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AAOS Now

Published 8/1/2014

AAOS Board Takes Professional Compliance Actions

At its meeting on June 14, 2014, the Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) considered two grievances filed under the AAOS Professional Compliance Program. In addition, the AAOS Board of Directors considered seven compliance matters not related to the AAOS Standards of Professionalism (SOP). These actions are summarized below.

SOP Grievances
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, New Jersey
Expelled

On April 2, 2013, a grievance was filed against Ronald M. Krasnick, MD, alleging violations of the Standards of Professionalism for Orthopaedic Expert Opinion and Testimony, Mandatory Standards Nos. 1–3 and 5–7. The grievance arose from statements made by Dr. Krasnick during deposition testimony as an expert for the plaintiff in a medical liability lawsuit. Dr. Krasnick opined that the Grievant deviated from the standard of care in his performance of right knee arthroscopy by failing to achieve anatomic fixation of the meniscal tear and that the Grievant’s failure to use a more secure standardized technique resulted in the patient’s having to have a second surgical procedure.

The patient in the underlying case underwent right knee arthroscopy, which included partial medial and lateral meniscectomies and repair of the peripheral medial meniscal tear followed by placement of nine (9) meniscal arrows. The patient returned to work with physical restrictions, and 5 months later returned with recurrent right knee pain after physical activities. A second opinion was obtained and the patient underwent a second arthroscopy where a peripheral tear of the posterior horn of the medial meniscus was repaired with sutures using an inside-out technique. The patient returned to full work duty 4 months thereafter.

In his deposition, Dr. Krasnick testified about his expert report wherein he stated that the Grievant violated the standard of care in his performance of the right knee arthroscopy by failing to achieve anatomic fixation of the meniscal tear in a vascular zone. He also opined that the use of the meniscal arrows was a deviation from the accepted practice. In his testimony, Dr. Krasnick admitted that he prepared his expert report without having reviewed the intraoperative images. Dr. Krasnick further testified that without the benefit of seeing the images, he still came to the conclusion that the Grievant did not properly reapproximate the torn cartilage and that the outcome (the patient’s revision surgery) speaks for his technique.

Dr. Krasnick also testified that he never used meniscal arrows in his prior practice and that he has never observed a repair of the kind that the Grievant performed in the patient’s first procedure.

On October 25, 2013, the Committee on Professionalism (COP) Hearing Panel conducted a grievance hearing. The Grievant and his counsel attended. Dr. Krasnick did not attend the hearing, but provided a written statement that was read into the record in lieu of his appearance.

After careful evaluation of all material submitted, as well as oral testimony provided during the proceedings, the COP Hearing Panel unanimously found Dr. Krasnick in violation of Mandatory Standards Nos. 1–3 and 5–7 and recommended expulsion.

In making its recommendation, the COP Hearing Panel relied on Dr. Krasnick’s admission under oath that he did not have the information needed to assess whether or not the Grievant performed the meniscal reduction and repair correctly. Despite testifying that he knew images existed and that he wanted to see the images, Dr. Krasnick still rendered an opinion on the standard of care without reviewing the images. In the COP’s opinion, Dr. Krasnick made statements that he knew were false to advocate for the plaintiff patient when he opined that the patient’s recurrent meniscal tear automatically meant that the initial repair did not meet the standard of care.

In making its decision, the Hearing Panel was of the opinion that Dr. Krasnick’s testimony was not fair and impartial. Dr. Krasnick opined that if the patient had a recurrent or new tear, the Grievant’s surgery on the patient must have been substandard, based solely on that outcome.

Furthermore, Dr. Krasnick admitted in his deposition that he did not have the knowledge or experience regarding the standard of care in this matter and that he had never performed or observed a meniscal repair of this kind (using meniscal arrows). He further failed to provide any reasonable, evidence-based explanation or personal experience to justify his expert testimony against the Grievant.

The Hearing Panel was of the opinion that Dr. Krasnick’s failure to examine the patient’s intraoperative images in this situation was also in violation of Mandatory Standard No. 6.

The COP Hearing Panel’s findings in connection with this matter were solely based on the facts related to this specific grievance, and prior grievances against Dr. Krasnick were not considered in reaching these findings. However, the deliberations and decision with regard to the recommended disciplinary action did take into consideration Dr. Krasnick’s pattern of behavior, as evidenced in the two membership suspensions issued by the AAOS Board of Directors in two prior grievances.

Dr. Krasnick appealed the recommendation and the Judiciary Committee conducted an appeal hearing in March 2014. Dr. Krasnick participated by teleconference. The Grievant provided a written response in lieu of appearance. The Judiciary Committee unanimously determined that the AAOS had afforded both parties due process and that the weight of the evidence supported the COP Hearing Panel’s recommendation.

