Respectful Insolence

A spectacular failure of a state medical board

One of the greatest mysteries I’ve encountered since I started following the case of Stanislaw Burzynski is how he’s managed to keep practicing for 36 years after he first began treating patients with his concoction of peptides purportedly isolated from blood and urine that he dubbed “antineoplastons” (ANPs) because of their alleged ability to inhibit the growth of cancer. This is not an issue that is by any means unique to Burzynski; I’ve discussed other cases like this, such as Rolando Arafiles, who used his business relationship with the local sheriff to fend off the Texas Medical Board (TMB); Mark Geier, who was only recently stripped of his license to practice in several states; Rashid Buttar, who went so far as to use his political influence to alter the law in North Carolina to be more quack friendly, and an oncologist who administered chemotherapy to patients who didn’t have cancer and defrauded Medicare for tens of millions of dollars. It’s a general problem. However, as far as doctors who should have been shut down a long time ago, Burzynski takes the cake.

Unfortunately, a recent tragic case of a neurosurgeon in Texas shines a fair amount of light on why Burzynski has been able to get away with it for so long. The Texas Medical Board is quite ineffective, but it’s only part of the problem. If you want to see how bad protections against bad doctors can be, check out this story about a neurosurgeon in Texas who was as incompetent as any surgeon I’ve ever heard of, to the point that he perpetrated what we derisively refer to as “clean kills” in the OR. See the anatomy of a tragedy in the form of doctor named Christopher Duntsch. As the story relates at the outset, Dr. Duntsch graduated from the neurosurgery program at the Department of Neurosurgery at the University of Tennessee Health Science Center and came to Dallas to start a neurosurgery practice. Before the TMB finally acted, he had been responsible killing two patients and leaving four paralyzed. As a word to non-medical people before I go on. It is very rare that I will say that a doctor killed a patient, but in this case there appears to be little doubt: If the story as described is accurate, Dr. Duntsch killed those two patients. You’ll see what I mean if you read the story, and you’ll see what I mean as I wade into the story more. Worse, this is not a case where there weren’t complaints. As the story describes, surgeons who scrubbed with Dr. Dunstch or who had to clean up the mess after his surgical misadventures were so horrified that they broke the wall of silence that all too often prevents surgeons from reporting fellow surgeons to the state medical board:

Physicians who complained about Duntsch to the Texas Medical Board and to the hospitals he worked at described his practice in superlative terms. They used phrases like “the worst surgeon I’ve ever seen.” One doctor I spoke with, brought in to repair one of Duntsch’s spinal fusion cases, remarked that it seemed Duntsch had learned everything perfectly just so he could do the opposite. Another doctor compared Duntsch to Hannibal Lecter three times in eight minutes.

And:

But the real tragedy of the Christopher Duntsch story is how preventable it was. Over the course of 2012 and 2013, even as the Texas Medical Board and the hospitals he worked with received repeated complaints from a half-dozen doctors and lawyers begging them to take action, Duntsch continued to practice medicine. Doctors brought in to clean up his surgeries decried his “surgical misadventures,” according to hospital records. His mistakes were obvious and well-documented. And still it took the Texas Medical Board more than a year to stop Duntsch—a year in which he kept bringing into the operating room patients who ended up seriously injured or dead.

In Duntsch’s case, we see the weakness of Texas’ unregulated system of health care, a system built to protect doctors and hospitals. And a system in which there’s no way to know for sure if your doctor is dangerous.

The incidents described in this story are shocking. The two patients he killed died because he cut their vertebral arteries. Now, don’t get me wrong. That is a potential complication of spine surgery. The vertebral arteries run right next to the spine. The incompetence comes from Dr. Duntsch’s apparent failure to recognize that’s what he did and a pattern of causing this sort of complication way too frequently. Worse, as described in the article, he didn’t appear to know how to recognize or deal with the complication when it did happen, something that’s part of the basic training of any neurosurgeon or orthopedic surgeon who does spine surgery. It would be as though I, as a breast surgeon, didn’t know how to deal with an injury to the axillary artery while doing an axillary dissection and, worse, when I did produce such an injury beyond my ability fo fix, didn’t call a vascular surgeon, leading to the the patient either bleeding to death or losing her arm. True, that’s an intentionally extreme example, but this guy is a neurosurgeon. Not only can people die if he cuts a vertebral artery and doesn’t fix it, those who survive can end up paralyzed. In Dr. Duntsch’s case, several of his patients did, in fact, end up paralyzed for various reasons, among them iatrogenic injuries to the vertebral artery due to surgical misadventure. To show you that, I’m going to skip around a bit in the article. Take a look at how the first patient died at Baylor Regional Medical Center of Plano:

Kellie Martin and her husband, Don, went to see Duntsch, who suggested a procedure called a microlaminectomy, in which part of the spine is removed to relieve pressure on the nerves.

“He sounded impressive,” Don said. “He talked impressive. He was very eloquent in stating the causes and the need for the procedure. He felt confident. We felt confident too.”

Kellie Martin went into surgery on March 12, 2012. It was supposed to be a simple procedure, which is, perhaps, why Baylor didn’t put anyone in the operating room to supervise Duntsch. Don Martin, who was waiting outside, was told the operation wouldn’t take more than 45 minutes. Forty-five minutes passed, then an hour, two hours, with no word.

Don was a lieutenant with the Garland Police Department, and had spent enough time in hospitals to know this delay wasn’t a good sign. He went to the operating room and asked to speak to the doctor. When Duntsch came out, he told Don there had been “some complications,” and that Kellie would have to stay the night, but that the operation had gone fine.

Duntsch went back into the operating room and left Don waiting. He waited until they told him his wife had been sent to the intensive care unit. Then he waited for several more hours until the nurses came out to tell him and his daughters that Kellie Martin was dead.

