New York Times

March 27, 2001

Doctors Punished by New York State Are Still Prized by
Hospitals

By JENNIFER STEINHAUER and FORD FESSENDEN

ne doctor performed an unneeded hysterectomy on an
ailing patient without giving her a routine checkup;
she had a problem with her lungs. New York State
proclaimed another doctor an imminent danger after he
botched baby deliveries. A third doctor cleared
patients for surgery without examining them.

These doctors have three things in common: all
practiced medicine at a New York City hospital; all
were disciplined by the state for negligence; and then
all easily found work again. Two of them are still
treating patients today.

While their practices differ significantly, their
cases together illustrate how easy it is for doctors
who have been disciplined to find work at other
hospitals or to be retained by the hospital where the
problems occurred.

Legally, of course, doctors who have been disciplined
but have not lost their medical licenses are allowed
to look for new employment once their punishment is
behind them. Hospital administrators, often doctors
themselves, argue that almost every doctor who errs
deserves a second chance, or even a third. And scores
of doctors get them, sometimes moving from hospital to
hospital between punishments for negligent or
incompetent care.

For its part, the State Health Department has been
criticized for failing to revoke more medical
licenses. Officials there say that a complicated
disciplinary system makes it hard to do so, and they
contend that hospitals share the responsibility to
weed out bad doctors.

"Should it be easy for disciplined doctors to find
work?" said Dr. Antonia C. Novello, the state health
commissioner. "My gut reaction is absolutely not.
People are not unemployable just because they have
made a mistake, but when you break the trust of public
good, I don't think you should be able to practice."

Yet interviews with health care policy experts and
hospital administrators and a review of state data
indicate that many New York hospitals routinely hire
and retain doctors with bad records — especially those
who bring in a lot of money. An examination by The New
York Times of the disciplinary records of doctors,
matched with hospital admitting records, found that
more than three-fourths of doctors disciplined over
the last eight years resumed working almost
immediately after the state punished them.

The data identified 285 doctors who were disciplined
yet kept their medical licenses from 1992 until 1999.
The review looked only at doctors who had been
disciplined for reasons relating to patient care, as
opposed to the dozens of doctors who are punished for
things like Medicaid fraud or drug use. Of the 285
doctors disciplined for clinical reasons, 51 could not
be located. Of the remaining 234, 199 were still
working with patients.

Medical errors have generated an unprecedented level
of attention since the Institute of Medicine of the
National Academy of Sciences concluded in a 1999
report that such mistakes killed 44,000 to 98,000
hospitalized Americans a year. In recent weeks, New
York City hospitals have come under criticism for
being the worst in the state at reporting medical
mistakes — including those that resulted in deaths —
to the Health Department.

Dr. Novello has made disciplining doctors one of the
hallmarks of her administration. Last year, she took
action against 411 doctors, a 21 percent increase over
1996.

Yet neither the state nor the federal government lays
out how hospitals should handle problematic doctors,
nor does the national organization that accredits
hospitals. Industry executives acknowledge that
hospitals themselves largely do not have specific
rules on hiring and monitoring doctors who have been
punished by the state; those that do frequently ignore
them. Further, when hospitals do dismiss a doctor for
poor care, interviews with administrators show, they
often do not communicate with other hospitals to
prevent the doctor from practicing elsewhere.

"Coordination is painfully lacking in most of health
care right now," said Martin J. Hatlie, president of
the Partnership for Patient Safety, an educational and
consulting organization. "The accreditation bodies,
legislatures and regulators are not working in sync."

Many health care policy experts say that hospitals are
hardly pressed to make do with troubled doctors in New
York City, where the ratio of doctors to the
population is 50 percent higher than the national
average. State data shows, however, that doctors with
disciplinary problems are often among the top third of
moneymakers at their hospitals.

