Articles by JCS

Criminal Medicine

                                                                                                         

Word count: 3543

Criminal Medicine

Shock waves hit the news recently when oncologist Dr. Farid Fata from Detroit, Michigan, was sentenced to 45 years in prison for mistreating over 500 patients who he purposely misdiagnosed with cancer.

Just take a look at the enormity of this multimillionaire medical predator who plunged hundreds of patients into poor health, disability, death, or bankruptcy by falsely diagnosing cancer and giving them unnecessary chemotherapy.

According to the newspaper Daily Mail.com:

  • Dr. Farid Fata gave 533 patients excessive and grueling cancer treatments.
  • He then billed insurance firms, scamming millions of dollars in the process.
  • Victims, some of whom did not actually have cancer, had their health wrecked.
  • Many sustained brittle bones and fried organs, with one losing both of his legs.
  • Some patients lost their homes and jobs, and were forced into bankruptcy. 
  • Judge deemed multi-million-dollar scam 'a horrific series of criminal acts'.
  • Oncologist's time in federal prison could be shortened with good behavior.

Where’s the Red Flag?

This was certainly a shocking revelation of medical malfeasance, but is not as uncommon as the media and public might think considering millions of Americans are misdiagnosed and mistreated annually.

When I first learned of this massive patient exploitation by Dr. Fata, I wondered where were the second opinions or the many layers of checks and oversight?

Obviously, he wasn’t working alone in a vacuum since many people also profited from his scam. Where were his oncologist colleagues, pathologists, office staff, and hospital administrators who should have noticed Fata’s misdiagnosis, mistreatment, and certainly the consistent poor outcomes among his patients? Did no one raise a red flag of concern?

Since the medical society is an inclusive and protected fraternity, it would be difficult to imagine his colleagues did not suspect something was wrong yet, obviously, they sat back silently. When his malfeasance was finally reported to the state medical board, it also did nothing to stop him.  Legal action over a year later by federal authorities was required to stop this maniac.

If not for the suspicion of a newly employed nurse with 25 years of experience, Angela Swantek, the whistleblower who broke this scam at Fata’s office, his crime may have never come to light.

In an interview in People magazine (July 13, 2015) she said, “I only lasted an hour and a half because I was looking at the bags [of medicine] and going, ‘that’s not right, that’s not right.’ I was shocked about what I saw because I knew what his motivation was. And I felt terrible for the patients because they had no idea what was going on in his office.”

At his sentencing in court, Dr. Fata admitted, “I misused my talents and permitted this sin to enter me because of power and greed.”

I wonder why people are so surprised at his attitude considering his creed embraces the same attitude of the AMA—power and greed! Indeed, the Hippocratic Oath was killed by Morris Fishbein over 85 years ago. “First Do No Harm” is poppycock from a bygone era in medicine where profits now rule.

Spine Surgeons Next

Certainly Fata is not alone as a physician motivated by money rather than doing what is best for his patients as fraud exists in every profession, especially in medical spine care where unnecessary treatments based on outdated concepts still run rampant.

According to Mark Schoene, the editor of TheBACKLETTER®, “Spinal medicine in the U.S. is a poster child for inefficient spine care.”[1] I might add that medical spine care is much worse than what Dr. Fata did because it is much more pervasive with misdiagnosis and mistreatment affecting hundreds of thousands of patients in the billion dollar spine market.

Undoubtedly with the plethora of spine research, a case can easily be made that standard medical spine care—opioid painkillers, epidural steroid injections, and fusion surgery—have been disproven contradictory to “best practices” as well as addictive, disabling, and often deadly.

Recently, two cases appeared in the lay media about rogue spine surgeons who now face lawsuits. One incident occurred in Baltimore where spine surgeon Randy Davis, MD, was named in a "fake implants" lawsuit involving Spinal Solutions, a hardware distribution company cited in 2012 for quality control issues, according to a Baltimore Sun report.[2]

Health insurance companies are also suing Baltimore Washington Medical Center for its role in allowing Davis to use Spinal Solutions products. The insurers allege overbilling for the fake implants made of stainless steel rather than titanium involved about 250 spinal fusion patients.

The lawsuit claims Dr. Davis also had a "lucrative" consulting contract where he received $458,962, primarily in consulting fees, and the hospital purchased more than $1 million in Spinal Solutions hardware.

