Special report

The Herald confirmed with the hospital that Dr. Anil K. Dutt, shown, is no longer a Titusville Area Hospital employee.

  • Since almost the start of his career, Dr. Anil Dutt has been the subject of allegations, investigations, and lawsuits

A general surgeon whose past malpractice cases have been under scrutiny from the newspaper since November parted ways with Titusville Area Hospital last month.

The Herald confirmed with the hospital that Dr. Anil K. Dutt is no longer a Titusville Area Hospital (TAH) employee.

In response to an email from the newspaper, Dutt wrote on Monday that he was “a member in good standing on Titusville Area Hospital’s medical staff” when his “position was eliminated for business/financial reasons.”

Dutt’s last day was Aug. 9.

Last month, when Lee Clinton, the hospital’s new CEO, was asked about Dutt’s departure, he would not say whether Dutt was terminated or had resigned, calling the doctor’s departure a “confidential employment matter.”

When contacted again, Monday, Clinton maintained that he was “not permitted to comment on employment issues.”

How our

investigation began

In the fall of 2015, the newspaper covered a civil case involving Titusville Area Hospital. That trial, which had absolutely no connection to Dr. Dutt, ended with a Crawford County jury awarding a Centerville couple $2.2 million.

After the conclusion of the trial, the newspaper began a review of past civil litigation involving TAH. The most recent lawsuit to name the hospital as a defendant, aside from the Centerville couple’s case, was a civil suit against Dutt that was settled in 2011.

After an online search for more information about Dutt yielded results that concerned the newspaper, we conducted interviews, obtained Pennsylvania Department of State documents and Crawford County Court files to piece together Dutt’s professional past, and learn how he obtained a position with TAH about a decade ago.  

Denied a license

in Pa. at first

 After Dutt applied for his license to practice medicine and surgery from the Pennsylvania State Board of Medicine, in June of 2005, the board issued a provisional denial in a letter dated Oct. 5, 2005.

The letter listed the board’s concerns about Dutt’s history in Alabama, citing five malpractice cases that resulted in payments.

In three of the cases, patients had ultimately died.

State medical boards are regulatory agencies. The primary reason for their existence is to license and discipline doctors, and investigate complaints.

The provisional denial of Dutt’s license put his plans to begin work as a surgeon for his new employer — Titusville Area Hospital — on hold.

In November 2005, an appeal was filed on Dutt’s behalf, and the board of medicine delegated the matter to a hearing examiner.

A state board of medicine hearing was held Jan. 6, 2006, in Harrisburg, before the examiner. The Herald obtained a transcript of that hearing from the Crawford County Courthouse.

After listening to testimony from Dutt, as well as former Titusville Area Hospital CEO Anthony Nasralla and former Titusville chief of surgery Dr. Ralph Nazzaro, the hearing examiner, John T. Henderson Jr., recommended in a March 8, 2006, proposed adjudication and order that the board of medicine not allow Dutt to practice in this state due to his “high number of injuries and deaths, coupled with patterns of complications during laparoscopic procedures.”

Henderson wrote that “in light of his (Dutt’s) practice history, applicant appears to be an unqualified physician.”

In the document, which was obtained by the newspaper from the state department, Henderson said, “Looking at the totality of circumstances in this case, it can be reasonably concluded that applicant (Dutt) has continuing problems with laparoscopic procedures.”

The hearing examiner concluded that Dutt “has had an unusually high number of injuries and deaths in his twenty years of practice that cannot be ignored: for example, the death of a patient from a perforated rectum following an aborted colonoscopy in 1993, and the death of a patient following [the] applicant’s alleged misfiring of a stapler during a splenectomy in 1999.”

Henderson noted the commonwealth attorney’s assertion during the January 2006 hearing that “we have trouble following every place that Dr. Dutt goes to.”

Dutt had been the subject of multiple lawsuits, since 1993 to the time of the 2006 hearing, in every location in which he has practiced, Henderson wrote.

Ultimately, the hearing examiner’s recommendation to deny Dutt was set aside, and, in the spring of 2006, the state board of medicine unanimously approved Dutt’s license, clearing the way for him to perform surgery at TAH.

Two years later, Dutt was blamed for botching a laparoscopic gallbladder surgery on Bridget Parker, and sending her home with a potentially fatal injury.

Parker and her husband, Jim Parker, sat for an interview with the newspaper in November of last year. (Editor’s note: Jim Parker died at the age of 49 in January of this year.)  