"There is not a labor shortage of doctors," said Renee
Pekmezaris, a hospital consultant and former director
of the Nassau-Suffolk Health Systems Agency. "But
there is a shortage of doctors who provide a stream of
patients."

The LapsesA Hysterectomy
For a Lung Condition

In 1995, Dr. Ashok M. Dhabuwala, a gynecologist at New
York Methodist Hospital in Park Slope, Brooklyn, was
punished by the state for performing unnecessary
hysterectomies on three patients. In one case, the
doctor admitted at his disciplinary hearing, nothing
in the patient's chart justified the surgery. Dr.
Dhabuwala's license was suspended for two years, but
the state reduced that sentence to probation.
Methodist then immediately reinstated his privilege to
practice there.

Hospital executives acknowledge that in reinstating
Dr. Dhabuwala, they ignored their own policy, dating
from the 1980's, which states that doctors whose
licenses are suspended or who are put on probation by
the state are to be automatically discharged from the
hospital.

And Dr. Dhabuwala was no exception; the executives
said that over the last several years, Methodist has
not removed any punished doctors.

The hospital's board "did not realize their own bylaws
say that they should be suspended," said Lyn Hill, a
Methodist spokeswoman, who discovered the policy only
after several months of inquiries from a reporter.
"They assumed that our bylaws were the same as
everyone else's," she said, referring to other
hospitals.

While there is no state or local data on whether city
hospitals have policies regarding sanctioned doctors,
Susan C. Waltman, general counsel for the Greater New
York Hospital Association, said most hospitals had
none.

According to data from the State Health Department,
Methodist has more doctors who have been disciplined
or investigated for negligence than any other major
hospital in the city.

In the obstetrics and gynecology department, Dr.
Dhabuwala and a colleague were disciplined for
botching cases, and another doctor was hired briefly
even though he was in the middle of a high-profile
investigation into a patient's death. Two surgeons are
now under investigation by the Health Department; one
is the president of the hospital's medical board.

Among the state's 253 hospitals, only two others,
Oswego Hospital and St. Luke's Hospital of Newburgh,
both upstate, employed three doctors at the end of
1999 who had been disciplined, according to state
records.

In the case of Dr. Dhabuwala, state documents show
that he performed hysterectomies on two patients
without conducting a physical examination.

In a third case, a 38-year-old woman went to the
doctor complaining of pain in her side and lumps in
her abdomen. Without consulting the radiologist who
took a chest X-ray of the patient, the state files
said, Dr. Dhabuwala performed a hysterectomy. The
X-rays revealed a problem with the patient's lungs.

Dr. Dhabuwala said in an interview that the charges
against him were false, although a review board
sustained the original findings of the state's Office
of Professional Medical Conduct.

"What was done to me was a total injustice," Dr.
Dhabuwala said. "There was not a single complication
in any of those cases."

Dr. Dhabuwala also denied that he had ever given
inappropriate care to his patients, including in the
cases of the hysterectomies.

A colleague in the obstetrics and gynecology
department at New York Methodist, Dr. John Luke, has
faced similar troubles since gaining admitting
privileges in 1983. According to state records, Dr.
Luke performed a hysterectomy and terminated a
patient's pregnancy — a pregnancy she was unaware of —
without conducting proper tests to determine why she
was bleeding.

In another case, Dr. Luke left a piece of surgical
equipment in a patient, causing an infection he failed
to treat promptly. The state's file on Dr. Luke lists
other problems with pregnant and gynecological
patients.

In 1993, Dr. Luke's license was suspended for three
months and he was put on probation and required to
attend medical education classes. The state also cited
him for a 1987 conviction for insurance fraud.

Dr. Luke said in an interview that although he
disagreed with the charges against him, he was forced
to sign a consent order that resulted in his
suspension and probation because he could not afford
to defend himself, and that a lawyer had given him
poor advice.

But while the state was harsh, the hospital was not,
Dr. Luke said. "They were very supportive because I
had a very good reputation. They told me when my
suspension was finished I could come back."

