Lawyers are a big impediment to disciplining bad doctors

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. 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 Data Bank.

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 it to re-operate 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.”

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

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

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  • Observer

    Phew, thank goodness we were able to clear that up. For a minute there I was afraid the fellow doctors, self-governing medical board, medical educators, hospitals, or administrators might have to rethink how they’re operating!

    • Jason Simpson

      Did you read the article? Doctors pay 40 million every year to fund these investigations and the state only lets them use 25% of those funds to investigate bad docs.

      • Guest

        27.5%. They have 11 million out of 40 million. You were “only” out by a million dollars, which is actually a fair amount to normal people.

        • kjindal

          What about the 29 million that doctors pay that ISN’T used for such investigations, but is stolen for other purposes- is that a “fair” amount???

  • Anthony D

    “I busted a mirror and got seven years bad luck, but my lawyer
    thinks he can get me five”.

    -Stephen Wright-

    • Alice Robertson

      Good quotes, except doctors fail to see their own weaknesses…it’s why there is suicide among them….some are substance abusers, and some suffer untreated depression, but as your quote shares that unlike the mere patient….they know the symptoms yet don’t seek help. Something is wrong in the system run by doctors and it’s not the patients, it’s not the lawyers….

  • Suzi Q 38

    He’s not the only one.
    He should be in jail. There are so many more.

    Why so many people look the other way with physicians like this continue is unthinkable.
    Doesn’t each hospital have a Chief of staff that can warn the chiefs at other hospitals??
    No communication.
    No thought to: “If we get him out of here, he will just continue to operate elsewhere.”

    If you kick someone out, at least “sound the alarm.”

    This is why I complained to the hospital. I worry about others. I am a “done deal,” but the others may not be so lucky.

    Why wouldn’t the new hospital call the old hospital HR and find out why he was “let go?”

    His family and friends filled out the HealthGrades evaluations.

    I guess the medical board just does not care.

    I am surprised no family member ran him over in the doctor’s parking lot with their truck.

    At least some people stopped him from operating.
    Kudos to them. Ditto for the surgeon that complained to the state board himself.

    Too bad there aren’t enough physicians that will complain and/or stop physicians from continuing to harm patients while they watch.

    It is kind of like watching a person tortured or murdered, only it is in a hospital.

    Shouldn’t they too, be arrested for allowing this?

    • Mika

      “If you kick someone out, at least “sound the alarm.””

      * * * * *

      As S.S. pointed out, “They may have held back because of fear that they would be sued for libel or slander.”

      • Suzi Q 38

        So you just hope for the best?
        Let someone maim or kill another?
        At least place an anonymous phone call to the patient BEFORE the surgery.

        • Cyndee Malowitz

          Interestingly, Senator Campbell (an ER physician) wrote a bill and, if passed, would no longer allow anonymous complaints against physicians. I testified against the bill on behalf of the Texas Nurse Practitioner’s Association. The TMB, TNA, TNP and TMA were all against it. The only people I remember testifying for it were doctors in trouble with the TMB… including the pain management physician I reported. Of course, that bill never made it out of committee. Although, it’s very disturbing that it was even introduced, especially by a physician.

          • Alice Robertson

            This is disturbing but let me say when Ohio passed a measure that no more anonymous calls could go to Social Services parents were dancing in the streets. I was a homeschooler who worried incessantly about the anonymous call by an arsehole who was upset with me. I imagine that’s part of the reason doctors are doing this, so it’s not an easy issue at all. It doesn’t mean the law can’t go after them. If a doctor has harmed you go forward with the complaint, but then coworkers say they now can’t complain about a doctor…well that puts them in the same position doctors keep complaining about….loss of their career. I find the whole thing so frustrating because I can’t find a concrete nor easy answer and that is completely flustering.

          • Cyndee Malowitz

            You should google “Winkler County nurses” – you’ll understand why it’s so important for complaints to remain anonymous.

            In my case, I signed a “waiver of confidentiality,” which was required by the TMB so I could testify at the informal settlement hearings. After I testified against him at the first settlement hearing, he filed the lawsuit. The lawsuit was accompanied by a temporary restraining order that barred me from filing additional complaints against him, speaking to the medical board, speaking to current or former employees or patients…basically denying me of my First Amendment rights. Fortunately, that was thrown out at the TRO hearing.

          • Tiredoc

            You lost me at “anonymous.” I’m sorry, but equal jeopardy applies. If you’re making an accusation that can ruin someone’s career, yours is implicitly on the line.

            As for the Winkler County case, the nurses released medical information without the patient’s or the family’s permission. They violated their own contract with the hospital.

            If you work for an odious organization, quit loudly and publicly in protest. Levy your accusation in person and to a camera if it’s true. Anonymous complaints are cowardly and unprofessional.

            As for the pain management doctor, there seems quite a bit of personal in addition to whatever medical is going on. It’s not cheap for him to maintain a lawsuit against you.

          • Suzi Q 38

            “….Anonymous complaints are cowardly and unprofessional…..”

            I disagree
            As a patient, I would like an anonymous warning of a physician that was incompetent.

            In the case where Dr. Duntsch is concerned, I would have cancelled my surgery, and saved my own life, due to the selfless act of a medical professional who cared about patients like me..the unsuspecting public.

            Look how many had to die or be maimed before he was stopped. This is just in Texas.
            Where was he, prior to this state?
            What was he up to there?

            How many others looked away?
            When it is obvious, let the patient know.
            There are “hints” that can be made when you see the patient. You can have a friend call the patient on a pay phone, if you can find one.

            If someone called me in time, I would have cancelled the surgery. Neurosurgery is just too risky not to report and warn the patient about.

            Aside from medicine, “Whistle blowing” works.
            Why would physicians and other medical professionals be exempt?

          • Tiredoc

            If you are tried in a criminal proceeding, witnesses against you are required you testify in person, facing you. This is a constitutional requirement.

            You are equating “whistle blowing” to anonymous tips. Whistle blowing works because people stand up for their convictions and state their case. Anonymous tips just unnecessarily strengthen bureaucrats.

            There is no moral justification for working for a company whose behavior you find reprehensible. If you pursue the company’s internal dispute resolution process without a result you can live with, then you need to put your career on the line.

            As for the “called me in time” you are stating that you should receive consideration above that of a random human. That if you had connections or friends you would not have been injured.

            “Anonymous” tips are inherently dangerous. If a regulator wishes to target someone, they can call the tip in themselves. There is no reason to presume that methods that would be laughed out of criminal proceedings should be encouraged in any way in civil ones.

            If the choice is between Dr. Duntsch keeping his license and allowing anonymous tips to be the standard by which licenses are investigated, I’m on the side of Dr. Duntsch keeping his license.

            It doesn’t sound like Dr. Duntsch is facing anonymous complaints. It sounds quite public to me.

          • Suzi Q 38

            Anonymous tips to that patient is far from dangerous. IMHO, it could save a patient.

            Yes, Dr. Duntsch is facing a litany of public complaints, but only after he had maimed and killed several patients. Even one life is a life worth saving. Now, so many are adding complaints to the list, as if their memory is clarified all of a sudden. Where were they before??? If even a few complaints streamed in, maybe someone in administration could have stopped him long before.

            If somewhat see your reasoning for the innocent, but there is such a physician shortage nowadays that rarely would someone turn on you and report you for no reason.

            Quite the opposite occurs. Physicians and other health professionals are covering for each other.

            Even the Chief of staff will cover up blatant errors in order to save a doctor.

            Is that the best situation for the patients?
            What is the oath? “Do no harm??”

          • Tiredoc

            Ah, the “if it could save one life” argument.

            The majority of murderers have previously been convicted of a felony. If we lock up all felons for life, we would have less murders. It would save at least one life.

            The anonymous whistleblower that leaked the Abu Ghirab photos saved no lives, but cost thousands of Iraqis theirs, as well as hundreds of Americans.

            When people talk about laying down their lives for liberty, what do you think they are talking about? An accusation carries real risk to the accused. Anonymous accusations have no place in a free society.

            Liberty is messy, with obvious cost that is paid daily. It is worth the cost paid then and paid now. It is the moral duty of every citizen to speak out at injustice. Cowards don’t deserve to be heard.

          • querywoman

            Abu Ghirab should never have happened. The average soldier is just a kid. We know that when people get power, there will always be a few who abuse it. Therefore, the system should expect that it will happen, and include checks and balances.
            If water boarding goes away, there will just be a new type of torture.

          • Tiredoc

            The photos from Abu Ghirab were taken far before they were released. They were evidence from an internal Army investigation that was actively disciplining the participants. The evidence was presented to a Senate subcommittee. A member of the subcommittee “whistle blew” to alert the world to something that had already stopped.

            The Senate is charged constitutionally with managing the war effort. The release of the Abu Ghirab photos unquestionably damaged the war effort. The anonymous traitor cost lives for political points. It is a perfect example of the dangers of anonymity. With no cost, there is abuse.

          • Alice Robertson

            Well….there are people who think that after we witness our servicemen get blown to bits we err not to head out and serve the enemy flamin tea and crumpets:)

          • Tiredoc

            I’m for serving up crumpets. My grandmother made some that had suitable armor piercing potential.

          • Alice Robertson

            Ha! She must have been British because the food there….yuck…so I live on pastries while there (crumpets aren’t my favorite either even when made well or with their fresh clotted cream:)…but the fresh cream in the pastries is to die for…well…and the curry and chips. Otherwise…I’m thinkin I know where your grandmother got her recipes:)

          • Tiredoc

            Nothing says good morning like stale crumpets and eggs fried in a bowl in a microwave. I actually thought British food better than my Grandmother’s cooking.

          • Alice Robertson

            Well…hmm…what can I say…I need to go back so I can lose some weight….I can’t wait to go to Cornwall…that’s only because that film Amazing Grace was filmed there (the one about the widow that has to grow MJ….Craig Ferguson wrote it…very funny). Hmm…..I think British food is more like Fear Factor Food!:) Gosh I hope my relatives don’t catch this..oh yes the fish n chips are brilliant.

          • querywoman

            I’ve not delved into Abu Ghirab deeply. Corruption is everywhere!
            Murderous Dr. Michael Swango would give shots. One nurse was appalled when she found out that a doctor gave a shot. That’s what nurses are for!
            Yeah, we know that occasionally docs give shots. A pulmonologist gave me the pneumonia shot.

          • Suzi Q 38

            It depends what the felony is for.
            Writing a bad check or stealing food for your family could be a felony, and not merit being locked up for life to, as you say, “save one murder.”
            Bad physicians who could have been stopped long ago is a tragic situation.

            As we patients continue to read about these criminals, I wonder how long they have been doing this, and who knew. Who could have prevented it?

            They system punishes the deliverer of bad news.

            Remove the punishment, and this will give chance to an investigation. If there is no merit or proof, then no action will be taken.

            Protect the patient. The one you are supposed to heal.

          • Guest

            So, you think that nurses and physicians should complain through “internal channels?” You do realize that it’s usually the hospitals who are protecting those physicians don’t you…at least the ones who are making them money?