In its report, the Judiciary Committee was of the opinion that the operative report of the Grievant noted that “the meniscus was probed and shown to be stable.” Furthermore, the Judiciary Committee considered Dr. Krasnick’s testimony when he stated that he was “never afforded the pictures” and that the images “would have confirmed adequate reconstruction in a vascular area which had a reasonable chance to heal.” The Judiciary Committee was of the opinion that without seeing the images, and in light of what the operative report stated about the meniscus being reduced and stable, there was no way Dr. Krasnick could have known that the patient’s meniscus had been improperly reduced. And yet, he did so opine, adding that the outcome spoke for the Grievant’s technique and that the patient ultimately did not do well due to the inadequate repair of the torn cartilage.

The Judiciary Committee considered that despite knowing that the patient was young, active, and may have been noncompliant, Dr. Krasnick maintained the opinion that it was solely poor surgical technique that led to the second procedure.

On June 14, 2014, the AAOS Board of Directors considered this matter. Neither of the parties attended the hearing, but the Grievant provided a written statement. After careful deliberation and discussion, the Board upheld the findings and recommendation of the COP Hearing Panel and Judiciary Committee and voted to expel Ronald M. Krasnick, MD, for his unprofessional conduct in the performance of expert witness testimony.

Raymond M. Vance, MD
San Diego, California
Censure

On Nov. 28, 2012, a grievance was filed against Raymond M. Vance, MD, alleging violations of the Standards of Professionalism for Orthopaedic Expert Opinion and Testimony, Mandatory Standards Nos. 1–5. The grievance arose from statements made by Dr. Vance in an Affidavit of Medical Expert Opinion as an expert witness for the patient’s family in a medical liability lawsuit. In his affidavit, Dr. Vance opined that the Grievant was negligent and breached the standard of care when he failed to recognize and treat the increased risk of deep vein thrombosis (DVT) and complications in an obese, immobilized patient who had a history of congestive heart failure and circulatory problems. The lawsuit did not proceed to trial and an agreement was reached by the parties. The case was dismissed with prejudice by the court.

The patient in the underlying case was an obese female who injured her right foot in an accident at work. Radiographs confirmed a fracture of the right fifth metatarsal base, and the patient was placed in a CAM walker boot and referred to physical therapy for assistance with mobility. In a follow-up appointment, the patient indicated that her foot hurt less and that she was walking more, but she reported pain when the CAM boot pushed on her calf, which stopped immediately when the CAM boot was removed. The Grievant examined the patient and found no swelling or cords in the calf; a radiograph showed the fracture to be stable. After returning home that afternoon, the patient complained of mild chest pain and her husband found her unresponsive on the floor that evening. The patient died of a pulmonary thromboembolism.

The patient’s medical history form at the treating orthopaedist’s office included a history of obesity and varicose veins. However, after her death, the Investigations Report by the Medical Examiner included additional pertinent medical history of myocarditis, congestive heart failure, and unstable angina from the primary care physician’s records.

On July 26, 2013, the Committee on Professionalism (COP) conducted a hearing with both parties present. After an in-depth evaluation of the facts presented, all materials submitted, and the oral testimony at the hearing, a majority of the COP found that Dr. Vance violated Mandatory Standards Nos. 2 and 4, but not Mandatory Standards Nos. 1, 3, and 5.

The COP Hearing Panel was of the opinion that Dr. Vance based his opinions, at least in part, on evidence in the postmortem autopsy report (ie, the patient’s comorbidities of myocarditis, congestive heart failure, and unstable angina). Furthermore, the Hearing Panel believed that although the comorbidities discovered at the time of the postmortem autopsy were important in determining the patient’s cause of death, it would be unfair to condemn the Grievant’s performance because of information he did not have and could not have without the patient’s disclosure at the time of treatment.

In the Hearing Panel’s opinion, Dr. Vance condemned performance that fell within generally accepted practice standards, and the Grievant’s performance fell within these standards. The COP Hearing Panel recommended that Dr. Vance be censured.

Dr. Vance appealed the COP’s recommendation, and in November 2013, the Judiciary Committee conducted an appeal hearing with both parties present. The Judiciary

Committee determined that AAOS had afforded due process to both parties and reaffirmed the report and recommendation of the COP Hearing Panel. The Judiciary Committee was also of the opinion that Dr. Vance’s affidavit relied heavily on information unknown to the Grievant at the time he treated the patient.

At its meeting on June 14, 2014, the AAOS Board of Directors considered this matter. After thorough evaluation and discussion, the Board upheld the findings and recommendations of the COP Hearing Panel and Judiciary Committee and voted to censure Raymond M. Vance, MD, due to unprofessional conduct in the performance of expert witness testimony.