The case

of Bridget Parker

On Mother’s Day 2008, six days after Parker’s surgery, her family was whispering about the yellow cast of the 29-year-old’s skin and eyes.

On May 5, 2008, Parker, a wife and mother of two, underwent a laparoscopic cholecystectomy at Titusville Area Hospital because of gallstones.

Laparoscopy is also known as minimally invasive surgery, or “keyhole” surgery. A camera inserted into a patient through a tiny incision serves as the surgeon’s eyes as he or she performs the operation.  

Parker’s roughly half-hour procedure involved easing a camera through an incision in her abdomen, and making several other small cuts to slide in instruments to dissect and remove her gallbladder.

The surgery was done on a Monday morning, and Parker and her husband, Jim, returned to their Fauncetown Road home that same day. That’s part of the appeal of laparoscopic surgery — short hospital stays.  

In the first few days after her surgery, Parker was in pain, and called the hospital. She was prescribed pain medication and advised to take a laxative.

Toward the end of that week, her pain was under control, but her skin and eyes were yellowing.

Her appearance was so alarming that she looked almost alien, Jim told the newspaper during the couple’s interview.

On the day after Mother’s Day, exactly one week after her surgery, Bridget went to a scheduled post operation appointment with Dutt at his former office location in the old WTIV building on West Central Avenue.

When Dutt saw Parker’s yellow coloring, he said he didn’t know what could be wrong, the couple recounted.

The Parkers said Dutt sent Bridget to the Titusville hospital to check for more gallstones on that same day.

On the drive home, after leaving TAH, the Parkers got a call from Dutt’s office. They said they were told to schedule an endoscopic retrograde cholangiopancreatography (ERCP), a “scope,” with Saint Vincent Hospital, in Erie.

A day later, Jim drove his wife to Saint Vincent for the procedure. He settled down in the waiting room after being told the scope could take up to an hour and a half.

But after just 30 minutes, a doctor hurried into the waiting area with an evident sense of urgency, holding forms for Jim to sign to allow Bridget to be transferred immediately to UPMC Presbyterian, in Pittsburgh.

Jim remembered being told there was something wrong with his wife, and that she “needs to go now.”

Before Jim left the hospital, a doctor gave him a CD of Bridget’s scope.

After his wife was loaded into a southbound ambulance, Jim stopped at home to gather a few belongings and make arrangements for their children before driving to Pittsburgh.

He decided to take a look at the CD before he left.

During an ERCP, dye is injected into a patient, to highlight their ducts on an X-ray. On his computer screen, Jim watched as the dye flowed through his wife’s abdomen. But just before reaching her liver, the dye came to a complete stop.

Jim didn’t know exactly what he was looking at, but he knew it had to be the reason his wife was on her way to Pittsburgh.

What the couple would soon learn was that the dye couldn’t finish its course through Bridget’s system because her common bile duct had been cut, meaning her liver was no longer connected to her small intestine. The snipped end of the duct was clamped.

The bile being formed in Parker’s liver was unable to flow into her small intestine and out of her body. Life-threatening toxins were building up in her system.

She needed to be completely opened up for a laparotomy, but was in no condition for surgery. So, a hole was cut in her body to attach a bag to catch her bile.

After two weeks, she was healthy enough for surgery at the Thomas E. Starzl Transplantation Institute, in Pittsburgh.

In a grueling, eight-hour operation, a doctor rebuilt Parker’s bile duct using part of her intestine, the Parkers said.

Bile duct reconstruction is slow and careful work. The duct is tangled in a network of arteries and veins. The liver is a multifunctional organ with a rich blood supply.

At some point, the surgeon found Jim in the waiting room, and told him that his wife was going to be alright, but that the operation had been a difficult one, and she had lost a lot of blood at one point.

After her surgery, Bridget spent about another week in the Pittsburgh hospital. She was discharged with a boomerang-shaped wound that went almost completely across her stomach and was closed by 37 staples, and a hole in her body with a tube inside.

For almost a year, the Parkers traveled to Pittsburgh, every six to eight weeks, to have a new sized tube put in Bridget’s side to help her recover. It was a physically painful ordeal that made it unbearable to even sleep in her own bed for 11 months. Jim said his Louisiana-born wife was always tough, but when she would return from Pittsburgh, she would be in the bathroom, in tears from the pain.