Dr. Davis is no professional slouch, having earned his medical degree from the Johns Hopkins University School of Medicine, where he also completed his residency. He is also a member of the North American Spine Society. He definitely should have known better.

The lawsuit alleges that there were similar arrangements with doctors in California, Texas, Wisconsin and Nevada, and that their hospitals were also complicit. In all, it named 17 hospitals and 15 doctors as well as Spinal Solutions and other companies, according to the Sun article.

"Shadowy product makers are trying to worm their way into the supply chains," said James Quiggle, spokesman for the Coalition Against Insurance Fraud, an industry and consumer watchdog that has been monitoring the Spinal Solutions case. "The junk is implanted in people and can cause permanent harm. Some luckless patients must face lifetimes of pain and disability."

Fusions Unnecessary Says Lawsuit

Not only was this surgeon using fake devices as the Baltimore Sun article reported, this lawsuit also alleges this "represented an opportunity to make money without regard as to whether surgery was necessary…and more importantly, without regard to the safety, health and well-being of patients."

This comment suggesting unnecessary spine surgeries were performed is a revelation rarely seen in the press, but a pandemic problem in medical spine care nationwide.

Considering spine surgery is the most lucrative money-maker in American healthcare, higher than cardiology and oncology[3], why would anyone be surprised to learn that a spine surgeon did unnecessary surgery or that hospitals turned a blind eye?

In his article, “Unsavory Publicity for U.S. Spine Surgeons,” Mark Schoene reported that one panelist at a spine conference put this situation quite bluntly, “This is a field where there is too much money and too few ethics.”[4]

Once again, we see the creed of the AMA—power and greed. There is simply too much money, too little oversight, and too much chirophobia for most MDs to follow the guidelines that recommend chiropractors as the portal of entry for spine-related disorders.

Indeed, what good are guidelines if no one follows them? This situation was well expressed by David Elton, DC, and Thomas M. Kosloff, DC, co-authors of Conservative Care: Ensuring the Right Provider for the Right Treatment”:

“Research and guidelines are consistent and clear. We don’t need another guideline, we do need to help patients receive treatment from providers aligned with research/guidelines.” [5]

Don’t Confuse Us With The Facts!

Not only are most spine surgeons ignoring “best practices” guidelines, researchers again confirmed that many spine fusions are based on a debunked ‘bad disc’ premise and the majority are shown to be ineffective.

Let me cite two recent examples how spine surgeons continue to ignore research and guidelines that do not support spine fusion.

First of all, in November, 2014, the Mayo Clinic released a systematic review by Waleed Brinjiki, MD, and his team who conducted a systematic review, “Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations.” They reviewed 33 previous studies on the prevalence of lumbar degeneration on MRI or CT scans among individuals with no history of low back pain and found the vast prevalence of ‘bad discs’ among pain-free people.[6]

Considering the ‘bad disc’ premise is the basis for many spine fusions, one would think this Mayo review would be a big game-changer among spine surgeons and breakthrough news among health reporters but, in reality, it was not.   

Usually when the Mayo Clinic speaks, people listen, but it appears this Mayo review has become the proverbial ‘elephant in the newsroom’—a huge story that goes unmentioned by medical reporters.

Months after the Mayo review was released but nothing mentioned on the news, I Googled for this Mayo review and was shocked that the only online article about this study was mine! Not one major newspaper, television news program, nor National Public Radio picked up on the importance of this review debunking ‘bad discs’ and undermining spine fusions.

Certainly Dr. Sanjay Gupta at CNN would never reveal the fallacy of the ‘bad disc’ diagnosis that has made he and his neurosurgeon colleagues billions of dollars annually. Gupta as CNN’s chief medical correspondent has purposely failed to inform his CNN viewers of this milestone research that could have helped millions avoid back surgeries.

Gupta is willing to endorse medical marijuana, but there is no way Gupta will reveal this breakthrough Mayo systematic review debunking the ‘bad disc’ finding.

To his credit, Gupta did expose the opioid painkillers fiasco in his Deadly Dose program in November, 2012, although he failed to go to the next logical step to endorse chiropractic care as a non-drug solution to the Hillbilly  Heroin epidemic or to expose the rampage of unnecessary spine surgeries.

Apparently it’s one thing to bust the pain management practitioners prescribing opioids like Halloween candy and injecting worthless ESIs at $600 a pop, but it’s another thing to expose his spine surgeon friends.

