Hospital attorneys, however, strongly defended Wood in court documents filed in Mengs malpractice suit, saying he broke no rules and acted appropriately within the accepted standard of care. Cases with procedural overlap, involving at least one patient with an open incision while the second case is underway, account for 3 percent of the total about 1,000 cases a year. Our hospital is being crucified for something that happens at hospitals across the globe, Wood said. He arrived stressing the need to reduce surgical complications generally and walked into the debate over the safety of double-booking. Ron is so worked up that he doesnt know whether to go to the Boston Globe or the FBI about this stuff, Torchiana told Burke, according to Burkes notes, which he gave to the Globe. Federal lawyers, meanwhile, have subpoenaed all of Burkes records on concurrent surgeries. Is it right, some MGH medical staff asked, for surgeons to divide their attention between two operating rooms especially when the patients dont know? Please join us in congratulating the 13 Mass General orthopaedic surgeons named Top Doctors by Boston magazine for 2022. The fact that surgeons are allowed to run two rooms simultaneously is known by physicians, administrators, compliance officers, booking clerks, nurses, residents, and others, Burke wrote in March 2012 to Dr. Keith Lillemoe, head of surgery at MGH, in an e-mail obtained by the Globe. Soon after the meeting, Burke found out that MGH had engaged Donald Stern, a former US attorney in Massachusetts and one of the best-known lawyers in Boston, to investigate Burkes concerns. Your email address will not be published. While a senior resident at the University of Michigan, Dr. Freiberg did a rotation at MGH and he went on to complete the Hip and Implant Fellowship there. When word of Mengs paralysis reached him in August 2012, he couldnt sleep, Burke says. General has revised its patient consent form over the years, doubling its length to roughly 500 words in the version printed last October. All Rights Reserved. MGH officials say their revised policy on concurrency stacks up well against their national peers. Gitajn IL, Heng M, Weaver MJ, Casemyr N, May C, Vrahas MS, Harris MB. When Warner presented the case at the monthly orthopedics meeting on complications, Burke said he shook his head and whispered to a colleague: Why doesnt someone ask if he was in the room when the vascular injury occurred?, Both Warner and Price, in written responses, disputed the account, but declined to provide specifics because of patient privacy laws. And thats why we brought in Donald Stern to investigate the situation., Slavin then concluded: He found no basis to support Dr. Burkes concerns.. For more information about these cookies and the data Congratulations on this new journey in your professional career. To relieve the symptoms, the surgeon would have to slice through the front of Mengs neck, navigate around arteries that supply blood to the brain, and remove parts of his vertebrae. Orthopaedics Advances in Motion provides health care professionals with information about the latest innovations from Mass General. Suffolk Superior Court Judge Bonnie MacLeod likened the newly discovered evidence to putting a cannon in the jury box and having it explode and put off jury selection until the two sides could fully explore how Woods work in the second case might have affected Gregorys care. He had skimmed a list of potential complications, including paralysis, in a consent form days earlier, but his focus was overwhelmingly on ending his chronic painTony Meng was diagnosed in July 2012 with a condition more prevalent among Asian men, known as ossification of the posterior longitudinal ligament or OPLL.. This is a realm where patient privacy and business information is, by law and habit, guarded zealously. After a resident positioned her for the surgery, the attending surgeon, Dr. Timothy Bhattacharyya, made an incision to expose the hip, according to medical and court records reviewed by the Globe. The end of his cases occasionally overlapped with the start of other cases, but it averaged just a few minutes. With more than 25 years of experience in academic orthopaedic surgery, Mitchel B. Harris, MD, has been named chief of the Department of Orthopaedics at Massachusetts General Hospital, effective October 1, 2017. Extensive e-mail correspondence, obtained from Mass. He also has received numerous faculty teaching awards in his previous academic positions. SunderNeelakantan