At its meeting on June 8, 2013, the Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) considered two grievances filed under the AAOS Professional Compliance Program. After considering the information presented and upon recommendation of the Judiciary Committee and the Grievance Hearing Panel of the Committee on Professionalism (COP), the Board took the following professional compliance actions.
Ronald M. Krasnick, MD
Mount Laurel, N.J.
On Oct. 7, 2011, a grievance was filed against Ronald M. Krasnick, MD, alleging violations of the Standards of Professionalism (SOP) for Orthopaedic Expert Witness Testimony, Mandatory Standards Nos. 1, 2, and 3. The grievance arose from statements made by Dr. Krasnick during deposition testimony as an expert for the plaintiff in a medical liability lawsuit. The plaintiff-patient alleged that she received second-degree burns during an arthroscopic shoulder procedure performed by the Grievant. The lawsuit was dismissed with prejudice after a settlement was reached.
The patient in the underlying case underwent right shoulder arthroscopy and arthroscopic subacromial decompression for rotator cuff tendinitis. The surgery was uneventful, but at the first postoperative visit, upon removal of the surgical dressings, the patient had a burn with blistering over the top of the shoulder. The surgeon broke the blister, removed the superficial dead skin, and applied Silvadene.
The Grievant did not know how the patient sustained the burn. The skin was washed after the surgical procedure and the area had not been taped. He speculated that an allergic reaction might be the cause. The patient was to return 4 days later, but did not return until 3 weeks later, at which time the burn appeared to be healing nicely.
In the interim, the patient had seen a dermatologist, who also treated the burn with Silvadene. According to the patient’s deposition testimony, the dermatologist had diagnosed second-degree burns, possibly related to contact with a hot instrument during surgery.
In his deposition, Dr. Krasnick testified about his expert report in which he stated that a burr, a shaver, or a trocar may have caused the burn. He opined that the burr will get hot enough to cause second-degree burns because, “One, it rotates at a phenomenal speed. Number two, as it contacts tissue, the contact-the speed itself-will generate tremendous amounts of heat very quickly.”
Dr. Krasnick stated that the trocar could get hot from sterilization, immersion in a hot fluid, or exposure to a heat source. However, he later acknowledged that the instruments used in the patient’s surgery had been autoclaved 2 to 4 days prior to the procedure and could not have caused the burn as stated in his expert report.
Dr. Krasnick stated that the shaver’s light attachment could have burned the patient’s skin or could have been put down for a split second, thus branding the skin.
Dr. Krasnick testified that the Grievant deviated from the standard of care by failing to appropriately refer the patient to a plastic surgeon for the treatment of her burn and by breaking the blister, which aggravated the situation and had consequences in terms of a greater scar.
On July 20, 2012, the COP Hearing Panel conducted a grievance hearing attended by both parties. When questioned as to possible scenarios for the burn, the Grievant confirmed the type of dressing used and said that no electrocautery was used during the procedure; that the draping was very wide; and that it is his practice to personally prep the shoulder, suture the incision, clean the shoulder, and place the dressings and slings in arthroscopic shoulder procedures.
When asked by the Panel about the burr’s generating tremendous amounts of heat by rotation, Dr. Krasnick replied that he did not have any scientific data, but that the rotating burr gets very hot and if it is put against the skin, it will cause a burn. Dr. Krasnick stated that a burn of this size and significance was a deviation from the standard of care. With respect to his own experience, Dr. Krasnick stated that he had performed the occasional shoulder arthroscopy, but that most of his experience had been with knees.
After careful evaluation of all material submitted as well as oral testimony given by both parties during the proceedings, the COP Hearing Panel found that Dr. Krasnick violated Mandatory Standards Nos. 2 and 3 of the SOP on Orthopaedic Expert Witness Testimony. Dr. Krasnick was not found in violation of Mandatory Standard No. 1.
In making its decision and recommendation, the Panel considered Dr. Krasnick’s erroneous conclusion that the Grievant must have deviated from the standard of care because the patient experienced a thermal injury as a complication of the surgery, even though he could not determine with any degree of certainty how this may have occurred. Dr. Krasnick provided no literature to support his statements that the burr could reach the boiling point and brand the patient.
The Panel also found that Dr. Krasnick failed to evaluate the medical condition and care in light of the generally accepted standards at the time, place, and in the context of care delivered. The Panel believed that an orthopaedist can effectively manage the care of a thermal injury of this nature. The COP Hearing Panel recommended that Dr. Krasnick be suspended from the AAOS for one (1) year.
Dr. Krasnick appealed the recommendation and the Judiciary Committee conducted an appeal hearing in March 2013. The Grievant was present; however, Dr. Krasnick did not attend. The Judiciary Committee unanimously determined that the AAOS had afforded due process to Dr. Krasnick and that the weight of the evidence supported the COP Hearing Panel’s recommendation.
On June 8, 2013, 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 Ronald M. Krasnick, MD, for one (1) year because of unprofessional conduct in the performance of expert witness testimony.
Ronald M. Krasnick, MD
Consecutive to any other professional compliance action
On Aug. 11, 2011, a grievance was filed by two Fellows against Dr. Krasnick alleging violations of Mandatory Standards Nos. 1 through 6 of the SOP on Orthopaedic Expert Opinion and Testimony. The grievance arose from statements made by Dr. Krasnick in his expert report for the plaintiff in a medical liability lawsuit that involved complications following bilateral total hip arthroplasty (BTHA). The lawsuit was concluded through an arbitration proceeding, which found the defendants not negligent.
