HEALTH
By Michael Booth
The Denver Post
POSTED: 04/10/2013 05:36:05 PM MDT
A surgical team prepares the da Vinci robotic system prior to an operation in August 2010. Hospitals spend more than $1 million on each of the da Vinci-brand surgical units and are under pressure to keep them busy. (Denver Post file)
The Colorado medical board has charged Dr. Warren Kortz with 14 counts of unprofessional conduct after a series of failed procedures with Porter Adventist Hospital’s robotic surgery arm, as federal officials launch a wider review of the highly touted procedures.
The state alleges that from 2008 to 2010, Kortz cut and tore blood vessels, left sponges and other instruments inside patients after closing, injured patients through improper padding and positioning, subjected some to overly long surgeries, and had to abort kidney donations because of mistakes.
Kortz also failed to document the mistakes in patient charts, the medical board alleged in a complaint filed earlier this month.
An attorney representing Kortz on the state charges declined comment. Lisanne Leasure, an attorney for Kortz in a negligence suit over one of the kidney patients, said in a statement that Kortz’s care was “reasonable and appropriate.”
“Dr. Kortz is a very experienced and excellent surgeon who has helped many Coloradans over his lengthy career,” Leasure said in the statement with co-counsel Bruce Montoya. The patient’s attorney in the malpractice case “is seeking to use the Board matter to gain advantage or force a settlement in the civil case,” they said. “These tactics are, in our view, inappropriate and will prove to be unsuccessful.”
State investigators are asking an administrative judge to “discipline” Kortz’s license to practice medicine, although they did not elaborate on what punishment they will pursue. Kortz is still featured prominently in Porter’s publicity for its robotic surgery and transplant departments.
Dr. Warren Kortz
“I’d really like to see that this never happens again. It never should have,” said Shanti Lechuga, a patient suing Kortz for negligence.
The formal complaint comes as federal officials seek more information on robotic surgery results and mistakes around the nation.
The U.S. Food and Drug Administration said it is stepping up interviews of surgeons about the devices after a new series of mishap reports, although the agency said it has not yet identified a trend. Hospitals spend more than $1 million on each of the da Vinci-brand surgery units and are under pressure to keep them busy.
“Since it is difficult to know why the reports have increased, the FDA has elected to talk with surgeons to better understand the factors that may be contributing to the rise in report numbers,” FDA spokeswoman Synim Rivers said in a statement.
Porter suspended Kortz’s robotic-surgery privileges for three months in 2010 and reported to the medical board that he had complications with 11 surgeries using a hospital robot, according to the state complaint.
Kortz used the robot for complex kidney donor removals in 2008, 2009 and 2010, when using it was not the “standard of care” for such procedures, the state said. Many of those procedures went bad and had to be converted on the fly to open surgeries to fix problems, according to the complaint and the malpractice lawsuit.
The Denver hospital would not say whether it required new training for Kortz before restoring his privileges after the 2010 suspension. “Under Colorado law, the physician peer-review process is confidential and we are not at liberty to comment on individual cases,” hospital spokesman Tim Shonsey said in a statement.
Kortz is on the Porter medical staff but is not an employee, Shonsey said. Porter, part of the Centura group of hospitals, currently advertises a relationship with Kortz for both transplants and robotic procedures. Porter undertakes a rigorous review “anytime there is a clinical quality concern,” the statement said.
The state medical board complaint, filed by the Attorney General, details 11 patient cases allegedly mishandled by Kortz. The cases include:
• “S.L.,” a 22-year-old woman who wanted to donate a kidney to her ailing brother. (Patients are identified only by initials in the state complaint.) The state said Kortz told S.L. that the robot was the “gold standard” for kidney removal and transplant, neglecting to say it did not have a long-term track record in such cases, or that open or laparoscopic surgery were also options.
During surgery, Kortz immediately injured S.L.’s aorta when first inserting a “trocar,” or pathway device allowing access to the abdomen. Kortz converted to an open surgery to stop the bleeding, then aborted the kidney removal and closed up. S.L. went into post-operative respiratory distress, and an X-ray found a sponge had been left inside her.
Kortz also improperly padded S.L. on the table, leading to nerve damage during the surgery, and S.L. “was not the first patient” of Kortz’s to suffer such an injury, the state said.
Lechuga said she is the patient listed as S.L.; she is named fully in her malpractice lawsuit against Kortz and a radiologist on the case, Dr. Keith Dangleis. Her brother, Christopher, was waiting at Porter to receive her kidney once Kortz removed it, the lawsuit claims. When the transplant had to be aborted, Christopher waited another six months on dialysis before getting a different donor, the lawsuit said.
Lechuga said she was told soon after the operation that hers was the only such complication. Now that she has read the state’s charges, she said, “it blew my mind there were so many before me, and so many who had aorta injuries, too.”
Kortz’s attorney, Leasure, said the Lechuga case complications had nothing to do with robotics. Lechuga was advised before the surgery of the possible risks, and consented, Leasure’s statement said.
• “J.S.,” an 86-year-old with metastatic cancer, with whom Kortz allegedly used a robot when the standard of care in such cases was open surgery. Kortz injured the aorta, then when converting to open surgery as an emergency, the robot arm moved when it shouldn’t have, causing another tear, the complaint said.
J.S. suffered kidney failure after the operation, and the family withdrew life support “shortly after the surgery,” the state complaint said.
• “E.W.,” a 26-year-old female hoping to donate her left kidney. A previous CT scan showed kidney stones developing in the remaining right kidney, and Kortz should have discussed and documented the dangers of retaining only one compromised kidney, the complaint said.
During the kidney removal, one of E.W.’s veins started bleeding; while working on that, Kortz allegedly injured an aorta with a scalpel held by the robot. E.W. lost blood pressure and had to be resuscitated. The robotic surgery was converted to an open surgery, and harvest of the organ was aborted.
Transplant centers are under tight scrutiny from regulators and accrediting groups as more hospitals advertise expertise in the complex procedures. Losing a potential donor organ is a blow, as waiting lists for kidneys are years long.
The 11 cases cited by the state include two where a sponge or another instrument was left inside patients, who then had to be reopened to remove the piece; and two cases where Kortz allegedly used an artery clip that the manufacturer had said years before should not be used in similar surgeries.
State officials said that in May, a date will be set for a hearing of the medical board complaints before a judge.
Michael Booth: 303-954-1686, mbooth@denverpost.com or twitter.com/mboothdp