These doctors are just the tip of the iceberg. Plenty of doctors who have negligently killed patients never even lose hospital privileges. The medical establishment has a remarkably high tolerance for mistakes. It's like a fraternity where they stand by each other.
Who's to blame? Largely, it's hospital peer review committees.
"Hospitals' peer review committees — the internal panels of medical staff that oversee and review complaints against clinical personnel — often do a poor job.
"'Much of the bottleneck in the physician discipline system is in the peer review committees,' says Philip Levitt, a retired Florida neurosurgeon who served as chief of the medical staff at two hospitals. 'Virtually everything of serious consequence gets balled up or blocked in the peer review process.'
T"he peer review system is rife with bias, Levitt says, noting that doctors on the committees often are inclined to protect their colleagues — or go after those who cross or compete with them. That dynamic invites lawsuits from doctors who say they've been treated unfairly, so hospitals generally are wary of suspending even those doctors who commit egregious misconduct, Levitt adds. Instead, they tend to look for a deal to persuade the doctor to leave quietly with no misconduct finding."
Thousands of doctors practicing despite errors, misconduct
Peter Eisler and Barbara Hansen
USA TODAY
August 20, 2013
Source: USA TODAY analysis of the U.S. government's National Practitioner Data Bank public use file; data include reports filed from Sept. 1, 1990-March 31, 2013
Frank Pompa, Alex Gonzalez and Barbara Hansen
A USA TODAY investigation shows that thousands of doctors who have been banned by hospitals or other medical facilities aren't punished by the state medical boards that license doctors.
Story Highlights
Hundreds of doctors with multiple malpractice claims still have their licenses
Weak oversight by state medical boards has been a concern for decades
Cracking down on bad doctors can take years; meantime, they keep treating patients
Dr. Greggory Phillips was a familiar figure when he appeared before the Texas Medical Board in 2011 on charges that he'd wrongly prescribed the painkillers that killed Jennifer Chaney.
The family practitioner already had faced an array of sanctions for mismanaging medications — and for abusing drugs himself. Over a decade, board members had fined him thousands of dollars, restricted his prescription powers, and placed his medical license on probation with special monitoring of his practice.
They also let him keep practicing medicine.
In 2008, a woman in Phillips' care had died from a toxic mix of pain and psychiatric medications he had prescribed. Eleven months later, Chaney died.
Yet it took four more years of investigations and negotiations before the board finally barred Phillips from seeing patients, citing medication errors in those cases and "multiple" others.
"If the board had moved faster, my daughter would still be alive," says Chaney's mother, Bette King, 72. "They knew this doctor had all these problems … (and) they did nothing to stop him."
Mari Robinson, executive director of the Texas medical board, says the Phillips case took "longer than normal, but we followed what we needed to do (by law)." Phillips could not be reached for comment.
Despite years of criticism, the nation's state medical boards continue to allow thousands of physicians to keep practicing medicine after findings of serious misconduct that puts patients at risk, a USA TODAY investigation shows. Many of the doctors have been barred by hospitals or other medical facilities; hundreds have paid millions of dollars to resolve malpractice claims. Yet their medical licenses — and their ability to inflict harm — remain intact.
The problem isn't universal. Some state boards have responded to complaints and become more transparent and aggressive in policing bad doctors.
But state and federal records still paint a grim picture of a physician oversight system that often is slow to act, quick to excuse problems, and struggling to manage workloads in an era of tight state budgets.
USA TODAY reviewed records from multiple sources, including the public file of the National Practitioner Data Bank, a federal repository set up to help medical boards track physicians' license records, malpractice payments, and disciplinary actions imposed by hospitals, HMOs and other institutions that manage doctors. By law, reports must be filed with the Data Bank when any of the nation's 878,000 licensed doctors face "adverse actions" — and the reports are intended to be monitored closely by medical boards.
The research shows:
• Doctors disciplined or banned by hospitals often keep clean licenses: From 2001 to 2011, nearly 6,000 doctors had their clinical privileges restricted or taken away by hospitals and other medical institutions for misconduct involving patient care. But 52% — more than 3,000 doctors — never were fined or hit with a license restriction, suspension or revocation by a state medical board.
• Even the most severe misconduct goes unpunished: Nearly 250 of the doctors sanctioned by health care institutions were cited as an "immediate threat to health and safety," yet their licenses still were not restricted or taken away. About 900 were cited for substandard care, negligence, incompetence or malpractice — and kept practicing with no licensure action.
• Doctors with the worst malpractice records keep treating patients: Among the nearly 100,000 doctors who made payments to resolve malpractice claims from 2001 to 2011, roughly 800 were responsible for 10% of all the dollars paid and their total payouts averaged about $5.2 million per doctor. Yet fewer than one in five faced any sort of licensure action by their state medical boards.
The numbers raise red flags for several experts in physician oversight, including David Swankin, head of the Citizen Advocacy Center, which works to make state medical boards more effective.
"Medical boards are not like health departments that go out to see if a restaurant is clean; they're totally reactive, because they rely on these mandatory reports — and they're supposed to act on them," Swankin says.
Not all doctors who lose clinical privileges or pay multiple malpractice claims necessarily should lose their licenses. In some malpractice cases, doctors or insurers may settle without admitting fault to avoid potentially expensive litigation.
Read the entire series: When Health Care Makes You Sick
When a disciplinary report shows up, "boards have a range of options," says Lisa Robin, chief advocacy officer at the Federation of State Medical Boards. "It could be a letter requiring that you get training, or it could be monitoring of (a doctor's) practices or, where there is patient harm, it could be something as severe as a (license) suspension or revocation."
The state boards "take their responsibility very seriously in taking actions, being thoughtful, and … protecting the public," Robin adds.
DECADES OF CONCERN
Concerns about medical boards' accountability date to 1986. That year, the Inspector General at the U.S. Department of Health and Human Services reported that the boards, typically comprising doctors and a lesser number of laypeople, imposed "strikingly few disciplinary actions" for physician misconduct. Several follow-up studies suggested improvements, but the reviews ended in the early 1990s after the Justice Department declared that an Inspector General would have no jurisdiction over state boards that are not funded or regulated by the federal government.
Some lawmakers disagree.
Early last year, Grassley and a bipartisan group of senators asked the Inspector General for a "comprehensive evaluation" of state medical boards' performance. But there's been no report, and the IG's 2013 work plan doesn't mention it.
Concerns about the boards resurfaced in a 2011 study by consumer watchdog group Public Citizen. The report was based on the same National Practitioner Data Bank records reviewed by USA TODAY, and it reached a similar conclusion: Medical boards "are not properly acting on (clinical privilege) reports after becoming aware of them."
Yet little has changed since Public Citizen's assessment — and the congressional concern it created. Physicians with records of serious misconduct are clearly still practicing:
• A California doctor made eight payments totaling about $2.1 million to resolve malpractice claims from 1991 to 2008. The doctor's hospital privileges were restricted twice in 2007, once for misconduct that posed an "immediate threat to health or safety" of patients, and surrendered for good in 2008. No action has been taken against the doctor's license.
• A Florida doctor made six payments totaling about $1.1 million to resolve malpractice claims from 1993 to 2009. In 2004, the doctor was hit with an emergency suspension of hospital privileges for misconduct that posed an "immediate threat to health or safety" of patients, and a managed care organization took similar action in 2005. He also kept a clean license.
• A Louisiana doctor made nine payments totaling about $2.7 million to resolve malpractice claims from 1992 to 2007, and at least five payments involved patient deaths, including two young girls. In 2008, a managed care organization indefinitely denied the doctor's clinical privileges. But the doctor's license remains unrestricted.
The doctors' names are a mystery: identifying information is stripped from the Data Bank's public file. Full access is limited to medical boards, hospitals and other institutions that are supposed to weed out bad doctors.
But the tracking system doesn't always work.
THE DEATH OF JENNIFER CHANEY
By the time Greggory Phillips began treating Jennifer Chaney in 2008, the Texas Medical Board had lifted the license restrictions stemming from his previous mismanagement of prescription drugs.
But more trouble was brewing. First, Phillips was caught pre-signing prescription pads, allowing a nurse to put "dangerous drugs" in the hands of patients who visited when Phillips was off and got no "adequate examination," board records show. Then, Debra Horn, a mother of two, died from an overdose of drugs Phillips prescribed.
Jennifer Chaney died after being prescribed a high dose of oxycodone, a narcotic more potent than morphine, plus an added prescription for hydrocodone — one the state medical board later described as "not medically indicated."
None of that was public when Chaney's family started seeing Phillips. He treated Jennifer for poor thyroid function and residual pain from neck surgeries after a car accident, board records show. He prescribed a mix of thyroid medicine, muscle relaxants, anti-anxiety drugs and painkillers.
Just before Christmas, Chaney fell in a parking lot and reinjured her neck. Phillips prescribed a high dose of oxycodone, a narcotic more potent than morphine, board records show. He also gave her an added prescription for hydrocodone, a painkiller already included in Chaney's ongoing drug regimen — and one the board later described as "not medically indicated."
A week later, Chaney complained one evening about feeling loopy from her medications. As her husband, three sons and mother headed to bed, she stayed up to watch TV.
She was still on the couch when her mother got up in the morning.
"I noticed Jennifer was on her back, and she never slept on her back, always her side," Bette King recalls. "I didn't think anything of it; I went into the kitchen, and then it dawned on me and I went back into the den and tried to wake her up. And I couldn't."
King yelled for Jennifer's husband, who tried CPR while King called 911.
The paramedics never found a pulse. The autopsy findings: "Cause of death: mixed drug intoxication. … Manner of death: Accident."
As weeks passed, Phillips' problems mounted.v
The medical board, which fined him $1,000 in the prescription pad case, sent notice that it was preparing to charge him with substandard care and prescription drug violations in the death of Horn a year earlier. The Horn and Chaney families each filed malpractice claims, and Phillips' clinical privileges were terminated at North Hills Hospital in suburban Fort Worth.
Yet Phillips' license remained unrestricted. He would keep seeing patients — and mismanaging their medication.
"There's no question that Dr. Phillips had (practice) violations; the question is what authority does the board have to act once those are found out," says Robinson of the medical board. "We want something to happen and we want it as quickly as it can happen. But the system isn't always set up for that. ... That can be frustrating."