The patient in the underlying case was first examined by Grievant #1 for bilateral hip pain and restricted function, for which oral medication was minimally effective. Although an appropriate candidate for BTHA, the patient deferred surgery for 3 years before undergoing BTHA. On her discharge to the rehab facility, postoperative incisions were clean and dry with scant drainage from the left hip. She returned to the emergency department (ED) later that day and was diagnosed with toxic metabolic encephalopathy secondary to her current medications.
The patient returned to the ED 5 days later due to increased swelling and incisional drainage. Her temperature was 98.5◦F. Three days later, Grievant #2 performed bilateral irrigation and débridement, exchanged the acetabular liners, and exchanged the right femoral head to correct slight instability.
Gram stains were negative for bacteria, and the wound fluid was serosanguinous and not purulent. Cultures later grew Enterococcus faecalis from broth only from the right hip and very light growth from the left hip. The left hip responded well to treatment, but increasing swelling and erythema developed in the right hip.
Grievant #1 removed the components from the right hip and inserted an antibiotic-impregnated cement spacer. A revision procedure was reportedly anticipated for 6 to 8 weeks later, but the patient elected to transfer her care to a third surgeon for the revision.
In his expert report, Dr. Krasnick stated that Grievant #1 was quick to recommend and schedule hip replacement surgery and did not offer the patient nonsurgical treatment options. He further opined that the patient should not have been discharged due to the presence of drainage, which is a known sign of infection.
Dr. Krasnick also stated that the diagnosis of toxic metabolic encephalopathy can indicate an ongoing infection and that the surgeon was negligent in not obtaining an infectious disease consultation at the time. Dr. Krasnick also stated that upon the second admission, the patient had a 103◦F fever and bilateral hip drainage. He further opined that the patient’s ongoing complications resulted from the negligent treatment provided by the Grievants and other healthcare providers.
On July 20, 2012, the COP Hearing Panel conducted a grievance hearing attended by Dr. Krasnick and Grievant #2, with counsel. Grievant #1 did not attend the hearing.
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. Krasnick in violation of only Mandatory Standards Nos. 2, 3, 4, and 5 of the SOP on Orthopaedic Expert Opinion and Testimony. The Panel determined that Dr. Krasnick’s testimony was not fair and impartial. On multiple occasions, the medical records contradicted his opinions regarding informed consent, timing of surgery, notification of the surgeon at re-admission, characteristics of wound drainage, patient’s temperature, and timing of the diagnosis of the wound infection.
The COP Hearing Panel also found that Dr. Krasnick did not have appropriate knowledge of the standard of care and was uninformed about issues such as wound drainage, indications for infectious disease consultations, and appropriate surgical care of early postoperative infection. Furthermore, Dr. Krasnick criticized or condemned treatments that were strongly supported by scientific literature and generally accepted practices. He also did not give creditable explanations for his opinions or why they varied from accepted practices.
The COP Hearing Panel recommended that Dr. Krasnick be suspended from the AAOS for two (2) years, to run consecutively with any other professional compliance action that might be rendered.
Dr. Krasnick appealed the recommendation, and in March 2013, the Judiciary Committee conducted an appeal hearing. Neither of the Grievants nor Dr. Krasnick attended. The Judiciary Committee unanimously determined that AAOS had afforded due process to Dr. Krasnick and reaffirmed the report and recommendation of the COP Hearing Panel.
At its meeting on June 8, 2013, the AAOS Board of Directors considered this matter. Grievant #2 attended; Dr. Krasnick did not. After thorough evaluation and discussion, the Board upheld the findings and recommendations of the COP Hearing Panel and the Judiciary Committee and voted to suspend Ronald M. Krasnick, MD, for 2 years due to unprofessional conduct in the performance of expert witness testimony. They also voted that this suspension run consecutively with any other AAOS professional compliance action.
Additional Professional Compliance actions
At its meeting on June 8, 2013, the AAOS Board of Directors also considered the following compliance matters not related to the AAOS Standards of Professionalism and took the actions indicated.
Jason Bergandi, MD
AAOS Fellowship suspended
In May 2012, the Illinois Department of Financial and Professional Regulation (IDFPR) indefinitely suspended Dr. Bergandi’s medical license for a minimum of 12 months for failure to comply with terms and conditions of an agreement with the IDFPR for drug screening. Dr. Bergandi’s Illinois medical license remains suspended.
The AAOS Board of Directors voted to suspend Dr. Bergandi’s Fellowship in AAOS until such time he has a full and unrestricted medical license.
Alfred R. Massam, MD
In October 2012, the U.S. District Court for the Southern District of Florida found Dr. Massam guilty of a felony, theft, and embezzlement of employee benefit funds and sentenced him to 24 months in federal prison. The Florida Department of Health also filed an Administrative Complaint against Dr. Massam for failure to notify the Florida Board of Medicine of his guilty plea to a felony count and his conviction.
The AAOS Board of Directors voted to expel Dr. Massam.
Raymond G. Shea, MD
AAOS Fellowship suspended
In August 2012, the Kentucky Board of Medical Licensure entered an Agreed Order, which is in effect for 5 years. The terms of the Order require Dr. Shea to complete select courses in prescribing controlled drugs, enroll in a Center for Personalized Education for Physicians Implementation Program, maintain a controlled substances log that may be examined by the medical board, submit to a consultant review, and pay related administrative costs. The action stemmed from an investigation by the Kentucky All Schedule Prescription Electronic Reporting Advisory Council of the state’s top prescribers of controlled substances. A Board consultant found that Dr. Shea departed from or failed to conform to acceptable and prevailing medical practices.
The AAOS Board of Directors voted to suspend Dr. Shea’s Fellowship in AAOS until such time he has a full and unrestricted medical license.
For more information on the AAOS Professional Compliance Program, visit www.aaos.org/profcomp