At its meeting on Dec. 5, 2009, the Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) considered both automatic compliance matters and grievances brought forth under the AAOS Professional Compliance Program.

Professional compliance action
After considering the information presented and upon the recommendations of the Hearing Panel of the Committee on Professionalism (COP), the Board took the following professional compliance action.

Jefferson J. Cartwright, MD
Arlington, Wash.
1-Year Suspension
On August 11, 2008, a grievance was filed against Dr. Cartwright alleging violations of Mandatory Standards Nos. 1, 2, 4, 6, 9 and 13 of the Standards of Professionalism (SOPs) on Orthopaedic Expert Witness Testimony.

The grievance arose from statements made by Dr. Cartwright during his deposition testimony in connection with a medical liability lawsuit. The plaintiff-patient alleged that the defendant-orthopaedist failed to assess the patient’s postoperative condition, leading to complications following surgery on his leg. The patient further claimed that the defendant-orthopaedist failed to make arrangements for another physician to provide for his postoperative care during the orthopaedist’s weekend absence. The lawsuit was dismissed in its entirety.

The patient in the underlying case had sustained a closed comminuted pilon fracture of the right ankle as a result of a 25’ to 30’ fall. Medical history was significant for a previous open right tibia/fibula shaft fracture complicated by Staphylococcus aureus osteomyelitis 15 years earlier, which had required skin grafting just proximal to the medial malleolus.

The patient was seen in an emergency department and, at that time, no suggestion of neurovascular compromise was evident. A long-leg posterior splint was applied and, at 11 p.m., an orthopaedic consult was requested. The defendant-orthopaedist gave holding orders via telephone and, at approximately 6:30 a.m. the next morning, the defendant-orthopaedist evaluated the patient. A computed tomography scan was ordered with plans for surgical management the following day.

At 11 a.m. on the following day, the nursing staff noted edema and diminished sensation in the toes and on the plantar aspect of the foot. At 7 p.m. on that same day, the patient underwent a closed reduction and external fixation of the intra-articular tibia fracture. Numbness and tingling were again noted on the first postoperative day and, at 7:30 p.m., the covering orthopaedic surgeon recorded increased pain, diminished plantar sensation, and elements of sensory change in the superficial and deep peroneal nerve distributions. Four compartment fasciotomies were performed along with dorsal foot “pie crusting.”

The patient was initially followed by the defendant-orthopaedist as well as by the covering trauma specialist and, by mutual agreement, the trauma specialist assumed care of the patient.

A partial delayed wound closure and split thickness skin grafting was performed and the patient was discharged 2 weeks following the injury with amitriptyline and Neurontin (gabapentin) for plantar neurogenic pain. Ultimately, the patient continued to experience sensory dysfunction in the foot.

In his deposition, Dr. Cartwright stated that he was not aware that the defendant-orthopaedist was off call the 2 weekend days immediately following the patient’s Friday surgery and that he was unaware of call arrangements where it is the responsibility of the on-call physicians to round on patients they are covering.

Dr. Cartwright stated that the surgery should have been performed “immediately” and attributed the neurogenic symptoms to the 48-hour delay in surgery; however, he admitted that he had not reviewed the initial injury films. Furthermore, his testimony that the patient had consequently developed foot drop was based upon documentation that an order for a “foot drop splint or something to that effect” had been made.

On July 10, 2009, the Committee on Professionalism (COP) Hearing Panel conducted a grievance hearing. The Grievant appeared with legal counsel. Dr. Cartwright did not attend, but submitted a transcript of his evaluation of the plaintiff-patient completed at the request of the patient’s attorney. In that transcript, it was noted that Dr. Cartwright asked the plaintiff-patient primarily leading, rather than objective open-ended, questions.

After careful evaluation of all material submitted as well as oral testimony provided during the proceedings, the COP Hearing Panel unanimously found Dr. Cartwright in violation of Mandatory Standards Nos. 2, 4 and 6 of the SOPs on Orthopaedic Expert Witness Testimony. The COP also determined that Dr. Cartwright was not in violation of Standards 1, 9 and 13.

In making its recommendation, the COP Hearing Panel determined that Dr. Cartwright did not provide his opinions in a fair and impartial manner when he asserted that the fracture care should have occurred within a 24–48 hour time frame. He stated that the literature supported his contention regarding the timing of surgical management but, despite several requests to provide that data, failed to supply any references.

