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http://www.nj.com/news/index.ssf/2012/05/nj_spinal_surgeon_previously_c.html

Richard Kaul, shown on a News 12 program about spinal surgery, may face suspension stemming from accusations that he performed surgeries without proper training.
Eleven years ago, a London jury convicted Richard Kaul, an anesthesiologist, of negligent manslaughter after a woman he sedated went into cardiac arrest and later died.
The 14-day trial in 2001 included testimony that Kaul chatted on his phone and ordered a beeping monitor to be quieted during the tooth extraction procedure, all while the patient’s blood oxygen levels sank to a dangerous level.
Stripped of his medical license in England, Kaul began practicing medicine in New Jersey without disclosing his criminal conviction to the state’s licensing board, an omission that later resulted in a six-month suspension and subsequent probation.
Now, the 47-year-old Kaul faces another attempt to temporarily suspend his license. This time, state officials contend he’s performed complex spinal surgeries in a number of clinics across the state without proper education or training.

The charges, outlined in a complaint filed last month by the state Attorney General’s Office, are scheduled to be heard today by the Board of Medical Examiners in Trenton.
Kaul’s attorney, Bob Conroy, told The Star-Ledger Tuesday his client has agreed to an interim consent order that prohibits him from performing spinal surgeries until further review. The consent order, which was described by Conroy and has not been made public, includes no admission of guilt and allows Kaul to continue administering anesthesia and performing minor surgical procedures, he said.

"There’s going to be further fact-finding that will happen at a later time," Conroy said. "You have to remember here, this is a lot like going before the grand jury. They bring lots of charges. Not a lot of them hold water."

Jeff Lamm, spokesman for the Division of Consumer Affairs, the agency that oversees the board, said he could not comment on any settlement.
According to the complaint, Kaul’s "flagrant disregard of his own lack of training and expertise and his continuing performance of surgical spinal procedures for which he is not qualified places the public in clear and imminent danger."

A board-certified anesthesiologist, Kaul did not receive any training in spinal surgeries during his residency at Albert Einstein-Montefiore Medical Center in the Bronx.
He later took continuing education courses on spinal surgical procedures, including some that involved cadaver training. He also studied minimally invasive spinal surgeries during a two-week fellowship in Seoul, South Korea, a trip that "falls far short" of the training needed for spinal surgeries, the complaint states.

Kaul owns the Spine and Rehabilitation Center, a Pompton Lakes facility that, according to the complaint, became "a one-room surgical office" in March 2011. He also has practiced medicine at a number of facilities across the state, including locations in Clifton, New Brunswick, Piscataway, Bloomfield, Elizabeth, Newark and Jersey City.

Officials say doctors who operate in one-room clinics must have hospital privileges or board permission to perform that surgery. Kaul has neither, according to the complaint.
Kaul, a tan, well-built man with a shaved head, has promoted his practice through local television appearances and charitable involvement.
His website includes a lengthy resume and video clips describing his founding of a charitable endeavor that coordinates spinal surgeries in Africa. Additionally, Kaul’s website states he’s donated $500,000 in services to The Spine Foundation for veterans of Iraq and Afghanistan.

He’s also amassed millions of dollars in real estate.
Property records show Kaul owns a 7,300-square-foot townhouse on Manhattan’s Upper West Side. The building — with four bedrooms, five bathrooms and a penthouse loft — is valued at more than $9 million, records show. In 2003, he bought an expansive home in Bernardsville, Somerset County, for $2.25 million.
That real estate is now at risk. The federal government this year has filed more than $3 million in liens against the properties in Manhattan and Bernardsville.
Kaul is one of two doctors scheduled for disciplinary action before the Board of Medical Examiners today. The other, Roger Lallemand Jr., was the subject of a Sunday Star-Ledger story outlining allegations he indiscriminately prescribed painkillers and anabolic steroids. Lallemand is one of 131 physicians registered to take part in the state’s medical marijuana program.
 

PMR2008

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lobelsteve

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Anyone want to pen a letter and we an all sign it telling NJ they are doing a great disservice to the public by allowing d-bag to continue with any licensure?
 

algosdoc

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In spite of his inadequate training, I would wager his outcomes are no different than spine surgeons. The problem is more the inappropriate choice of surgery or use of surgery where not indicated. This happens so frequently with spine surgeons that I have given up trying to determine the logic behind it.....
 

specepic

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So if you look at his website, the primary patient testimonial is the performance of a multilevel fusion on a teenager with spondylolisthesis. 16 yo! what a shame
 

Taus

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I figured it would be some endoscopic spine stuff.... but wow.... big open cases....