Sunder, M.D.Anesthesiologist would later retire, in part because he was fed up with the battle over double-booking. So when things went awry in some operating rooms with double-booked doctors, it was often anesthesiologists writing e-mails to hospital administrators and sharing information with Burke, whom they knew was willing to take their concerns to the top. Dr. Bridwell is the Co-Director and Founder of the Pediatric/Adult Spinal Deformity Service. At Mass General, the brightest minds in medicine collaborate on behalf of our patients to bridge innovation science with state-of-the-art clinical medicine. PCPs often are your first point of contact for your general health concerns. Days after Burke performed the follow-up operation on Pereira, he said, he approached RubashHarry E. Rubash, M.D.Chief of orthopedic surgery in the surgeons lounge on the fourth floor of the Gray Building to discuss what had happened. Yet the hospital did impose new limits on double-booking surgery after Burke spoke out, reining in what MGHs chief of surgery described in an e-mail echoing a phrase of Burkes, he says as the wild wild west era of concurrent surgery. Rubash, in written statements, said there was no connection between the Meng case and the leadership change. Paulino Pereira NR, Langerhuizen DW, Janssen SJ, Hornicek FJ, Ferrone ML, Harris MB, Schwab JH. Any senior resident who could hold a knife could have done it, Phan said. He said he had never, in his long career, encountered that particular complication. Is this how we are planning the future? General. American Academy of Orthopaedic Surgeons: Spinal Cord Blood Supply and Its Surgical Implications, The use of Autologous Free Vascularized Fibula Grafts in Reconstruction of the Mobile Spine Following Tumor Resection: Surgical Technique and Outcomes. He was happy to put himself in the care of Wood, a doctor who was recruited by MGH as chief of its orthopedic spine service in 2004 and who would draw many plaudits from patients. Hes as great a person as he is a doctor and Ill miss him at MGH. Orthopedic surgeons are also among the leaders when it comes to the less common but more controversial cases involving at least one patient with an open incision while the second case is underway. Specialties. We are committed to providing expert caresafely and effectively. Hospital officials, in an interview, say Wood never left Jenkss room during the surgery. Hi, I am looking at Mondays schedule and I see Dr. Wood booked in two rooms. Wollman, Burke, and Sunder, in separate interviews, all also said Lillemoe cautioned that it would be draconian to ban surgeons from double-booking altogether. and Andrew Pao, M.D. At Mass General, the brightest minds in medicine collaborate on behalf of our patients to bridge innovation science with state-of-the-art clinical medicine. MGH trauma surgeon from 2004-2009. He took his complaints outside the chain of command, and then outside the hospital, putting his career at risk. Burke raised his concerns about overlapping surgery. Its not fun to deal with this on a daily basis, Sunder said in an interview. He told the Globe that the second part of the operation, which lasted five hours and involved removing hardware from her spine, was not difficult. Learn about the many ways you can get involved and support Mass General. Wood said he handled all the critical parts of Mengs surgery, and MGH says he acted appropriately within the accepted standard of care. Jon has a tendency of counting operating time versus actual case time. Warner had a second procedure running simultaneously and was scrubbed into room 20. Produced by Russell Goldenberg, Gabriel Florit, Elaina Natario, Scott LaPierre, Emily Z. Fortier, David Butler. He is also the Chief of Orthopedics at Morton Hospital. I was concerned at that time that there was a major disconnect between the views of a very prominent and capable orthopedic surgeon here and what we were hearing from our OR leadership, said Slavin, the hospital president. He instructed Shervin to tell the family to find him the next morning and request a consult. Can you imagine, Burke wrote to Ann Prestipino, senior vice president of surgical and anesthesia services, in March 2012, the harm that will occur to this institutions reputation if it were to be discovered that this patients surgery was double booked?, Prestipino, in her response, sought to reassure Burke: The policy for working out of two rooms is in the process of revision under the leadership of Dr. Lillemoe, our new Surgeon-in-Chief.. Providing