Four AANS Members Suspended – Board Considers Six Complaints of Unprofessional Conduct

Six complaints of unprofessional conduct were considered at the November meeting of the American Association of Neurological Surgeons Board of Directors. As recommended by the AANS Professional Conduct Committee, the board dismissed one complaint and imposed sanctions in five cases. In one of those cases, the member will appeal the board’s sanction to the AANS membership at the annual meeting in April of this year.

The following is a highly condensed summary of the reasons for the four sanctions imposed:

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Abbott J. Krieger, MD: AANS Membership Suspended One Year. In a letter supporting a medical malpractice lawsuit, Dr. Krieger wrote that it was below the neurosurgical standard of care to perform an anterior C4-5 fusion for a painful C4-5 mobile subluxation. Dr. Krieger stated that because there was not a disc herniation, the standard of care required that the procedure be done posteriorly. Dr. Krieger further testified that dysphagia (secondary to pharyngeal plexus injury) following the anterior procedure indicated that “excessive force” had been used during surgery. There was no independent evidence that excessive force had been used, and Dr. Krieger admitted in the hearing that some dysphagia is not uncommon following anterior cervical spine surgery.

Joseph P. Krzeminski, MD: AANS Membership Suspended One Year. This case involved an infection following a repeat lumbar disc surgery. Dr. Krzeminski, who appeared as the plaintiff’s medical expert, failed to review any of the imaging studies, testified erroneously that prophylactic antibiotics had not been ordered, and that the standard of care required ordering a C-reactive protein in addition to the erythrocyte sedimentation rate and white blood cell count in a patient with rheumatoid arthritis. He further testified erroneously that a cyst found during the second surgery was an infected abscess when cultures from the area of the surgically opened cyst were negative. The board agreed with the committee’s conclusion that Dr. Krzeminski’s testimony was careless, poorly prepared, and in violation of the Expert Witness Guidelines.

Philip E. Stieg, MD, PhD: AANS Membership Suspended Six Months. This case involved a prominent athlete with a long history of refusing to take anticonvulsants for a seizure disorder. Dr. Stieg provided biased deposition testimony by refusing to accept detailed and appropriate medical care records as representative of the care and advice given because these records were not included in a hospital 23-hour short stay record. (The full records were included in the plaintiff’s office file and had been transmitted to the patient’s personal physician both verbally and in writing). Dr. Stieg also gave biased testimony in his deposition statements that the neurologist’s initial use of the word “declined” and his subsequent use of the word “reluctant” in describing the patient’s attitude toward taking anticonvulsants indicated that the neurologist had changed his mind about the need for giving anticonvulsants to the patient. Dr. Stieg further showed bias in his preference for accepting one party’s perceptions of the facts, rather than being neutral as to the validity of the conflicting perceptions.

Joel W. Winer, MD: AANS Membership Suspended Three Months. This was a complicated case that also included an operating room fire but the basis for the committee recommendation and the board’s action was Dr. Winer’s statement that it was below the neurosurgical standard of care to have explored the proximal carotid artery intracranially without first having exposed the carotid artery in the neck when, during surgery, a small posterior communicating aneurysm or infundibulum was found to not be the source of a subarachnoid hemorrhage. Dr. Winer also demonstrated bias and improper advocacy by refusing to answer the opposing counsel’s properly posed questions.

The AANS Professional Conduct Committee was established in 1982 to evaluate complaints of one or more AANS members about another member or members and to make recommendations to the Board of Directors. The majority of complaints brought before the committee involve expert witness testimony in medical malpractice lawsuits. The committee currently hears about 12 complaints yearly (up from three to four complaints per year several years ago).

The AANS Professional Conduct Program was the subject of a 7th Circuit Court of Appeals opinion published in June of 2001 (Austin v. AANS). This opinion is readily available via Internet search (7th Circuit Court, case number 00-4028). The program also received an honor roll designation by the American Society of Association Executives in 2002 and has been the model for similar programs adopted by several other professional associations

W. Ben Blackett, MD, JD, is chair of the AANS Professional Conduct Committee.