            Physicians and nurses are legally responsible for reporting dangerous practices to the medical or nursing boards…not doing so can lead to the loss of their professional license.

            I’m willing to bet there were many anonymous complaints against Dr. Duntsch. People are only stepping forward now b/c the medical board suspended his license. What you’re reading on the internet is only the tip of the iceberg. I guarantee you there are many cases, just as tragic, that you’ll never hear about.

          • Cyndee Malowitz

            But the problem is RETALIATION – it’s the #1 reason physicians and nurses don’t report these types of problems. There HAS to be protection for the complainant or people like Dr. Duntsch will continue to kill and maim patients.

          • Tiredoc

            There is protection. The Winkler county nurses got $750,000 for their year of trouble.

          • Cyndee Malowitz

            I don’t believe you read the final determination of the Winkler County case. The physician and his cronies went to jail for what they did to the nurses.

            Those nurses most DEFINITELY didn’t need the patient’s or their employer’s permission in order to report their cases to the medical board. In fact, they were legally obligated to do so. They could have lost their license for NOT reporting him.

            Same thing with my case, I was legally, ethically and morally responsible for reporting the PM doc’s activities as well.

            BTW – I have a counter-suit pending against him and his wife for malicious prosecution, defamation and retaliation. This isn’t over by a long shot.

          • Tiredoc

            I would respond, but the moderator is nerfing my comments right now. Maybe they’ll show up later.

          • Alice Robertson

            Be good.. be very, very good!:) .I was in jail all day Sunday. What a jailbreak that was:)

          • Tiredoc

            Heh. And I wasn’t even close to a Godwin’s law violation. Although the flag draping probably was a bit much.

          • Alice Robertson

            Hey you have been to the UK? That means you were a part of the sing songs at the pubs? But if not it’s all on youtube where there is a famous mostly British, but International pub song called, “Who the f$%& is Alice?” as the refrain…well so it is with Godwin? LOL

          • Tara Candela

            See my above comment. A big problem is the physicians protecting other physicians.

          • Suzi Q 38

            No kidding.
            I wonder how good those doctors feel after someone finally is maimed or dies.
            Do they “chock one up for the “team?””

          • ninguem

            The Patel case, see link below, when Patel left Oregon for Australia, not surprising his bad practice continued.

            One difference was the Queensland government wanted him there, for their own cost considerations. He reduced the waiting list for surgery. Basically, that’s a political matter in a country with socialized medicine.

            Problem was, they didn’t care if the patients got better or went six feet under; all they cared about was the waiting list was shortened.

            The docs who would have complained were foreign nationals. Their visa was tied to their licence which was tied to their job. They knew full well if they complained, they would get fired, and then deported. The few native-born Australians on staff complained, on behalf of the other docs at risk.

            The nurses tried to blow the whistle.

            They were threatened with JAIL.

            Lawyers from the Ministry of Health sat them down and pulled out some statute about revealing Government secrets. They were prepared to equate whistleblowing in a hospital, with, I dunno, revealing military secrets.

            It was quite the mess. Turns out, a lot of the government hospitals there, were like that. The Patel case was just the most spectacular, and because the doc came from the USA, it got attention in the USA.

            There’s lots of newspaper stories on the matter, both in Oregon (he was at Kaiser Portland), and of course tons of stuff in the Australian press, including Australian “60 Minutes”, which is like our version of the show.

            Guess all I’m saying is, as bad as Texas can be in this regard, there’s actually worse out there.

            FWIW, lots of government heads rolled when the story finally came out.

      • Cyndee Malowitz

        Absolutely – the pain management physician I reported to the TMB filed a SLAPP suit against me.

        • querywoman

          I need to research, in our timelime, the two other nurses in Texas who reported a doctor who had the local sheriff on his side, I think. Did the nurses lose their licenses at first? But the doctor eventually got his license revoked.
          This kind of bullstuff always backfires on the doc. They don’t seem to learn.
          Cyndee, I have researched your situation. From what I can tell, he may have told patients you stole case records. Hogwash!
          Someone commented that you have no trouble getting patients for your own clinic. I doubt that you even compete with him.

          • querywoman

            Dr. Rolando Arafiles. I wrote more about him in another post.

          • Cyndee Malowitz

            The Winkler County nurses were never in trouble with the BON – they had CRIMINAL CHARGES filed against them! The physician who retaliated against them not only lost his license, but he went to jail.

            Don’t believe everything you read on the internet about my case – very little has even been reported to the press. I heard he had employees posting comments about me…gee what a surprise! I certainly didn’t steal his records – there were others who reported him and he just can’t seem to accept that fact. I certainly don’t compete with him – we don’t even treat chronic pain at my clinic.

            His wife totally defamed me on camera. She said I was unhappy with what they were paying me and I was retaliating against him (sure glad we got that on camera!). Except I didn’t even have to work and I most DEFINITELY didn’t lie about any of the cases I reported. I had absolutely nothing to gain by reporting him. The medical board is his accuser…not me! I just blew the whistle.

          • querywoman

            I said I wasn’t going into the retaliatory acts of those nurses in great detail. Anyone can google Rolando Arafiles for more info.
            I don’t believe what I read about you. I got into the Corpus Christi reviews and read some of the reviews about you and him, I knew instantly that the stealing records accusation was just that! Maybe it was his employees or friends posting, or his wife, or himself.
            Cowards who retaliate generally follow a certain pattern, and the retaliation against you smacks of it!
            I read reviews of you from patients, which are overwhelmingly positive, which doesn’t surprise me. To provide low cost, quality, walk-in general care is a blessing.
            Someone posted that you don’t have any trouble getting business.
            I bet you prescribe a lot of four dollar medicines! Most practitioners are glad to write those up!
            One reviewer said you pumped him or her for details about what the pain doc’s up to! So what if you did? That’s not a crime! But I doubt you have time for gossip in your busy practice.

          • Cyndee Malowitz

            One day we’re all going to get what we deserve. I’ve been waiting for a long time.

          • querywoman

            I suppose is a gentlewoman’s way not to mention your pain doctor nemesis’ name on her, though it’s public info. Rolando Arafiles got the slammer, so his case is closed.
            When did you start practicing?
            I suggest you research the Psychiatric Institutes of America scandal in the early 1990s as an example of bad shrinks you need to watch out for.
            I think there is also a lot of scandal in the rehab business, charging the government for supplies and services for people with certain brain injuries who really won’t benefit.

        • querywoman

          Cyndee, I am surprised that he even got a lawyer to file the case. You have a constitutional right to free speech. Period! That includes complaining about licensed professionals to authorities.
          Cowards exhibit certain defenses, and he, his wife, and staff and whomever else appear to be using those cheap shoddy classic tactics.
          He may have even convinced himself you did something unethical like take files and patients. That kind starts to believe their own slander.
          Did you see the movie, “Witness,” where the bad police almost convince themselves that the good cop, the Harrison Ford character, is a killer?
          It’s obvious you opened up a walk-in low cost general practice that doesn’t compete with his.
          I think you are outspoken, and many people just hate that. I saw how you showed up at high school and walked your daughter to class on time.
          It’s probably still wise, even though he has been told he can’t shut you up, for you not to utter his name in public.

  • Guest

    Shocking, disturbing, and yet I’ve seen horrible, incompetent physicians like this neurosurgeon in practice. I’m not surprised at all that the useless board did nothing for a year while collecting dues from physicians all over the state (who else would pay for the inflated salaries of the board members?).

    I worked with an impaired physician for nearly 5 years when he finally stepped down voluntarily. There was complaint after complaint, including calls and letters written to the state board. Nothing happened. Nothing. No sanctions, no disciplinary action, no termination, no loss of license. He is no longer in practice, but he made that choice. Fortunately, he did not kill anyone, but it’s because time after time he was bailed out. It repulses me.

    There is literally no way to stop an impaired or incompetent physician. Well, no legal way.

    • guest

      Just curious, what state was this in? In general what kinds of complaints were made? It seems like Drug and Alcohol issues are often at the heart of these “incompetent” complaints.

      • Guest

        This was CA. The issue with this practitioner was not drugs or alcohol but impairment due to age. He could no longer do certain basic tasks and was endangering patients.

        • guest

          Not surprising at all in this state, is it? My sympathies. I am in California and have been completely underwhelmed with the Board of California. I came to learn if a patient has allegedly been sexually abused by their physician in California it can only be reported if the pt decides to report themselves. So the alleged doctor continues to practice if the pt decides not to report.

          • Guest

            Ridiculous! I spoke up against the physician I mentioned earlier. Nothing happened. I learned early on that getting a bad physician out is extremely difficult and that speaking up just puts you on the radar and makes YOUR life difficult.

            Unfortunately, I do know of a few bad apples. I don’t speak up anymore though. That’s the really terrible thing about our system. Sound like you know how it is.

          • guest

            Kind of a relief to talk to you as well. Yes they would not take my report about this pt with the alleged sexual abuse from her doctor. Meaning he started dating the pt and then when they broke up he dumped her as a pt.-according to the pt.

            I am sorry you have to watch these bad apples and don’t feel like you can speak up. That is disturbing.

            I don’t think I realized the depths of how bad it was until we chatted and i read this article. To my dismay I went to a conference and there he was. It was frustrating and disgusting frankly to watch this. Up to this point I was always baffled and frustrated by the Board. I feel like I understand more from reading this article. It takes a lot of the mystery out of it.

  • buzzkillerjsmith

    We had better quality control at Kaiser since it is a self-contained organization and every doc can watch every other do. One old dude diagnosed a big DVT but then didn’t anticoagulate the pt. He was gone soon thereafter.

    After I left Kaiser I did some locums, one in the Central Valley of CA. Scary. You don’t want to know what they’re up to to their, believe me.

    • Cyndee Malowitz

      I’ve witnessed far, far worse…you have no idea.

    • Kathleen

      Docs are better at protecting themselves and each other than patients. I wish it weren’t true, but it is, and Kaiser is its own closed world.

      I woke up screaming in the recovery room after a Kaiser doc operated on my right shoulder. I kept telling them that my shoulder was “in the wrong place” and next day I was in the ER for pain by noon, having already gone over the limit for my Rx pain meds. Over the next months, everyone smiled tolerantly and wondered why I (a stoic under-reporter) ) was still reporting terrible pain and could barely raise my arm, “but sometimes these things just take time.” Around a year after surgery I felt a big THUNK as my humerus slipped back into place, but even that improvement left me in terrible pain with limited function. And there were no docs on hand to witness, of course, so none of them believed that what I describes could have happened. An outside shoulder specialist took one look at me and my pre-op MRI and had a good idea what needed to be done, confirmed by another MRI. I tried different docs within Kaiser, and the internal administrative procedures to get the help I needed, and one Kaiser doc after another ganged up to oppose the suggestions of the outside specialist. “Medically unnecessary” don’t you know? Finally, I found the one Kaiser shoulder specialist in the region who did not agree with KP colleagues and, 2 surgeries later, relieved my pain and restored my movement by doing pretty much what the outside specialist recommended years earlier. Years of my life wasted in terrible pain with severely restricted function, and my only recourse is to write to the state board. Bad as my story is, it wouldn’t amount to malpractice. Whenever my own MD brother complains about malpractice suits and approves of damage limitation laws, I think of what a privileged life most docs lead compared to the damage too many of them do to others.

