Mass. General pays $14.6 million to settle whistleblower lawsuit over surgeries performed by unsupervised interns

She alleged the hospital violated Medicare and Medicaid rules that require surgeons to be present at least for critical parts of operations, although some overlapping of surgeries is allowed. Doctors also failed to appoint a backup surgeon for interns who might need immediate help in their absence. And, according to the lawsuit, government insurance programs were overcharged for anesthesia services because the practice of surgeons going back and forth between operating rooms lengthened procedures.

“I did this entirely for patient safety and transparency,” said Wollman, who now works at New England Baptist Hospital and left her position as an assistant professor at Harvard Medical School when she left MGH after 24 years. “My career trajectory has not straightened out. But it was a personal choice. »

Mass. General has not admitted any liability in the settlement, and executives emailed the hospital community Friday night saying they were happy to resolve the issue without further litigation.

“While MGH continues to believe that it has always complied with legal requirements regarding overlapping surgeries, we have determined that it would be more prudent to resolve the issue entirely by regulation at this time,” the author wrote. MGH President, Dr. David FM Brown and Dr. Marcela. del Carmen, president of the hospital doctors’ organization.

Dr. Jim Rickert, an orthopedic surgeon from Bloomington, Ind. and president of the Society for Patient Centered Orthopedics, said the settlement “sends a very strong signal.”

“There’s no world in which you should have someone under anesthesia for a long time waiting for a surgeon when everything is scheduled, elective surgery,” said Rickert, a longtime critic of absentee surgeons. the operating room. “Any patient should think twice before going to an institution that sanctions this kind of behavior.”

Attorney General Maura Healey, who supported Wollman’s lawsuit, said Massachusetts health insurers will split the settlement money.

“Patients should be fully informed of the details of any medical procedures, especially when they involve concurrent surgeries,” Healey said in a statement. “This resolution brings nearly $2 million to MassHealth and the Group Insurance Commission, and requires updated consent forms at Mass General Brigham to improve transparency.”

A Boston Globe Spotlight Team series in 2015 first detailed that the double booking had caused an extraordinary, long-lasting and largely invisible controversy that rocked the hospital. Mass. General has given financial incentives to orthopedic surgeons to perform more procedures, and a handful of doctors have routinely taken advantage of the policy by scheduling simultaneous surgeries in two rooms.

MGH leaders have been strong advocates for concurrent surgery. They said that the practice of overlapping operations was an efficient way to deploy the most talented doctors, allowing surgical interns to perform routine tasks such as closing surgical wounds while attending surgeons moved on to other cases. Nonetheless, the reports prompted a national debate in the medical community, a congressional investigation, and regulatory changes in Massachusetts.

Under the latest rule, surgeons at all hospitals in the Mass General Brigham network will have to notify patients when they plan to overlap operations with those of other patients. Wollman said the surgeons she complained about never told the patients they intended to perform concurrent surgeries.

His attorney, Reuben Guttman, of the Washington, DC, law firm Guttman, Buschner & Brooks, said Wollman’s lawsuit will help set “a new standard of care in informed consent for overlapping surgeries.”

She sued under the False Claims Act, a federal law passed during the Civil War that allows a private citizen to file a lawsuit on behalf of the federal government for fraud. She will receive about 25-30% of the settlement, Guttman said, and the rest will go to the federal and state governments.

Wollman was among several anesthesiologists who criticized double-booking on the Spotlight Team series. Another prominent critic, Dr Dennis Burke, a top orthopedic surgeon, was fired by the hospital in 2015 for allegedly breaching patient confidentiality when the Globe interviewed him, which he denied.

Four years later, Burke received extraordinary vindication. Mass. General agreed to pay him $13 million, offered him his old job (which he turned down), and named a safety initiative after him to settle his wrongful dismissal lawsuit in Suffolk Superior Court. Burke now practices at Beth Israel Deaconess Hospital in Milton.

That same year, MGH and a former spine surgeon agreed to pay former Red Sox pitcher Bobby Jenks $5.1 million to settle a medical malpractice lawsuit involving concurrent surgery. Jenks said he suffered a career-ending injury when spine surgeon Dr Kirkham Wood operated on his back while supervise another operation.

