Anatomy of a Tragedy

[thepoopologist]

http://www.texasobserver.org/anatomy-tragedy/
http://dfw.cbslocal.com/2013/07/22/plano-doctor-suspended-after-two-patient-deaths/


How does someone who is supposedly this bad get through a neurosurgery residency? The way they describe him, which I'm assuming is not the whole truth, he does nothing right. You'd think this would get noticed early on in residency.

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[thepoopologist]

http://www.youtube.com/watch?feature=player_detailpage&v=C542mx2aRJ4#t=56

He's the first doc profiled.

 

[JediZero]

Goodness. This is absolutely terrifying.

I mean, seriously, I've got a month of holding retractors for a general surgeon under my belt, and I could probably do a better job than he did. Either he managed to get through residency and fellowship while being truly and bizarrely incompetent (unlikely) or he was drunk/stoned/dropping acid in the OR and nobody noticed.

The medical education system usually filters these guys out before they make it through undergrad. If he was the uber-narcissist the article makes him out to be, then fine, maybe he charmed his way into residency. But how in the hell did anyone let him do a damn thing in surgery without realizing that he had zero technical skill? As the article suggests, it's got to be drugs.

To the broader point of the article, this is an extreme case, and a medical board is not designed to handle an extreme case. It's like if a drug company faked the Phase I trials for a new medication, ignoring that it invariably caused pancreatic cancer in 20 years. Post-market surveillance wouldn't be equipped to catch that, because that's what Phase I is supposed to do. In this case, med school/residency should have caught this guy and sent his ass to law school or something.

 

[Winged Scapula]

That is horrifying. Drug impairment and/or a psychological disorder seem most likely.

Here's the board action.View attachment Duntsch.pdf

 

[Paddington]

The article is BS though, because its an attack on tort reform. They are purposefully confusing the issues of malpractice lawsuits and regulatory oversight which are different things.

Big lawsuits wouldn't have changed the outcome in the story.

Also completely contrary to the assertions of the article, Texas is a relatively tough state to get licensed in.

As to how this guy passed through residency, it's probably a failure of American medical education especially with regards to hands on procedural training. Very few residents fail out because their procedural skills are bad.

 

[BrakngLyv]

The article is BS though, because its an attack on tort reform. They are purposefully confusing the issues of malpractice lawsuits and regulatory oversight which are different things.

I have to disagree with this part of your assessment. While the writer does detail some of the recent changes in tort reform, that is hardly the focus of the story. His contention is that the Texas Medical Board is now the primary enforcer of physician behavior given tort reform.

My guess, is the writer pitched the story like this: 'The Texas Medical Board is a weak enforcement agency, filled with bureaucratic red tape, and here's an egregious example...'

Whether you agree or not with that premise, I think the focus of this piece is the TMB and how it handles physician complaints.

 

[JediZero]

The article is BS though, because its an attack on tort reform. They are purposefully confusing the issues of malpractice lawsuits and regulatory oversight which are different things.

Big lawsuits wouldn't have changed the outcome in the story.

Also completely contrary to the assertions of the article, Texas is a relatively tough state to get licensed in.

As to how this guy passed through residency, it's probably a failure of American medical education especially with regards to hands on procedural training. Very few residents fail out because their procedural skills are bad.

Agreed, they're definitely conflating the two, though I didn't think the tort reform was a huge part of their thesis aside from attracting more doctors to the state. Still, hooray for buzzwords...

And really? I would assume that would be the primary basis of both official (boards) and unofficial (attendings letting you participate/perform surgeries) evaluation in a surgical specialty...

 

[Paddington]

I have to disagree with this part of your assessment. While the writer does detail some of the recent changes in tort reform, that is hardly the focus of the story. His contention is that the Texas Medical Board is now the primary enforcer of physician behavior given tort reform.

My guess, is the writer pitched the story like this: 'The Texas Medical Board is a weak enforcement agency, filled with bureaucratic red tape, and here's an egregious example...'

Whether you agree or not with that premise, I think the focus of this piece is the TMB and how it handles physician complaints.

The article doesn't prove jack ****. Patient complaints alone cannot be used as a basis to seize licenses from practicing attendings. Complications happen in high risk fields like spine surgery. For his egregious failures this guy could have had hundreds of successful surgeries and satisfied patients to vouch for him. Only when there was a definite pattern established were they able to stop him. The example of one or even a few bad physicians is not evidence enough to cast doubt on a state's regulatory framework as this article is trying to do.

