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AAOS Now

Published 8/24/2021

AAOS Board Considers Grievance Filed under the Professional Compliance Program

At its meeting on June 15, 2021, the Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) considered a grievance filed under the AAOS Professional Compliance Program. The following action was taken:

David C. Ring, MD, PhD
Austin, Texas

One-year Suspension

In May 2019, a grievance alleging violations of the Standards of Professionalism (SOP) on Orthopaedic Expert Opinion and Testimony was filed against David C. Ring, MD, PhD. The grievance was based on statements made by Dr. Ring in an expert opinion letter and deposition testimony. The patient in the underlying case was a 48-year-old female who presented with complaints of bilateral hand numbness, tingling, and pain in the ulnar aspect of her forearm. The patient also had an elbow injury the month prior in which she hyperextended her left elbow. She underwent right carpal tunnel release (which was not the subject of the grievance) and a few months later underwent a left arthroscopic debridement of synovitis and removal of loose bodies from the elbow, which was performed by the Grievant. Postoperatively, the patient had decreased sensation and an MRI showed a gap in the ulnar nerve of approximately 2.9 cm. The patient then underwent a left ulnar nerve repair with graft.

After thorough consideration and deliberation, the Committee on Professionalism (COP) Grievance Hearing Panel and the Judiciary Committee found that Dr. Ring’s expert testimony was in violation of Mandatory Standards Nos. 2, 3, 4, and 6. With regard to Standard No. 2, in both Panels’ opinions, Dr. Ring was not fair and impartial in his assessment of the loose bodies, or when he testified that elbow arthroscopy was not an appropriate treatment for this patient. To state definitively that there were no loose bodies ignored the patient’s documented complaints (including pain, decreased range of motion, and intermittent locking), the CT scan and images, the radiologist’s report, and intraoperative images. In reference to his opinion that the degree of damage to the nerve could not have occurred without negligence, the Judiciary Committee noted there is medical literature that indicates that these events occur in a certain percentage of cases without an obvious error. Accordingly, to opine that the degree of nerve damage alone was an indication of negligence was also not fair and impartial.

Both committees concluded that, although Dr. Ring has extensive experience in elbow surgery, his testimony that elbow arthroscopy was not indicated in this patient’s case showed that he did not evaluate the condition in light of generally accepted practice standards in the time, place, and context of the care delivered, which was in violation of Standard No. 3. Regarding Standard No. 4, the committees believed there was documented preoperative evidence suggestive of loose bodies and that performing an elbow arthroscopy was within the standard of care. During the grievance hearing, Dr. Ring stated that arthroscopic surgery was the most common procedure for the removal of loose bodies in the elbow, yet he condemned the Grievant for performing elbow arthroscopy. During the Judiciary Committee proceeding, Dr. Ring said that he recognized that he may have overstated his position in condemning the arthroscopy procedure.

With reference to Standard No. 6, the COP Grievance Hearing Panel believed that the intraoperative images should have been requested and reviewed prior to Dr. Ring rendering his opinion concerning loose bodies. In his deposition testimony, Dr. Ring was not clear about what imaging he reviewed and said he did not review the radiologist’s report of the preoperative scans. Conversely, during the Judiciary Committee hearing, Dr. Ring stated that he reviewed all the medical records and images. The Judiciary Committee found that Dr. Ring’s contemporaneous deposition testimony was a more credible indication of the records reviewed than his testimony before the Judiciary Committee. The committees did not find Dr. Ring in violation of Mandatory Standards Nos. 1, 5, 7, 10, and 11.

The AAOS Board of Directors upheld the findings of the Judiciary Committee and voted to suspend Dr. Ring for a period of one (1) year.

For more information on the AAOS Professional Compliance Program, visit www.aaos.org/profcomp.