Dr. Death did not win
February 16, 2017 8:22 AM   Subscribe

After what should have been routine spinal surgeries, Texas neurosurgeon and entrepreneur Christopher Duntsch left a horrifying trail of maimed humans and bodies.
Anyone close to me thinks that I likely am something between god, Einstein and the antichrist. Because how can I do anything I want and cross every discipline boundary like its a playground and never ever lose. But unfortunately, despite the fact I am winning it is not happening fast enough.
On Tuesday, after just four hours of deliberation, a Dallas County jury convicted Duntsch of aggravated assault for deliberately maiming his patient. He faces life in prison.
posted by Dashy (35 comments total) 17 users marked this as a favorite

 
We as patient/suckers need to have transparency. This is just ridiculous.
posted by Pembquist at 8:40 AM on February 16 [2 favorites]


"His fellow neurosurgeons found him to be fast-talking and cocksure, a bit of a loner. And yet nearly all who met him said they liked him immediately."

Common and well-known traits of a sociopath. Through life I have many a time found myself in a position of having to defend my choices to not interact with such a person to groups of people who were so charmed by him, they would overlook the little logical things that they'd never overlook in someone less "likable". For example- lying. Man how often I've seen someone blatantly lie and get away with it simply because they were deemed charming or likable. In my mind anyone who lies to me automatically loses all so called charm and likability. However I've learned that vast majority of human beings don't think this way. Hence why Trump is now president. I'll bet anything there were others who tried to warn others about this guy, but the charmed people around them didn't listen and pushed all the little hypocrisies they witnessed under the rug as harmless cuz the guy had a confident smile and was just... ya know.. "cool" and all.
posted by bearam at 9:04 AM on February 16 [27 favorites]


Screws in the wrong location, massive outflow of liquids, severing of important cords. Sounds like the f-ups of building contractors I've hired. And the cause--late night drinking, and, er, "partying" with chemicals--is the same as well.
posted by Gordion Knott at 9:04 AM on February 16


It's funny how "entrepreneur" has slowly become a warning word for me; a self-identifier that, like "fiscal conservative" or "free thinker," has transformed from a pretty neutral term to a cue to begin to backing away at great rates of speed.
posted by Shepherd at 9:05 AM on February 16 [45 favorites]


Christ, that's scary stuff. He was apparently doing his residency in Memphis at about the time that I lived there; good deal that I didn't need spinal surgery at the time.
posted by Halloween Jack at 9:08 AM on February 16


It needs to be noted that this scumbag had to be corralled using a criminal lawsuit, because doctors and hospitals are pretty much shielded by Texas' tort reform laws. From the first link...
Texas’ tort reform laws cap the amount that patients can sue physicians for malpractice at $250,000. And, to successfully sue a hospital, they must prove that the facility acted with malice—that, in granting a physician privileges, it intended to harm the patient. An incredibly difficult thing to prove.
In Texas, the bar for proving malpractice is set staggeringly high, while total possible compensation is set so low as to be worthless, especially in cases like these where entire lives are destroyed.
posted by Thorzdad at 9:19 AM on February 16 [40 favorites]


Private medical care, everybody! Doesn't it just lend itself so well to meaningful oversight when everyone is concerned with liability and money first and foremost?

I hope he is convicted.
posted by Dysk at 9:23 AM on February 16 [8 favorites]


I don't find 'entrepreneur' inherently bad, but combine it with things like "neurosurgeon.." shit no.
posted by Fig at 9:25 AM on February 16 [2 favorites]


So when I ran into this post, I figured it had to be about the Texas spinal surgeon featured in the Dr. Evil article from about ten years back. Nope.
posted by dances_with_sneetches at 9:29 AM on February 16 [2 favorites]


In Texas, the bar for proving malpractice is set staggeringly high, while total possible compensation is set so low as to be worthless, especially in cases like these where entire lives are destroyed.

I'm from Texas and I remember the campaign for tort reform, culminating in the 2003 law. I'll never understand why people were so adamant about removing their ability to get justice and compensation if they were hurt by malpractice. They must think it would never happen to them.
posted by Sangermaine at 9:35 AM on February 16 [16 favorites]


So hard to keep all the Dr. Evils straight anymore.
posted by rhizome at 9:36 AM on February 16


Paging Doctor Benway. Paging Doctor Benway...
posted by jim in austin at 9:44 AM on February 16 [4 favorites]


I'll never understand why people were so adamant about removing their ability to get justice and compensation if they were hurt by malpractice. They must think it would never happen to them.

