When Linda Bajadali first saw Dr. Richard G. Buch, she thought he was a "rebel." The tall surgeon in scrubs and lab coat wore a red, white and blue bandanna around his head and a self-assured smile.
Buch examined Bajadali's shattered knee for a few minutes.
"We'll take care of this in the morning," he said, sounding confident, almost arrogant. During the surgery at Medical City, he would remove shattered pieces of bone; she might need an artificial knee.
Dr. Richard Buch
Bajadali, a telecommunications manager, and her husband, Harold Bajadali, were relieved. After falling from a ladder in 2002, 57-year-old Linda had been in excruciating pain. A doctor in the emergency room at Baylor University Medical Center said her injury was so serious she needed an orthopedic surgeon. He gave them Buch's name, which the Bajadalis took as an endorsement of sorts.
Buch reinforced the feeling, saying that four other surgeons would be observing and learning as he worked on her leg the next morning.
"The inference was he was a hotshot," Harold says.
The Bajadalis now believe the "hotshot" botched the surgery, leaving her with a huge, infected open wound that required extensive treatment and repair by two other doctors. She lost mobility and her job.
Though the Bajadalis filed a lawsuit against Buch, the case was dismissed by a judge because medical charts did not indicate Buch had done anything wrong.
Lawsuits are a fact of life for doctors, especially someone like Buch, a highly trained physician in the high-risk specialty of orthopedic oncology and surgery. Now 54, Buch is perennially on D magazine's "Top Docs" list. His waiting rooms are packed with patients in need of knee and hip replacements or reconstruction of bones and joints.
Like television's Dr. Gregory House, Buch is a scourge of hospital administrators and underlings.
"The guy is one of the most brilliant surgeons that I've ever worked with in 25 years," says one former colleague, a nurse who asked not to be identified. "The guy can do things that most mortal doctors can't even dream of. He's also one of the most self-destructive, obnoxious, vicious people I've ever met."
Buch's medical license was suspended for unprofessional behavior in 2001. In a dozen medical malpractice lawsuits filed against him in Dallas County, his skills, ethics and personal behavior have been questioned. Some lawsuits have been dismissed; a few have been settled by his insurance companies. In the handful of cases that have gone to trial, Buch has won.
Lawsuits, even unsuccessful ones, can increase a doctor's malpractice insurance premiums, but far more damaging to Buch's career has been the controversy over his privileges at four of the largest hospitals in the Dallas area. As the result of negative peer reviews at St. Paul Medical Center, Buch was banned from performing surgery there. He resigned his "courtesy privileges" at Presbyterian Hospital and Medical Center of Plano under pressure. And Medical City suspended his privileges for 45 days pending an investigation
The doctor filed lawsuits against St. Paul and Medical City, claiming he was harmed by their revocation or suspension of his privileges and the hospitals' subsequent reports to the National Practitioner Data Bank.
Created in 1986 by the federal Health Care Quality Improvement Act, the NPDB is a central database that tracks health care professionals by "adverse action" reports. Its purpose is to solve the problem of doctors who go from state to state to avoid having their licenses revoked. The act also provides immunity from liability for doctors who participate on medical peer review committees, panels of doctors who evaluate other physicians' performance.
Suspensions of more than 30 days or lost hospital privileges trigger a negative report to the NPDB, as do lawsuits and investigations by health care agencies such as the Texas Medical Board.
The data collected is not available to the public. Reports of peer reviews by doctors at hospitals where Buch has practiced are secret. Hearings by the Texas Medical Board are secret. Reports to the NPDB are secret.
So, consumers have no way of knowing if their physician has zero "adverse action reports" or 20. Nor are they told a doctor has lost privileges as a result of negative peer reviews.
Such revocation—especially for an orthopedic surgeon who generates substantial revenue—is uncommon. "Hospitals now are less politically motivated and more quality-oriented when they dissociate themselves from a physician," says a board member of the nonprofit American Medical Foundation for Peer Review who asked not to be named. The foundation does independent peer reviews; since 1986, it has conducted reviews for 4,200 hospitals.
"Hospitals are reluctant to revoke privileges," the board member says. "It's usually either the mortality or infection rate, but it's something that's a serious quality issue."
According to statements in court documents by Dr. Kevin Gill, a spine surgeon and then-head of orthopedics at St. Paul, the peer reviews of Buch at St. Paul did not focus on patient care, but his behavior.
