You’ve paid $3 million to settle malpractice suits? Welcome to Texas, podnah! Wednesday, August 3, 2011
What do you call a brain surgeon who has been sued for malpractice nine times, who has been involved in cases that have already led to more than $3 million in settlements paid to injured patients and still has three malpractice suits pending, who has been ordered by the Minnesota Board of Medical Practice to have a supervising physician observe his surgeries in that state and submit quarterly reports on his performance to the board?
In Texas, you call him a doctor who can practice medicine with no restrictions whatsoever.
In 2003 Texas voters approved, by a narrow margin, Proposition 12, amending the state constitution to allow the legislature to place caps on the amount juries can award as compensation to people who are injured by medical negligence, harmed through no fault of their own. The legislature promptly passed caps on liability for both non-economic damages (including loss of mobility, loss of fertility, severe disfigurement or ongoing chronic pain) and wrongful death.
If Texas voters were hoping these caps would attract more doctors to the state, perhaps they should have thought harder about what doctors would be attracted.
Stefan Konasiewicz, a neurosurgeon who had practiced at St. Luke’s Hospital in Duluth, Minn., was reprimanded by the Minnesota Board of Medical Practice on September 13, 2010. The board made reference to four of Konasiewicz’s patients in its reprimand, as summarized by the Duluth News Tribune:
- In July 2007, Konasiewicz ordered an anesthesiologist to apply manual traction and placed a template into the surgical site, but noted a “sudden jerk’’ and movement of the cervical vertebrae. The patient was subsequently diagnosed with “persistent cervical quadriplegia.” Konasiewicz appeared before the board’s complaint review committee and admitted to movement of the patient’s spinal column during the procedure.
- In February 2005, Konasiewicz performed lumbar spine surgery on a patient who died from cardiopulmonary arrest 12 hours after surgery. An autopsy revealed a perforation of the lumbar disc, with extension of the perforation into the wall of the aorta. The autopsy concluded that the patient’s death was caused by a surgically-induced defect (emphasis added).
- In the fall of 2003, Konasiewicz recommended an epidural steroid injection to a patient with a history of chronic back problems and recent numbness in his right thigh. He injected a dye other than the one he intended to use. The injection caused muscle spasms, which resulted in fractures to three of the patient’s lumbar vertebrae.
- On June 14, 2000, a patient fell off a ladder onto a landing at work, injuring his left hip and buttock. The patient claimed to have suffered a nerve root injury as the result of injections performed by Konasiewicz.
As part of the reprimand, the state board ordered Konasiewicz be observed performing surgeries by a board-approved supervising physician at least five times per quarter, with the supervising physician submitting quarterly reports to the board.
But Konasiewicz had already left Minnesota before the reprimand was issued, moving to Corpus Christi, Texas, where he is listed as a surgeon (the second one down) on the website of the South Texas Brain and Spine Center. Perhaps one reason for the move was that Minnesota does not limit the amount of compensation patients can be awarded for their medical injuries. Texas does. (Konasiewicz has been licensed in Texas since 1997 but did not move to the state until after damage caps were implemented.)
And it turned out several of Konasiewicz’s patients had been compensated for their injuries. The state board reprimand prompted News Tribune reporters Brandon Stahl and Mark Stodghill to launch a full-blown investigation into Konasiewicz’s medical career in Duluth, published May 29, 2011:
When he moved from Duluth about three years ago, Konasiewicz left behind two dead patients, one woman paralyzed from the neck down and six others who say his treatment caused them serious physical harm….
Multiple sources also show that between 2005 and 2008, St. Luke’s and Konasiewicz settled five malpractice suits for a total of at least $3.2 million.
Stahl and Stodghill talked to six doctors at St. Luke’s who told them “they had been gravely concerned about Konasiewicz’s ability and competence.” Neurosurgeon William Himango said, “The problems confronting this physician had — not only by me, but by others — been brought to the attention of the administration prior to some of these incidents.” And neurologist David McKee said, “The scope of the problem was evident from an early date. Information provided to the administration by physicians and nurses was not well-received.”
St. Luke’s responded to the News Tribune article with a statement expressing its full support of Konasiewicz. The hospital had already expressed its support financially, not just by paying settlements to injured patients but by paying Konasiewicz. The News Tribune found he had been the hospital’s highest-paid physician in 2005, earning $1.3 million, and was the second-highest-paid physician in 2008, with earnings of $1.6 million.
The first claim of malpractice against Konasiewicz came when he allegedly ruptured a woman’s aorta during spinal surgery within a year of his arrival in Duluth. A jury did not find Konasiewicz at fault, but a fellow St. Luke’s neurosurgeon testified against him.
Until recently, that was the only case against Konasiewicz to go to trial. But it was far from the last allegation of harm.
