Tuesday, October 11, 2005

When Your Credentials Committee Fails You....
From the Wall Street Journal:A Doctor's Tale Shows Weaknesses In Medical Vetting
John Anderson King joined the staff of Putnam General Hospital here in November 2002. In seven months, the orthopedic surgeon performed about 500 operations, mainly on patients' spines, arms and legs.

During a routine review of the doctor's work, the hospital became concerned about some of his surgeries. In May 2003, Putnam, which is owned by the giant hospital chain HCA Inc., suspended his privileges, pending an internal investigation.

Edgar M. Dawson, a Los Angeles surgeon brought in for a peer review, called Dr. King a "snake-oil salesman" who was "not competent to practice medicine," according to a lawsuit Dr. King later filed against the surgeon in federal court in Los Angeles. In August 2003, before the hospital completed its inquiry, Dr. King resigned and turned in his West Virginia medical license.

Putnam and Dr. King's patients are still reeling from the surgeon's brief tenure. More than 100 malpractice suits have been filed against Dr. King and the hospital, according to state-court records in Putnam County, W.Va. Dozens of patients blame chronic back pain on allegedly unnecessary surgeries, court records show. None of the suits has been resolved.

One 90-year-old man died in 2003 from complications allegedly related to a back operation Dr. King is accused of recommending, despite the patient's age. A 38-year-old woman had her leg amputated in 2003 after an allegedly unsuccessful foot operation. State-court suits filed on behalf of the woman and the man's estate are pending. The suits accuse Dr. King of malpractice and the hospital of negligence in recruiting and employing him.

Many of the suits allege that Putnam overlooked warning signs, such as Dr. King's stop-and-start education, discrepancies in his résumé, and his involvement in past lawsuits, some of which he filed against employers when they tried to get rid of him
Apparently this guy was quite the "Joe Izuzu":
Described by patients as affable, Dr. King allegedly told some that he had once worked at the prestigious Cleveland Clinic. He hadn't. Patient James Cable of Charleston said that Dr. King told him he had competed in the Olympics in "kung fu." The doctor hasn't been in the Olympics, and kung fu isn't an Olympic event.
Oh yes, his dragon style was far superior to the tiger style of the other competitors. The hospital was apparently blinded by the need to bring in patients and income:

This is one of the problems that has haunted medicine for years," said Paul Schyve, senior vice president at the nonprofit Joint Commission on Accreditation of Healthcare Organizations. "Often the hospital is grateful the problem has ended without it having to take action for fear they may get sued.".......

......Financial pressures can drive hospitals to hire undistinguished doctors in highly profitable fields such as orthopedics. Putnam, a small 68-bed facility about 25 miles west of Charleston, has had an uneven financial record. It lost $630,574 on revenue of $65 million in 2001, the year before Dr. King arrived. The following year it turned a profit, only to fall into the red again in 2003.....

.......Putnam retained Comprehensive Healthcare Staffing of Norwalk, Conn., in October 2002 to recruit an orthopedic surgeon. After interviewing Dr. King on Oct. 9, 2002, the consulting firm sent a form to Putnam that included a handwritten note stating that his "hot button = $." Eight days later, Putnam signed Dr. King to a one-year contract with compensation of $420,000 and a signing bonus of $35,000. Comprehensive Healthcare said in a statement that it "received no indications of problems" with Dr. King's qualifications and that Putnam "retained the ultimate responsibility" for assessing him.

Dr. King certainly got around:
From 1990 through 1992, Dr. King trained as an obstetrics-and-gynecology resident at Albert Einstein Medical Center in Philadelphia. Putnam obtained a letter from Einstein dated Oct. 30, 2002, saying that he didn't complete the program, without explaining the circumstances, court records show.

In May 1993, he moved to an orthopedic residency at Hillcrest Health Center in Oklahoma City. Putnam received confirmation from Hillcrest that Dr. King completed the first two years of a four-year program. But court filings by Curry & Tolliver, the Charleston law firm representing many of the King patients, show that some documents Dr. King gave to Putnam during the hiring process list different dates or don't mention Hillcrest.

In fact, Hillcrest terminated Dr. King in March 1995, citing his marginal performance, according to a suit Dr. King filed in March 1997 in federal court in Oklahoma City. He accused the health center of poor training and fraudulent billing. To settle the suit, Hillcrest agreed to pay Dr. King $40,000 and allow him to resign, court records show.

HCA's Mr. Foust said that Putnam wasn't aware of the suit or settlement. He added that the letter from Hillcrest and a certificate indicating Dr. King had been at the Oklahoma City facility for two years outweighed any discrepancies with other documents. He noted that Dr. King's affiliation with Hillcrest was included on the AMA Web site. A spokeswoman for Hillcrest declined to comment, citing privacy issues.