Additional actions
The following compliance matters are not related to the AAOS Standards of Professionalism.

Mohammad Diab, MD
San Francisco
AAOS Fellowship suspended

In October 2013, the Medical Board of California entered a Stipulated Settlement and Disciplinary Order against Dr. Diab, effective Nov. 1, 2013. The action stemmed from an investigation of unprofessional conduct because he engaged in a sexual relationship with a patient. The order revoked Dr. Diab’s license to practice medicine; however, the revocation was stayed in favor of a 60-day suspension and probation for 7 years. Probationary terms included practiced monitoring and completion of additional CMEs on professional boundaries and ethics.

The AAOS Board of Directors voted to suspend Dr. Diab’s Fellowship in AAOS until he has a full and unrestricted medical license.

Gregory J. Dixon, MD
Placerville, Calif.
Expelled

In October 2013, the Medical Board of California entered a Stipulated Surrender of License and Disciplinary Order, wherein Dr. Dixon voluntarily surrendered his medical license in lieu of disciplinary action. The action stemmed from accusations filed against Dr. Dixon from an earlier 2009 DUI and testing positive for alcohol while under probation. In 2010, Dr. Dixon was arrested on another DUI and convicted of a second misdemeanor for having an open container of alcohol or marijuana while driving a motor vehicle.

The AAOS Board of Directors voted to expel Dr. Dixon.

Abubakar A. Durrani, MD
Cincinnati
Expelled

In March 2014, the Medical Board of Ohio issued an order to permanently revoke Dr. Durrani’s medical license. The Board found that Dr. Durrani presigned blank prescriptions for use by his employees who were not legally authorized to prescribe. The Board found that these blank prescriptions were used to issue prescriptions for dangerous drugs and controlled substances while Dr. Durrani was out of the country, which constitutes a felony in Ohio. Dr. Durrani also was cited by the Kentucky Board of Medical Licensure, which issued an emergency order of suspension based on his indictment in federal court on multiple felony counts, including distribution of oxycodone outside the scope of his professional practice.

The AAOS Board of Directors voted to expel Dr. Durrani.

Kevin E. McGovern, MD
Ellicott City, Md.
AAOS Fellowship suspended

In January 2013, the Maryland Board of Physicians issued a Consent Order wherein Dr. McGovern was reprimanded and placed on probation for a minimum of 2 years. The order stemmed from a complaint from a Maryland insurance company concerning workers’ compensation patients. The Board’s investigation found that Dr. McGovern failed to meet the appropriate standard of care and failed to keep adequate medical records. Dr. McGovern’s medical license remains active under probationary terms that include payment of a civil fine and completion of programs on medical ethics, record keeping, billing practices, and conservative pain management treatment.

The AAOS Board of Directors voted to suspend Dr. McGovern’s Fellowship in AAOS until he has a full and unrestricted medical license.

Rouben Mirbegian, MD
Hidden Valley Lake, Calif.
Expelled

In March 2012, Dr. Mirbegian surrendered his California medical license in lieu of disciplinary action. This action stemmed from an accusation filed by the Medical Board of California in 2011 concerning his treatment of four patients, alleging negligent acts of incomplete patient history and documentation; inadequate record keeping; inadequate patient consent; incorrect diagnosis; and failure to meet standard of care in execution of surgery. Dr. Mirbegian does not have an active license to practice medicine in California.

The AAOS Board of Directors voted to expel Dr. Mirbegian.

Lawrence M. Rubens, MD
Columbus, Ohio
AAOS Fellowship Suspended

In October 2013, the State Medical Board of Ohio and Dr. Rubens entered into a Consent Agreement that indefinitely suspended Dr. Rubens’ license to practice medicine, with interim monitoring conditions and conditions for reinstatement. The action was based on the doctor’s admission that he is impaired in his ability to practice medicine and surgery due to his diagnoses of alcohol dependence and depression.

The AAOS Board of Directors voted to suspend Dr. Rubens’ Fellowship in AAOS until he has a full and unrestricted medical license.

Franklyn E. Seabrooks, MD
Fairfield, Calif.
Expelled

In November 2012, the Medical Board of California issued an order suspending Dr. Seabrooks’ license to practice medicine. The action stemmed from a previous petition that alleged that Dr. Seabrooks sent threatening correspondence to employees, failed to maintain adequate patient documentation, and engaged in inappropriate behavior. The petition further alleged that Dr. Seabrooks was unable to practice medicine safely due to a mental condition. In September 2013, an administrative hearing was held and the Medical Board of California issued its decision to revoke his medical license.

The AAOS Board of Directors voted to expel Dr. Seabrooks.

For more information on the AAOS Professional Compliance Program, visit

www.aaos.org/profcomp