S.C. ranks last for disciplinary actions in medical profession

Doctor, addicted to cocaine, continued to practice in S.C.

By Matt Tomsic
mtomsic@scbiznews.com

In August 2006, Dr. Steven A. Matzinger used cocaine for the first time, snorting the drug through a straw while on a hunting trip.

“I was with a friend,” Matzinger said, according to a 2012 deposition. “We were going hunting in the evening, and I was going to sit out on a deer stand, and I took a hit.”

Matzinger’s drug use and medical practice continued for months, eventually leading to an investigation by the S.C. Board of Medical Examiners, which issued an order against Matzinger two years after investigators spoke with him. The board fined him but didn’t take his medical license, and Matzinger now practices in Myrtle Beach.

His case is one of hundreds that have come before the state medical board, and his story is told through malpractice lawsuits, a 65-page deposition, affidavits and other court documents.

They show a doctor who abused cocaine, had run-ins with co-workers and faced several malpractice lawsuits. One colleague refused to provide medical care for Matzinger’s patients because of liability reasons, and other colleagues said they wouldn’t allow Matzinger to operate on them or their family members.

Matzinger, meanwhile, said that he never came to work high and that his drug use didn’t affect his ability to practice medicine.

In some cases, medical professionals have kept their licenses after abusing drugs, having sex with patients, botching operations, leaving surgery while patients are sedated and performing operations on incorrect limbs.

A search of state arrest records did not show Matzinger has ever been arrested for his drug use.  Matzinger didn’t respond to phone messages.

“I would say that I abused cocaine,” Matzinger said in the 2012 deposition, adding the drug use didn’t detract from his abilities as a surgeon. Later, he added: “I think what a physician or any person does in their personal time, as long as it’s not affecting their work, is really none of my business as a person or a patient. I think there’s numerous examples of individuals that have trying issues in their personal life that they don’t allow to enter their professional life. And I feel that I was an upstanding and good surgeon then, and I feel that I’m an upstanding and good surgeon now.”

Matzinger attended the University of Toledo College of Medicine and graduated in 1996. He became chief surgical resident at
Mercy Hospital in Pittsburgh after graduation, working there until 2001 and winning two teaching awards in his final two years there. His specialty is general surgery, and he is certified by the American Board of Surgery.
After his residency, Matzinger moved to Newberry and began practicing at Newberry Surgical Associates and Newberry County Memorial Hospital. While there, he was sued for sexual harassment and medical malpractice.

From 2003 through 2004, Jessica Smith worked with Matzinger, who — according to a lawsuit filed in Newberry County in 2007 — subjected her to “sexual harassment and a hostile work environment.” The lawsuit was eventually settled for an undisclosed sum. In court documents, both parties agreed to keep the settlement confidential. Matzinger denied the allegations.

Eventually, Smith quit her job, but she returned to Newberry Surgical Associates in 2007 when the practice brought her back for temporary work and offered her a full-time job at a higher hourly wage than another job. After taking the job, Smith said she continued to be harassed by Matzinger, and it culminated in May 2007, when Matzinger grabbed the top of Smith’s shirt, pulled her over his lap and spanked her three times, according to court documents.

“We were having a conversation about her weekend,” Matzinger said later, in the 2012 deposition. “It got to be kind of playful and joking. She denied that she was out socializing that weekend, and I told her I didn’t think she was telling the truth, and I ended up putting her over my knee and tapping her on the thigh. ... I didn’t touch her rear end.”

Afterward, Smith quit for a second time, and that’s when she filed the lawsuit against Matzinger.

Matzinger’s issues also extended into the operating room, where in 2006, he left a patient on the table, according to the state medical board. An item needed for surgery wasn’t present, and Matzinger left and went to his office for about 30 minutes.

In the deposition, Matzinger said he left the surgery because he had to see another patient who had a mass on her breast and had been rescheduled twice.

“She was a younger female that had been waiting rather anxiously,” Matzinger said. “I felt that that was something that I could take the time I had allotted to address.”

“And you did that while another patient was in surgery?” asked
Mark Mason, the attorney deposing Matzinger.

“It’s not quite as simple as that,” Matzinger said. “The materials that were needed to perform the operation weren’t available. They were being sought.”

Later in 2006, Matzinger began using cocaine, according to his deposition. “It was infrequent at first and started to become more frequent to the point where I was doing a couple times a week,” Matzinger said in the deposition.

Meanwhile, Matzinger continued to operate on patients, performing nearly 1,000 cases per year.