"The guy is brilliant," says one malpractice attorney, who asked not to be named, "but he's also an asshole."
Buch admits he's demanding when it comes to patient care, but he contends that the medical peer review process has been unfair, allowing his enemies to blackball him in the NPDB. Some call it being "databanked."
He believes his colleagues at various hospitals have been driven by petty jealousy and competitiveness.
Through his attorneys, Buch declined an interview request by the Dallas Observer. Many doctors associated with him and physicians who have treated his former patients refused to talk about him, referring requests to their lawyers.
But voluminous court records and interviews with former patients paint a picture of a highly skilled physician trained at some of the best hospitals in the United States.
And a jerk.
A former co-worker describes him as "Archie Bunker": blunt, condescending, prone to cursing and making sexist or racist comments. When things go wrong he's known for screaming and calling nurses "idiot" or "fucking stupid."
Buch's bedside manner can be atrocious—labeling a patient "candy ass," for example—and his follow-up has been called poor by hospital administrators. When he loses his temper in the operating room, Buch often hits people with his hands or instruments, a move he calls "Buch caning," the former nurse claims.
"He has the patience of Job when he is trying to put something together in somebody," says his former nursing colleague. "But he has no patience for people. If you hand him the wrong thing, he'll flip out."
And he'd disappear.
"There were a lot of times he was unreachable," says the nurse. "He liked the surgery part but not the post-op."
Few nurses, however, will file complaints against powerful surgeons who use a hospital's operating rooms and bring in revenue.
Three patients who filed unsuccessful lawsuits against Buch wish they had known that physicians at the hospitals where they were treated had serious qualms about Buch's behavior.
If a committee of doctors deems that a physician isn't fit to practice in their hospital, shouldn't consumers be informed?
Plump, blonde and vivacious, Bajadali pulls up a leg of her athletic pants.
"This thing really screwed up my whole life," she says, showing the deep scar that snakes from her left ankle up her thigh.
After her first surgery, performed at Medical City in 2002, Buch explained that he had removed bone chips, but Bajadali's injury was more extensive than he had first thought and her leg was too swollen to operate again. He sent her home in a full plaster cast from her hips down, saying he'd do follow-up surgery after the swelling went down.
As the swelling subsided, the cast started irritating her skin. A woman at Buch's office recommended pain pills. After several weeks, Bajadali demanded to see the doctor.
"It was like it was a bother," her husband says.
When Buch removed the cast, Bajadali was shocked to see it had rubbed against her skin and destroyed a hunk of tissue on her knee.
Buch ordered another cast, advising Bajadali to use padding and Vaseline to soothe the wound. Four or five days later, he operated again.
"When I came out of surgery, there was a huge hole in my leg," she says. Three days later she left the surgical floor; during her remaining nine days in the hospital, Buch did not check up on her in person.
After Bajadali returned home, the gaping wound, which she describes as the size of a golf ball, became infected. In terrible pain, she twice went back to Buch, who insisted it would heal.
Two weeks later, Bajadali sought another doctor. He referred her to a wound doctor in hopes it would heal. Finally, after 28 weeks, the second surgeon took a calf muscle and pulled it up over her knee, then grafted skin over the wound.
No longer able to sit for extended periods, Bajadali lost her job and health insurance. She filed a lawsuit against Buch in 2004 but discovered the X-rays taken at Medical City had disappeared. And Buch's neatly typed medical record—produced for her lawyer and identified by a note as a "clean copy"—said very little.
Eventually her lawsuit was dismissed by a judge because her lawyer could not find an expert witness who was willing to testify—based on the "clean" medical records—that Buch had done anything wrong.
"He didn't keep good medical records at all, period," says his former nurse. "There were times he'd ask me, 'Do you remember this one?' We would have dozens of charts sitting there, and they didn't get done until several days, a week or more. When he dictates it two weeks later, he'll do it the way he wants to remember it."
Buch's lawyer Kelly Reddell says that Buch "categorically denies that he would wait days or weeks to write up charts."
In 1999, when Mary Mote saw Buch for a consultation about a hip replacement, she saw lots of pictures of family and diplomas on the walls of his office. One of Buch's patients, a nurse, had recommended Mote go to him for the procedure.