 

[Doctor Bagel]

He's also a pretty bad poet ...

https://twitter.com/duntsch

 

[Perrotfish]

The article doesn't prove jack ****. Patient complaints alone cannot be used as a basis to seize licenses from practicing attendings. Complications happen in high risk fields like spine surgery. For his egregious failures this guy could have had hundreds of successful surgeries and satisfied patients to vouch for him. Only when there was a definite pattern established were they able to stop him. The example of one or even a few bad physicians is not evidence enough to cast doubt on a state's regulatory framework as this article is trying to do.

He is a member of an extremely profitable, in demand specialty who was fired by two hospital systems. The fact that he was allowed to practice for a significant amount of time after being fired from the second hospital system is pretty good proof that the state is picking up on these patterns WAY later than they should. Two separate hospital systems were capable of establishing a pattern of complications in much less time.

 

[Arcan57]

He is a member of an extremely profitable, in demand specialty who was fired by two hospital systems. The fact that he was allowed to practice for a significant amount of time after being fired from the second hospital system is pretty good proof that the state is picking up on these patterns WAY later than they should. Two separate hospital systems were capable of establishing a pattern of complications in much less time.

It goes down like this. Bad doc has a serious safety event which is recognized by the hospital/hospital system. Peer review grades the case and determines what if anything needs to be done about these event. Minor variations lead to letters, more serious variations lead to being put on increased oversight including having past cases audited and being put on real-time auditing of cases going forward. In aggregious cases (usually involving drug/alcohol impairment or felony convictions), doc may have their privileges temporarily suspended.

If a pattern develops despite these interventions, the physician is typically offered the option of resigning their privileges. This is not board reportable and is typically offered because it minimizes risk of litigation against the hospital. Depending on the doc's degree of insight into what's going on, this is the typical route that's taken. Hospitals are not required to disclose any of the findings of the peer review process and often will not share information with other systems due to concerns about loss of opportunity lawsuits. So if a doc is smart enough to bail at that stage, nobody is going to know about it.

If the doc chooses to protest the allegations, then an investigation is convened. Unless the doc is exonerated, whatever happens next (including resigning under investigation) is reportable to the board.

 

[neusu]

Complications happen in high risk fields like spine surgery. For his egregious failures this guy could have had hundreds of successful surgeries and satisfied patients to vouch for him.

The surgeries described are junior resident level cases.

 

[Winged Scapula]

The article doesn't prove jack ****. Patient complaints alone cannot be used as a basis to seize licenses from practicing attendings

Agreed. Patients often complain about expected complications rather than true malpractice. However, in this case it was other surgeons who formed the basis of the complaints. Surgeons who had assisted in these cases for years and knew how the cases were done and Neurosurgeons seen in an effort to repair the damage. This is much more damning and is perfectly reasonable as a basis for action against a license.

Complications happen in high risk fields like spine surgery. For his egregious failures this guy could have had hundreds of successful surgeries and satisfied patients to vouch for him.

He could have but he was only in practice for less than 2 years when his license was suspended. Thus, there was no "hundreds of successful surgeries". As neusu notes, these were junior resident level cases. Hell, I'm not a neurosurgeon and can tell you that if I'd severed a vertebral artery in a case, that I'd be awfully damn sure that it didn't happen again, at least not within a few months.

Given the ability of practitioners to "hide" such problems from other health systems, it makes one wonder if a centralized credentialing process might not be such a bad idea if it were to allow for transparency in disciplinary actions.

 

[Perrotfish]

Given the ability of practitioners to "hide" such problems from other health systems, it makes one wonder if a centralized credentialing process might not be such a bad idea if it were to allow for transparency in disciplinary actions.

On the training side of things, I wonder if the procedural specialties need some kind of formal aptitude testing for manual dexterity. Its amazing, considering the battery of useless tests that they put us through, that there's never a single test of hand eye coordination.

 

[DrBowtie]

On the training side of things, I wonder if the procedural specialties need some kind of formal aptitude testing for manual dexterity. Its amazing, considering the battery of useless tests that they put us through, that there's never a single test of hand eye coordination.

That test for him is supposed to be 7 years of neurosurgery residency.

 

[Winged Scapula]

That test for him is supposed to be 7 years of neurosurgery residency.

Exactly. It's rare to find someone who has so little skill and coordination that they cannot be trained to at least be at least an average surgeon during residency.

That's why my money is on him being impaired by substance abuse rather than it being an issue with his training.

 

[K31]

That's why my money is on him being impaired by substance abuse rather than it being an issue with his training.