What makes Gupta’s omission more odious is the fact that he knows better since he works in the same department at Emory with Dr. Scott Boden, Director of the Spine Center at Emory University, whose seminal MRI research revealed the fact 25 years ago that ‘bad discs’ appear in pain-free people.[7]

Another example of research ignored by Gupta but should have made headlines at CNN was the JT  Anderson et al. study[8] in May, 2014, that initially appeared in the Spine journal that noted the poor outcome of disc fusions in two groups—spondylolisthesis (slippage of one vertebrae upon another) and degenerative disc disease (DDD).  Considering the hundreds of thousands of costly disc fusions done annually in this country, this should have been headline news for Gupta, chief medical correspondent at CNN.

This Anderson study had an incredibly low bar for success that the majority of patients still could not reach. A case was considered “successful” in this study if a patient could return to work within a two-year limit and work at least six months, although many were still taking opioids for nearly a year postoperatively.

 Despite the low bar, this study revealed rather pitiful success rates—only 36 percent for spondylolisthesis and 24 percent for DDD cases were able to return to work after two years of recovery. Conversely, this means nearly 2/3rds of the spondylolisthesis and 3/4ths of the DDD patients did not return to work within two years.

The Anderson study concluded:

“Our study is support for the conclusion that DDD is a questionable indication for spinal fusion. Given the generally poor outcomes of this study, future studies should determine if lumbar fusion surgery is an effective treatment modality in similar patients.”[9]

Yet, where were the cautionary tales in the mass media to warn patients about the high failure rates of spine fusions?

Surgeon Gone Wild

This medical mess in spine surgery rarely makes the national news until an egregious case develops that is unavoidable. This is exactly what happened last week in Dallas, Texas, when neurosurgeon Dr. Christopher Duntsch, was arrested.

The following is an unbelievable story of a rogue spine surgeon, enabled by a hospital paying him $50,000 monthly to be on staff that turned a blind eye in order to profit from his services, and a state regulatory board that did nothing to stop a dangerous surgeon leaving a trail of disability and death.

Since this story is so dumbfounding, I’ve excerpted the major elements from three stories by WFAA TV in Dallas in order to get the story right.[10],[11],[12] Although they paint this surgeon as an egregious lone ranger in the Lone Star state, in effect, he is not unlike many other spine surgeons who knowingly do spine fusions on people who don’t need them.

I’ve condensed these three stories. You might also watch the WFAA video on this sordid affair:

The Dallas spine surgeon accused of butchering patients and botching surgeries was put behind bars Wednesday (July 22, 2015).

Neurosurgeon Dr. Christopher Duntsch was charged with five counts of aggravated assault and one count of injury to an elderly person. The six charges apply to the care of five patients who either died or are scarred for life.

Duntsch is being held on $600,000 bond. He was stripped of his medical license in 2013, but now stands to spend up to 20 years in prison

In an online promotional video, Dr. Christopher Duntsch had billed himself as one of the most accomplished spine surgeons in North Texas. So much so that in July 2011, Baylor Plano agreed to pay him $50,000 a month plus expenses to work exclusively at their hospital.

But according to a lawsuit filed by Dallas attorney Kay Van Wey, Duntsch's previous employer had identified him as 'an egomaniac, mentally ill, an alcoholic, drug addict or a combination thereof.'

In an e-mail to his medical assistant discovered by one attorney suing him, a less-modest Duntsch said, "anyone close to me thinks that I likely am something between God, Einstein and the antichrist." He added, "You cannot understand that I really am building an empire."

In the e-mail to his medical assistant, Duntsch refers to his "vodka bottle and neuro-stimulants."

"Hospital staff knew Dr. Duntsch had a gallon jug of vodka under his desk," Girards said. "A baggie of white powder had been found in his bathroom."

While Duntsch was operating on Lee Passmore of Frisco, an assisting surgeon had to intervene.

"Dr. Duntsch had to be physically restrained by the surgeon who was operating with him," said Jim Girards, Passmore's attorney, who is suing Baylor Regional Medical Center at Plano. "That second surgeon recognized he was doing things that were not explainable and were extremely dangerous that were likely to lead to paralysis."

Other patients have similar stories. Four suffered severe nerve injuries. Duntsch's former roommate, Jerry Summers, will never walk again. Summers testified in a lawsuit that he witnessed Duntsch using drugs the night before his operation.