MGH said in a statement after the settlement that Wood provided “high quality and appropriate care” to Jenks and that “overlapping surgery played no part in this matter.” Wood left the hospital in 2015 and is a professor of orthopedic surgery at Stanford University Medical Center.

Although many surgeons at teaching hospitals schedule operations to overlap by a few minutes – letting trainees close the surgical wound from the first operation, for example, while the surgeon moves on to the second – doctors at the ‘MGH have complained of overlapping operations for much longer, sometimes for hours.

Wollman’s lawsuit listed 16 dates from 2011 to 2013 when five orthopedic surgeons allegedly performed at least two operations simultaneously over a period of hours. In all cases, according to the lawsuit, the patients remained under anesthesia longer than necessary, increasing the risk of complications and inflating anesthesia costs.

The suit used pseudonyms for the five surgeons who Wollman said defrauded the Medicare and Medicaid programs. But the Globe was able to identify some of them based on earlier reports.

One of them, identified as “Surgeon A,” was Dr. Jon JP Warner, the longtime head of the MGH’s shoulder department and one of the hospital’s highest-paid employees. . Wollman’s suit said Surgeon A routinely books two concurrent operations in the morning and two in the afternoon.

Wollman said that in 2011, a 65-year-old patient waited under anesthesia for 90 minutes for Surgeon A to arrive from another operating room where he was operating on a second patient.

Yet, according to the lawsuit, the surgeon wrote on the patient’s operating note that he was involved in the entire operation. Wollman complained to hospital officials, according to the lawsuit, and the surgeon corrected his report.

In the past, Warner has declined to discuss specific cases, citing patient confidentiality. In general, he wrote in a 2015 statement to The Globe: “The suggestion that I do not manage all of my patients’ care while they are in the operating room is both false and malicious. »

Wollman said another doctor “never appeared in the room” for ankle surgery in April 2013, even when the patient suffered a severe and sudden airway constriction, forcing a senior intern to take over. charged.

But Wollman said top medical officials at Mass. General had not acted on her concerns about the surgeon’s absence during the emergency “except to threaten her that she had violated the patient’s privacy and could be subject to legal action.”

During the trial, attorneys for Wollman obtained a copy of a confidential double-booking review that the hospital commissioned former U.S. attorney Donald Stern to prepare in December 2011 in response to complaints filed by Burke and the anesthesiologists. .

This painted a more complicated picture than what hospital leaders had previously portrayed. Stern said he couldn’t find widespread evidence of false billing, interns working unsupervised, and injured patients in double-booked operations.

He said, however, that “there have been isolated instances where some surgeons’ practice of running two rooms could have contributed to patient-related issues.” He said seven of the roughly 60 orthopedic surgeons routinely run two operating rooms, including several mentioned later in the Spotlight team report.

Stern recommended that MGH revise its policy on concurrent surgeries, limit the procedures that multitasking surgeons could perform, clearly define critical parts of surgeries and revise patient consent forms.

Other documents obtained by Wollman’s attorneys and filed in court suggested the hospital failed to act on some of Stern’s recommendations several years later.

Two weeks after the Spotlight Team report in October 2015, Dr. Keith Lillemoe, the Chief of Surgery, wrote to the Medical Director of Operating Rooms that “we will eventually need to take a closer look at our disclosure policy, and I personally think we need to tell patients” when their surgeries will overlap with other cases.

“We shouldn’t do this immediately so as not to give the impression that the Globe has affected our policy, but at some point we need to revisit the matter,” Lillemoe wrote in the email.

“I totally agree,” replied Dr. Peter Dunn, who oversaw the operating rooms.

Following the controversy, the Massachusetts Medical Board passed new regulations in 2019 that require physicians to provide more information to patients considering surgery and to document each time a primary surgeon enters and leaves the office. the operating room. The rules, which medical experts have described as among the most sweeping in the country, have been met with stiff resistance from hospitals and doctors in Massachusetts.

Jonathan Saltzman can be contacted at [email protected]

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