At its meeting on Aug. 22, 2022, the Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) considered two grievances filed under the AAOS Professional Compliance Program. The following actions were taken:

Steven I. Grindel, MD Milwaukee, Wis. Censured
A grievance alleging violations of the Standards of Professionalism on Orthopaedic Expert Opinion and Testimony was filed against Steven I. Grindel, MD. The grievance was based on statements made by Dr. Grindel in deposition and trial testimony he provided while serving as an expert in a medical liability lawsuit.

The patient in the underlying case was a female aged 50 years who underwent a left carpal tunnel release. Over the next two months, the patient presented with decreased sensation in the left middle finger, especially at two-point discrimination, and pain in the middle finger and over the A1 pulley consistent with possible trigger finger. An injection was performed, then a trigger finger release was done three months after the carpal tunnel surgery. Postoperatively, the patient had continued symptoms of numbness to the middle finger and stiffness in the left hand and was referred for a second opinion. A second electromyography noted some improvement of the sensory latencies to the fingers except for the middle finger, where it was difficult to obtain a reading as the results were inconsistent. The patient underwent a revision carpal tunnel surgery where the subsequent surgeon noted a pseudoneuroma formation at the wrist flexion crease, which was excised. As of the patient’s last evaluation in 2010, she still had complaints of pain in her left hand.

After thorough consideration, it was determined that Dr. Grindel violated Standard No. 2 when he made statements that were unnecessarily inflammatory, such as, “The patient is a real person who had a real nerve that was cut,” and “When I look at the sum total of this poor person’s hand,” and “This is a real woman sitting here that can’t use her hand.” He also testified that carpal tunnel surgery should alleviate pain “nearly 100 percent of the time.” The Board of Directors, consistent with the reports and recommendations of the Committee on Professionalism and the Judiciary Committee, felt that Dr. Grindel’s statements were not fair and impartial and were an overstatement of reasonably expected results. Additionally, Dr. Grindel used a diagram during his testimony which showed the jury a location different than the actual neuroma, which the Board, consistent with the committee reports, also believed was misleading.

It was also determined that Dr. Grindel violated Standard No. 4 because his testimony condemned performance that falls within generally accepted practice standards. Dr. Grindel testified that the Grievant fell below the standard of care when he failed to notice that the nerve was cut, did not address it in a timely fashion, and thus delayed the patient’s treatment. However, the Board, consistent with the reports and recommendations of the Committee on Professionalism and the Judiciary Committee, believed that the Grievant’s referral to another hand surgeon was appropriate and done within a reasonable time frame.

Dr. Grindel was not found to be in violation of Standards Nos. 1, 3, 5, or 6.

Ryan M. Nunley, MD St. Louis, Mo. Censured
A grievance alleging violations of the Standards of Professionalism on Orthopaedic Expert Opinion and Testimony was filed against Ryan M. Nunley, MD. The grievance was based on statements made by Dr. Nunley in deposition and trial testimony he provided while serving as an expert in a medical liability lawsuit.

The patient in the underlying case was a female aged 13 years who presented with symptoms of left knee pain. Radiographs of the left knee and pelvis showed no abnormalities, but the treating surgeon noted moderate left hip impingement and patellofemoral pain with possible patella femoral subluxation. Physical therapy was recommended; however, the patient returned with persistent knee pain, and radiographs of the hip were interpreted as showing a retroverted acetabulum and thickened femoral neck. A hip injection was administered, and the hip and knee pain improved.

In follow-up, the patient believed that her knee pain was coming from the hip, and radiographs at that time were interpreted as showing a crossover sign with anterior over-coverage and Cam morphology of the femoral head and neck. Hip arthroscopy was recommended. No preoperative CT or MRI scans were ordered because the treating surgeon believed the diagnosis was clear as a result of the patient’s restricted motion and the fact that the patient’s knee pain was relieved with the hip injection.

The patient underwent left hip arthroscopy with acetabular rim trimming, labral refixation, and femoral neck osteoplasty. Two months postoperatively, the patient had good flexion and internal rotation, occasional popping sensation in the hip, and some lateral hip pain. The patient returned seven months later with significant groin pain and limitation of flexion and internal rotation. Radiographs at that time revealed a residual Cam deformity, and an MRI showed a small osseous excrescence of the femoral head. The patient underwent repeat hip arthroscopy with femoral neck osteoplasty. Extensive acetabular cartilage damage with narrowing of the hip joint space was noted. The patient subsequently had left hip arthroplasty.

After thorough consideration, it was determined that Dr. Nunley violated Standard No. 2 when he testified that the patient and her mother were not informed of the risks of the procedure. During his trial testimony, Dr. Nunley was asked whether the Grievant informed the patient and her mother of the risks of the hip procedure, to which he responded, “No, not to my knowledge.” The Board, consistent with the reports and recommendations of the Committee on Professionalism and the Judiciary Committee, found that this statement was inconsistent with the office notes that documented consent, and it was thus not fair and impartial.

Dr. Nunley was not found to be in violation of Standards Nos. 1, 3, 4, 5, or 7.

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