Syracuse, N.Y. – A doctor at St. Joseph’s Hospital Health Center often slapped anesthetized patients on the buttocks and called them derogatory names before surgery, a government investigation alleges.
The doctor slapped them so hard he sometimes left red marks or hand prints, according to a report by the federal Center for Medicare & Medicaid Services.
The slapping and other inappropriate behavior by the surgeon went on for at least a year and the hospital did nothing about it until a complaint was filed with hospital administrators in December, the report says.
One staffer told investigators the hospital did nothing after the staffer reported the doctor’s behavior to OR administrators early last year. Others said they did not report it because they doubted anything would be done, they feared their jobs could be jeopardized or they did not want to confront the doctor.
The hospital is facing serious sanctions over the issue, including a possible termination from the Medicare and Medicaid programs which pay for the majority of patients treated in hospitals.
The federal report does not name the doctor. But a complaint filed in January with the state Health Department identifies him as Dr. Michael T. Clarke, an orthopedic surgeon who specializes in hip replacement and resurfacing.
That complaint, a copy of which was obtained by syracuse.com, says Clarke slapped patients’ buttocks and used foul language, the same allegations outlined in the federal report. That complaint triggered an investigation of St. Joe’s.
The state health department conducted the investigation on behalf of the federal agency. The health department’s findings are the basis of the federal report.
Also connecting the federal report to Clarke: The dates and allegations spelled out in the state complaint, which identifies Clarke, match those details in the federal report.
James Lantier, who is representing Clarke in the health department investigation, declined to comment on the allegations in the federal report.
“Although Dr. Clarke adamantly denies any wrongdoing on his part, he is not able to comment on the investigation during its pendency,” Lantier said in an email.
Clarke, 47, of Manlius, is a member of Syracuse Orthopedic Specialists, a large practice.
He operated at St. Joe’s until moving to Crouse Hospital in February.
The Onondaga County District Attorney’s Office is investigating Clarke for possible criminal conduct. The DA’s office began investigating Clarke after getting the same complaint the health department received, said Jeremy Cali, a senior assistant district attorney.
“We launched a grand jury investigation that’s still pending,” he said. “The health department talked to many of the same people we did.”
Cali said the state Office of Professional Medical Conduct, an arm of the state Health Department that investigates complaints about doctors, began investigating Clarke at the same time the DA’s office did.
Rick Trunfio, chief assistant in the DA’s office, said his office expects to complete its investigation within the next two weeks.
In a March 27 letter to St. Joseph’s CEO Kathryn Ruscitto, the federal agency says an investigation of the doctor’s operating room behavior and other problems at the hospital found “significant” deficiencies.
Health department investigators interviewed 24 staff members at St. Joe’s, 13 of whom had direct experience working with the doctor, according to the federal report. Of those 13, 11 said the surgeon sometimes slapped patients and eight said he used sexually explicit language during OR cases.
A St. Joe’s employee, who asked not be identified for fear of jeopardizing his job, said he was questioned in February by health department investigators. He said they asked him about allegations that Clarke slapped patients’ buttocks and used sexually explicit language in the OR. He said his comments are reflected in the federal report.
That report says the surgeon would slap the buttocks or hips of some sedated patients before operating. Three staff members told investigators the doctor called patients names, such as “fat ___ ,” while slapping them hard. One staffer described seeing the doctor “almost wind up” to deliver the slap to a patient. Another said the slaps seemed to be done as a gesture to say “let’s get this procedure going.”
The doctor said he slapped patients to test the adequacy of the spinal anesthetic, the report says. Eleven staff members interviewed told investigators they had never seen another doctor do this.
Dr. Stewart Lustick, a professor of anesthesiology at the University of Rochester Medical Center, said he’s never heard of that method being used. Surgeons often pinch the skin near the incision area to see if a patient has enough anesthesia, he said. Anesthesiologists also often check by pricking the patient’s skin with a needle, he said.
The federal report says the doctor used sexually explicit language during operations and sometimes directed these comments toward specific staff members.
“These actions were tolerated by OR staff and not reported to the hospital’s administration until December 2013,” the report says.
Ruscitto, St. Joe’s CEO, said in a prepared statement hospital administrators took prompt action after learning of the doctor’s behavior in December.
“Immediate disciplinary actions were taken with the physician and staff involved,” she said. She would not say what actions were taken.
After the complaint was filed, the medical director of orthopedics telephoned the doctor and told him to stop slapping patients and using foul language, and notified him he would be monitored in the operating room, according to the federal report.
The report says the hospital assigned four staffers to monitor the doctor in the OR, but did not adequately instruct them how to do that. As a result, their monitoring records were incomplete.
The report says the hospital did not have policies addressing patient abuse. It also says the hospital’s medical staff was not accountable for its conduct and quality of care.
Orthopedic surgery is one of the most profitable lines of business for hospitals, said Arthur Levin of the Center for Medical Consumers, a nonprofit consumer advocacy group in New York City. That’s why a hospital might be reluctant to discipline an orthopedic surgeon, he said.
“If you have an orthopedic surgeon who brings in a lot of money, you may look the other way,” Levin said.
In its letter to St. Joe’s, the Centers for Medicare & Medicaid Services notes the complaint about operating room behavior surfaced just five months after the agency cited the hospital for violating infection control practices. That violation was categorized as “immediate jeopardy,” the most serious type of deficiency that can cause serious injury or death to patients.
A report from a Sept. 9 inspection shows a nurse with gloves on each hand used a glucometer, a device used to test blood sugar levels, on a patient. After completing the test, the nurse picked up a meal tray and delivered it to another patient while still holding the bloody test strip from the glucometer and a used alcohol wipe in her gloved hands.
The nurse violated basic infection control techniques by potentially exposing one patient to another patient’s blood, not cleaning the glucometer after using it on a patient and skipping hand cleaning after removing the gloves, according to the report. The report shows the hospital immediately corrected the problem.
Because of the infection control deficiency and the more recent issue regarding patient abuse, the federal agency directed the state health department to do a comprehensive inspection of St. Joe’s to see if it is violating other federal rules. Jeffrey Hammond, a state Health Department spokesman, said that inspection has not been completed.
In its March 27 letter to St. Joe’s, the federal agency says:
“We have determined that the deficiencies cited are significant and limit your hospital’s capacity to render adequate care and to ensure the health and safety of your patients.”
Douglass Dowty contributed to this report.
Health writer James T. Mulder can be reached at firstname.lastname@example.org or (315) 470-2245. Follow him on Twitter @JamesTMulder.