Connecticut medical negligence case prompts reforms

  1. connecticut medical negligence case prompts reformsconnecticut officials are overhauling the way they investigate doctors accused of incompetence, after health department officials failed to act against a former norwalk hospital anesthesiologist accused of negligence in two cases in which healthy women under his care fell into irreversible comas.

    a closer look at doctors' actions
    negligence case prompts reforms

    june 30, 2004
    by jack dolan, courant staff writer

    state officials are overhauling the way they investigate doctors accused of incompetence, after health department officials failed to act against a former norwalk hospital anesthesiologist accused of negligence in two cases in which healthy women under his care fell into irreversible comas.

    first, public health commissioner robert j. galvin is recruiting investigators from outside the state to review his department's dismissal of a complaint from the husband of the first coma victim, to determine if connecticut officials overlooked information that could have helped them prevent the second tragedy.

    "we're going to ask some hard questions about what we knew, and what we did with the information," galvin said.

    in addition, officials are scrapping their system of relying on unpaid volunteers from the state's physician community to determine which complaints should be brought before the connecticut medical examining board, which is responsible for restricting and revoking medical licenses.

    under that system, from 1998 to 2002, 90 percent of the complaints alleging physician incompetence or negligence were dismissed before reaching the board, department of public health records show.

    upon investigation, some of those complaints boiled down to billing or scheduling disputes that don't warrant action by the board, health department officials said. but even when surgical skill and medical judgment are in question, health officials said, finding a doctor to recommend license action against a peer has been a constant challenge.

    this month, the courant reported that five doctors recruited from outside connecticut by attorneys representing the family of the first coma victim, sadie cole, testified that her anesthesiologist, jay angeluzzi, was directly responsible for the permanent brain injuries she sustained at norwalk hospital in july 1998. he failed to monitor her carefully while she was sedated for a tubal ligation, and he didn't try to resuscitate her quickly enough when her vital signs warned of grave danger, they agreed.

    angeluzzi and norwalk hospital eventually paid more than $12 million to settle the malpractice case without a trial.

    health department officials refuse to talk publicly about their investigation of the cole case, citing a state law that prohibits them from acknowledging that they investigated a doctor if the case is closed in 18 months or less and does not lead to license action against the doctor.

    but sources who spoke on the condition that their names not be used said health department investigators dismissed cole's complaint, in large part, because they could not find an in-state doctor who was willing to testify that angeluzzi's negligence caused the woman's coma. at least one doctor approached by state officials refused to review the case because he knew angeluzzi personally.

    "it's very unlikely that one professional would testify against another professional in this state, even if the charges are true," said rep. art feltman, d-hartford, co-chairman of the public health committee who advocates using out-of-state doctors as experts during health department investigations. "it's too small, everybody knows everybody."

    galvin agrees that out-of-state experts should review complaints against doctors in highly specialized fields with few practitioners. but he insists that the state is not so small that doctors in more common practices would hesitate to judge each other objectively.

    the current system fails, galvin said, because health department officials have to canvass the state looking for a doctor who is willing to spend his free time reviewing a case without compensation. the system may save money, but it doesn't always turn up the best witness, said galvin, who reviewed cases for the department while he was in private practice.

    "i thought it was a cumbersome way of doing things, and i'm not sure the department got the right decision," galvin said. "as a reviewer, i wondered if i was getting all of the information i really needed."

    to address the problem, galvin is recruiting a stable of four semi-retired connecticut doctors to work under contract for $150 an hour to review complaints in the future. the department has also asked legislators to pay the fees charged by out-of-state experts - sometimes as high as $500 an hour - to review cases in which the doctors under contract to the department feel they have a conflict of interest, or lack the specialized expertise to judge a case.

    state rep. andrew fleischmann, d-west hartford, a member of both the public health committee and the appropriations committee that would have to approve the extra spending, said he wants even routine cases referred to out-of-state consultants.

    "there's absolutely no reason we should not be using the best experts available," fleischmann said. "even better if they come from out of state. that means there's no danger of them being overly solicitous of doctors they may know, or may have to work with in the future."

    in another effort to solicit outside opinions of connecticut's often criticized medical regulatory systems, galvin has asked officials from the rhode island health department to review the investigation of the first angeluzzi complaint. he wants the independent investigators to determine whether connecticut regulators overlooked, or failed to track down, evidence that should have led to action against the troubled anesthesiologist.

    also, at least one doctor and one department lawyer will now review all complaints shortly after they arrive to make sure that ongoing threats to patient safety are investigated immediately, galvin said. in the past, nurses did the initial reviews.

    in march 2003, health department officials sent herman cole a two-line note announcing that their "thorough investigation" found no evidence that angeluzzi contributed to his wife's coma, so the case was closed. four months later, a second healthy woman in angeluzzi's care plunged into an irreversible coma while she was having her first child via caesarean section. angeluzzi immediately surrendered his hospital privileges. he surrendered his connecticut medical license months later.

    in both cases angeluzzi turned off the electronic monitors meant to warn him that the patient's pulse and respiration were slowing dangerously. he also could not account for commonly abused narcotics that were missing after each procedure, investigators found.

    angeluzzi could not be reached to comment for this story.

    along with the complaint cole sent the health department in february 2002, he gave state investigators summaries of testimony from the five doctors who said angeluzzi was responsible for his wife's coma.

    cole also provided the health department officials with a probationary agreement signed years earlier by angeluzzi in massachusetts, where he was granted a license only after agreeing to close supervision by medical regulators. the terms included meticulous documentation of the prescription drugs he took himself and those that he prescribed for patients. he also was compelled to receive regular psychotherapy.

    there were no such restrictions on angeluzzi's connecticut license.

    cole also gave the health department a copy of angeluzzi's own testimony describing the night in 1985 when he overdosed on tranquilizers while on duty at the hospital of st. raphael in new haven, leaving himself unfit to monitor anesthetized patients. the incident cost angeluzzi that job.

    "he was a risk, a very high risk," cole said. "and the health department just let him go. they let him go to maim another woman after he maimed my wife."
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