Tuesday, February 21, 2017

Dr. Death Sentenced to Life in Prison

I habitually read the news every day. As I scan headlines, I assiduously avoid various subjects that tend to increase my blood pressure. Among these are losing New Orleans Saints scores, people operating meth labs, high-speed police chases and more. 

On February 21, 2017, I read a headline that drew me in: Former Neurosurgeon Sentenced To Life In Prison For Maiming Patients. That one was catchy for a couple of reasons. Any headline with "maim" or "maiming" will likely be an attention-grabber for me, unless it is "Forty-Niners Maim the Saints Sunday." It is also attention-grabbing when you see "life in prison" in a headline. The seriousness of the topic is certainly suggested. But, "life" for "maiming," there has to be more to the story. 

I read the story. It was disturbing, but I went on with my morning. As I worked, the theme song from an old television show kept running through my thoughts. 
Come and listen to my story about a man named Jed
A poor mountaineer, barely kept his family fed,
And then one day he was shootin at some food,
And up through the ground come a bubblin crude. 
As this tune played and replayed in my thoughts, I subconsciously substituted lyrics, and the connection of this song to my morning became clearer. I re-wrote the lyric thus
Come and listen to my story about a doc named Chris
A neurosugeon god, with patients that he bled,
And then one day he was cuttin once again,
And botched up the cuttin til the lady was dead
dead that is, bled out, never coming back.
According to CBS News Dallas, Dr. Christopher Duntsch "botched" thirty-two spinal surgeries. Two of his patients are living in wheelchairs today. Two other patients are dead. These are not flattering testimonials to this physician's skill or expertise. But, the story becomes more disturbing. The jury convicted Dr. Duntsch of "intentionally injuring the patients he was supposed to be helping." This was apparently not a case of an incompetent surgeon, but a case of someone that decided to hurt people and used a position of trust to pursue a goal.

Last November, D Magazine labelled Dr. Duntsch "Dr. Death" and said he "left a trail of bodies." Its headline proclaimed "the shocking story of a madman with a scalpel." It reported that the two patients who died following surgery were Kellie Martin and Floella Brown. Ms. Martin died "from massive blood loss, and Ms. Brown's "sliced vertebral artery triggered the stroke that killed her."

According to CBS News, "prosecutors say Duntsch was malicious and reckless while he performed surgery." The recent criminal prosecution centered on victim Mary Efurd, who underwent a "botched" spinal surgery in 2012 and is now confined to a wheelchair. The doctor's conviction was for "intentionally causing serious bodily injury to an elderly person." One count, sentenced to life in prison.

According to the Dallas News, Ms. Efurd lost a third of her blood during the surgery performed (some will likely see a trend emerging here). Dr. Robert Henderson treated Efurd after the surgery. He "said Duntsch had 'done virtually everything wrong.'" Dr. Henderson's treatment revealed "implants placed in muscle instead of on bone, a screw drilled into her spinal cavity and a nerve root that had been amputated." He commented that "It's as egregious as you can imagine." 

CBS News reported that "jurors heard from several people who shared their nightmares." They testified that Dr. Duntsch "maimed them on purpose," from July 2012 and June 2013. Note that this behavior and malfeasance went on for a year. People were maimed and people died. Dr. Duntsch's attorneys argued that he did not do anything intentional or criminal, but that he was "just a lousy surgeon."

The Dallas News reported that these patients included Philip Mayfield, who "often passes out from chronic pain." Another patient, Barry Morgaloff, "limps with a brace and a cane as a result of irreparable nerve damage in his spine." Jeff Cheney, "woke up paralyzed from the neck down on his right side." Jackie Troy, "talks in a permanent whisper and almost died from an infection" from "puncture wounds in her throat." The News reported that Dr. Duntsch's attorneys claimed his errors resulted because "he was 'not a skilled surgeon'," and the chaotic operating room" distracted him. 

D Magazine's story featured a patient named Lee Passmore. He was "hooked on prescription opiates" for the "pain radiating from his lower back, down each of his legs." His pain management physician referred him to Dr. Duntsch. After surgery, he "can’t feel his feet," and he walks using his "hips to heave" his leg forward. 

That surgery, to remove a herniated disc, required assistance from a general surgeon. D Magazine reports that Dr. Mark Hoyle fulfilled that role. He first met Dr. Duntsch that day. He opened an incision, "and moved the blood vessels and organs out of the way," to facilitate access to the disc. As the surgery proceeded,Dr. Hoyle noticed "blood and not much else." He said it "was pouring out of the epidural blood vessels and pooling in the disc space." (others may now be joining those who see a pattern). Dr. Hoyle said that Dr. Duntsch commented at that point that "he was working by feel, not sight." 

According to D Magazine, Dr. Duntsch then "announced that he would be removing the ligament that separates the disc from the spinal canal." This is an important anatomical "stabilizer" and it is "less than a millimeter from the spinal canal." This is when Dr. Hoyle "stepped in front of Duntsch to block his way." Dr. Hoyle cleaned the wound and stopped the bleeding, but the surgery proceeded. Dr. Duntsch installed a "surgical cage," then "tried to reposition it" and instead "stripped a screw" holding it in place. Dr. Hoyle says he "was the first surgeon" to refuse to work with Dr. Duntsch, "but not the last."

D Magazine reported that there were "rumors circulated of late-night partying leading into early-morning rounds. There were "whispers of drug and alcohol abuse." It is apparent that there were some signs and symptoms that might have warned patients, or at least other medical professionals, of untoward outcomes. It is not clear whether those who were "in on" the "rumors" and "whispers" did anything to alert the authorities in Austin, the management of the hospitals, or the patients under Dr. Duntsch's care. 

Thirty-two patients with complaints following "botched" surgeries. The D Magazine story suggests that it is common, at least in some instances, for a surgeon and patient to be accompanied in the operating room by others. Lee Passmore was certainly lucky that Dr. Hoyle was present for his surgery. Had Dr. Hoyle not stepped in to stop the bleeding, Mr. Passmore might have joined Kellie Martin and Floella Brown, whose surgical blood loss was fatal. Who were the other medical professionals involved in these thirty-two surgeries? What did the anesthesiologists, nurses, assistants and other surgeons notice and think? What did each of them do to alert authorities and prevent further harm?

I guess I am left wondering why it took thirty-two patients, maiming, and two deaths before this surgeon was stopped. If the public is to have any faith in the medical care system, someone needs to explain a few things. First, how did this go on so long without intervention by hospitals or the state? Second, if such travesties can go on in this manner, what confidence can we consumers have that other doctors are not similarly misbehaving or under-performing?

How many fatalities does it take before there is publicly available information from news sources? How many rumors before a doctor is reported to hospital administration? What is the role of other medical professionals in spotting and reporting situations like this? What responsibility does the hospital have in spotting trends and outcomes? What role should the payer play in monitoring outcomes and trends? So many questions. 

After a horrific story like this, who will restore our faith that medical professionals, state license boards, and hospital administrations are worthy of our trust and faith?

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