The TMB apparently agrees with you. See point 8 of the findings in the board action--"Respondent is additionally unable to safely practice medicine with reasonable skill and safety due to impairment from drugs or alcohol."

 

[SouthernSurgeon]

On the training side of things, I wonder if the procedural specialties need some kind of formal aptitude testing for manual dexterity. Its amazing, considering the battery of useless tests that they put us through, that there's never a single test of hand eye coordination.

If you look at the surgical education literature, this is the pot of gold at the end of the rainbow most educators are chasing.

There are about a million studies out there about various directly observed metrics, simulator curricula, etc.

Unfortunately most of them are either ridiculously simplistic and unrealistic (most simulator curricula), or excessively cumbersome to initiate (most directly observed metrics), and research has not demonstrated that they translate universally into practice.

Then when you throw in the fact that most surgical educators aren't rigorous researchers and can't put together a robust study (mostly single center pilot programs, or ridiculously underpowered retrospective studies)...

 

[pgg]

The article is BS though, because its an attack on tort reform.

Yeah, the author definitely has a political agenda, or at least a bias. He reports that a Republican-dominated legislature capped damages for pain and suffering at $250K, but that little is left after paying for lawyers, implying that ALL damages are capped at $250K, which isn't true. California's Democrat-dominated legislature has also capped non-economic (ie, pain & suffering) damages at $250K.

Economic / compensatory damages are something else entirely, and this specific case seems absolutely ripe for some punitive damages too.


Locally, we had an orthopod move in and set up a practice, after fleeing a string of malpractice suits and "voluntarily resigned" hospital priviliges in another state. He carved his way through a year's worth of shoddy total joint replacements before getting shown the door here. Last I heard he was working for another orthopod, doing mostly clinic and some surgical assist work, PA-style. We all knew he sucked, we all made it known to the hospital admin, but their hands were tied for a long time.

Then you get into specialties that are more locums-friendly, like EM and anesthesia, and a hard problem gets nearly impossible. I've seen some frightening people blow through town on 2-week agency arranged vacation coverage stints.

 

[NotAProgDirector]

This is a problem in medicine, and one we should solve. We need a way to get dangerous docs out of practice (or supervised). Problem is, this type of thing has been abused in the past -- simply google "sham peer review" and read all about it. Seems like we need to empower the BoM to review physicians who are reported by other physicians before really bad outcomes occur, and once started these reviews should not be stopped by the physician resigning their license (or, if so, their status should be "resigned under investigation").

 

[Margo]

http://www.linkedin.com/pub/christopher-md-phd-fmis-neurosurgeon/b/1b7/40

Anyone care to think why would someone so accomplished come to a total disaster? There is no question what happened to his patients is truly a tragedy: some people lost lives, others are left debilitated. Yes, an easy solution is to prohibit Dr. Duntsch from practicing ever again, and to forget about it. Sign him off as "irresponsible doctor." Very convenient. Just a few years out of residency (2009), his clinical career is now over. Do you ever stop to think about this and what it means for a person who has gone through years and years of training?

Everyone is eager to examine outcomes (in this case, repeated cases of malpractice), but no one is willing to analyze the CAUSE. What no one seems to notice is that the medical system in the US is crippled, with young physicians under incredible stress, enduring sleep deprivation and inhuman working conditions. With Obamacare and many more newly insured patients flooding the system already stretched to capacity, I anticipate the situation will only get worse. Until we address the root cause of the problem, expect more cases like Dr. Duntsch's in the future.

 

[Arcan57]

http://www.linkedin.com/pub/christopher-md-phd-fmis-neurosurgeon/b/1b7/40

Anyone care to think why would someone so accomplished come to a total disaster? There is no question what happened to his patients is truly a tragedy: some people lost lives, others are left debilitated. Yes, an easy solution is to prohibit Dr. Duntsch from practicing ever again, and to forget about it. Sign him off as "irresponsible doctor." Very convenient. Just a few years out of residency (2009), his clinical career is now over. Do you ever stop to think about this and what it means for a person who has gone through years and years of training?

Everyone is eager to examine outcomes (in this case, repeated cases of malpractice), but no one is willing to analyze the CAUSE. What no one seems to notice is that the medical system in the US is crippled, with young physicians under incredible stress, enduring sleep deprivation and inhuman working conditions. With Obamacare and many more newly insured patients flooding the system already stretched to capacity, I anticipate the situation will only get worse. Until we address the root cause of the problem, expect more cases like Dr. Duntsch's in the future.