TOUGH INVESTIGATIONS, TIGHT RESOURCES
There's nothing tougher for state medical boards than competency and malpractice cases.
"There are laws, there is due process and there is confidentiality, and all those things make it difficult for state medical boards to do what they do," says Jon Thomas, a surgeon and past president of the Minnesota Board of Medical Practice.
"You have to get all the facts and you have to follow the law. And it's complicated," adds Thomas, an officer with the Federation of State Medical Boards. If a board is pursuing disciplinary action, "a good lawyer representing that physician will know all the appropriate levers to push, and they push every one of them. That can take a lot of time."
The cases typically require exhaustive investigation and legal preparation — a challenge for many boards wrestling with tight budgets and short staffs.
As the recession crimped state finances, "we saw a lot of boards having to do more with less," says Robin, the federation's advocacy officer.
With disparate funding and statutory authority, various boards use vastly different approaches to keep tabs on physicians.
Florida spends more than $200,000 a year to have the National Practitioner Data Bank continuously monitor the licenses of all of its physicians, so the board is alerted automatically when malpractice cases, hospital privilege actions and other problems are reported.
In Texas, doctors must submit a Data Bank report on themselves when they first apply for a license (the Data Bank allows doctors to query their own license records), but additional checks are not required for license renewals and are done only if a need arises, such as in complaint investigations. In California, there are no set requirements for checking the Data Bank and it is not queried routinely; officials check doctors' records on an as-needed basis.
"The states vary all over the lot in terms of the resources the boards have, whether they have good leadership, and whether they are regularly querying the (Data Bank)," says Sidney Wolfe, a physician and founder of Public Citizen's Health Research Group. "Some states do a pretty good job; a lot of them don't."
And it's getting more difficult to assess their work.
The Federation of State Medical Boards has stopped issuing medical board enforcement data that Public Citizen uses to rank the rate at which different boards discipline physicians. Wolfe says the federation wants to kill the state-by-state rankings because many boards detest them. The federation says it's figuring out how to release data that don't foster unfair comparisons between states that may have different disciplinary rules.
A LONG LEGAL FIGHT
Phillips wasn't giving up his medical license without a fight.
In May 2009, nearly 14 months after Debra Horn's death, the medical board invited Phillips to a settlement conference. He accepted the board's invitation but didn't accept its deal. That left the board one option: to take the case to a judge.
In Texas, as in many states, medical board complaints are adjudicated in administrative hearings, with their own judges and all the trappings of a full-blown trial. The board spent five months gathering evidence and lining up expert testimony before filing formal charges: negligence, non-therapeutic prescribing, failure to meet standards of care and poor medical decision-making.
Then, just before the hearing, Phillips opted for mediation — and the case stalled again.
"If a physician takes advantage of every hearing, every right to trial, it takes much, much longer" to resolve a case, says Robinson, the medical board's director. "He took advantage of every hearing, everything."
At about the same time, Bette King filed her own, handwritten complaint with the board in the death of Jennifer Chaney. Another investigation was launched.
King wanted the board to exercise its power to issue an emergency suspension of Phillips' license. But the burden of proof is extremely high, and the board's staff concluded that his misconduct did not meet the two-pronged legal test for an emergency order: The conduct has to be egregious and the doctor has to be an imminent, present danger. In 2012, just a dozen cases met that standard.
By the time King filed her complaint, nearly a year had passed since her daughter's death.
"We rely on complaints to (start) investigations, and people often wait a year or more to file," Robinson says. "But to show that a physician is a present danger, it's got to be now. If we are monitoring a physician for drug use and he fails a drug test, we have recent proof that he's a danger today. If we're talking about (actions) many, many months ago, it has to go through the regular disciplinary process."
So the Phillips case dragged on. It would be another year before his mediation, and it wouldn't end there. Throughout the process, anyone who checked Phillips' status on the board's website saw a license in full force — no mention of the malpractice cases or the terminated clinical privileges, even though all of that should have been listed.
"I kept waiting for them to stop him," King says, "and they just let him keep going."
FLAWS IN OVERSIGHT SYSTEMS
By law, hospitals and other health care institutions — from managed care operations to public health centers — must report to the National Practitioner Data Bank when doctors lose clinical privileges in connection with investigations of substandard care or misconduct. Insurers also must report any payments in a malpractice case, regardless of whether guilt was admitted.
In Texas and many other jurisdictions, state laws require similar reporting directly to medical boards, often by doctors themselves.
The reports are critically important — hospitals and other health care organizations typically are the first to know when a bad doctor is putting patients at risk. Yet they are notorious for skirting reporting requirements when they part ways with a physician.
At the start of 2011, more than 20 years after the National Practitioner Data Bank was set up, 47% of hospitals had never reported restricting or revoking a doctor's clinical privileges, according to data from the U.S. Health Resources and Services Administration, which runs the Data Bank. Public Citizen reported in 2009 that some hospitals mask cases by giving bad doctors a chance to resign before investigations are launched, or by restricting privileges for just under the 30-day threshold that requires reporting.
But the group also found another grave problem: Hospitals' peer review committees — the internal panels of medical staff that oversee and review complaints against clinical personnel — often do a poor job.
"Much of the bottleneck in the physician discipline system is in the peer review committees," says Philip Levitt, a retired Florida neurosurgeon who served as chief of the medical staff at two hospitals. "Virtually everything of serious consequence gets balled up or blocked in the peer review process."
The peer review system is rife with bias, Levitt says, noting that doctors on the committees often are inclined to protect their colleagues — or go after those who cross or compete with them. That dynamic invites lawsuits from doctors who say they've been treated unfairly, so hospitals generally are wary of suspending even those doctors who commit egregious misconduct, Levitt adds. Instead, they tend to look for a deal to persuade the doctor to leave quietly with no misconduct finding.
In the rare cases where a hospital does sanction a doctor, he says, "it usually means there were really bad things going on."
In the Phillips case, North Hills Hospital says the doctor's clinical privileges ended in May 2009, not long after Phillips was fined for signing blank prescriptions. The hospital would not comment on why it parted ways with him or whether it had anything to do with misconduct that would have required reporting to the medical board.
Whatever the circumstances, the board never heard about it. "There is no public information available to suggest that a report was ever made," says the board's Robinson.
To this day, Phillips' official profile on the board's website shows that he still has clinical privileges at North Hills. And the malpractice cases, which Phillips paid to settle years ago and was required to report to the board, are unmentioned.
TOUGH CHOICES, IMPERFECT DEALS
Based on a negotiated agreement with Phillips, the Texas Medical Board finally ordered sanctions in the Horn and Chaney cases in April 2011 — more than two years after Chaney's death; three years after Horn's.
The order charged that he "prescribed excessive quantities of high dosages of controlled substances and dangerous drugs … and engaged in a pattern of non-therapeutic prescribing of narcotics that were being used by (both) patients at the time of their deaths by drug intoxication."
Phillips agreed to pay for independent monitoring of his practice for two years, including quarterly reviews of at least 30 patients' records. He also had to take classes to correct deficient practices, including instruction in treating chronic pain and medical record-keeping, and pay a $3,000 penalty.v
But Phillips still was allowed to see patients and continue writing prescriptions.
Repeated efforts to reach Phillips for comment, including requests through his lawyers, were unsuccessful. But Jon Porter, one of his attorneys, said the sanctions were significant. He noted that paying to have a practice monitored and enrolling in the required courses can cost well over $10,000.
Still, the Phillips case wasn't over. In 2012, the board found that he'd continued to mishandle prescriptions while the Horn and Chaney investigations unfolded.
Phillips engaged in "non-therapeutic prescribing" for one patient and lacked documentation to justify the drugs he administered, the board found. In another case, he again prescribed drugs without documenting their necessity — and provided early refills without justification.
This time, the board struck a tougher deal: Phillips had to give up his certification to prescribe controlled substances.
Within a year, he'd stopped practicing, board records show. But last February, the board issued another, final order that forever bars Phillips from treating patients.
Phillips "prescribed controlled substances to multiple patients without documented medical justification … (and) without adequate evaluation and need," the order charged, noting that he also violated rules by prescribing drugs to family and close friends.
Again, though, the sanctions were negotiated and stopped short of revoking Phillips' license, allowing him to work in "administrative medicine" with no patient contact, such as evaluating insurance claims.
The deal reflects the tough choices the board often faces, Robinson says.
"This doctor was willing to agree to something that's very strict — he'll never be in contact with patients again — or we'd have to go to trial, which could take years, and he'd be practicing for all that time," she says.
Showing posts with label Medical Board. Show all posts
Showing posts with label Medical Board. Show all posts
Wednesday, August 21, 2013
Sunday, June 16, 2013
The Chargers' Doctor Is A Drunk Quack. Why Haven't They Fired Him? Because popularity is more important than competence
The Chargers' Doctor Is A Drunk Quack. Why Haven't They Fired Him?
Barry Petchesky
Deadspin
4/24/13
The California Medical Board believes that David Chao should lose his medical license. Nearly two dozen former patients who have sued him since 1998—alleging in all the medical superfecta of malpractice, personal injury, negligence, and fraud—would agree. Dissenting: the NFL and the San Diego Chargers, for whom Chao has served as team physician for the past 15 years.
The Chao dossier is lengthy. Two drinking-and-driving citations. A DEA investigation. Accusations that he enabled his former partner's prescription-drug habit. Four lawsuits from former Chargers he had treated. In early 2011, reporter Brent Schrotenboer, Chao's most dedicated watchdog, counted 20 lawsuits filed against Chao since 1998, with at least eight of those "settled with payouts to plaintiffs." Another was decided last summer, when Chao was found liable for negligence and fraud in the case of a 15-year-old girl, Whitney Engler, who had been disfigured in the course of Chao's treatment.
As far as the NFL is concerned, all of this is irrelevant. Last year, the NFL Players Association asked the league for a formal review of Chao's history. But the three-man independent panel hearing the case, per the collective-bargaining agreement, was not supposed to take into account the many suits stemming from Chao's private practice, or his own arrests, or even claims of perjury. Quietly, in February, Chao was "totally exonerated" by the panel, which dismissed the medical malpractice suits as irrelevant to "the quality of care that he provides to the San Diego Chargers players."