      Let’s see: jeopardize your career path vs permit pain, suffering and even death from negligent and incompetent docs to continue. As another poster said: it amounts to being an accessory to a crime.

      • Alice Robertson

        I had a similar experience years ago, but our friend is married to a paramedic who said they get an unusually high number of calls from Kaiser patients and the joke among the paramedics used to be that they wouldn’t use Kaiser for their pets. Yet, data would suggest this isn’t true. Locally, Kaiser teamed up with Cleveland Clinic for operations, childbirths, etc. and it’s been a move in the right direction. And when US and News Reports and others rate healthcare plans, etc. Kaiser (particularly in CA) seems to overall do well.

        Yet, during the Obamacare battle Cleveland Clinic had an alternative plan. To sum it up quickly and in general it was to expand Kaiser so the poor could get care at low cost. The bottomline was the same care could be achieved at something like ten percent of what Obamacare would cost. The reason is obvious….Kaiser has a system in place…they improved their image and care and expanding Kaiser and their management would be cost effective and help a lot of people gain access to care. I personally think that the big picture on their plan was far better than the destruction we will see with Obamacare.

        • Kathleen

          The big problem is healthcare as a profit center, and “Obamacare” leaves that firmly in place. I expect many aspects of medical care to get worse.

          There are good aspects to Kaiser. This Wed. I will get an ultrasound and then go right up 5 flights to see my new PCP, in whom I have confidence. She has brains, curiosity and heart. But I looked around for 10 years before I found her, and in the meantime previous docs entered medical errors were entered into my electronic records, then echoed from doc to doc. And I think most Kaiser docs are pretty good with ordinary health problems: most childhood illnesses, diabetes management, health education and such. Cookie cutter stuff.

          But their system really falls down when it comes to more unusual conditions. I have had (and have) a number of rare conditions, and for years got tolerant smiles to my reports and suggested diagnoses. “That would be very rare,” doc after doc told me, as though it was therefore impossible. They were entirely unmoved when I reminded them that I have already survived a cancer that was even more rare. So for 6 years, despite my suggestion that AHCM would account for all my symptoms, I was denied appropriate cardiac risk assessment screening. AHCM is often the cause for sudden death. Now I get big deal annual workups, but they flat out denied my suggestion of AHCM for 6 years. My current cardiologist tells me that I’m a clear case. Even textbook.

          After reporting strange headaches for years (and with a history of head and neck radiation) last year I finally went around my then-PCP and persuaded a specialist to order a brain MRI that revealed my rather large brain tumor – now fortunately removed and very well done indeed. But after dismissal after dismissal, getting the diagnosis was hell.

          That’s the worst with Kaiser: you can’t just go see another doc. And Kaiser docs will rarely say that another Kaiser doc was wrong, even if that’s what you must conclude from the evidence.

          Oh right, and until this year they never treated a dangerous and entirely treatable condition that I have reported for at least 10 years, one that plagues nearly 100% of head and neck radiation survivors. A recent Rx for drugs (that have been available for a very long time) now may help me keep my teeth and might even let me sleep at night. But nobody ever suggested it until my new PCP sent me to talk with the head of radiation oncology.

          I just love my shoulder surgeon, my neurosurgeon, my podiatrist and my new PCP. Like my GYN pretty well too. But all previous PCPs clearly saw themselves as gatekeepers to prevent obvious hypochondriacs like me from wasting their potential bonuses. The PCP is key at Kaiser. Frankly, with all I have going on, Kaiser would be dangerous if we couldn’t afford to go outside for private consultations. And I have to spend so much of my time doing research and calling around to specialist clinics for leads to docs within Kaiser. It amounts to a part time job.

          • Alice Robertson

            You gave a good summation of the pitfalls. I am at one of the world’s top hospitals…the one movie stars come to and millionaires fly in and give nurses $10,000 tips, and their motto is, “World Class Care”. Well………all I know is after a procedure last week I tried to get TWO Vicodin and a call to the nurse of my PCP told me off and refused to contact the doctor…pain managements supposedly overwhelmed nurse practitioner never did open the two messages sent by the secretary, and the doctor didn’t open his from her either and the head secretary doesn’t return the calls on her voice mail either….so it’s not personal….it’s just they can’t be bothered and they are a pain managment place (with a low key mostly immigrant staff but outstanding nurses in the OR). Now I am fearful to get the RFA I am going in for because I will want some pain meds and in Ohio that’s like begging to get the DEA at your door! Ha! Pain management here is a different story of physical and aqua therapy that is very profitable to the hospital….but it won’t help the cyst on my sciatica nerve or the pain resulting. So there is room for improvement no matter where you are at. Just don’t ask for drugs… may get beat! Ha!

            It’s good you research…it is not in vain. I finally researched and told the Rheumy I needed a spine doctor because I couldn’t walk more than ten feet without horrible pain. So they found the problem. Keep on it! I certainly hope you feel better very soon and that you can get good care and specialists.

          • Kathleen

            Good luck to you too. I hope your condition and pain are resolved.

            My experience with pain management is different. In my case they were quick to give me narcotics, but ignored my persistent contention that there was something WRONG. They put me in a program to manage chronic pain and would have kept feeding me pills, rather than fix the damage.
            There has been a major push from insurance companies to reduce access to PT in California. Now injured workers only get 24 visits per injury – carpal tunnel, vocal strain, torn shoulder or amputation – no maTT, or t.

          • Alice Robertson

            Years ago Kaiser did no PT, so I guess that’s an improvement. I think patients have used the internet to shine a light on the problems in medicine and I really do see improvements. There will always be lazy medical workers or overwhelmed and there is still much room for improvement. I really do hope you find help and relief there because pain is the pits:)

            It’s a very hard call for a doctor because a patient like me can’t be helped with PT, and they are literally putting their license on the line to help a patient. I don’t think the majority of patients do become addicted. Our friend’s step son was found dead in the basement. He had been chewing on his mom’s Fentanyl patches. Her doctor cut her off. She traveled out and got a new doctor. Two years later she was found dead at age 55 years old. Her husband sues the doctor AGAIN (different docs). I was shocked because one patch is good for three days. She had four on when they took her away.

            It’s the question of where patient responsibility comes into play and a doctor’s liability. I think with pain overall it’s the patient’s fault. I don’t see how a doctor is responsible if I buy cough syrup and go home and eat half the bottle of a one month’s prescription in one night.

            Yes, there are negligent doctors but this is a case of the patient’s irresponsibility and, therefore, if someone like me needs a Vicodin the doctor hesitates (I did get 20 in June after a bad xray, but the nurse said they should do me a long time….yeah I guess that was my lifetime supply:). Not because the doctor’s were negligent but because patient’s families have a very hard time blaming their own family member for making a choice to abuse legal drugs. They consider the doctor the drug dealer and sue and don’t really care if they hurt thousands of pain patients who aren’t going to get better…and some really do need those drugs (my poor father suffered immensely because doctors in Ohio are terrified. One gal was at the ER and they whipped out her list of drugs she had purchased online….oh horror of horrors she had been on Tramadol…omgoodness….what a drug whore! Ha!).

            Then it gets even harder because most families want a cash settlement which makes it hard for me to take them seriously when they say they are doing it for the good of mankind. I watch the TV (when I can bare watching it) and say to my kids….yes that’s because they are going to donate their settlement to a rehab. Yes, I am certain of it! :)

            To sum this up I do think a very small segment of doctors are negligent (one from near me is doing hard time, and another one will join him. Their crime?

          • Kathleen

            It’s wrong to go after docs who make pain relief possible, because I suspect the people they help far outweigh the few who abuse. You are right that not all painful conditions can be treated, with PT or anything else, and if someone takes drugs to relieve pain, that is not addiction. On the other hand, many docs are quick to label people in pain as drug abusers, when most are not.

          • Suzi Q 38

            I think the PCP’s are there to make sure you do not have to go to the specialist.
            This saves money.

            I have been told that Kaiser is good for when you are young AND healthy.

            Good luck if you are older and/or have more complex medical conditions.

          • Kathleen

            To be entirely fair, this cookie cutter “one size fits all” mentality, that creates an illusion of quality care and is, by-the-way, so much cheaper to provide, is not confined to Kaiser.
            When you have several complex conditions, it’s exhausting to have to work out your own diagnoses, time after time, and have to fight for appropriate care even then.

          • querywoman

            A doctor told me it costs HMOs money when you see a specialist, even at their own clinic.

          • querywoman

            In Texas, I could not get away from what my original Kaiser quack wrote about me when I saw their other drones. Justice was when I found out that idjiut was no longer seeing patients and was managing one of their offices. Now he works for some insurance company in another state.
            I have no words to express how relieved I was that he was no longer seeing patients. There is a purpose for insurance doctors, to keep clowns like him from direct patient care.

          • Kathleen

            All for keeping incompetent docs away from patients, but do we want them deciding which care does and doesn’t get authorized? There must be something even safer. Unfortunately, the gist of this article and discussion shows that other docs, usually those in the best position to judge, are unlikely to protect us. More likely to protect the dangerous doc, in fact. And then they wonder why people say such angry things about doctors.

          • querywoman

            I can argue with an insurance company in bureaucratic terms easier than I can with a doctor one on one.
            In my case, you just don’t know how happy I was when I found out he was no longer seeing patients. He had a round with a woman with whom my mama worked. The person who told me with a smile that he was no longer seeing patients told me she’d had umpteen fights with him.
            Sometimes I think about writing him a letter cc’ing the TX Medical Board and his current state board listing off how his actions effected me for years, but, in his case, I think I’ll just settle for him being out of direct patient care!!!

      • Suzi Q 38

        “…Let’s see: jeopardize your career path vs permit pain, suffering and even death from negligent and incompetent docs to continue. As another poster said: it amounts to being an accessory to a crime…..”

        I am so sorry for your medical troubles.
        I am the one that said that, and I meant it.
        There should be a law against it. That is why an anonymous report should be allowed. I can report a crime anonymously. It is called “We Tip.” Why not have this for medical “crimes?”

        I have learned through all of this that some physicians just don’t care or see so many patients that you and I are just another day and part of their paycheck.
        They “sign up” for a career that involves listening to patients then treating them. First, some just do not listen. If they actually listened, they would save us all a lot of time and pain.

        • Kathleen

          You are so right. Whenever I find a doc capable of listening and who actually cares, I cherish her or him, each one far more precious than gold. Even more, I cherish the ones who tell me the truth about the reputations of others. Like the one who told me the surgeon who damaged my knees is a rep for the maker of an orthopedic device that he himself stopped using because research shows that it causes long term damage to cartilage.

