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Just Make the Pain Go Away

The nagging aches and pains from a minor traffic accident sent Eileen and Paul Moore to the doctor in 1982. They just wanted him to make their pain go away. But over the next 23 months, until their insurance ran out, Dr. Ranjit Bisla sliced into their bodies ten different times--seven surgeries for Eileen, three for Paul. She was 38 then; he was twenty years older and in excellent shape from his years as a truckdriver and dockworker.

Now you can't stay very long in the small, warm living room of the Moores' Phoenix home without hurting right along with them.

Eileen Moore is 45 years old now, but she slumps in her easy chair like an old woman. Her feet rest heavily on a footstool. Some days, when the pain gets so bad she can't walk, Paul rents a wheelchair so she can get around. Paul Moore's "deep-bone pain" keeps him from sitting or standing in one position for more than ten minutes. "I eat Tylenol with codeine," he says.

The Moores wonder how this nightmare could have happened to them. Or how they allowed it to happen. They feel hurt and betrayed by the nice doctor they had so trusted. And they live each day wondering if a single surgery was even necessary.

EILEEN MOORE didn't have a single doubt at first. When she trusted Bisla enough to remove a disc--the cushion-like material between each vertebra--from her back. Or when she trusted him enough to replace both of her hips, one by one, with artificial hips. Or when she trusted him enough to operate twice on each knee. Problem was, an infection crept into one of her knees and ate away at her bone. She had to stay in the hospital for five weeks that time, but even now she recalls warmly that Dr. Bisla got her out of the hospital for Mother's Day.

She kept thinking each surgery was the last, only to find her doctor suggesting another one was necessary. It was only after both hips had been replaced, she contends, that Bisla told her the surgery would probably have to be repeated in ten years.

None of those surgeries took Eileen Moore's pain away. She has it still. On the days Eileen feels well, she hobbles around her small house trying to get the housework done. One leg is now shorter than the other and even on good days she has a peculiar gait. But what saddens her the most is that even after she's swallowed her pain pills, some days it still hurts too much to cuddle her grandchildren. Paul figures his pain has a lot to do with the three times Bisla operated on his back. As he recalls, Bisla told the couple that if they wanted to live in pain, they wouldn't need his help. But surgery would make the pain go away. He'd fix them right up, they remember him promising. So Paul docilely permitted the doctor to remove bits and pieces of his vertebrae; strip off a few discs; graft part of his hip to his spine.

After each surgery, Paul recounts now, the recovery period stretched on and on, never concluding before it was time for another operation that was intended to kill the persisting pain.

Paul recalls the time he'd just come out of the hospital when Eileen checked herself in for one of her seven operations. Paul wanted to visit his wife, but he couldn't turn his neck enough to safely drive the car. His mother-in-law sat beside him in the car, telling him when it was okay to change lanes.

Back then, the Moores couldn't even imagine that one day they'd sue this kindly doctor who had promised them relief. Or that at least a dozen other patients would sue Bisla for medical malpractice in just five years in Maricopa County Superior Court. Or that Bisla would become a "household word" at the Arizona Board of Medical Examiners (Bomex).

Later this month, a formal hearing will continue on Bomex's allegations that in 1985 alone, Bisla needlessly sliced into people's backs ten times. At the least, Bomex could find the allegations are unfounded; at the most, it could stop Ranjit Bisla from practicing medicine in Arizona.

"SOMEBODY HAD TO say `Enough,'" says attorney Kenneth Clancy, who represented the Moores in their 1987 malpractice lawsuit against Bisla and Humana Hospital-Phoenix. The suit charged that Bisla's numerous surgeries--all done at Humana--had permanently disabled and disfigured the couple. It also alleged the hospital was negligent: Its staff doctors had not properly performed their legally required peer-review duties. If they had, the suit charged, they would have realized Bisla was operating far too often on the couple. Clancy said he took the Moores' case, as well as three others, after "about fifty" people called his office about Bisla. "I began to see a thread," he recalls, as each caller questioned another surgery Bisla had performed. "What Bisla was doing was dead-wrong," Clancy maintains. "He preys upon the weak, the susceptible, the non-knowledgeable, the infirm." In the Moores' malpractice lawsuit, Clancy specifically charged Bisla with negligence because of "his apparent readiness to do unnecessary surgery, his disdain of conservative treatment and his choice of inappropriate surgeries. . . . "  

In answering such allegations, both the hospital and Bisla denied they'd been negligent in treating the Moores.

