Thursday, December 1, 2016

Dr. Death


Around that same time, Duntsch’s behavior was becoming erratic. During a deposition with Passmore’s lawyer, attorney James Girards, a woman named Megan Kane recalls Duntsch eating a paper blotter of LSD and taking prescription painkillers on his birthday in either 2006 or 2007. She also says they snorted cocaine from a small pile that he kept on a dresser in his home office. Also present, according to Kane, was Jerry Summers, the childhood friend who would later wake up a quadriplegic after a Duntsch operation. Kane dated Summers for a year. After they all partied through the night, powered by LSD and cocaine, she said she saw Duntsch put on his lab coat to make rounds the next morning.

“I thought it was pretty amazing that he was even able to go to work the next day,” she said in the deposition. “Like, he wasn’t scared. He didn’t not want to. He wasn’t paranoid. After you’ve spent a night using cocaine, most people become paranoid and want to stay in the house. They don’t want to go participate in any extraneous activities, and he was totally fine going to work.”…

Dr. Robert Henderson, a spine surgeon who has practiced in Dallas for more than 30 years, started digging after being assigned corrective surgery on two of Duntsch’s patients. He was so appalled at the results of the procedures that he faxed a photo of Duntsch to the University of Tennessee to see if the surgeon was an impostor. He recorded a conversation with Dr. Frederick Boop, who followed Robertson as the chairman of the department of neurosurgery. Boop told Henderson that Duntsch had been sent to an impaired physician program when he refused to take a drug test after an anonymous woman called to say she had seen him use cocaine, but he had been allowed to return to finish his residency. Boop also said that Duntsch spent his final year operating as an attending physician, and was not allowed to operate independently…

But on January 6, 2012, a week after the surgery, Duntsch went back in. Passmore says the space above a disc in his lower spine had been blown out in the first surgery, and Duntsch returned to pick out the pieces. Passmore later learned that a ligament in his leg had been severed. Nerve pain now fires through his back, the result of a screw lodged in a nerve bundle. He can’t run or swim with his children. He struggles with incontinence. When he stepped off the bed for the first time after surgery, the feeling on the bottom of his feet had vanished. It still feels as if his feet are asleep…

Passmore also learned about Kenneth Fennell, a 68-year-old who alleged in a lawsuit that, during a November procedure, Duntsch operated on the wrong body part. Duntsch, again, maintains this wasn’t true. He says Fennell’s surgery went so well that he agreed to be in a commercial for Baylor Plano.

Martin, it turned out, had bled to death in the intensive care unit while undergoing a relatively common procedure known as a laminectomy, which involves removing spongy tissue between the discs to relieve pressure. Six weeks after her death on March 12, 2012, the medical examiner ruled her fate an accident. But Dr. William Rohr did editorialize in his conclusion: “The collection of blood was most likely the result of a therapeutic misadventure.” Duntsch blames the death on an allergy to fentanyl, a powerful narcotic often used in intubation. “Not a single doctor, surgeon, staff, or the pathologist of the autopsy every [sic] stated that I surgically caused vascular injury,” he wrote…

She was also present for Summers’ operation. But she wasn’t in the room when he woke up a quadriplegic, telling anyone with ears that Duntsch had been using cocaine the night before the procedure. Summers had come in for an elective spinal fusion to relieve the pain he’d carried for years after a car accident. According to Texas Medical Board records, Summers’ vertebral artery was damaged, and he lost more than two liters of blood while intubated. When his patient woke up in the recovery room unable to move his extremities, Duntsch failed to perform a CAT scan or MRI…

It was sent on a Friday at 4 am. The message alluded to a week where “everything unraveled” with their relationship. Duntsch suspected that this had something to do with his “vodka bottle” and “neurostimulants.” It said he was $1 million in debt. It said, “Anyone close to me thinks that I likely am something between god, einstein, and the antichrist. Because how can I do anything I want and cross every discipline boundary like its [sic] a playground and never ever lose.”

