Boston Medical Center surgeon fined for leaving the operating room to eat in his car, then falling asleep and missing the procedure

In a recent decision, the State Council found that Tannoury, who was the attending surgeon for the orthopedic trauma emergency that night and escorted the patient with the resident into the operating room, had “behaved that undermines public confidence in the integrity of the medical profession.

The council also ordered him to complete five continuing education credits in “professionalism” and to review the regulations relating to the supervision of residents. It took almost five years for the case to be made public.

Before the board took action, Tannoury had received a written reprimand from the hospital for violating its policy requiring surgeons to be present for critical parts of operations, according to the consent order he signed. last month. Federal law also requires surgeons at teaching hospitals to be present for the key part of a surgery in order to bill Medicare for the cost of the procedure.

BMC reported the matter to the medical board, said hospital spokeswoman Jenny Eriksen Leary, who did not specify when. The incident occurred amid increased public scrutiny of surgeons leaving operating rooms before procedures were completed. Leary declined to provide details about the patient, but said the hospital was “completely transparent with the patient about the situation and who carried out the operation.” She added: “The surgical result was positive.”

Tannoury, who is also licensed to practice medicine in Maine, did not respond to requests for comment.

George Zachos, executive director of the board, said on Wednesday that the hospital first contacted the agency about the incident in January 2017, two months after the incident. He said a “number of factors” caused the case to take more than four years to lead to disciplinary action and the onus on the board to prove that a doctor broke the regulations or the law. by a “preponderance of evidence”.

Dr James Rickert, who is president of the Society for Patient Centered Orthopedics and has criticized surgeons who fail to tell patients they might not perform parts of the procedures themselves, said Tannoury’s actions were egregious . He also said the medical council’s reprimand and the $ 5,000 fine were insufficient and came too long after the incident, keeping the public in the dark for nearly five years.

“It’s just the proverbial slap on the wrist,” said Rickert, an orthopedic surgeon in Bedford, Ind. “I I can’t believe that if it was a board made up mostly of patients, they wouldn’t have had a much harsher sentence. Four of the five members of the state council are doctors, according to the council’s website.

Rickert called on state medical boards to increase the number of patient representatives in an article published online in August in the journal Clinical Orthopedics and Related Research.

Just a year before the episode, BMC officials had discussed Tannoury’s work in the operating room in a Globe Spotlight Team Report which focused on a handful of orthopedic surgeons at Massachusetts General Hospital who juggled two operations at a time without notifying patients. The 2015 Spotlight Report helped spark a national debate in the medical field about the controversial practice, sometimes referred to as double booking, at a number of US teaching hospitals.

At the time, BMC said Tannoury sometimes ran two operating rooms at the same time, with his cases overlapping by several hours. But the hospital described it as a closely watched program that allowed her to perform operations more safely and during daylight hours.

On Tuesday, Leary said that after BMC made these 2015 comments on Tannoury’s surgical practices but before the incident involving the ankle patient the hospital updated its policies to prohibit simultaneous operations by any surgeon. .

Tannoury has led spine surgery at the Boston University School of Medicine, which BMC is affiliated with, since 2006, according to his LinkedIn page. He specializes in minimally invasive spine surgery and on his practice website he promises patients to not offer “any treatment that I haven’t used or that I haven’t used on the limbs. of my immediate family and my closest friends “.

The incident that got him into trouble happened on November 22, 2016, according to the consent order, after a patient presented to the hospital for emergency ankle surgery. Tannoury and the head resident, who has not been identified, took the patient to the operating room at around 9:30 p.m.

Tannoury “left the operating room when the patient was being prepared for the operation and before the start of the operation, intending to eat something before performing the operation,” the order states. consent. He left the hospital, “bought something to eat in his parked car and fell asleep in the vehicle.”

For some, the episode may evoke memories of an even more surprising case of a patient abandoned by an orthopedic surgeon nearly two decades ago. In 2002, Dr David Arndt, a doctor at Cambridge’s Mount Auburn Hospital, abandoned a patient while undergoing complicated spine surgery to cash his paycheck. The patient was left lying on the operating room table, anesthetized and with an open incision. Arndt, who was struggling with a serious drug problem, lost his medical license. His life got out of hand and he ended up facing a series of criminal charges.

In 2019, the state’s medical board tightened regulations for surgeons who leave operating rooms before operations are complete, including when they are handling overlapping procedures. Although many university hospital surgeons schedule operations to overlap by minutes – letting trainees close the surgical wound from the first operation while the surgeon moves on to the second – the controversy in Mass. General focused on surgeries, mainly in orthopedics, which sometimes overlapped for hours.

The revised regulations, which medical experts have described as one of the most extensive in the country, require doctors to provide more information to patients beforehand about who will be involved in an operation. They also require hospitals to document every time a senior surgeon enters and leaves the operating room.

Jonathan Saltzman can be reached at [email protected]

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