Published 9/1/2009

AAOS Board takes professional compliance actions - Dr. Bright

Robert W. Bright, MD

Rochester, N.Y.

1-Year Suspension

On Feb. 8, 2008, a grievance was submitted against Dr. Bright alleging violations of Mandatory Standards Nos. 1, 2, 3, 4, 5, 10, 12, and 13 of the Standards of Professionalism (SOPs) on Orthopaedic Expert Witness Testimony. The grievance arose from statements made by Dr. Bright in a written report and oral deposition as the plaintiff-patient’s medical expert in a lawsuit. The plaintiff alleged that the defendant-orthopaedic surgeon was negligent in caring for a slipped capital femoral epiphysis. The jury returned a verdict in favor of the defendant-orthopaedist and judgment was entered against the plaintiff for no cause of action.

The patient was an obese 13-year old male whose initial symptoms included hip and groin pain but no injury, fever, or other joint symptoms. Physical exam showed decreased range of motion in the hip with slight spasm. Comparison view radiographs showed an open femoral capital epiphysis but no slip. A magnetic resonance image (MRI) revealed edema of the epiphyseal plate and a joint effusion. After a second opinion confirmed the diagnosis of pre-slip, the patient underwent a pinning. Radiographs taken 3 months after the procedure verified closure of the physis, and the patient returned to full activity. Hip pain recurred 2 months later, and radiographs revealed osteonecrosis (ON) of the femoral head. The patient was referred for treatment and underwent a core decompression and grafting procedure. At last follow-up, the patient was asymptomatic, and radiographs documented healing.

In his expert report, Dr. Bright stated that the defendant-orthopaedist performed an in-situ hip pinning without radiographic findings of slippage that would indicate surgery. He opined that the pinning of symptomatic pre-slip is contraindicated and was a deviation from the accepted standard of care at the time (1999). Moreover, Dr. Bright opined that the mechanics of the procedure deviated from the standard of care because “no pin need be placed more than three thread lengths into the femoral head so as not to interrupt the intraosseous blood supply” and no pin should be placed closer than 1 cm from the femoral head surface due to “greatly increased” risk of ON.

During his deposition, Dr. Bright stated that “a pre-slip is not a clinical entity that is diagnosable except in retrospect” and the MRI that showed edema in the growth plate was normal. He also testified that the ON was caused by “advancement of the screw too far into the femoral head” and that a screw placed within 6 mm to 7 mm of the subchondral bone was not in the safe zone.

Dr. Bright’s submitted curriculum vitae listed him as licensed through to “current;” however, it was determined that Dr. Bright was not licensed while working with this case.

Neither the Grievant nor Dr. Bright attended the hearing held on Oct. 24, 2008. The Committee on Professionalism (COP) Hearing Panel thoroughly reviewed all materials submitted, evaluated the facts of the case, and found that Dr. Bright violated Mandatory Standards Nos. 2, 3, 4, and 10 only of the SOPs on Orthopaedic Expert Witness Testimony. The COP recommended that Dr. Bright be suspended from the AAOS for 1 year. No appeal was requested.

On June 20, 2009, the AAOS Board of Directors carefully deliberated and discussed this matter, upheld the findings and recommendation of the COP Hearing Panel, and voted to suspend Robert W. Bright, MD, for 1 year because of unprofessional conduct in the performance of expert witness testimony.