"So I set it up, and I had it, and I almost died from it," says Mote, now 69.
A thin woman with coiffed strawberry blond hair and big eyes, Mote pads into the bedroom of her apartment in a senior living complex. Her husband lives in an Alzheimer's unit.
She brings back an armful of large envelopes, pulls out an X-ray of her artificial hip, holds it up to the light and traces the bones, the socket, a screw. "See, there's the drill bit," she says.
After the surgery, Mote went into rehab but remained in "excruciating" pain. Her leg started swelling. On a return appointment, Buch came in the room, threw down her X-rays and said her femur was fractured.
"He acts like he can't believe it," Mote says. "I thought this was his first look at the X-rays. He told me to go ahead and do my exercises."
But her foot and leg swelled even bigger, and the pain remained. Mote called and insisted on another appointment.
Buch was angry, she says.
He insisted there was nothing wrong with her foot and leg. She was just a drug seeker, a troublemaker, Mote claims he told her.
"He was in my face, making awful faces and shaking his finger," Mote says. "I was scared. He's the most disgusting man I have ever met in my life."
Pain like a needle in her hip continued to bother her. Another doctor finally diagnosed her with cellulitis, a dangerous cell infection that carried a risk of blood clots, and immediately put her in the hospital. After the infection was controlled, Mote had home health care for almost a year.
The second doctor ordered X-rays and explained that Buch had broken her femur while inserting a hip replacement that was too large.
She filed a lawsuit claiming Buch had used excessive force and failed to use screws of the proper length during the surgery, then broke off a drill bit in her hip and left it there without telling her.
But Mote dropped the lawsuit in December 2003 after her lawyer told her there was little chance she would prevail at trial. Because her husband's Alzheimer's disease became worse, she decided not to pursue her case. The drill bit is still there. Mote's doctor decided it was safer to leave it rather than risk another surgery.
"[Buch] sent my personal doctor a can of treats," Mote says. "I think he's a crazy man."
His left hand hurt so much that he couldn't use it, Ronnie Vest told the man in the white lab coat. "What do you think, doc?" he asked, after the man examined it carefully and scribbled in the medical file. The man just smiled.
"Dr. Buch will be with you in a moment," the man said and left.
Buch arrived and introduced himself.
"There's only one thing we can do about that," Buch said. "Take it out."
Abruptly, he left.
"He spent less than an entire minute talking to me," Vest says.
A weather-beaten insurance investigator who has lived in the tiny town of Celina, north of Dallas, all of his 63 years, Vest had been referred to Buch in 1998 by another orthopedic surgeon who specialized in hands and diagnosed the problem as a cyst on the bone.
"Buch is amazing," the physician said. "I've seen him operate. He's been written up in all the medical magazines."
In what was supposed to be day surgery at Medical City, Buch performed an open curettage of the lesion on the bone and ran two sharp rods through the bones of Vest's hand, terminating in plastic balls that stuck out of his skin.
After sitting in the waiting room for five hours, Linda Vest began wandering the clinic trying to find her husband. He was in the room where he'd started the morning, screaming because Buch had ordered no additional pain medication.
"The nurses had called Buch twice, and he hadn't come," Linda says. "They called him three more times." Buch arrived at midnight, apologized and ordered painkillers.
"He said, 'I never go out and talk to the people. The nurses do that.'"
Vest returned 30 days later to have the rods removed. "The waiting room was so crowded there were four or five of us sitting on the floor," Vest says. "Three of us had 1 o'clock appointments."
Accompanied by an assistant and two interns who had come from Japan to witness his surgery techniques, Buch pulled out one rod as Vest moaned in pain.
Saying his assistant would take care of the other rod, Buch left the room. "He's never in with you over a minute," Vest says. "It's like running cattle through a sale barn."
The assistant pulled off the plastic ball, leaving no way to grasp the rod. He had to resort to pliers.
Vest sits in the breakfast room of his country home, reliving the anguish with tears in his eyes. His hand started swelling. Worried about infection because the assistant didn't seem to be taking sanitary precautions, he called Buch's office asking for antibiotics.
"I could feel it eating on me," Vest says, waving his left hand. "They were like I was a wuss. Puss was running out of them holes."
Finally, the gnawing, throbbing pain sent Vest to the emergency room. He ended up in the hospital for seven days, diagnosed with an aggressive staph infection.