Bridget cared for her elementary school-age son and daughter, and worked toward her associate’s degree in pre-school education with the tube. She even did her pre-school field experience with the wound.

The Parkers decided to sue Dutt in 2009. They lived and breathed the case until their attorneys pushed them to settle in December 2011, they said, just two months before the case was scheduled to go to trial.

The Parkers were disappointed with the amount they received, which to them didn’t seem fair. They would not disclose the settlement figure, and the newspaper was unable to locate the dollar amount on file at the Crawford County Courthouse.

The Parkers said they never received a bill from Dutt or Titusville Area Hospital.

At the time of Bridget’s surgery, the couple had limited income, and didn’t have insurance.

The total bill for her Pittsburgh care was $134,000.

Bridget eventually made a complete recovery. About two years ago, the avid reader worked up the courage to start writing, and published her first novel in the niche genre of paranormal romance. She’s published about a dozen books.

But every three to six months, for the rest of her life, she is reminded of her brush with death when her liver function is tested.

And she fears that she will someday need bile duct surgery again, if too much scar tissue builds up.

The Herald first reached out to Dutt last winter, leaving a business card and verbal request to speak to him with staff members of his TAH office. No communication was received.  

Then, on Sept. 15, The Herald made its third and final attempt to set up an interview with Dutt after obtaining his email.

Here is his unaltered email response in its entirety:

“Patient privacy and peer review protection laws preclude me from commenting or providing information on specific quality of care or peer review inquiries. I cannot discuss any malpractice cases. The outcome of the 2006 hearing was that I got a license to practice medicine in Pennsylvania. Hospital medical privileges, medical licensure, and board certification are granted after a physician’s credentials have been extensively vetted. I underwent a vigorous peer review processes in connection with Titusville Area Hospital’s physician credentialing and its quality performance functions. In addition, I hold (i) a current and unrestricted Pennsylvania medical license, (ii) a current and unrestricted license from the federal Drug Enforcement Administration, (iii) board certification by the American Board of Surgery, and (iv) medical malpractice insurance in amounts required by Pennsylvania law. I was a member in good standing on Titusville Area Hospital’s medical staff when my position was eliminated for business/financial reasons. I have nothing further to add. Please do not contact me again. Dr. Dutt.”

Dutt has also been a fellow of the American College of Surgeons since 1994.

Two deaths

in the same year

Fifty-five-year-old Dutt earned a biology degree in 1982, and then graduated from the University of Arkansas for Medical Sciences College of Medicine, in Little Rock, in 1986. That same year, he began a five-year general surgical residency at a hospital in New York City.

After completing his residency, Dutt began doing surgery with the U.S. Army in 1991, at Fort McClellan’s Noble Army Hospital, in Alabama.

In 1993, he was blamed in two deaths at the Army hospital.

In one of those deaths, Dutt, who was chief of general surgery at that time, perforated a man’s rectum while doing a colonoscopy, and sent the man home without realizing what he’d done.

Dutt testified at the state hearing that he’d had problems seeing the man’s colon, so he ended the procedure and sent the patient home. He said he thought some kind of equipment malfunction was to blame.

Another doctor called that same patient about an unrelated matter, and learned that the man was having abdominal discomfort. That doctor recommended the man return to the hospital. The patient, however, did not do so, and was found dead by his sister the following day.

An autopsy discovered the tear in the rectum, according to the hearing examiner’s judgement.

Under cross-examination at the January 2006 state hearing, Dutt did not deny that his procedure perforated the man’s rectum.

The case was ultimately settled almost a decade later by the military for $71,000, according to a document on file at the Crawford County Courthouse.

The colonoscopy-related death happened in May of that year. About four months later, in August 1993, Dutt was blamed in the death of another patient during gallbladder surgery on the Army post.

In that case, Dutt caused a cautery burn injury to the patient’s common bile duct while performing a laparoscopic cholecystectomy.

Dutt allegedly opted not to do an intraoperative cholangiogram to obtain images before the surgery, and failed to convert to an open procedure in that case, the hearing examiner said.

At the 2006 state hearing, Dutt testified that he decided the patient needed a second operation after the bile duct burn, and during this procedure, the patient aspirated, had a severe lung injury and eventually died from severe respiratory distress “probably related to the aspiration,” according to Dutt, the hearing examiner’s judgement said. (Aspiration is the inhalation of secretions or gastric contents into the lower respiratory tract, which can lead to complications, such as pneumonia.)