Duntsch also said he was prepared to embrace the very darkest part of himself. “You, my child, are the only one between me and the other side,” he wrote. “I am ready to leave the love and kindness and goodness and patience that I mix with everything else that I am and become a cold blooded killer.”…

He performed his first operation at Dallas Medical Center on July 24, 2012; the hospital issued temporary privileges while it verified his credentials. During this time, out of three procedures, one patient died and another was partially paralyzed. Like Summers, Floella Brown’s vertebral artery was damaged, causing massive bleeding. Unlike Summers, Brown, 63, suffered from hypertension and was a stroke risk. She suffered a “massive posterior circulation stroke” and was transferred to UT Southwestern Medical Center. She arrived brain-dead. “No autopsy was done (at the family’s request) but it is well-documented that the stroke was due to a left vertebral artery injury due to Dr. Duntsch’s horrendous surgical technique,” wrote surgeon Randall Kirby in a letter to the Texas Medical Board. Kirby reported having “direct knowledge” of seven patients that “Dr. Duntsch has maimed or killed.” Hoyle, the surgeon who exposed the incision in Passmore, had also filed a complaint with the board. “I agree completely with Dr. Hoyle’s complaint to the board when he stated that Dr. Duntsch is the most careless, clueless, and dangerous spine surgeon either of us has ever seen,” Kirby wrote…

By December, Duntsch wrangled privileges at Legacy Surgery Center of Frisco, and Kirby, in his letter to the Texas Medical Board, narrated another grim outcome: Jacqueline Troy’s vocal cord was paralyzed, and her esophagus and trachea had become connected, “an unheard of complication.” A corrective surgery happened two weeks later, after she arrived at the emergency room of Texas Health Presbyterian Dallas, where Kirby practiced…

After another disastrous outcome, this time at University General, Kirby and malpractice attorney Kay Van Wey decided to turn to the criminal justice system. At University General Hospital, Kirby had been granted emergency privileges to operate on a Duntsch patient named Jeffery Glidewell. He discovered a significant esophageal injury that belabored Glidewell’s breathing and found a sponge that had been left in the soft tissue of his neck. He, too, had an injury to his left vertebral artery, and the incision was far from where it should’ve been and had begun to leak pus.

Despite receiving complaints dating back to 2012, the Texas Medical Board didn’t revoke Duntsch’s privileges until June 2013. That same month, Kirby wrote, he, along with the Glidewell family, brought the case to prosecutors and asked to press charges. “I am beginning to think the police are the only ones intellectually and physically capable of getting to the bottom of this matter,” he wrote…

Finally, in July 2015, the Dallas County District Attorney’s Office followed through. A grand jury returned five indictments of aggravated assault and one of harming an elderly person.

“I cannot recall a physician being indicted for aggravated assault for acts committed during surgery,” says Toby Shook, a Dallas defense attorney who spent 23 years working as a Dallas County prosecutor. “And not just Dallas County—I don’t recall hearing about it anywhere.”


  1. Just how difficult can it be to stop a highly credentialed but dangerous doctor from hop-scotching around a metropolitan area to perform brutal spinal surgeries in different hospitals, including a respected academic medical center? Just ask crippled patients, neurosurgeons, medical licensing officials, and prosecutors in Dallas what it took to derail Dr. Christopher Duntsch.

    As detailed well in the latest edition of the upscale city magazine D, Duntsch was a high-flying physician who moved from Tennessee to Texas, carrying with him an excellent reputation, which later would be challenged, as a medical scientist. Although established as a cancer stem cell-researcher, the neurosurgeon also morphed himself into a spinal surgeon based on training earlier in his career. He eventually won privileges to operate at three Dallas area hospitals, including the well-regarded Baylor Regional Medical Center at Plano, Texas.