Dr. Cartwright also made several statements in deposition regarding his lack of awareness of widely recognized call coverage arrangements that were inconsistent and difficult for the COP Hearing Panel to reconcile. The COP Hearing Panel also agreed that Dr. Cartwright appeared to adopt an inappropriate role of advocacy in his position as an expert witness.

Although the defendant-orthopaedist had ordered a “foot drop splint” as a convenient way to immobilize the extremity, Dr. Cartwright misinterpreted the reason and reached inaccurate conclusions based on this misunderstanding. He used these faulty conclusions to inappropriately condemn the defendant-orthopaedist’s performance as below the standard of care.

Finally, Dr. Cartwright failed to evaluate the original postinjury radiographs prior to rendering an opinion at the deposition, making statements based on his perception of what the radiographs would have shown.

The COP Hearing Panel recommended that Dr. Cartwright be suspended from the AAOS for a period of 1 year. Dr. Cartwright did not appeal this recommendation and, on December 5, 2009, the AAOS Board of Directors considered this matter. After careful deliberation and discussion, the Board upheld the findings and recommendations of the COP Hearing Panel and voted to suspend Jefferson J. Cartwright, MD, for 1 year because of unprofessional conduct in the performance of expert witness testimony.

Automatic compliance actions
With regard to the automatic compliance matters, the AAOS Board of Directors took the actions indicated. Actions were taken under Article VIII, Sections 8.2.d and 8.3.b of the AAOS Bylaws.

Bernard Z. Albina, MD
Houston, Texas
AAOS Fellowship Suspended
On July 31, 2009, Dr. Albina entered into an agreed order with the Texas Medical Board and accepted an immediate suspension of his medical license that prohibits his practice of medicine. Dr. Albina was arrested and charged with five counts of sexual abuse of a child, sexual assault of a child, and promotion of child pornography.

The AAOS Board of Directors voted to suspend Bernard Z. Albina, MD, until the complete and final resolution of all criminal charges and until he holds a valid and unrestricted license to practice medicine. It was also recommended that his status be reviewed if he is convicted of a felony.

Norman E. McElheney, MD
Stone Mountain, Ga.
AAOS Fellowship Suspended
On March 15, 2007, Dr. McElheney voluntarily surrendered his license to practice as a physician in Georgia and waived his right to a hearing on the matter. Dr. McElheney’s medical license in Tennessee expired as of Sept. 30, 2008, and he presently does not hold a valid and unrestricted license to practice medicine.

The AAOS Board of Directors voted to suspend Norman E. McElheney, MD, until he holds a valid and unrestricted license to practice medicine.

Michael W. Reed, MD
Panama City, Fla.
AAOS Fellowship Suspended
On July 29, 2009, the Florida Department of Health placed Dr. Reed’s medical license on emergency suspension as a result of federal drug charges. Dr. Reed was arrested for possession of cocaine and, on June 23, 2009, he was named in seven of 32 counts in the drug trafficking case. He is alleged to have possessed with intent to distribute cocaine as well as to have conspired and facilitated the commission of felonies.

The AAOS Board of Directors voted to suspend Michael W. Reed, MD, until the complete and final resolution of all criminal charges and until he holds a valid and unrestricted license to practice medicine. It was also recommended that his status be reviewed if he is convicted of a felony.

Hank Ross, MD
Port Washington, N.Y.
Expelled as Active Fellow
On April 26, 2006, the New York State Board for Professional Medical Conduct (BPMC) Hearing Committee found that Dr. Ross engaged in deliberate, fraudulent conduct by submitting false applications to medical facilities, the government, and a private insurer. The committee voted to suspend Dr. Ross’s license to practice medicine in New York and to place him on probation for 2 years following the suspension.

On Aug. 8, 2006, the Administrative Review Board (ARB) of the New York State Department of Health BPMC affirmed these findings; the ARB further determined Dr. Ross’s conduct to be morally unfit and in violation of public health law, and voted unanimously to revoke his license to practice medicine in New York. This penalty was appealed and denied.

The AAOS Board of Directors voted to expel Hank Ross, MD, from the AAOS.

For more information on the AAOS professional compliance program and the AAOS Standards of Professionalism, visit the AAOS professional compliance program online.