No, they get lied to by the doctors, who tell them that the reason medical care is so expensive is because of doctors needing to protect themselves from those evil trial lawyers.
posted by NoxAeternum at 9:52 AM on February 16 [25 favorites]


When I first read this story, I was expecting some sort of credentialing fraud, based on the descriptions of the malpractice. It almost sounded like an internist or chiro wanted to rake in the bucks of a neurosurgeon, and faked his way in, cut open some people and did ... some stuff near the spine. Stuff that a real neurosurgeon would have to be staggeringly blind drunk to do, or outright unfamiliar with the basic anatomy of the spine.

I was surprised to see that, although there was some exaggeration, he did have an MD and the standard training in neurosurgery. That is the biggest unsolved part of the story for me. If he really is a trained neurosurgeon, then that whole training program comes into question for me.
posted by Dashy at 10:01 AM on February 16 [4 favorites]


No, they get lied to by the doctors, who tell them that the reason medical care is so expensive is because of doctors needing to protect themselves from those evil trial lawyers.

To wit: this exhaustive 2012 study of tort reform in Texas [pdf], which found it did not help costs at all and may have even made things slightly worse. This 2013 study likewise found that tort reform had no effect on the number of physicians in the state, which (contrary to tort reform proponents' claims) was not unusually low before the 2003 tort reform law.
posted by jedicus at 10:03 AM on February 16 [15 favorites]


It needs to be noted that this scumbag had to be corralled using a criminal lawsuit, because doctors and hospitals are pretty much shielded by Texas' tort reform laws.

Just to clarify: there were lawsuits against the hospitals that allowed this to continue and hid behind a conspiracy of silence. And those cases all settled before trial. Duntsch was a party to the lawsuits, and his insurance company covered some claims and did not cover others. Duntsch himself declared bankruptcy to protect himself, and some of the injured families pursued claims against him personally in bankruptcy court. One of his primary assets was some patents he held.

But the thrust of you comment is correct. Duntsch was able to leave a trail of maiming patients, and the hospitals and physicians who knew about his problems all kept quiet and hid behind peer review and reporting privileges to keep it quiet. This allowed Duntsch to move from hospital to hospital injuring one patient after the next. When the patients pursued claims, the hospitals tried to claim that the only viable claim was "negligent credentialing" which required a showing of malice and actual knowledge. They hid their actual knowledge behind the claim of privileges. But the plaintiffs pursued other theories and fought successfully uphill on liability. The damage caps limited their recovery to the actual economic damages (which might be in the hundreds of thousands to millions) plus the noneconomic damage caps of $250k-$500k. While the damage caps are complete BS and do not allow for full and just compensation, the damage caps were not as much of a problem. The crappy law on liability was a bigger frustration.

It is truly remarkable that the Dallas District Attorney pursued criminal charges to Duntsch. There was quick pushback with the claim that never before had the Dallas DA ever prosecuted a doctor for hurting a patient during a medical procedure. It was claimed to be a dangerous precedent. But the DA pushed forward because Duntsch needed to be behind bars. They got their conviction, and now he faces a lifetime in jail.

Duntsch lost his license. The settlements took his financial net worth (and the plaintiffs obtained reasonable recoveries from the hospitals and Duntsch). And he will serve time in jail. The law in Texas is horrible, but this was one of the fullest measures of justice I have seen in a long time.
posted by dios at 10:12 AM on February 16 [27 favorites]


Some ways into the article, in one of his many gross acts of incompetence, there's this:

He was shocked at the CT scan: the spinal fusion hardware sat in her soft tissue. The nerve root had been amputated.

Which reminds me of a passage from Henry Marsh's Do No Harm. You get the feeling that Marsh, a neurosurgeon, is the ur-asshole, in a medical ranking of assholery that already places neurosurgeons at the top. But Marsh expects basic competence, at least. He allowed a resident to start a surgery sciatica surgery, when he'd take over as things became difficult; the resident severed the nerve root during the 'simple' sciatica surgery.
'Oh Jesus fucking Christ!' I blurt out. 'You've severed the nerve root!' I threw the forceps onto the floor and flung myself away from the operating table to stand against the far wall of the theatre. I tried to calm myself down. I felt like bursting into tears. It is, in fact, highly unusual for gross technical mistakes like this to occur in surgery. Most mistakes during operations are subtle and complex and scarcely count as mistakes. Indeed, in thirty years of neurosurgery I'd never witnessed this particular disaster, although I had heard of it happening. [... After a discussion of exactly what gross anatomical mistakes were made to even make cutting the nerve root possible so early in the surgery:] It [cutting the nerve root] was an utterly bizarre thing to have done.
"It really was staggeringly incompetent," he goes on to say. Of a resident. Duntsch was a licensed surgeon, working independently, and somehow wasn't caught until he had maimed or killed multiple patients.