    He was a loner and boastful, though colleagues liked him at first. They "quickly were horrified by his surgeries. Among the damages he is criminally accused of inflicting: amputating a patient’s spinal nerve, causing paralysis; cutting another patient’s vertebral artery and ignoring the major bleeding that occurred; installing a too-long screw so that it punctured a big vein, causing extensive bleeding and nerve damage; slashing a patient’s esophagus and a neck artery, leaving the man struggling to eat, breathe, and with blood loss to the brain. (continued)

  2. (continued)Duntsch kept moving around Dallas-area hospitals. Colleagues reported him to hospitals and medical licensing officials. They stepped in front of him in operating suites, and took instruments out of his hands during surgeries. Duntsch, D magazine says, abused drugs, partied, and talked about having wild sex often before long, complex operations. There have been reports that he may intentionally have tried to maim patients. His surgeries have been tied to deaths.

    Although he and the hospitals that allowed him to operate in their facilities have been sued and the Texas medical board has stripped Duntsch of his license, it took the Dallas District Attorney’s Office to stop him. Prosecutors took the rare step of indicting him for multiple counts of aggravated assault, crimes they say occurred when he operated so badly on patients. As D magazine says about the Duntsch case, which has dragged on several years now:

    Nobody stopped him soon enough. The hospitals didn’t do their due diligence until it was too late, and those who could’ve spoken up didn’t. Every patient mentioned in this story who has sued, except for [one], has settled. They all signed nondisclosure agreements that prohibit them from discussing their cases or their monetary awards. As one lawyer [said] off the record, they faced an almost impossible dilemma: settle and give their families a financial cushion for the future medical costs but sacrifice their right to tell their stories.

    Duntsch was arrested in Colorado, and sits in a Dallas jail, awaiting criminal trial, now scheduled in January.

    I’ve written how rare it is for criminal charges to be filed against a doctor, with the most recent case to receive national attention involving a pill-dispensing California physician. She was convicted of second-degree murder in connection with fatal overdoses of three of her patients. [see:] The Duntsch case also echoes a terrible series of spine surgeries in South Dakota involving Allen Sossan, a now disgraced and on the lam osteopath whom 30 patients have accused of maiming them.

    I’m angered by the number of bad doctors I have seen in my practice, and I have written how patients need to research their caregivers as if their well-being depended on it. As I’ve said before, doctors and hospitals must do more to rid their ranks of their terrible practitioners. This includes ensuring that bad surgeons don’t elude discipline by moving a few miles down the road. Medical licensing boards also need to act decisively and quickly for patients’ sake. Malpractice lawsuits may provide those harmed with the financial support they will need, as well as justice. When circumstances dictate, it’s good to see prosecutors act in the public good.

  3. Come Monday morning, Christopher Duntsch will appear in court for the first day of his trial.

    You may remember Duntsch from our November cover story, which followed the neurosurgeon from his time training in Memphis to his arrival in North Texas and the lengthy series of disturbing patient outcomes that followed. Duntsch has been confined to Lew Sterrett since July 2015, after being indicted on five counts of aggravated assault with a deadly weapon and one of injury to an elderly person. The ex-prosecutors and defense attorneys I spoke with while reporting that story could not recall a surgeon who was indicted for what happened inside their operating rooms during surgery. Two individuals died after a Duntsch operation. Kellie Martin bled out at Baylor Medical Center at Plano after her vertebral artery was severed. Five months later, at Dallas Medical Center, Floella Brown had a stroke after her vertebral artery was damaged. She was declared dead after being transferred to UT Southwestern.

    Fourteen patients sued Duntsch during the two or so years he had a license to practice. Court documents show that the Dallas County District Attorney found a total of 34, which they allege he “intentionally, knowingly, and recklessly caused bodily injury and/or serious bodily injury.” It took more than a year for the Texas Medical Board to revoke his license after first receiving complaints. He wound up receiving privileges at four area hospitals and allegedly harmed patients at each.