"I just laid in the bed and cried," Vest says. "I was begging them to amputate my hand."
A second surgeon cleaned out the wound and tried to repair the damage. After leaving the hospital, Vest was on intravenous antibiotics through a shunt to his aorta, twice a day for three months.
Because the pain persisted, Vest sought a third doctor, who diagnosed osteomyelitis, an infection of the bone.
The physician didn't understand why Buch used the rods. "Why didn't they just take that bone out of your hand?" the doctor asked. "You don't need that bone." He removed it and partially fused Vest's wrist. The pain was gone.
Like Linda Bajadali and Mary Mote, Vest suffered complications from surgery done by Buch that had to be repaired by other physicians.
All three say he became impatient or angry when they complained, that he was too busy or uninterested in their follow-up care, that he allowed nurses or a physician's assistant to handle tasks without proper supervision, and that he did not share important information with them, such as disclosing the drill bit left in Mote's hip.
Most upsetting: Buch blamed the severe complications on his patients, accusing Vest of removing his bandage, Bajadali of non-compliance with physical therapy and Mote of being a drug-seeker and troublemaker.
"Ladies and gentlemen, at the conclusion of this trial, it's my belief that none of you—none of you—will like my doctor at all." Defense attorney Bill Chamblee stood and addressed the panel of prospective jurors. "And the reason is: I don't like him either."
Next to him sat Buch. At the other table sat Vest and his lawyer.
Vest had been outraged to learn—thanks to information uncovered in another, separate malpractice suit filed against Buch—that his surgeon had a habit of consorting with hookers. In 2001, Vest sued for malpractice for his bone infection and deformed hand.
"I was just sick," Vest says. "Who knows what kind of diseases he could be exposed to? I didn't even sue for money. I just wanted this man out of the operating room."
Concerned that Vest's attorney might try to introduce evidence about his client's personal life and ongoing battles with hospital administrators and the Texas State Board of Medical Examiners (now the Texas Medical Board), Chamblee made a pre-emptory strike.
"You may hate him for his personal life," Chamblee said, "but I believe wholeheartedly that he did nothing wrong medically in this case."
The trial lasted two weeks. The jury had only one question to answer: Did Buch do something wrong during surgery by using the pins? Their answer: No. What came after the surgery didn't matter.
Doctors usually win, says Chamblee, who has defended malpractice lawsuits for 23 years. "In thousands of cases, more than 50 percent, the doctor did nothing wrong medically. All you have is a bad or less-than-favorable result, which is what is going to happen in medicine regardless."
Proving causation is the biggest obstacle in malpractice lawsuits, says plaintiff's attorney Amy Witherite, who filed a lawsuit against Buch on behalf of another patient. The impact of surgery, medications, pre-existing conditions, nursing care—all can affect the outcome. But making the connections is hard.
Chamblee has successfully defended Buch in malpractice trials twice and says the physician's medical skills have been overshadowed by his personality.
"He was involved in so many little personal battles and issues...," Chamblee says. "He's a good doctor but very poor in handling the politics of medicine. If they have a hearing at the hospital on privileges or on policies or procedures, he's not very good at being diplomatic. He just throws gas on the fire."
June 10, 1993, was unseasonably cool for trolling in the parking lot of the Deluxe Motel on Royal Lane near Harry Hines Boulevard, not far from St. Paul University Medical Center.
About 10:20 p.m., she got a nibble. A clean-cut man driving a Jeep Cherokee pulled up and looked her over.
"What's going on?" he asked.
"Not much," she said. "Whatcha looking for?"
"Blowjob," he said. "How about $40 for it?"
"That sounds good," she said. "I have a room. Let's go."
Moments after he entered room 112, the young woman turned on her customer and showed him a badge. A uniformed Dallas police officer put him under arrest and charged him with solicitation of prostitution.
The unhappy john was Buch. "The suspect was not placed in jail due to his occupation, a surgical doctor," the police report noted. "He had surgery scheduled the following morning at 7 a.m."
Buch had been living dangerously close to the edge for at least several years. Near midnight on September 21, 1989, Buch had propositioned another female undercover officer strutting down Harry Hines.
Late on April 11, 1996, Buch fell for the ruse again, again on Harry Hines.