          I’m as active as I can be, but my livelihood and so many years of my life have been squandered in terrible pain and disfunction, all entirely preventable. The docs who colluded in that live comfortable self-satisfied lives while people who shoplift a supermarket sandwich do jail time. I say that only to point out how disproportionate our society is when damage comes from people who have titles and nice offices. It does seem even more outrageous when the Hippocratic Oath is involved.

    • karen3

      Oh please, it’s kill’em Kaiser. I’ve never known of someone with Kaiser who doesn’t have a horror story.

    • querywoman

      Kaiser in Texas turned my life into a disaster, and they wouldn’t discipline anyone. I didn’t have surgery, where it is easier to track mistakes.
      Eventually, the State of Texas ran Kaiser Permanente out of Texas. Governor George Bush eventually passed the strongest and first real laws anywhere policing HMOs.
      I think the State had recordings of stuff like Kaiser nurses advising patients by phone to go the nearest ER and then denied payment.

  • Skeptical Scalpel

    Thanks for all the (mostly) good comments. It is infuriating and disheartening to hear about situations like this that take so long to be resolved. Meanwhile, unsuspecting patients suffer. I hope by calling attention to this, change may eventually occur.

    • rbthe4th2

      Thanks SS! We hope so too. Frankly, I don’t want lawsuits. I don’t want suits. I just want good healthcare. If a doc can’t provide that, they need to go. Simple as that. Get rid of them before the above stories come out and it just make the “us vs. them” game worse.

    • Cyndee Malowitz

      Skeptical Scalpel – thank you for writing this article and drawing attention to this problem. As I’ve already mentioned in other posts, I reported a pain management physician to the TMB in 2007 and he is still practicing. The TMB is trying to discipline him, but he has the $$$ to fight them…he even sued them for “harassing” him. Could I ever tell you some stories.

      After my case became public, physicians called to thank me for reporting him. These were physicians I had never even met. That was a real eye opener. Many physicians and nurses knew about him, but only a few bothered to report him. But then again…they were probably terrified to do so.

      More than anything, I want justice to be served and for all of us to get what we deserve.

      • Skeptical Scalpel

        I agree that his peers were afraid of being sued. Others probably didn’t complain to the board because they knew the board wouldn’t do anything. If this has been going on since 2007, they were right.

        • Cyndee Malowitz

          His peers may have been afraid of him before, but they aren’t now. I hear they’re coming out of the woodwork and reporting cases to the TMB…finally. It probably helps that the TMB filed a formal complaint against him for witness intimidation after he sued me.

          It doesn’t appear to be going too well for him. He has a new advertisement in the paper…”Tired of being medicated?” and then it goes on to say that he is offering “noninvasive procedures.” Well, I suppose those procedures can be performed by someone without a medical license, since even a shot of B12 is considered “invasive.”

          His cases have been referred to the Texas State Office of Administrative Hearings and his lawyer continues to get the hearing postponed. If he doesn’t like the outcome there, he’ll still be able to fight the TMB at the Travis County Court. Amazing how money can buy someone so much time, isn’t it?

          BTW – I’ve filed a counter-suit against him for retaliation, defamation and malicious prosecution.

          • Cyndee Malowitz

            BTW – that is my post – I’m not sure why I’m listed as “Guest.”

        • Suzi Q 38

          It would be interesting to research where this doctor was before he arrived in Texas, ready to maim and kill. what happened there?

          Doctors like this go from city to city and from state to state, if need be.

  • Tiredoc

    There is no reason to think that medical boards should or would effectively investigate and discipline incompetent physicians. They are not set up to do that. Their purpose is to prevent unqualified people from practicing as physicians. Unqualified and incompetent are two separate issues.

    As for the completion of a residency, what else would you expect when programs are paid 300% of the training cost per year of residency? Turnover? It’s much easier to just shuffle them along, hoping that they’ll figure out that they’re incompetent and stick with easier things once they graduate.

    • Alice Robertson

      Do you remember the WSJ article about Dr. Hodad? That article sorta rocked my world….it created real terror within my very soul. It felt like a glimpse into a world I was happier before I knew about it:) It was wrote by another doctor as a warning. His story of a residency where all the residents discussed Dr. Hodad. He wondered why he hadn’t met this doctor. You have guessed it was an acronym for Dr. Hands of Death and Destruction. And then he went on to share that there is a protected doctor of a similar negligence level in each hospital. You know the one surgeon the doctors know not to use….the nurses know that particular doctor has a high infection rate and watch their patients more closely but the one patients don’t find about until it’s too late.

      But as you state it’s a difficult call because while patients would desire spectacular results we know that’s not going to happen because of variables. And we clearly don’t want a witch hunt on doctors when so many really are conscientious and doing a great job.

      And, yet, the fear factor remains within patients who long for a way to find out what colleagues know about these doctors. And colleagues are in a bind with libel issues, etc. And sometimes it’s the patient’s fault and sometimes it’s the doctors… the dreaded lawyer becomes involved. Doctors love to cite TX as a type of pro-type for practicing in. The question is if doctor’s gained and patient’s lost? An objectionable question with subjective answers.

      So patients wish for a nemesis of all the Dr. Hodad’s in the land but until then they may very well use lawyers to expose them.

      • Tiredoc

        There are good Dr. Hodads and bad Dr. Hodads. The bad Dr. Hodads are the perverts the impaired. The good Dr. Hodads of the world generally suffer from poor judgement, not technical incompetence. They do things that a more humble doctor would accept as fate. They have a protected position at hospitals because the doctors all know that occasionally they will get a patient that a normal doctor won’t touch. Then they call Dr. Hodad. And Dr. Hodad, with an excessive gonad/brain ratio, does the stupid thing well. And just often enough to keep Dr. Hodad around, the stupid thing works. The important thing is to never see Dr. Hodad first, because the stupid thing should only be done when it’s the only option left other than death.

        • Alice Robertson

          So how does a patient discern when to get to hell out of a doctor’s office? Ha! I guess that’s not funny, but doctors know the intricacies much better than we do. Oh dear doctor please help!:)

          • Tiredoc

            Actually, doctors are probably the worst judges possible of other doctors. The old joke about alcoholics and doctors applies to quality as well.

            “What’s the diagnostic criteria for alcoholism?”

            “Someone who drinks more than their doctor.”

            Most doctors have a lousy system of analyzing other doctors: either better than or worse than themselves. The more narcissistic the doctor, the worse they are at realizing that, in fact, “about the same” is the most common answer.

            If you’re going to see a surgeon, see one that does the most of what you’re going to them for. I tell my patients not to worry about the personality of a surgeon, they’re paid for their hands, not their mouths.

            As for the rest, ask the MAs. They tend to jump from office to office and are usually more than willing to rat out the bad eggs. The MDs don’t know and the RNs are too concerned about their careers.

          • querywoman

            I walked in Kaiser taking one regular med. A year and 4 months later, I was taking 4 or 5 meds. Time to get out was before that.

    • querywoman

      Once I turned some woman in who had one of those “therapy” licenses for misrepresenting herself as a physician. The TX Medical Board said they could not discipline her because they had no jurisdiction over her. Luckily, they will do that now.

      • Cyndee Malowitz

        The TMB only has jurisdiction over physicians, PAs and surgical techs.

        • querywoman

          I have seen some cases now of disciplining, or issuing cease and desist orders, against people misrepresenting themselves as doctors.

          • ninguem

            By that logic, query, my brother the electrician could move to Texas and call himself a brain surgeon. The Board can’t do anything, he’s not a physician, nor is he a nurse practitioner or any healthcare professional. So I guess no board can touch him, except for the electrician board I suppose.

            I hear that all the time, multiple states, but of course the Board has authority if a person is holding out to the public as a physician without the credentials.

            Now the authority may just be to refer to the Attorney General for prosecution, but they are supposed to protect the public, and part of that, explicit in their charter, is to police the unauthorized practice of medicine.

            They may not have wanted to do anything about it, that’s another matter. But yes, the Boards have th authority to investigate the unauthorized practice of medicine.

          • Alice Robertson

            This is informative, but the last part needs a bit of clarity. The ability to do something is much different than actually doing so. The boards often sit on the wayside for what is a myriad of reasons…sometimes patients are just hurt and need to rant…there is just so much at stake in this battle of lives as far as health and careers. But overall patients think it’s a Boy’s Club type of mindset because patients just feel there is an unwritten medical code of silence about colleagues (realizing you are probably fed up hearing that…but this is a high-stakes battle on both sides).

            On a few levels it irritates me that good doctors gotta put up with all this crappy bureaucracy but overall patients think your colleagues caused it. And, ultimately, patients will get the government more and more involved and some will get their single payer and then they will be empowered to treat their common cold while they die waiting for true medicine to help them. Yep, that’s gloom-and-doom from Alice…honestly, I am terrified of socialized medicine.

          • querywoman

            Just absorbed your post. What I am saying is now the Texas Medical Board does seem to be taking action against those who misrepresent themselves as doctors.
            I am a former student of law, didn’t finish. Tried it an older age with out of control diabetes.
            I worked 10 years for state and federal agencies.
            Sometimes I help people with tax, welfare, and other document-type issues. I make it clear that I am not a lawyer, and I do not practice law.
            Practicing law without a license is taking money for it.
            My father was a master electrician licensed in Texas. It’s very difficult to pass the master’s test for electricians, and we always heard that the plumbing tests are even harder.
            Why is water clogging up everything more dangerous than electric malfunctions, which can kill?

  • ninguem

    Skeptical, there are lots of articles accusing the Texas Medical Board of corruption and abuse of power.

    I’m not convinced the “problem is lawyers”, though I take a back seat to no one when it comes to disdain for them.

    The Texas Medical Board has been the target of numerous complaints that they target docs over trivial matters.

    I strongly suspect they let this doctor slide as long as they did, because of good old bureaucratic incompetence, laziness, and cowardice.

    Why go after one doc like this, who will fight back, and the matter can be complicated to sort out in court?

    They would rather take the effort needed for that one doc, and instead go after fifty docs over trivial matters, paperwork. Throw the book at a doc who is late with a medical record dictation.

    The bureaucratic mentality is to look better that fifty good docs were disciplined over trivial matters, rather than expend the effort to go after one doc who is truly a menace.

    Well, until finally presented with overwhelming evidence, and they’re forced to act to protect their jobs.

    • guest

      that’s amazing. As a doctor you don’t tend to question the Board. Many I think are afraid of them. But as I have learned they are much like the Wizard of Oz.

      • Tiredoc

        More like the flying monkeys.

    • Cyndee Malowitz

      I agree with you 110% – I know all of this from first hand experience.

  • Lemmethink101

    Why do people CONTINUE to expect medical boards to investigate and discipline doctors? It’s like bearding the lion in his den.

    Besides, why would doctors discipline his/her “best” friends? You cover my ass, and I will cover your ass. Unwritten rules.

    • Alice Robertson

      Because hurt people seek answers…sometimes…like myself they come to boards like this and desperately try to gain empathy for those who used to expect godlike respect while performing less than godlike actions. Patients almost beg to understand the doctor they need to trust…and when that trust is broken (blame on both sides here) there is a deep seated need to understand yet patients feel like they are in the dark. And I do fear patients are going to win this game and many good doctors are going to have wasted tons of years of training to be cast aways. There has to be a way to disciplined doctors but not ruin them.