Ms. Waltman of the hospital association said most
hospital administrators believed that if the state did
not pull a doctor's medical license, it was giving a
"vote of confidence" that the doctor was fit to
continue practicing.

Not all hospitals agree. At Montefiore Medical Center
in the Bronx, for instance, the president, Dr. Spencer
Foreman, automatically suspends the privileges of
doctors who are suspended or put on probation by the
state.

While each doctor is given a hearing, not a single one
in 15 years has convinced the hospital that he or she
should be retained, Dr. Foreman said.

The ReticenceOut at One Hospital,
In at Another

Dr. Niels H. Lauersen had delivered thousands of
babies in nearly 25 years of practice in New York, and
was working at his fourth city hospital in August when
Dr. Novello, the health commissioner, suspended his
medical license. The state was considering negligence
charges against him — the second set of allegations
against him in three years.

Dr. Lauersen started his career in obstetrics and
gynecology at New York Hospital in 1979, then went to
Mount Sinai and Lenox Hill Hospitals. (No one at New
York Hospital, now part of the New York Presbyterian
system, would comment on his departure.) He was forced
to resign from Mount Sinai in 1984; the hospital would
not provide further details. Executives and former
employees there contend that there were problems with
the way he managed his patients' pregnancies.

Dr. Lauersen said he left New York Hospital to go to
Mount Sinai, and left Mount Sinai because he also had
admitting privileges at Lenox Hill, and did not
believe that he needed to work at both. In 1998, Dr.
Lauersen was forced to resign from Lenox Hill amid
more allegations that his care was inadequate. A
malpractice case was also filed against him involving
a baby who suffered brain damage after Dr. Lauersen
twice tried unsuccessfully to deliver the boy using
forceps. Dr. Lauersen characterized his departure as
"a disagreement" with Lenox Hill and would not comment
further.

More than a dozen of his former colleagues, who spoke
on the condition of anonymity, said in interviews that
Dr. Lauersen's troubles were widely known at Lenox
Hill, and residents were discouraged from working with
him even as the hospital kept him on. Administrators
at Lenox Hill would not comment on his practice there.
In general, health care policy experts say, key
hospital administrators are usually doctors themselves
and are reluctant to punish one of their own.

"The physicians around that doctor may take his side,"
said Dr. Mark R. Chassin, a former state health
commissioner who is now the chairman of the department
of health policy at Mount Sinai Hospital. "They feel
the whole process is unjust."

While the state pondered his case, Dr. Lauersen, on
probation, quickly found work with St. Vincent
Catholic Medical Centers, at the Manhattan campus on
West 11th Street. He had been there several months
before the state decided to suspend his license
pending a hearing and proclaimed him an "imminent
danger" to his patients' health.

Perhaps more significantly for St. Vincent, the state
said, Dr. Lauersen provided false information about
his employment history and the investigations against
him; Dr. Lauersen was also the subject of a federal
insurance fraud prosecution.

Dr. Mark G. Ackermann, a St. Vincent spokesman, said
the hospital looked into Dr. Lauersen's background.
"We had heard hearsay that his departure was under
less- than-ideal conditions," he said. "But there were
no people who would comment on that when we checked on
the references. We did all of our due diligence, we
reached out to a number of individuals at Lenox Hill,
including the department chairman, and no one would
give us any information about the reasons for his
departure. If we are not given entirely accurate
information, well, we have done our best."

Jean Brett, a Lenox Hill spokeswoman, said: "Lenox
Hill Hospital did respond to all written inquiries
about Dr. Lauersen submitted by St. Vincent. It did
disclose in writing that Dr. Lauersen was suspended."

Dr. Novello said the state depended on hospitals to
communicate with one another, but noted that they
often fell down on the job. "We assume that the
process works and cases like Lauersen show there are
may loops out there in which patients are totally left
hanging and at risk. You have to ask yourself here,
why was public good not served?"

