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It has long been routine, albeit often controversial, to welcome medical device vendors and surgical trainees into operating rooms to watch surgeons and nurses work. But now the University of Missouri healthcare system may have reset the bar with its $ 16.2 million settlement with nearly two dozen patients over questionable knee surgery.
The contested procedures, which were carried out on minors, were in part carried out by a veterinarian.
This veterinarian, James Cook, is listed on the university’s website as the William & Kathryn Allen Distinguished Chair in Orthopedic Surgery. In the online explanatory text and a posted video, he describes how his lead role at the school focuses on research into people and animals in joint disease. He experiments with techniques, especially in dogs, where living materials can be used to replace problematic joints.
22 patients sued Cook, orthopedic surgeon Dr. James Stannard and the university system and said it was inappropriate for the vet to operate on people. Plaintiffs also said Cook and Stannard exaggerated the success of their “BioJoint” operations of “replacing parts of the knee with cadaver bones or cartilage to treat arthritis or joint damage … to avoid traditional artificial knee replacement,” court documents about which the service of Kaiser Health News (KHN) reports.
As a reporter, Lauren Weber wrote:
“Plaintiffs alleged in court documents that Stannard failed to tell them that the operation he proposed had a failure rate of up to 86%. Court documents argued the surgeries were “experimental” and “unproven”, sometimes leaving patients in need of follow-up surgeries and even knee replacements, including young patients. The defendants denied these allegations in the court records, and the university closed the cases with no acknowledgment of liability or negligence after the claims against Cook, Stannard, and another employee were dismissed. The Mizzou BioJoint website states that the program does not have 10-year efficacy data because the operations “are based on improvements to traditional techniques”. Unlike prescription drugs or medical devices, surgical interventions are not directly regulated by federal or state authorities. “
Still, questions remain about Cook’s role in the proceedings. In his published university video, he says that after completing his veterinary degree and practicing and researching, he returned to school to train as an orthopedic technologist. But as Weber reported:
“At the heart of the dispute in the consolidated litigation is Cook’s account that veterinarians and veterinarians are generally not allowed to administer medication to humans. Trials alleged that Stannard negligently allowed Cook to perform portions of Mizzou BioJoint operations on plaintiffs “without proper medical instruction and supervision”. Some patients claim in court documents they did not know when they underwent the procedure, that Cook was not a “doctor or licensed medical practitioner.” Defendants deny Cook was listed as a surgeon in response to this case, but said he was listed as part of the surgical team. An additional filing by defendants stated that Cook was “Orthopedic Technician – Surgery Certified” and that he had joined the surgical team for the “majority of the operations performed by Dr. Stannard.” In one file, defending attorneys said Stannard and Cook were under no obligation to tell patients that Cook had never been a doctor or licensed medical practitioner at any time prior to surgery, as the operation usually involves people in the operating suite who are not licensed doctors are . ‘”
KHN reported that Cook attracted media attention for his work on animals, including recent surgery on the tiger’s joints in Chicago. He is well compensated and the state will pay him more than $ 300,000 in 2020.
Stannard, his orthopedic surgeon partner, said KHN is “one of the highest paid employees at the University of Missouri, aside from top athletic coaches … [He] received a government salary of $ 981,977.52 for 2020. His titles include chief medical officer for procedural services, medical director of the Missouri Orthopedic Institute, and chairman of the orthopedic surgery department of the medical school. He is also a team doctor for Mizzou athletes. “
The KHN article said Jeff Howell, executive vice president of the Missouri State Medical Association, told Weber, “You must be licensed to operate on a person.”
History doesn’t tell whether medical, veterinary, or hospital licensing authorities will investigate this unusual case.
In my practice, I see not only the harm patients suffer in seeking medical services, but also the major barriers they face in making sure they know their fundamental right to consent. This means that they are given clear and complete information on all the key facts they need to make an intelligent decision about which treatments to receive, where to get them, and from whom. When minors are involved, the standard of information for them and their parents or guardians should be the same or higher, including explaining complex medical decisions in a clear, understandable way to younger patients.
It is true that surgeons can find new ways of performing procedures to help both patients and their outcomes, but also to make a name for themselves and improve their earnings potential. It is also true that, apart from the concerns of animal rights activists, many medical breakthroughs include insights that carry over to humans from working on creatures large and small.
However, patients are owed a full, detailed explanation of the routine and experimental work on them, especially the latter. It is unacceptable that anyone who is not fully licensed and authenticated can practice medicine on human patients, especially when they are under anesthesia and unconscious.
The folks at Mizzou’s healthcare system have a lot to show and explain to patients how aggressively they are promoting experimental surgery, as the school has done in direct mail in places like typically busy O’Hare Airport, KHN reported.
This could be another example of institutional “what do you think?” Missouri officials may want to consult with colleagues in Ohio. Medical admissions found they had to re-examine hundreds of complaints against doctors to make sure they weren’t unfairly dismissed. It did so after a sexual abuse scandal broke out at Ohio State University that involved dozens of young men in the school’s sports program. Ohio authorities have reopened 91 cases with reported complaints of sexual abuse against doctors and are investigating 42 additional cases where doctors may have withheld important information.
Not good. We still have a lot to do to make sure doctors are accountable for their practices.