Patients complain about B.C. surgeon barred in Arizona

Several people in Quesnel, B.C., have filed complaints about their hospital's general surgeon, Dr. Fernando Casses. They claim they suffered needlessly and were damaged permanently when he failed to address serious complications from his surgeries.

"He said to me, 'Lady, you just had surgery. Go home and have a hot bath,'" said Tammy Mead, who said she ended up at "death's door" following routine gallbladder surgery at G.R. Baker Memorial Hospital.

"After the third day, I knew there was something wrong because I was throwing up green bile. He had cut my liver, my bowel and my intestine," Mead said.

Mead and several other complainants said they were also shocked to learnCasses had been asked to leave his medical practicein Arizona, but was later granted a permanent licence to practise in B.C.

After Casses "dismissed" her symptoms on followup, Mead said, her husband rushed her to another hospital, where other doctors performed emergency surgery.

"If I wouldn't have taken Tammy to Prince George to emergency she wouldn't be here today," said Chuck Mead.

The former patients and their families are speaking out in frustration. They believe their complaints weren't taken seriously enough by the College of Physicians and Surgeons of B.C.

"All of us have complained," said Robin O'Diorne, whose complaint to the college was not upheld. "What are they doing? What is anybody doing?"

Complaints and lawsuits in B.C.

At least nine complaints have been filed. In six of those cases, the complainants were later informed that the investigation was completed. Three of the complaints were upheld, including Tammy Mead's. However, the college did not criticize Casses in three others. After hearing his explanations, it agreed his treatment was appropriate.

"As far as [the college] is concerned, our case is written off," said Doug Backer. His mother, Edith Backer, died last year after her bile duct and pancreas were sutured during gallbladder surgery. The college said it "would not be specifically critical" of Casses for how he handled her case.

Three B.C. lawsuits have also been filed against Casses two have been settled and one is set for trial next year.

"We were told we didn't have enough time or money to take him on [in a lawsuit]," said Chuck Mead.

O'Diorne, Mead and others said they realize all surgery is risky,but they were shocked to discover how similar their experiences were.

The most common complaint is not just that they suffered complications after Casses operated on them, but that he refused to acknowledge and/or treat those complications.

In most cases, they said, serious perforations or post-surgical infections were not revealed or treated until after other physicians became involved.

"[The other surgeon] told me that it was 'a bloody mess' in there and if it had been the next day he would have been on the golf course, and I probably wouldn't have survived," said O'Diorne, who's suffered complications after she said her bladder was "nicked" during surgery by Casses.

The patients want to know why Casses has been allowed to practise in B.C.

"The College of Physicians should give a reason why they did that," said Caroline Mitchell, daughter of the patient who died. "Why would they allow that when they knew his history?"

'Unprofessional conduct' in Arizona

Nine years ago, Casses's privileges were suspended at a hospital in Sun City, Ariz., following surgical complications there. Before coming to Quesnel, he surrendered his Arizona medical licence, admitting to "unprofessional conduct" in one case.

"Because [Casses] was not allowed to practise in Arizona why is he allowed to practise here?" asked Krystal Cook, whose grossly swollen and infected toe had to be removed by another surgeon.

The College of Physicians and Surgeons gave Casses a "temporary/provisional" licence when he came to B.C. from Arizona in October 2000. His B.C. licence was made permanent in 2003.

Casses declined to be interviewed by CBC News about his background or the specific complaints against him, citing patient confidentiality.

The College of Physicians and Surgeons of B.C. also refused a request for an interview and would not explain why Casses's first licence was temporary or how and why it was made permanent. Spokeswoman Susan Prins said all doctors under temporary licence are supervised.

The complaints from patients who spoke to CBC News were all about surgeries performed by Casses after he got his permanent B.C. licence in 2003.

Tammy Mead feels she "won" in her complaint to the college in 2005. Casses insisted his surgery did not cause her injuries but the college disagreed with him. It also advised him to follow his patients more closely.

"My bowels were shutting down and they were going to put me on a bag for the rest of my life with 12 IV's.I wish they'd seen that picture," said Mead.

"They need to investigate him fully," she added.

Doctor says all surgery has risks

In a written statement, submitted to CBC News through his lawyer, Casses pointed out "every surgical procedure has inherent risks" and that accidental perforations are quite common.

