Banned At Giuffre, Accused In N.y. How Pa. Lost Track Of Inquiry On Surgeon

Posted: December 22, 1991

Three years ago, Dr. Leonora Weissman was one of three surgeons banned from a North Philadelphia hospital after state investigators found dozens of cases of what they termed unnecessary surgery and improper treatment.

As many as 12 people may have died as a result, the investigators said.

But while the state Health Department stopped the three doctors' surgical group from practicing at the James C. Giuffre Medical Center, where the problems arose, nothing was done to keep the doctors from working elsewhere.

Today, Weissman, 51, has a surgical practice in New York - where again she is facing allegations of medical malpractice.

Several recent lawsuits filed against her contain allegations similar to the Pennsylvania Health Department's findings at Giuffre.

Pennsylvania medical licensing officials say they had intended to discipline Weissman and the other two doctors.

But they forgot. In a series of bureaucratic blunders, the case got lost - literally, forgotten in a file cabinet - for more than two years.

Had the licensing officials acted, Weissman might not have had such an easy time getting licensed in other states. As it was, she had no trouble at all.

When she went to New York months after leaving Giuffre, she joined the offices of Jeffrey E. Lavigne, a controversial hemorrhoid specialist who promoted himself in newspaper and subway car advertisements as "M.D. Tusch."

Lavigne himself was accused in July 1990 of 49 counts of unprofessional conduct, incompetence and negligence by the New York Board for Professional Medical Conduct. Hearings on the allegations haven't been completed.

In leaving Philadelphia, Weissman left behind nine malpractice cases. In New York, Weissman, now divorced and practicing under her maiden name, Monroe, is a defendant in six more cases stemming from her work at Lavigne's offices, where Lavigne said she was employed from November 1988 to September 1990.

According to the New York lawsuits - which, like the Philadelphia cases, have not yet been tried - the new allegations against Weissman include:

* Damaging the rectal muscle of a 61-year-old Manhattan woman while doing laser surgery to remove hemorrhoids. Afterward, the woman had difficulty controlling her bowel movements. Her current doctor says the laser surgery was unnecessary.

* Failing to realize that a 77-year-old patient was suffering serious complications from earlier laser surgery for hemorrhoids, performed by another doctor in the office. Weissman blamed George Nyerges' problems on not eating and sent him home. Two days later, he was rushed to a hospital, where he was found to have a massive infection and nearly died, hospital records show.

* Perforating the colon of a 78-year-old man who had come to her for a colonoscopy, a normally routine diagnostic procedure. As a result, Abraham Parnes of Queens, N.Y., had to have an ileostomy and wear a plastic bag to collect his feces for eight months, hospital records show.

Weissman declined to comment for this story. She has not yet responded to the substance of the allegations in most of the lawsuits against her, although in a deposition for the Parnes case she blamed his problems on a physical defect.

Weissman currently has a surgical practice in Monsey, N.Y., about 35 miles northwest of New York City. She is also on the surgical staff at Wyckoff Heights Medical Center in Brooklyn and its Jackson Heights division in Queens.

LEFT GIUFFRE IN 1988

Weissman left Giuffre hospital - which is now a part of North Philadelphia Health System - in January 1988, the same month that the state Health Department began its investigation.

The department found 29 cases in which patients who underwent surgery or diagnostic tests at Giuffre between 1986 and 1988 either died as a result of unexpected complications, were accidentally injured, were given major surgery for ulcers instead of being treated with commonly prescribed drugs, were misdiagnosed, or were operated on for problems that hospital pathology reports did not confirm.

The state also found dozens of other cases of patients' having complications after surgery. Most of the problem cases were handled by a

surgical practice made up of the hospital's namesake, James C. Guiffre, his daughter Adrienne, and Weissman.

In one case, Weissman was found to have perforated the colon of a patient who was undergoing a colonoscopy. The man died a month later, and the city Medical Examiner's report labeled his death a "diagnostic misadventure."

