At the joint annual business meeting of the AANS and the American Association of Neurosurgeons on April 18 in New Orleans, the membership upheld an appealed decision of the Board of Directors expelling a member for unprofessional conduct. Also during the annual meeting the Board of Directors decided six new cases including another expulsion (not being appealed), a two-year membership suspension (being appealed to the general membership in April of 2006), one censure, and three dismissals of charges. A brief summary of the three sanctions appears below:
L. David Rutberg, MD:
Expelled From AANS Membership
The charges against L. David Rutberg, MD, were based on his submission of an expert opinion letter to a plaintiff’s attorney certifying that another neurosurgeon had deviated from the applicable standards of care in the placement of pedicle screws in a patient, in failing to diagnose and treat a postoperative wound infection in a timely manner, in failing to properly monitor and assess the patient’s condition and then in failing to consult with or refer the patient to appropriate specialists in a timely manner. Based on Dr. Rutberg’s letter, a medical malpractice lawsuit was filed. However, after the initiation of preliminary discovery, and after consultation with other experts, the plaintiff’s counsel determined that the suit was without merit and voluntarily dismissed the case.
The AANS Professional Conduct Committee concluded that if Dr. Rutberg had reviewed all of the clinical material in an unbiased manner, he would also have reached the conclusion that the complaint was without merit in the first instance and the lawsuit would not have been filed. The committee concluded, and the Board of Directors agreed, that Dr. Rutberg’s Letter of Merit constituted unprofessional conduct and that this, coupled with his previous suspension of membership for unprofessional conduct, warranted Dr. Rutberg’s expulsion from the AANS. After the Board of Directors approved the committee’s recommendation to expel Dr. Rutberg, he filed a Notice of Appeal to the General Membership. Dr. Rutberg’s letter explaining his position was distributed to all voting AANS members prior to the joint annual business meeting, as was a letter by then-AANS President Robert Ratcheson explaining the rationale for the board’s decision. At the meeting, the members upheld the Board of Directors’ decision and Dr. Rutberg was expelled.
Robert Rand, MD:
Expelled from AANS Membership
The Board of Directors approved the AANS Professional Conduct Committee recommendation that Robert Rand, MD, be expelled for unprofessional conduct consisting of certain expert testimony statements made in a professional liability lawsuit. Dr. Rand had been suspended previously for unprofessional conduct due to his testimony in an earlier matter. The current case involved a cervical intramedullary tumor that had been missed by other physicians and the patient had been quadriplegic for 12 hours prior to neurosurgical referral. Dr. Rand testified that if the patient had received immediate surgery, the patient would have been able to walk and would have regained most other activities of daily living.
The committee was not critical of Dr. Rand’s testimony that immediate surgery should have been offered to the patient (the tumor was removed 48 hours later), but concluded that Dr. Rand’s testimony about the patient’s expected recovery with surgery amounted to egregious advocacy and was flagrantly unprofessional. The Professional Conduct Committee concluded and the board agreed that this testimony, considered along with the prior unprofessional conduct suspension, warranted Dr. Rand’s expulsion from the AANS.
Edward C. Tarlov, MD:
Censured by AANS Board of Directors
The Board of Directors approved the AANS Professional Conduct Committee recommendation that Edward C. Tarlov, MD, be censured for unprofessional conduct based upon an expert opinion letter supporting a professional liability lawsuit.
The case involved a middle-aged woman who underwent a repeat lumbar disc excision that was complicated by a tenuously sutured dural tear. She had a difficult postoperative course that was felt to be consistent with low cerebral spinal fluid pressure. She was readmitted urgently the day after discharge with dysphasia and a computed tomographic scan of the head demonstrated a hemorrhagic venous infarction. Dr. Tarlov provided the plaintiff’s attorney with an expert opinion letter stating that the patient “was confused and at times used words inappropriately” and concluded that “it was clear that she was developing a neurological deficit with speech disturbance” which the treating neurosurgeon failed to recognize as a developing stroke. Review of the medical records covering the initial hospitalization indicated evidence of normal speech with no observation of a developing dysphasia in either the treating neurosurgeon’s progress notes or in the nursing notes. Dr. Tarlov’s opinion was based upon subsequent deposition statements of the patient’s husband that were in direct contradiction to the hospital records and the recollection of the treating neurological surgeon.
The committee concluded, and the Board of Directors agreed, that in assuming the correctness of the husband’s statements and rejecting the statements of the treating neurosurgeon, as well as the hospital records, Dr. Tarlov failed to be an unbiased educator (deciding between the conflicting “facts” was a jury responsibility) and became an advocate for the plaintiff.
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. The committee has recently been averaging about 12 cases per year, most of which involve expert witness testimony in medical malpractice lawsuits. Four cases are scheduled for hearings in Boston during the 2005 Annual Meeting of the Congress of Neurological Surgeons. Over the last decade the AANS has dismissed between 30 percent and 40 percent of the complaints alleging unprofessional expert testimony.
Established in 1982, the AANS Professional Conduct Committee 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, indicating the need for a professional association to have an internal mechanism for self-regulation. The program also received an honor roll designation from the American Society of Association Executives in 2002.
W. Ben Blackett, MD, JD, is the chair of the AANS Professional Conduct Committee.
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