So egregious was the death that the Collin County medical examiner listed the cause of death as “therapeutic misadventure” because the cause of death had been an injured vertebral artery. You just don’t see coroners putting that sort of phrase on a death certificate. In any case, after Kellie Martin’s death, Dr. Duntsch either resigned or was forced out, but there was no black mark on his record. He got privileges at another hospital, Dallas Medical Center. Now look at how the second patient died:

In the second [operation], while doing a cervical fusion on a woman named Floella Brown, Duntsch “removed a bone from an area that was not required by any clinical or anatomical standards, resulting in injury to the vertebral artery,” according to Texas Medical Board records. Brown was later found unresponsive in her hospital room and staff couldn’t contact Duntsch for 90 minutes, according to those records. Brown had suffered excessive blood loss and a stroke, according to the agency. By the time she was transferred to UT Southwestern Medical Center later that day, she was brain dead.

Cutting vertebral articles was not the only error to which Dr. Duntsch was prone. Brown was just one of three cases on three consecutive days that Dr. Duntsch did, the second. The third was a woman named Mary Efurd. She was told that the case went fine, although she woke up in horrible pain, worse pain than she had been in before surgery, and barely able to move her legs. Another neurosurgeon at Dallas Medical Center, Dr. Robert Henderson, was asked to operate to fix the problem after a postoperative CT showed that the metal spinal fusion hardware that is normally screwed into the vertebrae to keep them from moving while the fusion heals were in the back muscles, inches from where they needed to be. They weren’t holding anything together. Dr. Henderson was shocked at what he saw. As recorded in the article, Dr. Henderson said, “He had amputated a nerve root. “It was just gone. And in its place is where he had placed the fusion. He’d made multiple screw holes on the left everywhere but where he had needed to be. On the right side, there was a screw through a portion of the S1 nerve root.”

So bad was this that Dr. Henderson thought that Dr. Duntsch must be an impostor, because to him no one with an MD and a PhD who had managed to graduate from a respected neurosurgery residency could possibly be that bad. So Dr. Henderson contacted the University of Tennessee and even sent a picture. The residency program reported that Dr. Duntsch had finished it. Meanwhile, as the complaints to the TMB rolled in, made in increasingly desperate tones, Dr. Duntsch kept operating, not only cutting vertebral arteries, but forging ahead with new, previously unheard-of complications of spinal surgery, such as paralyzed vocal cords.

There were further incidents, too, the last of which reminded me of Stanislaw Burzynski. Remember University General Hospital? I pointed out that Stanislaw Burzynski and some of his cronies apparently managed to get clinical privileges there. That’s where they treated Fabio Lanzoni’s sister as she died. At the time, I wondered about any hospital that would grant clinical privileges to a doctor like Burzynski, who isn’t even board-certified or board-eligible in internal medicine, and his employees at the Burzynski Clinic, and quite rightly too, in my not-so-humble opinion. Alarmingly, Dr. Randall Kirby, who was a neurosurgeon at Plano when Dr. Duntsch plunged into his first surgical misadventures and was one of the earliest surgeons to raise the alarm about Dr. Duntsch, received an invitation from University General Hospital to meet its new neurosurgeon. That neurosurgeon was—you guessed it!—Dr. Duntsch. Dr. Kirby immediately called the owner of UGH to warn him that UGH had a big problem. This is what happened:

According to Kirby, the hospital owner told him that Duntsch had privileges to do only minimally invasive surgeries.

It was a minimally invasive surgery, Kirby said, that killed Kellie Martin.

Two weeks later, on June 14, 2013, Kirby got a call to come to University General to do a recovery surgery on one of Duntsch’s patients. The surgery had gone so badly, Kirby later wrote to the Medical Board, that the rest of the OR team had to physically restrain Duntsch from continuing. For two days the patient, Jeffrey Glidewell, lay unattended in the ICU while Duntsch made excuses to the family. Finally the family fired him. When Kirby saw Glidewell, he later wrote the Medical Board, he was “horrified.” The incision, he wrote, was cut into Glidewell’s throat “two or three inches lower and an inch midline from where it should have been oriented … saliva and pus were coming out of the wound.”

Duntsch, it turned out, had, as with other patients, cut into Glidewell’s vertebral artery; an MRI found that he had also left a sponge festering in the soft tissue of Glidewell’s throat.

Likely the reason for the saliva and pus coming out of the wound was because the surgical sponge probably eroded into the esophagus. Either that, or Dr. Duntsch had cut the esophagus as well, which is certainly possible.

This case is disturbing on so many levels that it’s hard to know where to begin. First of all, as someone involved in training residents myself, I can’t help but discuss one thing that the article glossed over: How the hell did the Department of Neurosurgery at the University of Tennessee let Dr. Duntsch finish its program, thus presenting him as qualified and well-trained as a neurosurgeon? Every surgical residency program occasionally admits a resident who reveals himself over time to be incompetent to the point of being untrainable. We surgeons who are affiliated with residency training programs have all at one time or another seen the resident with “hands of stone” or the resident who “can’t operate his way out of a paper bag.” We’ve all seen the occasional resident who seems to have zero surgical judgment or even worse, as I’ve sometimes heard it called, “negative surgical judgment,” which I like to characterize as the unerring ability to choose in any given clinical scenario exactly the wrong course of action. Indeed, at least a couple of surgeons who reported him described Dr. Duntsch in terms similar to negative surgical judgment, bemoaning his seemingly uncanny ability to choose exactly the wrong course of action in any given situation in the operating room. Surely, the residency director and the faculty at UT must have known that Dr. Duntsch was so bad, although it was brought up in the comments that it’s possible that Dr. Duntsch was an okay surgeon during residency but then something, such as drug or alcohol abuse, happened. Even so, this happened so soon after Dr. Duntsch finished residency that it’s hard to believe there weren’t some fairly obvious indications of problems when he was still a resident. Of course, one problem these days with residency programs is that they are afraid to get rid of trainees who are clearly not making it; specifically, they are afraid of being sued. Enormous amounts of caution and, above all, documentation are needed before a residency director will fire an incompetent resident.