In recent weeks, we've learned some more supposedly irrelevant things about Chao, a Harvard- and Northwestern-trained orthopedic surgeon. Like a license hearing pursued by an aggressive California attorney general who wants to know why Chao was ordering vodka at a nightclub while one of his patients was losing a leg. Or a medical repair executive who tells us that Chao's MRI machines were outdated, inaccurate, and poorly maintained. Or a San Diego coroner's report that found a prescription sedative in the system of Junior Seau, for whom Chao acted as drinking buddy and personal physician.
NFLPA executive director DeMaurice Smith, in brief remarks before Chao had been exonerated by the panel, said, "It seems to me that the players of the National Football League deserve to have a doctor who's not been found liable of malpractice."
California also thinks its citizens deserve better than Chao. This past July, before the NFL's review, the state medical board filed a formal complaint against him. The board seeks to suspend or revoke his license, citing "repeated negligent acts."
That Chao remains the Chargers' doctor even now, amid a hail of accusations and universally terrible PR for both the team and league, owes less to his ability to treat his patients than to the unresolved conflict at the heart of the modern NFL: How can the league keep players safe and healthy without being legally responsible for the safety and health of the players?
This isn't the first time the state of California has gone after David Chao. In 2002, the medical board fined him for writing Gary Losse's prescriptions. Losse, Chao's former partner, was addicted to prescription painkillers, according to depositions of coworkers. A pharmacy technician testified that Chao regularly wrote the prescriptions and charged them to Losse's personal account. Losse and Chao were sued by former Charger DB Mark Montreuil, who claimed Losse had operated on his knee injury while high. Montreuil never played again, and he reached an out-of-court settlement with the two doctors. According to Losse's longtime nurse, a partner at the clinic told her that in 1998 the Chargers had pressured Losse to step down because of the drug use. Losse would leave the medical field altogether. Chao and another partner inherited his contract with the team, and in 2002 Chao became the sole, official scalpel of the Chargers.
In 2010, drug enforcement agents searched Chao's office after learning of more than 100 prescriptions apparently made out to himself. (The DEA became involved after the arrest of former Charger Kevin Ellison, who was found with a large stash of illegally obtained Vicodin pills.) The investigation was closed two years later, with the DEA saying Chao was not suspected of using the pills himself, and that "with the DEA's guidance, Dr. Chao's controlled substance record keeping is now in compliance."
In 2011, the medical board filed another complaint, to address Chao's two citations for drinking and driving. The second DUI had taken place in 2006, and Chao was accused of failing to disclose it while applying for a license to evaluate worker's compensation claims. (He would be disqualified for the license when it emerged that he had lied on his forms. He "knowingly [made] material misrepresentations under penalty of perjury," according to the director of the state's worker's comp division.)
The complaint revealed that the first thing Chao had told police upon being pulled over was that he worked for the Chargers:
Chao would testify that his blood alcohol content, 0.11, was measured three hours after the last of his two drinks and might have been high due to his Asian genes. Matthew Davis, a California deputy attorney general arguing on behalf of the board, said Chao's testimony "stretches credibility."
In his defense, Chao had himself examined by a board-certified psychiatrist, Stephen Sobel, who reported that Chao did not and does not abuse alcohol. That Sobel has served as the Chargers' "consulting psychiatrist" since 2003 was not brought up.
Davis, in his closing argument, declared that "sound judgment is part and parcel to the qualifications and duties of a physician. The DUI conviction evidences a problem in that area." The judge officially reprimanded Chao, recommending probation, a further psychiatric exam, and ethics training (that decision can be found at the bottom of this page).
The most recent complaint, the one the medical board argues should get Chao's license taken away, cites three negligence cases that took place between 2007 and 2010. One case involved Kathleen Adams, who was crippled by a botched hip replacement and won a $2.2 million payout from Chao. (Chao would later sue the makers of the surgical scissors used in the operation.)
A second patient had dangerous blood loss from "significant blood vessel lacerations" during hip replacement surgery. A third, in for a knee replacement, suffered deep venous thrombosis and a pseudoaneurysm.
The full document, which can be found at bottom, lists the board's executive director, Linda Whitney, as the complainant. It requests a hearing for Chao before the Office of Administrative Hearings, where the state's case will be argued by the attorney general's office—in this case, Matthew Davis. It closes with this request for action:
There are plenty of former patients who aren't cited in the complaint—yet. Like Whitney Engler, a teenage track star left disfigured after undergoing minor knee surgery in 2003. For her recovery, Chao prescribed a controversial cold-therapy device called Polar Care—and did not disclose that he and his company made money by renting it to her.
He'd had trouble with the machine in the past. In 2002, he settled out of court with a SeaWorld performer who had suffered frostbite after using the device. Engler suffered similar pain and tissue damage from the treatment. In her lawsuit, she claimed that Chao had played dumb about the device's history. "I asked him specifically if he knew what could have caused this," she told a reporter, "and he said, 'I don't know, I've never seen anything like this before.'"
On July 31, four days after the state medical board filed its complaint, Engler was awarded more than $12 million in total compensatory and punitive damages, split between the three defendants. (A jury assigned 50 percent of the responsibility for her harm to Chao. The clinic came in for 10 percent; Polar Care's manufacturer, 40 percent.) In the verdict, Chao's legal team was accused of some pretty underhanded tactics:
The [defendants] engaged in a number of ill-conceived strategies to derail the litigation, including hiding the location of witnesses, failing to produce witnesses, and engaging in a clandestine attempt to disqualify [Plaintiff's] counsel. In one such plot, they claimed that they dummied up a letter from Dr. Chao's attorneys, addressed to Dr. Chao, which contained incriminating information, with the idea that it would be leaked by someone to [Plaintiff's] counsel, and then they would be able to successfully move to have [Plaintiff's] counsel disqualified.
In an email to us, Chao's attorney, Robert Frank, writes that "Whitney Engler agreed, as did her expert orthopedic witnesses, that the knee surgery performed by Dr. Chao was excellent and allowed her to return to high school competitive sports, where she qualified for and succeeded in California state track events. Her case was not about the orthopedic surgery performed by Dr Chao. Instead it was a product liability case about a postoperative cold therapy healing device."
Then there's Tom Fagan, who in 2007 came in for a knee replacement and lost a leg while Dr. Chao was out at a nightclub.
It's good for business to be a sports franchise's "head team physician." (According to court documents filed in the Engler case, Chao's net worth is about $3.4 million, with an annual income between $700,000 to $1.4 million in recent years.) That's why many health-care providers actually pay for the right, though Chao's medical group only offers the Chargers reduced rates. Whatever the quid pro quo, it's a baroque, conflicted arrangement that often pits a doctor's sworn duty to an athlete's health against his responsibility to the team that pays him.
Fagan, a then-53-year-old artist and a big football fan (and former college player), specifically chose Chao for his surgery because of his association with the team. He saw Chao's ad in every gameday program, placed for free. He saw Philip Rivers prominently displayed on Chao's website. When he first walked into the doctor's office, he was greeted by framed photos of Chargers players and other star athletes through the years. You can see some of them on the "Patients in Action" section of Chao's site.
Fagan writes in an email that he went to Chao thinking "he was the best, naively assuming that if the Chargers had employed him for so long he had to be. ... The Chargers' doctor must be the top surgeon at least in San Diego."
On Feb. 9, 2007, Fagan underwent a knee replacement at Scripps Memorial Hospital in La Jolla, with Chao overseeing the operation. That evening, according to nurses' notes, Fagan began experiencing pain and swelling in his leg consistent with Compartment Syndrome, a dangerous condition that affects circulation. Nurses attempted to locate Chao, but he had left the hospital. And, against hospital rules, he had failed to appoint another physician responsible for Fagan's care.
The Chargers' Doctor Is A Drunk Quack. Why Haven't They Fired Him?Expand
"I came very close to dying," Fagan remembers.
The nurses' notes record that by 1:45 a.m., Fagan's condition had worsened to the point where the doctor on call in the emergency room had to be summoned. After performing a test, she called Chao. Fagan had a blood clot, the ER doctor suspected, and needed an operation to restore circulation. Chao said he was unable to come in. By 4 a.m., when emergency surgery was performed (not by Chao), Fagan's leg was beyond saving. Three months later, it was amputated.
"I believe it was the next morning Chao showed up with his story about going to L.A. to see his mother," Fagan recalls. "When I did ask him what went wrong, he just said it was a very difficult surgery, whatever that meant."
Where was David Chao while his patient crossed the point of no return? Chao told the court the same thing he had told Fagan. According to his May 15, 2008, deposition in Fagan's lawsuit (found at bottom), he was in his car, driving north to Los Angeles to visit his sick mother.
Chao was placed under oath, and examined by Fagan's lawyer, Janice Mulligan:
Q. With whom did you drive?
A. By myself.
Q. Where did you go?
A. I was heading to my mom's house.
[...]
Q. Can you give us your best estimate as to approximately what time you left your house on the evening of February 9th with the intent of driving to Los Angeles?
A. It was late at night. It was something that I thought about doing earlier in the day, because my mom wasn't feeling that well. And in any case I had given some thought about going up earlier in the evening, decided not to because I hate driving in traffic, and it was later that night that I decided, well, if I were to go up now and not miss sleeping, and I'm kind of worried about her, there isn't going to be much traffic. And then I could go up and at least see her in the morning and zip right back down to my other commitments.
In Chao's sworn deposition, he answered dozens of questions about driving to his mother's, filling in some details when pressed, failing to recall others. He played up his role as a dutiful child: "I was primarily going up there as a son that feels guilty that I haven't seen her very often," he said, "and that she was alone and not feeling well."
A. Without being overly melodramatic, my mom is not the kind of person that if it really were bad to say that it's really bad. She's always going to say, as an immigrant, her personality and whatever, she's going to say no, I'm fine; I know you're busy. And I wasn't — I'm not suggesting that I was speeding up there to save her life in any way, shape or form, but I'm not sure where she was. My assumption was that she just wasn't feeling that well and there was nothing to take her to the emergency room for or anything else, but perhaps my peace of mind would be better having just seen her.