ADMISSIONS BANNED

In May 1988, the state Health Department temporarily banned admissions to Guiffre and told hospital officials not to let the surgical team continue practicing there.

Today, both Weissman and Adrienne Giuffre still hold medical licenses in good standing in Pennsylvania.

The only reason the third surgeon, James Giuffre, is no longer licensed is

because he is dead.

Adrienne Giuffre has stopped practicing medicine, according to a deposition she gave earlier this year.

Pamella Raison, chief counsel for Pennsylvania's Department of State, which licenses and regulates physicians, said an active investigation of the three surgeons by her agency came to a halt by mistake - after a lawyer who was supervising the probe took another job within the department in May 1989.

Through an oversight, the probe never was reassigned and the case records remained in a file cabinet for more than two years, she said.

"I would say it is one of the worst-case scenarios of a bureaucratic crack in the floor," Raison said. "I think we're going to be hard-pressed to give an excuse why this didn't culminate in a disciplinary action."

Such action can range from revocation or suspension of a medical license to a civil fine, special license restrictions or a reprimand.

As a result of questions by The Inquirer for this story, Raison said the state was resurrecting its investigation of the three Giuffre doctors.

LICENSED IN N.J., N.Y.

After leaving Giuffre, Weissman had no trouble obtaining a medical license in New Jersey in July 1988 and in New York two months later, records show.

On the application for her New York license, Weissman was asked whether any hospital "restricted or terminated your professional training, employment or privileges or have you ever voluntarily or involuntarily resigned or withdrawn

from such association to avoid imposition of such measures?" According to a copy of that application, Weissman checked the "No" box.

She went to work for Lavigne in November 1988, Lavigne said in an interview. He runs an outpatient surgical practice known as Laser Medical Associates out of several offices in the New York City area. His ads have touted quick and painless relief from hemorrhoids through laser surgery - a technique many doctors feel is an expensive gimmick and potentially dangerous. ''Call 1-800-MD-TUSCH," the ads said.

Lavigne, who denies the allegations against him by the State of New York, said he knew nothing about the controversy at Giuffre when he hired Weissman in the fall of 1988.

He said that he had found her through a personnel agency, and that a check of her credentials - including contacting Pennsylvania's medical licensing authorities - had turned up nothing negative.

After Weissman joined the practice, Lavigne sent a letter to patients touting her credentials.

"In December of 1988 (Leonora) Weissman, M.D., fully trained surgeon, joined Laser Medical Associates," the letter said. "Dr. Weissman is an expert in colonoscopy, which is the ultimate state-of-the-art test to assess the health of the colon, and to assess the presence or absence of polyps and tumors."

What follows is based on interviews, medical records and allegations in three of the malpractice suits filed against Weissman in New York:

*

At 78, Abraham Parnes was vibrant and active and blessed with good health.

Except he had hemorrhoids.

So in July 1989, he went to the East 68th Street office of Laser Medical Associates, where he was examined by Dr. Weissman.

Before treating his hemorrhoids, she performed a diagnostic test called a colonoscopy, which involves inserting a viewing instrument into the rectum to check for problems in the intestines. The procedure is normally uneventful.

But while Parnes sat in the office waiting for the anesthesia to wear off, he became sweaty, turned blue, had difficulty breathing, and his belly became very swollen, medical records show. The doctors at Laser Medical sent him to the hospital.

At Lenox Hill Hospital, doctors determined that Parnes' colon was perforated. They did an emergency operation.

Doctors cut out nearly two feet of his colon. They also performed an ileostomy, which involved rerouting his digestive tract.

Parnes ended up spending 20 days in the hospital, and had to rely on ileostomy bags for eight months, which meant that instead of using a toilet, his waste was deposited in a bag attached to his abdomen.

"I couldn't swim. I play paddle ball at the senior center. I couldn't - I couldn't for fear of that (bag) breaking open," Parnes said in a suit against Weissman, Lavigne and Laser Medical.

His sex life came to a halt because of the condition, he said.

