At its meeting on June 13, 2015, the Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) considered two grievances filed under the AAOS Professional Compliance Program. In addition, they considered a compliance matter not related to the AAOS Standards of Professionalism (SOP).
After considering the information presented and upon recommendation of the Judiciary Committee and the Committee on Professionalism, the Board took the following professional compliance actions.
David B. Basch, MD
Sparta, N. J.
On Aug. 14, 2013, a grievance was filed against David B. Basch, MD, alleging violations of the SOP for Orthopaedic Expert Opinion and Testimony, Mandatory Standards Nos. 1, 2, 4, and 6. The grievance arose from statements made by Dr. Basch, a treating physician and an expert witness for the plaintiff, during his trial testimony in a medical liability lawsuit. Dr. Basch opined that the patient’s leg length discrepancy was the result of a left total hip arthroplasty (THA) and that anything greater than 1 cm is a deviation from the accepted medical standards. The case proceeded to a jury trial but was dismissed based on pretrial motions prior to jury deliberation.
The patient was a 59-year-old woman with a 2-year history of increasing pain in the left hip due to degenerative osteoarthritis (OA). The patient underwent a left THA performed by the Grievant and postoperatively noted a sensation of the left leg’s being longer than the right leg. The Grievant evaluated the postoperative radiographs and noted a 3 mm to 4 mm lengthening of the left leg.
The patient had reduced hip pain, but pain developed in her right knee. An MRI of the right knee showed a degenerative medial meniscal tear and patellofemoral joint OA, which was treated with injections. The patient subsequently sought the care of Dr. Basch, who diagnosed her with severe OA of the right knee resulting from the leg-length inequality following the left THA. The patient was seen by Dr. Basch on three occasions, during which he measured her leg length clinically and noted different measurements of 2¼ inches, 1 inch, and 1½ inches.
In his trial testimony, Dr. Basch stated that the patient’s leg-length discrepancy was a result of the left THA and that anything greater than 1 cm is a deviation from the accepted medical standards. Dr. Basch further opined that clinical measurement was more precise than reading a radiograph and that he did not need the patient’s radiograph to accurately measure a discrepancy in the patient’s leg length.
On March 15, 2014, the Committee on Professionalism (COP) Hearing Panel conducted a hearing attended by Dr. Basch, his legal counsel, and the Grievant. After an in-depth evaluation of the facts presented, all materials submitted, and the oral testimony at the hearing, the Panel found that Dr. Basch violated Mandatory Standards Nos. 1, 2, 4, and 6.
Dr. Basch testified at the grievance hearing that his trial testimony had been taken out of context. He added that he agreed that a scanogram is the best way to measure leg-length discrepancy. Dr. Basch testified that he ordered a scanogram and confirmed that the patient did not comply with that order.
The COP Hearing Panel was of the opinion that Dr. Basch’s inconsistent clinical findings of the actual leg-length discrepancy were indicative of the need for a more objective form of measurement, such as a radiograph or scanogram. Dr. Basch’s failure to include an objective form of measurement in his evaluation process, compounded by his inability to achieve a reliable measurement through his own devices, led the majority of the Panel to conclude that Dr. Basch knew his testimony on the measurement of the leg length discrepancy was false.
The Panel also found that Dr. Basch was absolute in his opinions and was not fair and impartial. The Hearing Panel found no other evidence to support Dr. Basch’s claim of a 1½-inch leg-length discrepancy other than his own chart notes. Dr. Basch did not compare the pre- and postoperative radiographs by templating them prior to trial. The Panel was of the opinion that Dr. Basch’s testimony was based on an incomplete record, which led him to condemn care that fell within generally accepted practice standards, and that his inconsistent clinical measurements should have been corroborated or supported by radiologic measurement comparing the pre- and postoperative radiographs before rendering his opinion. The COP Hearing Panel recommended that AAOS suspend Dr. Basch for a period of 2 years.
Dr. Basch appealed the recommendation, and the Judiciary Committee conducted an appeal hearing in October 2014. Dr. Basch and his counsel attended. The Grievant did not attend but provided a written statement that was read into the record. The Judiciary Committee unanimously determined that the AAOS had afforded due process to Dr. Basch and also concluded that the clear weight of evidence supported the COP Hearing Panel’s recommendations. However, the Judiciary Committee recommended to the Board that AAOS suspend Dr. Basch for 1 year.
