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September 4, 2013

Why 'the worst surgeon I've ever seen' wasn't stopped

Daily Briefing

    Texas authorities needed more than a year to stop neurosurgeon Christopher Duntsch even after numerous colleagues reported Duntsch for gross medical malpractice, including two cases that resulted in patient deaths and several that ended in paralysis.

    Writing in the Texas Observer, Saul Elbein reviewed why physicians' complaints about Duntsch—which included comparisons to "Hannibal Lecter" and "the worst doctor I've ever seen"—went largely unheard, illustrating some of the challenges with how medical boards accredit physicians and health care providers share information.

    Physicians filed complaints against Duntsch

    Duntsch launched his Dallas-based neurosurgery practice—Texas Neurosurgical Institute—in 2011, and by year's end, he had obtained surgical privileges at the Baylor Regional Medical Center of Plano. There, he performed several procedures that ended with major adverse effects on the patients.
    • In a spinal fusion procedure performed in January 2012, Duntsch nicked a patient's vertebral artery during a spinal fusion procedure and left him with bone fragments that lodged into his nerves, causing intense pain for months. Randall Kirby—a Baylor surgeon who assisting Duntsch in the surgery—filed a complaint with the Texas Medical Board (TMB), writing that Duntsch operated at a "first- or second-year neurosurgical resident level, but had no apparent insight into how bad his technique was."
    • In another case, Duntsch nicked an artery running down the spine, causing massive bleeding that he attempted to staunch by packing the wound with coagulants; the patient woke up paralyzed, and Duntsch did not order follow-up scans. A senior surgeon called in to fix the damage to the patient attributed the paralysis to "surgical misadventures" and noted that the delay to order follow-up tests likely cost the patient the use of this arms and legs. 
    • Duntsch sliced through an artery during a minor surgery and allowed the patient to bleed to death, according to TMB records. The medical examiner attributed the death to "therapeutic misadventure."

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    After the patient's death, Duntsch resigned from Baylor and applied for surgical privileges at Dallas Medical Center (DMC). An initial background check came up clean, so DMC allowed Duntsch to join their team. In Duntsch's first three surgeries at DMC, he left a patient brain dead and paralyzed another.

    DMC neurosurgeon Robert Henderson attempted to correct Duntsch's botched surgeries and was horrified to find that the surgeon had "no idea what he was doing." He even thought he might be an imposter and faxed Duntsch's photo to his residency program to confirm he had been trained. (He had.) Henderson called TMB and was told to fill out a complaint that would be answered in 30 days.

    In July 2012, DMC CEO Corazon Hernandez fired Duntsch and reported him to TMC, according to Henderson.

    In May 2013, Kirby and Henderson received a letter inviting them to a celebratory dinner for University General Hospital's newest neurosurgeon: Duntsch. On June 14, 2013, Kirby was called in to perform a recovery surgery on one of Duntsch's new patients.

    Kirby then sent a sworn statement to TMB, outlining all the issues he had seen with Duntsch's patients, as well as other surgeons' experiences. "The [Medical Board] must stop this sociopath Duntsch immediately or he will continue [to] maim and kill innocent patients," Kirby wrote.

    Finally, on June 26, TMB—which had been investigating Duntsch since summer 2012—took action, suspending Duntsch's license. TMB's report stated, "Respondent is unable to practice medicine with reasonable skill and safety due to impairment from drugs or alcohol."

    Elbein writes that since then, Duntsch has "disappeared."

    Why the board took so long to stop Duntsch

    According to Elbein, TMB failed to stop Duntsch mostly because it has limited power to do so under Texas law and insufficient manpower. The board has just 156 employees, who are expected to review the 6,000 to 8,000 complaints that are filed each year, Elbein writes.

    "The [Medical Board] must stop this sociopath immediately or he will continue [to] maim and kill innocent patients."

    Medical board spokesperson Megan Goode says that the "way the law is currently written, with a high bar of evidence for the board to meet, the process can take time so that the board can build a solid case."

    As for patients, a series of reforms over the past decade "have severely limited patients' options for holding doctors and hospitals accountable for bad care," Elbein writes. Hospitals are allowed to keep credentialing information confidential, which makes it difficult for malpractice plaintiffs to make their cases. Patients that do prove medical malpractice can only receive $250,000 in damages.

    Those credentialing privacy laws also limit what becomes public knowledge. Even as Duntsch's patients were dying, the neurosurgeon maintained a clean public record. Moreover, he maintained 4.5 out of five stars on the HealthGrades website (Elbein, Texas Observer, 8/28).

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