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AAOS Now

Published 2/11/2021

AAOS Board Considers Grievances Filed Under the Professional Compliance Program

At its meeting on Nov. 16, 2020, the Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) considered two grievances filed under the AAOS Professional Compliance Program. The following actions were taken:

Brian E. Coleman, MD
Delray Beach, Fla.
Censured

In February 2019, a grievance alleging violations of the Standards of Professionalism (SOP) on Orthopaedic Expert Opinion and Testimony was filed against Brian E. Coleman, MD. The grievance was based on statements made by Dr. Coleman in his deposition and trial testimony. The patient in the underlying case was a 51-year-old male who presented to the emergency department (ED) with a closed crush injury of the right foot with multiple metatarsal fractures, a Lisfranc injury, and great toe injury. The patient was admitted for observation for the possibility of development of compartment syndrome but was transferred to another hospital at his employer’s request. Upon transfer, Dr. Coleman examined the injury and noted significant swelling, fracture blisters, and pain with passive range of motion and assessed compartment syndrome and performed a three-incision fasciotomy of the foot. Postoperatively, the patient developed a fever, and antibiotics were started. The patient underwent a second decompressive fasciotomy with incisions of the right leg below the knee and had complications of a hematoma and an abscess in the foot. A third procedure of irrigation and debridement identified necrotic tissue, and the patient ultimately underwent a below-knee amputation.

After thorough consideration and deliberation, the Committee on Professionalism (COP) Grievance Hearing Panel and the Judiciary Committee found that Dr. Coleman’s expert testimony was in violation of Mandatory Standards Nos. 2 and 4. With regard to Standard No. 2, in both Panels’ opinions, Dr. Coleman was not fair and impartial when he unequivocally stated that the patient’s compartment syndrome and infection developed within the first 24 hours of admission under the Grievant’s care.

Both Panels concluded that Dr.
Coleman violated Standard No. 4 because his testimony condemned the Grievant’s care (i.e., not checking compartment pressure via a monitoring device or ordering a creatine phosphokinase workup) when he also did not do so in his own assessment of the patient. The Panels did not find Dr. Coleman to be in violation of Mandatory Standard No. 6.

The AAOS Board of Directors upheld the findings of the Judiciary Committee and voted to censure Dr. Coleman.

David A. Halsey, MD
Edgartown, Mass.
Censured

In March 2019, a grievance alleging violations of the SOP on Orthopaedic Expert Opinion and Testimony was filed against David A. Halsey, MD. The grievance was based on statements made by Dr. Halsey in two expert opinion letters. The patient in the underlying case was a 53-year-old male with medial compartment knee arthritis and several comorbidities, including hepatitis B and C, diabetes, and past opioid drug dependence. The patient underwent a right medial compartment unicondylar knee replacement. One month postoperatively, the patient had regained some motion but had slight issues with the wound, knee pain, and swelling. The patient subsequently was seen in the ED for chronic knee pain and swelling. In his next office visit with the Grievant a few weeks after the ED visit, it was noted the patient had continued complaints of pain but had excellent range of motion and was doing well. The patient presented to another ED two weeks later with a swollen, red knee and fever and chills. Cultures grew methicillin-sensitive Staphylococcus aureus (MSSA), and the patient was transferred to the Grievant’s hospital, where he underwent an irrigation and debridement and polyethylene exchange, and cultures taken again grew MSSA. Two months later, the patient again presented to the ED with knee swelling and pain and underwent an explant of the arthroplasty, and an antibiotic spacer was inserted; cultures again were positive for MSSA. Three months after explant of the arthroplasty components, when inflammatory markers were negative and intraoperative cultures were negative, the patient underwent a total knee replacement (TKR). Thereafter, the patient underwent subsequent surgeries, including a resection of the TKR and antibiotic spacer, exchange of the spacer, and a revision TKR, each growing different organisms on cultures. The patient was to remain on antibiotics for life but stopped taking them after two years. After a subsequent knee revision was done to address loosening components, another infection developed, and ultimately, the patient had an above-knee amputation in 2014.

After thorough consideration and deliberation, the COP Grievance Hearing Panel and the Judiciary Committee found that Dr. Halsey violated Standard No. 2. In his expert opinion letter, he opined that “[h]ad the prothesis been appropriately removed … followed by appropriate antibiotic coverage and successful cure, [the patient] would never have required multiple additional procedures, experienced years of pain and suffering, and amputation.” Both Panels found that it was not fair and impartial for Dr. Halsey to opine that the patient would “never” have required additional procedures or amputation had he been cured by the Grievant. The Panels also agreed that it was unfair to isolate only the Grievant’s care, when the patient had many comorbidities and underwent multiple procedures by other physicians leading up to the amputation. The COP Hearing Panel did not find Dr. Halsey in violation of Standards Nos. 1, 3, and 4.

The Judiciary Committee, however, also found Dr. Halsey in violation of Standard No. 4. In the view of the Judiciary Committee, while the parties disagreed as to whether the patient’s infection was chronic or acute, the committee was concerned that the certainty with which Dr. Halsey condemned the Grievant’s use of the irrigation and debridement with polyethylene exchange and not having a “successful cure” as the reason for many of the patient’s subsequent issues and amputation. The Judiciary Committee found that even had the implant been removed and a two-stage revision performed, holding anyone to a complete “cure” standard is a very high bar, as complications can occur with any procedure. The Judiciary Committee agreed with the COP that Dr. Halsey did not violate Mandatory Standards Nos. 1 and 3.

The AAOS Board of Directors upheld the findings of the Judiciary Committee and voted to censure Dr. Halsey.

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