In 2013, witnesses to the surgeon's behavior filed a criminal complaint with the Dallas County district attorney. Now — two years later — a grand jury indicted Duntsch on five counts of aggravated assault on five different patients.

Girards refers back to Duntsch's e-mail to his assistant, in which Duntsch wrote: "What I am being is what I am, one of a kind, a [expletive] stone cold killer [...]"

Kenneth Fennell of Oak Point said he was one of Duntsch's first victims. He underwent two surgeries. Van Wey says both were unnecessary; the second left Fennell permanently disabled.

In December 2011, Duntsch performed back surgery at Baylor Plano on Lee Passmore. Passmore who said he lives in constant pain with no hope for relief is also suing Baylor.

'I haven't been able to walk straight, or run, or anything since that surgery,' Passmore said.

During his surgery, according to the suit, an assisting surgeon noticed Duntsch allegedly botching Passmore's operation and had to physically intervene.

'He said, 'Stop doing what you are doing,' because Duntsch was going to damage Lee's spinal cord if he continued,' said James Girards, Passmore's attorney. 'Duntsch refused to stop.'

One month later, according to the suit, other surgeons described Duntsch as 'an impaired physician, a sociopath who must be stopped from practicing medicine.'

But no one stopped him from operating on his own roommate and best friend Jerry Summers, who could walk the day before the operation at Baylor.

The day after his surgery, he was a quadriplegic.

'It was supposed to be a pretty common surgery, and I was supposed to walk in one day and walk out the next,' Summers said.

According to Fennell's suit, Summers admitted to nursing staff that he had witnessed Duntsch using drugs the night before surgery. The lawsuit alleges an attorney representing Summers called Baylor Plano and 'reported the allegations concerning Dr. Duntsch's drug use.' Duntsch's privileges were suspended, but only for a few weeks.

The suit alleges on his second day back from suspension at Baylor Plano, hospital officials let him operate on Kelly Martin of Garland. Duntsch allegedly botched her surgery. She died from massive blood loss.

'They should have stripped him of his hospital privileges,' Van Wey said. 'They should have reported him to the Texas Medical Board. They should have reported him to the National Practitioner Data Bank.'

Instead, after leaving Baylor Plano, Duntsch received temporary privileges to operate at Dallas Medical Center. The suit alleges 'Baylor Plano sent a letter of recommendation for Duntsch to Dallas Medical Center [...] stating there were no adverse events or adverse issues associated with Duntsch.'

'I had no negative reviews or disciplinary actions,' Duntsch told News 8 during a phone conversation last summer. 'They wrote me a letter saying that I was in good standing the whole time. There was never any discipline, and I was never, ever reviewed.'

According to the lawsuit, after Duntsch left Baylor in 'good standing,' another of his patients, Floella Brown, died of excessive blood loss.

Another patient suing Duntsch, Jeff Glidewell, said the doctor left him partially paralyzed as well.

Victim after victim (or their surviving families) are all making the same or similar claims that Christopher Duntsch should have been stopped before he was allowed to operate on them.

'They should have suspended his license until they figured out what was going on, but they didn't,' Passmore said.

The lawyers suing Baylor say their cases are made difficult by Texas law, which says they can't just prove Baylor was 'negligent.' Those lawyers have to prove 'malice' essentially having to prove that Baylor meant to harm patients when they let Duntsch operate on them.

No Lone Rogue Ranger

Certainly Dr. Duntsch is a rogue surgeon ‘gone wild’ fueled by greed, pride, liquor, and drugs, but he is not alone performing unnecessary fusions considering the majority of back surgeries cannot be given a pathoanatomical reason, a fact revealed 25 years ago but ignored.

Daniel Cherkin, PhD, a senior investigator at Seattle’s Group Health Research Institute, admits “in 85 percent of people, it’s not possible to confidently identify a cause of back pain.”[13] Increasingly, the growing consensus in the spine field suggests the paradigm shift away from ‘bad discs’ as the causative factor to pathophysiologic reasons—altered spinal mechanics, motion, compression.

