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. As an anesthesiologist, Dr. Akshay Dalal, watched, Vrahas explained the procedure that would be done on the patients lower leg, and gave him the consent form, which both the patient and Vrahas signed. The orthopedic surgery department at Mass. But as the surgical team began taking out parts of two vertebrae compressing Mengs spinal cord, electrodes attached to his body indicated that nerve signals between his limbs and brain were fading a warning of potential spinal cord damage. But where should hospitals draw the line between efficiency and individual attention, between modern case management and traditional ways? BostonMA, 02114, Wyndham Hotel - Beacon Hill To document his case, Burke blacked out identifying information about patients and gave the records to the Spotlight Team saying, Dont take my word for it.. Chief of Partners Orthopedic Trauma Service, he was recruited in 1999 to develop a trauma program across the states largest health care network. 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. The General Hospital Corporation. He instructed Shervin to tell the family to find him the next morning and request a consult. Mengs scar from surgery. MGH concluded that none of the injuries was the result of double-booking, but the hospital declined to provide details to the Globe. Copyright 2007-2023. Double booking is fine, if done properly, and our policy will change the practice at the MGH. And since I know a lot of surgeon-colleagues they are honest with their opinions and dont hold back., Orthopedic surgeons as a group tend to think of their careers in a linear fashion, i.e., I am going to do this for X number of years and then retire or do something different. I am 55 and some people would say, What are you doing? Explore fellowships, residencies, internships and other educational opportunities. Search for condition information or for a specific treatment program. SunderNeelakantan Sunder, M.D.Anesthesiologist would later retire, in part because he was fed up with the battle over double-booking. He told Burke that Wood had faced an appropriate punishment for violating the new concurrent surgery policy losing the right to do simultaneous procedures. 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. What began as an internal discussion about safe surgical practice long ago turned personal and bitter, pitting top medical figures against one another. But, this is a separate issue. In the spring of 2012, two anesthesiologists and Burke met with Lillemoe to discuss their ongoing concerns about patients waiting under anesthesia for their surgeon and not knowing that their cases are double-booked. Such indirect supervision, where the attending is not present, is allowed under certain circumstances at teaching hospitals. Anesthesia, Critical Care & Pain Medicine, Billing, Insurance & Financial Assistance, Mass General/North Shore Center for Outpatient Care. We use cookies and other tools to enhance your experience on our website and 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. The first is the education of surgeons, residents, fellows, and even the sales force. He uses them to make things and fix people. Seventy-year-old Monique Pereira had Parkinsons disease, but she lived independently in the south of France and had recently flown to visit her son, Stephane, and his partner who ran a French bistro nearby on Newbury Street. He is a member of the Department of Orthopedic Surgery at the Massachusetts General Hospital and New England Baptist Hospital, and an Associate Professor of Orthopaedic Surgery at . As Burke recalls it, Shervin sobbed into the phone, asking what she should do. Watch the full documentary and learn more about concurrent surgeries at the homepage for Globe coverage of the issue. Frank X. Pedlow, Jr., M.D. He and his wife even loaned Shervin $375,000 to help her pay off debts and launch her own practice. Dr. Jay J. Patel brings his expertise to Hoag Orthopedic Institute as new Chief Strategy Officer. After more than two years, the board, according to MGH, recently informed several surgeons they were no longer under review. He told OTW, The company wanted someone who had an active practice and was a leader in the realm of education. We offer the full spectrum of orthopaedic care and are the best and most comprehensive orthopaedic surgery department in New England. Orthopaedics Advances in Motion provides health care professionals with information about the latest innovations from Mass General. MGH declined to say how much orthopedic surgeons there earn on average. In emergencies, when cases can overlap by more than an hour, he added, then the attending surgeon must have a second attending surgeon immediately available.. Dr. Pedlow is a board-certified, fellowship-trained spine surgeon, specializing in the surgical treatment of disorders of the adult spine. The hospital only allows certain types of procedures to run concurrently and not the kind that Tony Meng had. Thats the most appropriate utilization of this concurrent surgery not having two cases going exactly at the same time and the surgeon bouncing back and forth between the two, said Kirk. Overall, patients at MGH share their surgeon for some part of the case 15 percent of the time, figures provided by the hospital show. One recurring complaint was that patients lingered under anesthesia for long periods, as the operating room staff waited for the attending surgeon to arrive from work on another concurrent case. Our Team: Orthopaedic Spine Center - Massachusetts General Hospital From my understanding, the delay was not 2.5 hours. We allow cases to have a staggered start, he said in an interview. A multidisciplinary team of clinicians, including surgeons, physiatrists, pain specialists and advanced practitioners, to ensure your treatment is tailored for your needs, Non-operative treatment options and the latest surgical techniques, including minimally invasive procedures, to get you back to your active lifestyle, 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. His chosen path would lead him back to MGH for his residency and the heart of his 35-year career. General orthopedics ranks fourth in reputation among all US hospitals, according to US News and World Report. Read the final policy. Wood said he handled all the critical parts of Mengs surgery, and MGH says he acted appropriately within the accepted standard of care. The board last month filed documents in two of Woods malpractice suits, saying that its investigation of the surgeon was open and ongoing. A state spokeswoman told the Globe, We are unable to provide a definitive timeline for completion due to the complexity of the investigation.. Meet our team Conditions & Treatments 617-724-8636 Contact Information Phone: 617-724-8636 Request an appointment 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. 