David Hetzel, a Gynecologic Oncologist in North Carolina, just filed a lawsuit against a healthcare facility where he worked. The lawsuit alleges, in 2020, he was placed on precautionary suspension. More on that shortly. At the time of suspension, he had one foot out the door. He was scheduled to assume Chief of Gynecologic Oncology at Texas Tech El Paso Tenet Hospitals. That offer was withdrawn. A negative National Practitioner Data Bank report related to the precautionary suspension was the ostensible reason.

Dr. Hetzel then obtained a position as the Chief of Gynecologic Oncology at the University of Texas Health East Texas. However, that job offer process stalled in March 2021, after the hospital learned of the NPDB report.

Rejection letters piled up.

From March 2021 through April 2023, Dr. Hetzel has continued to be denied positions as a gynecologic oncologist, likely due to the NPDB report. These denied opportunities included positions at the following hospitals: Marshfield Clinic (Marshfield, Wisconsin), Virginia Hospital System, Gunderson Clinic (La Crosse, Wisconsin), CARTI Health System (Little Rock, Arkansas), Genesis Care (Venice and Lakewood Beach, Florida), Mercy Health (Rockford, Illinois), Ironwood Cancer and Research Center (Phoenix, Arizona), Advocate Aurora Health (Milwaukee, Wisconsin), Meritus Health (Hagerstown, Massachusetts), Upstate Medical University (Syracuse, New York), Northwell Health (Long Island, New York), University of Miami and Holston Valley Hospital (Kingsport, Tennessee).

In January 2022, Dr. Hetzel was hired at Ironwood Cancer and Research Center in Phoenix, Arizona, pending a background check and licensure in Arizona. Dr. Hetzel was informed on October 1, 2022, that Ironwood’s offer was being withdrawn due to NPDB and temporary suspension.

Dr. Hetzel also applied for a medical license in the State of Arizona, which was denied because of the NPDB report and temporary suspension which led to a greater than two-year unemployment gap. The Arizona Medical Board offered Dr. Hetzel only a probationary license, which would have led to yet another inappropriate NPDB entry.

Now to what happened?

On March 2, 2020, Dr. Hetzel performed surgery to debulk a massive gynecologic tumor that invaded a patient’s abdomen.

He successfully removed the anterior abdominal tumor, resected the cancerous omentum, and removed tumor from the right and left colic gutter. He resected the uterus, ovaries, and fallopian tubes, then dissected the largest of the tumors, debulking the tumor in the pelvic area to the extent that could be accomplished.

So far, so good.

During the procedure, Dr. Hetzel also observed that the tumor heavily affected the bowel and colon and understood that an enterotomy caused by the tumor had developed in the very proximal small bowel near the duodenum. Given the nature of the tumor and its proximity to the bowel, it was impossible to bypass it without mobilizing the duodenum. Dr. Hetzel made the intraoperative decision to involve a hepatobiliary surgeon and surgical oncologist. The hepatobiliary surgeon and surgical oncologist did not mobilize and bypass the bowel at first but rather continued to debulk the tumor to such an extent that they ultimately removed the patient’s colon and all of the small bowel with a high blood loss – which was a complication and risk of the surgery.

The next day, March 3, the Chief of Staff and CEO placed Dr. Hetzel’s clinical privileges on precautionary suspension, based on the above-referenced complication and two other intraoperative organ injuries over the prior six months.

Interestingly, Dr. Hetzel’s portion of the procedure had been performed successfully. It’s not clear the hospital was even aware of who did what portion of the procedure.

The Credentials Committee was scheduled to review and consider the precautionary suspension, and to meet with Dr. Hetzel to hear his version of events. Dr. Hetzel stated he was not contacted.  The Credentials Committee supposedly had zero members that performed the same type of procedure performed by Dr. Hetzel, gynecologic oncology.

On March 10, 2022, the Credentials Committee modified the precautionary suspension to a “lesser sanction with conditions.”

On March 25, 2020, Dr. Hetzel received a letter from the CEO and Credentials Committee Chair, stating that the Committee had again imposed a precautionary suspension of Dr. Hetzel’s privileges pending the full investigation.

Starting to feel like a ping-pong ball.

On April 3, 2020, Dr. Hetzel provided a response letter to the Committee explaining the reasonableness of his actions, which fell within the standard of care for a physician with his training and experience.

On April 10, 2020, Dr. Hetzel met with the Investigating Committee. On April 17, 2020, and April 22, 2020, Dr. Hetzel provided the Investigating Committee with additional written responses.

Following this investigation, the hospital concluded that the clinical care that was the subject of the initial precautionary suspension did not warrant a limitation on Dr. Hetzel’s clinical privileges.

On April 23, 2020, the Committee modified Dr. Hetzel’s precautionary suspension and fully restored his privileges, subject to Dr. Hetzel’s satisfactory completion of a fitness-for-duty evaluation.  As to the purpose and scope of a fitness-for-duty evaluation, the lawsuit is mute.