    Duntsch is an anomaly. It’s rather difficult to secure a criminal conviction of a physician related to the care he or she provided because of the burden of proof. The prosecution will likely need to prove that Duntsch was operating with a gross deviation from the accepted standard of care. Toby Shook, a former Dallas County prosecutor, says they’ll likely have to show that Duntsch was “aware but that he consciously disregarded a substantial and unjustifiable risk.”

    “And the risk must be in such a nature that its disregard suggests a gross deviation from the standard of care that an ordinary person would recognize under these circumstances,” he said. “Basically, the doctors (who testify) will have to say that whatever he did was so out there that he was disregarding a justifiable risk.”

    Going all the way back to medical school at the University of Tennessee Health Science Center, Duntsch has been dogged by allegations of drug and alcohol abuse. He took partial blame for only one of those injured patients, Mary Efurd, who woke up after a procedure with searing pain and unable to stand. Duntsch said he was so distraught from Brown’s outcome that he misplaced a screw. He doesn’t mention the hardware left in Efurd’s soft tissue or the severed nerve root or the rogue screw holes far from their desired location, all of which was observed by the physician who was called in to correct the operation.

    That surgeon, Dr. Robert Henderson, is listed among the 80 witnesses that prosecutors plan to call to the stand. So too are Drs. Mark Hoyle, Randall Kirby, and Martin Lazar, all of whom ran Duntsch up the ladder upon seeing his outcomes. There are anesthesiologists and hospital administrators and office staff. There is Kimberly Morgan, Duntsch’s surgical assistant with whom he had a sexual relationship. Other documents show that the state will attempt to prove that Duntsch made false or misleading statements about eight patients he is accused of harming, that he snorted cocaine from his pen caps, and that he attempted to have a medical staffer alter Brown’s medical records to make the bleeding look like an effect of her not taking blood thinners instead of something else.

  4. Over and over, nurses and doctors testified Monday that Duntsch seemed remarkably nonchalant during and after the botched surgeries that claimed the lives of Martin and another patient. Others were left paralyzed or maimed.

    Surgical nurse Catherine Kelly-Lorenz testified about what happened after Kellie Martin came out of surgery. “She was screaming in pain,” she recalled.

    When asked if she had ever seen a patient come out of surgery in that condition, Kelly-Lorenz, sobbed, “No, ma'am.” She said Duntsch did not seem concerned. It was a surgery she'll never forget.

    “I don't ever want to do another one again,” she said...

    Anesthesiologist Dr. Joy Gathe-Ghermany testified that Summers lost a third of blood during that surgery. Gathe-Ghermany said because of the amount of blood loss, she asked Duntsch repeatedly during the surgery if everything was OK and he said it was.

    Once she saw after the surgery that Summers couldn’t move his arms and legs, she decided that she would stay and monitor him rather than doing another scheduled surgery with Duntsch.

    Duntsch performed the other surgery, which surprised her given Summers’ condition.

    Surgical Nurse Laura Strasser, who had taken Summers to the recovery room, testified that she had never seen an outcome like from that type of surgery.

    She says Duntsch seemed remarkably unconcerned after the surgery. “He was just coming down the hallway eating chips,” she said.

    His defense attorney suggested that perhaps Duntsch was just hungry.

    Nurse Marcia Adlam testified that she in the operating room when Duntsch performed a second surgery on Summers to try to repair the problem.

    She testified that the one thing that stood out her in mind was how Duntsch was taking “chunks” of tissue out of Summers. Adlam found that odd because that was not typical of the way she had seen neurosurgeons work.

    Typically, they work slowly and meticulously because they are working near the spinal code.

    “It just seemed like he was hurrying, hurrying through the operation,” Adlam testified.

    Debra Gunaca, another nurse testified that she heard another doctor say during that second surgery something that surprised her.

    “Holy (expletive), what the (expletive) did that guy do” she recalled the doctor saying.