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. Hospital leaders would define the critical parts for many surgeries, and identify operations and types of patients whose surgeries should not overlap. Meet Dr. Joseph Schwab. Michael Daubs, M.D. Burke and his allies remain unpersuaded, and believe MGH is in a state of denial or something worse particularly when it comes to the critical matter of patient consent. Pearson, who joined the Brigham in 2017, led a hospital-wide effort to obtain Magnet designationthe highest national honor for nursing excellencefrom the American Nurses Credentialing Center. There is no known connection between the complications and deaths and the double-booking, but none of the patients and family members interviewed had any idea that the surgeons were involved in a second operation at the same time. He died in 2008 at the age of 99. Burke says he told her it might be unethical to take over another doctors case but, in his mind, the needs of a patient in distress trumped that concern. At Lahey Hospital & Medical Center, you can trust our orthopedic surgeons to provide expert, personalized and compassionate care. Rubash, according to a hospital spokeswoman, says the meeting with Burke never took place. Drs. He had become the sounding board and champion for those at MGH who shared his concerns about concurrent surgeries. In court papers, a medical expert hired by Jenks disputed the hospital account, noting that Wood was listed as the surgeon in charge of a second case that completely overlapped Jenkss. There are those in our profession who have been co-opted by the balance sheet, Burke wrote in September 2012 to Dr. Lillemoe, the hospitals surgery chief. In addition to his leadership role in trauma, he spent 14 years serving as an active member of the Orthopaedic Spine Service at BWH and initiated a weekly multidisciplinary spinal oncology meeting. When the patient requested that Dr. R. Malcolm Smith stay with her for the whole surgery, Wollman wrote that she saw Smith became irritated, accusing the patient of manipulating the system and causing delays. Get the latest news, explore events and connect with Mass General. Among his many accolades, Dr. Harris received the BWH Hippocrates Society Humanitarian Award and both held the chair position and served as a mentor for the AAOSs Leadership Fellows Committee. Mass. Trustee of Mass. With new Gene and Cell Therapy institute, MGB is staking its claim in She asked Bhattacharyya if he wanted to remix it, according to court documents. An MRI revealed a condition causing compression of his spinal cord. Goolsby and Shubin Stein, M.D. In addition to providing the consent form, MGH says its surgeons are expected to verbally discuss with the patient the plan for the surgery and potential risks, though there is no requirement that patients be told their surgeon is overseeing two cases at once. Explore fellowships, residencies, internships and other educational opportunities. Previously, Dr. Harris served as the chief of the Orthopaedic Trauma Service at Brigham and Women's Hospital (BWH). 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. When I am in an OR and focusing on three square inches, bombs can be going off around me, and I am focused on three square inches.. The group has successfully integrated with the numerous services that are needed to treat complex oncologic patients. So when he crossed paths with a trustee for the Massachusetts General Physicians Organization in early November 2010, the surgeon couldnt help himself. New Director at Rady Childrens San Diego, Goolsby and Shubin Stein New Co-DirectorsHSS Womens Sports Center, Raj Gala, M.D. Let us help you navigate your in-person or virtual visit to Mass General. Orthopaedic Journal at Harvard Medical School - annual publication Several anesthesiologists and surgeons, as well as a doctor who served on the committee that assigned OR time, told the Globe that, under Rubash, the orthopedics department increasingly allowed surgeons to schedule two surgeries at once. 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. Dr. Lillemoe, a genial native of a small town in South Dakota, came to Mass. The end of his cases occasionally overlapped with the start of other cases, but it averaged just a few minutes. MGH says it has been reviewing the safety of concurrent surgery for some time. 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. When people in medicine trace the origin of overlapping surgery, one name invariably comes up: Dr. Michael DeBakey. Shervin had herself tried and failed to put the hip back into place. Are we allowing 2 rooms for major spine surgery? 