In a deposition taken last month in Parnes' lawsuit against Weissman, Lavigne and Laser Medical, Weissman suggested that Parnes' problems were due to a "rare inherent abnormality" of his bowel, and not her fault.

The Parnes case marks the second time Weissman has been accused of perforating a patient's bowel. In a 1988 case at Giuffre, a 68-year-old man was found to have a perforated colon after Weissman performed a colonoscopy. He died a month later.

When George Nyerges, 77, underwent surgery at Laser Medical Associates, he said, a doctor there told him he'd feel like a new person in a matter of days.

That was good news to Nyerges, who had plunked down $3,000 for the operation. He'd gone to the office because of constipation and rectal pain, and hoped to get some help for what seemed to be a hemorrhoid problem.

When Nyerges' wife saw him later that day, she said she knew something was wrong.

"He had no bandages or anything. Just a piece of tape hanging from his tush," Anna Nyerges said in an interview.

"I was bleeding like a dog," said George Nyerges, a large man with a forthright manner.

Nyerges didn't feel any better when he went for a follow-up appointment a week later. He was weak and listless and could barely eat, he recalled.

Mrs. Nyerges, who accompanied him, said her husband was "like a zombie."

On that second visit, Nyerges was seen by Weissman, according to a medical record of the visit.

Nyerges said Weissman - who did not do the initial surgery - examined him and then said his problem was that he wasn't eating. Mrs. Nyerges said Weissman came into the waiting room and angrily told her: "The reason he's not getting better is because he's not eating. He has to eat to heal."

Mrs. Nyerges said the doctor gave her husband a prescription for a sitz bath to help heal his bottom, and then sent them on their way.

Nyerges was so weak when he left the office that his wife and nephew had to carry him upstairs when he got home. They suggested he go to the hospital, but he chose not to.

In the early morning of Nov. 20, 1989, two days after Nyerges was seen by Weissman, his wife rushed to a telephone and dialed 911, according to the couple. Their house was only a half block from Rahway Hospital, but Nyerges was in such bad condition he needed an ambulance to take him there.

According to hospital records, Nyerges had a high fever and chills, was dehydrated and had a rectal abscess, which was oozing. He had an infection in his rectal area that was spreading to the rest of his body, records show.

"If we hadn't treated him, he'd be dead," Dr. John Tsai, a Rahway surgeon who handled Nyerges' case, said in an interview.

Nyerges was immediately started on intravenous antibiotics, and a couple of days later he was taken into surgery to remove dead tissue from his pubic area - a problem Tsai said had resulted from bad laser surgery.

Nyerges ended up spending three months in the hospital, during which time it was discovered that he had colon cancer.

Nyerges has since sued Lavigne, Weissman and Laser Medical Associates. He said that no one at Laser Medical ever mentioned the possibility of cancer. Nyerges' attorney, Patricia D'Arcy, said his rectal pain and constipation were probably due to the cancer, not hemorrhoids.

Weissman has not yet responded to Nyerges' allegations.

A 61-year-old patternmaker from Manhattan went to Laser Medical Associates in April 1989 complaining of hemorrhoids.

She was told by Dr. Jeffrey Lavigne that "with this laser, they could dissolve the hemorrhoids," and she would "be back at work on Monday," according to the woman's attorney, Gary A. Zucker.

Much to her surprise, the woman was operated on that very day - by Weissman, Zucker said.

Now, the hemorrhoids are gone, but the woman has trouble controlling her bowels because of the surgery, according to a lawsuit filed against Weissman and Lavigne in New York Supreme Court.

The woman, who works for a Manhattan clothing designer, requested that The Inquirer not reveal her identity because she is embarrassed by the personal nature of her problem.

Dr. Bruce Gingold, a colorectal surgeon who is now treating the woman, said she continues to be plagued by the problem of soiling her underwear.

"She probably has some weakness in the muscle because she had some injury to the muscle" that controls bowel movements, said Gingold, who is chief of colorectal surgery at St. Vincent's Hospital and Medical Center in New York City.