Please tell me this is an elaborate troll job. If you're implying that it's inappropriate to ban a doctor from practicing when they present an on-going hazard to public health, than I don't think it's possible to have a conversation with you on the topic. Given what we go through to be able to serve our patients, the idea that someone would practice while impaired (and I don't buy the sleep deprivation is the same as being drunk argument) is sickening. The idea that someone would do so repeatedly in the face of maiming and killing their patients through preventable mistakes without voluntarily entering into a substance abuse program is unthinkable.

 

[Margo]

Please tell me this is an elaborate troll job. If you're implying that it's inappropriate to ban a doctor from practicing when they present an on-going hazard to public health, than I don't think it's possible to have a conversation with you on the topic. Given what we go through to be able to serve our patients, the idea that someone would practice while impaired (and I don't buy the sleep deprivation is the same as being drunk argument) is sickening. The idea that someone would do so repeatedly in the face of maiming and killing their patients through preventable mistakes without voluntarily entering into a substance abuse program is unthinkable.

You are missing the point. He SHOULD be banned and he will be. Like I said, his clinical career is over. However, Dr. Duntsch is a product of a crippled medical system. You don't go from a star medical student and all-around accomplished resident/fellow to a substance abuser and a "dr. death" for no good reason. No one is willing to think "why." And that it can happen to any of you.

 

[shopsteward]

You are missing the point. He SHOULD be banned and he will be. Like I said, his clinical career is over. However, Dr. Duntsch is a product of a crippled medical system. You don't go from a star medical student and all-around accomplished resident/fellow to a substance abuser and a "dr. death" for no good reason. No one is willing to think "why." And that it can happen to any of us.

Fixed that for you.

 

[Top Gun]

I would like to know how he actually performed in residency. What his attendings thought of his surgical skills, whether he had to remediate at any point, whether his program was reluctant to graduate him, etc...

 

[deuist]

Very few residents fail out because their procedural skills are bad.

This is so true. Even residents who lack clinical knowledge can go right on getting promoted. The problem is that there is such a pressure to keep passing students and residents that the public gets left with a few bad docs.

 

[Birdstrike]

http://www.linkedin.com/pub/christopher-md-phd-fmis-neurosurgeon/b/1b7/40

Anyone care to think why would someone so accomplished come to a total disaster? There is no question what happened to his patients is truly a tragedy: some people lost lives, others are left debilitated. Yes, an easy solution is to prohibit Dr. Duntsch from practicing ever again, and to forget about it. Sign him off as "irresponsible doctor." Very convenient. Just a few years out of residency (2009), his clinical career is now over. Do you ever stop to think about this and what it means for a person who has gone through years and years of training?

Everyone is eager to examine outcomes (in this case, repeated cases of imalpractice), but no one is willing to analyze the CAUSE. What no one seems to notice is that the medical system in the US is crippled, with young physicians under incredible stress, enduring sleep deprivation and inhuman working conditions. With Obamacare and many more newly insured patients flooding the system already stretched to capacity, I anticipate the situation will only get worse. Until we address the root cause of the problem, expect more cases like Dr. Duntsch's in the future.

***Disclaimer: I have no connection to this case, I do not know this doctor or any of the hospitals or individuals in any way. My comments are based completely on speculation and what I read on the linked articles and the below public board action referencing substance abuse (page 5, subsection e)

http://forums.studentdoctor.net/attachment.php?attachmentid=24946&d=1378060964

Would it be easier to understand if you knew the surgeon was operating blind?
Would it be easier to understand if you knew the surgeon was operating blind drunk? Or stoned, blind drunk?

Is it still hard to understand why someone so "together" and who had "everything going for him" would throw it all away?

You've seen brilliant artists, actors, politicians, friends, family and your patients' lives destroyed by substance abuse...

Yet we are supposed to be different.

We are supposed to be "heroes."

We supposed to cure disease but not succumb.


"Doctors are different."


Well they are not.

We are not.

Speak to next patient you see whose life is being destroyed by addiction, just like you do your patients with cancer. The survival rates are about the same and you just might have one in 20 come back to thank you for saving their life. I have. I understand many won't want help.

The same goes for your colleagues. Don't look the other way. Encourage early treatment. Doctor who seek help and "recover" are helped and save their careers. Those that don't may lose everything.

If you have a problem call the AA or NA 1-800 line right now.