    • guest


    • Suzi Q 38

      I have come to realize this.

      I am wondering if the “Risk Management” department would care. Maybe they would be critical of physicians who did stupid things and put their hospital at legal risk.

      What is left?
      Lawsuits or the internet.

      Some of us are good writers. Maybe we can write a one or two page article and submit it to several magazines.

      Maybe we can write a full written evaluations of the doctor on Healthgrades, Vitals, Yelp, and others. Describe what happened and your outcome.

      Consumer Reports Magazine especially likes good stories. They like accompanying pictures.
      You can also write a book about your experience.

      Just make sure to check with your lawyer. You can only review negatively if it is true. If the public can review a physician in a positive way, we can also state the truth about any physician in a negative way.

      State the facts. Save the evidence. Save future patients from harm. If nothing happens to them, at least you did your part.

      If you are very brave, and are well enough to do so, “camp out” at the next hospital community presentation night.
      You can stand on public property with your poster board and complaint(s). This way, the public will beware of hiring your errant physician who did not care.

      If you are independently wealthy and have money, sue them anyway, regardless if it is unlikely that you would prevail.
      Serve the doctor when he is teaching his med students, or at a CME physician lunch (they are fairly easy to gain access to).

      Somehow legally serving them at home would be too polite.

      • Alice Robertson

        Risk management is a shark pool. The Ombudsman is paid by the hospital. Patient advocates at hospitals are often multi-taskers who try to prevent problems.

        Also I wish Consumer Reports could do more than just report. They can’t get involved in any consumer issues on a personal level. The WSJ has some of the best articles I have seen on reporting to local chapters not the state board, etc. And Trisha Torrey is informative. I do know Good Morning America had a whole department helping people settle medical problems but that may have been more on a billing level. There was an online site titled Doctor’s Behaving Badly and Cheryl Handy was a risk management lawyer who now sends out updates on what doctors have faced discipline (but that’s usually if they were taken to court. Where I live some poor foreign doctor who his patients loved, but doctors didn’t, was taken up on charges for hugging some employment prospects too hard and lost his license. He is facing jail time and we miss him. I thought he was a good doctor whose wife was there with him running the office and he had a lot of Medicaid patients. He can earn no income while his appeal is waiting. So doctors have so much to lose. I doubt this doctor will have a practice to come back to when he is, hopefully, found innocent. Locally they say other doctors did this to him).

        It’s very hard for a patient to be heard, and I really do think that doctors have issues to complain about too. But they are often at a greater disadvantage than we are…the problem is that they often handle it poorly. I was reading about the doctor who was certain the flu vaccine was ineffective and how his colleagues turned on him (socially) and how isolating it is to go against their status quo. It may be why doctors discuss different methods at choosing those who go into medicine and why the fight between PhD’s and MD’s can actually become so fierce (my one doctor is a very unhappy bother…poor guy doesn’t know what world he fits in, or maybe he hates them both:)

        Suzi about the protestors….I don’t know how effective it is. May or may not work….I often think we need whistleblower laws but gosh I am tired of legislation and to be honest I am not certain it would be as fruitful as it appears. Same with protestors…I don’t know. When Obamacare was just an issue and not really legislated yet you would drive past the hospital and there were signs all over the place. I didn’t read them because I knew where I stood but a few of them would come in the Clinic to go potty or whatever. They would call doctors “Communists” or other words from both sides I don’t think should be shared here. There were some very funny comments about the protestors who weren’t taken seriously. Most patients found them annoying.

        It’s like the “Don’t Shop Here” signs. Some people may turn around but overall I think most people just go in and get their goods at a discount. We seem to make decisions based on what serves us.

        • Suzi Q 38

          Yes, Protesting may or may not work, but even it a few people are effective, that is one more doctor that is “on notice” or embarrassed enough to “move on.”
          If I was getting ready to have surgery, I would look at the protester and ask a few questions, only to make sure that my surgeon was not the physician featured in the protest.
          If he were, I might postpone the surgery until I gathered enough information to make a decision.
          It depends. Protesting about Obamacare might be different than standing in front of an event designed to bring in new patients. That is a political protest. This would be a personal health protest. The patient would be warning others about the doctor and the way the hospital administration did not care.

          I might think twice about being treated there.

          Yes, it is more like the “Don’t shop here” signs.
          Some definitely will NOT care, but other will.
          Going into a store to buy groceries or whatever is on a much lower level than trusting a hospital and physicians with your medical care.
          I might heed a warning or two if the warning was believable and had merit.

          • Alice Robertson

            Boy do I wish we could find a way to make it work. I get so angry at the lifelong problems that ENT left us and the bills because I refused to sue out of nothing but sheer mercy (that he isn’t thankful for and people are still complaining about this particular doctor. People will hear me tell our story and say, “Let me guess! Was that Dr. Arsehole from Strongsville?” Yes! How did they know? You guessed it, and these people complained to management. I can’t figure out what it’s going to take to shut the man down.

            I don’t want to ruin careers, but I once posted that Dr. Arsehole (I didn’t even call him that then) needed a vacation in Tahiti until he isn’t burned out anymore. Do you know a few doctors turned into tyrants and abusive? Until an anonymous female doctor told them to shut up. It was a few weeks before a neck dissection (which is a terrible operation where each lymph is cut out. She lost 49 lymphs that day because that doctor let cancer spread and the removal of that drainage tube with no pain relief. Omgoodness no wonder patients get awnry). So the female doc just blasts those meanspirited doctors who hurt their whole profession.

            But I think boards like this really are good because gosh there are some bad seed doctors out there, who are probably repulsing their colleagues but let me say their colleagues put up quit a fight on that peer review. Only one doctor told the truth and we are his patients now because he is so skilled he doesn’t need to lie to cover his arse. I admire him beyond words.

          • Suzi Q 38

            “……Only one doctor told the truth and we are his patients now because he is so skilled he doesn’t need to lie to cover his arse. I admire him beyond words.”

            Something similar happened to me!
            He did not criticize the others, but said that I needed cervical spine surgery…STAT. He shook his head in disgust when I told him who my two doctors were, repeated my symptoms, and told him how long I had been complaining about them. I told him that my neurologist had told me NOT to worry about my symptoms close to a year ago….that the severe cold that I was feeling in my hands and feet were Renaud’s. My urinary and bowel changes were hormone changes after my hysterectomy.

            He was very strong and pushed me to tell my physicians that I needed certain tests because “He said so.” he was a former chief of staff and had worked at that hospital for over 20 years.

            There are good doctors. They just need to kick out the bad ones.

          • querywoman

            That’s a good idea, Alice. Free speech lets you do that, but they can’t talk about you.

          • Alice Robertson

            Right because they are paid for a service and the government used the big HIPPA guns (that act is problematic at times).

          • querywoman

            As for protesting, if you are up to it, I promise it would work. You would see what a coward the doctor who experimented on you is.

      • querywoman

        I’m real pleased that you quoted me, Suzi Q. Most of us who get shafted by docs are too sick to protest. I’m hoping someone who reads this will.
        Abortion protesters have put doctors out of business by picketing, and that includes their homes and places of worship.
        Walk up and down in front of Dr. SawHatchet’s house with a sandwich sign on your body, “Dr SawHatchet is a quack!”
        Do it peacefully.

  • Tiredoc

    The problem with all of the hand wringing over incompetent doctors is that it leads to empowering incompetent bureaucrats.

    There is no evidence to suggest that our current method of training physicians is the best possible method of producing quality. As the example of Dr. Duntsch shows, academic brilliance is no substitute for steady hands and calm nerves.

    The Texas Medical Board does a fairly reasonable job of removing or rehabilitating impaired or perverse physicians. Apparently, this is what occurred with Dr. Duntsch. Unfortunately for Texans, it also removes boorish and unpleasant physicians who frequently are otherwise excellent.

    The problem with attempting to remove incompetent or unwise is that the evaluation for both is the same as evaluating excellence. It isn’t possible to do it yet, and certainly can’t be accomplished by anecdote.

    One of the more bizarre aspects of medical malpractice is its compete dissociation from medical error. The oft-quoted statistic of 100,000 annual deaths from medication error is matched by the 100,000 annual lawsuits for wrongful death. Unfortunately, there is no statistical correlation between the two. What’s wrong with the medical malpractice system is that it doesn’t punish malpractice. It punishes bad outcomes.

    So, we have a Medical Board that doesn’t discipline incompetence. We have a malpractice system that doesn’t punish malpractice. The solution for now is to do nothing at all. Figure out how to measure excellence first. Everyone wants to be excellent. Once that’s figured out, exposure will sort the incompetents out of practice.

    After all, we do have to get bureaucrats from somewhere.

    • Alice Robertson

      Good points….but how can we change the system because, personally, I think it needs changed. Some doctors post here in a type of narcissistic doctors have supreme knowledge and sacrificed so much, therefore, only the kings and queens can even tread upon their understanding of human suffering. And that attitude, in itself, should be an alert that there is no place for narcissism in medicine.

      Can I ask why there aren’t psychological testings like policemen go through to filter out burned out doctors for treatment, or to see who really will put themselves in a position of not thinking they are the king or queen (med students complain about a feudal system and it’s a fair analogy…realizing they can work their way out of it….but as a patient we hope they always remember what it felt like to be a serf:). So how do we identify the knights?

      • Tiredoc

        That’s the problem with trying to change a system that’s populated by humans. We have a complete and total lack of perfection. What if the psychological tests identify the wrong things?

        I think that you’re right about the narcissism and supreme knowledge bit. A lot of doctors have sacrificed a lot, but that doesn’t mean that they sacrificed for self-improvement as opposed to bowing before the royalty of the ones in line in front of them.

        I think if you took any group of high achievers and immersed them for years in the toxic soup that is academic medicine you’d get the same result. A bunch of eggshell egomaniacs.

        Personally, I would eliminate most of the redundant oversight. Make one board in charge of all of it. Medical malpractice, licensing, credentialing. Tinker with it until it works OK, then leave it alone.

        • Alice Robertson

          That’s probably true and I am really grateful for your honesty and insight. But the desire remains from both camps…how to weed out those bad apples or those who just need a break. And I know it’s imperfect…it doesn’t work with policeman completely (and may hinder?).

          But it’s definitely a sign that you are a good doctor because of your willingness to answer questions. It’s actually sorta rare here where a segment of doctors only want to truly communicate with their own peers and rant to the patients.

          So many patients come here and leave in a huff…so this is good! Thank you!

          • Tiredoc


            To be honest, I’ve never really understood assigning social status to doctors because we have MD or DO after our names on a business card.

            I agree with Miss Manners. The only reason to be introduced as “doctor” at a social gathering is so the other attendees know who to grab when they’re choking on a carrot.

            Her other observation, that it is our job to take money from sick people, should give every doctor pause who wants to complain about patients. Government, on the other hand, is fair game in my book any day.

