At its meeting on Sept. 6, 2014, the Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) considered a grievance filed under the AAOS Professional Compliance Program. After considering the information presented and upon recommendation of the Committee on Professionalism (COP), the Board took the following professional compliance action.

Mark Sobel, MD
Atlantic Highlands, N.J.
Censure

On July 23, 2013, a grievance was filed against Mark Sobel, MD, alleging violations of the Standards of Professionalism for Orthopaedic Expert Opinion and Testimony, Mandatory Standards Nos. 1, 2, 3, and 6. The grievance arose from statements made by Dr. Sobel in his trial testimony as an expert witness for the plaintiff in a medical liability lawsuit, in which he alleged that the Grievant deviated from the standard of care in performing a revision total knee arthroplasty. The case proceeded to trial and the jury rendered a verdict in favor of the defendants.

The patient in the underlying case was a 65-year-old male who had pain in his left knee 11 years following a primary total knee arthroplasty (TKA). The patient underwent revision surgery by the Grievant who noted in the operative report that there was very good soft-tissue balance with the components in place. The records indicate that two separate incidents occurred during a postoperative rehabilitation stay and a physical therapy session; in both instances, the patient complained of sudden severe knee pain. During an office visit 6 weeks postop, the patient’s knee was noted to have gapping with varus stress. Lateral reconstruction was offered, but the patient declined. A subsequent treating orthopaedic surgeon performed a second revision.

In his trial testimony, Dr. Sobel stated that the Grievant’s failure to balance the knee at the time of the surgery resulted in the patient’s varus instability. He further testified that the Grievant’s failure to perform a medial release was a departure from the standard of care. Dr. Sobel testified that a medial release involves “cutting or severing of the ligaments along the medial side of the knee joint,” and if the ligaments were not cut or removed, then a medial release was not performed and the knee was not balanced. When pressed regarding the actual need to cut the ligament, Dr. Sobel did not waver.

Dr. Sobel also acknowledged that his practice is limited to foot and ankle surgery. The last time he performed a knee arthroplasty was more than 20 years ago during his residency, and he noted that much has changed in the field since that time.

On March 14, 2014, the Committee on Professionalism (COP) Hearing Panel conducted a hearing with both parties present. After an in-depth evaluation of the facts presented, all materials submitted, and the oral testimony at the hearing, the COP found that Dr. Sobel violated Mandatory Standards Nos. 2 and 3, but not Mandatory Standards Nos. 1 and 6.

The COP Hearing Panel was of the opinion that Dr. Sobel’s trial testimony was not fair and impartial. Dr. Sobel opined that the Grievant’s failure to balance the knee at the time of surgery resulted in varus instability and that his failure to perform a medial release was a departure from the standard of care. These statements convey the perceived absence of soft-tissue release. Dr. Sobel did not acknowledge the operative note, which indicated the stemmed tibia and femur revealed “a very good soft tissue balance.” Furthermore, Dr. Sobel failed to consider the immediate postoperative radiograph that showed no abnormality and supported soft-tissue balance.

The Hearing Panel was also of the opinion that Dr. Sobel did not have the knowledge or experience regarding the standard of care and that he did not evaluate the medical condition and care in light of generally accepted standards. Dr. Sobel admitted that he last performed a knee replacement more than 20 years ago and that much of his testimony was based on what he learned in his residency and participation in the Maintenance of Certification process. The Hearing Panel recommended that Dr. Sobel be censured by the AAOS.

Dr. Sobel did not appeal the COP Report and Recommendation and, on Sept. 6, 2014, the AAOS Board of Directors considered this matter. After due deliberation, the Board upheld the findings and recommendation of the COP Grievance Hearing Panel and voted to censure Mark Sobel, MD, due to unprofessional conduct in the performance of expert witness testimony.

For more information on the AAOS Professional Compliance Program, visit www.aaos.org/profcomp