In the months after his drug use began, Matzinger removed gallbladders from two patients: an 11-year-old and a 12-year-old. The two surgeries led to lawsuits filed in 2013, and the cases are pending.
Both children, now teenagers, consulted Matzinger for abdominal pain, and Matzinger diagnosed them with “chronic cholecystitis,” recommending surgery to remove their gallbladders.

Ultrasounds performed prior to the surgeries didn’t show any issues with either patient’s gallbladder, according to the lawsuit, and after the surgeries, tests showed both patients’ gallbladders were normal and did not have cholecystitis, inflammation or obstruction.

“The gallbladder removal surgery performed by Matzinger ... was unnecessary,” according to one of the lawsuits, which added that the patients both experienced digestive problems after surgery.

The lawsuits also argue that Matzinger failed to advise the patients of alternative treatments, such as dietary changes, that could potentially resolve their pain.

After Matzinger’s cocaine use started, colleagues starting noticing symptoms of drug abuse, according to affidavits filed as part of a lawsuit against Matzinger over an unsuccessful hernia surgery in April 2007. The parties settled the lawsuit in May.

“Dr. Matzinger regularly and habitually outwardly exhibited the physical and behavioral signs of substance abuse,” said Dr. Kevin W. Davis, who worked with Matzinger in Newberry, in an affidavit.

“He was very short-tempered. He was very irritable. He was a difficult person. He was depressed. He exhibited dilated pupils and bloodshot eyes. He exhibited wild mood swings. He would leave the office and return in a very different mood. ... In this condition, Dr. Matzinger posed an immediate threat to the health and safety of his patients. Dr. Matzinger’s main concern did not appear to me to be the well-being of his patients,” Davis said.

Eventually, Davis refused to provide medical care to Matzinger’s patients, for what he described as liability reasons.

“An impaired surgeon presents a material risk to a patient,” Davis said in the affidavit. “The standard of care requires an impaired surgeon who seeks to obtain informed consent to perform surgery to tell his patient about his impairment.”

Another staff member at Newberry County Memorial Hospital corroborated Davis’ remarks about Matzinger’s signs of substance abuse.

In an affidavit, Margaret Biviano said: “Based upon Dr. Matzinger’s outward display of the signs of substance abuse, the staff in the medical surgical unit at NCMH discussed the fact that they would not allow Dr. Matzinger to operate on them or their family members.”

By 2007, the state medical board began investigating Matzinger. At this point in time, Matzinger was performing chest surgeries, vascular surgeries, abdominal surgeries, hernia surgeries, thyroid operations and carotid operations, among others.

In February 2007, an investigator with the medical board interviewed Matzinger in his office and recommended he enroll in rehab.

Matzinger was still using cocaine, and he would continue to do so until March 30, 2007, according to his 2012 deposition.

“I think she was trying to say, ‘You know, we know you’re in trouble, and you should seek help,’ ” Matzinger said in the deposition. “I didn’t. I hid behind it. I was scared. I was embarrassed. I thought I could stop on my own. Tried to, and I didn’t do real well.”

In June, he checked into rehab, where he went through a couple days of inpatient therapy and had 23 outpatient visits.

“Those were in the evening,” Matzinger said in the deposition. “So I practiced through there the whole time.”

Matzinger finished his treatment, and in 2008, he began working at
Baptist Easley Hospital. There, he performed an operation that also led to a lawsuit.

In July 2008, Matzinger removed a patient’s gallbladder. The patient wasn’t doing well after the procedure and about two weeks later died from an infection, according to a lawsuit filed in Pickens County against Matzinger and four other doctors who treated the patient. The case was settled in 2012.

Matzinger later moved to Myrtle Beach and began practicing at Grand Strand Surgical Specialists, where he still practices — and where he has faced another malpractice lawsuit. In 2011, one in 100 South
Carolina doctors was sued for medical malpractice.

In January 2009, during a gallbladder surgery, Matzinger severed the patient’s common bile duct and then switched from a laparoscopic gallbladder surgery to an open procedure to try to repair the damage. The procedure was supposed to be an outpatient surgery, but the patient remained in the hospital for six days. In 2011, the patient sued for damages in excess of $100,000; in 2012, Matzinger and the patient settled the case for an undisclosed sum.

A few months after that surgery — and two years after an investigator first spoke with Matzinger — the state medical board filed its final order against Matzinger for using cocaine and leaving a patient during an operation. The board fined him $5,000, required him to continue his enrollment in the Recovering Professional Program and suspended his license — but stayed the suspension as long as Matzinger paid the fine and administrative costs.

