Trail of misery follows doctor
Lack of disclosure, medical mistakes alleged in Mass.
ATTLEBORO - Robert A. Whitney dreaded going to the bathroom. For almost four years after his 1997 hernia operation, the simple act of urinating caused bleeding and a fierce burning sensation that often drove him to his knees. The father of three young children became addicted to the narcotics his surgeon at Sturdy Memorial Hospital prescribed to dull the pain, and in the years that followed, he lost 40 pounds, his job, and his marriage.
Finally, a doctor in Boston told Whitney that the surgeon had made a terrible mistake, embedding surgical staples into his bladder. Whitney didn't know it at the time, but he wasn't alone: State regulators have alleged that Dr. Jose Veizaga-Mendez provided dangerously substandard care to at least seven other patients from 2000 to 2003, including two who died as a result.
But, by the time Massachusetts officials lodged formal charges against Veizaga-Mendez in January, the Bolivia-trained surgeon had already moved on to a new job at a veterans' hospital in rural Illinois - where he is in deep trouble again. The US Department of Veterans Affairs is investigating Veizaga-Mendez's role in the deaths of up to 10 patients over the past two years, including a 50-year-old Air Force veteran who died after what was expected to be routine gallbladder surgery on Aug. 9, 2007.
"When I heard about the veterans, I called my wife and said 'He's at it again,' " said Whitney, who has been pain-free since doctors at Brigham and Women's Hospital removed the last staple from his bladder in 2001.
"They survived wars and bombs, and they go in for a simple operation and they die . . . I blame [Veizaga-Mendez] for everything."
Now the two US senators from Illinois want to know how Veizaga-Mendez, 69, could get a job in their state in January 2006 while he was under investigation for negligence in another. Several national databases are supposed to provide information on doctors who have been sued or punished for providing poor care, a setup designed to prevent them from continuing their practice by moving to another state. But Veizaga-Mendez showed how easy it is to beat the system: He simply relocated to an out-of-state hospital before the Massachusetts Board of Registration in Medicine made public the results of an investigation that took more than two years.
Senators Richard J. Durbin and Barack Obama have criticized the Department of Veterans Affairs for not asking more questions about Veizaga-Mendez's background before hiring him. "This is an extremely alarming revelation that calls into question the adequacy of the oversight exercised by the VA as it evaluates and monitors those who provide care to our veterans," they wrote earlier this month to the VA, which has reassigned four administrators at the Marion VA Medical Center, pending results of an independent investigation.
But the case also illustrates an oversight system that sometimes protects doctors' rights at the expense of patients. Like medical regulators in many states, Massachusetts officials are not allowed to talk publicly about ongoing investigations, even to potential employers. As a result, when VA officials called to ask why Veizaga-Mendez had "voluntarily" agreed to suspend his Massachusetts medical license in the summer of 2006, medical board officials acknowledge that they said nothing about the ongoing investigation. In fact, the board listed the suspension as "nondisciplinary" with the tracking databases.
Meanwhile, Sturdy Memorial Hospital in Attleboro, where Veizaga-Mendez worked as a general surgeon for nearly 30 years, quietly disciplined Veizaga-Mendez in 2004, but allowed him to continue performing surgeries until he left Sturdy in 2006.
The hospital forwarded numerous allegations of substandard care to the state medical board for investigation, according to state records. But the hospital, saying it's a confidential personnel matter, will not discuss - or even acknowledge - the punishment or the report to the state.
A lawyer for Veizaga-Mendez in Chicago, A. Jay Goldstein, declined to comment, and attempts to reach the doctor through his wife, a cancer specialist at Sturdy Memorial, were unsuccessful. A woman who answered the phone hung up on a reporter.
Veizaga-Mendez's case is not isolated. Nearly 90 percent of the 5,000 doctors who faced disciplinary action in the United States last year had medical licenses in more than one state, according to the Federation of State Medical Boards, giving them the option of moving to another state to practice if they fear losing their license in the first. As Veizaga-Mendez's troubles deepened in Illinois in August, he applied for a license in yet another state, North Dakota.
Medical regulators have become far better at tracking dangerous doctors since the early 1990s when serial killer Michael Swango poisoned patients and co-workers at several hospitals, repeatedly landing new jobs with forged documents. In recent years, regulators using the federation's national alert service have caught numerous would-be border-jumpers.
But Dr. James N. Thompson, the federation president, acknowledges that the system remains vulnerable to doctors who deliberately deceive regulators. Massachusetts regulators say they would have known about Veizaga-Mendez's problems at least a year earlier if he had disclosed two malpractice lawsuits that had been filed against him, including one by Whitney, when he renewed his medical license in 2003. Instead, Veizaga-Mendez is facing licensing fraud charges four years after the fact.