          • Alice Robertson

            Yes, but now an NP can do the carrot trick! Ha! Oh no….watch Alice get shunned by the NP crowd, doctors, and patients. Hmm….what’s a girl to do:)

          • Tiredoc

            Heh. I’ll give you a vote for that one.

          • Alice Robertson

            LOL Oh no…the shunning of moi? Ha!

          • Alice Robertson

            You are a prohet! Ha!

          • querywoman

            I saw an article somewhere years ago, and I do wish I had the reference, by a doctor who was staggered at why people believed what he said just because he is a doctor.

          • Tiredoc

            Did you know that MD is a sexually transmitted disease? Our friends ask my wife medical questions all the time, to which she responds, ask my husband, he’s the doctor!

          • querywoman

            Why don’t you turn your wife into an evangelist, the kind who brings in lots of money and buys expensive cars? If she did faith healing, that might conflict with you some.
            My own minister’s wife said she likes to ask her husband why they don’t have a BMW. I suggested the ones who do have evangelist wives. She said she couldn’t cry on cue.
            I’ll have to check out the MD version of VD. Slightly OT, but I always wondered if the LA County Jail did VD screening on Dr. Conrad Murray.

          • Tiredoc

            I don’t know. My wife doesn’t wear that much makeup and I don’t think I have the hair to be a TV preacher. And every time I say “be healed” it doesn’t work. I do have a few patients I wouldn’t mind baptizing before I see them.

            As for the competition, I moved my office recently. I’m now on a block with a pentecostal church in a strip mall, a chiropracter and an acupuncturist. I tell my wife that it’s the only chance she’s going to get to be with the most conventional medical practioner on the block. That is, off course, until I buy snakes.

          • Alice Robertson

            Well I simply can’t resist responding to your witty post. What some guys will do to keep their wives entertained:)

            But when you fail the patients can head up to that preacher:) And sometimes it really does work. My oldest was sent home to die when he was seven years old. An astrocytoma brain tumor was the death sentence years ago. Oddly our Rabbi/Neurologist told me to trust in the “Lord” and I started to go to church (Christian). Anyhoo….we ended up on TV as a documented miracle and the Cleveland Clinic let it be filmed there complete with MRI’s of the tumor and without it. It’s old…it’s on youtube (I am young:)…it’s under “Alex Robertson healing”.

          • querywoman

            Heh! Heh! Your wife has to be an expert in something.
            Surely one can be a wealthy evangelist without excessive cosmetics and big hair.
            When I taught children’s Sunday school with a medical doctor, I would remind the children that he was not at work! But he couldn’t shut up about being a doctor!

          • Tiredoc

            “The purpose of the physician is to amuse the patient while nature heals the disease.”

            Would seem a little much to try to upstage the great healer while in church.

          • Alice Robertson

            Amen! And I think I need to delete my other post on Godwin….this morning was a, ‘Oh no you didn’t” moment!

          • Tiredoc

            Is there a particular reason you decided to forego both cloth and paper diapers and go with plutonium for your children?

            And does your nightly prayer go something like, “Dear Lord, please heal my family and pick someone else to demonstrate your divine grace.”

          • Alice Robertson

            Who me? I I don’t understand why that came up as “Guest”. It happened to Cyndee too. Maybe Guest is my evil British twin? Which one are you talking too? The twin is at the pub….I’m on my knees asking God to please kill that girl! Ha!

          • Alice Robertson

            Wow is that weird. That post isn’t in my Disqus. I wonder how that happens? It was under my name when I posted and in my Disqus…but poof the plutonium police got it:)? Anyhoo…about plutonium and my kids….all joking aside…watching my daughter drink radiation was one of the hardest days of my life…but it was effortless…you listen to Geiger meters that match your heartbeats but nothing recognizes your mother’s heart cry. . And the useless beam radiation that is the gift that keeps on giving. Doctors are the ones that hand out plutonium and mothers believe it will help then it harms. It’s a horrible conundrum.

          • Tiredoc

            I was responding to your deleted post.

            From reading her posts, it appears that Cyndee uses plutonium for its traditional purpose.

          • Alice Robertson

            Okay…sorry! I want to delete my “Guest” Godwin response too and now I can’t because somehow it’s not mine anymore…wonder how that happens (I guess if you threaten to delete you better be bloody well quick….the deletion prevention police are definitely doing their job well:). Hey doc please do a cyber surgical technique on that Guest and euthanize her please:) Otherwise these ghost appearances need to go bugger all!:)

            I hope I didn’t get in the way of the momentum….gosh I need to get off of here but I am listening to Os Guinness on Bill Bennett and it’s a good show and I do email while listening.

          • querywoman

            Gee, Tiredoc, I like you; I really do.
            So here’s a pearl for you:
            A lawyer is a witch doctor whom you pay for retaliation when someone has cast a spell on you,

  • guest

    What is interesting to me is that as a doctor, in medical school they always instill the fear of God into you about Medical Board action if you don’t follow the 3 golden rules. Malpractice companies make you feel that if you don’t give 30 day notice to pts to terminate care that this will lead to Board action. In reality, it sounds like if the Board can’t handle the most threatening cases to society at large, then minor infractions of pt abandonment really go nowhere as far as actions. It explains a lot. On their site I think they define ethical reasons to report but in reality it is a myth.So if you are a surgeon you can go take your 2 month trip to Italy, provide no coverage for pts and decide not to follow standard of care with existing pts really i think without need to worry about repercussions. Sad but true. We hope there would be more ethical concern but when there is not apparently there is just no governing board. I guess the Boards are just false fascades and doctors are paying more in the way of taxes then they are aware of to their state.

    • Alice Robertson

      This was a good post, but oddly when I came here…um…maybe three years ago as mad as hell at a doctor who harmed my child the few doctors who contacted me privately (one even phoned me and I met his family when we went on vacation and spent two days with them) said to tell the state board about it. I never did….what I wanted….and I mean desperately wanted was an apology and requested that (so even when my daughter turned 19 years and we gave up our rights to sue the doctor he still refused….and I am still unclear why I was so heartbroken for so long that he didn’t care enough to just say he was sorry he let her cancer spread).

      Oddly all the other doctors I see apologize for him….it speaks well of them…but, honestly, somehow my heart needed to hear it from him. I have given up and got over myself…and am glad I didn’t pursue actions against. But…it’s omg difficult when your child is harmed from negligence that could easily have been prevented.

      • Suzi Q 38

        I understand why you would want an apology.

        My doctor did not give me an apology either, because I knew that he was taught not to. He had called me because he realized that he had screwed up and allowed my condition to worsen. He knew I needed cervical surgery ASAP. I could hear a resignation in his voice, and he was very tired. He was worried, finally. I think it was because he knew he got caught. He also knew that the longer I waited for my surgery, the worse I would or could get, and if I were paralyzed, there definitely could be a lawsuit. He was actually contrite, but he still would not directly apologize.
        He did allow me to yell at him for about 2 hours without hanging up on me. He called me. As you could imagine it is not easy to listen to someone like me complain.

        Your doctor is probably weak. Keep in mind that his colleagues all know. He is probably embarrassed and has no conscience. He is a jerk. Jerks can not be changed into caring people. Karma will be returned to them in some way. Someday, he or his family will need medical care. Maybe he will get some of the same.

        • guest

          very sorry to hear what you have been through. How are you feeling at this point? I know nerves are slow at regenerating.
          I have a surgeon who I had to call the Presidents office of the university to give me a follow up treatment plan. He acted stupid like he did not get my messages. Even to this day, it changed his attitude toward me but he seems to not grasp what i am telling him until I almost have to hit him over the head repeatedly to get a response. Most frustrating as I am out of state and he was the guy that did this somewhat procedure the most.

          • Suzi Q 38

            Thank you.

            I am feeling better. The recent MRI of my c-spine area was still horrible, despite my cervical surgery in January. I called my family friend who is a neurosurgeon in Northern California. He told me that I just have to go by how I feel everyday.

            During the daytime, I feel better. My pain is managed without narcotics, just Tylenol and Advil.
            I need a sleeping aid (melatonin) at night because of night pain.

            My walking is affected. My legs are weak and barely weight bearing, but getting stronger.
            I have to walk slowly and deliberately. I get tired if I stand or sit too long. My hands and feet are “tingling” 24/7. I am very tentative and stiff if I try to stand up.

            I cannot dance or run. My urinary and bowel systems are affected.

            The new teaching hospital neurosurgeons only said they would try to halt to progression of the neuropathies and paralysis. IMHO, I am slowly improving and getting stronger.

            Walking better is one of my goals. I went to PT about 4 times in the last month, and will use those lessons at the gym to improve my walking ability.

            Since I have realized that complaining may be futile, I may have to agree and just write about my experience. The purpose is to warn others about how little some physicians regard their patients. This is why the doctor bashing continues. If physicians want it to stop, shun the “bad apples,” report them to your bosses, and protect unsuspecting patients.

            We are “sitting ducks,” and we truly have no idea.

          • Alice Robertson

            I am so glad you are feeling better. You lend a nice voice for patients.

          • Suzi Q 38

            Thanks Alice, so do you.

      • guest

        I can understand why you would need to hear it from him and why that would be important. It seems so very simple. But i wonder if he felt that if he said he was sorry that it would acknowledge he made a mistake. ( which from your description sounds obvious to others). So it’s more important for him to keep his own version in his head of the reality so he can come out looking good. I may be wrong since I don’t know all the details but just what came to mind when i read that. Anyway I know it does not count so much since you need to hear it from him. But I am really sorry. That is devastating-with or without an apology! How is your daughter doing if i may ask? So sad to hear that.

        • Alice Robertson

          Thank you so much for asking. My daughter’s name is Brittany Faith and the doctor didn’t read the lab notes that had the warning that the slide had arrived too dry to be read. He sent me home and said, ‘Great News! No malignancies!” And I foolishly believed him. We went back six months later and without another biopsy he sent us home for a year. I had a terrible feeling and found a research doctor who showed me what the lab said and refused a diagnosis without another biopsy. It was cancer…the delay in treatment meant it had a new spread throughout her lymphs. Now more swollen lymphs the ENT said he knew to take them but knew if he did she will not be playing volleyball again because the spinal accessory nerve needs cut this time (she had a volleyball scholarship at college). We go back to the Endo on Sept. 24 for the usual ultrasound/biopsy so we will know more then. When she showed me the swollen lypmhs on the back of her neck my legs went weak and I became nauseated. Flickers of anger towards the doctor who was negligent flashed across my mind as my heart wept. At an appointment with our Endo/Director he said to me that he knows I have been told that thyroid cancer is the one to have…but I have been lied to (because we aren’t in the easily curable category). Do you know I thought I couldn’t breath as a mental ticker tape of doctor’s saying just that to me ran through my head. I asked the Endo had I offended him somehow…he seemed surprised and said no….I asked if an email had been offensive….again No…he had waited for the last response but I had not responded therefore it was not offensuve…it was reality. The resident, the doctor, my daughter and I get up to walk through the sterile white walls to the biopsy room and it’s that awkward silence on display. My daughter mutters out that her mom is crazy in a effort to make everyone laugh. Her Endo holds out his arm to stop the resident from walking and turns to my daughter and firmly says, “No! She is exceptional!” How kind was that? And why the first ENT has steadfastedly refused to take the olive branch I held out is beyond me. His Chair sided with him in the Peer Review saying our daughter’s age set them off course so not looking closely at the lab report was status quo for someone who is only sixteen. That, too, felt unacceptable. The Ombudsman in charge cited him but it’s just an internal hand slap, not the apology we desired. We are not sure why our complaint and many others against this particular doctor have been squashed. But an apology would have helped me know he cared but messed up. The truth is he gave his password to an MA and she would look at the computer and read him what he needed on his way into the office. Like a short order cook gets their orders. With long lasting, irreversible cancer spread that could have been prevented.