“I had enrolled in RPP in June of 2007 and went through some steps with them,” Matzinger said in the deposition. “I thought things with the board were over with. I was kind of shocked to hear from them in the early part of 2009.”

After the medical board released its order, Matzinger voluntarily surrendered his license to practice medicine in Pennsylvania and Tennessee.

He kept his license in South Carolina.

Reach Matt Tomsic at 843-849-3144.

 
By Matt Tomsic
mtomsic@scbiznews.com
Published Aug. 6, 2013

Since 2006, the S.C. Board of Medical Examiners has ranked last or second to last in serious disciplinary actions taken against the state’s doctors.

The rankings are part of a yearly report put together by Public Citizen, a watchdog group that analyzes the number of medical professionals per 1,000 who have their licenses revoked, suspended or surrendered, among other penalties, and ranks them based on the number of serious actions taken by the medical boards. Some doctors criticize the rankings, though, saying the model is flawed.

“The supposition that a serious sanction means that doctors in that state are of a lower-caliber doctor is absolutely counterintuitive,” said Dr. Louis Costa, president of the medical board, adding that it’s like saying the safest state is the one with the highest level of criminal convictions. “It takes a lot to get a medical degree and get licensed, and in some instances we feel the doctors are capable of rehab and can offer safe services in the future.”

In South Carolina, doctors have kept their medical licenses after abusing drugs, having sex with patients, botching operations, leaving surgery while patients are sedated and performing surgeries on incorrect limbs, according to a Charleston Regional Business Journal review of medical board orders. Sometimes, those medical professionals are reprimanded and suspended but the suspension is stayed as long as certain conditions are met and fines are paid.

South Carolina rankings
Total investigations

“The assumption is most doctors in all states are practicing good medicine, and there’s no evidence that varies from state to state,” said Dr. Sidney Wolfe, founder and senior adviser of Public Citizen, which monitors state medical boards across the country. “Conversely, there are some doctors who are not practicing good medicine. So the question is do they get investigated, do they get disciplined? And it varies. It is a serious public health threat in the states that have medical boards that aren’t doing their job.”

‘A pitiful job’
From fiscal year 2004 through fiscal 2012, the S.C. Board of Medical Examiners has revoked 16 licenses and suspended 68 licenses after investigating more than 3,000 medical professionals, according to statistics compiled by the S.C. Department of Labor, Licensing and Regulation. Since fiscal 2004, 30 doctors have voluntarily relinquished their licenses.

The lower discipline rates in South Carolina are a reversal from earlier years.

In the 1990s, the state ranked in the top 20, according to Public Citizen. In 2000, the state ranked 27th, but in 2001, it fell 20 places to 47th.

“We’ve been doing this for 20-plus years,” Wolfe said, adding the rankings don’t indicate that overall quality is better or worse between the states, and states are quick to point to overall quality as a reason their discipline rates are low. “The real issue is what happens to the small fraction of doctors in every state that are doing things that merit discipline. In some states, year after year, they’re much more likely to get disciplined. And year after year in other states, they’re much less likely.”
Jones Andrews Jr., a medical malpractice attorney in Columbia, said that most doctors in the state are very good and do their jobs well but that a handful of them should face tougher consequences when they violate the board’s rules and state law governing medical practice.

“The medical board does an absolutely pitiful job of policing their own doctors,” Andrews said. “I see it as a systemic problem.”

In 2012, Andrews has filed two cases against a doctor whose license was restricted by the medical board. According to the board’s 2009 final order, among other issues the doctor kept one patient under anesthesia for more than eight hours before operating, and he falsified medical records to say he performed surgeries when nurses actually performed them. As South Carolina eased its restrictions on the doctor, North Carolina ordered him to surrender his license — the Business Journal’s examination found several instances of doctors keeping their S.C. license while losing licensure in other states. Eventually, the doctor faced two malpractice lawsuits for operations he performed after the medical board issued its order, and in 2012, the doctor voluntarily surrendered his license.

“He should have never been practicing medicine,” Andrews said. “He was brought before that board some time ago, and they slapped him on the wrist.”

‘This board is better’
Costa criticized Public Citizen’s rankings.

“You could split the same equation and say South Carolina ranks best,” Costa said.

One reason for the state’s lower number of serious sanctions is its vetting process, which includes in-person interviews, he said. One in six states requires interviews as part of licensing.

“We think that’s important, and it may seem archaic, if not medieval,” Costa said. “Doctors will tell you that they found that to be a higher burden, and we find doctors licensed in other states that are marginal in terms of qualifications. When it comes down to sitting for an interview, they just won’t come. They’ll withdraw their application.”

