Medical Justice provides consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. If you are navigating a medico-legal obstacle, visit our booking page to schedule a consultation – or use the tool shared below.
“Can Medical Justice solve my problem?” Click here to review recent consultations…
all. Here’s a sample of typical recent consultation discussions…- Former employee stole patient list. Now a competitor…
- Patient suing doctor in small claims court…
- Just received board complaint…
- Allegations of sexual harassment by employee…
- Patient filed police complaint doctor inappropriately touched her…
- DEA showed up to my office…
- Patient “extorting” me. “Pay me or I’ll slam you online.”
- My carrier wants me to settle. My case is fully defensible…
- My patient is demanding an unwarranted refund…
- How do I safely terminate doctor-patient relationship?
- How to avoid reporting to Data Bank…
- I want my day in court. But don’t want to risk my nest egg…
- Hospital wants to fire me…
- Sham peer review inappropriately limiting privileges…
- Can I safely use stem cells in my practice?
- Patient’s results are not what was expected…
- Just received request for medical records from an attorney…
- Just received notice of intent to sue…
- Just received summons for meritless case…
- Safely responding to negative online reviews…
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 That offer was withdrawn.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?
Medical Justice provides consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. If you are navigating a medico-legal obstacle, visit our booking page to schedule a consultation – or use the tool shared below.
“Can Medical Justice solve my problem?” Click here to review recent consultations…
all. Here’s a sample of typical recent consultation discussions…- Former employee stole patient list. Now a competitor…
- Patient suing doctor in small claims court…
- Just received board complaint…
- Allegations of sexual harassment by employee…
- Patient filed police complaint doctor inappropriately touched her…
- DEA showed up to my office…
- Patient “extorting” me. “Pay me or I’ll slam you online.”
- My carrier wants me to settle. My case is fully defensible…
- My patient is demanding an unwarranted refund…
- How do I safely terminate doctor-patient relationship?
- How to avoid reporting to Data Bank…
- I want my day in court. But don’t want to risk my nest egg…
- Hospital wants to fire me…
- Sham peer review inappropriately limiting privileges…
- Can I safely use stem cells in my practice?
- Patient’s results are not what was expected…
- Just received request for medical records from an attorney…
- Just received notice of intent to sue…
- Just received summons for meritless case…
- Safely responding to negative online reviews…
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 decades of combined 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.
Adverse Action report should never have been filed, and should now be voided.
Not going back to the law, but as you quote the 2018 Guidebook and assuming your other assumptions and dates are correct, the first suspension should not have been reported, but if one was, it should then have been revised or voided. The second suspension should also not have been reported (though it could have been), but it should also be voided. That the report was made 11 days after the less-than-30 day suspension was lifted also suggests negligence or malfeasance on the part of the hospital party who was responsible.
Glad he’s suing, perhaps like vanBoven in TX he will win a sizeable judgment for loss of his career. This pernicious system in which hospitals are allowed to pull the “patient safety” card and issue summary suspensions without even an investigation into the facts of the case OR the standard of care by a qualified practitioner who KNOWS the applicable standard (let alone due process) is unconscionable. After this is done, all the hospital needs to do is to delay the required committee meeting until after the 30 days and *poof!* career immolation.
One certainly is left wondering why the other two surgeons who took over the case and (at least according to your interpretation of the filings) were actually responsible for the harms. And why a “Fitness for Duty” evaluation was demanded, perhaps just punitive. (And how anyone could do it with any relevance…. proctor a complex gyn-onc procedure?) The ultimate facts of the actual case should prove very interesting.
This is a disgusting use of power by a hospital. Unacceptable. Never should have happened. I’m appalled.
Jeff, you alluded to, but didn’t specify, that this could have been politically motivated. I strongly suspect that the general surgeons had a beef with the gyn-onc field in general and/or this doc in particular, and used this case as an excuse to stir up trouble.
Without taking sides in the general surgery vs gyn surgery turf war, I think this case is deplorable, at least as presented. Some gyn-onc career is torpedoed after doing his best during one surgery, regardless of the specific outcome? How many hundreds or thousands of other patients did he help?
