At its meeting on January 24, the Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) considered a grievance filed under the AAOS Professional Compliance Program. The following action was taken:

Edward Green III, MD
Long Beach, Calif.
Censured
A grievance alleging violations of the Standards of Professionalism on Orthopaedic Expert Opinion and Testimony was filed against Edward Green III, MD. The grievance was based on statements made by Dr. Green in a declaration and deposition testimony. The patient in the underlying case was a female aged 29 years who sustained a left ankle fracture from a fall in May 2016.

The patient initially was seen in an urgent care center and then referred to the Grievant’s practice. The patient was seen eight days later by the Grievant’s physician assistant, whose clinical examination revealed a moderate amount of swelling and ecchymosis but no tenderness along the medial malleolus. Radiographs demonstrated a left distal fibular fracture with mild displacement with an intact ankle joint. The patient was placed into a cast and recommended to be non–weight-bearing. When the patient returned for follow-up a week later, the cast was removed for clinical examination. Radiographs showed a minimally displaced distal fibula fracture in an “overall satisfactory position.” The short leg cast was replaced, and the patient returned two weeks later for recasting when it became wet.

In June, the cast was again removed for radiographs, which showed early callous formation. The patient was placed into a walking moon boot, given a home exercise program, and encouraged to follow up in three weeks for additional radiographs. The following month, the patient returned with no complaints of pain, and radiographs demonstrated that the distal fibular fracture was in “overall satisfactory position with callous formation.” The patient was scheduled to return to work the following week and was instructed to follow up on an as-needed basis.

In September, the patient presented to the ED with pain in the left ankle and radiographs that demonstrated a “displaced, incompletely healed Weber B fracture.” The patient opted for surgical repair with open reduction and internal fixation for an ankle malunion.

After thorough consideration and deliberation, the Committee on Professionalism (COP) Grievance Hearing Panel and the Judiciary Committee found that Dr. Green’s expert testimony was in violation of Mandatory Standards Nos. 2 and 4. In his declaration and deposition testimony, Dr. Green testified that the fracture required surgical intervention and that the closed treatment likely resulted in the malunion. By his own admission, Dr. Green acknowledged that his testimony was not fair and impartial, and in his response to the grievance he noted that his testimony was “too aggressive and was made with an incorrect retrospective influence.” The COP Grievance Hearing Panel was in agreement with Dr. Green’s assessment and found his testimony was not fair and was impartial and in violation of Standard No. 2. With reference to Standard No. 4, the COP Grievance Hearing Panel was of the view that conservative treatment would have been reasonable in this patient’s case. However, the COP offered several instances where Dr. Green testified in absolute terms that surgical intervention was the only option. Although Dr. Green expressed remorse and apologized in his response and during the hearing, the COP Grievance Hearing Panel must analyze the testimony in alignment with the standards. The Panel felt that Dr. Green’s testimony condemned performance that fell within generally accepted practice standards.

The Judiciary Committee affirmed the COP Hearing Panel’s findings that Dr. Green violated Mandatory Standard Nos. 2 and 4. During the Judiciary Hearing, Dr. Green argued that he did not violate Standard No. 2 because his opinion was not biased or done with any malice or prejudice. The Judiciary Committee was of the view that, although Dr. Green’s bias may not have been of a personal nature, he was influenced by the retrospective knowledge that the fracture did not heal with nonsurgical management. Based on the information available at the time, the Judiciary Committee believed that a nonsurgical approach would not have been below the standard of care. For these reasons, the Judiciary Committee found that the COP’s determination that Dr. Green violated Standard No. 2 was supported by the weight of the evidence. Dr. Green admitted to the Judiciary Committee that he violated Standard No. 4 because he made an error in giving an incorrect opinion that nonsurgical treatment of the patient’s ankle fracture was contrary to the standard of care. Accordingly, the Judiciary Committee found that the COP’s determination that Dr. Green violated Standard No. 4 was also supported by the weight of the evidence.

The COP Grievance Hearing Panel and the Judiciary Committee did not find Dr. Green to be in violation of Standards Nos. 1, 3, 5, or 7.

The AAOS Board of Directors upheld the findings of the Judiciary Committee and voted to censure Dr. Green.

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