  5. Ken – a man with a snow white beard who looks a lot like Old Saint Nick can only walk short distances. The pain's too much. But he's enduring the pain to be there for the trial of Dr. Christopher Duntsch, the former neurosurgeon he blames for all that pain.

    Prosecutors are trying Duntsch in the case of another botched surgery involving Mary Efurd, who is now confined to a wheelchair.

    “We just want to make sure that he can't do it to anybody else,” Ken Fennell says.

    The former head of the Baylor Plano peer review committee testified Tuesday that Duntsch submitted tap water rather than drug urine on his first drug test. Duntsch passed a second drug test several days later.

    Baylor decided to drug test after a patient named Jerry Summers told an ICU nurse that he had used cocaine with Duntsch the night before the surgery. Summers, a friend and former employee of Duntsch, was left a quadriplegic after complications from a February 2012 surgery performed by Duntsch.

    In a video deposition played in court Monday, Summers said that he had made up the allegations of drug use because he wanted the nurses to get Duntsch to come to his room after he woke up from the surgery in horrible pain and unable to move.

    Angelina Fusco, an ICU nurse, testified that Summers told her he had used cocaine with his girlfriend and Duntsch the night before the surgery. She recorded in her patient notes that she heard Summers tell Duntsch’s assistant that he would “blow it all up. You know I’m talking about, what’s going on.”

    She said also recorded in her notes that she heard Duntsch telling Summers that he was going to get him into trouble and that if he didn’t stop saying things he would have to fire him as a patient.

  6. But two of the three doctors called to the stand on Friday, the vascular surgeon Randall Kirby and the neurosurgeon J. Michael Desaloms, spoke of Morguloff’s result as a unique medical failure.

    “He performed worse than any spine surgeon I’ve seen in the operating room,” said Kirby, who cut into Morguloff’s abdomen and helped move his organs and blood vessels away from the spine so that Duntsch could operate, a procedure that he said just four surgeons in North Texas perform. Desaloms, who performed Morguloff’s corrective surgery about nine months after Duntsch’s operation, called the result a “striking abnormality,” adding that it was “definitely an outlier” in his nearly two decades of practicing post-residency. Kirby called the results “catastrophic.”...

    And yet Duntsch apparently struggled immediately. Instead of using a scalpel to remove the disc in Morguloff’s lower back — a method that Kirby says “99.9 percent” of neurosurgeons use — Duntsch used a grabbing device and began jabbing at the disc without cutting it out. Months later, Desaloms said he discovered a piece of bone had been knocked off the spine and was pushing on a nerve root. The surgical cage, meant to put space between the vertebrae, was “malpositioned” and the fusion did not take. Morguloff woke up with searing pain in his left leg. His toes went numb, and he could not move his left foot — that condition, called drop-foot, was also present in Mary Efurd, one of the victims Duntsch is charged with harming. On Friday, he walked with a surgical boot and a special brace, leaning heavily on a cane...

    In Passmore’s surgery, Duntsch performed a “sub-optimal” placement of a surgical cage on his spine and stripped a screw, preventing it from being moved in the future. Dr. Luis Mignucci, the spine surgeon who went back in to correct what he could and stabilize the spine, said the procedure was a bad outcome but would not characterize it as a mistake. “Bad outcomes happen all the time,” he said, adding that as much as 30 percent of his Plano practice is corrective procedures. Today, Passmore walks with a severe limp, cannot feel his feet, struggles with incontinence, and lives with pain that radiates between a level four and a level 10. He said it hits the most severe degree “once or twice a month.” Neither Passmore nor Morguloff can run or play with their children; both were physically active before their surgeries.

  7. Thursday marked a week since testimony began in the case (which was the focus of our November cover story), and today prosecutor Michelle Shughart riddled expert witness Dr. Martin Lazar with a bevy of hypotheticals structured to mirror Duntsch’s outcomes: “Would a trained neurosurgeon know,” she’d begin, her query filled with things like whether an educated, board-certified neurosurgical physician know the complications of significant blood loss during surgery. Or whether hardware left in the wrong spot would cause some sort of disorder. By the end of the day, she grew more pointed, asking Lazar the ethics of a surgeon continuing to practice after multiple patient deaths and paralyses.

