Dallas Has a Real-Life Dr. Gregory House in Dr. Richard Buch

Buch sued St. Paul and Gill, charging that the doctors "entered into a horizontal conspiracy" and published a statement to the NPDB "maliciously."

Buch had made similar misrepresentations to Medical Center of Plano, which terminated his privileges in May 1999. Presbyterian canceled his privileges in May 2001 after he refused to resign. One doctor at Presbyterian, asked about Buch's reputation, said in a deposition: "I think that there have been occasions in which there have been long lapses of communication with Dr. Buch in which patients either were not seen or inappropriate documentation was placed on the charts."

After submitting his application for reappointment to Medical City in February 2006, Buch was reappointed for six months, pending a 45-day suspension, beginning on May 29, 2006, because "his conduct, as detailed in recent occurrence reports, interfered with orderly operation of the hospital."

Buch has called all of these actions shams, politically motivated, unfair.

Medical City also submitted an "adverse action report" to the NPDB accusing him of unprofessional conduct. Though his privileges were restored, Buch sued Medical City for defamation and conspiracy; the case is set for trial September 22. (A spokesman for Medical City declined comment.)

Buch is still a busy orthopedic surgeon. He performs surgery at Medical City, Centennial Medical Center in Frisco and Frisco Orthopaedics and Sports Medicine Center, a surgical facility complete with an emergency room, which he co-owns and at which he serves as vice president. Under Texas law, physicians are not required to disclose ownership of a hospital to consumers. These kinds of boutique or niche hospitals are increasing.

Physicians at such hospitals are not subject to mandatory review by their peers. "You can own your own clinic and do all your procedures there, and there is no peer review process," Robinson says.

On October 29, 2001, when attorney Steve Nagle received a packet from the lawyer representing Lou Ann Tipps, he got a nasty surprise: a sworn "secret statement" by Dr. Buch blaming the loss of Tipps' leg on three nurses.

A Sherman woman, Tipps had sued Buch and St. Paul after a total knee replacement by Buch on December 3, 1998, ended in the amputation of her leg. In return for being dismissed from the lawsuit, Buch submitted his statement, which exonerated himself and got back at St. Paul at the same time.

Early on December 3, 1998, Buch performed a total knee replacement on Tipps, a woman from Sherman. On December 5, Tipps' lower leg developed "compartment syndrome"—essentially dying from lack of blood. Buch blamed the nurses for not notifying him until 11 p.m. Buch operated again two days later. Tipps' leg had to be amputated below the knee. A jury found that negligence by the hospital caused her injuries and awarded her $1,801,505. (The case ended with a confidential settlement.)

Tipps wrote to the judge: "For us, this was about truth and taking responsibility for your actions. If our actions can save another, then it is worth the heartache of a couple of weeks."

Regardless of the outcome of the Tipps case, Buch eventually won his battle with St. Paul over privileges, settling out of court. Buch's attorney Hopkins says that after "re-consideration," the hospital "unconditionally approved" his application for privileges in 1999 and has "rectified" its earlier report to the NPDB.

After that victory, Buch resigned his privileges.