The last time he was jailed overnight, leaving a patient experiencing complications stranded in the hospital without coverage. Released at 8:46 a.m., Buch didn't go to the hospital to see his patient Carol DeWitt Russell, who had been re-admitted to the hospital on April 10. Nor did he arrange for another doctor to take his calls, instead giving his unlicensed physician's assistant the responsibility. (The man would later testify that he had no idea Buch was jailed or that he was supposed to cover for him.)
The elderly Russell had undergone a total right hip replacement by Buch in October 1995. Russell's attorney would later allege in court documents that: "During the surgery, Dr. Buch used the wrong size rasp/broach which became lodged in Mr. Russell's femur. Once Dr. Buch recognized his error, he tried to impact [hammer] it out without success...Dr. Buch next tried using an extractor with the help of three assistants. Dr. Buch then proceeded to remove the prosthesis by making a stress relief cut in the femur, but the prosthesis was still too tightly engaged. Finally, Dr. Buch resorted to cutting open Mr. Russell's femur the entire length of the prosthesis in order to disengage it. Since Dr. Buch split the femur open, he had to place wires around the femur to close the split. The graft used to repair the femur was inadequate."
The picture is of a frustrated surgeon, who would later blame a scrub nurse for giving him the wrong size rasp. Russell had to undergo additional surgeries. Another doctor made note that the prosthesis was protruding out of the shaft of the femur. Russell's hip continued to come out of its socket until a "lock" was placed on it, limiting his range of motion.
Buch's expert witness said the femur fractured because of Russell's "poor judgment" and "lack of compliance in not protecting his femur"—meaning the overweight man had fallen or moved around too much.
Russell's claim was settled by an insurance carrier for the hospital, Buch and a nurse, but not before an attorney for Russell discovered Buch's arrests.
Ordered to attend counseling for sex offenders by the Dallas Probation Office, Buch had pleaded no contest and received deferred adjudication on each of the three charges. The records were expunged.
The records were leaked to KXAS-Channel 5. Irresistible story, doctor trolling for blowjobs in the red light district, knowing he had to get up early the next morning and scrub in for a complex surgery.
Humiliated, Buch accused the plaintiff's attorney of besmirching his reputation to force a large settlement.
Then Sandy Rose, a hooker found by a private investigator, gave a statement saying that a customer who looked like Buch had "dated" her regularly since 1996, paying $150 for sex in her car. He'd identified himself as a doctor, but Rose didn't believe him. On February 3, 1998, she signed a statement saying their last "date" had occurred about three weeks earlier.
A woman identifying herself as Trina Smith signed a similar statement, saying "the doctor" had given her money for sex in late 1997. Always $150, always between midnight and 4 a.m.
Stephani Moore charged him $200 for sex and an extra $100 "for me to get naked in the car." He told her he was a doctor and showed her his card.
The news of Buch's arrests sent rumors flying around St. Paul, still run by Catholic nuns. (St. Paul is now UT Southwestern Medical Center at Dallas.) Mostly they puzzled over why a physician making nearly $1 million a year would be soliciting streetwalkers. "Maybe it was the excitement of getting away with it," says the nurse. "That's Buch."
Russell's attorney requested that Buch undergo a psychiatric exam, saying that he was an "impaired physician who does not have the requisite emotional, mental or psychological faculties to be a health care provider."
Rycke Marshall, a forensic psychotherapist, reviewed depositions in the case and testified in a hearing that in her opinion Buch had "poor judgment and engages in impulsive and self-defeating behavior"; that he "had a propensity to blame others for his mistakes"; and that to "solicit prostitutes the evening before surgery shows problems with proper decision making, impairing his ability to make good decisions in surgery."
Judge Ann Ashby agreed that "good cause exists for a compulsory mental examination" and ordered that Buch undergo "at least" a four-hour interview and extensive psychological testing. Her order was overturned on appeal after Buch argued it violated his right to privacy.
The negative publicity from the prostitution arrests gave those who disliked Buch incentive to document his infractions.
By the fall of 1998, so many "incident reports" had been filed against him at St. Paul that Buch was convinced there was a "vendetta" against him. In a letter to the hospital's chief executive, he complained that a nurse he'd argued with in the operating room was "forced to write it up...This has also been done in the past and is well known among the house staff and the nurses at St. Paul Hospital, who are also suspicious of these written incidents about me."
