Why Don't Doctors Stop Lousy Doctors?

If the public's first line of defense against lousy doctors weren't sometimes a joke, there wouldn't be surgeons in this state performing unnecessary operations on innocent people. But even doctors admit there are major flaws with that first line--a state law requiring hospital physicians to police each other in secret "peer review" meetings. Doctors acknowledge they're terrified of lawsuits by peers they judge to be incompetent. As a result, questionable doctors continue practicing and innocent people end up paying the tragic price.

Questions about the value of the peer review system have been spotlighted as officials try to sort out the allegations against Dr. Ranjit Bisla. Through the years, at least four Valley hospitals have had peer-review concerns about Bisla, New Times has learned from public records and the doctor's own testimony. And although some of the allegations against the doctor were horrifying, Bisla maintains staff privileges at three of those hospitals.

Bisla's most serious peer-review clash occurred at St. Luke's Medical Center. In 1987, the hospital suspended his privileges to practice medicine for a few days, but then reinstated him. However, Bisla sued the hospital in 1988, contending the "groundless" suspension robbed him of his due process and caused him to suffer "anxiety, embarrassment, humiliation, emotional distress, loss of sleep, loss of employment, loss of benefits, loss of income and damage to his reputation."

Because the law specifies peer reviews are totally secret, the only insight into St. Luke's suspension comes, ironically, from Bisla's lawsuit against the hospital. His suit spells out St. Luke's allegations:

* inadequate surgical care of Alex Feldhuhn, a patient whose own malpractice lawsuit is currently pending against Bisla and the hospital, * "questionable prescribing practices for patients with documented substance abuse histories," * "an allegation that [Bisla] untruthfully revealed only one of a number of lawsuits against him when completing his reappointment applications." In responding to Bisla's suit, St. Luke's argued it should be immune from such litigation because it was simply obeying the peer-review statute. Bisla's suit against the hospital is pending. And so is the case St. Luke's specified when it temporarily suspended Bisla in the first place.

Alex Feldhuhn contends both Bisla and the hospital were negligent in treating his broken leg. As a result, he says, one of his legs is three inches shorter than the other. He also charged in court papers that Bisla got him hooked on "excessive narcotics."

Feldhuhn's malpractice suit says he was admitted to the emergency room at St. Luke's in 1983 after a diving accident. An admitting x-ray revealed that one of the bones in his thigh had a simple fracture. But after Bisla operated to repair the leg, records say, he told Feldhuhn that he'd discovered the bone was "a mess." Bisla blamed the hospital for dropping Feldhuhn's leg in the traction room. Feldhuhn blamed Bisla, who admitted in court documents that he'd broken a metal rod while trying to secure it to Feldhuhn's bone during surgery. Feldhuhn declined to be interviewed. "I'd like to talk to you," he said, "but my lawyer calls the shots."

Bisla and the hospital have both maintained in court records that they were not negligent in treating Alex Feldhuhn.

St. Luke's isn't the only hospital Ranjit Bisla has sued over staff privileges. In 1986, he sued Chandler Community Hospital after it refused to let him practice there. The little hospital said it based its rejection on Bisla's "failure to provide accurate information on past and present malpractice cases." Bisla's suit was later dropped, and he recently testified he "withdrew" his application to practice at that hospital.

Bisla also has revealed that St. Joseph Hospital's peer-reviewers scrutinized him at least once. He admitted to Bomex that St. Joe's insisted another doctor approve the necessity of ten spine and back surgeries he wanted to perform there.

Bomex records also show that peer reviewers at Humana Hospital were asked to monitor Bisla. Dr. William Helme told Bomex last January that he once asked both Humana's "chief of staff and the chief of surgery" to "audit" Bisla's surgeries. Helme testified the chief of surgery told them after the review, "Bill, you understated the case." However, Helme said he heard the audit results were "swept under the table."

Bisla's attorney, Dan Cracchiolo, tried to discredit Helme at that January hearing and asked him to explain, if he were so concerned, "why did you not do more?" Helme replied, "I had done what I could. . . . I was sort of helpless." An attorney who specializes in health-care law says doctors will continue feeling helpless unless the state law is changed. "Society has an interest in seeing that doctors are qualified," says attorney Barry Halpern. "But there are some situations where physicians are unwilling to be as overt as they should be because of the threat and cost of litigation." Halpern suggests the law be changed to give doctors "absolute immunity" from being sued for their peer-review decisions.

"The problem is big enough and real enough," he says, "that it should be tried.

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Terry Greene