journalistic work product, particularly during an ongoing project The General Hospital Corporation. Some even wonder at his motives, believing he is driven by outrage at the hospital for placing a Burke protege on academic probation and not hiring her. Then the chief stood up and left, Burke recalled. Candidate must be an arthroplasty fellowship-trained, board-certified orthopaedic surgeon with an exemplary record that exhibits the . In another case several years ago, an anesthesiologist says he was stunned that the surgeon never showed up for the procedure at all. Andrew Rogers, MD, FRCSC is the Director of Hip Preservation at Newton-Wellesley Hospital and is a Team Physician for Boston College Athletics. An MRI revealed a condition causing compression of his spinal cord. I am disappointed that you felt the need to take this to an outside authority as I am confident that changes internally are in place that could deal with the problems. And what must patients be told about their care, and when? But he did say that Sterns findings affirm his confidence in the soundness of MGH practices. I was called a whistle-blower and crusader by some not true, Burke said he told Stern. He was recently promoted to full professor at Harvard Medical School. Sunder. ShervinNina ShervinOrthopedic surgery resident later testified that while he was gone, she helped mix the cement for the hip implant, but felt uncomfortable going further on her own. General in May 2011 after a distinguished career as a pancreatic cancer surgeon and surgeon-in-chief at Indiana University Hospital. John Henry, the principal owner of the Red Sox and the owner of The Boston Globe, was a trustee of the hospital from 2005 to 2014. Wood then went to the other operating room to make sure the surgical fellow had, according to Woods testimony, done the appropriate operation on the 70-year-old patient. Seeking to complete the procedure and possibly relieve the nerve symptoms, Wood then operated for several more hours on the back of Mengs neck. CHIEF OF ORTHOPAEDIC SURGERY, MASSACHUSETTS GENERAL HOSPITAL EDITH M. ASHLEY PROFESSOR OF ORTHOPAEDIC SURGERY, HARVARD MEDICAL SCHOOL Introduction As I write my 11th annual Chief's Report to the Orthopaedic Journal at the Harvard Medical School, the financial world seems to be crumbling around us. Everyone in America has done it at some time.. Vassallo and Shervin did not respond to repeated requests for comment. General Physicians Organization, Former US Attorney hired by Partners to investigate double-booking, Chairman of the chiefs council, a founder of Partners HealthCare, visit our home for Globe coverage of the issue. I am surprised to find this out from the schedule. Let us help you navigate your in-person or virtual visit to Mass General. He then completed a General Surgery Internship and the Orthopedic Training Program at the University of Michigan Hospitals. Dr. Kirkham WoodKirkham Wood, M.D.Spine surgeon, chief of spine 2004-2013, in a deposition last year, described the scheduling of Tony Mengs surgery to run concurrently with another complex case as a way to make efficient use of his time and expertise; it is the most commonly cited goal of hospitals that have adopted the practice. Earlier this year, an anesthesia resident filed a safety report after a patient in March lay anesthetized on the operating table for more than an hour while the surgical team waited for the vascular surgeon to arrive from a concurrent operation. No one knew it at the time, but it was, for Burke and MGH, the triggering moment in a seven-year conflict. The form now emphasizes that medical care will be provided by a team and says my doctor or an attending designee will be present for the critical parts of the procedure. Step away from the bed, VassalloSusan A. Vassallo, M.D.Anesthesiologist said she insisted. Although on a different track, Dr. Glickel managed to spend some time with Dick and even operated with him as a resident. If this results in my career at the MGH ending, so be it, he told the Globe months before his firing. First, Dennis Burke a leading hip and knee replacement specialist who hastily flew to Switzerland to aid Secretary of State John F. Kerry when he broke his femur in May went to war with hospital administrators and some of his peers over his assertion that running concurrent surgeries is ethically unthinkable and dangerous. Dr. Christopher M. Bono is a board-certified, fellowship-trained adult spine surgeon in the Orthopaedic Spine Center at Massachusetts General