Having been on both sides of this line, as a credentials and MEC member, and as a surgeon whose practice has been monitored in the same fashion as every other surgeon by the peer review process, I am appalled at this turn of events. I wonder if the hospitals and practices and state licensure boards who have rejected this guy are faultless in their own operations, and if they could stand the same kind of idiotic “you have a citation on your NPDB report, so you are disqualified” logic they employ at others’ expense. How many patients have been harmed by the absence of this surgeon’s practice in their communities due to this prejudice.
We as physicians hate the med-mal system and the plaintiff’s attorneys. But why are we so eager to cause our fellow physicians undue harm? Where’s the team spirit? Where’s the compassion? It’s not difficult to identify the bad actor docs who need to be monitored and disciplined. They generate multiple reports. But one report to NPDB? No work for 2 years? This is so sad.
As someone that spent 17 of 25 years on the med exec committee which in our hospitals functioned as the credentials committee, I can state that this entire action was unfounded.
This physician has been permanently damaged and may likely to be unemployable at as a gyn oncologist. The NPDB reports have sealed his fate making him unemployable.
His only option may be to remain at the hospital he was at, if he still has privileges there.
More importantly to the medical system as a whole, how many physicians are undeservedly destroyed by such actions such that they can no longer practice. How long did it take to train this physician, and build up a skill level to tackle such complex cases.
It is no wonder that hospital employed surgeons turn down these complex cases more and more, because of the potential adverse impact on their careers. Forget about what is best for the patient, since that is no longer part of the equation.
We already have a crisis shortage of physicians. As one University Hospital Surgical Chairman recently related to me, when interviewing surgical fellows for staff positions, their first question is how much vacation time are they going to get, how much call are they going to take, and how much are they going to get paid. In my day it would have been unthinkable to bring that up in a first conversation, let alone as the first questions to ask an interviewing employer.
But given the above circumstances can we blame them?
Should we now consider physicians to be like professional baseball players?
They are only as good as their last case or season.
They are going to only be able to work for 10 or 20 years before being sidelined by an injury, or in the physician case by a lawsuit, inappropriate sham peer review, or adverse finding by a medical board, or the National Practitioner Data Bank.
When I was still in practice and was licensed in multiple states for occasional locum tenens purposes, I got all of the board newsletters. Each newsletter was filled with disciplinary cases. Aside from the few physicians that had issues with drugs affecting their licensure, and the few physicians that were really bad with multiple multiple malpractice suits, the bulk of cases were typical disputes due to sham peer reviews, one off cases, and overly aggressive board or NPDB actions.
Perfection is not possible in medicine. Physicians are not G-d. Things can and will go wrong.
Studies have shown that with similar cases, and similar physician performance but just a difference in outcome due to patient variables, the cases with good outcomes the physicians were judged to be fine. The cases with bad outcomes, the physicians were judged to be villains.
The only real variable was the patient. Fair? No.
How many physicians wake up and say “Today, I will create malpractice”. None.
Therefore, if we judged physicians for malpractice on the legal basis of intent, there would be none. But intent is not a component of malpractice.
We have created an environment that is so hostile to physician practice that is amazing that we still have so many people applying to go to medical school. We are throwing legal rocks at our very talented physicians. Do they tolerate throwing rocks at musicians in concert, or at sporting events? No.
Why we have allowed this to occur is beyond me.
Physicians should strike to stop all of this major league hostility to the profession, and not go back to work until the laws are changed to protect the physicians.
Thank goodness I am retired.
When the first serious inclinations of Democrat regulations against physicians occurred, MD professional organizations had the ability to control them, if not stop them. They demurred and allowed them to be created, and now morphed. They are now used by hospitals and employers to fire outstanding physicians and end their careers, without cause.
That is not true for all professions. The plaintiff’s attorney and injury bar usually detest each other. However, if Government or any private entity conspires to take away their power, they will get together to fight it, almost heroically. You have to hand it to them. They put aside their personal grievances and raise fortunes to fight. Even chiropractors and dentists do. DPMs are much less powerful, but we at least try. We could all have combined our forces against the Democrat regulators years ago. Our enemies instead split us up into warring factions.
When the first NPDB law was passed, your professional association allowed them to pass, unchanged from regulators’ demands. That would have been the time to at least modify them. Is it too late? Are you still a paying member of AMA? If so, why?
Michael M. Rosenblatt, DPM