Then there’s Texas itself. The article is a truly depressing read in that it shows how the very law in Texas is written to facilitate incidents of this sort. For example:

One might think that if a doctor had paralyzed one patient and had another die in the course of a month, it would be someone’s job to figure out why. But as in many other areas in Texas—benzene pollution from hydraulic fracturing sites; ammonium nitrate pileups at fertilizer plants—Martin’s death and Summers’ paralysis fell into a regulatory no man’s land. Once Duntsch left Baylor, he was no longer the hospital’s problem. The only entity that could stop Duntsch from seeing more patients was the Texas Medical Board.

But the board is limited in its ability to investigate malpractice. For one thing, it can open a case only if it receives a written complaint—akin to a police department that forbids its officers from investigating criminal activity they witness. With the exception of pain management clinics and anesthesiologists, the board doesn’t have the authority to inspect a doctor, or to start an investigation on its own.

It’s further explained this way:

But the Medical Board wasn’t designed to be an aggressive enforcer. It was mostly designed to monitor doctors’ licenses and make sure the state’s medical practitioners are keeping up with professional standards. The board’s mandate, spelled out in the Medical Practice Act, recognizes a doctor’s license as a hard-won, valuable credential. Doctors’ rights are to be protected at every step of the process. The board can’t revoke a license without overwhelming evidence, and investigations can take months, with months or years of costly hearings dragging on afterward. The protections make some sense. The Legislature doesn’t want the Medical Board taking a doctor’s license—and livelihood—unnecessarily or based on flimsy or frivolous claims. But the result is that unless a doctor is caught dealing drugs or sexually assaulting patients—or is convicted of a felony—it is difficult to get his or her license revoked.

This is basically the problems with state medical boards in other states, but on steroids, and amplified by other protections that are weak, such as the cap on pain and suffering damages in medical malpractice lawsuits and laws that make it very difficult to sue hospitals. Indeed, the attitude is completely wrong. It is a high privilege to be a physician; the state in essence trusts us to do things to other people that no other person can do. For example, as a surgeon, I am given the power to rearrange people’s anatomy for therapeutic intent. If anyone else besides a surgeon does what surgeons routinely do, it would be assault and battery. I like to think that that privilege is earned. To me, if that privilege is abused mechanisms need to be in place to rapidly stop that abuse. Patients must come first, not the privilege of physicians. Certainly, there do need to be legal protections for doctors against frivolous complaints; physicians are not immune from professional rivalries and enemies looking to hurt them by going after their license. (Hell, I’ve had someone—and I’m pretty sure I know who it was—try to do just that to me to get back at me for my posts about Stanislaw Burzynski, but fortunately my state’s medical board recognized it for the nonsense that it was.) However, Texas goes way too far in the opposite direction, protecting doctors over patients. The case of Dr. Duntsch is a particularly spectacular example of that.

I also think I now know why Burzynski has been able to keep his license in Texas for 36 years and why he’s managed to get admitting privileges at University General Hospital.

Comments

  1. #1 c0nc0rdance
    September 20, 2013

    Just for clarification: The Baylor Regional Medical Center of Plano is a 160-bed extension of the main hospital near downtown Dallas (1,065 beds). I suspect the clinical quality at these outpatient-focused, satellite “professional centers” is not comparable to a proper university hospital.

    For disclosure: I worked at Baylor University Medical Center in 1998-9 in a transplant immunology lab. My impression was always of a top-notch institution. It’s a ranked hospital nationally, and locally has an amazing reputation. Very sorry to hear the name associated with this kind of story.

  2. #2 Damien
    September 20, 2013

    Reading this story, I simply cannot express the shock and horror I feel at what this man has been allowed to get away with.

    I am agog.

  3. #3 herr doktor bimler
    September 20, 2013

    forging ahead with new, previously unheard-of complications of spinal surgery

    Now there is a phrase for the ages.

  4. #4 Herder of Nerf
    September 20, 2013

    My takeaway from this is what finally gets the TMB to take action is a doctor’s peers raising an unbelievable stink. Also, we hear that there is something called an “emergency meeting” at which licenses can be suspended. I believe that pushing the physicians at Children’s Memorial who have “never seen a patient of Burzynski’s live” should be pressing ahead with complaints regarding the condition of Burzynski’s patients. If they were familiar with the trajectory that the patients seem to follow (believing that getting worse is a sign of getting better, etc.), the physicians might have a greater appreciation of the urgency and travesty of B’s continued practice.

  5. #5 Chris Hickie
    September 20, 2013

    This is where you would like to think his attendings during residency would have done something if he was just as bad or worse in training. There is of course, the consideration that Duntsch did ok during residency and then something happened–like substance abuse, a medical condition (visual difficulties, mental illness, even a cervical radiculopathy of his own spine), but none of these are reasons for letting a physician continue to maim and kill patients.

    It’s very sad when about the only way to have kept this unqualified physician from practicing would have been to take out billboards and post picketers outside his office.

    I do remember seeing in the newspaper a case in Texas (when I was in grad school in Houston in the 90’s) where a surgeon, who had been convicted of attempted murder on his wife–whom he’d severely injured by shooting her in the head with a shotgun–still had a hearing in front of the TMB to see if he would be allowed to keep his license, even though he was going to prison for at least 10-20 years ( I never did find out what happened). I couldn’t believe that then, and it’s clear things are as bad or worse in Texas now.

