A MEDICAL MOVING TARGET
Doctors who surrender license in one state can practice in another – and you might never know
In Louisiana, Larry Mitchell Isaacs gave up his medical license after he removed an allegedly healthy kidney during what was supposed to be colon surgery. ❚ In California, he mistakenly removed a woman’s fallopian tube. More surgeries on the woman followed, including one in which he allegedly left her intestine unconnected. Facing state sanctions, he surrendered his license there, too. ❚ In New York, where regulators were moving to take action based on his California problems, he also agreed to give up his license. ❚ But in Ohio, he has found a home.
There, his medical license remains unblemished, allowing Isaacs to work at an urgent care clinic in the Cincinnati area.
Surrendering a license is often done in the face of overwhelming evidence of unprofessional conduct.
States can take action against doctors based on license surrenders in other places, but some states don’t even search a national database of troubled physicians.
Voluntary license surrenders can mean the public gets no access to information about what happened.
More than 250 doctors who surrendered a medical license were able to practice in another state, an investigation by the Milwaukee Journal Sentinel, USA TODAY and MedPage Today found.
“There seems to be an inconsistency and danger. As a physician, I want our patients to be safe, and I want these people not practicing,” said John Harris, an assistant professor of medicine at the University of Pittsburgh Medical Center who has researched how doctor discipline varies from state to state.
In a third of the 250 cases, doctors who surrendered their licenses were able to practice elsewhere without any limitations or public disclosure, simply by changing their addresses.
In the other cases, they faced disciplinary action that patients might not be able find out about.
The analysis used data provided by TruthMd, a private firm that compiles information on doctors from thousands of sources, such as state medical boards and local courts. The analysis was limited to doctors who had action by a state board recorded since 2013.
Isaacs said he gave up his licenses in California, Louisiana and New York to avoid costly legal fights. In defending his actions, he provided letters from other doctors who said he acted appropriately. “I didn’t do anything wrong anywhere,” he said.
In case after case, a license surrender in the face of discipline for bad behavior in one state was met with far more lenient discipline – if any punishment at all – in another.
❚ Heart surgeon Sean Yetman performed just seven surgeries at Meriter Hospital in Madison, Wisconsin. Two patients died. Malpractice lawsuits were filed in both cases. Yetman surrendered his Wisconsin license in 2014. He was able to continue practicing in New York, where he had a license.
❚ In February 2015, cardiologist John Strobeck was charged by the Passaic County, New Jersey, prosecutor’s office with criminal sexual contact. He allegedly had inappropriate sexual contact with six female patients in an exam room “under the guise of providing medical treatment.”
Six months later, Strobeck agreed to surrender his New Jersey license. California took action based on the case, and he surrendered his license there. In New York, he has no restrictions. The original charges are still pending. “All of those cases are troubling,” said Michael Carome, a physician with Public Citizen, which has studied state-tostate variation in doctor discipline. “Actions should have been taken against them in the states where they remained licensed.”
Secretive system hides problems
In some states, surrenders are particularly secretive – leaving patients in the dark about what happened.
Records show that psychiatrist Robert Sack permanently surrendered his Maryland license in 2012 rather than face discipline – but his public file does not spell out what he did.
Neighboring Virginia quickly suspended him from practicing there.
Shortly thereafter, he opened a legal battle to be allowed to practice in Pennsylvania. The Pennsylvania board issued a reprimand, but it allowed Sack, who specializes in child and adolescent psychiatry, to practice.
In fact, by surrendering his Maryland license, the board said, he demonstrated “the good moral character and judgment the Board expects from its licensees.”
To try to determine what prompted the case, reporters filed a series of open records requests. Maryland refused to release any documents. Pennsylvania released several hundred pages of material that showed the surrender stemmed from a romantic relationship with a former patient.
Sack did not respond to efforts to reach him through his attorney and his employer. His attorney declined to comment.
State hopping begins in California
Isaacs’ problems began in California. On May 4, 2009, a woman identified in records only as “G.G.” was admitted to the Henry Mayo Newhall Memorial Hospital in Valencia with abdominal pain. Isaacs suspected she had appendicitis. A medical board document says he failed to perform the proper diagnostic tests. Indeed, G.G. didn’t even have an appendix.
Isaacs instead took out a fallopian tube, according to the documents. Four days later, the hospital discharged her.