          • Cyndee Malowitz

            The only thing I can think to say is O.M.G.!

          • Suzi Q 38

            I am so sorry. I can’t believe all of this happened to your daughter, you and your family.

            I can only hope that she improves and lives a long and happy life. Thank goodness you are her advocate.

            The doctor should be fired.

  • Skeptical Scalpel

    More good comments today. Thank you, everyone. The medical boards of most states are similar to the one in Texas. They are incapable of policing the profession. They are underfunded, understaffed and depend upon volunteer physicians in practice to investigate their peers. It’s slow and inefficient. No wonder it doesn’t work.

    • karen3

      So, how do you suggest we improve regulation of doctors? If the boards don’t work, all that leaves is lawsuits.

      • Skeptical Scalpel

        Lawsuits take to long. Why don’t we just make the medical boards stronger. Step 1-Fund them with the money doctors pay for licensing. I’d say another $29 million would beef up the Texas Medical Board a lot. Step 2-Pay doctors who review the performance of other doctors a decent fee for their time.

        • EmilyAnon

          Isn’t there a fear that the doctor being investigated could file a lawsuit for defamation and slander. Maybe tort reform for clinicians would be appropriate in this situation.

          And as far as medical boards doing what they were hired to do… in California, all medical board members are appointed by the governer. Cronyism and scandals are not uncommon.

          http://tinyurl DOT com/lr68zua

          • guest

            I am not sure but I did not think that a doctor or pt can sue the Board. The whole idea I thought is they are like the supreme court. Does anyone know? I have never heard of anyone suing them and I think if they were it would be on the news at some point.

          • EmilyAnon

            Guest, I should have been more clear. I was referring to the accused doc suing the whistleblower or witness doc. There were a couple of doctors here stating that this was a real threat.

          • guest

            Oh never thought about that. THat’s ridiculous. Seems like anyone should be able to whistleblow technically without fearing doing that to the Board. Sounds like the Board is a toothless watch dog from what their saying anyway. Thanks for clarifying that.

          • Cyndee Malowitz

            The pain management physician I reported to the Texas Medical Board filed a lawsuit against them for “harassing” him.

            The TMB filed a formal complaint against him for “intimidation of a witness” for filing the SLAPP suit against me.

          • guest

            Sorry that happened to you. Can you report anonymously in Texas? Wonder if that would help.
            What kind of complaint was made?
            they should outlaw SLAPP suits. sounds like he was a pain in more than one way.

        • Guest

          It would be ideal if there was a privately run organization like JCAHO that hospitals and the public could depend on to handle complaints about practitioners. The medical board can handle licensing and bureaucratic BS that has no urgency. Outsource the handling of complaints. Make information about practitioners (ALL practitioners) available online in one centralized place. Promote transparency about this. It’s a start.

          • Skeptical Scalpel

            I don’t see that ever happening. The states will not give up their right to license doctors. Each state has different requirements for licensing. As it is now, a doctor who loses his license in one state does not lose it for any other state. The solution to all of this is not simple.

          • karen3

            If the federal government takes it away, the states will have no choice. But leaves us with Medicare, which is also a rats nest.

          • Skeptical Scalpel

            It will never happen.

          • querywoman

            Almost all licenses are state: cosmetologists, electricians, plumbers, etc.
            Are their federally licensed pilots? I guess we have federally licensed cops.

          • Skeptical Scalpel

            I believe the FAA licenses pilots.

          • karen3

            JCAHO is more corrupt than the medical boards.

        • Tiredoc

          Why don’t we mandate that every surgery be videotaped in such a way as to make the surgeon and OR unidentifiable. Then we’d mandate that every equivalently licensed surgeon had to review and grade 20 videotapes per year in lieu of a license fee. The surgeries would be selected randomly and the grading would be performed by physicians outside of the practice area of the physician. Automatically require the bottom 1% do an mandatory year of 100% supervision of their surgeries. Since it’s non-adversarial, it would be cheap and effective.

          I can’t say what to do about the non-surgical side. I think you’re stuck with the drunks and skunks model for getting rid of bad MDs.

  • buzzkillerjsmith

    This was Kaiser in the Bay Area, and I will say in my defense that I wrote “had” not “has” since I left that life-sicking hellhole of a practice long ago.

    Still ,n, –an impressive smackdown on the Buzz. My tail is between my legs. And now I’m very interested in getting a job at Portland Kaiser so as to be able to continue my incompetent yet enjoyable practice style.

    • ninguem

      Are you sure this work will be in competent hands?

      Soitenly, we’re all incompetent

      ………..Slippery Silks (1936)

      • buzzkillerjsmith

        Say, they still lookin’ for docs down under?

        No rules, as Walter stated about “Nam in the Big Lebowski.

        • ninguem

          To my knowledge, they still are.

          I’ve got mortgages and all that, so I can’t look.

          The docs I know who have, for the most part have liked it.

          I’d have strongly considered Australian practice in younger days, but licensure was a real problem for Americas in the day. They say it’s easier now.

          Give it a look, both Australia and New Zealand.

    • ninguem

      You see, Patel was finally dealt with, at Kaiser in Oregon, so he left to practice in Queensland, Australia.

      Oh, and if you follow the Patel case out to Australia, you can see what’s even worse than the “doctors policing themselves”. That’s when the Queensland Ministry of Health, responsible for the healthcare budget in their healthcare system, decided that they would overlook the dangerous doctor from Oregon, let him continue bad practice, as it saved the Government money.

      The physicians were mostly foreign nationals. The Ministry could use the power of GOVERNMENT to silence the physicians by linking their job with their visa. Any whistleblower physician would be fired and DEPORTED.

      Oh, and when the nurses complained, they were sat down and advised by Government attorneys that they would be prosecuted AND JAILED if they spoke out.

      The government there, not only knew of the doctor’s dangerous practice, they used the power of government to force the silence of those who would speak out, doctors and lawyers.

      Again, all this……in both countries… in the public domain.

      • CredQueen

        Tragically, I know a general surgeon who lost his license in Pennsylvania, and is now practicing in Afganistan. I guess the really bad ones just move on to do their deeds.

  • karen3

    Skeptical, the constitutional due process threshold for disciplining a doctor is very low. Constitutional due process requires an evidentiary burden that is even less than a lawsuit — less than preponderance of the evidence.

    The laws can most certainly be rewritten to make it easier for the boards. And I bet if the doctors lobbied for it, it would happen.

    • karen3

      the other thing that could be done is to track problem doctors across jurisdictions, publish the National Practitioner database information, require a track record of sobriety/lack of impairment as a condition of regaining licensure rather than allowing impaired practitioners to be on “probation,” and to go after licenses for those who cover up for impairment, Adding proof of restitution/compensation/as a condition of regaining one’s license would also be useful I have had a professional license and security clearance and those have been key components on keeping things clean. As well is making sure that there are enough resources on oversight.

  • Payne Hertz

    All this article does is highlight the failure of allowing doctors to police themselves. The malpractice system was not set up to police or discipline doctors. It was set up to compensate patients for acts of negligence. The malpractice system has no means of disciplining a doctor in and of itself.

    Medical boards throughout the country are notoriously lax in disciplining and removing bad doctors. When you allow an industry to police itself, this should not be surprising. We can see the same thing with the police in many jurisdictions that allow police departments to investigate and discipline themselves. A study of the Chicago Police Dept showed that out of 10,000 accusations of police brutality, only 19 resulted in meaningful disciplinary action. We see the results of lax oversight in the finance industry.

    Contrast this with the airline industry, which is closely monitored by government agencies throughout the world and has an amazing safety record. Accountability works.

    The medical profession has failed to police itself. There is a culture of cover up where doctors protect each other from accountability and complaints are ignored. Some type of government oversight of this industry with the power to investigate and discipline bad doctors is long overdue. It is the “Iron Rule of Responsibility,” which holds that those who fail to regulate themselves will be regulated by others.

    • guest

      great post. THis is news to me after paying the exorbitant Board fees, I thought that money was going to an independent government agency to do its job. The fact that a physician wrote this piece and it is attracting a lot of physicians to respond to feel there needs to be more policing of its own speaks to how incredibly corrupt this is. Don’t know any other word for it.

    • Suzi Q 38

      You are so right.

      Have you ever heard of all the corruption in the New Orleans police department a few years back? Chilling.
      I hope that they have “cleaned up” their police department.

      They need a separate independent group of medical professionals.

    • Michael Rack

      Medical Boards are not doctors policing themselves. Many medical boards have non-physician representatives. In addition, the doctors (and others) on the boards are typically appointed by the state governor/legislator and are not chosen by docs. If I am ever brought before the MS state medical board, I would consider myself to be judged by a government agency (although one I have high respect for), not by my peers. I don’t have a solution for the many valid complaints presented here other than this: don’t blame doctors in general. IF you, the general public, don’t feel that your state medical board is doing a good job, contact your state representative and lobby for reform of this government agency/board.

    • querywoman

      Over a period of time when I was preteen, my parents made completed complaints about some horrible adolescent neighbors and their parents. They went down to the police department once and saw that only one or two complaints had actually been registered.

  • Cyndee Malowitz

    The reason so many of these physicians get away with murder is because other physicians are afraid to either report them or testify against them. Why? Because of fear of retaliation – either professionally, physically or legally.

    • Suzi Q 38

      I would have to agree with you.
      Can you write a series of anonymous reviews on medical sites on the internet?

      • Alice Robertson

        I think it’s more than that though, but you are right about part of it. A type of Medical Mafia exists and it goes way beyond the state boards. My one doctor friend just got a call a few months ago from the DEA. Now he is terrified to even script Vicodin. He is fearful his medical license will be taken because his old colleague is under investigation. So who ultimately gets hurt? A lot of patients and a few doctors. Yet, I do really think guilty docs get off but there needs to be some patient liability. Our friend’s wife was found at age 55 years old dead on the couch. He tried to sue even though that gal had FOUR Fentanyl patches on her and her 25 year old son was found dead in the basement two years earlier with his mother’s chewed up Fentanyl patches near. Surely patient’s families suing because they can’t deal with the fact that their own family member misused scripts is hurting everyone. In Ohio being a chronic pain patient like I am is really hard because you suffer. Why? Because of irresponsible patients and their families suing. That doesn’t make doctors immune though…you are right there’s plenty of blame to go around. I hope someday we can find a happy medium because at least around here malpractice lawyers are packing up shop, so when doctors come here and complain wildly in my area risk management at Cleveland Clinic is pretty scary (I believe they messed with my daughter’s file because I have an email from my doctor who quit saying the notes that were under his name had “no business being there” and his Chair disregarded his written plea to remove them. It’s a messy business.