Ranjit Bisla, 45, did not respond to written queries requesting an interview to discuss the lawsuits. When reached by telephone, he told New Times he wouldn't grant an interview at this time. His lawyer, Dan Cracchiolo, did not return this newspaper's telephone calls. The "thread" also is evident in Superior Court files. New Times has found that from 1983 to 1987, at least twelve other patients claimed that Bisla was negligent in treating them. Like the Moores, several of the victims also sued the hospitals where the surgeries took place, alleging that the hospitals' "peer-review committees" had not adequately monitored Bisla. (See related story on this page.) In each case, Bisla and the hospitals denied any negligence. Only two of those cases are still pending. The rest were settled out of court.

Clancy's four lawsuits all were settled, although there wasn't much to collect, he says. He found Bisla didn't have adequate malpractice insurance during the time he'd operated on Clancy's clients. "I flatly concede these cases were settled out on a discounted basis," the attorney says.

Many of those who sued Bisla and settled out of court either refused to talk to New Times or are not listed in the Phoenix telephone directory. Only one man was willing to talk on the record, and he agreed to an interview only if his name were changed. He's just had two open- heart surgeries, he says, and he fears that if he's branded as a fellow who sues doctors he may not get the best care. "You know how doctors are," he says.

In 1987, "Dwight" sued Bisla and a Tempe hospital in Superior Court. Both the hospital and the doctor maintained there was no basis for Dwight's charges of negligence. Both parties settled out of court for undisclosed sums. As with the Moores, Dwight discovered that Bisla did not have malpractice insurance coverage to cover his particular case. (In 1986, Bisla sued St. Paul Fire and Marine Insurance Company for refusing to renew his malpractice insurance. The company said in court papers that it dropped Bisla because too many malpractice claims had been submitted against him. The court ruled the company did not have to renew his insurance.) Dwight says he's especially angry about his piddling settlement because he lives out his days and nights trying to escape a red-hot pain that sears through his lower back and shoots down his left leg to his foot. Nothing, not even codeine-based painkillers, eases his agony. For five years, the sixty-year-old former accountant says he hasn't been able to make love to his wife, who is ten years younger than he. Or play golf. Or tend his beloved garden.

He blames it all on Bisla. In the short span of one month in 1984, Bisla operated twice on Dwight's spine. The first surgery entailed removing a disc and inserting a piece of bone from a bone bank into Dwight's back. Just days later, he told Bisla his lower back hurt. He says the doctor spent only five minutes examining him. Bisla said that a second surgery would make Dwight "good as gold," he recalls. This time, Dwight says, Bisla inserted metal rods into his back.

Dwight remembers that when the anesthetic cleared from his head, he felt a "grinding" in his back every time he was turned over by the nurses. But when he mentioned the pain to Bisla, who would pop into Dwight's room each day clad in orchid-colored surgical fatigues, the doctor would say Dwight was progressing well. Months later, a different doctor performed a corrective operation on Dwight's back. According to Dwight, the doctor said the metal rods had caused mounds of raw scar tissue to form. The scarring had damaged the nerves feeding into his lower back and leg, Dwight said. What's more, he says, the second surgeon discovered a misplaced cotton ball. He says that "Bisla never told me about that cotton ball." But Dwight suspects Bisla knew about the mistake, because his operative records say that an x-ray machine was wheeled into the operating room to try and find a foreign object in his body. KENNETH CLANCY REMEMBERS the long search to find an orthopedic surgeon to testify on the necessity of Eileen and Paul Moore's surgeries. What he found was that doctors are scared to death of being sued if they single out a peer who isn't doing a good job. They'd rather not be publicly critical. The only doctor Clancy could find to testify was Dr. Glen Bair. In a 1987 deposition, Bair said, "It seems that the way our system works is that the persons that try to straighten out doctors . . . are the ones that end up being punished. As opposed to the doctors that are not practicing to the standard of care." In sworn testimony, Bair has said he does not feel Ranjit Bisla practices "up to the standard of care" of his peers. The fear of legal retaliation is precisely why there's so much caution from Bomex, the state body empowered to monitor and discipline doctors. Bomex board members admit they won't take the ultimate step of pulling a doctor's license unless they have an airtight case that won't be overturned by the courts. Executive director Doug Cerf notes that his board has twice been forced to retract its disciplinary decision after a doctor challenged it in court.  

But critics say Bomex invites that grief by being inconsistent in how it reprimands doctors. While the law gives Bomex broad powers to protect the public health, critics note that mandate has been interpreted both liberally and conservatively, depending on the philosophy of the dozen sitting board members--nine doctors, one nurse and two members of the public, all appointed by the governor. "I'm of the opinion that Bomex is trying to do a better job, but it's like the criminal justice system," says Clancy. "They have an overwhelming desire to be more than fair. They presume innocence. All professionals, be it doctors, lawyers or architects, are just that way when they judge each other." The history of Bomex and Ranjit Bisla is a case in point.