About a year later, Chao was ordered to produce proof of his whereabouts that night. His lawyer sheepishly turned in a receipt. The purchases were redacted, but it showed Chao was at the Belo nightclub in the Gaslamp Quarter ("San Diego's only true superclub!") at the exact time the hospital was desperately trying to reach him.
Janice Mulligan launched her own investigation into the receipt and discovered that Chao had run up a tab of over $300 at Belo, including an entire bottle of vodka. The waitress serving the doctor that night remembered him well, Mulligan noted in a memo, because Chao had "stiffed her on her tip."
Chao settled with Fagan out of court, which allowed the doctor to avoid any potential liability.
(One of Chao's insurers would go to court in an attempt to recover costs for defending Chao and paying out the malpractice settlement. Documents from that case, including a 2011 Los Angeles Superior Court Statement of Decision, provide a glimpse into the evidence produced against Chao and can be found at bottom.)
When the medical board initially declined to pursue a case against Chao over his handling of Tom Fagan, Mulligan wrote a letter to Patricia Stillwell, a board investigator. Mulligan was astounded that the state would let the matter go.
Not only did we provide your office with evidence of Dr. Chao's negligence, we also provided you with incontrovertible evidence of him committing perjury in his deposition and black and white evidence of his real whereabouts on the night in question- both in the form of a receipt and phone records.
Mulligan offered to provide two experts "who both were outraged by Dr. Chao's conduct," and who would "testify that his conduct fell far below the requisite standard of care." Mulligan closed with this:
Based on Dr. Chao's track record, it is only a matter of time before another patient is injured or killed because of Dr. Chao's recklessness. Will the Medical Board please reconsider its position on this case before it is too late?
When asked about the Fagan case, Robert Frank, Chao's attorney, writes in an email: "There was not any finding of malpractice by Dr. Chao." He added: "The California Medical Board reviewed Dr Chao's care of Mr Fagan and exonerated him. You know they would not have done so had there been any wrongdoing by Dr. Chao given the medical board's history with Dr. Chao."
We're told that Deputy AG Matthew Davis, representing the medical board, isn't necessarily done building his case. The attorney general's office declined comment, citing the ongoing action, but a person familiar with the process says Whitney Engler's and Tom Fagan's cases, among others, could be included in an amended medical board complaint. Because of that possibility, a hearing and decision in Chao's case may not happen until 2014, when his medical license is set to expire.
Accusations of substandard care extend all the way to Chao's medical equipment. Deadspin spoke with an executive at a medical repair company, one that maintained the MRI machines at Chao's office until 2011, when it stopped servicing the clinic after a dispute over unpaid bills. The company won a judgment against the clinic, says the executive, who requested anonymity because they still haven't been paid.
Chao's clinic owns two MRI machines, with which he scanned both NFL players and regular patients. One of Chao's machines, the executive says, "was in worse condition than any MRI I'd ever seen." The other lost its national accreditation after Chao refused to have it serviced.
The older, smaller machine was the Lunar Artoscan M extremity scanner, which the executive calls "arguably the lowest-quality MRI that's capable of doing a knee scan that's in use in America." It surely wasn't in widespread use: The Artoscan M, introduced in 1993, was phased out for its successor in 2004. GE, which had acquired Lunar Corp., junked its stockpile around 2006.
The last time Chao's machine was examined was in 2008, when the executive told him it would be cheaper to buy a new, more modern machine than to fix everything wrong with it. Chao declined to do either.
The executive believes Chao stopped using his Artoscan M soon after, but the images obtained with it are still around. This very much matters, the executive says, because the scans can be more difficult to read than those from higher-quality machines—the details aren't nearly as fine.
The tesla (T) is a unit of measurement of magnetic field strength. It's used to calibrate the imaging power of an MRI machine. Today, the industry standard is at least 1.5T, with 3T becoming widespread. The Artoscan-M has a magnet capable of just 0.2T.
"You don't know what you cannot see" on a diagnostic scan, the executive says, and even today, radiologists consulting the files of Chao's patients may be working with fuzzy images. According to one sports-medicine specialist who has worked for a pro sports team, it's entirely possibly to miss subtle tears in cartilage or ligaments when consulting lower-definition images. To this, Chao's attorney responds that "the radiologists who read the MRI studies from Dr. Chao never complained about the quality of the MRI machines and felt very comfortable putting their names on the reports interpreting the studies."
Chao's other full-body MRI machine was a Hitachi AIRIS II, introduced in 1999. It's relatively modern, the executive says, but still "at the lower end of the quality spectrum." It's a so-called open MRI, which is more comfortable for larger or claustrophobic patients. But the trade-off is that it will necessarily have a weaker field strength. (Our sports-medicine specialist says there's no reason athletes can't use a closed MRI: "No football player has ever gotten stuck in one.") In the case of the AIRIS II, the field strength is 0.3T, an order of magnitude weaker than today's top-of-the-line machines.
Chao began using the AIRIS II exclusively when he put the Artoscan M in mothballs, but for an extended period he failed to keep up its maintenance. An MRI physicist conducting a routine inspection noticed calibration issues in the AIRIS II, and in 2011 the repair company advised Chao to have it adjusted. Chao declined, the executive says.
As a result, Chao's AIRIS II lost its accreditation from the American College of Radiology. The ACR has accredited more than 35,000 facilities, and while the program is voluntary, beginning in 2012 it became mandatory for certain types of Medicare reimbursement. It's not known if Chao has since gotten the recommended repairs to his machine, but it still lacks accreditation from both of the major agencies.
The players likely know none of this, and it might not make a difference: They adore Chao. That he performs 90 percent of player surgeries, reads the report of the NFL-convened panel that cleared him, indicates "the high regard the players, medical staff and team have for him." Chargers players speak highly of Chao According to a person close to current and former Chargers players, they view him as a friend and a drinking buddy who happens to have a prescription pad.
One of those buddies was Junior Seau, who was very close to Chao while playing, and who continued to use him as his personal physician until his suicide last year. Chao still serves on the board of directors of the Junior Seau Foundation, a position he's held since at least 2002. Seau officiated at Chao's 2011 wedding. "David loved Junior with all his heart and soul," former Charger Mark Walczak told USA Today.
In 2007 two women sued Seau, claiming that after meeting him at the Gaslamp's popular Side Bar, Seau turned ugly, threw drinks on them, told one to "put your shirt on, your tits are too small," and the other to "get on a treadmill, you cunt." The women's lawyer said Seau was out drinking with David Chao that night. He'd sent Chao to the women's table to invite them over.
After Seau's death, Chao continued to hand out inspirational photos of the late player, including to athletes in the X Games, for which Chao serves as the chief medical officer. (Chao was on the scene in January, when Caleb Moore was struck by his snowmobile. Moore was diagnosed with a concussion and sent to the hospital. He died a week later, after heart and brain complications arose. It's not clear if Chao had any role in Moore's treatment.)
In August 2012, the San Diego County Medical Examiner's office released the findings from Seau's autopsy. (It can be found at bottom.) His toxicology report revealed the presence of Zolpidem, the prescription sedative commonly sold as Ambien. More Ambien was found in Seau's house. The "investigative narrative" notes that Seau was under the care of Chao.
Seau long battled insomnia. According to lawsuits filed by his parents and his four children, he had also been suffering from "severe depression." The FDA-approved labeling for Ambien urges caution when administering it to patients whose sleep troubles persist, and to patients "exhibiting signs of symptoms of depression" and warns that the medication could make those symptoms worse:
In primarily depressed patients, worsening of depression, including suicidal thinking, has been reported in association with the use of sedative/hypnotics.
"Confusion," "dementia," and "suicide attempts" are specifically listed as adverse effects that cropped up in clinical trials. The level of Zolpidem in Seau's body was consistent with ingestion fewer than 90 minutes prior to his death.
"I understand that he and Dr. Chao were close friends," Chao's attorney tells us. He adds: "Of the few people Seau noted in his Chargers Hall of Fame speech he mentioned Dr. Chao. He publicly and with great passion thanked Dr Chao many times for keeping him healthy. The issue you raise seems ridiculous."...
Read more, including lots of official documents, HERE.
Barry Petchesky
Deadspin
4/24/13
The California Medical Board believes that David Chao should lose his medical license. Nearly two dozen former patients who have sued him since 1998—alleging in all the medical superfecta of malpractice, personal injury, negligence, and fraud—would agree. Dissenting: the NFL and the San Diego Chargers, for whom Chao has served as team physician for the past 15 years.
The Chao dossier is lengthy. Two drinking-and-driving citations. A DEA investigation. Accusations that he enabled his former partner's prescription-drug habit. Four lawsuits from former Chargers he had treated. In early 2011, reporter Brent Schrotenboer, Chao's most dedicated watchdog, counted 20 lawsuits filed against Chao since 1998, with at least eight of those "settled with payouts to plaintiffs." Another was decided last summer, when Chao was found liable for negligence and fraud in the case of a 15-year-old girl, Whitney Engler, who had been disfigured in the course of Chao's treatment.
As far as the NFL is concerned, all of this is irrelevant. Last year, the NFL Players Association asked the league for a formal review of Chao's history. But the three-man independent panel hearing the case, per the collective-bargaining agreement, was not supposed to take into account the many suits stemming from Chao's private practice, or his own arrests, or even claims of perjury. Quietly, in February, Chao was "totally exonerated" by the panel, which dismissed the medical malpractice suits as irrelevant to "the quality of care that he provides to the San Diego Chargers players."
In recent weeks, we've learned some more supposedly irrelevant things about Chao, a Harvard- and Northwestern-trained orthopedic surgeon. Like a license hearing pursued by an aggressive California attorney general who wants to know why Chao was ordering vodka at a nightclub while one of his patients was losing a leg. Or a medical repair executive who tells us that Chao's MRI machines were outdated, inaccurate, and poorly maintained. Or a San Diego coroner's report that found a prescription sedative in the system of Junior Seau, for whom Chao acted as drinking buddy and personal physician.
NFLPA executive director DeMaurice Smith, in brief remarks before Chao had been exonerated by the panel, said, "It seems to me that the players of the National Football League deserve to have a doctor who's not been found liable of malpractice."
California also thinks its citizens deserve better than Chao. This past July, before the NFL's review, the state medical board filed a formal complaint against him. The board seeks to suspend or revoke his license, citing "repeated negligent acts."