    “It’s inconceivable. How can you not know that you’re going to cause a disaster?” Lazar asked, adding later: “If you have a conscience, that’s when the conscience tells you, ‘Stop!’”

    He said a neurosurgeon practicing in spite of outcomes that severe would point to the individual being in “massive denial,” or showing signs of “some psychopathy,” “a disorder with thinking.”

    In order to get a guilty verdict on a charge of aggravated assault, the state needs to prove that Duntsch acted recklessly and provided care that was far beyond the accepted standard. Other surgeons who corrected Duntsch’s errors have already called his outcomes “catastrophic.” Lazar, a practicing neurosurgeon for more than 40 years, walked through four of the patient outcomes he analyzed via medical records, including Mary Efurd, the woman who Duntsch is being tried for harming. He analyzed three of those records on behalf of civil lawsuits, while Dallas County asked him to analyze Efurd’s.

    Two of those patients, Kellie Martin and Floella Brown, died after Duntsch damaged their vertebral arteries. Martin bled out, Brown suffered a massive stroke. Another, Jerry Summers, woke up a quadriplegic. Efurd’s nerve roots were damaged by a rogue screw, fusion hardware sat in the muscle that makes her able to raise her knee, and the other side of her spine was pockmarked by false-starts with the screws. Lazar said these errors were all visible in imaging taken after the surgery, and should’ve been caught by Duntsch and immediately corrected. Instead, his post-operative report showed that he was “quite pleased.” And, besides, Duntsch shouldn’t have begun the elective procedure anyway—Brown lay dying from her surgery as he began operating on Efurd.

    “Do not go in the operating room,” Lazar said. “You do not start another case.”

    He said that the medical records indicated that Duntsch did not perform the correct tests to identify where Efurd’s pain was originating from, and instead just “guessed.” He wound up operating at the wrong level. In Brown, Summers, and Martin, Duntsch removed too much of the bone that protects the vertebral artery, exposing it to damage. Lazar noted that each case incurred significant blood loss—up to a third of their blood volume in their bodies—and showed evidence of mistakes in surgical technique.


  9. This podcast is good for those who are interested in: Neurosurgery, spinal surgery, malpractice, investigative reporting, true crime, narrative storytelling, medical ethics, health policy

    Typical length of episodes: About 30–45 minutes

    How often a new episode comes out: The six-part series has been fully released, but updates continue to be occasionally released.

    Episode topics: The podcast features physician and patient stories, and at the center of it all is Christopher Duntsch, who claimed to be a top spinal surgeon in Dallas, TX. He operated on 33 patients, and most of these surgeries ended in tragedy. Two surgeons, Drs. Robert Henderson and Randall Kirby, led the efforts to stop him. The podcast explores how the medical system allowed Dr. Duntsch to slip through the cracks and continue to harm so many patients.

    Sample episode — “Three Days in Dallas”: The inaugural episode follows Dr. Duntsch’s first week at Dallas Medical Center in July 2012, during which he botched three spinal surgeries. He cut open a patient’s vertebral artery during the first surgery, causing her to suffer a massive stroke and loss of consciousness the next day. Dr. Duntsch rendered another patient nearly immobile when he inserted hardware into soft tissue that was supposed to fuse two vertebrae and completely amputated a spinal nerve root.

    The damage is so extensive that the hospital brings in veteran spinal surgeon Dr. Robert Henderson for a second opinion, who questions whether Dr. Duntch is an imposter.

    Tidbit about the show: The podcast is produced by the Wondery Network, the creators of popular true crime podcast Dirty John.

    About the host: The story is reported by Laura Beil, an independent journalist with over 20 years of experience in health and science writing.

    Listen via: iTunes, Stitcher, Spotify, TuneIn