        • Suzi Q 38

          There are no hard and fast, easy answers.
          Every case has to be given time and careful consideration before action is decided upon and taken.

      • Cyndee Malowitz

        Nothing is anonymous on the internet.

    • Guest

      Correct, Cyndee. I’d add too added hassles and scrutiny from the hospital board and administration. Whistleblowers are NOT rewarded.

      • Suzi Q 38

        They should be.

    • querywoman

      My daddy always said doctors bury their mistakes.

  • Tara Candela

    I think you can rename your article, “Doctors and hospitals are a big impediment to disciplining bad doctors.” …. You mention the legislation, but legislators – as everyone knows – are influenced by others in a variety of ways. If it was made easy to take away or suspend a doctor’s license, there would be a revolt – from the doctors. Here there was a problem with the medical review board (doctors), and within the hospital credentialing system potentially, and again when a hospital reported there were no problems with this particular doctor. Arguably, other doctors worked with him and remained silent too. All problems. This problem isn’t from one thing alone. Certainly not the lawyers.

    As an aside (and I’d have to dig up the source), it has been said that a small number of doctors are responsible for a large portion of malpractice claims. If this is true, and if they are known, surely there is something that can be done to stop their practice. But it’s up to the doctors to suggest measures that work to the legislators. If you want to fix the problem, come up with a solution that you really think would work, investigate it from all angles, and get to work.

  • Cyndee Malowitz

    I suspect the TMB had been investigating that doctor for years before they finally pulled the plug. As long as physicians have the money to fight the regulatory boards, their lawyers can delay the disciplinary process for years. None of that is made public…it’s all confidential.

    BTW – Texas is well known as the place to practice for physicians who’ve lost their license in other states. You should Google “Stefan Konasiewicz, M.D.” I wonder if he went through the same residency program as Dr. Duntsch?

  • Cyndee Malowitz

    I suspect the TMB had been investigating that physician for years before they finally pulled the plug. A physician with a lot of cash can get disciplinary action postponed for years, leaving dead and maimed patients in their wake. Of course the public wouldn’t be aware of this, since everything is confidential.

    Google “Dr. Stefan Konasiewicz” for another example of incompetence – maybe he attended the same residency program as Dr. Duntsch?

  • Cyndee Malowitz

    I suspect the TMB had been investigating that physician for years before they finally pulled the plug. A physician with a lot of cash can get disciplinary action postponed for years, leaving dead and maimed patients in their wake. Of course the public wouldn’t be aware of this, since everything is confidential.

    • karen3

      And in many states, the reason for the unnecessary rules that hamstring the board and give bad doctors leverage is the medical lobby.

  • meyati

    I knew there was a good reason not to go to Texas and let them cut the right side of my face off, including the bone. We don’t have such problems, only doctors that poison you or inject glass into the spine for slipped discs. I told a doctor once that if I didn’t have hypothyroid, I wouldn’t go to a doctor. I really distrust doctors and their administrators.

  • hilly leopold

    Have you ever tried finding a good lawyer who will go after a bad lawyer, pursuant to mistakes, And abandonment, that have costs and implications of seven figures. I have and it’s impossible. These are mistakes in and around someone’s medical and physical damages that have been deemed catastrophic. I have, if they exist they certainly don’t advertise. Lawyers are not doctors nor should they be allowed to create a conflict of interest , where settlement becomes a choice between dollars with percentages attached to them versus medical help, medication and ongoing treatment but unfortunately no percentage in this scenario for the lawyer’s pocketbook. help!

    • Alice Robertson

      You know our libraries have databases beyond what we can get free online. They pay the subscriber rates so you can gain access. You can browse from home. But if you go in there are some very good free legal services. Each state is different and some states have quite large small claims court amounts. But it’s tricky because if you lose a civil suit in some states you could owe the defendent’s legal fees. It’s not always the lawyers or doctor’s fault, but from where I am sitting doctor’s simply aren’t getting sued the way they claim (but they should be fearful). I think a bigger fear is the government taking them to court or losing their license for all sorts of problems (like dealing with online pharmacies, etc.).

      Anyhoo… may want to get counsel in your state via some very good help at the library with lists (our library has a couple of retired lawyers who will chat away for free). I was surprised recently when an airlines owed us $4000 refund on a first-class overseas fare mess up and no way would United cough it up. I wrote everywhere from Consumer Reports to my retired CEO friend from Continental who said I would never see that refund but to bug the CEO to death (even Chris Elliott the travel writer tried and said he gave up with that particular airlines and he plans on writing about it) and finally filed in their main city with the Better Business Bureau. They aren’t even members of the BBB. I had a refund within two weeks (and this was after months of begging them with calls and letters, and a charge card dispute personnel involved, etc.). It just took being a persistent bugger. So for any companies involved you may have to become a very good letter writer and don’t give up.

      And when all else fails mention names online so others don’t get harmed. I decided that’s more freeing than money.

    • querywoman

      It’s supposed to be easier to discipline lawyers than doctors.

  • ninguem

    Skeptical, you seem to want to give the Boards absolute power.

    You know what Lord Acton said about that.

    And the system can be very corrupt.

    This series was from a decade ago.

    Doctors can….and DO…..get railroaded.

  • Tiredoc

    Every OR is equipped with lights that are directed on the field. Cameras would be an tiny addition to the cost of the lights. You could store all of the videos for minimal cost in comparison to the cost of a normal investigation. The videos could be added to any EMR. There is no logistical or economic reason not to do it.

    The reason it isn’t done is that no surgeon in their right mind wants to be videotaped every time they do surgery, because if there’s a bad outcome the surgeon will have to explain every quiver of their pinkie on live TV to a jury.

    • EmilyAnon

      “no surgeon in their right mind wants to be videotaped every time they do surgery, because if there’s a bad outcome …”

      I’m sure Dr. Duntsch would have prescribed to that philosophy too. But wouldn’t you agree that a video of his operations might have served a purpose, like exposing what a dangerous surgeon he was right from the beginning and maybe preventing many harmed or dead patients.

      And another curious thing, there are hundreds of complete operations on youtube. I wonder why those surgeons weren’t afraid of being taped.

      • Tiredoc

        With the right editor, Dr. Duntsch probably looked like a genius. A little CGI and he’d look like a god. Big difference between one selected video and all operations. I’m not a surgeon, just wanted to make a suggestion to wad Skeptical Scapel’s drawers a bit.

  • querywoman

    Dallas Medical Center used to be Brookhaven Medical Center. Could you doctors and other health care people on this blog explain what you know about management changes at hospitals?
    Brookhaven was infamous in the days of the psychiatric scandal in Texas, locking up people in the nut ward for no reason but to get their mental health insurance. I’m sure they got a few criminal charges.

    • Cyndee Malowitz

      Querywoman – that’s quite disturbing, isn’t it? In reality, it probably happens all the time.

      I believe in karma…in the end we’re all going to get what we deserve.

      • querywoman

        Now the mental institutions seldom keep anyone long como child killer mom, Andrea Yates.
        Do you remember the Psychiatric Institutes of America scandal? They were big in North Texas. I’m not sure Brookhaven was part of it.

        It broke wild and climaxed in the early 1990s. A lot of mental institutions were imprisoning people against their will. It was so bad that teenagers, who were often victims, who knew their care was costly and coming out of their parents’ insurance, would do damage inside mental institutions that would be deducted as charges and make the insurance run out sooner. Then they’d get out.
        A couple of psychiatrists did stuff like travel the world while billing for their services, meaning seeing patients. The defense was the patients were still getting care.
        That did not fit anyone else’s definition of work.
        I think two psychiatrists actually pled guilty, knowing full well they would serve 15 years in the federal pen. Wonder if they are out now?

  • querywoman

    I was reviewing another Texas case since Cyndee Malowitz’s ongoing conflict with a Texas pain doctor comes up. It appears he sued her in 2008 for something like “stalking.” And that his allegations were found baseless. He’s been in trouble with the TX Med Board for trying to silence her, and there’s an ongoing investigation into his practice.
    Read about Dr. Rolando Arafiles in the Texas Observer online. Apparently, he came to Texas after having been in trouble in New York. In 2009, a couple of nurses ratted on him to the Texas Medical Board. He did retaliated somehow. In 2011 he surrendered his Texas medical license, and the nurses have been cleared.
    Retaliation against whistle blowers is bad medicine for doctors.

  • querywoman

    As a Texan and, sadly, a professional patient, I read all the disciplinary reports my medical board has as they come out. Some docs get disciplined for substance abuse. Some get diddly fines, like about $500, for not following some administrative rule. A few get in trouble over patient care, and I’m sure there are just a very few of those. Some get in trouble for overprescribing narcotics. I know of two male doctors who got in trouble for exposing themselves, well, it surely was the private part! There seems to be a disproportionately high share of women doctors who get disciplined.
    I always say patients need a real complaint system that works without court action. That should be the Medical Boards, but it’s not.
    Texas is a big state, and sh!t happens. California is big too, with its loony docs, like Dr. Conrad Murray, whom California and Texas once shared. Then there’s Dr. Michael Kamrava, Dr. Paul Fleiss, and Dr. Arnie Klein. Poor Dr. Klein! I think he at least once was an excellent doctor! Now Arnie has squandered his fortune and doesn’t understand why California wants him to go to a nut cracker.
    In Texas, we had murderous nurse, Geneene Jones. Back then, a lot of hospitals destroyed medical records of children she probably killed, so no one knows how many kids got her lethal cocktails. Should we fine hospitals for disappearing records? Is it harder to do these days with the EMR’s?
    The coverup of the bad docs, like the Catholic church did with its pedophile priests, is what’s is so unconscionable in the medical world.

  • disqus_OSH3u3yWoj

    One of the members on my state’s medical board is a medical malpractice defense attorney appointed by the Governor. There’s no doubt that most state’s medical boards will protect doctors over patients. In California, the attorney general’s office may assume responsibilities of investigating complaints and have the medical board merely collect licensing fees..

  • querywoman

    I read stuff on you online in the Corpus Christi media. Somebody said you pumped her for details in your office about him!
    So what? Even if you did, I think you are an outspoken person, like me, a person who likes to mouth off about what we perceive as injustice.
    Yeah, your daughter found out her mama meant business in high school.
    Your doctor-nemesis is a coward, and so is his wife.

  • Richard Willner

    Without knowing the specific facts, I just do not believe this article. This does not pass the “smell test”. I have 13 years as a consultant to surgeons.

    Richard Willner
    The Center For Peer Review Justice
    “Doctors are our Patients”
    http://www.PeerReview (dot) org

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