  6. #6 Todd W.
    http://www.harpocratesspeaks.com
    September 20, 2013

    @Chris Hickie

    I could be wrong, but don’t most states at least suspend, if not outright revoke, a license for those who are convicted of a felony?

  7. #7 Orac
    September 20, 2013

    Yes, and but, depending upon the state, it can take a while for the board to learn of a felony conviction. Communication between state agencies isn’t always the swiftest or surest.

  8. #8 DLC
    September 20, 2013

    The man’s either a high-class bungler or a deliberate uncaring hack. Either way he should be never allowed to do so much as issue a band-aid, ever again.

  9. #9 Old Rockin' Dave
    September 20, 2013

    These things don’t just happen in red states.
    Early in my PA career I had a per diem job in surgery at one of New York’s less famous hospitals. I worked a 24-hour shift with a foreign medical graduate, a gynecologist from Iran doing his obligatory year as non-resident house staff before he could get his license. His name was Elyas Bonrouhi. Without going into details, I was left so appalled that I quit the job rather than ever work with him again. Some years later I heard a news item about an Iranian-born gynecologist named David Benjamin who had been indicted for second-degree murder in the death of a patient in his office. In spite of the name, I was sure it was Bonrouhi, and his picture in the paper proved me right. He had performed a second trimester abortion in his office, ruptured the patient’s uterus, and failed to act for hours while the patient bled out. He had previously had actions taken against him by the state board, but the most recent was on appeal, permitting him to continue to practice. The different name came about because at that time a license suspension would not track across a name change.
    He is currently serving 25 to life.
    The number of botched procedures that he had racked up before the final disaster should have led to revocation long before.

  10. #10 lilady
    September 20, 2013

    Duntsch has good credentials:

    http://reg.tmb.state.tx.us/OnLineVerif/Phys_ReportVerif.asp?ID_NUM=553188&Type=LP&LicensePermit=N8183

    The Board order suspending his license:

    http://reg.tmb.state.tx.us/TMBPublicWebSite/WebDocuments/StreamView.aspx

    I’ve heard of tort reform, but the limiting of awards to plaintiffs who have been maimed or who die from medical malpractice is ridiculous. I’m willing to bet that many cases of egregious medical malpractice never even get into court; an examiner at the medical malpractice insurance company, just issues a check for $ 250,000 (the policy limits), to the patient or his/her survivors.

  11. #11 Denice Walter
    September 20, 2013

    About two years ago, I wrote about one of Gary Null’s rants describing how several states had high taxes and “too many laws”, especially those restricting medical and quasi-medical procedures; Texas however, was held up as a shining example of the converse- it exemplified the ideals of health freedom and proudly displayed a lack of governmental interference. He advises alt med/ libertarian followers to move there.

    MIke Adams loves the place. AJW and Jake reside there. Drs B and Arafiles also.

    Null recently announced that he will create a medical facility there where people can enjoy a luxury spa experience and get cured of various serious medical problems through radical lifestyle change and “medical” treatments:
    he’s already tested out the spa ( as a radio fund raiser) and his RN ( woo division) is re-locating- she had a “wellness” practice in NY administerig ozone, vitamin C, counselling et al-: supposedly other physicians and practitioners will follow.
    Photos of the place and its grateful clients are at Gary Null.com ( Family and Friends Retreat 2013).

  12. #12 Scared Momma
    September 20, 2013

    So how do you protect yourself or your loved ones from these doctors?

  13. #13 Ren
    Not in Texas (Though my exes are)
    September 20, 2013

    Somebody should tell Texas that they’re looking more and more like third world countries do when it comes to their laws. Authoritative, despotic, restrictive… Oh, Texas, my Texas, what has become of you?

  14. #14 lilady
    Not in Texas.
    September 20, 2013

    “Oh, Texas, my Texas, what has become of you?”

    That would be the “Texas Miracle”, Ren.

    http://www.medscape.com/viewarticle/748221

    Medscape Medical News > Neurology
    Neurosurgeons Face Highest Malpractice Risk

    Allison Gandey
    Aug 18, 2011

    “… Tort Reform

    Alex Valadka, MD, a spokesperson for the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, said this study clearly shows physicians are under attack. “I’m concerned this will bolster defensive medicine — a practice that is believed to cost our nation billions in unnecessary dollars.”

    Dr. Valadka, a practicing neurosurgeon in Austin, says he’s impressed by the effect tort reform has had in the state of Texas. “Have you heard of the Texas miracle?” he asked. “Since the 2003 law that capped malpractice awards, we’ve seen a complete reversal in problems like this and physicians have been flooding to the state.” Some estimate that 20,000 physicians have relocated to Texas since the law was passed.

    “You can’t argue with results,” Dr. Valadka said….”

  15. #15 Peebs
    September 20, 2013

    This side of the pond we have a ‘Corporate Manslaughter’ Charge. i.e. If a company is found to have inadequate safety procedures in situ and someone dies, the Company bosses are held responsible. Admittedly it’s rarely used and even more rarely successful.
    Is there a similar or equivalent charge on your side?

  16. #16 Eric Lund
    September 20, 2013

    Of course, one problem these days with residency programs is that they are afraid to get rid of trainees who are clearly not making it; specifically, they are afraid of being sued. Enormous amounts of caution and, above all, documentation are needed before a residency director will fire an incompetent resident.

    Perhaps Duntsch’s bosses in Tennessee may have found it easier to let him finish the residency, knowing that they would thereby get rid of the problem. A form of social promotion. This would particularly be true if Duntsch only started displaying signs of gross incompetence near the end of his residency (e.g., if he had a steadily worsening substance abuse problem, perhaps it only became serious enough to make him incompetent in the last few months of his residency).