This case settled for more than $200,000, according to a document on file at the Crawford County Courthouse.

After those two deaths, the military limited Dutt’s clinical privileges, and sent him for additional training in endoscopy and laparoscopy, Dutt testified.

A serious injury

in 1994

In December 1994, Dutt cut a woman’s common bile duct while attempting laparoscopic gallbladder surgery.

Though the patient recovered, she had long-term follow-up with the Army, according to the hearing examiner.

Dutt testified before the state hearing that the anatomy of the patient had been unnatural, and her common bile duct appeared to be a cystic duct.  

The military paid $100,000 in that case.

Dutt testified that he had no opportunity to defend himself in the military cases.

Dutt said he was honorably discharged from the Army in 1995.

A lawsuit

in 1996

After leaving the Army, Dutt went into his solo practice in Calhoun County, Alabama, but was also on staff at the three county hospitals where he had previously acquired privileges.

In November 1996, Dutt allegedly unnecessarily took out a man’s appendix.

Dutt testified that he thought the man had a ruptured appendix based on a laparoscopy he did on him, the hearing examiner reported.

When the patient did not improve after the appendix was out, a CAT scan revealed that the problem had not been a ruptured appendix, but was instead a case of diverticulitis, which was treated with antibiotics, according to the hearing examiner.

Dutt made the claim during the state hearing that if he had operated for diverticulitis, it would have been a more extensive procedure.

Diverticulitis happens when pouches on the lining of a person’s digestive system become inflamed or infected. Rest, a change in diet, and antibiotics are the typical courses of treatment. Surgery is generally only necessary if other treatments don’t work, or the problem is chronic.

Dutt testified that the man’s claim that he performed unnecessary surgery was debatable, but he had been advised by his insurer that it would be less costly to settle the case than fight it, the hearing examiner reported.

The case was settled for $11,500.

A death after

spleen surgery

In May 1999, Dutt was assisting a colleague with a laparoscopic spleen removal on a 55-year-old woman at his private practice in Calhoun County.

During the procedure, the patient’s inferior mesenteric artery was avulsed, meaning torn away, “leading to blood loss and the patient’s ultimate demise,” according to the hearing examiner’s report.

During his testimony before the state, Dutt said he had been holding the camera and talking the operating surgeon through the procedure.

At some point, the operating surgeon needed to take a break “because she had to change a glove or something, and she allowed me to put my hand in the abdominal cavity and see how she had done,” Dutt testified at the state hearing.

“At some point, there was a fair amount of bleeding. Then, I fired the stapler maybe twice, detaching the spleen from its attachments. So then we did run into some bleeding,” Dutt testified before the state.

His testimony about the incident continued: “At that point, I did not scrub — I mean, I broke scrub, and started helping the anesthesiologist with lines and recitation [sic] and helped the patient that way.” (Editor’s note: The hearing transcript uses the word “recitation.)

Dutt testified, “Another surgeon who just happened to be in the operating room came in to help, and to give her a hand. They stirred a lot more bleeding up at that point. They ended up having to pack the patient because they couldn’t control the bleeding.”

Dutt testified that the patient died about a week later of subsequent sepsis or infection.

He also testified that the operating surgeon amended her operating report a month later to suggest that Dutt fired the stapler without having a camera inside the patient’s abdomen.

That case went to trial, and both Dutt and his colleague were named as defendants.

The case was settled voluntarily by Dutt for $1 million.

A gastric bypass gone awry

Dutt was the subject of a malpractice suit that claimed he failed to properly manage a gastric bypass in October 2001 that ultimately resulted in a woman’s death, according to the hearing examiner.

After the operation, the patient required a tracheostomy tube to breathe, the hearing examiner said. The woman improved slowly, but an infection in her abdomen, her obesity and other medical issues made her ill, and kept her on a respirator. While at a respiratory care center, her tracheostomy tube fell out, and she ended up dying in an emergency room, according to the hearing examiner.

In that case, Dutt admitted under cross-examination at the state hearing that he used 2.5 millimeter staples on the woman’s stomach and intestines. In his testimony, Dutt conceded that 2.5 millimeter staples for a laparoscopic gastric bypass is an “off-label use.”

This means the FDA had not approved those particular staples for gastric bypasses.  

It is unclear whether Dutt’s use of the wrong staples contributed to the patient’s respiratory problems and ultimate death, the hearing examiner said.