Here's another sad example of someone who waited too long, an anesthesiologist arrested, going berserk in a cop car (same disclaimer applies):

http://m.youtube.com/watch?v=qd6cuFCbpgU&desktop_uri=/watch?v=qd6cuFCbpgU

 

[dpmd]

***Disclaimer: I have no connection to this case, I do not know this doctor or any of the hospitals or individuals in any way. My comments are based completely on speculation and what I read on the linked articles and the below public board action referencing substance abuse (page 5, subsection e)

http://forums.studentdoctor.net/attachment.php?attachmentid=24946&d=1378060964

Would it be easier to understand if you knew the surgeon was operating blind?
Would it be easier to understand if you knew the surgeon was operating blind drunk? Or stoned, blind drunk?

Is it still hard to understand why someone so "together" and who had "everything going for him" would throw it all away?

You've seen brilliant artists, actors, politicians, friends, family and your patients' lives destroyed by substance abuse...

Yet we are supposed to be different.

We are supposed to be "heroes."

We supposed to cure disease but not succumb.


"Doctors are different."


Well they are not.

We are not.

Speak to next patient you see whose life is being destroyed by addiction, just like you do your patients with cancer. The survival rates are about the same and you just might have one in 20 come back to thank you for saving their life. I have. I understand many won't want help.

The same goes for your colleagues. Don't look the other way. Encourage early treatment. Doctor who seek help and "recover" are helped and save their careers. Those that don't may lose everything.

If you have a problem call the AA or NA 1-800 line right now.

Here's another sad example of someone who waited too long, an anesthesiologist arrested, going berserk in a cop car (same disclaimer applies):

http://m.youtube.com/watch?v=qd6cuFCbpgU&desktop_uri=/watch?v=qd6cuFCbpgU

I would be just as outraged if a surgeon who was having eyesight issues failed to disclose them or get treatment for them and ended up maiming patients. Addicts/alcoholics don't get some special license to ruin lives without judgement just because addiction is recognized as a disease.

 

[Birdstrike]

I would be just as outraged if a surgeon who was having eyesight issues failed to disclose them or get treatment for them and ended up maiming patients. Addicts/alcoholics don't get some special license to ruin lives without judgement just because addiction is recognized as a disease.

You missed the point completely. I did not say or imply that, "Addicts/alcoholics should get some special license to ruin lives without judgement." I think this guy and all others who have acted similarly should be held fully responsible to every extent of the law, whether that means immediate license suspension as occurred, criminal charges, or both. My point was twofold: 1-Physicians are just as affected by addiction, and just as many allow their lives to be ruined by it, as other segments of society. 2-By recognizing this, future calamities could be prevented if people are aware of these issues early on, rather than hiding their heads in the sand, naively assuming it won't happen to any fellow physicians because of a false belief that physicians have an immunity to addiction proportional the the length of their CV. How many people looked the other way, or falsely assumed the "problem" didn't fit the "profile"?

You can argue all you want, for or against "the disease theory" of addiction, but if your solution to preventing the next such case is not to encourage early detection, early intervention and early treatment, then what is it?

 

[jdh71]

http://www.linkedin.com/pub/christopher-md-phd-fmis-neurosurgeon/b/1b7/40

Anyone care to think why would someone so accomplished come to a total disaster? There is no question what happened to his patients is truly a tragedy: some people lost lives, others are left debilitated. Yes, an easy solution is to prohibit Dr. Duntsch from practicing ever again, and to forget about it. Sign him off as "irresponsible doctor." Very convenient. Just a few years out of residency (2009), his clinical career is now over. Do you ever stop to think about this and what it means for a person who has gone through years and years of training?

Everyone is eager to examine outcomes (in this case, repeated cases of malpractice), but no one is willing to analyze the CAUSE. What no one seems to notice is that the medical system in the US is crippled, with young physicians under incredible stress, enduring sleep deprivation and inhuman working conditions. With Obamacare and many more newly insured patients flooding the system already stretched to capacity, I anticipate the situation will only get worse. Until we address the root cause of the problem, expect more cases like Dr. Duntsch's in the future.

But for the grace of God there goes any of us . . .

I'm not sure the cause is anything more than the human condition trying to live in a stressful world, coupled with a natural penchant for impulsiveness and compulsiveness, on top of a general lack of insight, and anyone is a single norco script from a lot of trouble.

You can't fix this stuff a priori. All you can do is hope it gets caught soon enough. The good news is that most people don't do enough damage or are so far gone to be beyond redemption. Most of these docs aren't bad people trying to get good, they are sick people trying to get well, sometimes they just don't know it yet, and you have to hope they don't hurt anyone on the way to figuring it out.