Spine researcher Chien-Jen Hsu, MD, admitted this point in the Journal of Neurosurgery:

"By far the number one reason back surgeries are not effective and some patients experience continued pain after surgery is because the disc lesion that was operated on is not, in fact, the cause of the patient's pain."[14]

Today there are more random controlled trials on spinal manipulative therapy for low back pain than any other treatment.[15] Researchers now vindicate chiropractic treatments over medical care for the majority of ‘mechanical’ back pain cases that comprise the majority (~85 percent) of all back pain cases, a fascinating yet untold story never revealed by medical journalists in the print media or cable news.[16]

Considering these major studies showing the disproven ‘bad disc’ basis and poor outcomes for most fusion surgeries, one would think the media would have jumped all over this medical scam as it did with Dr. Fata, but nothing was said by the lay media about the Mayo review and the Anderson or Chien-Jen Hsu studies, to name a few of many studies now showing the poor outcomes, high costs, and lack of support for medical spine care methods.

Nor did the Randy Davis or Christopher Duntsch lawsuits gain national attention at CNN. I have to assume Dr. Gupta may allow bad press for oncologist Fata, but he will never cast suspicion on his fellow spine surgeons.

Although the medical crime by Dr. Fata involved 533 victims, the “wake of disability” left by spine surgeons must be in the millions.

This is not a new issue since it was first mentioned in 1989 when orthopedist/author, Gordon Waddell, MD, wrote that  “Low back pain has been a 20th century health care disasterback surgery has been accused of leaving more tragic human wreckage in its wake than any other operation in history.”[17]

I daresay this spine fusion wake of disability has only gotten worse in the 21st century, but where is the media outcry about the hundreds of thousands of unnecessary spine surgeries victims?

This should be our foot in the door to this national discussion on criminal negligence in spine care. In my next commentary, I will suggest how the F4CP and our national associations should heed the call to shine the light transparency, research, and CMS policy on this medical malfeasance.



[1] The BACKPage editorial vol. 27, No. 11, November 2012.

[2] Local hospital, doctor named in lawsuit over fake surgical hardware by Meredith Cohn, The Baltimore Sun, July 18, 2015

[3] Thomas M. Kosloff, DC, David Elton, DC, Stephanie A. Shulman, DVM, MPH, Janice L. Clarke, RN, Alexis Skoufalos, EdD, and Amanda Solis, MS, Conservative Spine Care: Opportunities to Improve the Quality and Value of Care, Popul Health Manag. Dec 1, 2013; 16(6): 390–396.

[4] Unsavory Publicity for U.S. Spine Surgeons, The BACKLetter, Volume 22, Number 2, 2007

[5] Optum. Conservative Care: Ensuring the Right Provider for the Right Treatment, 2012.

[6] Brinjikji W, et al., Systematic literature review of imaging features of spinal degeneration in asymptomatic populations, American Journal of Neuroradiology, 2014, prepub ahead of print; www.ajnr.org/content/early/2014/11/27/ajnr.A4173.long.

[7] SD Boden, DO Davis, TS Dina, NJ Patronas, SW Wiesel, “Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatic Subjects: A Prospective Investigation,” J Bone Joint Surg Am. 72 (1990):403–408.

[8] Anderson, Joshua T. BS; Haas, Arnold R. BS, BA; Percy, Rick PhD; Woods, Stephen T. MD; Ahn, Uri M. MD; Ahn, Nicholas U. MD, Single-Level Lumbar Fusion for Degenerative Disc Disease Is Associated With Worse Outcomes Compared With Fusion for Spondylolisthesis in a Workers' Compensation Setting, Spine: 01 March 2015 - Volume 40 - Issue 5 - p 323–331

[9] http://journals.lww.com/spinejournal/Abstract/2015/03010/SingleLevelLumbarFusionforDegenerativeDisc.15.aspx

[10] Brett Shipp, Dallas doctor arrested after botched surgeries, WFAA July 22, 2015

[13] Jill U. Adams, Going to the doctor for back pain can be a slippery slope, The Washington Post,  May 26, 2014

[14] Hsu CJ, et al. Clinical follow up after instrumentation-augmented lumbar spinal surgery in patients with unsatisfactory outcomes. J Neurosurg: Spine, October 2006;5(4):281-286.

[15] Rubinstein SM, Terwee CB, de Boer MR, van Tulder MW. Is the methodological quality of trials on spinal manipulative therapy for low-back pain improving? International Journal of Osteopathic Medicine. 2012;15(2):37-52.

[16] RA Deyo, “Conservative Therapy for Low Back Pain: Distinguishing Useful From Useless Therapy,” Journal of American Medical Association 250 (1983):1057-62.

[17] G Waddell and OB Allan, “A Historical Perspective On Low Back Pain And Disability, “Acta Orthop Scand 60 (suppl 234), (1989)



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