"That's a tough situation," acknowledged Thompson. He said regulators have to keep investigations secret, but should do more to complete the work quickly and release their findings. "The sooner they can investigate and complete investigative actions, the less likely it is that someone can go to another jurisdiction."
That's not any comfort to Katrina Shank, whose husband, Robert E. Shank III, died from massive internal bleeding on Aug. 10, 2007, at Marion VA hospital one day after Veizaga-Mendez performed a minimally invasive surgery to remove his gallbladder. She has filed a notice of intent to sue the VA for $12 million, alleging that Veizaga-Mendez botched the operation, then waited too long to reopen her husband's incision to stop the bleeding.
She also alleges that the VA was negligent in letting Veizaga-Mendez perform surgery at all.
Veizaga-Mendez resigned three days later, and by the end of August, the 55-bed hospital had shut down all inpatient surgery amid concerns that the hospital had suffered a much higher-than-expected death rate in cases he was involved with.
Durbin and Obama have said that several of the 10 deaths under investigation involved complex surgeries that were beyond Veizaga-Mendez's skill level as a general surgeon without specialized credentials.
"The guy has no clue as to what his limitations are," Dr. Stanley Heller of Chicago, a lawyer who represents Katrina Shank, said in an interview. Heller said his firm is also investigating a surgery in which Veizaga-Mendez allegedly took out the wrong section of a cancer patient's lung.
Others wondered whether Veizaga-Mendez's skills as a surgeon had declined or his health had declined. In February , he underwent surgery for a detached retina.
Bennett Bergman, a Rhode Island lawyer, said he suspected Veizaga-Mendez was doing work he wasn't qualified for when he represented the family of a 58-year-old man who died of an infection in 2000 after the surgeon performed minimally invasive surgery for acid reflux. Bergman argued in a lawsuit that the surgeon was doing a procedure that he had learned to do during a weekend seminar in Cincinnati and that he lacked the skill to do it correctly. He also argued that the procedure was wholly unnecessary to treat the patient, Geronimo Coronado.
"Mr. Coronado had come in for burping up. Dr. Veizaga-Mendez saw a dangerous procedure that would potentially kill him, and he went forward with it," said Bergman.
Veizaga-Mendez's malpractice insurance company paid the family an undisclosed amount in 2004, but Bergman didn't drop the issue. Months later, when he did not see disclosure of the lawsuit in Veizaga-Mendez's profile at the Board of Registration's website, he mailed the board a copy of the doctor's testimony about Coronado's surgery.
By then, Sturdy Memorial officials had already reported to the state - as required by law - that they had disciplined Veizaga-Mendez for providing substandard care, triggering the medical board to conduct its own inquiry. For more than two years, the board interviewed witnesses and gathered evidence about seven patients who were injured or killed allegedly because of Veizaga-Mendez's quality of care, including a 20-year-old man who suffered a lacerated aorta when the surgeon tried to perform a minimally invasive hernia repair. The investigation also looked at a 72-year-old man who, like Shank in Illinois, died from postsurgical bleeding that Veizaga-Mendez was allegedly slow to treat.
Byron Taylor, the lawyer who represented Whitney, said he believes that Veizaga-Mendez's problems began in the 1990s as he started to perform minimally invasive surgeries, which are done using surgical tools and a miniature video camera called a laparoscope that are inserted through small incisions. Taylor said Veizaga-Mendez successfully repaired Whitney's hernia in 1981 using a standard 6-inch incision that allowed the surgeon to see the injury more easily. But when Whitney came back for hernia repair in 1997, Veizaga-Mendez suggested the laparoscopic surgery that ended so disastrously.
In the lawsuit, Veizaga-Mendez argued that the surgical staples embedded in Whitney's bladder drifted there from the site of the hernia operation, but in March, a Fall River jury ordered the surgeon to pay Whitney and his estranged wife $652,000 for their ordeal.
However, both the jury verdict and the findings of the state investigation released in January came a full year after Veizaga-Mendez had gone to work at the Marion VA hospital. Officials there said that when they hired him, Veizaga-Mendez had no limits on his medical license in Massachusetts and no history of disciplinary action.
Russell Aims, Massachusetts medical board spokesman, said the investigation into Veizaga-Mendez did not take an unusually long time considering that it involved multiple patients - a process that can generate thousands of pages of paperwork. He said the board urges doctors facing lengthy inquiries to consider voluntary license suspensions to protect patients, but acknowledged that doesn't help other states.
As a result, he said, Veizaga-Mendez essentially got more than two years' notice to find a job in another state before Massachusetts made its findings public.
"It may just be bad timing," said Aims.
Scott Allen can be reached at firstname.lastname@example.org.