That Chao remains the Chargers' doctor even now, amid a hail of accusations and universally terrible PR for both the team and league, owes less to his ability to treat his patients than to the unresolved conflict at the heart of the modern NFL: How can the league keep players safe and healthy without being legally responsible for the safety and health of the players?
This isn't the first time the state of California has gone after David Chao. In 2002, the medical board fined him for writing Gary Losse's prescriptions. Losse, Chao's former partner, was addicted to prescription painkillers, according to depositions of coworkers. A pharmacy technician testified that Chao regularly wrote the prescriptions and charged them to Losse's personal account. Losse and Chao were sued by former Charger DB Mark Montreuil, who claimed Losse had operated on his knee injury while high. Montreuil never played again, and he reached an out-of-court settlement with the two doctors. According to Losse's longtime nurse, a partner at the clinic told her that in 1998 the Chargers had pressured Losse to step down because of the drug use. Losse would leave the medical field altogether. Chao and another partner inherited his contract with the team, and in 2002 Chao became the sole, official scalpel of the Chargers.
In 2010, drug enforcement agents searched Chao's office after learning of more than 100 prescriptions apparently made out to himself. (The DEA became involved after the arrest of former Charger Kevin Ellison, who was found with a large stash of illegally obtained Vicodin pills.) The investigation was closed two years later, with the DEA saying Chao was not suspected of using the pills himself, and that "with the DEA's guidance, Dr. Chao's controlled substance record keeping is now in compliance."
In 2011, the medical board filed another complaint, to address Chao's two citations for drinking and driving. The second DUI had taken place in 2006, and Chao was accused of failing to disclose it while applying for a license to evaluate worker's compensation claims. (He would be disqualified for the license when it emerged that he had lied on his forms. He "knowingly [made] material misrepresentations under penalty of perjury," according to the director of the state's worker's comp division.)
The complaint revealed that the first thing Chao had told police upon being pulled over was that he worked for the Chargers:
Chao would testify that his blood alcohol content, 0.11, was measured three hours after the last of his two drinks and might have been high due to his Asian genes. Matthew Davis, a California deputy attorney general arguing on behalf of the board, said Chao's testimony "stretches credibility."
In his defense, Chao had himself examined by a board-certified psychiatrist, Stephen Sobel, who reported that Chao did not and does not abuse alcohol. That Sobel has served as the Chargers' "consulting psychiatrist" since 2003 was not brought up.
Davis, in his closing argument, declared that "sound judgment is part and parcel to the qualifications and duties of a physician. The DUI conviction evidences a problem in that area." The judge officially reprimanded Chao, recommending probation, a further psychiatric exam, and ethics training (that decision can be found at the bottom of this page).
The most recent complaint, the one the medical board argues should get Chao's license taken away, cites three negligence cases that took place between 2007 and 2010. One case involved Kathleen Adams, who was crippled by a botched hip replacement and won a $2.2 million payout from Chao. (Chao would later sue the makers of the surgical scissors used in the operation.)
A second patient had dangerous blood loss from "significant blood vessel lacerations" during hip replacement surgery. A third, in for a knee replacement, suffered deep venous thrombosis and a pseudoaneurysm.
The full document, which can be found at bottom, lists the board's executive director, Linda Whitney, as the complainant. It requests a hearing for Chao before the Office of Administrative Hearings, where the state's case will be argued by the attorney general's office—in this case, Matthew Davis. It closes with this request for action:
There are plenty of former patients who aren't cited in the complaint—yet. Like Whitney Engler, a teenage track star left disfigured after undergoing minor knee surgery in 2003. For her recovery, Chao prescribed a controversial cold-therapy device called Polar Care—and did not disclose that he and his company made money by renting it to her.
He'd had trouble with the machine in the past. In 2002, he settled out of court with a SeaWorld performer who had suffered frostbite after using the device. Engler suffered similar pain and tissue damage from the treatment. In her lawsuit, she claimed that Chao had played dumb about the device's history. "I asked him specifically if he knew what could have caused this," she told a reporter, "and he said, 'I don't know, I've never seen anything like this before.'"
On July 31, four days after the state medical board filed its complaint, Engler was awarded more than $12 million in total compensatory and punitive damages, split between the three defendants. (A jury assigned 50 percent of the responsibility for her harm to Chao. The clinic came in for 10 percent; Polar Care's manufacturer, 40 percent.) In the verdict, Chao's legal team was accused of some pretty underhanded tactics:
The [defendants] engaged in a number of ill-conceived strategies to derail the litigation, including hiding the location of witnesses, failing to produce witnesses, and engaging in a clandestine attempt to disqualify [Plaintiff's] counsel. In one such plot, they claimed that they dummied up a letter from Dr. Chao's attorneys, addressed to Dr. Chao, which contained incriminating information, with the idea that it would be leaked by someone to [Plaintiff's] counsel, and then they would be able to successfully move to have [Plaintiff's] counsel disqualified.
In an email to us, Chao's attorney, Robert Frank, writes that "Whitney Engler agreed, as did her expert orthopedic witnesses, that the knee surgery performed by Dr. Chao was excellent and allowed her to return to high school competitive sports, where she qualified for and succeeded in California state track events. Her case was not about the orthopedic surgery performed by Dr Chao. Instead it was a product liability case about a postoperative cold therapy healing device."
Then there's Tom Fagan, who in 2007 came in for a knee replacement and lost a leg while Dr. Chao was out at a nightclub.
It's good for business to be a sports franchise's "head team physician." (According to court documents filed in the Engler case, Chao's net worth is about $3.4 million, with an annual income between $700,000 to $1.4 million in recent years.) That's why many health-care providers actually pay for the right, though Chao's medical group only offers the Chargers reduced rates. Whatever the quid pro quo, it's a baroque, conflicted arrangement that often pits a doctor's sworn duty to an athlete's health against his responsibility to the team that pays him.
Fagan, a then-53-year-old artist and a big football fan (and former college player), specifically chose Chao for his surgery because of his association with the team. He saw Chao's ad in every gameday program, placed for free. He saw Philip Rivers prominently displayed on Chao's website. When he first walked into the doctor's office, he was greeted by framed photos of Chargers players and other star athletes through the years. You can see some of them on the "Patients in Action" section of Chao's site.
Fagan writes in an email that he went to Chao thinking "he was the best, naively assuming that if the Chargers had employed him for so long he had to be. ... The Chargers' doctor must be the top surgeon at least in San Diego."
On Feb. 9, 2007, Fagan underwent a knee replacement at Scripps Memorial Hospital in La Jolla, with Chao overseeing the operation. That evening, according to nurses' notes, Fagan began experiencing pain and swelling in his leg consistent with Compartment Syndrome, a dangerous condition that affects circulation. Nurses attempted to locate Chao, but he had left the hospital. And, against hospital rules, he had failed to appoint another physician responsible for Fagan's care.
The Chargers' Doctor Is A Drunk Quack. Why Haven't They Fired Him?Expand
"I came very close to dying," Fagan remembers.
The nurses' notes record that by 1:45 a.m., Fagan's condition had worsened to the point where the doctor on call in the emergency room had to be summoned. After performing a test, she called Chao. Fagan had a blood clot, the ER doctor suspected, and needed an operation to restore circulation. Chao said he was unable to come in. By 4 a.m., when emergency surgery was performed (not by Chao), Fagan's leg was beyond saving. Three months later, it was amputated.
"I believe it was the next morning Chao showed up with his story about going to L.A. to see his mother," Fagan recalls. "When I did ask him what went wrong, he just said it was a very difficult surgery, whatever that meant."
Where was David Chao while his patient crossed the point of no return? Chao told the court the same thing he had told Fagan. According to his May 15, 2008, deposition in Fagan's lawsuit (found at bottom), he was in his car, driving north to Los Angeles to visit his sick mother.
Chao was placed under oath, and examined by Fagan's lawyer, Janice Mulligan:
Q. With whom did you drive?
A. By myself.
Q. Where did you go?
A. I was heading to my mom's house.
[...]
Q. Can you give us your best estimate as to approximately what time you left your house on the evening of February 9th with the intent of driving to Los Angeles?
A. It was late at night. It was something that I thought about doing earlier in the day, because my mom wasn't feeling that well. And in any case I had given some thought about going up earlier in the evening, decided not to because I hate driving in traffic, and it was later that night that I decided, well, if I were to go up now and not miss sleeping, and I'm kind of worried about her, there isn't going to be much traffic. And then I could go up and at least see her in the morning and zip right back down to my other commitments.
In Chao's sworn deposition, he answered dozens of questions about driving to his mother's, filling in some details when pressed, failing to recall others. He played up his role as a dutiful child: "I was primarily going up there as a son that feels guilty that I haven't seen her very often," he said, "and that she was alone and not feeling well."
A. Without being overly melodramatic, my mom is not the kind of person that if it really were bad to say that it's really bad. She's always going to say, as an immigrant, her personality and whatever, she's going to say no, I'm fine; I know you're busy. And I wasn't — I'm not suggesting that I was speeding up there to save her life in any way, shape or form, but I'm not sure where she was. My assumption was that she just wasn't feeling that well and there was nothing to take her to the emergency room for or anything else, but perhaps my peace of mind would be better having just seen her.
About a year later, Chao was ordered to produce proof of his whereabouts that night. His lawyer sheepishly turned in a receipt. The purchases were redacted, but it showed Chao was at the Belo nightclub in the Gaslamp Quarter ("San Diego's only true superclub!") at the exact time the hospital was desperately trying to reach him.
Janice Mulligan launched her own investigation into the receipt and discovered that Chao had run up a tab of over $300 at Belo, including an entire bottle of vodka. The waitress serving the doctor that night remembered him well, Mulligan noted in a memo, because Chao had "stiffed her on her tip."
Chao settled with Fagan out of court, which allowed the doctor to avoid any potential liability.
(One of Chao's insurers would go to court in an attempt to recover costs for defending Chao and paying out the malpractice settlement. Documents from that case, including a 2011 Los Angeles Superior Court Statement of Decision, provide a glimpse into the evidence produced against Chao and can be found at bottom.)