At the time of the 2006 state hearing, civil litigation in that death was still pending. The paper could not determine the outcome of the case.

An ad placed in the Anniston Star newspaper by Jacksonville Hospital in August 2001 listed Dutt as “Calhoun County’s only surgeon experienced in laparoscopic gastric bypass.”

Dutt testified before the state that at the time of the 2001 incident he had performed about 30 laparoscopic gastric bypasses.

A hospital investigates

On Jan. 10, 2001, Stringfellow Memorial Hospital, in Anniston, Ala., restricted Dutt’s privileges.

Dutt testified before the state that he believed Stringfellow was prompted into action by three cases involving laparoscopy: a hernia repair, an appendectomy, and a gall bladder removal, the hearing examiner wrote.

Under questioning from his attorney at the state hearing, Dutt said a report by Stringfellow Memorial that said he had a high complication rate was “probably politically motivated.”

He testified that “out of nowhere, I was summarily suspended because I had a, quote, high complication rate. I was never given any figures, but, behind the scenes, unofficially, I heard it was as high as 33 percent. But I had nothing to hide. I wanted to know more about it. They wanted to have my charts reviewed by an external peer review organization.”

Dutt testified that an external peer review did not confirm a 33 percent complication rate.

Dutt’s testimony is unclear in this portion of the transcript. He’s quoted as saying: “In fact, I don’t think — if there was any discussion, it may have been two or three percent of the cases that had any discussion about.”

Dutt testified that he was reinstated at the hospital, but the whole process took about six weeks, and his privileges were restricted during that time.

After its investigation, Stringfellow Memorial, as required, reported Dutt to the Alabama State Board of Medical Examiners.

In February 2001, the Alabama board began its investigation, which resulted in Dutt meeting with the board.

Under cross-examination by the commonwealth at the 2006 hearing, Dutt said he was referred to the Colorado Personalized Education for Physicians (CPEP) program in June 2002 for assessment through an informal agreement with the Alabama board.

The CPEP is a non-profit group that is supposed to prepare doctors to re-enter practice.

Over a few days, the CPEP assesses a doctor through a multiple choice exam, oral exam and other methods. The hearing examiner noted in his report that the assessment doesn’t test a doctor’s actual, physical surgical skills.

The CPEP assessment concluded that Dutt “demonstrated a sufficient level of clinical competence to continue to practice unsupervised.”

Dutt testified before the state that he was allowed to pick the charts that the CPEP program took a look at. He testified that none of the charts that he sent the program involved any of the incidents that spurred Stringfellow’s investigation.

He testified that he was asked by CPEP to provide “run-of-the-mill” charts.

Dutt testified, “They said I should probably avoid anything that was being contested because they didn’t want to be the arbitrator for that discussion.”

During the 2006 state hearing, the commonwealth noted in contrast to the CPEP’s assessment that when Dutt applied to serve the Government Employees Hospital Association, a not-for-profit association that provides health and dental plans to federal employees and their families, he was denied. The state said the association was concerned about Dutt’s multiple malpractice cases and restrictions on his hospital privileges.

The Alabama Board of Medical Examiners and Medical Licensure Commission of Alabama database indicates that no disciplinary action was ever taken against Dutt.

An alleged common bile duct injury

In 2005, Dutt was the subject of yet another common bile duct injury suit in Alabama, the hearing examiner reported.

This was another laparoscopic cholecystectomy.

In this case, the complaint alleged the patient had to undergo additional surgery and spend six days in the hospital as a result of Dutt’s operation, according to the examiner.

During the 2006 state hearing, the commonwealth’s attorney asked Dutt if he was aware that the Alabama State Medical Board was still investigating him.

Dutt replied, “Now I am. I was not aware of that.”

Dutt said that he’d had a visit from an investigator with the Alabama board in early 2005. He said the investigator showed up, unannounced, and told the doctor that his visit was a routine follow-up.

Dutt testified that the investigator asked if he had any new lawsuits, and he told him about the 2001 gastric bypass. He said the investigator asked him to put that case in writing.  

A letter, dated June 23, 2005, from the Alabama State Board of Medical Examiners was entered as a commonwealth exhibit for the 2006 state hearing.

The letter stated, “Please be advised that there is a current investigation concerning Dr. Dutt’s medical practice, which has not been completed. No additional information is available at this time.”

