At its meeting on Oct. 3, 2015, the Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) considered a grievance filed under the AAOS Professional Compliance Program. In addition, they considered compliance matters not related to the AAOS Standards of Professionalism.

SOP Grievance
After considering the information presented and upon recommendation of the Judiciary Committee and the Committee on Professionalism, the Board took the following professional compliance action.

Cary I. Skolnick, MD
Manalapan, N.J.
Censure
On Dec. 10, 2013, a grievance was filed against Cary I. Skolnick, MD, alleging violation of Mandatory Standard No. 6 of the Standards of Professionalism for Orthopaedic Expert Opinion and Testimony. The grievance arose from expert witness testimony provided by Dr. Skolnick on behalf of the plaintiff in a medical liability lawsuit. Dr. Skolnick testified at trial that it was a deviation from the standard of care not to immediately operate on the patient for the drainage of a cervical abscess, and that the delay caused the patient's deteriorating condition and neurological damage. The trial resulted in a jury verdict in favor of the defendant.

The patient, a 57-year-old female, was admitted to the hospital with neck pain and difficulty swallowing. A cervical MRI, taken 2 days later, showed prevertebral and paravertebral fluid collection consistent with an abscess and some cord impingement from C4 to C6 with a probable epidural phlegmon. The Grievant scheduled the patient for surgery 3 days later. The surgery, however, was cancelled by the anesthesiologist due to significant hyponatremia.

Upon admission, the patient's sodium level was 137, which dropped to 120 on the scheduled day of surgery. Over the next several days, the patient was seen by different residents, who noted that her neurologic status went up and down with some mild weakness (measuring 4 out of 5 on a strength score) in her lower extremity muscles. A week after admission, the patient's sodium level returned to 136 and she underwent an anterior decompression and fusion with posterior surgical drainage on her cervical spine. Postoperatively, the patient had 5/5 upper body limb strength, but 4/5 on the lower.

The Grievant alleged in his grievance that Dr. Skolnick violated Mandatory Standard No. 6 because he did not review the initial MRI images taken after admission or the deposition of the radiologist, relying instead on the MRI report when he testified.

In July 2014, the Committee on Professionalism (COP) Hearing Panel conducted a hearing attended by Dr. Skolnick, his legal counsel, and the Grievant. There, Dr. Skolnick testified that he never knew about the radiologist's deposition, so he could not ask for something that he did not know existed. Dr. Skolnick also testified that he was aware of the MRI scans and that he had requested the films from his attorney, but the attorney could not obtain them. He further testified that it was more important to look at the patient's changing neurologic picture and the fact that the other treating physicians agreed with the radiologist's report.

After an in-depth evaluation of the facts presented, the materials submitted by each party, and the hearing testimony, the COP Hearing Panel found that because Dr. Skolnick was unaware of the radiologist's deposition, it was reasonable to conclude that he could not have requested it. The COP therefore did not find his failure to review the deposition a violation of the standard. However, the COP Hearing Panel was of the unanimous opinion that his failure to seek and review the MRI images prior to giving his expert testimony violated Mandatory Standard No. 6. Under these circumstances, the committee believed that an image review was extremely important in rendering an opinion concerning the care and treatment of the patient. The COP Hearing Panel recommended that, as a result of this violation, Dr. Skolnick be officially censured by the AAOS.

Dr. Skolnick appealed the recommendation, and the Judiciary Committee conducted an appeal hearing in March 2015. After careful consideration, the Judiciary Committee found that AAOS and the COP Hearing Panel afforded both parties due process. By a majority vote, the Judiciary Committee affirmed the COP Hearing Panel's finding that Dr. Skolnick violated Mandatory Standard No. 6 when he failed to review the MRI images.

In both the COP Grievance hearing and the Judiciary Committee Appeal hearing, Dr. Skolnick and his counsel emphasized that the images were requested but were not obtained by the plaintiff's attorney. The Judiciary Committee concluded that, in this instance, the inconclusive MRI report was an insufficient basis on which to determine that a deviation of the standard of care occurred and that the MRI film should have been reviewed prior to offering an expert opinion on the care and treatment of the patient.

At its meeting on Oct. 3, 2015, the AAOS Board of Directors considered this matter. After thorough evaluation and discussion, the Board upheld the findings and recommendation of the Judiciary Committee and voted to censure Cary I. Skolnick, MD, due to unprofessional conduct in the performance of expert witness testimony.

Additional actions
Abdul Razaq, MD
La Plata, Md.
Expelled
In April 2015, the Maryland State Board of Physicians revoked Dr. Razaq's license to practice medicine due to a federal felony conviction. On Dec. 2, 2013, Dr. Razaq pled guilty to conspiring to defraud the United States, in violation of 18 U.S.C. § 371, in the U.S. District Court for the Eastern District of Virginia. Dr. Razaq was placed on probation, including home detention and fines. Dr. Razaq did not appeal the decision.

The AAOS Board of Directors voted to expel Dr. Razaq.

Terry L. Seeman, MD
Watertown, S. D.
AAOS Fellowship Suspended
In January 2015, Dr. Seeman's license to practice medicine in Minnesota was suspended by the Minnesota Board of Medical Practice ("Minnesota Board") until such time that he satisfactorily demonstrates his ability to resume the competent practice of medicine with reasonable skill and safety to patients and complies with the Minnesota Board's Order for Mental and Physical Examination. The Minnesota action stemmed from notification by the South Dakota Board of Medical and Osteopathic Board of Examiners that Dr. Seeman failed to renew his South Dakota medical license, which was subsequently forfeited.

The AAOS Board of Directors voted to suspend Dr. Seeman's fellowship in AAOS until he holds a full and unrestricted license to practice medicine.

Eric Senat, MD
Old Westbury, N.Y.
Expelled
In March 2015, the New York Department of Health revoked Dr. Senat's license to practice medicine due to a felony conviction. Dr. Senat pleaded guilty to one felony count of healthcare fraud in a federal criminal case in the U.S. District Court, Southern District of New York. He was sentenced to imprisonment, supervised probation, and restitution payment.

The AAOS Board of Directors voted to expel Dr. Senat.

Raymond Severt, MD
Santa Rosa, Calif.
Expelled
In December 2013, the AAOS Board of Directors suspended Dr. Severt's membership in AAOS until he had a full and unrestricted license to practice medicine.

In August 2014, Dr. Severt was found guilty of five felony counts of attempting lewd acts with a minor. Dr. Severt was sentenced to prison and supervised probation. In August 2015, the Medical Board of California revoked Dr. Severt's license to practice medicine.

The AAOS Board of Directors voted to expel Dr. Severt.

Scott E. Strasburger, MD
Lincoln, Neb.
AAOS Fellowship Suspended
In December 2014, the State of Nebraska Department of Health and Human Services ("Nebraska Board") entered an Order on Agreed Settlement with Dr. Strasburger which included a 6-month suspension of his medical license, retroactive to Nov. 26, 2014. The order also provided that upon application for reinstatement of his license, Dr. Strasburger must provide proof that he successfully completed a chemical dependency treatment program, as well as compliance with aftercare recommendations for relapse counseling and support groups.

The AAOS Board of Directors voted to suspend Dr. Strasburger's fellowship in AAOS until he holds a full and unrestricted license to practice medicine.