At its meeting April 21 in San Francisco, the AANS Board of Directors approved the recommendation of the Professional Conduct Committee that four members be disciplined for unprofessional conduct while testifying as expert witnesses in medical malpractice lawsuits. Two of those disciplinary actions, an expulsion and a six-month suspension of membership, are being appealed to the general membership of the AANS. The two disciplinary actions that are not being appealed are summarized below.
| About the AANS Professional Conduct Program The AANS Professional Conduct Committee evaluates complaints by one or more AANS members about another member or members and makes recommendations to the Board of Directors. Established in 1982, the PCC has served as a model for other professional associations to structure and adopt similar professional conduct programs. In June of 2001, the AANS Professional Conduct Committee’s work was examined by the 7th Circuit Court of Appeals in a landmark case for professional associations, Austin v. AANS. This opinion strongly supported the AANS Professional Conduct Program and the importance to a professional association of having an internal mechanism for self-regulation. The program also received an honor roll designation from the American Society of Association Executives in 2002. The AANS rules for expert witness testimony are reprinted below. These rules, the AANS Code of Ethics and more information related to association governance are available online at www.aans.org/about in the Governance and Leadership area. |
In the underlying malpractice litigation, a 53-year-old man who experienced sudden nontraumatic onset of back pain, sense of leg heaviness, and leg pain was admitted to a hospital through the emergency room in January of 2000. The admitting neurologist ordered that vital signs and neurological evaluations be obtained every four hours by the nursing staff during the night. When the neurologist examined his patient the next morning on rounds, he found him to be densely paraparetic/paraplegic. The ordered neurological checks had not been documented and apparently had not been performed during the night. An emergency MRI of the thoracic and lumbar spine demonstrated a large left-sided disc herniation with cord compression at T8-9. A neurosurgeon was then consulted and performed an emergency decompression with left posterolateral excision of the herniated disc at T8-9. The patient gradually improved from his essentially paraplegic state to a paraparesis with neurogenic bladder.
The patient sued the hospital, the nurse who had been on duty the night of the patient’s deterioration, and the neurosurgeon. The neurosurgical expert witness for the plaintiff testified to the hospital’s negligence but was not at all critical of the surgery for removal of the thoracic disc herniation. Dr. Buster, the defense medical expert for the hospital, testified in his discovery deposition that the failure of the nursing staff to check vital signs and neurological function as ordered by the admitting neurologist did not fall below the acceptable standard of nursing care. Dr. Buster further testified that the surgical procedure was inappropriate and that the defendant neurosurgeon could have been “up to 50 percent responsible” for the patient’s resulting neurological deficit.
During the Professional Conduct Committee hearing, Dr. Buster stated that he had not thoroughly reviewed the nursing records prior to testifying in his deposition and that “looking back on it now” the standard of proper nursing care was not met. The Professional Conduct Committee concluded that Dr. Buster’s testimony as a defense expert witness for the hospital consisted of improper advocacy in denying negligence by the hospital and in misrepresenting the range of surgical standards for excising thoracic disc herniations in an attempt to shift responsibility for the neurological deficits from the hospital to the treating neurological surgeon. The AANS Board of Directors agreed with the PCC’s findings and voted to suspend Dr. Buster’s membership in the AANS for one year.
William H. Bloom, MD
The underlying lawsuit in this case involved a 44-year-old man who complained of a history of right arm pain with numbness in his right index and middle fingers. The problem reportedly began when he awakened one morning with scapular pain that was soon followed by right arm pain. A CT scan showed foraminal narrowing with spondylosis and some spinal stenosis. Approximately one month later the patient reported having experienced some “electric shock” sensations in his left arm. Surgery was carried out in the lateral position with bilateral laminectomies at C4, C5, C6 and C7. The operative note describes decompression of the right C5, C6 and C7 nerve roots and the left C6 and C7 nerve roots. Postoperatively the patient experienced pain in his left hand, and his right deltoid was very weak. The deltoid strength recovered spontaneously, but the left-hand pain persisted. A cervical MRI done postoperatively showed an abnormal signal in the left paracentral region of the cord at about C5-6. The patient was treated with some sympathetic blocks that did not relieve the pain, and he underwent implantation of a cervical epidural stimulator. The patient filed his lawsuit shortly after learning about the abnormal signal shown in the MRI.
Dr. Bloom, the plaintiff’s medical expert, testified in his deposition that the postoperative abnormal cervical cord MRI signal indicated a surgical cord contusion despite having disclaimed personal expertise in the interpretation of abnormal MRI signals. In his deposition, Dr. Bloom was excessively vague, unclear, and forgetful about what he reviewed or did not review. He did not recall whether he saw all of the MRI films or any of the CT films.
The Professional Conduct Committee concluded that, despite some problems with documentation, surgical indications and confusion about some aspects of the surgical procedure on the part of the treating neurosurgeon, Dr. Bloom failed to sufficiently review and familiarize himself with the relevant medical records. Because Dr. Bloom disclaimed any expertise in the interpretation of abnormal MRI signals, he therefore improperly gave unequivocal testimony that nothing other than operative contusion could have caused the postoperative MRI findings. The Professional Conduct Committee concluded that Dr. Bloom demonstrated inadequate subject matter knowledge and/or improper advocacy in parts of his testimony. The AANS Board of Directors concurred and since Dr. Bloom’s membership in the AANS had previously been suspended in another matter, the board voted to extend that suspension by one year from whatever point Dr. Bloom might otherwise be entitled to reapply for active AANS membership.
W. Ben Blackett, MD, JD, is chair of the AANS Professional Conduct Committee, and Russell M. Pelton, JD, is AANS general counsel.