 

[jdh71]

You missed the point completely. I did not say or imply that, "Addicts/alcoholics should get some special license to ruin lives without judgement." I think this guy and all others who have acted similarly should be held fully responsible to every extent of the law, whether that means immediate license suspension as occurred, criminal charges, or both. My point was twofold: 1-Physicians are just as affected by addiction, and just as many allow their lives to be ruined by it, as other segments of society. 2-By recognizing this, future calamities could be prevented if people are aware of these issues early on, rather than hiding their heads in the sand, naively assuming it won't happen to any fellow physicians because of a false belief that physicians have an immunity to addiction proportional the the length of their CV. How many people looked the other way, or falsely assumed the "problem" didn't fit the "profile"?

You can argue all you want, for or against "the disease theory" of addiction, but if your solution to preventing the next such case is not to encourage early detection, early intervention and early treatment, then what is it?

Exactly. Responsibility doesn't shift just because there is a disease model for addiction and alcoholism.

 

[Birdstrike]

Exactly. Responsibility doesn't shift just because there is a disease model for addiction and alcoholism.

Yes. Thanks for "getting it." There are plenty of character flaws that can go hand in hand with addiction, but "character" isn't treatable by us as physicians. A disease can be treated, maybe, if there's a willing patient and someone willing to treat them. Like I tell my patients, "Your addiction is a disease just like any other. But just like a diabetic is responsible for seeking help, getting his medicine and taking it to keep himself alive, you also are responsible for seeking treatment, and doing what is required, no matter how hard to get well, and to keep yourself alive."

Often it falls on deaf ears, but if someone's ready to listen, the words can have impact. Sure, many may have made poor choices along the way, but I've had better success speaking to people in the above way, as opposed to leading with a reminder of how many poor choices and mistakes they've made in the past.

 

[dpmd]

You missed the point completely. I did not say or imply that, "Addicts/alcoholics should get some special license to ruin lives without judgement."

Forgive me for misunderstanding. Your statement at the start of your post "would it be easier to understand if the surgeon was operating blind?" made me think you were trying to excuse the guy. I didn't think anyone was opposing the idea that impaired providers are a possibility or that they should be helped/seek help. I don't understand how any addict throws their life away any more than I understand how people with treatable conditions lose their life or suffer complications rather than deal with their disease. It doesn't mean I don't try to help though.

It would be interesting to know whether any of the people who filed complaints about the guy suspected the possibility of impairment. They might have just though the guy was a really ****ty surgeon though. Unfortunately, it is not always easy to tell when someone is impaired. I don't think it comes from thinking it can't happen to physicians, so much as it is about not knowing how to recognize the signs. Maybe the medical board could be empowered to require drug/etoh testing if a certain number of separate serious complaints are filed. Or the hospitals could require testing of all new physicians sometime during the proctoring period, and randomly (or not so randomly if there are a number of serious bad outcomes in a short period). However, then I am sure you would have people all up in arms about violating their rights.

 

[jdh71]

Forgive me for misunderstanding. Your statement at the start of your post "would it be easier to understand if the surgeon was operating blind?" made me think you were trying to excuse the guy. I didn't think anyone was opposing the idea that impaired providers are a possibility or that they should be helped/seek help. I don't understand how any addict throws their life away any more than I understand how people with treatable conditions lose their life or suffer complications rather than deal with their disease. It doesn't mean I don't try to help though.

It would be interesting to know whether any of the people who filed complaints about the guy suspected the possibility of impairment. They might have just though the guy was a really ****ty surgeon though. Unfortunately, it is not always easy to tell when someone is impaired. I don't think it comes from thinking it can't happen to physicians, so much as it is about not knowing how to recognize the signs. Maybe the medical board could be empowered to require drug/etoh testing if a certain number of separate serious complaints are filed. Or the hospitals could require testing of all new physicians sometime during the proctoring period, and randomly (or not so randomly if there are a number of serious bad outcomes in a short period). However, then I am sure you would have people all up in arms about violating their rights.

My guess would be that many of us don't want to get anyone into that kind of trouble, or have a hard time believing that could happen to anyone (ie. us). It's actually a lot more comfortable to most of us I think to subscribe the problems with the neurosurgeon here to being a bad surgeon than to being altered.

 

[dpmd]

My guess would be that many of us don't want to get anyone into that kind of trouble, or have a hard time believing that could happen to anyone (ie. us). It's actually a lot more comfortable to most of us I think to subscribe the problems with the neurosurgeon here to being a bad surgeon than to being altered.

I agree. I also think that the "anyone" isn't limited to medical personnel. If I heard about a mechanic that was screwing up a lot of cars, my first thought would be crappy mechanic.