When the medical board initially declined to pursue a case against Chao over his handling of Tom Fagan, Mulligan wrote a letter to Patricia Stillwell, a board investigator. Mulligan was astounded that the state would let the matter go.
Not only did we provide your office with evidence of Dr. Chao's negligence, we also provided you with incontrovertible evidence of him committing perjury in his deposition and black and white evidence of his real whereabouts on the night in question- both in the form of a receipt and phone records.
Mulligan offered to provide two experts "who both were outraged by Dr. Chao's conduct," and who would "testify that his conduct fell far below the requisite standard of care." Mulligan closed with this:
Based on Dr. Chao's track record, it is only a matter of time before another patient is injured or killed because of Dr. Chao's recklessness. Will the Medical Board please reconsider its position on this case before it is too late?
When asked about the Fagan case, Robert Frank, Chao's attorney, writes in an email: "There was not any finding of malpractice by Dr. Chao." He added: "The California Medical Board reviewed Dr Chao's care of Mr Fagan and exonerated him. You know they would not have done so had there been any wrongdoing by Dr. Chao given the medical board's history with Dr. Chao."
We're told that Deputy AG Matthew Davis, representing the medical board, isn't necessarily done building his case. The attorney general's office declined comment, citing the ongoing action, but a person familiar with the process says Whitney Engler's and Tom Fagan's cases, among others, could be included in an amended medical board complaint. Because of that possibility, a hearing and decision in Chao's case may not happen until 2014, when his medical license is set to expire.
Accusations of substandard care extend all the way to Chao's medical equipment. Deadspin spoke with an executive at a medical repair company, one that maintained the MRI machines at Chao's office until 2011, when it stopped servicing the clinic after a dispute over unpaid bills. The company won a judgment against the clinic, says the executive, who requested anonymity because they still haven't been paid.
Chao's clinic owns two MRI machines, with which he scanned both NFL players and regular patients. One of Chao's machines, the executive says, "was in worse condition than any MRI I'd ever seen." The other lost its national accreditation after Chao refused to have it serviced.
The older, smaller machine was the Lunar Artoscan M extremity scanner, which the executive calls "arguably the lowest-quality MRI that's capable of doing a knee scan that's in use in America." It surely wasn't in widespread use: The Artoscan M, introduced in 1993, was phased out for its successor in 2004. GE, which had acquired Lunar Corp., junked its stockpile around 2006.
The last time Chao's machine was examined was in 2008, when the executive told him it would be cheaper to buy a new, more modern machine than to fix everything wrong with it. Chao declined to do either.
The executive believes Chao stopped using his Artoscan M soon after, but the images obtained with it are still around. This very much matters, the executive says, because the scans can be more difficult to read than those from higher-quality machines—the details aren't nearly as fine.
The tesla (T) is a unit of measurement of magnetic field strength. It's used to calibrate the imaging power of an MRI machine. Today, the industry standard is at least 1.5T, with 3T becoming widespread. The Artoscan-M has a magnet capable of just 0.2T.
"You don't know what you cannot see" on a diagnostic scan, the executive says, and even today, radiologists consulting the files of Chao's patients may be working with fuzzy images. According to one sports-medicine specialist who has worked for a pro sports team, it's entirely possibly to miss subtle tears in cartilage or ligaments when consulting lower-definition images. To this, Chao's attorney responds that "the radiologists who read the MRI studies from Dr. Chao never complained about the quality of the MRI machines and felt very comfortable putting their names on the reports interpreting the studies."
Chao's other full-body MRI machine was a Hitachi AIRIS II, introduced in 1999. It's relatively modern, the executive says, but still "at the lower end of the quality spectrum." It's a so-called open MRI, which is more comfortable for larger or claustrophobic patients. But the trade-off is that it will necessarily have a weaker field strength. (Our sports-medicine specialist says there's no reason athletes can't use a closed MRI: "No football player has ever gotten stuck in one.") In the case of the AIRIS II, the field strength is 0.3T, an order of magnitude weaker than today's top-of-the-line machines.
Chao began using the AIRIS II exclusively when he put the Artoscan M in mothballs, but for an extended period he failed to keep up its maintenance. An MRI physicist conducting a routine inspection noticed calibration issues in the AIRIS II, and in 2011 the repair company advised Chao to have it adjusted. Chao declined, the executive says.
As a result, Chao's AIRIS II lost its accreditation from the American College of Radiology. The ACR has accredited more than 35,000 facilities, and while the program is voluntary, beginning in 2012 it became mandatory for certain types of Medicare reimbursement. It's not known if Chao has since gotten the recommended repairs to his machine, but it still lacks accreditation from both of the major agencies.
The players likely know none of this, and it might not make a difference: They adore Chao. That he performs 90 percent of player surgeries, reads the report of the NFL-convened panel that cleared him, indicates "the high regard the players, medical staff and team have for him." Chargers players speak highly of Chao According to a person close to current and former Chargers players, they view him as a friend and a drinking buddy who happens to have a prescription pad.
One of those buddies was Junior Seau, who was very close to Chao while playing, and who continued to use him as his personal physician until his suicide last year. Chao still serves on the board of directors of the Junior Seau Foundation, a position he's held since at least 2002. Seau officiated at Chao's 2011 wedding. "David loved Junior with all his heart and soul," former Charger Mark Walczak told USA Today.
In 2007 two women sued Seau, claiming that after meeting him at the Gaslamp's popular Side Bar, Seau turned ugly, threw drinks on them, told one to "put your shirt on, your tits are too small," and the other to "get on a treadmill, you cunt." The women's lawyer said Seau was out drinking with David Chao that night. He'd sent Chao to the women's table to invite them over.
After Seau's death, Chao continued to hand out inspirational photos of the late player, including to athletes in the X Games, for which Chao serves as the chief medical officer. (Chao was on the scene in January, when Caleb Moore was struck by his snowmobile. Moore was diagnosed with a concussion and sent to the hospital. He died a week later, after heart and brain complications arose. It's not clear if Chao had any role in Moore's treatment.)
In August 2012, the San Diego County Medical Examiner's office released the findings from Seau's autopsy. (It can be found at bottom.) His toxicology report revealed the presence of Zolpidem, the prescription sedative commonly sold as Ambien. More Ambien was found in Seau's house. The "investigative narrative" notes that Seau was under the care of Chao.
Seau long battled insomnia. According to lawsuits filed by his parents and his four children, he had also been suffering from "severe depression." The FDA-approved labeling for Ambien urges caution when administering it to patients whose sleep troubles persist, and to patients "exhibiting signs of symptoms of depression" and warns that the medication could make those symptoms worse:
In primarily depressed patients, worsening of depression, including suicidal thinking, has been reported in association with the use of sedative/hypnotics.
"Confusion," "dementia," and "suicide attempts" are specifically listed as adverse effects that cropped up in clinical trials. The level of Zolpidem in Seau's body was consistent with ingestion fewer than 90 minutes prior to his death.
"I understand that he and Dr. Chao were close friends," Chao's attorney tells us. He adds: "Of the few people Seau noted in his Chargers Hall of Fame speech he mentioned Dr. Chao. He publicly and with great passion thanked Dr Chao many times for keeping him healthy. The issue you raise seems ridiculous."...
Read more, including lots of official documents, HERE.
Wednesday, May 15, 2013
Medical Board of California, led by Kaiser doctor Sharon Levine, has an inept, do-nothing approach to oversight
Legislature should pull plug on inept Medical Board of California
Legislators should sunset the medical board's do-nothing, know-nothing membership and executive director, and start over fresh.
By Michael Hiltzik
Los Angeles Times
April 26, 2013
The time has come to put the Medical Board of California out of its misery.
The board oversees the licensing of doctors and their discipline for misdeeds or incompetence. It also has jurisdiction over doctor-owned surgical clinics. Long ago the board acquired the reputation of being one of the least effective regulatory bodies in Sacramento.
But evidence has mounted that it's worse: It's a danger to the community.
Because of its ineffectiveness in a variety of spheres, patients have died. Dangerous doctors have been allowed to continue operating for years after their malpractice first surfaced; surgical clinics allowed to remain open for years after dangerous conditions there were identified.
Today the board is facing a sort of medical crisis of its own: It's up for legislative re-authorization under the state's sunset rules. The legislators in charge of that procedure are talking about rubbing out the current membership and their executive director as of Jan. 1, and starting over fresh.
"That's not an idle threat," says Sen. Curren Price (D-Los Angeles), who chairs the board's sunset review with Assemblyman Richard Gordon (D-Menlo Park).
Let's hope not.
The board has sat inertly by while its disciplinary program against incompetent and dangerous doctors falls to pieces. Its regulation of the 1,200 physician-owned outpatient surgical centers under its jurisdiction — settings where patients routinely undergo surgery under potentially life-threatening conditions — is almost nonexistent.
"People are dying at these outpatient centers and your paramount responsibility is to keep that from happening," Julie D'Angelo Fellmeth, a San Diego public interest lawyer who was appointed by the legislature to monitor the board's enforcement program in 2003-2005, lectured the members last week. One would think the board knew that, but the news seemed to strike the members like a bolt from the blue.
The board's enforcement record is dismal. Since 2007 California has typically ranked among the worst states in terms of serious disciplinary actions per 1,000 licensed physicians; the public interest group Public Citizen reported in 2011 that the board had failed to take action against more than 700 physicians whose privileges had been reduced or revoked by hospitals or other clinical settings, including 102 who had been found to pose an "immediate threat" to patients.
The board says statewide hiring freezes and furloughs have eroded its enforcement staff. But in 2010 it was given the authority to hire 18 investigators despite the freeze. It still hasn't filled the positions.
The real crime of the medical board's nonfeasance is that it's a fraud on the public. Today's board is largely the product of a major change in malpractice oversight in 1975. That's when the legislature enacted MICRA, the Medical Injury Compensation Reform Act, to address a largely fabricated malpractice insurance "crisis." MICRA limited payouts for malpractice judgments so severely that it effectively made malpractice lawsuits extinct in California.
In return for the elimination of patient lawsuits as a check on dangerous doctors, the medical profession agreed to accept tougher disciplinary standards and procedures from regulators. After a few more legislative tweaks, the medical board was born.
