After a 35-year career as a cancer surgeon and teacher of laparoscopic surgery, a pulmonologist at my home hospital, Sequoia Hospital, was promoted to Quality Assurance Director. This QA Director misinterpreted her QA computer output and wrongly informed my colleagues for over two years that a computer print-out showed that I had a 20% takeback rate. The administration investigated me for “increased complications, infections and takebacks to the OR” when their data and my own counts showed this was untrue. They refused to share with me their “data” despite my repeated asking.

 

The QA Director ignored her QA computer print-outs from the National Surgical Quality Improvement Project (NSQIP) data showing my accurate total complication rate of 6.3%, infection rate of 3%, and takeback rate of 3%. She ignored the hospital electronic medical record data showing my total complication rate was 7%. She ignored the hospital’s count of 28 total complications and count of 628 total cases: 5%. (5 divided by 628 = 5%)

 

Every surgeon has complications. It is important to practice in a way that minimizes them, identifies them early, addresses them properly and then learn from them. They will always happen, and they should be rare. Many surgical publications detail acceptable complication rates, and I had published 13 studies from my laparoscopic work with over 2,300 patients, demonstrating that my rates were consistent with those of other gynecologic cancer surgeons.

 

The QA Director was advised by the American College of Surgeons NSQIP staff to compare my data with other Gynecologic Oncology publications, but she testified under oath that she declined to do this. Rather, she told over 30 colleagues in the administration and Medical Executive Committee for two years, and 16 times under oath, that my take back rate was 20%. This caused good colleagues of many years to have to vote to expel me from the hospital. (I would too, if it were true.)

 

It was only during the appeal process that I received their data records, and found out that the QA Director had been misinterpreting a hospital bed census statistic for an actual takeback rate and that all their quality data and counts showed that my rates of complication, infections and takebacks were safe, the same as all publications from gynecologists. It was too late.

 

Being expelled from a hospital automatically triggers a review by the Medical Board. The hospital sent these four "worst" cases out of 628 procedures I had done over 44 months. The Medical Board did not review the hospital's truthfulness or accuracy in expelling me; it only reviewed these four cases.

• In one case, a patient had undergone hysterectomy and had an episode of low blood pressure and hematocrit during the night, which normalized immediately with all normal vitals signs and activity the rest of her stay. She qualified for nursing discharge per hospital policy the next morning, and  developed internal bleeding later that afternoon and returned for laparoscopic repair. Nationally this happens to 3% of Outpatients receiving hysterectomy. While there was no evidence that she was having internal bleeding that next morning, it would have been more cautious of me to ask her to stay for more observation.

• In another case, a patient had undergone removal of an ovary and appendix and had developed internal bleeding a few hours after her surgery, requiring takeback to the operating room. While all the old clots were removed, there was no active bleeding, and she had a normal blood level afterwards. She remained well, with all normal vitals signs and activity the rest of her stay. She qualified for nursing discharge the next morning, per hospital policy, and developed internal bleeding on her 3-hour drive home and had to return for laparoscopic repair.

• A nurse responsible for conducting the “flight-check,” called the TimeOut before an operation, and failed to follow hospital policy, by reading not from the patient's signed consent, but from an administrative scheduling form, mistakenly indicating to me that a patient's ovaries were to be removed. When I asked if she were certain of the removal of the ovaries, she reaffirmed it. In fact, the patient had not changed her mind, and we should have preserved her ovaries. The hospital conducted an investigation and never interviewed me, only the nurses. The nurse admitted reading from the wrong form, but the hospital never shared this report with me. The Department of Public Health fined the hospital $45,000 for her mistake. I still could not understand how I could have made such a mistake. When hospital administrators and I met with the patient to explain her care, I took full responsibility for the error, and the hospital administrators cynically watched, and never admitted their fault.

• I planned the removal of a cancer recurrence adjacent to the Aorta Artery, coordinating with a vascular surgeon for potential vessel repair. The procedure went as intended, and the patient has since been cured; however, the hospital inaccurately labeled it a “near miss.” They somehow assumed that such an operation was beyond my credentials, and never obtained the opinion of another gynecologic Oncologist who would have told them that. The hospital never confirmed my credentials to do this advanced procedure, or discovered that I had performed it 145 times in the past three years, even laparoscopically. I had also published and taught and made teaching videos on that exact procedure. Nonetheless, I was summarily suspended after the uncomplicated curative operation!

 

I was promptly offered probation for these four cases, but I was unable to operate locally or maintain my practice.

 

After incurring nearly $300,000 in legal fees and at the age of 66, with retirement on the horizon, I ultimately surrendered my medical license to the MBC, requesting they acknowledge the merits of merely issuing a letter of reprimand. Unfortunately, this information was omitted from the final MBC report circulated to all doctors in California.

 

My last surgical procedure took place in May 2020.

 

After teaching 19 laparoscopic surgery courses, and nearly annually at the Society for Gynecologic Oncologists or American Association for Gynecologic Laparoscopy, I was unable to teach anymore.

 

As it stands now, I am not practicing surgery, only tennis.

 

But trust me, I was better at surgery.