I remember a residency interview where I got asked about what I would do if my staff showed up obviously drunk to the case. I tried pulling him aside, getting other people involved, offering alternatives to him scrubbing (just having him "supervise" me), and I forget what else but the interviewer said he wouldn't stop and was about to cut on the patient. I ended up saying I would physically restrain him and call for help. I don't know what the hell they wanted me to say. In reality you probably wouldn't even know they were drunk, but even if you could smell some alcohol is it reasonable to come to blows over stopping them? Plus, imagine the trouble you would get into if you don't prove impairment.

 

[jdh71]

I agree. I also think that the "anyone" isn't limited to medical personnel. If I heard about a mechanic that was screwing up a lot of cars, my first thought would be crappy mechanic.

I remember a residency interview where I got asked about what I would do if my staff showed up obviously drunk to the case. I tried pulling him aside, getting other people involved, offering alternatives to him scrubbing (just having him "supervise" me), and I forget what else but the interviewer said he wouldn't stop and was about to cut on the patient. I ended up saying I would physically restrain him and call for help. I don't know what the hell they wanted me to say. In reality you probably wouldn't even know they were drunk, but even if you could smell some alcohol is it reasonable to come to blows over stopping them? Plus, imagine the trouble you would get into if you don't prove impairment.

Exactly. It would be a nightmare scenario, especially for a trainee.

We have less to lose personally with colleagues in most situations (though it could be your Chair in academics or maybe your Medical Director in the private world, so still not without conflicts potentially), but I think it would still hard. It's the kind of thing that can completely derail a career (often appropriately so) or set a career back/aside for a few years while someone gets better, so I think with that in mind most of us approach the topic very carefully. If someone just sucks as a doctor, then maybe you can get them some remediation or some pressure on them to be more careful or maybe even get them to stop dealing with the more important or acute issues, while still not preventing to stopping them from being physicians, but when a physician has an impairment issue, once recognized, it's FULL STOP, and it stays fell stop for a long while in many cases.

 

[dozitgetchahi]

What I find interesting are the descriptions from the article about how this guy was doing the *exact* wrong thing in many of these cases - i.e, he had to know how to do things right to do them so completely and consistently wrong, etc. It sounds like more than just sloppiness attributable to drug/alcohol use.

 

[wholeheartedly]

It's incredibly crappy to have to report an impaired coworker. I had to do it at my job, non physician but allied health. I was like two months out of training after a transfer too, so pretty new and had to call my supervisor at 200 in the morning and tell her the guy I was working with was too messed up to work and putting patients at risk.

It's weird too, the thought process you go through. I mean its prettyy easy to say you would not stand for someone putting patients at risk, but a lot of different possibilities to get them outtta there. It's a lot harder to deal with in reality.

First it's, is he really intoxicated? I mean you don't want to be wrong. You really dont want to be wrong. Then, maybe someone else will report it, or suggest he goes home. (There's some overlap with the shifts, before we're mostly alone for the night). But no one does, so am i wrong, imagining things? Then the guy goes to break, where I think he did more of whatever he was doing and all of a sudden it's not "he seems kinda buzzed" but he seems totally messed up.

Ok, now how do I get him away from work? he's always been a nice guy, but way bigger than I am and you never know how ppl are going act when they're messed up. Do I call one of his friends that works here to take him home? Call my lead? Call security? Call our boss? He's a nice guy, good at his job usually, just made a really bad bad decision and has a very big problem. Losing his job isn't going to make his problem better.

He said he was tired so I told him to go put his head down in the management area for a few and I'd cover for him and wake him up if I needed him. Whew, away from patient stuff, no conflict. Then I tried my lead but no answer. Called my asst. supervisor, no answer. Took a breath then woke my supervisor up at 2 a.m. and just came out with it "hi, it's WH sorry to wake you. John is either drunk or high and not safe to work and I'm running this place by myself."

Then she came in to deal with him, my assistant supervisor came in to help me with the work load, then security came to escort him to the ED for drug testing.

He wound up in treatment and gets to keep his job as long as he complies with that and monitoring. (We don't work with meds so there's no risk for drug diversion).

In the end I think he was somewhat relieved he got forced into it, he was different after that, seemed happier.

 

[BrakngLyv]

Update on this in today's Dallas Morning News after a federal lawsuit is filed. Today's piece fleshes out the story a bit more--including the revelation that problems were apparent during residency.


http://watchdogblog.dallasnews.com/...om-harming-patients-at-dallas-hospitals.html/

 

[Cmdr_Shepard]

Horrifying.