    Another possibility is that Duntsch had gotten into hot water with the Tennessee medical board and decided to set up practice in another state. I have heard rumors of incompetent doctors doing exactly this. Often the medical board of the destination state never bothers to contact the medical board of the state the doctor left, so the doctor’s past doesn’t cross the state line with him. And even if the latter medical board knew that a bad doctor from their state set up a medical practice in another state, often state laws prohibit them from disclosing the doctor’s prior record. Those laws would also prevent disclosure of complaints to a resident’s bosses–they would only know of a complaint if they themselves had filed it.

  17. #17 Neal
    San Diego
    September 20, 2013

    > So how do you protect yourself or your loved ones from these doctors?

    Some ideas:
    – make sure they are board certified in their specialty
    – go to a university teaching hospital where doctors work in teams
    – ask around
    – get a referral from a trusted doctor

  18. #18 Politicalguineapig
    September 20, 2013

    Yet another reason to get rid of Texas altogether; think Mexico would take the state back?

  19. #19 Carl
    September 20, 2013

    Texas has plenty of laws, just not the right ones. Try buying Sudafed or an Erlenmeyer flask. They’ll jump on that in a second.

  20. #20 PassionlessDrone
    September 20, 2013

    Superb post. Very nicely done.

  21. #21 Dan J. Andrews
    September 20, 2013

    In Canada, Dr. Brian Goldman (who has a well-regarded CBC show, White Coat, Black Art) did an episode on whistle-blowers among doctors. It was rather a discouraging listen. There is so much pressure for doctors not to whistle-blow even when patients are put at risk. The fact that doctors spoke out against Dr. Duntsch indicates he really transgressed. Otherwise, they probably would have stayed silent like they often (usually?) do.

    Info on the program I mentioned should be here: http://www.cbc.ca/whitecoat/2013/09/06/blowing-the-whistle-on-bad-medicine/

    but currently CBC is experiencing technical difficulties so I can’t check it.

  22. #22 Old Rockin' Dave
    September 20, 2013

    @Scared Momma: Start with research. It should be possible in most states to see state medical board records of disciplinary actions. You can also look for news stories. Personal recommendations from someone you trust are also useful. A recommendation from someone in a closely related field is often a good idea, eg. asking a neurologist to recommend a neurosurgeon, or a cardiologist for a chest surgeon. While doctors in the same specialty may be reluctant to speak freely, often people who associate with them in the hospital will. OR nurses, anesthesiologists, ICU staff, etc., generally get to know who the bad surgeons are and put it on the grapevine.
    Maybe the most important tool you have is your gut feeling. If a surgeon. or any other physician, gets your hackles up, or seems too smarmy, or appears impaired, or tries to dissuade you from a second opinion, you should look elsewhere.
    Of course in an emergency, you may just have to hope that the people on the job are competent, which is the case far more often than not.

  23. #23 Krebiozen
    September 21, 2013

    I think the answer to this problem is transparency. In the UK performance data on surgeons are now being made public. I assume Dr. Duntsch would have been picked up by an initiative like this. If medical boards are unable to sanction errant doctors, perhaps the public would avoid them if their mortality rates were made public.

  24. #24 DrBollocks
    September 21, 2013

    @Krebiozen

    This plan, whilst superficially attractive, has many pitfalls. Unless the figures take account of the complexity of the surgery or the comorbidities of the patient, then a surgeon whose practise has a disproportionate number of sicker or more complex cases may appear, unjustly, to have worse outcomes than average. Publication of these unadjusted figures may also discourage surgeons from taking on more difficult cases.

  25. #25 Shay
    September 21, 2013

    @Scared Mamma:

    I hate to say it, but having a relative or close friend in the medical field helps. When the spousal unit was going to have some minor surgery performed through the VA, one of my sisters (former Navy medic and current VA RN) was able to steer him towards the right doc and away from the wrong one.

  26. #26 Krebiozen
    September 21, 2013

    DrBollocks,

    Unless the figures take account of the complexity of the surgery or the comorbidities of the patient, then a surgeon whose practise has a disproportionate number of sicker or more complex cases may appear, unjustly, to have worse outcomes than average. Publication of these unadjusted figures may also discourage surgeons from taking on more difficult cases.

    There has been a lot of discussion about this in the UK, and some adjustments have been made to make it fairer. I think that as long as the data are accurate and properly explained this is an excellent idea. It has been suggested that the fact these figures are published may make surgeons think twice about referring complex cases to a more experienced specialist surgeon.

    The figures show essentially a funnel plot of the number times the procedure has been carried out and the national comorbidity nationally, showing where the individual surgeon falls. I would hope that surgeons taking on particularly challenging cases would do a larger number of less challenging cases as well, which would show up in the chart.

    As an example, here’s the data on one of my local cardiac surgeons, and here’s an explanation of the graphs. I’m very happy that this data is available to me as a patient, and I am a bit suspicious of any doctors who disagree ;-)

  27. #27 Scared Momma
    September 21, 2013

    @Neal, Old Rockin’ Dave and Shay; Thank you all for answering my question. And Shay, I am very glad you got some good advice on which doctor to use. We were very lucky too, when my mother in law had a brain aneurism, a family friend is head of the pharmacies for that hospital, and had complete confidence in the brain surgeon there. It’s just amazing to me that this day and age that hospitals would put themselves on the line for a doctor/surgeon. They can lose everything?