"I have performed over 5,000 (five thousand) surgical procedures in the span ofnine years," he wrote. "My surgical complication rate is approximately .3% (point three per cent!), well below the average for a general surgeon."

However, Dr. David Butcher, vice-president of medicine for B.C.'s Northern Health Authority, told CBC News that Casses has performed 1,500 surgeries in Quesnel since becoming a full-time surgeon there eight years ago.

If Casses's surgical complication rate is .3 per cent, then only 4.5 surgeries of his surgeries at the Quesnel hospital should have resulted in complications. CBC News has found 18 cases there, where patients or their families said there were complications following surgery by him at G.R. Baker.

Butcheralso said doctors calculate their own surgical complication rates and those figures are not tracked by the hospital. If a patient's complication is treated at another hospital as many of the complaining patients were he said that would not reflect back to the original surgeon's records.

"That would not show up in our system," saidButcher. "We are currently working to develop a physician-specific performance management system."

"Following surgery," Casses said in his statement, "my invariable practice is to ensure that each patient is given a truthful and accurate explanation, in plain English, concerning his or her surgery, and I appropriately follow them to the best of my ability in recovery."

"If a complication has occurred, they are given an explanation of the circumstances of that complication," he added.

Leigh-Anne Monahan is another patient who filed a formal complaint to the college, but she said she received no response. She sued Casses, claiming he failed to identify her deteriorating medical condition after surgery.

"He was supposed to just tie her [Fallopian] tubes. Instead, he cut the ligaments that go alongside the tubes and she just about bled to death," said Wendy Monahan, who said her daughter received an out-of-court settlement from Casses in 2007.

In the recovery room, her mother said Leigh-Anne heard the nurses arguing with Casses about her condition telling them she was not OK, while he insisted she was.

"Why would he argue with the nurses when her vitals were crashing?" asked Monahan.

She said another doctor stepped in and saved her daughter's life and later told the family it was "a matter of minutes before her heart would have stopped."

"It was so scary. I will remember that for the rest of my life," said Monahan.

'Cone of silence' criticized by patient group

Phil Hassen, chief executive of the Canadian Patient Safety Institute, said all surgeons have an ethical obligation to disclose and treat any adverse event as soon as possible. He said non-disclosure causes serious problems for the health care system.

"It's a cone of silence," said Hassen. "The problem is that if someone is harmed there are consequences that could be fairly severe, and therefore the disclosure is to be able to take care of it right away."

"[Casses] never admitted to doing anything," said Stephanie Aaslie, who said her life was also at risk from complications following gallbladder surgery.

"The only thing he had said is there was an infection inside of me, that had pooled inside of me, but he was going to let it run its course," said Aaslie.

Her husband said he pulled her out of Quesnel and got her to another hospital, after her eyes rolled into the back of her head and hospital nurses urged him to get another doctor.

"The nurses pulled me aside and said, 'We are really concerned about her, and we feel that you should go and get a second opinion,'" said Stig Aaslie. "I believe they went beyond what they are allowed to do."

Other doctors found a large amount of bile in her abdomen, Aaslie said. There was a bile leak at the site of a T-tube installed by Dr. Casses.

Because she was young and nave when it happened, she said, she did not file any formal complaints.

"How many people are really out there like us?" asked O'Diorne.

"The hospital should go back to every surgery that man has performed and do a followup on every one of them," suggested Backer.

Casses obtained his medical degree in Bogota, Colombia, in 1981 and completed his residency at the University of Toronto teaching hospital, from 1986 to 1991. Two years later, he was licensed to practice in Arizona.

In 2000, the Boswell Memorial Hospital in Sun City suspended his privileges to perform surgeries there, citing "quality assurance concerns."

Arizona doctor 'horrified' by cases

Dr. Tim Hunter, vice-chair of the Arizona Medical Board at the time, told CBC News the hospital then submitted several patient cases to the board for review.

"I was just horrified reading the cases," said Hunter. "There were a large number of very poor surgeries and a number of people harmed."

"There were many, many bad cases. It wasn't just an isolated case where there was an accident," he said. "The complications he had and the large numbers of them were way beyond expectations."

One of those cases was Beverly North, who died six weeks after Casses cut a major vein, during vascular surgery to remove blockages in her legs.

"She lost so much blood," said her daughter Sandy Hix. "They had to fill her with saline water to keep her alive."

