(2013) Pain doctor: A shocking story of damaged patients and weak oversight

http://www.northjersey.com/news/pompton-lakes-pain-doctor-a-shocking-story-of-damaged-patients-and-weak-oversight-1.584714

Before authorities caught up with him, Dr. Richard Kaul performed back operations for years in same-day surgery centers around North Jersey, even though he was an anesthesiologist, not a surgeon trained to operate on spines.

Patients went to him to treat their pain, but some described horrifying problems following his operations. A mother of young children told state officials she was left to ride home in agony, unable to walk after surgery that went on for hours. The operation left her feet splayed and her gait unbalanced, she said, and she is in such pain she has to sleep in a recliner rather than in a bed. A blasting supervisor who worked at Ground Zero testified that he lost his job and his professional licenses after the operation left him in such agony he became dependent on painkillers. A policeman said he can no longer stand for more than a few minutes.

They were among 11 patients whose cases were recounted, sometimes in gruesome detail, at an appeals hearing on Kaul’s license, which has been suspended. Expert witnesses testified that the doctor, who practiced at nine locations in North Jersey, performed operations that were unnecessary and implanted spinal screws so poorly in one patient that they caused excruciating damage.

Remarkably, before all this, Kaul had been convicted of negligent manslaughter in England after a patient he had anesthetized died while having a tooth pulled. After his conviction in 2001, he was sentenced to a six-month suspended jail term. The British medical board stripped him of his license, concluding that the “gravity of the offense” was so serious the only recourse was to “erase” Kaul from the registry of doctors.

But that didn’t stop Kaul from moving to New Jersey and establishing a practice treating mostly car accident victims and people with out-of-network coverage in their health insurance plans. His decade here has been marked by misrepresentation, malpractice complaints and allegations of racketeering and insurance fraud.

His is the story of a shrewd physician who exploited licensing rules that allowed him to perform complicated and risky procedures outside his training and who figured out how to skirt the rules of a state with one of the nation’s weakest systems of doctor discipline. It is a system that relies on doctors to be honest when answering questions on official forms about their training, their practices and their pasts…

Kaul lied on his license renewal form when he said there were no criminal charges against him, but the state never checked that. State officials never checked whether, as required, he was affiliated with a hospital or had other permission to operate in his single-operating-room surgery center. They never checked whether he had the required malpractice coverage in case something went wrong.

Even when the state learned of the lies surrounding the death in England, the Board of Medical Examiners allowed him to continue practicing after a six-month suspension.

Furthermore, the state did not restrict Kaul’s practice to anesthesiology He was able to perform surgery because his license, like medical licenses in all states, was a general authorization to practice medicine and not limited to a specialty — a long-standing national licensing norm that may be outdated.

His case raises a disturbing question: How can patients know their doctor is qualified to diagnose and perform the procedures he or she prescribes — particularly in the state’s one-room surgery centers, which are largely unlicensed? …

One man, whose name was withheld by the state at the hearing to protect his privacy, testified that he went in expecting an injection for pain and ended up with hours of surgery to remove a disc and fuse two bones in his spine. Others showed long scars from surgery they’d been told would be “minimally invasive.” They described crippling injuries, intractable pain and the betrayal they felt at the hands of a doctor whose credentials and skills they trusted…

He had come to New York in 1989, following medical school in London, and bounced around three surgical internships — none of which would have given him enough training to operate on spines, the state said — before entering the three-year anesthesiology program. In 1996, the American Board of Anesthesiology gave him a lifetime certification as a specialist. Every two years, even when he was working outside the United States, he renewed his license to practice in New Jersey using a form of mostly yes or no questions…

As Kaul’s criminal trial got under way in London in January 2001, he applied for a medical license in Kansas. The board in that state checked with the British hospital where he had practiced and rejected him outright.

In contrast, he had no such issues in New Jersey. In April, after his conviction, Kaul applied to Hackensack University Medical Center for privileges, and to state authorities for a license to prescribe narcotics. Both were granted…

During this period, Kaul was struggling with drug addiction, he said in a recent interview. He developed a taste for party drugs in New York in the mid-1990s and then became addicted to opioids, which he obtained easily as an anesthesiologist, he said. He said he received help from the British medical board, but relapsed in the United States, where he checked into a monthlong rehabilitation program in 2002. He said he is now clean…

Kaul did not practice in a hospital again. But he was able to find work in a burgeoning field of health care — pain management.

He rotated among a variety of free-standing chiropractic, surgical and pain-treatment centers, which have proliferated in New Jersey, allowing physicians to share in the high out-of-network reimbursements they receive for treating patients and to tap into the state’s generous auto-insurance coverage for personal injury. Several such businesses have been sued by insurance companies alleging overtreatment and fraud…

An anesthesiologist with a similar spine practice in Washington State, Dr. Solomon Kamson, flew in to testify at Kaul’s hearing. He said that Kaul’s board-certification as an anesthesiologist, as well as his surgical training and additional coursework, amply qualified him to perform minimally invasive spine surgery. Kamson has faced his own regulatory issues — his medical license has twice been placed on probation in Washington State, said a spokeswoman for the Washington Department of Health…

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6 thoughts on “(2013) Pain doctor: A shocking story of damaged patients and weak oversight

    • I don’t think your insurance is going to save you from doctors like this. Maybe if your state has a better monitoring system for doctors. But even that might not save you, since it’s so easy to be accredited for any medical specialty. Recently, doctors have been switching practices to treat addiction, even though they have no background or experience doing so. Addiction and rehabilitation is just one “specialty” that isn’t recognized, but there are plenty more.

      Liked by 1 person

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