At its meeting on Dec. 6, 2008, the AAOS Board of Directors considered a grievance filed under the AAOS Professional Compliance Program. After consideration of the information presented and the recommendations of the Committee on Professionalism (COP), the Board suspended James A. Ghadially, MD, for violations of the Standards of Professionalism (SOPs) on Orthopaedic Expert Witness Testimony.

James A. Ghadially, MD
Houston, Texas
1-Year Suspension

On Oct. 16, 2007, a grievance was submitted against Dr. Ghadially alleging violations of the Mandatory Standards 1, 2, 3, 4, 5, 6, 7, and 15 of the SOPs on Orthopaedic Expert Witness Testimony. The grievance arose from statements made by Dr. Ghadially in his prepared written report and videotaped deposition as the plaintiff’s medical expert in a lawsuit. The plaintiff alleged that the defendant-orthopaedic surgeon failed to properly treat his left ankle injury. The legal case focused on Dr. Ghadially’s contention that the use of a short leg cast was the likely cause of a reported fibular nonunion. In September 2007, the case against the defendant-orthopaedic surgeon was dismissed.

On June 19, 2008, the COP Hearing Panel conducted a grievance hearing at which Dr. Ghadially was present. After thorough evaluation of the facts of the case, the COP Hearing Panel found that Dr. Ghadially had violated Mandatory Standards 2, 3, 4, 5, 6, and 7 of the SOPs on Orthopaedic Expert Witness Testimony, but not Mandatory Standards 1 and 15. The COP Hearing Panel recommended that Dr. Ghadially be suspended from the AAOS for a period of 1 year.

In making its recommendation, the COP Hearing Panel considered all materials submitted, including Dr. Ghadially’s videotaped deposition and his comments at the hearing.

Dr. Ghadially’s opinion was exclusively based on the operative report of the second treating surgeon. The COP Hearing Panel opined that the approach adopted by this second orthopaedist was not a course with which a majority of prudent orthopaedic surgeons would agree. Further­more, the COP Hearing Panel determined that greater than 50 percent of orthopaedic surgeons would find the second treating surgeon’s statements and conclusions to be without credibility.

Dr. Ghadially admitted to not reviewing the second treating surgeon’s records carefully. He stated that he did not see anything “particularly inappropriate” about the second surgeon’s care. Although the second orthopaedist’s records were deemed crucial to the analysis of this case, Dr. Ghadially proceeded to provide testimony without proper consideration of that information.

Dr. Ghadially adopted a role of strong advocacy for the plaintiff. He made condemning statements regarding the defendant-orthopaedic surgeon not having used a Cam walker for treatment when, in fact, he had. He reported that the defendant-orthopaedic surgeon was documenting pain without “paying attention to it” when review of the records reflected otherwise. Dr. Ghadially also made several inaccurate time references during his deposition, drawing incorrect conclusions based on his own miscalculations.

Throughout the deposition and in his comments to the COP Hearing Panel, Dr. Ghadially discussed standard of care as it pertains to the treatment of bimalleolar fractures. He focused exclusively on the argument that the patient’s difficult outcome was the result of the defendant-orthopaedic surgeon’s failure to utilize a long leg cast. The COP noted that Dr. Ghadially ignored the mechanism of injury, the lack of displacement of the fracture in the short leg cast, the apparent healing of the fracture on plain radiographs, and the lack of any objective proof of a nonunion.

The COP noted that Dr. Ghadially failed to account for alternate appropriate treatment that would be considered within standard of care by medical and legal criteria. He also did not consider that fibular nonunions are exceedingly rare. Dr. Ghadially did not reference any scientific studies to support his position that the lack of a long leg cast in this particular fracture would, with medical probability, cause a nonunion. His description of fracture healing specific to the fibula was misleading and unscientific.

Later in the COP hearing, Dr. Ghadially acknowledged he did not agree with the second surgeon’s diagnosis and treatment. In his deposition testimony, however, he had relied heavily on the second treating surgeon’s initial operative report, despite overwhelming evidence in the available medical records that the descriptions in that operative report were incorrect. The COP Hearing Panel concluded that if Dr. Ghadially had reviewed these records objectively, he would have reached different conclusions.

Dr. Ghadially did not appeal the COP Hearing Panel’s recommendation to the Judiciary Committee.

On Dec. 6, 2008, the AAOS Board of Directors considered this matter. Dr. Ghadially was not present. After careful deliberation and discussion, the Board upheld the findings and recommendations of the COP Hearing Panel and voted to suspend James A. Ghadially, MD, for 1 year because of unprofessional conduct in the performance of expert witness testimony.

The AAOS Board of Directors found that Dr. Ghadially had violated Mandatory Standards Nos. 2, 3, 4, 5, 6, and 7 of the AAOS Standards of Professionalism on Orthopaedic Expert Witness Testimony. These Mandatory Standards are:

2. An orthopaedic expert witness shall provide opinions and/or factual testimony in a fair and impartial manner.

3. An orthopaedic expert witness shall evaluate the medical condition and care provided in light of generally accepted standards at the time, place, and in the context of care delivered.

4. An orthopaedic expert witness shall neither condemn performance that falls within generally accepted practice standards nor endorse or condone performance that falls outside these standards.

5. An orthopaedic expert witness shall state how and why his or her opinion varies from generally accepted standards.

6. An orthopaedic expert witness shall seek and review all pertinent medical records related to a particular patient prior to rendering an opinion on the medical or surgical management of the patient.

7. An orthopaedic expert witness shall have knowledge and experience about the standard of care and the available scientific evidence for the condition in question during the relevant time, place, and in the context of medical care provided and shall respond accurately to questions about the standard of care and the available scientific evidence.