The same day, Buch wrote Gill, a spine surgeon and the hospital vice president, complaining that his "favorite nurse" who "inappropriately named me as a problem" had never apologized. "I have acted the same way as I always have for 10 years and I have not changed one bit...My behavior is not anywhere inappropriate compared to the other physicians at this hospital over the years."
Buch had been practicing primarily at St. Paul since 1988 and had been sued for malpractice at least nine times. Before the end of 1999, an additional three lawsuits were filed.
But nothing was ever his fault. For example, Buch signed a blank sheet giving orders for patients while he was out of town and then blamed his physician's assistant for using it to discharge patients from the hospital.
"No untoward effect happened," Buch said in a letter to the hospital CEO in September 1998. Though he had signed the order, Buch blamed his assistant for not bringing it to his attention. The convoluted reasoning was classic Buch.
"Even if he's wrong, he's going to prove he's right," says his former nurse. "Most surgeons are that way. But most surgeons know there's a wall. There's a limit to how far you can take that. He never bends from that position."
As the controversy built in 1999, on April 25, Buch, driving his Jeep Cherokee, collided with another vehicle, killing the passenger and rendering the driver a quadriplegic. Accused of negligent homicide for running a red light, Buch was sued for wrongful death. Buch did not admit wrongdoing, saying the accident was the other driver's fault. He was no-billed by a grand jury and a lawsuit for wrongful death was settled out of court.
The Texas Tort Reform Act of 2003 was passed by the Legislature to solve the perceived crisis of physicians being driven from the field by frivolous claims. Malpractice lawsuits dropped by 50 percent almost overnight. With caps on non-economic damage—pain and suffering—of $250,000, plaintiff's attorneys no longer could afford to pursue claims against doctors on a contingency fee basis.
Aggrieved patients now must obtain within 180 days a "4590i statement" from an expert that provides a fair summary of the standard of care received. Those are submitted to a judge who decides whether there is enough cause to go forward with a lawsuit.
Most 4590i claims do not develop into lawsuits. Plaintiffs' lawyers have trouble finding doctors who will testify against other physicians, and proving violations of standards of care, especially in complex cases, can be near impossible.
The thinning of the plaintiffs' attorney herd has had an impact on complaints reported to the Texas Medical Board. From fiscal year 2006 to 2007, complaints against physicians went up by 1,000 to 6,800.
"We don't know exactly why that is happening," says Mari Robinson, the board's director of enforcement. "We're hearing anecdotally that when plaintiffs' attorneys don't take a case, they may tell the client to call the state board."
Of complaints filed, 65-75 percent concern "standard of care" or negligence, Robinson says. Impaired physicians—drugs, alcohol, mental illness—account for less than 5 percent.
Very few physicians lose their licenses; in the fiscal year 2006, 335 received disciplinary actions, 89 administrative penalties, 11 temporary suspensions and 41 license revocations.
As a result of tort reform, the medical board received extra funding and staff to investigate physicians who were impaired or the subjects of frequent malpractice claims. The industry would police itself.
Soon after the bill was passed, the medical board ran a "master report" of all physicians who had more than three lawsuits of any kind. Every doctor who had more than eight "adverse actions"—lawsuits, loss of privileges or an investigation, all which must be reported to the NPDB—came under scrutiny.
"It was a massive undertaking to make sure there was nobody falling through the cracks," Robinson says. "What we are looking for is a pattern of multiple lawsuits over time."
The medical board now looks at all physicians with more than three "adverse actions" reported to the NPDB in five years, though investigation is discretionary at that point.
"There may be a doctor with only three [lawsuits], but all three had a payout," Robinson says. "Another doctor may have five with no payout."
The number of "adverse actions" on a physician's record with the NPDB may prompt hospital administrators to submit the doctor to more scrutiny.
The Texas Hospital Association does not keep statistics on or track doctors who have had privileges revoked by hospitals, says Charles Bailey, general counsel for the association. Before allowing a physician privileges, all hospitals have a thorough credentialing process, which includes contacting the NPDB, Bailey says.
Once a doctor is on staff, privileges are usually renewed with little fanfare.
But Buch's operating room antics, his treatment of subordinates and the revelations about his personal life built to a storm within the St. Paul community of physicians. St. Paul had been named with Buch in several malpractice lawsuits, but that wasn't the only issue. Administrators were also concerned about potential lawsuits from nurses over a hostile work environment.