Hospital. Surgeons at Mass General are allowed to run two operating rooms at the same time, as long as they are present for the critical parts of each surgery and are immediately available if a problem arises in either procedure, or have a backup immediately available. I was brought here to build a fabulous academic department, which we are, Rubash said. As the internal controversy stirred by Burke and others escalated, Dr. Peter Dunn, medical director of the hospitals OR, began looking for ways to improve the departments performance, including a review of the hospitals guidelines for concurrent surgeries. Chief, MGH Department of Orthopaedic Surgery;Edith M. Ashley Professor of Orthopaedic Surgery,Harvard Medical School Joseph McCarthy, MD; Visiting Associate Professor of Orthopaedic Surgery Harvard Medical School John M. Siliski, MD; Clinical Instructor in Orthopaedic Surgery,Harvard Medical School William Tomford, MD; Locally, most teaching hospitals allow minor overlap of cases, but only a few permit doctors to run two surgical cases simultaneously over an extended period. He is the inaugural recipient of the Stepping Strong Distinguished Chair in Orthopaedic Surgery while serving as the founding director of the Gillian Reny Stepping Strong Center for Trauma Innovation. Anesthesia, Critical Care & Pain Medicine, Billing, Insurance & Financial Assistance, Mass General/North Shore Center for Outpatient Care, Director, Spine Oncology & Co-Director, Stephan L. Harris Chordoma Center, Associate Professor of Orthopedic Surgery, Harvard Medical School, Executive Vice Chair, Department of Orthopaedic Surgery, Program Director, Harvard Combined Orthopaedic Residency Program, Professor of Orthopaedic Surgery, Harvard Medical School, Assistant Chief, Orthopaedic Spine Service, Director, MGH/BWH Orthopaedic Spine Surgery Fellowship Program, Assistant Professor of Orthopaedic Surgery, Harvard Medical School, Instructor in Orthopaedic Surgery, Harvard Medical School, Director, Adult Spinal Deformity & Spinal Reconstruction, MGH Orthopaedic Spine Surgery Fellowship Site Director, Adult Spinal Reconstruction Orthopaedic Surgeon, Pediatric Spine & Scoliosis Surgeon, Mass General for Children, Director of Spine Training for the Harvard/Spaulding Sports Medicine Fellowship Program, Instructor in Physical Medicine and Rehabilitation, Harvard Medical School, Nurse Practitioner with Dr. Christopher Bono, Dr. Stuart Hershman & Dr. Joseph Schwab, Physician Assistant with Dr. Frank Pedlow, Inpatient Physician Assistant - Shoulder; Spine, Inpatient Nurse Practitioner - Shoulder; Spine. Mark Vrahas is a nationally respected trauma surgeon and under his leadership, MGH created an orthopedic trauma team system that has been emulated across the country.. But change came to his door. Meng felt betrayed. Jenks had publicly accused his surgical team of botching the surgery, failing to smooth a sharp place on his spine that sliced me open after the surgery and, he believes, ended his career. Our multi-disciplinary spine team uses non-operative therapies and advanced surgical techniques to treat all spine conditions and disorders. Phone: 617-726-9111 Im very proud of my department and our surgeons and our care.. In June, he sat down with members of US Attorney Carmen Ortizs health care fraud unit at their request and outlined his concerns about double-booking, according to several individuals briefed on the meeting. Get Warner! the surgeon-in-training yelled out in operating room 23 in the Gray Building at Mass. The group has successfully integrated with the numerous services that are needed to treat complex oncologic patients. And the attending surgeon, once the work is underway, is committed to managing two cases. In 2000, Dr. Freiberg joined MGH as Chief of the Adult Reconstructive Surgery Service. So tightly guarded was the report that, at one point, Mass. Explore fellowships, residencies, internships and other educational opportunities. Richard M. Pino, M.D., Wilton Levine, M.D., Peter Dunn, M.D. General staffers, offers a behind the scenes look at the heated battle inside one of the nations top-rated hospitals, involving some of the most prominent names in Boston medicine. Copyright 2007-2023. Step-by-step guidance: our spine team, spine anatomy, preparing for surgery and more. Jenks says the possibility that his case might be double-booked was never raised with him. Rubash, in an interview, said concurrent surgery did not become more common during his tenure. Our multi-disciplinary spine team