    Thank you all again, this is very informative, since I want to help make sure my sister is getting the best care. She feels comfortable with her OB, and I researched the doctor a bit online, so hopefully I don’t have to be paranoid anymore ;)

  28. […] Interesting: […]

  29. #29 Bob G
    Los Angeles
    September 22, 2013

    This would be interesting (and of course tragic and simultaneously enraging) if it were anything that I hadn’t already learned at the dinner table 50 years ago. The “conspiracy of silence” among physicians in terms of reporting on incompetent doctors, combined with their refusal to testify in medical malpractice cases, left the public essentially unprotected. Some brave maverick doctors (the real kind) were willing to get up on the witness stand and tell the truth, and the result was a “malpractice crisis” that was solved by making it more difficult for the injured to win compensation in the courts. One way that this was accomplished was to put a lid on jury awards that went beyond actual costs and extrapolated lifetime medical costs for the damage that was done. In California, the limit is $250,000, and has not been readjusted for inflation since it went into effect in the 1970s.

    Lots of ways have been suggested for dealing with the problem at a non-medical level. One way is to create a no-fault system for patient compensation, perhaps involving special courts analogous to the vaccine court system. But the better solution would combine this with a more honest medical profession in which the truly incompetent doctors are dealt with. I can imagine some way that such doctors might end up usefully employed, although I will leave it to the licensed physicians here to figure out if this would even be possible.

    I applaud Orac for bringing this issue up in such a straightforward way. I will also agree that the law itself is a substantial part of the problem in the sense that hospitals and medical boards have become reluctant to take action due to their fear of being sued. Perhaps they should ask for help from the state legislatures (particularly in Texas) so that they will be less exposed legally. The Constitution protects members of congress against slander suits for what they say in their official activities. Perhaps medical training programs, hospitals, and medical licensing boards should ask for reasonable protections.

  30. #30 DrBollocks
    September 22, 2013

    @Krebiozen

    You make an important point:

    ….as long as the data are accurate and properly explained this is an excellent idea.

    Essentially, I agree with you.

  31. #31 elburto
    September 27, 2013

    Ah Texas, land of health freedumb and small government. So small, in fact, that it fits neatly into the uterus.

    It’s horrifying that TRAP laws forbid gynaecologists from performing even medical abortions in facilities where the corridors don’t reach a certain width, yet a neurosurgeon can kill and maim with gay abandon because his licence is too precious to revoke.

    Doctors and surgeons consensually performing legendarily safe procedures=bad

    Surgeon inventing his own horrific neurological procedures by randomly shoving hardware into any old body part=good.

    Only in Texas, or maybe Florida.

  32. #32 JJ
    Los Angeles
    September 27, 2013

    The hospital should have suspended his privileges long before this got to the state medical board.

    • #33 Orac
      September 27, 2013

      No argument from me there.

  33. #34 Sofia
    Crete/Chania
    September 27, 2013

    How can you all, say what are you saying……….. I understand that AUTHOUR – cinical, bitter and jelous doctor that was never smart enough to safe not even one person in his all carreer is writing that but you people….. All you are known of is SKEPTICISM——— critisizing everything and everyone……………. I don’t know even one person that got cured by conventional treatments ( from TV neither) 20 years we are hearing this doctor is achieving something no one ever achieved ………. so explain me what is bothering you so much dr Gorski …. THAT IT WASNT YOU ????? you say his treatments are expensive ——— hell YEAH they are saving lifes actually in the cases that conventional medicine is giving them up to 6 month of living, second why we don’t make this available for insurances to cover expences of this treatment………… as far as i know even conventional chemo is MUCH MORE EXPENSIVE if you dont have insurance…………….. your blog is demagogic….. you put the facts the way you like it so there is no other way to comment it……………..grey mass is always affraid of what they dont understand….. but it surprise me that THE DOCTORS are affraid…..instead of learning trying and then to say IT DOESNT WORK……… i wonder if some of you guys were sick and nothing would give you a prospects …………… and you tried everything that doesnt work…….. and its killing ……….. I’m sure you would crawl in a Sh*** just to get better if it was said THAT IT MIGHT HELP ………. they tried to “burn” Copernicus for saying the truth………. that time people didn’t know it was truth………… why we don’t give opportunity to test this treatments ………… yes FDA didnt stop you say mr. Burzynski…………. DEMAGOGIC……….. you know very well they did everythign to make his work impossible!!!!!!!!!!!! JAPAN IS ALREADY TRYING THIS TREATMENT ………….

    My uncle is a doctor so it called old date doctor,,, when he sa new students in our medical univeristies, he said “god blees the people……….” my mother is always saying: nowadays they don’t teach doctor to cure people, they teach them name of sicknesses and name of medicines that “can stop” them ………………

    post scriptum

    And if it happens in my family i will need to find a way out……………. i will pay every penny to do it…………… cuz in my country as well we need to pay for chemoo ( and it doesnt work for anyone) so what a hell if anyway i am paying at least I am gonna choose my pair of shoes !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

  34. #35 Mephistopheles O'Brien
    September 27, 2013

    Sofia,

    Why do you defend Dr. Burzynski (who isn’t even the main topic for discussion in this particular thread) so passionately? Do you have evidence that he provides better results with his methods than the current standard of care? If so, can you please point to the peer reviewed published articles that demonstrate this, along with any replication of his results?

    The key reason people speak badly of Dr. Burzynski is that there is little credible evidence that his treatments are safe or effective. If you have data to the contrary, please share.

  35. #36 Mephistopheles O'Brien
    September 27, 2013

    Sofia,

    Why do you defend Dr. Burzynski (who isn’t even the main topic for discussion in this particular thread) so passionately? Do you have evidence that he provides better results with his methods than the current standard of care? If so, can you please point to the peer reviewed published articles that demonstrate this, along with any replication of his results?

    The key reason people speak badly of Dr. Burzynski is that there is little credible evidence that his treatments are safe or effective. If you have data to the contrary, please share.

  36. #37 herr doktor bimler
    September 27, 2013

    I don’t know even one person that got cured by conventional treatments ( from TV neither)

    I don’t know anyone who was cured by TV either.

