, these are supposed to be legal documents? I had taken my roommate into the exam room with me because I thought I might need a witness. The doctor made the assumption that he my husband and that did get on the record.

Unknown said... a lot of pain have to take brakes.

Skeptical Scalpel said...

I apologize for the delay in responding. I'm sorry to hear about all your problems. I hope you can find another doctor who you can trust and will try to help you. I wish there was something I could do.

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