uses non-operative therapies and advanced surgical techniques to treat all spine conditions and disorders like spinal deformities & injuries, scoliosis and spinal stenosis. In addition, the Brigham says it requires that the backup doctor be identified to the patient and listed on consent forms. Thats when he bumped into Dr. W. Gerald Austen, the 85-year-old retired chief of surgery and a founder of Partners HealthCare, the parent company of MGH. Burke met twice with Stern in July 2011. I saw these hypocrites, sanctimonious hypocrites, who were going to string this woman up, he said in an interview. One Patient at a Time was the way Mass. No one knows why it happened to Tony Meng, or how, or even exactly when. However due to violation of the policy that you feel is not going to make any difference, the spine surgeon involved in the case, has lost this privilege. He removed a damaged disc from the womans lower back and plugged it with bone; it would be the last surgery he did on her that day, though he checked on her twice and gave instructions to her medical team. We bring together the clinical professionals with the most appropriate skills to deliver your care. Double-booking also fit well with the business-like approach that Dr. Harry Rubash brought to Mass. Former US attorney Donald Sterns 2012 report remains private, its conclusions known only at the institutions highest levels. Is it right that their patients may have no idea? But then, one Saturday night in June 2008, the phone rang in his home. Dr. Mark Vrahas, chief of Partners orthopedic trauma service, met with a patient in a holding room just before a surgery one morning about five years ago. Mass General Waltham Now Offering Outpatient Joint Surgery. Burke sided with Shervin, testifying against the hospital. We use cookies and other tools to enhance your experience on our website and mleelman@partners.org. Although numerous teaching hospitals permit concurrent surgeries, there is no consensus among top doctors about which procedures can safely overlap, and how much overlap is appropriate. Mass. Brigham and Women's Hospital . The patient was reduced to tears, started to have a full blown panic attack, wrote WollmanLisa T Wollman-Kliman, M.D.Anesthesiologist. He had lost all muscle responses in his arms and legs, and doctors still did not know why. Other fields looked at that model as they got busier.. I see things that are not right and thats not the way we practiced medicine for a long time.. General stemmed from alleged incidents directly witnessed by the anesthesiologists, whose critical role in surgery is often not fully understood by patients. The reason he was upset, Burke said, was that he simply couldnt swallow the idea that the young doctor was faulted, while the attending physician, managing two and, briefly, three cases at once, went unscathed. Michael Daubs, M.D., selected as the 50th president of The Cervical Spine Research Society (CSRS). Copyright 2007-2023. I do not have one regret over coming forward. Hospital policy specifies that the patient be told generally of the involvement of the attending surgeon in the operation, but there is no written requirement to disclose whether the doctor will be responsible for a second overlapping operation. Burkes account is not an accurate reflection of what actually took place that morning, the spokesman said. Malcom Smith, M.D.Chief of MGH orthopedic trauma, in a written statement, said it would be unethical and illegal under federal privacy laws to respond to anything about the case specifically. Kirk said that double-booked operations can increase efficiency if done correctly, with brief overlaps at the start and end of cases. The risks are real; the benefits can be huge. After completing his work on Meng around 7:30 p.m., Dr. Wood went off to his third surgery of the day, a three-hour procedure, leaving the resident, MelikianRojeh MelikianOrthopedic surgery resident, to check on Tony Mengs neurological function. MGH officials assert that Burke violated hospital rules and possibly federal privacy laws by supplying the Globe with copies of some internal records. Director, Harvard Combined Orthopaedic Residency Program . We use cookies and other tools to enhance your experience on our website and It would be almost nine years before he learned, in January, that during the nine-hour case Wood had left him for a time in the hands of a fellow while he operated on a second patient with what Wood later testified was an infected spine. Bitter internal debates about