At its meeting on June 13, 2015, the AAOS Board of Directors considered this matter. Dr. Basch attended with his counsel. After thorough evaluation and discussion, the Board upheld the findings and recommendation of the Judiciary Committee and voted to suspend David B. Basch, MD, for 1 year due to unprofessional conduct in the performance of expert witness testimony.
Albert B. Thrower, MD
Westfield, N. J.
On March 24, 2014, a grievance was filed against Albert B. Thrower, MD, alleging violations of the SOP for Orthopaedic Expert Opinion and Testimony, Mandatory Standards No. 4. The grievance arose from statements made by Dr. Thrower, an expert for the plaintiff, in his trial testimony in a medical liability lawsuit against the Grievant. Dr. Thrower testified that the Grievant was negligent in not surgically fixing the fibula alone within the first 2 weeks of the patient’s injury, and as a result, the patient suffered from pain, decreased strength, and weakness of the ankle. The case proceeded to a jury trial where a verdict was rendered in favor of the defendant.
The medical case involved a 52-year-old woman with a fracture of the left lower leg as a result of a fall at work in 2009. The patient was immediately seen by the Grievant at his office where radiographs revealed an extra-articular fracture of the distal metaphysis of the left tibia and fibula above the syndesmosis. The ankle mortise was said to be intact. The Grievant verbally discussed treatment options at that time with the patient and her husband, including surgical and nonsurgical management, which was not documented in his records.
The patient declined surgery and was treated nonsurgically with a long-leg cast for 5 weeks, followed by a short-leg cast for 5 more weeks. She was then placed in a CAM walker and underwent physical therapy. By 8 months post-injury, the patient had minor complaints of discomfort and ankle swelling at the end of the day. Radiographs were obtained and the Grievant thought the tibia had healed. He recognized the fibula was displaced at the fracture site but thought that position was insignificant because it was above an intact syndesmosis and the mortise was intact. The patient was released to return to work.
The patient had continued pain and sought a second opinion. A CT scan in April 2010 showed a nonunion of the tibia that was treated with a bone stimulator and eventually healed. A subsequent independent medical examination (IME) was performed by a foot and ankle specialist who noted that the tibia fracture had healed in a slight varus angulation of less than 5 degrees. The IME physician recommended that the patient continue to work on muscle strengthening, but he did not believe there was indication for further surgical intervention as the fibular nonunion was clinically asymptomatic and not functionally limiting.
On Oct. 24, 2014, the COP Hearing Panel conducted a hearing attended by the Grievant. Dr. Thrower did not attend, but submitted a response that was read into the record. After an in-depth evaluation of the facts presented, all materials submitted, and the oral testimony at the hearing, the Panel found that Dr. Thrower violated Mandatory Standard No. 4.
The COP Hearing Panel was of the opinion that Dr. Thrower violated the standard by condemning the conservative management of the patient’s injury, opining instead that the fibula fracture should have been surgically repaired without repairing the tibia. The Panel also noted that Dr. Thrower was absolute in his opinion that it was a deviation from the standard of care to not surgically repair the fibula with plate and screws, a degree of confidence that, in the panel’s opinion, was not supported by the medical record or medical literature. The COP Hearing Panel recommended that AAOS suspend Dr. Thrower for 1 year.
Dr. Thrower did not appeal the COP report and recommendation and, on June 13, 2015, the AAOS Board of Directors considered this matter. After due deliberation, the Board upheld the findings of the COP Hearing Panel and voted to suspend Albert B. Thrower, MD, for 1 year due to unprofessional conduct in the performance of expert witness testimony.
The following matter is not related to the AAOS Standards of Professionalism.
Surendranath K. Reddy, MD
AAOS Fellowship suspended
In January 2015, the New York State Board of Professional Medical Conduct entered a Consent Order against Dr. Reddy, effective Feb. 2, 2015. The order indefinitely suspended Dr. Reddy’s medical license for a period of no less than 1 year, after which he may petition for a modification order staying the suspension. The action stemmed from Dr. Reddy’s admitted plea of guilty to a charge of aggravated driving under the influence.
The AAOS Board of Directors voted to suspend Dr. Reddy’s Fellowship in AAOS until he holds a full and unrestricted license to practice medicine.
For more information on the AAOS Professional Compliance Program, visit www.aaos.org/profcomp