It’s long been routine, if often controversial, for operating rooms to welcome medical device sales people and surgical trainees to watch the work of surgeons and nurses. But now the University of Missouri health system may have reset the bar with its $16.2 million settlement with almost two dozen patients over questionable knee surgeries.
The contested procedures, done on minors, were performed in part by a veterinarian.
That vet, James Cook, is listed on the university’s web site as the William & Kathryn Allen Distinguished Chair in Orthopaedic Surgery. The explanatory text online and a posted video has him describing how his chief role at the school focuses on research in people and animals in joint disorders. He says he is experimenting with techniques, notably in dogs, in which live materials can be used to replace problem joints.
But 22 patients sued Cook, orthopedic surgeon Dr. James Stannard, and the university system, saying it was inappropriate for the veterinarian to operate on humans. The plaintiffs also said that Cook and Stannard exaggerated the success of their “BioJoint” surgeries, “replacing parts of the knee with cadaver bones or cartilage to treat arthritis or joint damage … as a way to avoid a traditional artificial knee replacement,” according to court documents reported on by the Kaiser Health News (KHN) service.
As reporter Lauren Weber wrote:
“Plaintiffs alleged in court documents that Stannard did not advise them that ‘the surgery he was proposing has a failure rate as high as 86%.’ Court documents argued the surgeries were ‘experimental’ and ‘unproven’ and sometimes left patients requiring follow-up surgeries and even total knee replacements, including for young patients. The defendants denied those allegations in the court filings and the university settled the cases without admission of liability or negligence after the claims against Cook, Stannard, and another employee were dismissed. The Mizzou BioJoint website says the program does not have 10-year data on effectiveness because the surgeries are ‘based on improvements to the traditional techniques.’ Unlike prescription medicines or medical devices, surgical procedures aren’t directly regulated by federal or state agencies.”
Still, questions persist about Cook’s role in the procedures. He says in his posted university video that he returned to school after earning his veterinary degree and practicing and researching for training as an orthopedic technologist. But as Weber reported:
“Central to the dispute in the consolidated lawsuits is how Cook was presented, given that veterinarians and veterinary surgeons are not generally allowed to perform medicine on humans. The lawsuits allege Stannard was negligent for allowing Cook to perform parts of the Mizzou BioJoint surgeries on plaintiffs ‘without appropriate medical direction and supervision.’ Some patients allege in court documents they did not know when they underwent the procedures that Cook was not a ‘medical doctor or a licensed physician’ … The defendants deny Cook was listed as a surgeon in response to that case but said he was listed as part of the surgical team. An additional filing by defendants said Cook was ‘orthopedic technologist — surgery certified’ and that he joined the surgery team for the ‘majority of such surgeries performed by Dr. Stannard.’ In one filing, the defending attorneys said Stannard and Cook had no obligation to tell patients that Cook was neither a medical doctor nor a licensed physician at any time prior to the operations because ‘surgery commonly includes persons in the operative suite who are not licensed physicians.’”
KHN reported that Cook has attracted media attention for his work on animals, including recent surgeries on the joints of tiger in Chicago. He is well-compensated, with the state paying him more than $300,000 in 2020.
Stannard, his orthopedic surgeon partner, KHN said, is “one of the highest-paid University of Missouri employees other than top athletic coaches … [He] received a state salary of $981,977.52 for 2020. Among his titles are chief medical officer for procedural services, medical director of the Missouri Orthopaedic Institute and chairman of the medical school’s orthopedic surgery department. He’s also a team doctor for Mizzou athletes.”
The KHN article says that Jeff Howell, executive vice president of the Missouri State Medical Association, told Weber that, “You have to be licensed as a physician to perform surgery on a human being.”
The story does not say whether medical, veterinary, or hospital licensing authorities will look at this unusual case.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the big obstacles they encounter in ensuring they experience their fundamental right to informed consent. This means they are told clearly and fully all the important facts they need to make an intelligent decision about what treatments to have, where to get them, and from whom. When minors are involved, the standard for informing them and their parents or legal guardians should be equally high or higher, including in explaining complex medical decisions in clear, comprehensible ways to the younger patients.
It is true that surgeons may push new ways to perform procedures, both to benefit patients and their outcomes but also to make a name for themselves and improve their earning potential. It also is true that — animal rights activists’ concerns aside — many medical breakthroughs involve learnings carried over to people from work on creatures great and small.
But patients are owed a full, detailed explanation of routine and experimental work on them, more so of the latter. It is unacceptable that anyone who is not fully licensed and credentialed can practice medicine on human patients, especially if they are under anesthetic and unconscious.
The folks in the Mizzou health system have a lot to show and explain to patients about their aggressive promotion of experimental surgery, as the school has done in direct advertising in places like typically bustling O’Hare Airport, KHN reported.
This may be yet another instance of institutional “What are they thinking?” Missouri officials may want to consult with colleagues in Ohio. Medical licensing authorities found they had to reexamine hundreds of complaints against doctors to ensure they were not wrongly dismissed. This occurred after a sexual abuse scandal erupted at Ohio State University, involving dozens of young men in the school’s athletic program. Ohio authorities have reopened 91 cases involving reported sexual abuse complaints against doctors and are scrutinizing 42 more instances where doctors may have withheld important information.
Not good. We have a lot of work to do to ensure that doctors are accountable for their practices.