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. No, this should be fine, Bhattacharyya said, according to Shervins account. No one knows why it happened to Tony Meng, or how, or even exactly when. collected, please refer to our Privacy Policy. I will spotlight the many significant contributions by the orthopaedic staff at the Massachusetts General Hospital (MGH). Chiefs Reports: Massachusetts General Hospital MGHs charges for Woods services that day totaled about $73,000, according to copies of the bills provided to the Globe by Mengs attorneys at the Boston law firm Lubin & Meyer. These residents and fellows can relieve senior doctors of routine tasks, like stitching up patients and more, as their training progresses, allowing surgeons to move from one operating room to the next, where others have already prepared the patient. Mass General is a designated Blue Distinction Center for Spine Surgery from Blue Cross Blue Shield of Massachusetts. Wood later testified that he performed this particular procedure only once or twice a year, working in a delicate space where the difference between recovery and ruin is sometimes a scalpels width. We took those concerns very seriously, Slavin said. As chief, he was instrumental in the creation of the Orthopedic Research Laboratories. Rubash announced the departure with mixed emotions, saying Wood built an outstanding spine service. Barr, Joseph S., MD - Massachusetts General Hospital, Boston, MA 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. From that moment, battling concurrent surgery became Burkes cause and the gap between him and the hospital he loved now poisoned ground would only grow. Madelyn "Maddy" Pearson, DNP, RN, NEA-BC, is chief nursing officer and senior vice president of patient care services at Brigham and Women's Hospital. Thanks, Sunder. Hospital officials, in an interview, say Wood never left Jenkss room during the surgery. Best of luck to you, Dr. F. Zimmer is so lucky to have you! She later sued the hospital for alleged gender discrimination, an accusation ultimately rejected by a federal court jury after almost five weeks of testimony from MGH doctors and leaders, including Rubash. Learn about the many ways you can get involved and support Mass General. 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. The risks are real; the benefits can be huge. His stature and roster of well-known patients would prove no protection against what was coming. Free Vascularized Fibula Graft with Femoral Allograft Sleeve for Lumbar Spine Defects After Spondylectomy of Malignant Tumors, Modified En Bloc Spondylectomy for Tumors of the Thoracic and Lumbar Spine. Burke met twice with Stern in July 2011. He says he is at peace with that. 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. Vivek Babaria, DO, RMSK has joined DISC Sports & Spine Center as its first osteopathic physician. This summer, Wood said he would leave Boston to become a professor of orthopedic surgery at Stanford University in his native California, starting in November. The surgical team, led by Wood, worked intensely to figure out why. Still, the Spotlight Team found that the 2012 Meng case reignited an extraordinary, long-running controversy at one of the nations top-rated hospitals over the propriety and safety of a fairly common but little studied practice that goes to the heart of a doctors obligation to his unconscious patient. For several hours after anesthesiologists put Meng to sleep around 8 a.m., Wood tended to him and to the woman down the hall. She first checked room 22, where she had earlier assisted BhattacharyyaTimothy Bhattacharyya, M.D.Trauma surgeon on a third case that also overlapped briefly with Pereiras. Is it right that their patients may have no idea? In one of the few scientific studies of simultaneous surgeries, a University of Virginia researcher found no increase in complications in operations that overlapped by up to 45 minutes. But the Globe, through dozens of interviews and a review of hospital records, court filings, and hundreds of e-mails shared by current and former medical staffers, pieced together a portrait of this remarkable and revealing episode, one which changed surgical practice and procedure at the hospital and resulted in double-booking being raised as an issue in malpractice lawsuits. Orthopaedic Journal at Harvard Medical School - annual publication Read the draft version. To learn more about concurrent surgeries, visit our home for Globe coverage of the issue. Wood said he believed the cause of the worrisome neurological responses could be compression on the spinal cord from the back side. And it isnt over yet. He was also an Associate Professor of Orthopedic Surgery at Harvard Medical School. Congratulations on this new journey in your professional career. 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.. Raj Gala, M.D. Our education portal was built to answer our patient's most common questions. After other surgeons cut open a patients chest, DeBakey would come in, put the patient on a special blood-circulating machine, and then bypass blocked coronary arteries with blood vessels taken from the patients body. Burke sent a blistering e-mail to top hospital leaders, reviewing his long-running efforts to rein in the practice. At MGH, the acrimony has threatened careers and relationships and potentially much more, a drama that escalated with two steps almost unimaginable in the rigorously professional world of medicine, not to mention the life of a great hospital. Long afterward he learned that Wood had a second spinal surgery going at the same time as his. He said he had never, in his long career, encountered that particular complication. Dr. Warner had a second procedure running simultaneously and was scrubbed into room 20. This story was reported by Globe Spotlight Team reporters Jenn Abelson, Jonathan Saltzman, Liz Kowalczyk and editor Scott Allen. Im just a concerned doc worried about poor patient care and potential damage to the hospitals reputation.. 5 5 Blossom St Double-booking his first two cases enabled Wood to conduct three major operations on the day of Mengs surgery, logging a collective 21 hours as attending surgeon. Anesthesia, Critical Care & Pain Medicine, Billing, Insurance & Financial Assistance. 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. Burke had prepared 17 bullet points, including one addressing his own motives in raising the issue of double-booking. Orthopaedic Spine Center - Massachusetts General Hospital Bono CM, Leonard DA, Cha TD, Schwab JH, Wood KB, Harris MB, Schoenfeld AJ. Both agencies declined to comment.
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