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AAOS Now

Published 9/1/2009

AAOS Board takes professional compliance actions - Dr. Ratner

Irving P. Ratner, MD

Burlington, N.J.

Censure

On May 12, 2008, a grievance was filed against Irving P. Ratner, MD, alleging violations of the Standards of Professionalism (SOPs) on Orthopaedic Expert Witness Testimony, Mandatory Standards Nos. 2, 4, 6, 8, and 12. The grievance arose from statements made by Dr. Ratner in a Certificate of Merit and in his oral deposition as expert witness for the plaintiff in a medical liability lawsuit. The underlying case claimed that a 1-inch leg length discrepancy outcome was the result of negligent performance during total hip arthroplasty (THA). The orthopaedic surgeon and hospital were both named as defendants. The hospital-employed orthopaedist was later dismissed with prejudice from the lawsuit and the hospital paid an out-of-court settlement.

The plaintiff-patient in this case had limited range of motion and increased pain on both internal and external hip rotation. The defendant-orthopaedist’s documentation revealed a discussion of risks and the decision to proceed with a hip replacement, but made no mention of leg-length measurement. The defendant-orthopaedic surgeon performed a left THA and, approximately 2 months postoperatively, recorded a leg-length inequality. It was noted that the patient was most comfortable with a 1/2-inch outside shoe lift on the opposite side for corrective purposes. The plaintiff-patient pursued a second opinion, complaining that the operated leg was markedly long. She stated that she had to bend her knee to walk, resulting in back and opposite hip pain. The second surgeon noted that the leg discrepancy was almost an inch, although an exact measurement was never made. Available information indicated that the discrepancy was approximately 1 inch. The second surgeon recommended that the plaintiff-patient return to the defendant-orthopaedist for leg length radiographs and consideration to shorten the femoral neck. She returned to the defendant-orthopaedist for a final visit 5 months following the original procedure, and revision surgery to shorten the leg was discussed.

After reviewing hospital records and office visit notes of the second opinion physician, Dr. Ratner produced a Certificate of Merit. In this document, Dr. Ratner opined that the defendant-orthopaedist violated the standard of care by failing to take appropriate steps to ensure proper postsurgical leg length while performing a left THA. He stated that, as a direct result of the standard of care violations, the patient suffered an excessively lengthened left leg and was otherwise injured and damaged.

When testifying at deposition, Dr. Ratner admitted that he did not review the defendant-orthopaedist’s office records prior to preparing his written report and signing the certificate and acknowledged that he had not requested additional records or information. He stated that facts about the case were not disclosed to him and that he relied solely on the available medical records to offer his opinion. Dr. Ratner further stated that the standard of care in performance of THA does not permit a full inch of leg length discrepancy though it does allow for 1/2 inch. He declared that anything more than 1/2 inch is unacceptable and that a 3/4 inch discrepancy would fall into the range of negligence, except under the most unusual circumstances such as lengthening to achieve stability. He added that if a surgeon adheres to pre- and intraoperative measuring, leg length comparison will measure within 1/4 inch to 3/8 inch.

On Feb. 27, 2009, the Committee on Professionalism (COP) Hearing Panel conducted a hearing; the Grievant attended but Dr. Ratner did not. The panel determined that Dr. Ratner was absolute in his statements regarding standard of care and leg length discrepancy without considering other possible causes. Dr. Ratner condemned performance that fell within generally accepted practice standards as no established standard for leg length discrepancy exists. Furthermore, Dr. Ratner did not seek and review all pertinent medical records prior to rendering an opinion.

After thorough consideration of the issues and all materials submitted, the panel found that Dr. Ratner had violated only Mandatory Standards 2, 4, and 6 of the SOPs on Orthopaedic Expert Witness Testimony and recommended that the Board of Directors officially censure Dr. Ratner.

Neither the Grievant nor Dr. Ratner appealed the recommendation to the Judiciary Committee.

On June 20, 2009, after careful deliberation, the AAOS Board of Directors upheld the findings and recommendation of the COP Hearing Panel and voted to censure Dr. Ratner due to unprofessional conduct in the performance of expert witness testimony.