If he really is a trained neurosurgeon, then that whole training program comes into question for me.

The story answered that to my satisfaction with repeated references to way too many drugs and way too much alcohol. But the training facility should feel some heat and exposure over this, certainly.
posted by flibbertigibbet at 10:14 AM on February 16 [6 favorites]


No, they get lied to by the doctors, who tell them that the reason medical care is so expensive is because of doctors needing to protect themselves from those evil trial lawyers.
posted by NoxAeternum at 11:52 AM on February 16


That's partially correct. The lie wasn't from doctors necessarily. The lie was from the Insurance industry. In 2003, the insurance industry (primarily Texas Medical Liability Trust which insures the vast majority of Texas doctors) and their lobbying arm "Texans for Lawsuit Reform" sold this lie that there was an insurance crisis in the state. They painted a picture of doctors fleeing the state because premiums were too high because of lawsuits. They claimed doctors were refusing to deliver babies, rural counties being left with no doctors, and emergency rooms couldn't find coverage. They got House Bill 4 passed and got the citizens of the State of Texas to pass a constitutional amendment to the state constitution to allow damage caps (previous damage caps had been struck down as unconstitutional).

It was all a lie. There was no crisis. Damage caps did nothing to lower premiums. Nor did they change the availability of doctors. Insurance companies didn't need damage caps of 250k. Insurance companies love to cap risk because then they price in the exposure into the packages. They just wanted to eliminate the open-ended risk. Damage caps could have been 1m or 4m--the companies could then price that in. But they tried the 250k and pulled it off. It was nonsense. And now its in the state constitution.

Injured plaintiffs now cannot get a full recovery and often cannot find a plaintiffs lawyer to take the case because the cost of litigating a medical malpractice case is often in the six-figures so there's no way to pursue a smaller damage claim. Doctors pay the same premiums as before and are no better off.

Insurance companies have made a profit charging the same amount but paying less in claims.

Fuck insurance companies.
posted by dios at 10:21 AM on February 16 [32 favorites]


Duntsch was a licensed surgeon, working independently, and somehow wasn't caught until he had maimed or killed multiple patients.

Oh, there were people who knew and caught him. But they didn't say anything. Hospital administrators, a group he practiced with, nurses and anesthesiologists who he performed surgery with. They all knew from the first patient he maimed. The hospitals would ask Duntsch to leave and go to the next facility, promising not to report him and not give him a bad reference if he would go quietly. The next institution did not know initially there was problem because the first hospital didn't report it, but they found out after Duntsch's first procedure. They passed him on to the next facility. And on it went, as he racked up the bodies.
posted by dios at 10:26 AM on February 16 [6 favorites]


They all knew from the first patient he maimed. The hospitals would ask Duntsch to leave and go to the next facility, promising not to report him and not give him a bad reference if he would go quietly. The next institution did not know initially there was problem because the first hospital didn't report it, but they found out after Duntsch's first procedure. They passed him on to the next facility. And on it went, as he racked up the bodies.
dios, this I can't quite square with your statement above that 'this was one of the fullest measures of justice I have seen in a long time'. How is this justice to all of his victims after the first one? They paid a very handsome price, and no punitive damages awarded after the fact can restore to them what was taken by this criminal, and the negligence (or outright collusion) of all those who covered up his crimes.
posted by aiglet at 11:00 AM on February 16 [2 favorites]


aiglet: "dios, this I can't quite square with your statement above that 'this was one of the fullest measures of justice I have seen in a long time'. How is this justice to all of his victims after the first one? They paid a very handsome price, and no punitive damages awarded after the fact can restore to them what was taken by this criminal, and the negligence (or outright collusion) of all those who covered up his crimes."

Whenever a crime results in death or permanent injury, no punishment assessed on the perpetrator can make the victim whole again. If that's our definition of justice, then no murder conviction has ever achieved justice.

But I think dios's point is that it was unusually just for Duntsch to have been prosecuted in a criminal court. A doctor who did half of what Duntsch did should still (in my opinion) be jailed for the rest of his life, but that doctor wouldn't have been prosecuted criminally in the first place.

To me, though, the most just outcome would be that this case leads to the repeal the 2003 tort reform measure. But our do-nothing state government won't let that happen any time soon.
posted by savetheclocktower at 11:12 AM on February 16 [5 favorites]


savetheclocktower has it. I was not speaking about moral or metaphysicial justice. Our criminal and civil justice do not begin until a wrong has occurred, and that wrong can never be erased. Our criminal and civil justice systems are limited in what they can achieve to try to redress wrongs. And it is within those limited means that these cases represented one of the fuller measures of justice that I have seen. You don't often success in the civil courts and a (potential lifetime) punishment for a wrongdoer. For a host of reasons, ordinary crimes typically do not typically have substantial civil recoveries; cases with substantial civil recoveries are not often followed by criminal convictions of the wrongdoer.