The Herald was unable to determine any more about the investigation, and, based on the transcript of the 2006 state hearing, it appears the commonwealth wasn’t able to make much headway with the matter, either.

Why did Dutt come

to Titusville?

At the 2006 state hearing, the commonwealth’s attorney asked Dutt, “Why Titusville Area Hospital? What prompted you to want to come to Pennsylvania?”

Dutt testified that he had gone through a divorce, and his children lived in Maryland.

“I originally started looking in areas of the state closer to them, and ended up taking the opportunity in Titusville, and that’s why I moved up here.”

Dutt testified that he opted to not seek employment in Maryland because that state “seems kind of saturated” with surgeons.

The Titusville

CEO testifies

Former Titusville Area Hospital CEO Anthony Nasralla testified on Dutt’s behalf during the 2006 state hearing.

Nasralla retired from TAH this July, after nearly three decades as the local hospital’s CEO. In March, the newspaper emailed Nasralla’s assistant, asking her to inform him that the paper wanted to speak with him about Titusville’s decision to hire Dutt. The assistant said she forwarded the email to Nasralla. He did not respond to the paper’s request.

Nasralla testified before the state that on July 1 (no year is given in the transcript, but presumably Nasralla was referring to July 2005) he received resignations from two board-certified surgeons within 45 minutes of each other. He said that left the hospital with one surgeon.

At the time of Nasralla’s testimony in January 2006, the hospital still had just the one surgeon, who was on call 24 hours a day, seven days a week.

The remaining surgeon was 66-years-old, and wanted to retire at the end of 2006, Nasralla testified.

He said the hospital had been seeking another surgeon prior to receiving the two resignations, but the process had not borne fruit.

“We had interviewed several general surgeons, and to that point, had not been successful for various reasons, ranging from the size of the community to, in some cases, the scope of the practice, which entails a lot more than the general surgeons wanted to take on,” Nasralla said.

He told the state that the hospital received a curriculum vitae from Dutt, and Nasralla took it to the hospital’s recruitment committee, which was comprised of Nasralla, three doctors, one hospital board member, and a physician recruiting coordinator.

He testified that Dr. Ralph Nazzaro volunteered to interview Dutt over the phone.

“Based on the preliminary findings of the phone interview, we decided to invite Dr. Dutt for a personal interview,” Nasralla testified.

At that point, the hospital was not aware of entries on the National Practitioner Data Bank about Dutt, Nasralla testified.

The National Practitioner Data Bank, which operates under the Department of Health and Human Services, gathers information about medical malpractice payouts and some disciplinary actions taken against doctors and other medical professionals. The only people who have access to the database’s more sensitive information are hospital administrators, doctors, law enforcement, insurance companies, and a few others.

During the hearing, Dutt’s attorney asked Nasralla if the hospital was concerned when it learned of the data bank entries.

“Oh, absolutely,” Nasralla responded.

During one of Dutt’s interviews, the hospital questioned the doctor about his old cases, Nasralla said.

The data bank findings were then presented to the hospital’s credentialing committee, Nasralla testified.

Under cross-examination, the commonwealth’s attorney asked Nasralla about the credentialing committee’s vetting of Dutt’s old cases on the data bank.  

The attorney asked Nasralla if he was aware of the hospital’s credentialing committee obtaining any records from Dutt’s five medical malpractice cases in which payments were made.

Nasralla testified, “To the best of my knowledge, they have not reviewed any of those records.”

The lawyer then asked, “Do you know if they even reviewed the civil complaint allegations?”

Nasralla answered, “Not to my knowledge.”

The lawyer asked, “Basically, it’s your understanding that the credentialing committee, with regard to this, pretty much just asked Dr. Dutt’s opinion of the matters?”

Nasralla responded, “Yes.”

The lawyer then asked, “At this point, Dr. Dutt has been extended employment by Titusville?”

Nasralla answered, “Contingent upon credentialing and licensure and malpractice coverage.”

By the time of the January 2006 hearing, Dutt and the hospital had already agreed to a proposed, three-year contract, according to Nasralla’s testimony.

When the commonwealth’s lawyer asked Nasralla if anyone from the hospital’s credentialing committee had been in contact with the Alabama State Board of Medicine, Nasralla said, “To the best of my knowledge, no, they have not.”

Nasralla testified that his confidence in Dutt was strengthened after he spoke with a doctor who had worked with Dutt in Ozark, Alabama. That doctor had made a note on her recommendation for Dutt that when she needed surgery, she elected to have Dutt do it.

