Robert Iacono, 55, doctor criticized for Parkinson's surgery
LOS ANGELES -- Dr. Robert P . Iacono, the troubled neurosurgeon who was one of the first practitioners of a radical form of surgery for Parkinson's disease but whose impetuousness derailed his career, died June 16 in a plane crash. He was 55.
Dr. Iacono was flying alone from Los Angeles to Mississippi in a twin-engine Beechcraft 58 Baron to visit family when the plane crashed into the western face of the Sandia Mountains in New Mexico.
Rescue efforts began after satellites picked up a signal from the plane's emergency transmitter about 8 p.m. The body was recovered Monday.
Dr. Iacono made a national reputation for himself during the 1990s while he was at Loma Linda University Medical Center, performing a controversial surgical procedure called a pallidotomy on patients with Parkinson's, which is characterized by tremor and rigidity in the limbs and a loss of muscle control.
Pallidotomies involve destruction of a small part of the globus pallidus, a region of the brain involved in the control of movement. Destroying part of the pallidus restores balance in that part of the brain, and Dr. Iacono was one of its early promoters.
In the surgery, a probe is inserted into the brain while the patient is awake, so that speech and other functions can be monitored. When the probe is positioned correctly, a radio frequency current is passed through it, producing heat that destroys nearby tissue.
The effects are almost immediately apparent and include a dramatic reduction in tremors and rigidity and a decreased need for levodopa, the drug most commonly used to treat the disorder.
Iacono performed hundreds of the operations during the 1990s. In a 1995 article in the journal Neurosurgery on his initial 126 patients, he reported an 85 percent success rate in improving the patients' mobility and a surgical complication rate of 6.3 percent.
Critics were brutal, however. Dr. Roy A.E. Bakay of Emory University said at the time that "Dr. Iacono and his colleagues have undoubtedly overestimated their surgical success and underestimated their surgical complication rate."
In a Wall Street Journal article, Dr. Robert Feldman, a neurologist at Boston University, said that he "wouldn't refer patients to Iacono."
"I don't think he is thinking critically," Feldman wrote. "He's thinking surgically."
The American Parkinson Disease Association, the largest patient group in the country, also refused to refer patients to Dr. Iacono on the advice of its medical board, although the group did not explicitly say why.
Many of Dr. Iacono's patients praised him effusively for the benefits they received from the surgery. But Dr. Iacono and Loma Linda also had to defend several malpractice suits resulting from operations gone awry.
By the end of the decade, most neurosurgeons had switched to an alternative procedure called deep-brain stimulation, in which the destruction of tissue is not necessary. Electrodes are permanently implanted in the brain, and passing a small current through them produces the same benefits as pallidotomies, but without the risk.
Meanwhile, Dr. Iacono's career began to deteriorate.
In 1992, he was accused of using sexually inappropriate language and touching a female staff member. In 1994, he was accused of using drugs not approved by the Food and Drug Administration. On at least two separate occasions, he was accused of verbal or physical abuse of staff, and in 1999 the hospital suspended him 20 days.
Following two subsequent charges of abuse, the hospital's executive committee began making plans to terminate Dr. Iacono's privileges. He voluntarily resigned before his privileges were revoked.
Two months later, he applied for privileges at Desert Regional Medical Center in Palm Springs, Calif., but he marked no on a box asking if he had ever been in trouble at any other hospital. As a result, he faced a formal accusation of wrongdoing by the California Medical Board and surrendered his license to practice medicine, effective Sept. 19, 2005.