  37. #38 Sofia
    Crete/Chania
    September 27, 2013

    Mephistopheles,

    Why won’t you show the data of people that are still alived after chemo and radiation…………… because the examples of successes of DR BURZYNSKI are available for everyone …………… And there is no need to play a fool……….

    Maybe you would like to give you data of people that I know personally that died from “current standard of care”………… I will be glad to even call you and to say to you how they look like the days before they die ……….. if we only knew about other ways of treatments …………….. HAD A CHOICE !!!!!!!!!!!!!!!!!!! THAT WHAT MAKES ME ANGRY BECAUSE OF YOU LITTLE BAD PEOPLE SHOUTING and making a mess we are missing the POINT…. doing everything for saving lifes….. I am gonna defend him ……….. you all put him under the name QUACKER …………… it is not like he is telling us to dance in the rain to cure ourselfs or doing chinesse cup massage ……….. you say little EVIDENCE ??then this disscussion is pointless………… inteligent person wouldn’t say LITTLE EVIDENCE….. inteligent person wouldn’t say “waste their money for therapies” (as i read in previous posts”)HUMAN BEING WOULDN”T SAY IT !!!!!!!!!!!!!! you give only examples of people that died during the treatment of dr Burzynski …….. thats ok but remember fortune is fickle and favours the brave believe it or not. – apropos MAGICS :P;D

  38. #39 Sofia
    Crete/Chania
    September 27, 2013

    herr doktor bimler well you re trying to be funny ? want to see how you gonna speak greek ? If you havent noticed english is not my mother tongue so i have a big problems to describe my opinion in foreign for me language BYEEE

  39. #40 herr doktor bimler
    September 27, 2013

    i have a big problems to describe my opinion in foreign for me language

    You do indeed. There is no point asking for your readers to be charitable when they have no idea what you are trying to say.

  40. #41 Shay
    September 27, 2013

    Sofia: not “little” evidence. How about “no” evidence..

  41. #42 herr doktor bimler
    September 27, 2013

    well you re trying to be funny ? want to see how you gonna speak greek ?

    Sofia, you parachuted in here to insult the commenters and call them LITTLE BAD PEOPLE SHOUTING. You have a choice at this point. I can make fun of your English, or I can call you a foul-mouthed fool. Any preference?

  42. #43 Calli Arcale
    September 27, 2013

    Sofia, the “success stories” you hear about with Burzynski tend to fall into one of two categories: they are either unverifiable, or we know they later died. Sometimes within weeks of recording a glowing testimonial to how Burzynski was curing them.

    You can’t rail against chemo and support Burzynski without completely misunderstanding what’s going on. Because what Burzynski is using *is* chemo. Both the antineoplastons (which are pretty damn toxic on their own) and the “personalized” chemo that he’s giving out now. If you’re against chemo, you should be against him too, because that’s what he uses.

    Oh, and you mention money. Did you know Burzynski manipulates patients into using his pharmacy where the drugs are several times more expensive? These are drugs which insurance does normally cover, but not at the rates he charges. He just tries to keep his marks from realizing that.

  43. #44 Khani
    September 28, 2013

    #38 Some data for people alive after chemo and radiation can be found here: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-031941.pdf

    More specific information could likely be found if you would specify a particular form of cancer, as they are not all the same and do not all have the same survival rates or prognoses, either with or without proper treatment.

  44. #45 herr doktor bimler
    September 28, 2013

    I suspect that Sofia has announced the flounce.

    Clearly she had not read the original post, or she would know that it was not primarily about Burzynski. But her primary complaint was that the commenters here are on Orac’s side vis-a-vis Burzynski. Now this may well have an element of truth, but it is not in the comment thread. At the same time, her limited command of English has not stopped her from learning Orac’s Super Sekrit Identity.
    Perhaps she came here from reading DJT’s blog, and picked up some misinformation from him as well as his style of punctuation.

    they tried to “burn” Copernicus for saying the truth
    That can’t be blamed on English as a second language; that’s just plain stupidity and ignorance, which surpasses national boundaries and tongues.

  45. #46 lilady
    September 28, 2013

    Hmmm…I just blew past all of Sofia’s rants and rages because they were so outrageous and so far afield of the subject Orac posted about.

    Yeah, she did manage to find the name of Orac’s “friend”…no doubt provided by DJT or one of Burzynski’s patients. You’ve got to wonder if she is really posting from Crete on behalf of Uncle Stan.

  46. #47 Mephistopheles O'Brien
    September 28, 2013

    Sophia,

    Why won’t you show the data of people that are still alived after chemo and radiation

    I think Khani’s comment sums it up nicely.

    Maybe you would like to give you data of people that I know personally that died from “current standard of care”

    Not particularly, but if you feel inclined to share I don’t think anyone will stop you. However, please keep in mind that cancer is a deadly, debilitating, and highly painful disease. Please be sure to consider whether the people you know have died “from” the care they received or “in spite of” it.

    if we only knew about other ways of treatments

    Perhaps if the people involved had completed (or started) the necessary trials and had published the necessary data to show that their treatments worked, then perhaps those treatments would be more available.

    THAT WHAT MAKES ME ANGRY BECAUSE OF YOU LITTLE BAD PEOPLE SHOUTING

    I’m not shouting. You’re the only one I see shouting here.

    you say little EVIDENCE ??then this disscussion is pointless………… inteligent person wouldn’t say LITTLE EVIDENCE

    I agree, it really is rather pointless to discuss Dr. Burzyinski’s methods in the absence of data about his results. I disagree with you, though – if there is very little available evidence, then an intelligent person would have an obligation to acknowledge that, and indeed to point it out. Why do you feel otherwise?

    I don’t know even one person that got cured by conventional treatments

    I personally know several people who had breast cancer, lymphoma, skin cancer, or colon cancer who were cured by conventional treatments. Which is more significant, your story or mine? Why?