From 1995 through 1997, Dr. King "performed the duties" of an orthopedic resident at Lincoln Medical and Mental Health Center in New York's Bronx borough, according to a certificate he provided to Putnam. But Harvey P. Insler, then chairman of orthopedic-residency training at Lincoln, said in an interview that Dr. King "was not an approved resident," meaning that he didn't get formal credit for the educational program.

Dr. Insler said that he raised questions with his board about giving Dr. King the certificate, but Lincoln decided it was appropriate. Despite the questions he said he raised, Dr. Insler provided Dr. King with a positive letter of recommendation. He said Putnam didn't ask him about the prospect before offering him a contract.

Putnam did contact Lincoln, which confirmed that Dr. King was there from October 1995 to March 1997, court records show. But in answer to the question of whether the residency had been completed, the Bronx center wrote "n/a," short for "not applicable." Even so, Mr. Foust said that Putnam relied on the certificate, the Insler recommendation and the AMA site.

In the late 1990s, Dr. King worked at Jackson County Hospital in Marianna, Fla., where he was arrested and charged with theft. The Florida hospital alleged that he removed two log books from the operating room, according to a January 1999 criminal complaint in Jackson Country Circuit Court. Dr. King pleaded not guilty and resolved the case without a conviction by paying a $225 fine and serving six months probation
The article points out a JCAHO citation of the hospital's credentials committee and their poor oversight. Poor information also played a role:
Some key information about Dr. King available to potential patients wasn't accurate. Putnam General advertised him on its Web site in 2003 as a medical doctor in orthopedic surgery. But he doesn't have an M.D. Instead, he is a doctor of osteopathy, an alternative school of medicine that emphasizes the relationship of illness to the muscular-and-skeletal system. Osteopaths can function as full-fledged physicians and can do surgery.

The physician-information Web site of the American Medical Association listed Dr. King as having graduated from the Meharry Medical College in Nashville. That, too, is wrong. He graduated from the University of New England College of Osteopathic Medicine in Biddeford, Maine. The AMA couldn't explain the discrepancy.

Dr. King isn't certified by one of the 24 national medical boards that offer credentials in specialty fields and are recognized by the American Board of Medical Specialties. About 90% of doctors have such a certification, but as is the case with some smaller hospitals, Putnam doesn't require it.

In doing its background check, Putnam consulted the AMA site and other physician databases, according to HCA's Mr. Foust. Dr. King provided documentation of his training and employment. But the industry practice is for hospitals to verify such information on their own. In the case of Dr. King, seemingly obvious red flags didn't stop Putnam from recruiting him.

The AMA listed Dr. King as having trained as a resident at five different institutions in three disparate specialties: orthopedic surgery, obstetrics and gynecology and anesthesiology. Records show that from 1985 through 1987, he dropped out of two residency programs in anesthesiology before completing a third. This pattern alone is unusual and could suggest a problem.

HCA's Mr. Foust says that Putnam didn't examine Dr. King's anesthesiology and obstetrics-and-gynecology training because the hospital wasn't hiring him to work in those areas.

Just a few months before Putnam hired Dr. King, the Joint Commission on Accreditation of Healthcare Organizations surveyed the hospital and concluded that its approach to checking doctors' credentials was "deficient." The hospital was required to make improvements, and the commission said it was in compliance by the following year, 2003.

After the anesthesiology residencies, he took a job in that field in 1989 at Walker Regional Medical Center in Jasper, Ala. The center soon suspended his privileges after he allegedly falsified patient records, according to copies of letters that an attorney for Dr. King wrote to Walker in June 1989. The letters have been filed in lawsuits brought on behalf of former patients. Dr. King's attorney, William N. Clark, declined to comment, citing client confidentiality.

Dr. King denied any unprofessional or unethical conduct at Walker but offered to resign if the suspension was rescinded, according to the letters. Walker then lifted the suspension, and he resigned.

Mr. Foust said Putnam wasn't aware of these events. A spokeswoman for Walker, which has been taken over by the Baptist Health System, said that it has no record of the dispute.
In my time on the credentials committee we faced issues, while not this severe, did cause concern. Physicians today are more mobile, but this guy seemed to be just a few steps ahead of the sheriff. One reason for the lack of information may be the ever-present threat of a lawsuit. Not only does the threat of a lawsuit impede the exchange of information but also discourages participation in peer review.
The problem here rests with the hospital's economic concerns trumping their mission of ensuring patient safety.
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