Gingold said that if a laser beam was not aimed precisely at its target, it could damage surrounding tissue.

Gingold, who said he had to do corrective surgery to alleviate damage from the laser surgery, said a review of the woman's medical history indicated that the woman had not even needed a hemorrhoid operation. He said placing tiny rubber bands around the hemorrhoids - a common method of treatment - would have caused them to shrivel away.

The case was cited by New York's Board for Professional Medical Conduct in its list of charges against Lavigne. The board said that the operation was performed without the patient's informed consent; that proper blood tests were not done beforehand; and that the patient was put at risk because she did not fast before being given sedation for the surgery.

Weissman has not yet responded to the suit.

Weissman was able to take up practice in New York and escape scrutiny

because Pennsylvania licensing officials never took any disciplinary action against her.

When a doctor applies for a medical license, authorities check other states where the doctor has been licensed, to see if there is any blot on the record. Weissman's official record was clean.

Dr. Vito J. D'Alessandro, vice president for medical affairs at Wyckoff Heights Medical Center, said the hospital had found no problems with Weissman's background before she joined the staff in July 1990.

He said one of her letters of recommendation came from her old Philadelphia colleague Adrienne Giuffre - one of the doctors banned from practice at Giuffre Medical Center.

Attorneys in the New York malpractice cases - including Chris Pappas, a New York lawyer who represents Weissman - said in interviews that they were unaware of her background at Giuffre.

"I have a hard time believing that the state of Pennsylvania would close a hospital and not take any action against (the) doctors," said Mary Rita Wallace, a Long Island lawyer who represents Parnes.

The Pennsylvania state officials charged with investigating complaints against doctors agree. Raison, of the Pennsylvania Department of State, said the failure to discipline Weissman was the result of a succession of bureaucratic mixups that included:

* A lack of cooperation between the two state agencies that investigated the doctors - the Department of Health and the Department of State - despite an agreement to work together.

* Poor communication. Correspondence shows that a Department of State investigator spent months trying to obtain the Department of Health's investigative report on the hospital - even though it was already in the hands of a lawyer in his own agency.

* A failure to monitor published reports on Giuffre. The Department of State never managed to obtain the names of any patients allegedly mistreated at the hospital - even though The Inquirer published a Page One story in April 1988 that identified 18 of them.

"I cannot explain how it is that we missed that," Raison said. "I think that highlights in my mind a real agency problem."

The Department of Health temporarily banned admissions to Giuffre in May 1988, based on its own findings.

Meanwhile, the Department of State was attempting to gather its own evidence of patient mistreatment, which would be required for disciplinary hearings before the state's medical licensing board. The agency was hampered

because hospital employees were refusing to cooperate and the Department of Health was reluctant to share its information and patient records, Raison said.

"We did have some problems in getting information from the Department of Health because, as with most enforcement agencies, they wanted to wait until their investigation was concluded before releasing information," she said.

The Department of Health finally turned over an investigative report on Giuffre on Nov. 15, 1988, to the Department of State's legal department. The report, however, failed to identify any patients by name and lacked the kind of solid evidence needed to bring a disciplinary action, Raison said.

Furthermore, no one apparently told the Department of State's investigator on the case that a copy of the report had been given to the agency. In a memo dated Oct. 25, 1989 - the last recorded update on the case - the investigator said he was still trying to get a copy of the Health Department report, Raison said.

By then, the case had been filed away and apparently forgotten.

In May 1989, the attorney who was supervising the case, Frank Kahoe, was promoted to a new job. All of his cases, including the Giuffre case, should have been reassigned to other attorneys, according to Raison. But for reasons that both Kahoe and Raison say they cannot explain, the Giuffre case remained in a file cabinet from the summer of 1989 until now.

Raison said she now expects the state to bring disciplinary charges against Weissman and Adrienne Giuffre in the next three to six months.

"We will certainly take disciplinary actions against the doctors," she said, adding later, "Disciplinary actions must be imposed, not only as a deterrent but also to restore public confidence in the system."

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