But the promise of tougher enforcement never was fulfilled. The legislature and governor's office deserve plenty of blame for that. Although the board is funded entirely from license fees paid by doctors, not from taxpayer revenue, it wasn't exempted from the layoffs and furloughs imposed by the Schwarzenegger administration as budget-cutting measures. Meanwhile, medical lobbies such as the California Medical Assn. have opposed efforts to increase license fees to adequately fund the board's activities.
The board, which by law comprises eight physicians and seven "public" members, is unpaid except for expenses and per diems while on official business. (Four seats subject to appointment by Gov. Jerry Brown are currently vacant.) Californians get what they pay for: The members don't seem to have any conception of the breadth of their authority, and precious little inclination to use it.
That was made evident by board President Sharon Levine's appearance on March 11 before the sunset committee headed by Price and Gordon. Levine, an executive at Kaiser Permanente, made some remarkable assertions in her testimony. For example, she excused the board's terrible record on discipline by explaining that it must wait for a complaint from a patient or other outside source before opening an investigation of a doctor.
In deference to Levine's tenure on the medical board, which started in 2009 (she became president last year), I'm inclined to take a charitable view of this statement. So I'll merely call it the single most ignorant description by a government regulator of his or her authority I've heard in 30 years.
The fact is that the board has all the power it needs to act on its own, with or without a complaint; indeed, such proactivity is the hallmark of effective state medical boards. In a blistering letter following the hearing, Price and Gordon cited the specific provision of California law that "unequivocally authorizes" the board to initiate its own investigations.
More blunders came when Levine addressed the board's oversight of outpatient surgery centers owned by physicians, which came under its jurisdiction as the result of a state court ruling in 2007.
The board has outsourced oversight of these clinics, which perform an increasing number of such serious procedures as weight-loss and cosmetic surgeries, to four private, nonprofit accreditation organizations. These accreditors are not government regulators. They don't have subpoena power or the authority to close down a dangerous clinic, and they don't have consistent standards or procedures for granting accreditation.
Legislators should sunset the medical board's do-nothing, know-nothing membership and executive director, and start over fresh.
By Michael Hiltzik
Los Angeles Times
April 26, 2013
The time has come to put the Medical Board of California out of its misery.
The board oversees the licensing of doctors and their discipline for misdeeds or incompetence. It also has jurisdiction over doctor-owned surgical clinics. Long ago the board acquired the reputation of being one of the least effective regulatory bodies in Sacramento.
But evidence has mounted that it's worse: It's a danger to the community.
Because of its ineffectiveness in a variety of spheres, patients have died. Dangerous doctors have been allowed to continue operating for years after their malpractice first surfaced; surgical clinics allowed to remain open for years after dangerous conditions there were identified.
Today the board is facing a sort of medical crisis of its own: It's up for legislative re-authorization under the state's sunset rules. The legislators in charge of that procedure are talking about rubbing out the current membership and their executive director as of Jan. 1, and starting over fresh.
"That's not an idle threat," says Sen. Curren Price (D-Los Angeles), who chairs the board's sunset review with Assemblyman Richard Gordon (D-Menlo Park).
Let's hope not.
The board has sat inertly by while its disciplinary program against incompetent and dangerous doctors falls to pieces. Its regulation of the 1,200 physician-owned outpatient surgical centers under its jurisdiction — settings where patients routinely undergo surgery under potentially life-threatening conditions — is almost nonexistent.
"People are dying at these outpatient centers and your paramount responsibility is to keep that from happening," Julie D'Angelo Fellmeth, a San Diego public interest lawyer who was appointed by the legislature to monitor the board's enforcement program in 2003-2005, lectured the members last week. One would think the board knew that, but the news seemed to strike the members like a bolt from the blue.
The board's enforcement record is dismal. Since 2007 California has typically ranked among the worst states in terms of serious disciplinary actions per 1,000 licensed physicians; the public interest group Public Citizen reported in 2011 that the board had failed to take action against more than 700 physicians whose privileges had been reduced or revoked by hospitals or other clinical settings, including 102 who had been found to pose an "immediate threat" to patients.
The board says statewide hiring freezes and furloughs have eroded its enforcement staff. But in 2010 it was given the authority to hire 18 investigators despite the freeze. It still hasn't filled the positions.
The real crime of the medical board's nonfeasance is that it's a fraud on the public. Today's board is largely the product of a major change in malpractice oversight in 1975. That's when the legislature enacted MICRA, the Medical Injury Compensation Reform Act, to address a largely fabricated malpractice insurance "crisis." MICRA limited payouts for malpractice judgments so severely that it effectively made malpractice lawsuits extinct in California.
In return for the elimination of patient lawsuits as a check on dangerous doctors, the medical profession agreed to accept tougher disciplinary standards and procedures from regulators. After a few more legislative tweaks, the medical board was born.
But the promise of tougher enforcement never was fulfilled. The legislature and governor's office deserve plenty of blame for that. Although the board is funded entirely from license fees paid by doctors, not from taxpayer revenue, it wasn't exempted from the layoffs and furloughs imposed by the Schwarzenegger administration as budget-cutting measures. Meanwhile, medical lobbies such as the California Medical Assn. have opposed efforts to increase license fees to adequately fund the board's activities.
The board, which by law comprises eight physicians and seven "public" members, is unpaid except for expenses and per diems while on official business. (Four seats subject to appointment by Gov. Jerry Brown are currently vacant.) Californians get what they pay for: The members don't seem to have any conception of the breadth of their authority, and precious little inclination to use it.
That was made evident by board President Sharon Levine's appearance on March 11 before the sunset committee headed by Price and Gordon. Levine, an executive at Kaiser Permanente, made some remarkable assertions in her testimony. For example, she excused the board's terrible record on discipline by explaining that it must wait for a complaint from a patient or other outside source before opening an investigation of a doctor.
In deference to Levine's tenure on the medical board, which started in 2009 (she became president last year), I'm inclined to take a charitable view of this statement. So I'll merely call it the single most ignorant description by a government regulator of his or her authority I've heard in 30 years.
The fact is that the board has all the power it needs to act on its own, with or without a complaint; indeed, such proactivity is the hallmark of effective state medical boards. In a blistering letter following the hearing, Price and Gordon cited the specific provision of California law that "unequivocally authorizes" the board to initiate its own investigations.
More blunders came when Levine addressed the board's oversight of outpatient surgery centers owned by physicians, which came under its jurisdiction as the result of a state court ruling in 2007.
The board has outsourced oversight of these clinics, which perform an increasing number of such serious procedures as weight-loss and cosmetic surgeries, to four private, nonprofit accreditation organizations. These accreditors are not government regulators. They don't have subpoena power or the authority to close down a dangerous clinic, and they don't have consistent standards or procedures for granting accreditation.
Saturday, August 4, 2012
Philanthropist’s death sparks lawsuit against UCLA psychiatrist who was treating her
Philanthropist’s death sparks lawsuit against UCLA psychiatrist who was treating her
By Associated Press
August 4, 2012
Philanthropist's Death Sparks Unusual Lawsuit
By LINDA DEUTSCH
August 4, 2012 (AP)
When former model and philanthropist Phyllis Harvey died last year at the age of 59, little note was taken. Brief paid obituaries appeared in Los Angeles and her hometown paper in North Carolina.
There was no mention of how she died. Nothing was said about her struggle with alcoholism and mental illness. And there was no reference to one of the final projects she helped fund with nearly a half million dollars.
Those details now figure prominently in a medical board complaint and wrongful death lawsuit claiming her psychiatrist coaxed $490,000 in research funding from her while she was under powerful doses of psychotropic drugs that eventually killed her.
The suit filed on behalf of Brian Harvey by attorney Daniel M. Hodes accuses University of California, Los Angeles psychiatrist Dr. Alexander Bystritsky of causing Phyllis Harvey's death with a dangerous combination of drugs that altered her heart rhythm.
Hodes says that Mrs. Harvey was hospitalized several times for heart abnormalities associated with drugs, and that emergency room doctors discontinued her medications only to have Bystritsky resume giving them to her when she was discharged.
Brian Harvey earned a fortune by selling an invention for coating electronic wires with recycled metal from beer cans. Following the sale of his company, he and his wife formed the Brian and Phyllis Harvey foundation to fund scholarships and other donations. The lawsuit claims Bystritsky knew of the couple's wealth and charitable giving and insinuated himself into their lives with house calls, long chats and email with Phyllis Harvey while treating her undiagnosed mental illness. He allegedly touted his own credentials and convinced her to give large donations to research a device that might cure her.
The claim that a physician solicited research funds from a patient provides a new wrinkle in the debate over the relationship between doctors, wealthy patients and the overuse of prescription drugs.
"Was he continuing to treat her with these high-powered drugs to keep her as a patient?" said James J. Walter, a professor at the Center on Bioethics at Loyola Law School. "Every bioethicist would say that practice should be discouraged."
The lawsuit filed in Los Angeles County Superior Court claims wrongful death due to medical negligence, fraud, fraudulent concealment and intentional infliction of emotional distress.
Numerous phone messages left for Bystritsky and his lawyer by The Associated Press were not returned.
The suit also names the UC Board of Regents as defendants, noting that they sent glowing letters of thanks to the Harveys for their donations.
A spokeswoman for UCLA said she could not discuss medical specifics because of privacy concerns but said UCLA will contest the lawsuit.
"The UCLA health care system is committed to the highest standards of patient care and safety," said spokeswoman Roxanne Moster. "This is a regrettable and unfortunate case for everyone involved and we extend our deepest sympathies to members of the Harvey family for their loss."
Bystritsky began treating Harvey in 2004, five years after she was diagnosed as possibly suffering from bipolar disorder, early dementia or schizophrenia, according to documents in the case.
None of those diagnoses was ever fully confirmed by tests and Bystritsky soon had her on a regimen of several psychotropic drugs including Seroquel, a powerful anti-psychotic, said John Harwell, a lawyer who filed a complaint with the Medical Board of California last November on behalf of Brian Harvey.
The lawyers contend that drug, which is known to alter heart rhythm, killed her when she died in her bed April 5, 2011.
"Mrs. Harvey died from sudden cardiac death," Harwell told the medical board, "the very kind of consequence warned against by the FDA in its required Black Box Seroquel warnings, the ones Dr. Bystritsky either ignored or of which he was ignorant."