A FORMAL HEARING IS SCHEDULED later this month on allegations that Ranjit Bisla has conducted himself in a way "which might be harmful or dangerous to the health of the patient or public." Specifically, the hearing will focus on Bomex's charges that in a single year, Bisla performed at least ten unnecessary back surgeries, mostly disc removals. It's taken a long time to get to this point.

Bisla first got in trouble with Bomex in 1982. The board sent a "letter of concern" to Bisla for not writing his operative reports promptly. Letters of concern, Bomex staffers say, aren't punishment, exactly. But they do document a doctor's performance in case of trouble down the road. And not keeping proper records is considered by Bomex as a sign of trouble. For all its inconsistencies, Bomex is adamant on this point: proper recordkeeping provides a paper trail so a doctor's performance, and the care patients are receiving, can be easily traced.

In 1983, Bisla was again called before the board for poor recordkeeping. "You owe it to yourself and your patients to do a decent job with your records," admonished David Ben-Asher, a Tucson doctor whose term on the Bomex board has since expired. The board wrote a second letter of concern, and Bisla promised that he'd do a better job with his records.

But Bisla was in identical trouble just two years later, when he was accused of not dictating an operative report until months after the surgery. Bisla blamed the hospital for losing the records. "I don't accept that," one angry Bomex doctor retorted.

According to Bomex records, Ben- Asher was particularly upset at that 1985 meeting. "You've become a household word," he told Bisla, noting the board had received seven complaints about the doctor. "There is something happening here I can't put my finger on," Ben-Asher told Bisla before the board decided to write a third letter of concern. "I think it may be time to take a hard look at where you're going and what you're doing."

In 1986, Bomex investigators randomly pulled Bisla's files. They questioned 37 of the 40 back surgeries he had performed that year. After a yearlong investigation of those cases, Bomex called Bisla back for an "informal interview" in March 1987. The doctor was accompanied by his lawyer, Dan Cracchiolo.

Bisla told Bomex that his neck surgeries were "95 percent" successful. He admitted that his back operations didn't always have such a high success rate, but pointed out he only operated on 40 of his 400 back patients. The reason for the low success rate with back patients, he said, was that other doctors had already operated on such patients.

"I usually don't do the back surgery for the first time," he explained. "They have usually had two or three surgeries before they come to see me. . . . They are still hurting so they come to me.  

"Those patients are failures when you begin with them."
Lawrence Housman, a Tucson orthopedic surgeon who had reviewed the cases for Bomex, countered: "My feeling is patients come to see the doctor not for an operation but for reassurance, and most of these get an operation."

"I think," Cracchiolo purred, "we're talking about a little bit of philosophy here, not a little, a lot, and with all respect to Dr. Housman, I don't believe you've got a situation where you've got any measure of incompetence at all." The lawyer also scolded Bomex for its "constant investigations" of his client: "Dr. Bisla, for the first time in his career, within the last six months, ever since this investigation started, has been sued five times for malpractice. . . . The insurance company has just dumped him, said the hell with him. So we're defending him without insurance coverage."

Despite Cracchiolo's pleas for mercy, Bomex voted to send Bisla's dossier to the state Attorney General's Office for a formal hearing. Only four of the eleven members present voted to dismiss the Bisla matter.

Among those who favored dismissal was Daniel Meredith, who had just been appointed to Bomex by former Governor Evan Mecham. Meredith announced that Bisla's answers to the board were "sensible" and "good." What's more, Meredith said, Bisla "seems to have gotten good results on his follow-ups . . . I was very happy and satisfied with his explanation."

Dr. Bisla himself later revealed that he had a professional relationship with Meredith. In fact, Bisla testified in 1988 that Meredith had referred "four or five patients in the last year" to him. In one surgery, Bisla testified, Meredith actually assisted him.

Cerf, the Bomex director, says Meredith didn't disqualify himself because he was new on the board. But, says Cerf, Meredith "now understands that if he knows a physician, he can't vote on the matter." Meredith, the father of House Majority Leader Jim Meredith, did not return New Times' telephone call.

Critics say Bomex took its own sweet time preparing the charges against Bisla. But Cerf points out the AG's Office, which legally represents Bomex, was no Johnny- on-the-spot, either. It took Bomex about a year to investigate the 37 different cases it pulled. Then it took the AG's Office another year to prepare for the formal hearing. The hearing finally was started in January. But then Bisla's attorney requested another delay because he was going to Switzerland. The hearing is expected to reconvene in late March and finish a few days later.