"He drew a little thing on a napkin and said he nicked her vein and she lost a little bit of blood and everything was fine from the surgery but when she got to ICU, she had a heart attack," Hix said.

An autopsy later showed her mother's heart was healthy and undamaged.

"If my mom had died right away, that night [after surgery] my family would not know what really happened," Hix added.

Casses left for B.C. soon afterward, in the fall of 2000.

After North's death, the family sued Casses and the hospital. A Maricopa County jury found him 90 per cent at fault. Hix said the Arizona Medical Board told her that her mother's case was number 17 on the list of problem surgeries by Casses, reported by the hospital.

The Arizona Medical Board held a hearing in January of 2001 and decided to summarily suspend Casses's licence, if he didn't surrender it within 30 days.

Because he knew Casses had spent time in Canada,Dr.Hunter wanted to see a paper trail preventing the doctor from practising in Canada.

"I wanted documentation that we were in the process of trying to have his licence either surrendered or revoked," saidHunter.

Casses surrendered his Arizona licence the day after that hearing, listing his address as Port Alberni, B.C.

Although the board had reviewed several of his Arizona cases, he admitted fault in only one, agreeing he "fell below the standard of care which might have been harmful to the health of a patient."

By that time, he was already working at his new job as a surgeon at the West Coast General Hospital. He had received his new B.C. medical licence three months earlier.

B.C. licence obtained before U.S. investigation

To get that licence, the college indicated Casses would have had to produce a "certificate of good standing" from Arizona which he could have obtained before the Arizona investigation began.

"When we saw him and interviewed him [in the fall of 2000] there was nothing in the pipeline," said Dr. Robert O'Dwyer, head of internal medicine for West Coast General.

"He had a letter of good standing [from Arizona]."

He said Casses told them nothing about any trouble he might have been facing. "He gave us references," he added, "They were good references."

Later, when Sandy Hix saw Casses's new Canadian address listed on the Arizona document she called the health authority in B.C. to report his history.

"I was astonished to get her call," said Dr. Robin Hutchinson, who wasvice presidentof medicine for the health authority at the time. "I then reported it to the college, which is my duty," he added.

Hutchinson said hospital brass then informed Casses of what they knew.

"He just up and left," said O'Dwyer. "It was a big blow to us."

The College of Physicians and Surgeons suggested it would have contacted Arizona after Casses's history was reported to them.

"If we learn of an incident that causes us concern after a licence has been granted, we would certainly make contact with the appropriate regulatory authority to gather more information for an investigation," wrote spokeswoman Susan Prins in an email.

Casses then spent a short time working at the Creston Valley Hospital in the B.C. interior. That resulted in his first B.C. lawsuit from a patient named Carol Alvarez, who alleged his hernia surgery resulted in painful, "grotesque" scarring. The lawsuit was settled in 2006.

According to Dr. Becky Temple, northeast medical director for the Northern Health Authority, when Casses applied for credentials to work in Quesnel, in 2001, he wrote a letter, as part of his application, advising them he voluntarily gave up his privileges in Arizona because of complaints about one case there.

Health Authority didn't check background

She said the health authority did not check with the Arizona Medical Board, to see if it knew of more cases or what its overall assessment of him was.

"That would not be a normal procedure for the hospital," saidTemple. "If he was granted licence in the province of British Columbia, that would be sufficient for us."

Temple said Casses provided three positive references, as every applicant is required to. She added, his hospital credentials are reviewed every year.

"If he was stopped from operating now the health authority might have to admit they were wrong [to give him credentials], " said Leigh-Anne Monahan's daughter, Justine Norgaard.

The college doesn't tell the public anything about individual doctors, except whether they have a licence, unless the doctor has been disciplined. Casses has not been.

"The college is not able to provide information about an individual registrant, including details of his/her application for licensure, complaints filed against him/her, or any subsequent investigation," spokeswoman Prins wrote.

That means even when complaints from patients are found valid, as in Tammy Mead's case, that information is not released.

"Don't they have the responsibility to protect us?" asked Mead.

"Why wasn't all of it public knowledge?" said Krystal Cook. "Why didn't I know that he wasn't allowed to practise in Arizona? I shouldn't have been 19 years old and missing a toe."

Temple said she would not speculate on what, if any, action the health authority might take, now that it has new information on Casses's history.

"Northern Health will accept and investigate and respond to all complaints from all patients who feel they have been harmed by any physician who practises in Northern Health," she added.