In 2001, a medical student who was treated by Konasiewicz for carpal tunnel syndrome lost the use of her right arm for several years and says her right hand is still numb. The News Tribune reported she sued Konasiewicz and St. Luke’s and settled for about $85,000.
The patient who suffered fractured vertebrae after being injected with the wrong dye in 2003 (one of the cases referred to in the state board reprimand above) settled for about $300,000.
In 2004 Konasiewicz operated on a 56-year-old woman to alleviate pain from a herniated disc. The woman got an infection from the procedure and was in progressively worse pain until she died at her home within a week of the operation. Her widower won a settlement of about $355,000.
In 2005 Konasiewicz cut the aorta of a 25-year-old mother of two during spinal surgery (another case referred to in the state board reprimand). But he apparently didn’t notice the hole in her artery, and she bled to death 12 hours later. Her family settled for $1.45 million.
And in 2007 a patient wound up paralyzed from the neck down after being improperly secured during neck surgery (also referred to in the reprimand). Her family settled for more than $1 million.
(The stories of all these injured patients are told in detail in the News Tribune.)
But when you look at Konasiewicz’s record on the website of the Texas Medical Board, you will find that, according to Konasiewicz, he has no reportable malpractice claims. No Texas patient who went to the state licensing authority for information about this doctor would have any clue that there had been more than $3 million in malpractice settlements resulting from his care.
The malpractice information on the Texas Medical Board website is reported by the physician him- or herself. News Tribune reporters Stahl and Stodghill talked to board spokeswoman Leigh Hopper:
Konasiewicz received his license from the Texas Medical Board in 1997 and is required to renew it every two years, Hopper said. She said the board is supposed to review a doctor’s malpractice and disciplinary action when it renews a license, but she couldn’t say if that happened with Konasiewicz.
“It’s actually possible that the board doesn’t know about all the medical malpractice cases in another state,” she said.
What might come as a shock is that the Texas Medical Board doesn’t go looking for malpractice information from outside sources. Again, from Stahl and Stodghill:
All state medical boards have full access to the National Practitioner Data Bank, which lists malpractice cases and disciplinary actions taken against doctors. But Hopper said that because the Data Bank charges for queries, it would cost the state of Texas too much — she estimated $160,000 a year — to check on every doctor licensed in the state.
“We might query it as part of an investigation, but it won’t be a source to start an investigation,” Hopper said.
The ultimate responsibility of disclosing malpractice cases is on the doctor, Hopper said.
“If the doctor doesn’t want to tell us and is not truthful when he renews his license, then we’re not going to find out about it, either,” she said.
Konasiewicz’s page on the Texas Medical Board website does include this information:
Disciplinary Actions By Other State Medical Boards
The physician has reported the following:
Description: DISCIPLINARY ACTION TAKEN BY THE MN BOARD OF MEDICAL PRACTICE REQUIRING MENTORING OF CASES AND REPORTING TO THE MN BOARD.
But there is no information about the nature of that disciplinary action. And the requirement for a supervising physician to monitor Konasiewicz’s surgeries and file quarterly reports is not being observed in Texas, according to the News Tribune:
If a doctor relocates to Texas, that state’s medical board typically adopts the disciplinary actions and sanctions imposed by a previous state, said [Hopper].
However, she said, as far as Texas is concerned, Konasiewicz has a clear medical license with no restrictions.
“And I don’t know why that is,” she said.
…Minnesota has no obligation or authority to require Konasiewicz to follow the discipline order, said Ruth Martinez, the complaint review unit supervisor for the Minnesota medical board.
After the News Tribune published its initial investigation into Konasiewicz, the reporters heard from more of his former patients and told the stories of four of them in an article published August 1. That same day, a report by Stahl focused on “the efforts of Konasiewicz’s former colleagues to warn the St. Luke’s administration about his practice, and the hospital’s response.”
Konasieweicz is now back in court in Minnesota, facing another malpractice allegation. Alan Meinershagen says he has been unable to walk since a cerebral hemorrhage caused by a brain biopsy performed by Konasiewicz in 2006. The trial was moved 150 miles from Duluth to suburban St. Paul at the request of Konasiewicz’s attorneys “because of concerns about jurors being prejudiced by previous news coverage,” according to Meinershagen’s attorney. (UPDATE: Konasieweicz was found to be not negligent in a verdict returned on August 10.)
Meanwhile, news of Konasiewicz’s history of malpractice has reached Corpus Christi, where he now practices. And a patient who said he’s having difficulty recovering from a recent spinal fusion surgery performed by Konasiewicz “says he feels deceived because he even tried searching the Texas Medical Board website for complaints against Dr. Konasiewicz and nothing turned up,” according to a report from KRIS-TV.