Another interesting part of the court documents was the repeated distinction that his ABIPP certification did not make him board certified in pain or qualified to perform the procedures. Just another example of why I have been scared away from going non-agcme.
 

facets

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Absolutely, this guy is a complete ***** and a disgrace to physicians everywhere,[

QUOTE=lobelsteve;12498147]Anyone want to pen a letter and we an all sign it telling NJ they are doing a great disservice to the public by allowing d-bag to continue with any licensure?[/QUOTE]
 

lovebailey2001

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http://www.njsrlaserspine.com/doctors-in-the-news/bid/31797/The-Daily-Mail-UK-on-Dr-Richard-A-Kaul

This guy was seriously crossing the boundary between spine surgeon and pain physician. Does not matter if you have taken20 three days cadaver courses you are still not board certified to do these procedures. I bet he will not lose his license and probably just cut back for a few years until he moves to a different part of the county.
I understand that this guy is inadequately trained and law will take its own course! But the question remains- where does the boundry of a pain physician end and spine surgeon's start! Are, we, the pain physicians allowed to do minimally invasive spine procedures such as Endoscopic Discectomies, Foraminotomies etc or not.:confused: I think some of us are doing them...
 

Jcm800

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Attorney Services

New Jersey Spine & Rehabilitation has over eight years of experience with no-fault cases. Our physicians and staff have a detailed understanding of the administrative, clinical and legal requirements of such cases. New Jersey Spine & Rehabilitation makes it a priority to produce timely and comprehensive medico-legal reports and works closely with attorneys should the case go to trial.

New Jersey Spine & Rehabilitation and it’s associated physicians provide an extensive range of procedural and diagnostic services that assist in the clinical management of patients with traumatically-induced orthopedic and musculosketal injuries.

New Jersey Spine & Rehabilitation understands the organizational constraints that personal injury cases impose on an attorney, and will provide a cooperative and efficient medico-legal service.

The following medico-legal services will, as a matter of professional courtesy, be provided without any additional fees to counsel and their respective client/patient:

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algosdoc

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Endoscopic spine work is a nebulous area, having been eschewed by spine surgeons. Therefore, it is fair game. The open procedures are amazing that they are being done in a physicians office. I have an OR suite in my office, but geesh....what he was doing was gutsy. The most important piece of information I find lacking is what training did he have in spine surgery in Europe? Is he a spine surgeon there but an anesthesiologist here? I know others that are in that situation....
 

PinchandBurn

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wow...i thought this was going to be about a real minimimally invasive procedure.

Not that I would ever advocate what this guy did, but really is there a difference b/w putting transpedicular screws and placing transpedicular cannulas in for Vert Aug ? Same 'principle', aside from the more open nature of the former.
 

lovebailey2001

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Endoscopic spine work is a nebulous area, having been eschewed by spine surgeons. Therefore, it is fair game. The open procedures are amazing that they are being done in a physicians office. I have an OR suite in my office, but geesh....what he was doing was gutsy. The most important piece of information I find lacking is what training did he have in spine surgery in Europe? Is he a spine surgeon there but an anesthesiologist here? I know others that are in that situation....
If it is a nebulous area then we, pain physicians, have every right to venture in to it, in my humble opinion! The question remains of adequate training, so why dont you and other Masters of Pain Medicine take up the task of teaching these endoscopic spine interventions. I know you are concerned abt the baseline knowledge, I suggest take a preliminary exam before these fine courses. Pain medicine needs to add new offerings to survive!:xf:
 

Jcm800

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Endoscopic spine work is a nebulous area, having been eschewed by spine surgeons. Therefore, it is fair game. The open procedures are amazing that they are being done in a physicians office. I have an OR suite in my office, but geesh....what he was doing was gutsy. The most important piece of information I find lacking is what training did he have in spine surgery in Europe? Is he a spine surgeon there but an anesthesiologist here? I know others that are in that situation....
he was doing anesthesia in England. thats where he allegedly, per the article, lost his medical license during a complication of a tooth extraction...
so it would seem he IS an anesthesiologist by training even on that godforsaken swamp/island
 
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For the same reason that it's wrong for me to go to weekend courses on cardiac stenting - as a physiatrist - and then start advertising myself as a minimally invasive heart surgeon. Spine care is a team sport, the surgical part is for spine surgeons.
 