SPECIFICALLY, BOMEX alleges Bisla: * performed at least ten unnecessary back surgeries, mostly disc removals. * administered three unnecessary chemical injections into disc areas. The substance used in two of the shots was likened by a Bomex doctor to "meat tenderizer." * kept poor medical records in two different instances.

Depending on the outcome of the hearing, Bomex might decide to suspend Bisla's license. Or it might put him on probation. Or it might demand his surgeries be monitored. Or it might censure him. Or it might decide to do nothing.

Ranjit Bisla has denied all of Bomex's charges. He politely refused to interview with New Times because, he says, the hearing is pending. "I will tell you anything once they decide," he said.

But Bisla's position was made clear by his lawyer last January at a Bomex hearing. Cracchiolo contends competing doctors are out to get Bisla for financial reasons. According to Bomex records, Cracchiolo announced to a hearing officer that this "torture of hell" Bomex was putting Bisla through was actually a turf battle among greedy M.D.'s. The doctors who opposed Bisla were simply squabbling over "who the hell does back surgery and who lines their pockets with some money . . . this is all this case is really about," the lawyer said. Cracchiolo singled out Glen Bair, one of the few orthopedic doctors who has publicly criticized Bisla. Cracchiolo noted that Bair is a business partner with Dr. Steven Stein, a member of Bomex, and charged that Bomex's investigation was "motivated" by this association. Dr. Stein refused to comment on that allegation and has disqualified himself from any board action on Bisla. Bair did not respond to a New Times call.

RANJIT SINGH BISLA was born in India, where he graduated from medical school in 1968. Two years later he came to Arizona. He interned at Maricopa County General Hospital and quickly became a star. "Without a doubt, he has been our most outstanding orthopedic resident," one doctor wrote in a 1973 letter that is in Bisla's public Bomex file. "I can't emphasize what an outstanding young man he is and what worthwhile contributions I would expect from him in private practice." Bisla was licensed to practice medicine in Arizona in 1974. He also is licensed in New York and New Mexico, according to his file.  

Bisla has testified that he's written articles for orthopedic journals, that he was an instructor at Cornell University in 1975, and that he directed the county hospital's orthopedic residency program from 1975 to 1985. Bisla set up private practice in the early Seventies. "We've changed our name about three or four times," he once testified of his practice. "Originally we were Arizona Orthopedics and after that we were Valley Bone and Joint and last year we changed . . . to Arizona Orthopedics and Spine Center."

Somewhere along the line, Ranjit Bisla married and moved to a house in Paradise Valley. It was such a beautiful home that it was featured in the Arizona Republic's Sun Living section during one of Eileen Moore's hospital stays in the early Eighties. Eileen remembers reading the article and reasoning that since her doctor was already rich, he couldn't possibly be trying to make money off her surgeries. "These surgeries must be necessary," she remembers thinking to herself.

FOR ALL HIS detractors, Bisla maintains loyal patients and supporters. Most prominent are some of the very patients whose surgeries are being questioned as unnecessary by Bomex.

One woman, who had a disc removed by Bisla when she was in her early twenties, announced that the surgery didn't help her back problems. "It's like I never had surgery," she said. But, she stressed, Bisla did not force her into the procedure. A middle-aged woman said an operation Bomex called "unnecessary" actually cured a pain in her left arm. She is still Bisla's patient.

And a former Fry's grocery store cashier who had allowed Bisla to operate four different times said hotly: "It was my idea to have the surgeries, not his." This unflagging loyalty doesn't surprise Eileen and Paul Moore. Even after all they've been through, part of them still thinks kindly of Ranjit Bisla. "He was so nice to us," says Eileen. "Just very nice." That's why at first, when their friends suggested maybe the surgeries weren't all necessary, the Moores didn't really pay much attention.

They admit they were flattered to be Bisla's star patients. They liked the things he did for them. They never had to wait, even when the waiting room was so crowded that patients were standing out in the hall. The Moores were ushered right into the examining room. When they began suspecting that maybe their friends were right, they felt betrayed. "How could he do this?" Eileen asks over and over. What scares Eileen Moore the most is the thought of going into an operating room again. She even has flashbacks. One starts with her being rolled down to the operating room by the very same orderly who wheeled her to her seven operations. The flashback ends with everything going blank.

"I don't think I can take another operation again," she says. "I just don't think I can take it.


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