Can surgeons effectively police surgeons?

Laura Dyrda -   Print  |

Tort reform is a huge issue among healthcare professionals, particularly physicians. It could ease the costs associated with medical practice and unnecessary tests. But if medical liability is reformed, who will police physicians? Can surgeons police surgeons?

An op-ed in the New York Times covers New York legislators' efforts to expand medical malpractice with a bill that had bipartisan support, was sponsored by the majority of the State Senate and endorsed by Gov. Andrew Cuomo. The bill never reached final vote — Senate Majority Leader John J. Flanagan didn't allow the vote — but support for the effort was staggering.


The law was named after a patient who died from lung cancer that should have been identified much earlier. Most physicians are familiar with the Institutes of Medicine's 1999 report "To Err is Human" that concluded 44,000 patients are killed in hospitals every year from medical errors, and the subsequent 2011 HealthAffairs study estimating the number of avoidable deaths is about 10 times higher.


There are efforts to improve quality and reduce deaths and injury to patients, but are those efforts really making an impact on every-day decisions?


A separate study in 2013 concluded that only 1 percent of medical errors result in claims and only a small percentage of malpractice cases result in curtailing physicians' privileges at hospitals. Medical societies don't always take away the physician's license; according to the report, in New York, less than 4 percent of the complaints filed resulted in serious sanctions like losing or suspending the physician's license in a state that requires six malpractice judgments or settlements before the state medical licensing agencies initiate license reviews.


There have been multiple high-profile cases of spine surgeons who lost their licenses, but only after their records became egregious. Even then, some were allowed to continue.


Neurosurgeon Aria Sabit, MD, for example, was forced to surrender his license in California after a patient he operated on died from postoperative complications. However, he moved to Michigan and continued practicing until he was accused of billing for spinal fusions he didn't actually perform and performing medically unnecessary procedures.


In another case, Atiq Durrani, MD, who practiced in Ohio, had his licensed suspended after multiple complaints from his patients that were "buried by the hospital for financial concerns," according to a WCPO report. He performed surgery in Butler County from 2010 to 2013 and now has 285 lawsuits filed against him.


Most recently, Texas neurosurgeon Christopher Duntsch, MD, was indicted in July, charged with aggravated assault and injury to an elderly person while performing surgery. Multiple patients report suffering nerve wounds after operations Dr. Duntsch performed and he lost his license in 2013.


His troubling behavior goes back to 2011 in an email where he wrote, "I am ready to leave the love and kindness and goodness and patients that I mix with everything else that I am and become a cold blooded killer." His colleagues described him as a "sociopath" and the "worst surgeon" they'd ever seen, according to a Washington Post article.


There was even one procedure where a fellow surgeon operating with Dr. Duntsch forced him to stop because of "unacceptable" technique, but that wasn't Dr. Duntsch's last case. He left Baylor Medical Center, where he had been practicing, and the hospital provided a letter saying his medical record was clean. He continued to practice for another year after a patient bled to death on his operating table. It took a former colleague to file a complaint with the Texas Medical Board for the Board to review Dr. Duntsch and revoke his license in 2013.


According to the Texas Observer, Dr. Duntsch's mistakes were well-documented and a half-dozen doctors and lawyers complained to Baylor without avail. Patients were injured and died in his care during the interim between complaints and the Texas Medical Board's action.


These instances are clearly extreme examples and other medical practitioners did try to take the proper steps toward preventing problem surgeons from picking up the knife again. But in these cases — and perhaps others not yet reported — the process breaks down. And activists to expand medical liability become louder.


Can surgeons and healthcare providers effectively police their colleagues? Can medical societies take the reins and revoke licenses before horror stories commence? With more data collected in healthcare about complications and malpractice — and that data being published and used in payment decisions — it will be harder to slip through the cracks.


But for now, who's watching?

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