In his testimony, Nasralla emphasized a local need for access to medical care, testifying that 25 percent of the hospital’s service area population is within 200 percent of the poverty level, and one out of every five people in the service area was age 65 or over.

“I think, self-evident in that, is the limited ability of some of these people to travel outside of the area for access to medical care,” Nasralla said.  

A Titusville surgeon takes the stand

Dr. Ralph Nazzaro is known to many in the community for his solo practice in Titusville from 1977 until 2001, and his community involvement.

In 2006, he testified that he was board certified, and a member of the American College of Surgeons.

At the time of his testimony before the state, he was retired from active practice, however, he was still an employee of TAH. Nazzaro testified that he performed physical exams, reviewed charts, recruited, and talked to medical students for the hospital. He also testified that he’d recently begun proctoring surgeons in the operating room.

The Herald obtained an email address for Nazzaro, and sent him a message on Sept. 15. We did not hear from him.  

Nazzaro testified that he believed the hospital checked the National Practitioner Data Bank report sometime after Dutt’s face-to-face interview.

Dutt’s attorney asked Nazzaro what he did when he became aware of the data bank information.

Nazzaro testified, “I looked at it and said, ‘Gee, whiz.’ Then, I looked at each case on there. And I said, ‘Gee, I have done that. Yes, I have done that.’ Each of those cases seemed like the kind of complications that are expected and most busy general surgeons have seen personally.”

When asked about Dutt’s laparoscopy incidents in the early 1990s, Nazzaro testified that laparoscopy was new during those years, and the complication rate across the country was high as surgeons transitioned from operating with three-dimensional visualization to two-dimensional.

As for the colonoscopy-related death, Nazzaro testified that he, too, had at some point perforated someone’s colon. He testified that this was a recognized complication of the procedure.

While under cross-examination, he conceded that while perforation is a risk, with about 1 percent of colonoscopy patients sustaining such an injury, the risk of dying as a result of a colonoscopy was “a much smaller percentage of that one percent,” he said.

The American College of Physician’s Annals of Internal Medicine, published an article in 2006 that reported one death was found in 16,318 colonoscopies from January 1994 to July 2002.

The New York Times reported in 2013 that data from the Centers for Disease Control and Prevention suggests that more than 10 million people get colonoscopies each year in the United States.

Dutt’s attorney asked Nazzaro, “Did the review of the data bank entry, then, cause much concern on your part?”

Nazzaro answered: “No. Yes, when I saw the 30 pages or whatever the data bank package was. But as an individual case, no, it did not.”

Dutt’s attorney then asked Nazzaro about the case in which the appendix was allegedly removed unnecessarily. If you recall from earlier in this article, that patient actually had a case of diverticulitis, and required antibiotics.

Nazzaro testified, “As I got to know Dr. Dutt better, I wanted to hit him in the back of the head and say, ‘Why did you settle this case?’”

Nazzaro continued, “If I were in that situation, and I did something, number one, correctly, and doing the right operation for the wrong reason, curing this guy of a potentially fatal disease and sending him home in good condition, and then he sues me for taking out an appendix. I would have fought that case as hard as I could.”

Under cross-examination by the commonwealth’s attorney, Nazzaro said he had not reviewed any medical records or charts for the appendix case.

The commonwealth lawyer asked him, “You’re basing your opinion on what Dr. Dutt told you?”

Nazzaro responded, “And what I gathered from the other doctors in Alabama.”

Under cross-examination by the commonwealth’s attorney, Nazzaro clarified some of what Nasralla had said about the credentialing committee’s vetting of Dutt. Nazzaro stated that “the actual in-depth credentialing has not started, and that [it] can’t start until his (Dutt’s) [license] application is complete.”

The commonwealth’s attorney asked Nazzaro if the hospital would review the charts from the malpractice cases.

Nazzaro responded, “I don’t know about the chart review — or you had talked before about the court record review. I have been in court and I don’t know how valuable those records really would be, the court records.”

The lawyer asked, “Aside from the court records, the medical records in these matters would be of some value, wouldn’t they?”

Nazzaro responded, “They would be. Normally, we would not be looking at medical records on any doctor. I’m not sure that the patient in Alabama would release them to Titusville hospital.”

Nazzaro testified that he did speak with several doctors in Alabama about Dutt’s lawsuits.