On Feb. 6, 2010, she returned to the hospital, again complaining of abdominal pain. CT scans indicated she had a hernia in her abdomen and a second one in the pelvis. Isaacs performed surgery.
Six days later, X-rays showed a hernia in the same area. The documents say either there was a different, undiagnosed hernia, or Isaacs’ surgery was inadequate.
A few days later, another CT scan showed a large hernia that involved the small intestine. Isaacs performed another surgery, removing part of G.G.’s small intestine. That same day, he operated on her again.
Over the next few days, CT scans showed that Isaacs had left a portion of her intestine unconnected, creating an environment that allowed infection to occur, documents say.
On March 2, G.G.’s care was transferred to another surgeon. Isaacs was relegated to an assistance role.
California records do not indicate what happened to G.G.
Isaacs said she is doing well. He acknowledged she sued him and received a $310,000 settlement. He said he told the insurance company to settle.
In 2014, G.G.’s case wound up in front of the California medical board, when Isaacs was accused of gross negligence and incompetence.
Isaacs admitted only to inadequate record keeping. He agreed to surrender his California license in 2016.
A serious matter
There are tools to help medical boards stay up to date on the actions of the doctors they license. The National Practitioner Data Bank was started by Congress in 1986 as a central repository for malpractice payments, state disciplinary actions, restrictions from health plans or hospitals and other limits on any health care professional.
It’s open to hospitals, insurers and state medical boards, but it is not available to the public. Medical boards often don’t even use it. Last year, 30 medical boards performed fewer than 100 searches; 13 didn’t perform any.
Attorney Eli Stutsman of Portland, Oregon, who specializes in representing medical professionals, said he represented at least two people who got the help they needed and are back at work, without any new problems.
“Do they have some history? Yes. Did they make some compromises to return to work? Yes. Are they reinstated? Yes, and I wouldn’t be afraid to see either of them,” he said. “Regulations are stringent and good practitioners have been caught up in this. I’d be careful to not paint with such broad strokes.”
A second chance, then a third
In January 2012 – as Isaacs faced potential discipline in California – he moved to Bastrop, Louisiana, and went to work at Morehouse General Hospital as a surgeon.
Shortly thereafter, Isaacs informed the Louisiana board that a hospital in the state had suspended his privileges.
The Louisiana board accused Isaacs of failing to recognize he had removed a healthy kidney from a patient during colon surgery. Isaacs denied the allegation, but in the fall of 2013, he agreed to surrender his Louisiana license. He told the board he had moved to New York.
In New York, Isaacs worked in 2013 and 2014 as assistant director of trauma services at a hospital in Middletown, about an hour and half north of Manhattan, according to his resume.
The New York board cited his California license surrender in 2016 as evidence of misconduct. That led Isaacs to agree to permanently give up his license in New York in 2017.
Isaacs works at Tri-State Urgent Care in Cincinnati.
Citing confidentiality rules, Tessie Pollock, a spokeswoman for the Ohio medical board, would not say why the board has not taken action against him.
In an interview and emails, Isaacs offered a detailed defense of his conduct in the three states where he no longer is allowed to practice.
He said a big reason for giving up his licenses in California, Louisiana and New York was the cost of defending against the allegations, including paying attorneys who charged hundreds of dollars an hour. He claimed the system was rigged against him.
He said he did not leave the intestine of the California patient, G.G., unconnected, as the medical board alleged. He said sutures broke down, which allowed the intestine to leak.
He said G.G.’s lawsuit was settled because it would be hard to win the case, since many of the jurors would have been Hispanic and identified with the patient.
In the Louisiana case, Isaacs denied the board’s allegations and said he improperly dictated the surgery into the medical record. Had he dictated it properly, he said, it would have been clear that removing the kidney was warranted.
Isaacs said Ohio is the only state to fully investigate all the cases and it concluded he should be allowed to practice.
Still, he said, he no longer does surgeries.
“This was my last stop,” he said. “I’m going to be 64 years old. I am just working as a physician and trying to live out my last years in peace.”
John Fauber is a reporter for the Milwaukee Journal Sentinel. Matt Wynn is a reporter for USA TODAY. This story was reported as a joint project of the Journal Sentinel and MedPage Today, which provides a clinical perspective for physicians on breaking medical news at medpagetoday.com.
“As a physician, I want our
patients to be safe, and I
want these people not prac
ticing.”
John Harris University of Pittsburgh Medical Center