Dr. Novello added that publicizing the names of
doctors and hospitals she punishes — a controversial
tactic that has become the hallmark of her tenure — is
meant to keep the doctors unemployed.

Most patients rarely find out about a doctor's past
problems. Hospitals, as a unspoken rule, will not
discuss a doctor's record, citing the right to
privacy.

Jennifer Froman is the mother involved in the Lenox
Hill delivery case, and her son Jake is severely brain
damaged. She blames both hospitals for disregarding
Dr. Lauersen's checkered past.

"Lenox Hill knew what they were dealing with and they
did nothing about it," Ms. Froman said. As for St.
Vincent: "It is disturbing to me to think that a
hospital would take on this man knowing his problems,
and I certainly think that they knew them. It makes
you feel like there is no protection."

In October 2000, the state revoked Dr. Lauersen's
medical license for good, upholding several charges of
gross negligence and of fraudulent practices relating
to false information the doctor gave to insurance
companies and hospitals about his disciplinary
history. Three months later, he was convicted in
federal court in Manhattan of health care fraud. He is
scheduled to be sentenced on May 10.

The BillingsDespite Troubles,
Making Money

At Methodist in Park Slope, Dr. Dhabuwala's practice
generated $1.62 million in charges in 1999, placing
him in the top 10 percent of all doctors who admitted
patients at the hospital that year. A sizable portion
of those came from Park Slope Midwifery, where he is
the consulting doctor. Dr. Dhabuwala admits each of
the group's laboring mothers for 25 percent of the
practice's fee, he said.

In 1999, amid his legal troubles and the State Health
Department investigation, Dr. Lauersen made $944,796
in charges for St. Vincent, putting him among the top
third of doctors who generated patient charges for the
hospital. Charges are the amount hospitals bill to
patients or insurance companies; the hospitals do not
always collect fully on such bills.

Though both are gynecologists, the two men could not
have had more different practices: Dr. Dhabuwala
treats many poor and working-class women from
Brooklyn; Dr. Lauersen offered fertility treatments
along Park Avenue and counted a few celebrities among
his patients. What they did share was the ability to
bring in patients — and revenue — for their hospitals.

This is often the case among doctors who are punished
and work again. In 1999, the last full year for which
records are available, 32 hospitals had doctors with
bad records among their top third of revenue
generators, state data shows.

Dr. Habib M. Monas, for example, was disciplined by
the state in 1998 on charges of negligence and
fraudulent practice. An internist, Dr. Monas is one of
the top earners among doctors at both Long Island
Jewish Medical Center and Westchester Square Medical
Center in the Bronx. He also admitted patients to Our
Lady of Mercy Medical Center in the Bronx and New York
Presbyterian Hospital, but was suspended by both those
hospitals, where his billings were relatively low,
after the state took action.

The state record in Dr. Monas's case is sketchy, and
he did not respond to telephone calls or a registered
letter requesting an interview. According to state
records, Dr. Monas admitted that he cleared two
patients for surgery without examining them at Our
Lady of Mercy in 1997. The state ordered his license
to be suspended for five years; all but two months was
stayed with probation.

Dr. Monas now admits most of his patients through
Westchester Square, according to state records. Even
though he was on suspension for two months in 1999, he
still generated $4.3 million in charges for the
hospital — 5 percent of the center's total billings
that year.

His practice at the hospital actually grew in 1999,
despite the suspension. "He was a physician in good
standing here," said a spokeswoman, Lisa Nenner.

At Long Island Jewish Medical Center, Dr. Monas
brought in $662,733 in charges in 1999. He was
reinstated there as soon as his license was restored.

Asked whether the hospital had any rules that governed
disciplined doctors, Julie Barovick, the deputy
general counsel for Long Island Jewish, responded, "I
am not going to tell you our policies." Then she
added, "I don't really know them."

Copyright 2001 The New York Times Company


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