False (We Believe) Accusation Against Dr. Myron Mariano
We see many false allegations by the Medical Board against doctors. We reviewed the Accusation against Dr. Myron Mariano of Torrence and believe that it serves as a lesson as to how a patient with many problems can be unfairly blamed on the doctor. The Medical Board with little investigation can then file charges and destroy a doctor's practice and reputation.
We reviewed the accusation against Dr. Myron Mariano of Torrence, California and find it unimpressive. The core allegation is negligence and it is deemed “repeated acts of negligence”. This is deceptive. There is a disagreement with the care of a single patient. The tag along claim is failure to keep proper records. This type case does not make sense. The Accusation reveals that the patient was elderly and had many conditions that pre-existed. He suffered from sepsis which is common enough at that age and particularly after colorectal surgery. It is unlikely that the Medical Board looked in detail at confounding factors such as the hospitals NSQIP data as to those types of surgeries and subsequent infections, whether the hospital followed standard infection control procedures as required by CMS and the Joint Commission.
The Accusation reads like a standard primer and does not adequately address the particular patient or procedure.
Anastomotic leaks and bowel perforation are inherited risks of a sigmoid colectomy. Appropriate surgical techniques and evaluation of the bowel, after completion of an anastomosis,
is paramount to avoiding such complications.
The doctor stated that he did the inspection and why wouldn’t he? It would normal to do and in fact automatic. The board complains that he didn’t put this in writing and assumes that because he did not write it down, he did not do it.
33. Respondent's operative report of the May 17,2019, surgery, which was signed on
August 10, 2019, indicated that a stapled side-to-side colonic anastomosis was performed as the
descending colon was brought down to the front ofthe distal rectum. Respondent does not note
any evaluation of the viability of the bowel ends or their blood supply. Respondent also failed to
include an evaluation ofthe anastomosis with air insufflation to detect a possible leak. As such,
Patient A's eventual complications were not unexpected. During an interview with the Board,
Respondent stated that he did inspect the anastomosis, although there is no documentation that
this was done.
The board has (probably) a single expert who voiced an opinion as to what needed to be written down and how. Other experts would differ. One wonders whether the complaint was supplemented by attorneys who filed a civil lawsuit against the doctor. That is a common scenario in quality of care cases.
Here’s the problem. If this were a medical malpractice lawsuit the attorney filing the claim would have “skin in the game”. He/she would have to pay an expert and devote hours of time.
The board has a free attorney and no downside if they lose. The doctor’s life is completely disrupted and the public record reflects the Accusations but not the defense.
Mark this case in your check back book. My guess is that this doctor will be completely exonerated. The key takeaway from this “blog” is that early intervention with medical experts and aggressive defenses are the proper approach to most medical board investigations.
If your quality of care is the focus of a Medical Board investigation, Daniel Horowitz and lawyer plus doctor, Mark Ravis will tear into the medical side. Call us - we can help.