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AAOS Now

Published 9/1/2009

AAOS Board takes professional compliance actions - Dr. Season III

Edwin H. Season III, MD

Columbus, Ohio

1-Year Suspension

On Oct. 8, 2007, a grievance was filed against Dr. Season alleging violations of Mandatory Standards Nos. 1, 3, and 6 of the Standards of Professionalism (SOPs) on Orthopaedic Expert Witness Testimony. The grievance arose from statements made by Dr. Season during deposition testimony as expert for the plaintiff in a lawsuit. In this case, the plaintiff-patient contended negligence in the defendant-orthopaedic surgeon’s failure to recognize signs and symptoms of osteomyelitis and to appropriately treat the osteomyelitis. The claims against the defendant-orthopaedist and medical center were later dismissed with prejudice.

The plaintiff-patient was involved in a dirt bike accident and sustained a segmental tibial shaft fracture. It was described as an impending open fracture due to a large spike of bone tenting the skin with accompanying bruising of the tibial skin from having been dragged. The patient underwent intramedullary (IM) rodding of the tibia fracture and, due to concerns of soft-tissue trauma to the skin, was given a 2-week regimen of antibiotics including ciprofloxacin. He attended two scheduled follow-up visits and, at approximately 5 weeks postoperatively, went to the Emergency Department (ED) where he was diagnosed with cellulitis and prescribed Levaquin®. One week later, the patient went to a second ED facility where he was diagnosed with an abscess as well as osteomyelitis. A lag screw was removed from the tibial cortex and the patient underwent irrigation and débridement of the abscess. Cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA).

The plaintiff-patient returned to the defendant-orthopaedist at approximately 8 weeks after surgery and was prescribed a 6-week intravenous antibiotic course of treatment. Four months following the initial injury, the plaintiff-patient underwent removal of the IM nail. The infection completely resolved and the fracture healed, enabling the patient to return to a normal lifestyle.

In his oral deposition, Dr. Season testified with certainty that osteomyelitis is a permanent condition and appeared to classify a complicated fracture as “minor.” He stated that he did not recall the fracture as a complex segmental fracture. He also stated that he was no longer performing IM rod fixations and referred them to someone more regularly involved with the procedure. When asked about his concerns regarding ciprofloxacin, Dr. Season responded that it was a broad spectrum antibiotic that could mask the progression of infection. He declared that it was not the best antibiotic to treat MRSA, but then acknowledged he did not know whether ciprofloxacin was used at all to treat MRSA. He further stated that he would defer to the infectious disease specialists.

On June 20, 2008, the Committee on Professionalism (COP) Hearing Panel conducted a grievance hearing attended by both parties. When asked by the panel whether all records were available to him, Dr. Season admitted that he had relied on the attorney to provide the materials and did not review all of the records. He acknowledged that other records could have been reviewed, saying, “They were never given to me but I could have reviewed them and I would have advised them to drop the case on the basis of that.”

After careful evaluation of all material submitted as well as oral testimony given by both parties during the proceedings, the COP Hearing Panel found Dr. Season had violated only Mandatory Standards Nos. 3 and 6 of the SOPs on Orthopaedic Expert Witness Testimony. In making its decision and recommendation, the panel considered that Dr. Season did not evaluate care provided in light of generally accepted standards at the time, place, and in the context of care delivered and did not seek and review all pertinent medical records related to the particular patient prior to rendering an opinion on the medical or surgical management of the patient. The COP Hearing Panel recommended that Dr. Season be suspended from the AAOS for 1 year.

Dr. Season appealed the recommendation of the COP Hearing Panel and the Judiciary Committee conducted an appeal hearing in February 2009. The Grievant was present; however, Dr. Season did not appear or submit a written statement. The Judiciary Committee unanimously determined that due process had been afforded Dr. Season and that the clear weight of evidence supported the COP Hearing Panel’s recommendation.