The board also has 10 physicians among its 12 members. Whenever the board has a quorum, a majority of the members will be doctors.

“We understand the practice of medicine,” Costa said. “That’s one of the reasons we believe this board is better than other models.”

The board also has stronger revocation laws than other states, and when it revokes someone’s license, that doctor can never practice again in the state. In other states, Costa said, someone can reapply after having his or her license revoked.

“You’ve got to understand the relative scale of what they consider to be a heavy hit and what we consider a heavy hit,” Costa said.

The board also uses other penalties to ensure physicians practice safely after being investigated. Those include competency evaluations that can cost medical professionals as much as $30,000 to $50,000. They also include restricting practices to certain settings, mandating peer oversight and charging physicians fines, among other penalties.

“Those are pretty heavy deterrences — and I think necessary to put them back into constructive practice,” Costa said.
Dr. Bruce Snyder, president of the S.C. Medical Association — the state’s professional organization for the industry — also criticized Public Citizen’s rankings, saying he’s been “very pleased” with the S.C. board.

“We think that the rankings are somewhat unfortunate and inaccurate,” Snyder said. “The board has been very careful about initial licensing, and in so doing, feel like we have fewer problem physicians admitted for licensure in the state.”

‘More likely to require discipline’
As one example of what’s at stake, Wolfe referenced the case of Dr. Kermit Gosnell, the Philadelphia abortion doctor who received life in prison this year for performing illegal late-term abortions on babies who were moving and breathing after he delivered them.

“Almost a decade ago, a former employee of Gosnell presented the (Pennsylvania) Board of Medicine with a complaint that laid out the whole scope of his operation: the unclean, unsterile conditions; the unlicensed workers; the unsupervised sedation; the underage abortion patients; even the overprescribing of pain pills with high resale value on the street,” a grand jury report said. “The department assigned an investigator, whose investigation consisted primarily of an off-site interview with Gosnell. The investigator never inspected the facility, questioned other employees or reviewed any records. Department attorneys chose to accept this incomplete investigation and dismissed the complaint as unconfirmed.”

Before that complaint, Wolfe said, the medical board caught Gosnell using an unapproved device for abortions.

“The medical board should have taken his license away then,” he said. “And they didn’t. So, as a result, he winds up doing more damage long after the time when he should have been taken out of commission.”

A 2007 study provides some support for Wolfe’s assertion. In “Sanctions and Recidivism: An Evaluation of Physician Discipline by State Medical Boards,” researchers analyzed disciplinary actions taken by medical boards from 1994 through 2002.

“The most significant finding is that there are a very large number of repeat offenders among physicians who have received board sanctions, indicating a possible need for greater monitoring of disciplined physicians or less reliance upon rehabilitative sanctions,” according to the study, which was published in the Journal of Health Politics, Policy and Law.

Researchers found that more than 20% of physicians who received a sanction in the first period of the study also received another sanction during the second period. A physician who received a severe sanction in the first period of the study was 32.4 times more likely to receive another severe sanction than a physician who didn’t face any disciplinary action.

“These relative risks confirm that physicians who have been disciplined are substantially more likely to require discipline in the future,” according to the study. “The number of repeat offenders indicates that board sanctions are not fully effective among a subset of disciplined physicians.”

Protecting the public
Costa said the medical board considers recidivism and has checks to keep tabs on the state’s doctors. For example, he said, the board monitors medical malpractice lawsuits and builds reporting requirements into its final orders.

“There are conditions that go into that agreement,” Costa said, adding that if those conditions aren’t met, often the physicians are automatically suspended and brought back before the board.

For substance abusers, the board requires random urine testing, and those medical professionals are required to call in each morning to find out whether they’ll be tested that day.

“We’ve got relative assurance when it comes to substance abuse issues that the doctor was being fully monitored,” Costa said.

The board also monitors the National Practitioner Data Bank, which reports malpractice lawsuits. Costa said the board can decide to open investigations into doctors based on those lawsuits and the data bank’s report. They also have experts review lawsuits to determine whether a physician isn’t meeting standards of care that put patients’ health and lives at risk, Costa said.

The board uses standard of care as its guiding factor when determining sanctions, Costa said, and its goal is to ensure South Carolina has safe, effective health care. Costa said the board acts when there’s evidence of patient harm.

“We’ve got to hold a physician responsible for misconduct,” Costa said. “And in holding them accountable, we protect the public.”

Reach Matt Tomsic at 843-849-3144.

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