At its meeting on Sept. 24, 2016, 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 Board considered compliance matters 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 (COP), the Board took the following professional compliance actions.
John D. Maskill, MD
Grand Rapids, Mich.
On May 5, 2014, a grievance was filed against John D. Maskill, MD, alleging violation of Mandatory Standard Nos. 1, 2, 5, 6, and 7 of the SOP for Orthopaedic Expert Opinion and Testimony. The grievance arose from statements made by Dr. Maskill in his summary correspondence and deposition testimony in a medical malpractice lawsuit.
Dr. Maskill was the subsequent treating physician of the patient and rendered opinions related to the patient's future prognosis and predictions on the patient's future medical needs. He did not offer opinions on the Grievant's treatment of the patient or standard of care. The underlying matter was settled and the lawsuit was dismissed with prejudice in 2013.
The medical case involved a 17-year-old male who sustained a fracture of the distal third tibia in October 2010 while playing football. After being treated with closed casting, the patient complained of increased pain and swelling, raising concern for compartment syndrome. He had sensory abnormalities and developed a nonhealing great toe ulceration.
Dr. Maskill performed a right subtalar joint fusion with flexor hallucis longus tenotomy and gastrocnemius recession. The patient regained good function, although he used medical marijuana to manage chronic pain and a seizure disorder developed. The patient was noncompliant with treatment recommendations, ultimately developing painful callosities due to worsening toe contractures. Nonetheless, he cancelled the surgery scheduled to address these issues.
In March 2015, the COP conducted a hearing attended by Dr. Maskill and the Grievant. After an in-depth evaluation of both the material submitted by the parties and the hearing testimony, the COP Grievance Hearing Panel found by a majority opinion that Dr. Maskill violated Mandatory Standard No. 2. The COP found that Dr. Maskill was not fair and impartial when he testified to the cascade of potential complications and dire consequences awaiting the patient, including a greater than 50 percent probability of below-the-knee amputation. The Hearing Panel believed this testimony was very imbalanced and not based on medical fact.
The Hearing Panel also believed that if Dr. Maskill intended to remain a treating physician witness rather than an expert witness, he could have refused to respond to speculative questions about possible dire outcomes, particularly when such outcomes are not supported in the scientific literature. The COP Hearing Panel recommended that, as a result of the violation of Standard No. 2, Dr. Maskill be officially censured by the AAOS. The COP Hearing Panel did not find Dr. Maskill in violation of Mandatory Standards Nos. 1, 5, 6, or 7.
Dr. Maskill appealed the recommendation, and the Judiciary Committee conducted an appeal hearing in October 2015, which was attended by Dr. Maskill, his counsel, and the Grievant. Dr. Maskill testified that his extensive interactions with the patient and his family led him to believe that the patient was unlikely to be compliant in the future. Although Dr. Maskill may have intended to be a fact witness, the Judiciary Committee believed that he crossed into providing expert testimony when he opined on the patient's future prognosis and necessary medical treatment up to 60 years in the future.
In the Judiciary Committee's opinion, these projections incorporated subjective impressions and probabilities that were not supported with either medical literature or Dr. Maskill's own personal experience treating similar patients. Dr. Maskill told the Judiciary Committee that he had little experience as an expert witness and that he had learned much from the grievance process. Dr. Maskill also acknowledged that he could have worded his opinions more carefully. After careful consideration, the Judiciary Committee found that AAOS and the COP Hearing Panel afforded both parties due process and unanimously agreed with the recommendation of the COP Hearing Panel to censure Dr. Maskill.
At its meeting on Sept. 24, 2016, the AAOS Board of Directors considered this matter. Both parties attended. After thorough evaluation and discussion, the Board upheld the findings and recommendation of the COP and the Judiciary Committee and voted to censure Dr. Maskill due to unprofessional conduct in the performance of expert witness testimony.
Richard A. Matza, MD
On Feb. 9, 2015, a grievance was filed against Richard A. Matza, MD, alleging violations of Mandatory Standards 1 through 7 of the SOP for Orthopaedic Expert Opinion and Testimony. The grievance arose from Dr. Matza's statements in an expert report and trial testimony, which he gave as an expert for the plaintiff in a medical liability lawsuit.
Dr. Matza testified that the patient's need for revision surgery was due to the leg length discrepancy (LLD) caused by the primary total hip surgery, and that a postoperative LLD of more than five-eighth inch is below the standard of care. The lawsuit went to a jury trial where a verdict was rendered in favor of the defendants.
The patient in the underlying case was a 41-year-old male with 2 years of left groin pain due to osteoarthritis of the hip. The patient's history was significant for scoliosis, sciatica, and a previous L5-S1 fusion. The patient had an initial LLD of the left leg, which was one-half inch longer than the right leg. Radiographs showed osteoarthritis involving both hips.