The medical board declined to comment on whether a complaint is pending before it.
Harvey had overcome alcoholism when she was younger, but she relapsed after her mother's death in 2009, Harwell said. During one of several hospital admissions, she told a doctor she was drinking a bottle of liquor a day along with the sedative Ativan, a potentially lethal combination.
In the two months before her death, the lawyers said she was receiving nine different drugs including benzodiazepine sedatives, Invega, a drug for schizophrenia, and Seroquel which was prescribed by Bystritsky at 180 tablets in 17 days.
Heavy doses of drugs in large volumes led to hospitalizations for overdoses of benzodiazepines, leading to falls, disorientation and intoxication, Harwell said. Emergency room doctors discontinued her medications, but Bystritsky resumed giving them when she was discharged. At times, he said, she became delirious and had hallucinations that bugs were crawling on her skin.
The lawsuit claims that the psychiatrist told Harvey he might be able to cure her with a device he invented, but that he said he needed more money to continue research on the machine.
An Internet search shows that Bysrtritsky, who heads the anxiety disorders program at UCLA, was a partner in a privately held company called Brainsonix which is collaborating with UCLA and Harvard Medical School on an ultrasound device to modulate brain function and treat brain disorders including depression, autism, Parkinson's Disease, epilepsy, obesity and other ailments.
His list of credentials shows that he was trained in neuroscience, psychopharmacology and psychiatry at Pavlov Medical Institute in Russia, New York University and UCLA. He also is a visiting full professor at Harvard University School of Medicine.
Harvey declined to seek criminal charges against Bystritsky because that might have required proving he intended to harm his patient, attorney Hodes said.
Experts said the case would be divided into two issues — the standard of care provided and ethical considerations involved in soliciting donations from a patient.
If true, "It would be a horrible indictment of the fund raising efforts of UCLA," said Donna Darling, a former New York assistant district attorney who now represents plaintiffs in medical malpractice suits. "They should have known she was a patient."
Attorney Harland Braun, who has represented doctors in malpractice cases, said Bystritsky may raise a strong defense that he was trying to help a gravely ill patient and had no intent to harm her. The fact that money was donated to his research, he said, suggests no desire for personal enrichment.
"Jurors have a tendency to trust doctors," said Braun, "and If you can't show the doctor had a motive to do harm, jurors will side with him."
By Associated Press
August 4, 2012
Philanthropist's Death Sparks Unusual Lawsuit
By LINDA DEUTSCH
August 4, 2012 (AP)
When former model and philanthropist Phyllis Harvey died last year at the age of 59, little note was taken. Brief paid obituaries appeared in Los Angeles and her hometown paper in North Carolina.
There was no mention of how she died. Nothing was said about her struggle with alcoholism and mental illness. And there was no reference to one of the final projects she helped fund with nearly a half million dollars.
Those details now figure prominently in a medical board complaint and wrongful death lawsuit claiming her psychiatrist coaxed $490,000 in research funding from her while she was under powerful doses of psychotropic drugs that eventually killed her.
The suit filed on behalf of Brian Harvey by attorney Daniel M. Hodes accuses University of California, Los Angeles psychiatrist Dr. Alexander Bystritsky of causing Phyllis Harvey's death with a dangerous combination of drugs that altered her heart rhythm.
Hodes says that Mrs. Harvey was hospitalized several times for heart abnormalities associated with drugs, and that emergency room doctors discontinued her medications only to have Bystritsky resume giving them to her when she was discharged.
Brian Harvey earned a fortune by selling an invention for coating electronic wires with recycled metal from beer cans. Following the sale of his company, he and his wife formed the Brian and Phyllis Harvey foundation to fund scholarships and other donations. The lawsuit claims Bystritsky knew of the couple's wealth and charitable giving and insinuated himself into their lives with house calls, long chats and email with Phyllis Harvey while treating her undiagnosed mental illness. He allegedly touted his own credentials and convinced her to give large donations to research a device that might cure her.
The claim that a physician solicited research funds from a patient provides a new wrinkle in the debate over the relationship between doctors, wealthy patients and the overuse of prescription drugs.
"Was he continuing to treat her with these high-powered drugs to keep her as a patient?" said James J. Walter, a professor at the Center on Bioethics at Loyola Law School. "Every bioethicist would say that practice should be discouraged."
The lawsuit filed in Los Angeles County Superior Court claims wrongful death due to medical negligence, fraud, fraudulent concealment and intentional infliction of emotional distress.
Numerous phone messages left for Bystritsky and his lawyer by The Associated Press were not returned.
The suit also names the UC Board of Regents as defendants, noting that they sent glowing letters of thanks to the Harveys for their donations.
A spokeswoman for UCLA said she could not discuss medical specifics because of privacy concerns but said UCLA will contest the lawsuit.
"The UCLA health care system is committed to the highest standards of patient care and safety," said spokeswoman Roxanne Moster. "This is a regrettable and unfortunate case for everyone involved and we extend our deepest sympathies to members of the Harvey family for their loss."
Bystritsky began treating Harvey in 2004, five years after she was diagnosed as possibly suffering from bipolar disorder, early dementia or schizophrenia, according to documents in the case.
None of those diagnoses was ever fully confirmed by tests and Bystritsky soon had her on a regimen of several psychotropic drugs including Seroquel, a powerful anti-psychotic, said John Harwell, a lawyer who filed a complaint with the Medical Board of California last November on behalf of Brian Harvey.
The lawyers contend that drug, which is known to alter heart rhythm, killed her when she died in her bed April 5, 2011.
"Mrs. Harvey died from sudden cardiac death," Harwell told the medical board, "the very kind of consequence warned against by the FDA in its required Black Box Seroquel warnings, the ones Dr. Bystritsky either ignored or of which he was ignorant."
The medical board declined to comment on whether a complaint is pending before it.
Harvey had overcome alcoholism when she was younger, but she relapsed after her mother's death in 2009, Harwell said. During one of several hospital admissions, she told a doctor she was drinking a bottle of liquor a day along with the sedative Ativan, a potentially lethal combination.
In the two months before her death, the lawyers said she was receiving nine different drugs including benzodiazepine sedatives, Invega, a drug for schizophrenia, and Seroquel which was prescribed by Bystritsky at 180 tablets in 17 days.
Heavy doses of drugs in large volumes led to hospitalizations for overdoses of benzodiazepines, leading to falls, disorientation and intoxication, Harwell said. Emergency room doctors discontinued her medications, but Bystritsky resumed giving them when she was discharged. At times, he said, she became delirious and had hallucinations that bugs were crawling on her skin.
The lawsuit claims that the psychiatrist told Harvey he might be able to cure her with a device he invented, but that he said he needed more money to continue research on the machine.
An Internet search shows that Bysrtritsky, who heads the anxiety disorders program at UCLA, was a partner in a privately held company called Brainsonix which is collaborating with UCLA and Harvard Medical School on an ultrasound device to modulate brain function and treat brain disorders including depression, autism, Parkinson's Disease, epilepsy, obesity and other ailments.
His list of credentials shows that he was trained in neuroscience, psychopharmacology and psychiatry at Pavlov Medical Institute in Russia, New York University and UCLA. He also is a visiting full professor at Harvard University School of Medicine.
Harvey declined to seek criminal charges against Bystritsky because that might have required proving he intended to harm his patient, attorney Hodes said.
Experts said the case would be divided into two issues — the standard of care provided and ethical considerations involved in soliciting donations from a patient.
If true, "It would be a horrible indictment of the fund raising efforts of UCLA," said Donna Darling, a former New York assistant district attorney who now represents plaintiffs in medical malpractice suits. "They should have known she was a patient."
Attorney Harland Braun, who has represented doctors in malpractice cases, said Bystritsky may raise a strong defense that he was trying to help a gravely ill patient and had no intent to harm her. The fact that money was donated to his research, he said, suggests no desire for personal enrichment.
"Jurors have a tendency to trust doctors," said Braun, "and If you can't show the doctor had a motive to do harm, jurors will side with him."
Saturday, January 7, 2012
San Diego Kaiser Permanente doctor turns in medical license for reportedly viewing child porn at work
Doctor turns in medical license for reportedly viewing child porn at work
Dave Thomas
San Diego News Examiner
December 22, 2011
An area doctor was prohibited from practicing medicine after he was reportedly nabbed viewing child porn in his El Cajon practice.
According to a 10News report, Dr. Mark Zweifach had to turn in his medical license earlier this month as a result of being caught looking at images of child porn while at work. Reports say Zweifach has been practicing medicine since 1982.
The California Medical Board records noted:
"In about July, August, and September 2007, Respondent, a physician with Kaiser Permanente in San Diego, California, used his Kaiser Permanente assigned computer in his office in the Kaiser Permanente Bostonia Medical Office Building, located in El Cajon, California, to access suspected child pornography websites on the internet. When confronted by Kaiser Permanente investigators, Respondent, admitted accessing the websites at work, and further admitted an addiction to internet pornography."
After it was discovered he had viewed child pornography, records show Zweifach -- who ceased working at Kaiser Permanente in 2007 -- voluntarily suspended his practice, but the board did not order him to surrender his license until this December. The board also required Zweifach to register as a sex offender.
Dave Thomas
San Diego News Examiner
December 22, 2011
An area doctor was prohibited from practicing medicine after he was reportedly nabbed viewing child porn in his El Cajon practice.
According to a 10News report, Dr. Mark Zweifach had to turn in his medical license earlier this month as a result of being caught looking at images of child porn while at work. Reports say Zweifach has been practicing medicine since 1982.
The California Medical Board records noted:
"In about July, August, and September 2007, Respondent, a physician with Kaiser Permanente in San Diego, California, used his Kaiser Permanente assigned computer in his office in the Kaiser Permanente Bostonia Medical Office Building, located in El Cajon, California, to access suspected child pornography websites on the internet. When confronted by Kaiser Permanente investigators, Respondent, admitted accessing the websites at work, and further admitted an addiction to internet pornography."
After it was discovered he had viewed child pornography, records show Zweifach -- who ceased working at Kaiser Permanente in 2007 -- voluntarily suspended his practice, but the board did not order him to surrender his license until this December. The board also required Zweifach to register as a sex offender.
Subscribe to:
Posts (Atom)