Distaste for Their Own Medicine

Dr. Ram Krishna delivered the best news possible to Mary Nixon: Her daughter, Billye, did not have cancer.

Too bad he was wrong.
Krishna, a Yuma orthopedic surgeon and secretary of the state Board of Medical Examiners (BOMEX), thought Billye's cancer was a simple fracture. But when Mary tried to get BOMEX to look into whether Krishna was negligent, she discovered the agency isn't any better at disciplining its own top officials than it is at dealing with other doctors.

Krishna's colleagues on the board dismissed the complaint against him--which is about par for the course for the agency. Later this year, Krishna and the other members of BOMEX will decide a complaint against departing board chairman Dr. Philip Keen. If past history is any indication, that complaint also will be dismissed.

Keen and Krishna both say they did nothing wrong in the cases against them, and both point out that individual board members do not vote on their own complaints.

But members of BOMEX regularly sit in judgment of each other's actions, and in those cases, BOMEX's staff has to investigate its own bosses. Even though this raises the possibility for conflicts of interest, there is no other procedure to handle complaints against board members.

Of the eight current physician members of BOMEX, three have had complaints decided while they've been on the board. Another had a complaint filed while she was a medical consultant for BOMEX. All complaints were dismissed.

Keen says board membership doesn't make any difference in how a complaint is handled.

He's right about that. BOMEX's average isn't any better for other doctors. The board doesn't discipline physicians in nearly 90 percent of the cases that come before it.

Keen won't actually be on the board by the time BOMEX gets around to voting on his complaint. He was replaced last week, after nine years with BOMEX, by Dr. Richard Carmona. Carmona has had two complaints filed against him--one for malpractice and one for quality of care. Both were dismissed. The board has not yet elected a new chairman.

Exactly what Keen may have done wrong is unclear. BOMEX won't release details of a complaint against a doctor until the matter has been resolved. Keen's complaint falls into a category BOMEX calls "other violations of law."

Keen, who is also Maricopa County's medical examiner, says the complaint rose out of his decision to keep a family from viewing the body of a relative in the morgue. The complaint is "quite frivolous," Keen believes.

"I do not permit the family to see them, certainly not before I see them," he says. "I prefer that they remember them as they were, and not as they are."

But Keen doesn't think it makes a difference whether a physician is on the board when it comes to applying the law. "I would like to think that you take the same due diligence, in terms of justice being blind. I really look at the case on its own merits."

That's small comfort to Mary Nixon, whose daughter died July 23, 1996.
"She was the most thoughtful child I had," Mary Nixon says. "It's still hard. I miss her terribly."

Billye was developmentally disabled and lived at home. While on vacation at the family's summer place in Show Low, she fell and hurt her leg. A local doctor who x-rayed the injury told her there was a fracture. Even worse, he said Billye might have bone cancer--an aggressive, painful and often fatal form of the disease.

Mary took Billye to Krishna, who looked at the x-ray and a bone scan and said there was no cancer--just a break and a cyst. He put a cast on Billye's leg and sent her home.

"I was so relieved, I didn't want to question any further," Mary recalls.
However, when the cast came off, what Krishna thought was a benign cyst turned out to be life-threatening. "Then he really got excited, and then he was really apologetic," Mary says.

Billye was sent to Phoenix, where her leg had to be amputated below the knee in an attempt to stop the cancer that would eventually claim her life.

Nixon says she was told by her physician in Phoenix that chemotherapy could've started four weeks earlier if Krishna had caught the cancer.

Krishna disputes this. He says there was no time lost, even though he didn't diagnose the cyst as cancerous on the first visit.

Krishna maintains that the bone scan he did showed no evidence of cancer. "Most of the time, you have a benign cyst, and have a fracture, too," he says. He believes the cancer was only evident after four weeks. Krishna also says Billye would have had to have the amputation anyway.

Nixon, however, felt Krishna should've done a biopsy on the first visit. "It would have saved Billye from some of the severe pain she is still suffering," she said in a May 1996 complaint letter to BOMEX, written while Billye was still alive.

BOMEX dismissed the complaint in October 1996, after a preliminary investigation. Nixon is still not sure exactly why.

"They sent me a tape of the meeting, but it didn't say anything. It was just when they decided to throw this out, with no negligence," she says.

Krishna says there's no conflict of interest because he left the room while the other board members reviewed the case. An independent medical consultant presented his findings to BOMEX, and then the members voted to dismiss.

"When I came back, I was not aware of what happened in that case until I got a letter from the board," Krishna says. "To this day, I am not aware of who that independent expert was."

That still doesn't change the fact that, in cases like Keen's and Krishna's, BOMEX's investigators and medical consultants are asked to evaluate the conduct of their bosses.

Keen, however, sees no alternative.
"I really don't know where else you would send them [complaints against board members]," he says.

There is no provision in state law to send these cases to outside consultants, Keen says. And Claudia Foutz, BOMEX's recently hired executive director, says she doesn't know of any state medical board that has a way to avoid voting on its own members.

Foutz says that if the disciplinary process is working properly, it shouldn't make a difference who's before the board. "It's the system that prevails, not the personality," she says.

But BOMEX's system has serious problems. The board currently has a backlog of more than 1,100 cases, and takes more than 16 months, on average, to resolve complaints. Many of the most serious complaints, which could mean suspension or revocation of a doctor's license, are stuck waiting for BOMEX to schedule hearings. In addition, the agency recently has lost key staff members.

Krishna says the board's process prevents conflicts of interest in cases against BOMEX's physician members. "I think we should leave the room. That's the right thing to do," he says.

That's not good enough for Mary Nixon.
"It's doctors that are judging these things about other doctors," Mary Nixon says. "They're good old boys."

Read more New Times' coverage of BOMEX

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