The patient underwent a primary left total hip replacement in June 2010 and, one month later, complained of increased left leg length and concern that the increased length would cause more back pain. He was offered shoe inserts as an interim measure and told of the opportunity to balance the leg lengths if his right hip required replacement. The patient sought additional opinions. A scanogram showed a 25 mm LLD. The Grievant interpreted this difference as 23 mm, with 12.7 mm due to the pre-existing increased length of the left femur and tibia.
The patient underwent revision arthroplasty by an oncologic orthopaedist in September 2010, which resulted in a 6 mm to 7 mm reduction in length of the left leg. The surgery was complicated by an intraoperative fracture of the proximal femur, treated with Dall-Miles cable and subsequent protected weight bearing. The postoperative notes indicated the patient recovered with no limp or weakness and the cable was subsequently removed.
In October 2015, the COP conducted a hearing attended by the Grievant. Dr. Matza was invited, but did not attend. After an in-depth evaluation of both the material submitted by the parties and the hearing testimony, the COP Grievance Hearing Panel found by a majority vote that Dr. Matza violated Mandatory Standard No. 2 when he repeatedly testified that the standard of care for postoperative LLD was within five-eighth inch, but did not provide any supporting literature. The Hearing Panel found that this testimony was not fair and impartial, and that Dr. Matza did not factor the preoperative LLD into his opinions. Furthermore, the Hearing Panel found that Dr. Matza gave no allowance for the need to have a stable reduction, as described in the operative report.
The COP Grievance Hearing Panel also unanimously found that Dr. Matza violated Standard Nos. 3 and 4. The Hearing Panel concluded that Dr. Matza demonstrated a lack of knowledge of the standard of care for leg-length discrepancy following total hip replacement when he testified that five-eighth inch is the maximum acceptable discrepancy and gave no allowance for flexibility of the standard due to the preoperative status of the patient. The Hearing Panel also found that Dr. Matza condemned performance falling within the generally accepted practice standards—specifically, the Grievant's attempt to obtain hip stability and adjust leg length appropriately.
Finally, although Dr. Matza had extensive training and experience in joint arthroplasty, a majority of the COP Grievance Hearing Panel found that he did not have sufficient orthopaedic knowledge on the specific implant system used in this case prior to rendering his opinions, in violation of Standard No. 7. The Hearing Panel believed that Dr. Matza should have gained familiarity with the characteristics of the prosthesis in question and should have known that the use of the lateral offset component in this system would not lengthen the leg.
The COP Grievance Hearing Panel recommended that, as a result of the violation of Standard Nos. 2, 3, 4, and 7, Dr. Matza be officially suspended for a period of 1 year by the AAOS. The Hearing Panel did not find Dr. Matza in violation of Mandatory Standard Nos. 1, 5, or 6.
Dr. Matza did not appeal the COP Report and Recommendation and, on Sept. 24, 2016, the AAOS Board of Directors considered this matter. After due deliberation, the Board upheld the findings of the Hearing Panel and voted to suspend Richard A. Matza, MD, for 1 year due to unprofessional conduct in the performance of expert witness testimony.
Additional actions not related to the AAOS SOP
At its meeting on Sept. 24, 2016, the AAOS Board of Directors considered the following licensure compliance matters not related to the AAOS SOPs and took the actions indicated.
Ascar Egtedar, MD
AAOS Fellowship Suspended
In November 2015, the Nevada Board of Medical Examiners issued an order of Summary Suspension and Notice of Hearing, which summarily suspended Dr. Egtedar's license to practice medicine. Following an investigation, the Medical Board determined that the health, safety, and welfare of the public was at imminent risk. The suspension remains in effect until further order of the Investigative Committee and Nevada Board of Medical Examiners.
The AAOS Board of Directors voted to suspend Dr. Egtedar's Fellowship in AAOS until he holds a full and unrestricted license to practice medicine.
David Lehrman, MD
North Miami Beach, Fla.
In December 2015, the State of Florida Board of Medicine entered an order in which Dr. Lehrman voluntarily relinquished his license to practice medicine. The order stemmed from the investigation of a complaint in which Dr. Lehrman was found to have given unauthorized individuals access to order medications in his name and use his DEA number. The individuals ordered approximately 64,700 units of oxycodone, 100 units of Lorcet, and 11,650 units of Endocet during a 7-month period from January to July 2010. In October 2010, his pain clinic surrendered less than 5,000 total units, with at least 72,000 units unaccounted for. The Administrative Complaint alleged that Dr. Lehrman was in violation of the following three counts: failure to register to dispense medications; practicing beyond the scope permitted by law; and improperly delegating others to dispense these substances on his behalf.
The AAOS Board of Directors voted to expel Dr. Lehrman.
For more information on the AAOS Professional Compliance Program, visit www.aaos.org/profcomp