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Life in Prison for 'Dangerous' Spine Surgeon
INEPT OR SINISTER? The Texas Medical Board suspended Dr. Duntsch's medical license in 2013 after a string of surgical mishaps. He was arrested on aggravated-assault charges in 2015.

It took a jury in Dallas, Texas, just over an hour to sentence a 45-year-old neurosurgeon nicknamed "Dr. Death" to life behind bars.

Last week Christopher Duntsch, MD, was convicted of injuring an elderly individual — a first-degree felony — for deliberately maiming one of his patients, Mary Efurd. Ms. Efurd, who was 74 years old when Dr. Duntsch botched her 2012 spinal fusion surgery, is now partially paralyzed and wracked with constant pain. Prosecutors said Dr. Duntsch caused her injuries by placing implants in muscle instead of on bone, drilling a screw into her spinal cavity and severing a nerve root. She is now confined to a wheelchair.

Throughout the 13-day trial, jurors learned that Ms. Efurd's injuries were merely the tip of a much larger iceberg. Between 2012 and 2013, 2 patients died as a result of injuries Dr. Duntsch inflicted during surgery, and prosecutors said his abuse and neglect derailed the lives of more than 30 patients in all. During the trial, a dozen patients who had trusted Dr. Duntsch to provide them with relief from back problems testified he instead left them disfigured and struggling to cope with debilitating pain.

The defense claimed Dr. Duntsch was not sadistic, just "not a skilled surgeon." Defense attorney Robbie McClung said his client, who practiced at various hospitals in Dallas and Collin counties, was "at the level of a first-year resident." Prosecutors argued that Dr. Duntsch had 17 years of training and research behind him, meaning he knew exactly what he was doing. They also noted his history of erratic behavior, citing a bizarre email sent to an employee, which read: "what I am being is what I am, one of kind, a [expletive] stone cold killer."

Dr. Duntsch's troubles date back to his time practicing in Tennessee, where, prosecutors said, he incurred mounting debt from having to defend lawsuits filed by multiple patients. Prosecutors said he fled Tennessee for a new start in Dallas, but the victims of his botched surgeries continued to pile up.

In 2013, after a string of mind-boggling surgical mishaps, the Texas Medical Board stripped Dr. Duntsch of his medical license. In complaints to the board, 2 surgeons who had worked with Dr. Duntsch described him as "the most careless, clueless and dangerous spine surgeon either of us has ever seen." He was arrested in 2015 on 5 charges of aggravated assault.

Bill Donahue

FDA Warns About Safety of Weight-Loss Balloons
WEIGHT-LOSS ISSUES The FDA approved the ReShape Dual Balloon System in 2015.

Intragastric balloons designed to help overweight individuals shed excess pounds have been linked to spontaneous hyperinflation and acute pancreatitis, according to the FDA, which is recommending that healthcare providers closely monitor implanted patients.

The FDA's warning impacts use of the ReShape Integrated Dual Balloon System made by Reshape Medical and the Orbera Intragastric Balloon System made by Apollo Endo-Surgery. Most of the reported adverse events have been linked to the Orbera system, according to the FDA.

The systems, which the FDA approved in 2015, are inserted into the stomach through the mouth during endoscopic surgery. Once inserted, the dual balloons of the ReShape are filled with saline and methylene blue dye, while the single balloon of the Orbera system is filled with saline only. Both systems are designed take up space in the stomach and have been approved as temporary weight-loss solutions that should be removed within 6 months of implantation, according to the FDA.

Over-inflation can occur within 9 days of implantation when the balloons spontaneously fill with air or more fluid. The exact cause of the spontaneous malfunction is currently unknown, says the FDA, which adds over-inflation of the devices can cause abdominal pain, abdominal distention, difficulty breathing and vomiting. The balloon systems can also compress gastrointestinal structures and cause acute pancreatitis within 3 days of implantation, says the FDA. Those dangers are not listed on the labeling of both systems, so healthcare providers might not be aware that the devices are the cause of the associated symptoms.

Healthcare providers should closely monitor patients who received the implanted systems and remove the devices if they are found to be the cause of the adverse reactions, says the FDA. Providers should also submit reports of related problems to MedWatch, the FDA's Safety and Information and Adverse Event Reporting program. Questions about the safety warning can be directed to the FDA via email or by calling 800-638-2041.

Daniel Cook

Push to Make Ambulation a Key Patient Recovery Metric
UP AND AT 'EM Ambulation can significantly reduce length of stay, notes the Physician-Patient Alliance for Health & Safety.

The ability to move should be considered a key metric in the patient recovery process, says the Physician-Patient Alliance for Health & Safety (PPAHS), which is calling for clinicians and government to identify and codify best practices related to ambulation, and device manufacturers to develop wearable, wireless devices that can monitor vital signs while patients walk.

Patients are too often tethered to their beds by current monitoring equipment, the PPAHS says in a recent position paper, adding that the ability to walk independently, with or without assistive devices, can dramatically reduce length of stay by improving joint and muscle strength and preventing pressure ulcers.

In addition to citing studies demonstrating the importance of early ambulation with total knee and total hip patients, the group cites a 2010 study in which elderly patients admitted for a broad range of conditions reduced their length of stay by nearly 2 days by significantly increasing ambulation.

Additionally, says the group, overburdened nurses need to be given enough time to make sure patients are sufficiently ambulated. It cites a 2008 study that found that only 7.2% of nurses' time is devoted to patient assessment and reading of vital signs.

Clinicians should be focused on identifying priority patients, and device makers should develop technology that, along with being mobile, can track and measure ambulation, says the group.

Jim Burger

InstaPoll: Do You Have a Policy for Dismissing a Patient From Care?

There are times when you have to cancel a patient's surgery or dismiss him from care of the facility. The reasons can be medical (NPO status, intoxication) or behavioral (violence, no escort). Tell us in this week's InstaPoll if you have a written policy covering for such occurrences.

Medication errors were the leading "never event" cited by the 183 respondents to last week's poll. The results:

What was the last "never event" to occur in your facility?

  • medication error 44%
  • patient fall 21%
  • wrong-site surgery 18%
  • retained object 13%
  • pressure ulcer 4%

Dan O'Connor

News & Notes
  • Joint Commission to Certify Compounders Working with the United States Pharmacopeial Convention, the Joint Commission has developed a new certification program to ensure that compounders comply with standards related to the process, testing and verification of sterile and nonsterile drugs.
  • Intraoperative adverse events drive up rate of readmission A surgical procedure with a major intraoperative adverse event — an injury caused by medical management rather than the underlying disease — has a higher 30-day readmission rate (24.7%) compared with a procedure without an event (9.8%), according to a study published in The American Journal of Surgery. Of the 9,274 surgeries analyzed in the study, 921 resulted in readmission. Of these, 183 had intraoperative adverse events, including 73 considered major. The study's authors said preventing or mitigating the effects of these events, should decrease surgical readmissions.
  • Robotic surgery for $500? Researchers at the University of Michigan have developed a handheld instrument that mounts to a surgeon's wrist in order to match the precision and dexterity of a robotic arm during conventional laparoscopic surgery. The device costs $500 and is intended to provide surgical facilities with an alternative to robot platforms that cost millions of dollars.