And tort reform should be repealed. Unfortunately, that isn't happening until Texas goes blue. The Texas Lege actually became more hostile to the civil justice this election/session, as the Texas Democratic coalition in the Lege dropped below the threshold to block anything. And the tort reformers are already proposing even broader tort reform in other areas of the law in what may be the highwater mark for their influence in the Lege. The pendulum swings, and it's always darkest before dawn. I think the Texas Lege is at the outer limit/darkest. I think it will start shifting back.
posted by dios at 11:45 AM on February 16 [2 favorites]


Henry Marsh's Do No Harm ... the resident severed the nerve root during the 'simple' sciatica surgery

Yes, I thought of this same passage.

The things Duntsch did were so grossly ... awful, that he had to have been just staggeringly out of his mind drunk or high to have done, or just not trained at all and trying to bluff his way along (and possibly also somewhat under an influence).

I can't imagine he would have been allowed to come near a patient if he were that extremely impaired -- to the point where he left hardware in soft tissue, drilled in the wrong places several times, used screws that were far too long for the spine level, etc. So my brain turns to the other possibility -- than he was not actually trained to do what he did, and trying to fake it, while under some level of chemical impairment.

I'm left wondering about the training program, either the training itself or its willingness to let him loose on the world with obviously substandard skills and/or ethics. If he was so well trained, I have doubts that it could have gone as far as it did. But maybe I'm trying to make sense, to find order where there really was none.
posted by Dashy at 11:54 AM on February 16 [1 favorite]


Doctors are not on our side. They just aren't. No more than cops are.
posted by Beholder at 1:40 PM on February 16 [1 favorite]


I do wish I could talk to his friend who stayed up all night doing coke with him before his own operation. What was going through his head back then? What is their relationship like now?
posted by atoxyl at 2:47 PM on February 16 [4 favorites]


I actually once sabotaged a pretty significant opportunity for myself staying up all night on drugs - I had felt doomed/unprepared already going in, I had for some reason scheduled myself to quit said drugs the very next day, and I just - I don't fucking know. So I can sort of imagine someone doing this as a doctor, if they had a deficiency of conscience as well. But what could that whole experience have been like for the friend?
posted by atoxyl at 3:01 PM on February 16 [1 favorite]


I am outraged and horrified. Not just at Duntsch; I'm glad he was convicted.

But what about the institutional failures to protect society? What changes have been made to the system of checks and balances that is supposed to protect the public?

From a related article in the same publication as the first FPP link:
On Monday, Dr. Carlos Bagley, the director of the Neurological Surgery Spine program at UT Southwestern, took the stand and joined the choir of surgeons who have called Duntsch’s surgical techniques poor and the outcomes “sub-optimal.” But he argued that the blame extended beyond Duntsch. It was the failure of the system as a whole—Baylor Regional Medical Center at Plano did not refer Duntsch to the National Practitioners Databank after Kellie Martin bled to death and he gave up his privileges. The renowned Memphis neurosurgeon Dr. Kevin Foley allowed him to leave a yearlong minimally invasive spine fellowship and did not mention hearing of adverse outcomes when hospitals in Dallas contacted him for a reference. The University of Tennessee Health Science Center allowed him to practice after residency and medical school, despite his skills being questionable. The Texas Medical Board allowed him to keep his license for more than a year after first being notified. Dallas Medical Center CEO Raji Kumar did not inform the hospital’s chief medical officer that Duntsch had self-reported a bad outcome and resigned from Baylor Plano.
To me, the individuals and institutions above should share the blame for inflicting the pain and devastation suffered by Duntsch's patients and their loved ones. As mentioned by dios above, the medical facilities passed the buck to protect their own reputation, but they failed in their duty to protect the public. They are just as culpable.
posted by cynical pinnacle at 7:50 PM on February 16 [4 favorites]


It was all a lie. There was no crisis. Damage caps did nothing to lower premiums. Nor did they change the availability of doctors. Insurance companies didn't need damage caps of 250k. Insurance companies love to cap risk because then they price in the exposure into the packages. They just wanted to eliminate the open-ended risk. Damage caps could have been 1m or 4m--the companies could then price that in. But they tried the 250k and pulled it off. It was nonsense. And now its in the state constitution.