 

[Substance]

The core of medicine is corrupt; mostly because of CEO-style business practices.

Baylor had a lot of forewarning about this particular neurosurgeon, but chose to do nothing since his practice would bring in millions to the hospital. His residency program knew of his dangerous habits, yet also stayed mum.

The victims are absolutely justified in suing Baylor for this. I would also extend the suit to the residency program that trained Dr. Deuntsch - its like suing a car manufacturer that sells cars known to have malfunctioning brakes. Perfectly justified. I hope they win a large settlement.

 

[deuist]

Not just business-style of practice. There's such pressure on residency directors and hospitals to never say anything negative or to fire a physician for reasons such as retaliation, looking incompetent yourself for hiring the bad doc, and your own failures at your inability to train someone. Look at the general residency threads from residents who were fired. The process take a lot of work and the fired doc usually tries to sue or complain to the authorities.

 

[Kahreek]

On the training side of things, I wonder if the procedural specialties need some kind of formal aptitude testing for manual dexterity. Its amazing, considering the battery of useless tests that they put us through, that there's never a single test of hand eye coordination.

i dont think that would help, it would not be a good gauge for performance.
Let's set manual dexterity as being able to walk and surgery as being able to safely walk along a cliff. it is not about how good you can walk, most of the time.

 

[Vandalia]

The core of medicine is corrupt; mostly because of CEO-style business practices.

It also happens under the single-payer model. From the United Kingdom:

A police investigation has been launched into the deaths of patients treated by a cancer surgeon who lied on his CV and had fatality rates twice as high as the average.

The NHS is facing a multi-million compensation bill over the care given by Sudip Sarker, a doctor who worked in the West Midlands and London, who is accused of failing to accurately diagnose cases, and botching surgery on others.

 

[Cmdr_Shepard]

It also happens under the single-payer model. From the United Kingdom:

A police investigation has been launched into the deaths of patients treated by a cancer surgeon who lied on his CV and had fatality rates twice as high as the average.

The NHS is facing a multi-million compensation bill over the care given by Sudip Sarker, a doctor who worked in the West Midlands and London, who is accused of failing to accurately diagnose cases, and botching surgery on others.

You're making a different argument. When the above poster referred to "CEO-style business practices" they were arguing that the profit motive in healthcare actually reduces patient care. This is an inherent problem ("the core of medicine is corrupt") with all profit-driven systems and has nothing to do with corrupt individuals. These individuals are just rational actors doing what they're expected to do (even though we might be disgusted by the behavior, it's not necessarily indicative of corruption). In this case (Baylor surgeon), I'm sure there was a little bit of both involved however.

What you are arguing is that there can be corrupt individuals in any environment. This is a trivial conclusion and does not add anything to the discussion.

 

[Vandalia]

You're making a different argument. When the above poster referred to "CEO-style business practices" they were arguing that the profit motive in healthcare actually reduces patient care. This is an inherent problem ("the core of medicine is corrupt") with all profit-driven systems and has nothing to do with corrupt individuals. These individuals are just rational actors doing what they're expected to do (even though we might be disgusted by the behavior, it's not necessarily indicative of corruption). In this case (Baylor surgeon), I'm sure there was a little bit of both involved however.

What you are arguing is that there can be corrupt individuals in any environment. This is a trivial conclusion and does not add anything to the discussion.

No, the critical point is that leaders in every healthcare system will be driven by motivations that are not perfectly aligned with patient interests.

In the military, leaders are motivated by the promise of promotion to meet healthcare metrics imposed from above. In the current American system, leaders are motivated by the promise of profit. In the UK healthcare system, leaders are motivated by the desire to meet metrics imposed by Parliament to maximize their bonuses.

The case I linked does not show one individual who committed gross malpractice in a vacuum. Instead, the leaders of his NHS trust refused to investigate complaints against him, because if they did so, and removed him from performing surgery, it would have damaged their patient-wait-time statistics which would have looked bad on their annual performance review.

With the possible exception of healthcare systems that are founded on purely religious principles, EVERY structure devised will motivate leaders at all levels to act in ways that are not always best for the patients they serve.

 

[Cmdr_Shepard]

With the risk of possibly veering off topic, I feel I should say that most systems of healthcare have, at the very top of the administrative food chain, people who are concerned with money first, and the individual patient second. This is a necessary thought process because healthcare is a finite resource to be allocated where it will provide the greatest benefit for the greatest number of people.

Physicians and nurses advocate for their individual patients, but we shouldn't be surprised if news stories break that go counter to our moral/ethical codes if they're happening at a top-admin level.