On May 4, 2020, the hospital initially reported Dr. Hetzel’s investigation to the National Practitioner’s Databank for removal of privileges due to a professional review action under 45 C.F.R. § 60.12, and/or for negative actions or findings taken by peer review organizations under 45 C.F.R. § 60.12.

Dr. Hetzel sued arguing that the precautionary suspension was not the result of a professional review action, a prerequisite for reporting to the NPDB. This will be a tough climb. A summary suspension must be reported to the Data Bank if it is:

• In effect or imposed for more than 30 days
• Based on the professional competence or professional conduct of the physician, dentist, or other health care practitioner that adversely affects, or could adversely affect, the health or welfare of a patient, and
• The result of a professional review action taken by a hospital or other healthcare entity
•  

In addition, summary suspensions imposed for an indefinite length that have not lasted more than 30 days but are expected to last more than 30 days, and that are otherwise reportable, may be reported to the NPDB. If the summary suspension ultimately does not last more than 30 days, the report must be voided.

Here’s the calendar.  It’s confusing. It sounds like there was some type of restriction in place for more than 30 days. The initial restriction, a precautionary suspension, began on March 3rd. 

On March 10, a lesser sanction with conditions was implemented.

On March 25th, precautionary suspension was again implemented.

On April 23rd, the precautionary suspension was lifted, and privileges were restored, subject to Dr. Hetzel’s satisfactory completion of a fitness for duty evaluation. I’m assuming that condition took time to execute, but the lawsuit is mute on that.

Is a summary suspension a professional review action? Typically, yes.

The NPDB treats summary suspensions differently from other professional review actions because the procedural rights of the practitioner are provided following the imposition of a suspension, rather than preceding it. A summary suspension is often imposed by an official (for instance, the chairman of a department) on behalf of the hospital or health care entity for the purpose of protecting patients from imminent danger. Commonly, this action is then reviewed and confirmed by a hospital committee, such as a medical executive committee (MEC), as authorized by the medical staff bylaws or other official documents (e.g., rules and procedures, standard operating procedures). Summary suspensions are considered to be effective when they go into effect, even though they may be subject to review by some committee or body of the health care entity according to the entity’s bylaws or other official documents.

For purposes of reporting a summary suspension to the NPDB, if the summary suspension is confirmed by the review body, the action is considered to have taken effect when it was first imposed by the hospital official. If a summary suspension is in effect for more than 30 days before an action is taken by the authorized hospital committee or body, it must be reported to the NPDB. If the authorized hospital committee or body does not confirm the initial action or takes a different professional review action, a Revision-to-Action Report must be submitted. If the authorized hospital committee or body vacates the summary suspension, the entity must void the previous report submitted to the NPDB.

If the summary suspension subsequently is modified or revised as part of a final decision by the governing board or similar body, the health care entity must then submit a Revision-to-Action Report to supplement the Initial Report submitted to the NPDB.

(From NPDB Guidebook 2018).

Let’s assume the first precautionary suspension was less than 30 days. Then the second restriction was modified to: “lesser sanction with conditions.” That lasted less than 30 days.

The next precautionary suspension lasted less than 30 days. Privileges were restored pending a fitness for duty exam. Let’s assume the fitness for duty exam was immediately completed.

If accurate, no individual restriction lasted more than 30 days, and there appeared to be multiple professional review actions. But, in aggregate, the clinical privileges were restricted more than 30 days? Is that reportable?

Perhaps, but unclear.

If a single professional review action produces multiple clinical privileges actions (for example, a 12-month suspension followed by a 5-month mandatory consultation period requiring approval of a department chair before the exercise of clinical privileges), only one report, reflecting the multiple actions taken, should be submitted to the NPDB. The reporting entity may select up to five Adverse Action Classification Codes on the reporting format to describe the actions taken. Reporting entities should use the narrative description to explain any additional adverse actions imposed.

A Revision-to-Action Report must be submitted when each of the multiple actions is lifted or otherwise changed. For the example in the previous paragraph:

• • If the Initial Report clearly states that the suspension is to end after 12 months, and the mandatory consultation period is to end after 5 months, and if these penalties are not changed and are fully met by the practitioner, no additional reports should be submitted
  • If, after the Initial Report is submitted, the suspension period is extended to 14 months or the mandatory consultation period is shortened to 4 months, a Revision-to-Action Report must be submitted when either change is imposed

If an adverse action against the clinical privileges of a practitioner is based on multiple grounds, only a single report should be submitted to the NPDB. However, all reasons for the action should be reported and explained in the narrative description. The reporting entity may select up to four Basis for Action Codes to indicate these multiple reasons. Additional reasons should be summarized in the narrative description.

In Hetzer’s case, there were multiple updates to his clinical privileging status, and, assuming the fitness for duty evaluation did not delay resumption of full privileges, no one restriction lasted more than 30 days. But his privileges were restricted in some capacity for more than 30 days.

This is all very confusing. What is not confusing is that the NPDB report made Dr. Hetzel essentially unemployable or under-employable. A shame.

What do you think?

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation. Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases. Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors. In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders. Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2023 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.