Injured plaintiffs now cannot get a full recovery and often cannot find a plaintiffs lawyer to take the case because the cost of litigating a medical malpractice case is often in the six-figures so there's no way to pursue a smaller damage claim. Doctors pay the same premiums as before and are no better off.

Insurance companies have made a profit charging the same amount but paying less in claims.

Fuck insurance companies.
posted by dios at 2:21 AM on February 17 [22 favorites +] [!]

The comment in which no really, I'm not even gonna step foot in Texas.
posted by saysthis at 11:35 PM on February 16 [2 favorites]


>I do wish I could talk to his friend who stayed up all night doing coke with him before his own operation. What was going through his head back then?

Cocaine.
posted by Joseph Gurl at 12:56 AM on February 17


I know it is little consolation to the damaged and the dead, but he won't be hurting anyone else again.
posted by Samizdata at 1:57 AM on February 17


I would be immensely interested in the actual attending surgeon evaluations of Dr Duntsch as he progressed through residency. A surgeon who goes out and screws up things that quickly and comprehensively cannot have known what he was doing in PGY7 (ie, seventh and final year of neurosurgery residency) and there must be a trail of poor evaluations and hand-wringing in his ACGME and New Innovations files.

It's always purely a judgment call when you have poor-performing residents who are about to fledge into the world of independent practice. Many, many of those struggling trainees actually turn out pretty ok. Especially if they have a "soft plan for remediation" which comes from an agreement to pursue subspecialty fellowship training.

Maybe Duntsch had such a thing arranged? But he appears to have left the minimally-invasive spine fellowship early. Worst of both worlds in that case.

I am a neurologist, not a neurosurgeon, but there's enough overlap that I can tell you what he did truly was a series of never events. I'm appalled at his badness at his job. And basically OK with the criminal conviction.

Source: I am on the residency committee at my academic practice and furthermore and fellowship director of clinical neurophysiology.
posted by adoarns at 4:35 AM on February 17 [8 favorites]


Doctors are not on our side. They just aren't. No more than cops are.

Yeah, adding capitalism into the mix can make near anything a problem. Fuck private health care.
posted by Dysk at 5:30 AM on February 17 [2 favorites]


In the comments section, several people straight up theorize that he had to be making these mistakes on purpose (i.e. was a psychopath who hid his maimings under the guise of botched operations), because no one is that incompetent. I don't buy it myself, but it helps me understand just how bad this doctor was...
posted by xammerboy at 7:25 AM on February 17 [1 favorite]


In law school I was very tangentially involved in a med mal case in North Carolina. The attorney who took it on was known as a crusader; the accusation was that an ob/gyn had raped a patient during pelvic exams. As the case wound its way through the courts, more and more women came forward -- she ended up with THIRTY plaintiffs who were willing to be named and testify in court. THREE insurance companies had documents showing they'd dropped him because they were aware of his "risky" behavior and he became too dangerous to insure; none of them reported him. FIVE hospitals had allowed him to resign after patients made reports of his sexual abuse to the hospital, rather than fire and report him, to avoid the scandal and lawsuit. He even left one state (I think California?) after they told him if he'd just leave the state they wouldn't pull his license.

This dude clearly raped HUNDREDS of women, and at least three insurance companies and five hospitals (as well as, clearly, countless doctors and administrators) knew what was going on and were more concerned with ass-covering than patient welfare or ensuring he was never alone with a patient again.

Two or three months after the women won a massive lawsuit against him and some of the deep-pocketed institutions involved, North Carolina capped med mal claims, such that the case could never have been brought, because it wouldn't pay enough for a law firm to be able to afford bring a suit of such complexity, and plaintiffs would receive essentially no recovery. It's capped at $500,000 non-economic damages FOR ALL PLAINTIFFS, so the 30 women who came forward would have to split that amount.

The most infuriating part of the whole thing is, NC does allow you to recover uncapped damages for loss of future income if you are maimed -- if the doctor's conduct results in "disfigurement, loss of use of part of the body, permanent injury or death." -- but rape doesn't result in loss of use of body parts.

There have been a couple of changes to the law since this case went down (15+ years ago), but the problem remains substantially the same: it essentially bars bringing lawsuits against the most egregious offenders because the cases are too expensive when they're anything outside the norm. The North Carolina medical board did eventually get spanked by the state supreme court for its utterly egregious lack of investigation of sexual assault claims made against doctors, but the resulting reforms in the state medical board were really very minor and nobody actually audits or supervises to see if it's any better.
posted by Eyebrows McGee at 10:51 PM on February 17 [4 favorites]


Duntsch got sentenced to life in prison.
posted by dios at 1:28 PM on February 20 [3 favorites]


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