In May 1999, when Buch signed his reapplication for privileges—attesting incorrectly that he had no current or pending malpractice claims, suits or settlements, and had no investigations by a hospital, state licensing agency or NPDB the previous two years—he stepped into a trap.
At first it looked as if his reapplication for privileges at St. Paul was perfunctory. An initial peer review panel issued a recommendation to the hospital's Medical Executive Committee that Buch's privileges be renewed for one year and that he be given a formal reprimand for the inaccuracies on his application.
Noticing that Buch had not included in his reapplication a malpractice suit that had also named St. Paul, the credentials committee requested that he provide detailed information about new or pending malpractice suits and any state, health care agency or federal investigations, required under hospital bylaws to be reported to the administration within 15 days of filing.
Dr. Kevin Gill, who considered Buch a good physician, had received a visit from an FBI agent, who said the agency was investigating Buch for alleged Medicare fraud—specifically billing Medicare for a certified physician's assistant though someone unlicensed did the work. Gill gathered surgical charts and made them available to the FBI. Buch's assistant was removed from the staff. (The fraud investigation ended with no action. The assistant was charged with one felony count of forging Buch's name to a prescription; it was reduced to a misdemeanor.)
In a long, rambling, almost incoherent letter dated August 16, 1999, "to whom it may concern," Buch defended his assistant and brushed off their concerns as much ado about nothing.
He noted that the hospital and malpractice insurance companies were settling the 1997 Russell lawsuit "against my advice."
In trying to "clean up this continued fire storm that I have undergone these last two years," Buch outlined three lawsuits he had not mentioned on his application for privileges: Terry Perkins, a total hip replacement, which Buch called "a nuisance suit"; Mary Sue Britton, "easily defensible"; and Ronnie Vest, also a "nuisance" case.
He hadn't mentioned them because they were not important, he rationalized. The only one "outstanding" was filed by Patrick and Starlinda Sanders, also a nuisance case, Buch claimed.
But in addition to pending malpractice claims, Buch had not disclosed that he had been the subject of an investigation by the Texas Medical Board in 1998. (The investigation had been closed with no action.)
Citing Buch's inaccuracies as "serious and substantial," the executive committee in October 1999 submitted a recommendation that the board of trustees deny Buch's application for privileges. Buch appealed, and in a three-day evidentiary hearing before a five-physician panel, Buch brought in witnesses and documents.
Perhaps without the trail of disrespect and grandiosity Buch had left in his wake, the misstatements on his application would have been forgiven and his privileges granted. He even submitted affidavits from nurses and doctors that his "behavior and self-esteem" were similar to other orthopedic surgeons they had observed. All the affidavits used virtually the same phrases. (According to Healthgrades Inc., an online physician referral service, 99.6 percent of physicians specializing in orthopedic surgery do not have disciplinary actions.)
Calling the process a "witch hunt," Buch argued that with his loss, St. Paul would no longer have a bone tumor specialist.
The executive committee did not change its recommendation. For his "failure to be forthright and direct" on his reapplication for appointment, Buch was denied privileges. The hospital's board of trustees agreed and permanently severed his relationship with St. Paul in May 2000.
St. Paul reported its action to the Texas Medical Board, which opened another investigation of Buch. In March 2001, Buch's medical license was suspended for improper supervision of his physician's assistant and unprofessional conduct by omitting information from his application for his medical license, including a conviction for disorderly conduct when he was 17, and later failing to disclose the arrests for solicitation of prostitution.
The suspension was stayed for five years and Buch was ordered to obtain 10 hours of ethics training, attend at least 50 hours per year of continuing medical education, with at least 10 hours in risk management. He also was ordered to pass the Medical Jurisprudence Examination given by the board, fined $5,000 and required to give a copy of the order to all health care entities where he practiced. After successfully completing his probation, Buch is no longer under board order.
Buch sued St. Paul and Gill, charging that the doctors "entered into a horizontal conspiracy" and published a statement to the NPDB "maliciously."
"Doctors are forced to stay and fight," says Buch's attorney Mike Hopkins, "because the negative database report has such a domino effect. If you don't stay and fight, you can't get it removed. These actions, when they are wrong, then have a cumulative bad consequence for the physician."
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.
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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.