Orthopedic Surgeon Sued Over Fraudulent Cases

A New York orthopedic surgeon at the center of at least 250 lawsuits accusing him of fraudulent, unnecessary or excessive procedures as well as medical negligence is still licensed to operate in the state, according to a recent news report.

Spyros Panos, MD, who practiced in suburban Dutchess County, N.Y., north of New York City, is said to have scheduled as many as 22 surgeries in a day, according to his former patients' attorneys. He has reportedly failed to adequately cement joint replacement components, implanted incorrect components and carried out an unneeded rotator cuff repair while ignoring a fractured clavicle.

In one publicized incident, Constance Nenni, a 76-year old woman, underwent surgery in March 2010 in a Poughkeepsie hospital to repair an arthritic knee. She died less than 24 hours after the procedure. The medical examiner determined that her death was a result of a pulmonary embolism that may have been caused by a blood pressure drop during the case. But the examiner's report also noted that, even though Dr. Panos' op notes detailed the removal of torn cartilage and soft tissue and the smoothing of rough joint surfaces, these treatments never actually took place.

"He put her under anesthesia, placed the scope in her knee and then closed her up without performing any surgery," says an attorney for Ms. Nenni's family. "The reports showed no hardware in place and, certainly, no evidence of a total knee reconstruction."

According to the news report, Dr. Panos was terminated from the Mid Hudson Medical Group, in 2011, but maintains a license to practice and does not appear in the state's database of medical misconduct and discipline. Jeffrey Feldman, an attorney for Dr. Panos, declined to comment. He noted, however, that Dr. Panos does not presently hold privileges at any hospital and is not presently seeing patients. The Mid Hudson Medical Group's chief executive officer did not immediately return calls seeking comment.

David Bernard

Is Robotic Surgery Losing Momentum?

Stagnant sales, dropping stock values, a recent FDA recall and concerns about the safety and cost-effectiveness of robotic surgery have business minds and clinical leaders questioning the future of Intuitive Surgical's da Vinci system.

The Wall Street Journal says the company reported $575 million in second quarter sales, $55 million short of what analysts expected, and has sold fewer systems than it had the previous year for the first time since 2009.

Bloomberg News reports the company has lost 32% of its market value — $7 billion — since February 27, the day before the FDA's investigation of the use and safety of robotic surgery hit the wires.

Last March, the New York Times accused Intuitive Surgical's reps of relentlessly pursuing increased sales. A report issued by the FDA in May warned Intuitive of deficiencies, including the company failing to report illnesses or injuries allegedly caused by the use of its robots. An Intuitive spokeswoman assured Bloomberg News the company would work with FDA officials to address the concerns to their satisfaction. Finally, earlier this month, the FDA recalled 30 da Vinci robots because the systems may have been tested improperly.

According to the WSJ, Intuitive's Chief Executive Gary Guthart said in April that "despite a concerted effort by vocal critics of robotic surgery, support remains strong among patients, surgeons and hospitals." The paper says Mr. Guthart declined to comment recently, but remarked that his positive outlook might be harder to maintain considering the numerous financial and clinical challenges his company is attempting to endure.

Daniel Cook

Epidurals Produce Better Outcomes in Spine Patients

Patients undergoing reconstructive spine surgery have significantly less pain and nausea, earlier mobility and significantly less blood loss when they're treated with a combination of epidural and general anesthesia, as compared to patients who treated with general anesthesia and narcotics, according to a study published in the July 1 issue of the journal Spine.

The study, which was conducted at the Nizhny Novgorod Research Institute of Traumatology and Orthopedics in Russia, looked at 45 patients who were given epidural anesthesia and endotracheal anesthesia with sevoflurane during surgery and continuous epidural analgesia with ropivacaine, fentanyl and epinephrine after surgery.

Researchers compared the patients' results with those of 40 patients who were given general anesthesia with sevoflurane and fentanyl and systemically administered opioids after surgery. According to the study, the epidural group fared better in every outcome measured, including overall satisfaction.

Jim Burger

InstaPoll: What Do You Pay Your PACU Nurses?

Tell us in this week's InstaPoll what you pay your recovery room nurses per hour.

If you've ever been fired or laid off from a job in surgery, you're not alone. More than one-fourth (26%) of last week's 477 InstaPoll respondents have either been fired or laid off from a job in surgery.

Dan O'Connor

News & Notes
  • Endoscope infection scare Neosho Memorial Regional Medical Center in Chanute, Kan., has warned 244 patients who underwent colonoscopies between January 3, 2013, and July 3, 2013, that endoscope reprocessing may have been inadequate, putting them at a slight risk of contracting hepatitis C, hepatitis B and HIV. The facility says staff did not flush auxiliary channels on scopes because the channels weren't used during procedures. Manufacturers' cleaning instructions, however, indicate the water channels should be routinely flushed as part of the reprocessing process.
  • The recurrence of ACL repair A patient who has undergone anterior cruciate ligament reconstruction surgery is 6 times more likely to require another repair in the 2 years following the surgery than a patient who has never torn his ACL, say researchers who presented their findings (see page 2) at the American Orthopaedic Society for Sports Medicine's annual meeting.
  • Shoulder surgery: a good investment While younger patients who've suffered their first dislocated shoulder may be steered toward rest and physical therapy, arthroscopic bankart repair surgery can still deliver a cost-effective outcome, according to researchers. In a presentation at the American Orthopaedic Society for Sports Medicine's annual meeting, they described their calculations of value for the procedure's outcomes.