concurrent surgeries have erupted in recent years at medical institutions in Chicago, Milwaukee, Nashville, and Syracuse, and have led to litigation. Thanks, Sunder. Each and every one of these allegations of a potential incident was investigated, a hospital spokeswoman said in a statement to the Globe, adding that federal privacy law and hospital personnel policies prevent the hospital from saying what investigators found or what action, if any, was taken. The existing rules, outlined in a 2002 hospital memo, did little more than require surgeons to be present for the key portions of the case, leaving it to the surgeons to decide what that meant. Chief, Department of Orthopaedic Surgery, Massachusetts General Hospital, Professor of Orthopedic Surgery, Harvard Medical School Christopher M. Bono, MD Executive Vice Chair, Department of Orthopaedic Surgery, Program Director, Harvard Orthopaedic Residency Program (HCORP), Professor of Orthopaedic Surgery, Harvard Medical School Vicky wanted to get back to her active life. In June 2012, Lillemoe unveiled the much anticipated guidelinesThe final policy formally adopted in October 2012 had some changes from a draft shared in spring 2012. See some of our current research publications. Or more directly: Does a patient have a right to know that he could be sharing his surgeons focus and skills with the patient down the hall? With more than 25 years of experience in academic orthopaedic surgery, Mitchel B. Harris, MD, has been named chief of the Department of Orthopaedics at Massachusetts General Hospital, effective October 1, 2017. As Burke recalls it, Shervin sobbed into the phone, asking what she should do. A new research institute at Mass General Brigham seeking to rethink the traditional biotech research model and create a new role for the state's largest healthcare system in the industry. Burke is a fierce traditionalist when it comes to medicine: He says proudly that he never leaves the operating room until the last stitch is in. Doctors could not be the attending surgeon for three rooms simultaneously, something already prohibited by Medicare rules. Burkes looming departure does not, however, mean an end to the controversy. Burke and Austen had known each other since the early 1970s. Some doctors, Wood among them, consider disclosure of double-booking a case-by-case call. They in a sense have traded in their New England Journal of Medicine for the Wall Street Journal., Dr. Kirkham Wood, a graduate of Albany Medical College who later trained under a spinal deformity specialist in Minnesota, took on some of the most ambitious concurrent surgeries, a challenge, he acknowledged in court testimony, that was strenuous.. It is a struggle few outside MGH and its parent company, Partners HealthCare, know anything about. Our orthopedic surgery team includes renowned surgeons who are highly skilled and experienced in their specialty area. He never came back until the surgery was finished, said Dalal, who worked mostly on orthopedic cases at MGH from 2001 until he retired in 2013. I just simply did not know what to do with this kind of situation., Vrahas, in a written statement, said he does not recall any such situation and that Dalal never raised concerns about any incident like this with me either at the time or at any time despite our close professional association., MGH said, Dr. This story was reported by Globe Spotlight Team reporters Jenn Abelson, Jonathan Saltzman, Liz Kowalczyk and editor Scott Allen. But the investigation continues. BostonMA, 02114. Did you approve this? Chief, Orthopedic Surgery Brigham and Women's Faulkner Hospital . He is an internationally-recognized expert on the treatment of foot and ankle fractures and other traumatic injuries to the lower extremity. Our education portal was built to answer our patient's most common questions. By getting involved in Pereiras case, Burke had embarrassed the trauma service, Rubash said. Instructor or Assistant Professor of Medicine (Division of Endocrinology, Diabetes and Hypertension) Brigham and Women's Hospital Date Posted: 11/18/2022. to analyze our web traffic. Dr. Bono obtained his medical degree (MD) from the State University of New York (SUNY) Health Science Center at Brooklyn (now called SUNY Downstate Medical Center). Partway through the procedure, Bhattacharyya left Shervin and another resident in room 21 and scrubbed into operating room 25 as the attending for an ankle fracture case that had started two minutes after Pereiras case, according to medical records.