  47. #48 Sofia
    Chania/Crete
    September 28, 2013

    First: my comment was to all post by author to all people their wasting energy on discrediting others, instead of finding better solution than one we have

    Second: burzynskipatientgroup.org yes i agree with you this list of over 80 patients that therapy helped (THEY are saying that!!!!)
    this is not evidence of efficacy … of miracle maybe, so perhamp we should canonize him – SAINT BURZYNSKI???
    heh

    My comment was to all the authors post about especially Burzynski :

    Extremely Expencive therapies :

    Please call to Chania Hospital In Mournies (Crete)
    Ask how much costs one month treatment of Pneomonia
    5,800 Euros (I wish you could come here and check ithe standard of our GREAT HOSPITAL)
    Believe me for Chaniotis saying that 10,000 Dollars (a month) for treatment that might cure cancer is a joke

    With chemo nobody gives you as well guarante you gonna survive ………. that happened with my husbands mother (one year after descovering a breast cancer she died – done chemo,)

    my bestfriend mother breast cancer cured with chemo – cancer came back after 3 years and in 1 year she died

    my friend (brain tumor) im sorry i cant remind myself the name of this particular type was given 6 months (after chemo died)

    My friend (mother of 2 children and widow) cancer of the lymphatic system doctors told her Chemo mights help (which was a lie and we know it now after studying more and more to understand what was happening) IT DIDNT help ………. they wanted money that’s all

    Don’t you dare to write little evidence because for this people this is the evidence that they need just to start fighting again.

    And joke as much as you want about my english =)
    στα τετια μου !!!!!!!!!!!!!!!!!!

  48. #49 Sofia
    September 28, 2013

    Believe me for Chaniotis saying that 10,000 Dollars (a month) is expencive for treatment that might cure cancer is a joke whe we have a compare to pneomonia treatment prices ://////////

  49. #50 Alain
    September 28, 2013

    Sofia, are you from russia or one of the cyrillic speaking country?

    Alain

  50. #51 Lawrence
    September 28, 2013

    @Sofia – except we know exactly how to teat and cure pneumonia…..Dr. B has yet to publish anything that shows us he has any idea what he is doing….

  51. #52 Khani
    September 28, 2013

    #48 No reputable doctor is going to guarantee a cure from cancer in general, Sofia. Generally, all they can do is give you the odds, and you decide accordingly what treatment you want. Guaranteeing a cure is a big red flag for quackery, I’m afraid.

    Very little is guaranteed in life; I can’t even guarantee that I won’t get hit by a car and killed as I’m crossing the street today.

    The bottom line here is, we all *want* more options for legitimate cancer treatment. And Burzynski *does* have the option of convincing every one of us that his treatment works. All he has to do is produce the data.

    We would prefer that he produce the data in the form of a paper in a reputable, peer-reviewed journal, but honestly, he could probably just put the raw data online in a WordPress blog for free, and if it was good enough and shown to be accurate, someone would crunch the numbers and we would be convinced anyway.

    We can *all* be convinced, Sofia. We’d be happy to be wrong; all it takes is the data.

  52. #53 Mephistopheles O'Brien
    September 28, 2013

    my comment was to all post by author to all people their wasting energy on discrediting others, instead of finding better solution than one we have

    Who says you can’t do both? I personally am not involved in cancer research, however I understand that others who post here including Orac are, in fact, researching cancer treatment.

    Regardless of one’s own ability to improve cancer treatment, though, it is important to ask for proof that new treatments are at least as good as what is currently done. Lots of people claim they can cure cancer with all kinds of strange things. Without good evidence that something works, using it may not only waste time but it may actually injure you further.

    It is absolutely the case that there are no guarantees with current cancer treatments. What we have are statistics – if a cancer is caught at a particular stage and treated in a particular way, then the chances of long term survival are increased some amount.

    If you knew that Dr. Burzynski – or any other physician – provided treatment that had a better chance of long term survival than current standard, then it would be important to pass that information on in a way that is statistically meaningful. Sadly, Dr. Burzyinski has not published any such statistics that are in any way convincing.

    Don’t you dare to write little evidence

    I do so dare. By “little evidence” I mean “there is not sufficient information of sufficient quality to show that the treatment being discussed works at least as well as standard treatments, much less better.”

  53. #54 Alain
    September 28, 2013

    Sofia, it seem your language is Greek, my mistake. I looked up the regulation of medical doctors here in Quebec, canada:

    Ο ιατρός πρέπει να ασκήσει το επάγγελμά του, σύμφωνα με τα ιατρικά πρότυπα
    παρουσιάζουν την υψηλότερη δυνατή και για το σκοπό αυτό, πρέπει να περιλαμβάνει
    αναπτύξουν, να βελτιώσουν και να εκσυγχρονίσουν τις γνώσεις και τις δεξιότητές τους.

    In French, the actual language of the regulation:

    Le médecin doit exercer sa profession selon les normes médicales actuelles les plus élevées possibles; à cette fin, il doit notamment développer, parfaire et tenir à jour ses connaissances et habiletés.

    Another rules:

    Ο γιατρός πρέπει να δράσει έτσι ώστε ο θάνατος ενός ασθενούς που
    φαίνεται αναπόφευκτο συμβαίνει με αξιοπρέπεια. Θα πρέπει επίσης να διασφαλίσει ότι ο ασθενής
    κατάλληλη υποστήριξη και ανακούφιση.

    In French:

    Le médecin doit agir de telle sorte que le décès d’un patient qui lui
    paraît inévitable survienne dans la dignité. Il doit assurer à ce patient le soutien et le soulagement appropriés.

    Isn’t these important principles to strive to? Unfortunately, Burzinski doesn’t abide by them.

    Alain

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