On June 20, 2009, the AAOS Board of Directors considered this matter. Neither of the parties attended the hearing. After careful deliberation and discussion, the Board upheld the findings and recommendations of the COP Hearing Panel and Judiciary Committee and voted to suspend Edwin H. Season III, MD, for 1 year because of unprofessional conduct in the performance of expert witness testimony.

Edwin H. Season III, MD

Columbus, Ohio

1-Year Suspension

Consecutive to any other professional compliance action

On Nov. 27, 2007, a grievance was filed against Dr. Season alleging violations of Mandatory Standards Nos. 3, 4, and 7 of the Standards of Professionalism (SOPs) on Orthopaedic Expert Witness Testimony. The grievance arose from statements made by Dr. Season during deposition testimony as expert for the plaintiff in a lawsuit. In the underlying court case, the plaintiff-patient asserted that the defendant-orthopaedic surgeon was negligent in failing to provide proper anticoagulation treatment while treating an ankle fracture. The claims against the defendant-orthopaedist were voluntarily dismissed with prejudice.

The plaintiff-patient sustained, as the result of a slip and fall, a closed trimalleolar fracture of the left ankle, with a large posterior piece, and a sprain of the right midfoot. An open reduction internal fixation of the left ankle was performed and, 1 day after surgery, the patient was reported ambulatory with physical therapy. The plaintiff-patient was discharged within 3 days and seen 2 weeks later for follow-up at which time the splint was removed and a short leg cast applied. Approximately 1 month after the fall, a pulmonary embolism developed and, on the second day following, the plaintiff-patient sustained an embolic stroke. It was determined that the plaintiff-patient had a patent foramen ovale.

In his oral deposition, Dr. Season stated that the defendant-orthopaedic surgeon was negligent in failing to do an analysis of risk factors for deep vein thrombosis (DVT) and prescribe appropriate prophylactic measures. He also stated that failure to document such an analysis is below the standard of care. Dr. Season acknowledged that he did not review any orthopaedic surgical peer-reviewed literature pertaining to DVT prophylaxis. Furthermore, he stated that he did not know the rate of occurrence of DVT from surgical repair of isolated ankle fractures and had not researched that subject matter.

On June 20, 2008, the Committee on Professionalism (COP) Hearing Panel conducted a grievance hearing, which Dr. Season attended. The Grievant did not attend the hearing but provided a written statement to the panel.

After careful evaluation of all material submitted as well as oral testimony given by Dr. Season during the proceedings, the COP Hearing Panel found Dr. Season in violation of Mandatory Standards Nos. 3, 4, and 7 of the SOPs on Orthopaedic Expert Witness Testimony. The panel determined that the scientific literature did not support Dr. Season’s opinions on anticoagulation treatment and that he lacked any knowledge concerning how the guidelines he used to justify his opinions were produced. Furthermore, he admitted that more than 51 percent of orthopaedic surgeons were not conducting written DVT risk analysis in 2003 and, therefore, he was condemning performance that fell within generally accepted practice standards. The COP Hearing Panel recommended that Dr. Season be suspended from the AAOS for 1 year.

Dr. Season appealed the recommendation, and in February 2009, the Judiciary Committee conducted an appeals hearing. Neither Dr. Season nor the Grievant attended nor did they submit additional materials or written statements. The Judiciary Committee, in reviewing the issues and submitted materials, including the report from the COP Hearing Panel, noted that during the Grievance Hearing, Dr. Season attempted to recant a portion of his expert witness testimony. Following careful consideration, the Judiciary Committee unanimously agreed that both parties had been afforded appropriate due process and reaffirmed and adopted the report and recommendation of the COP Hearing Panel.

At its meeting on June 20, 2009, the AAOS Board of Directors considered this matter. Neither party to the grievance was in attendance. After thorough evaluation and discussion, the Board upheld the findings and recommendations of the COP Hearing Panel and Judiciary Committee and voted to suspend Edwin H. Season III, MD, for 1 year because of unprofessional conduct in the performance of expert witness testimony. They also voted that this suspension run in sequence with any other AAOS professional compliance action.