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This guy was not doing minimally invasive surgery - he was doing fusions with rods and screws. Wayyyy outta scope of practice for anesthesia.
This - rods, screws, and even TLIFs - can be done minimally invasively with stab wounds and portals, but it's still wrong for a non-surgeon to attempt this.
 
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http://www.nj.com/news/index.ssf/2012/06/state_suspends_license_of_nj_s.html

TRENTON — The state Board of Medical Examiners voted tonight to temporarily suspend the license of a Pompton Lakes anesthesiologist for performing spinal surgeries without proper education or training, saying his actions "put the public at grave risk."
This is the second time New Jersey's doctor disciplinary panel has suspended Richard Kaul. The board prevented him from practicing for six months in 2003 for failing to disclose that a London jury had convicted him of negligent manslaughter in 2001. A woman he sedated during a tooth extraction went into cardiac arrest and later died six days later.
This time, the board voted 11-1 to suspend Kaul’s license immediately for his treatment of six patients, including one woman who developed an infection and needed corrective surgery after a seven-hour botched lumbar fusion.
"Given the lack of any formal surgical training or expertise, (Kaul) repeatedly subjected multiple patients to significant complex spinal surgery in a one-room surgery center with no hospital privileges or access to manage life-threatening complications that might occur," according to the order.
Kaul’s attorney Bob Convoy, who declared during the often tense hearing the board "wants to get Dr. Kaul’s license by hook or by crook," said he would appeal the decision.
"We believe what happened was preordained" because of public comments Attorney General Jeffrey Chiesa made about the case last month, Convoy said after the vote.
Chiesa told WCBS Radio 880 last month: "Whatever training he has is not sufficient for the kinds of surgery including, discectomies and spinal fusions, which, as people can appreciate, is a highly technical, highly complex surgery that’s gotta be performed by people who have been trained for years in that kind of specialty."
The board was "intimidated" by Chiesa’s comments and didn’t give him a fair shake, Convoy said.
Chiesa made the comments last month after Convoy and the board agreed Kaul would not perform any surgeries — unless they were minor procedures, such as the removal of moles or the treatment of lacerations — until a full hearing was held. The board also granted him permission to administer anesthesia as long as he obtained hospital privileges and worked with a board-certified surgeon.
In deciding to suspend Kaul, the board cited his failure to cooperate with the order, which also required he would revise his practice’s website in which "misrepresents himself as a spinal surgeon," according to the order. On his website, Kaul describes himself as a "board certified Minimally Invasive Spine Specialist" with expertise diagnosing and treating "spinal conditions using Non-Surgical Interventional Pain Techniques."
A board-certified anesthesiologist, Kaul did not receive any training in spinal surgeries during his residency at Albert Einstein-Montefiore Medical Center in the Bronx, according to the complaint.
Deputy Attorney General Doreen Hafner called expert witness Andrew Kaufman, an associate professor of anesthesiology at the New Jersey Medical School in Newark.
Kaufman said he reviewed Kaul’s credentials and testified Kaul had completed some limited training courses on spinal procedures in Korea. But when asked whether surgical training is part of the curriculum for an anesthesiologist, Kaufman replied, "No."
Kaul's offices are located in Pompton Lakes, Newark, Piscataway, and Queens, N.Y., according to the website.
 

mid|ine

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This - rods, screws, and even TLIFs - can be done minimally invasively with stab wounds and portals, but it's still wrong for a non-surgeon to attempt this.
This is a bad test case because there seem to be some real professional and character flaws with this guy.

However, what are the limits on scope of practice for a physician? If you didn't learn it in residency you can never do it?

What if you work with a neurosurgeon/ortho spine surgeon and do X number of cases with them a over a period of years (good luck finding one to train you, but...). Could a pain guy do laminectomies? Discectomies?

We do implants (SCS and pumps).
Discography progresses naturally to percutaneous discectomies. And is not far from their to endoscopic discectomies.
The mild procedure removes some lamina. Vertos has a foraminoplasty procedure in the works.

The lines get very blurry and its really more about turf wars then anything else. I know a lot of anesthesia docs don't think other specialties have the right or training to do most of the pain procedure...