The doctors he spoke with, however, were not involved in any of the cases, Nazzaro said. He told the state that he found the doctors’ names on a listing of American College of Surgeons on the internet. He said the surgeons were from “Jacksonville, particularly Calhoun County,” in Alabama.  

He said the surgeons he talked with were aware of the malpractice cases against Dutt.

During his testimony, Nazzaro told the state that he chose to retire from active practice because he was tired of dealing with litigation.

“I said, ‘I’m tired of this.’ I just got released from one lawsuit and the same day the sheriff gave me another summons, which two years later I was released from. I said, ‘I’m tired of this.’ I said, ‘That’s it. I’m not in the practice of surgery at all.’”

The commonwealth’s attorney asked, “Somebody that also has a number of lawsuits, you certainly have been through that, and you have some affinity for their situation?”

Nazzaro responded, “Yes, sir.”

The commonwealth attorney asked, “And some sympathy, so to speak?”

“Understanding,” Nazzaro responded.

When Dutt’s attorney had an opportunity to question Nazzaro again, he asked him about the phone calls to doctors in Alabama. Nazzaro said he called “two general surgeons and a gastroenterologist.” None of the doctors were Dutt’s references, he said. He testified that he asked the doctors for their overall impression of Dutt.

“They all said, you know, nice guy or something along those lines, morals, community. Everything was very good on that level.”

Nazzaro testified that when he asked about the malpractice cases, “One surgeon had never actually worked with Dr. Dutt. He had nothing to tell me really. He was a little hesitant to keep talking to me. The other surgeon has worked with Dr. Dutt, I believe, assisting on a limited basis. His conclusion was very good, technically safe, good surgeon. He was not involved in those cases as far as I know. The gastroenterologist knew Dr. Dutt much better, knew of the alleged thirty-some percent complications rate [at Stringfellow Memorial], and said that was a vendetta. He said the rate was two or three percent after this outside review came through.”

Both Nasralla and Nazzaro testified that Dutt would be proctored for a period of time, most likely six months.

It was Nazzaro who would be Dutt’s proctor.

Under questioning from the commonwealth’s lawyer, Nazzaro said that he had never specifically trained in laparoscopy.

If Dutt were to perform a laparoscopic splenectomy or a laparoscopic gastric bypass, “you (Nazzaro) would be proctoring a procedure that you have no experience in performing yourself?” the lawyer asked.

Nazzaro responded, “Yes and no. I have not done the procedure, but I have done the individual steps of the procedure. I would be able to observe the competency.”

As an example, he said he’s proctored two podiatrists over the years. “With the one, you can tell the way she handled herself, handled the technical aspects of surgery, that she was a very good operating surgeon. The other one, you could very easily tell shouldn’t be in an operating room, and he is not.”

Nazzaro also testified that TAH didn’t do gastric bypasses at that time.  

A recommendation

to deny Dutt again

The hearing examiner was not convinced by Nasralla and Nazzaro, and, on March 8, 2006, ordered that Dutt’s application for a license to practice medicine and surgery in Pennsylvania be denied again.

However, that recommendation was set aside, and, 20 days later, the Pennsylvania State Board of Medicine unanimously approved Dutt’s license with temporary restrictions, helping to clear the way for his employment with Titusville Area Hospital.

The state board required a six-month probation period for Dutt, and that all his surgical procedures be proctored during that time.

According to minutes from the Aug. 22, 2006, state board of medicine meeting, Dutt requested that the board “shorten the probationary terms/relax the proctoring requirements that he is currently under.”

It does not appear that the board opted to do so.

Upon satisfactory completion of his probation, Dutt was issued an unrestricted license on Oct. 5, 2006.

New York license surrendered

Dutt voluntarily surrendered his New York medical license in September 2006.

In a New York State Board of Professional Medical Conduct document, Dutt acknowledges that the New York board had charged him with misconduct based on his professional history.

The board accepted Dutt’s license surrender, making him no longer allowed to practice in that state.

Meadville Medical Center’s position

On Nov. 30 of last year, The Herald reached out to Meadville Medical Center, which had acquired TAH in October, asking to discuss the past suits against Dutt that involved serious injuries and deaths before he joined TAH. We also asked to discuss the Bridget Parker case.

Don Rhoten, president of the Meadville Medical Center Foundation and vice president of community engagement for Meadville Medical Center, responded on Dec. 4. He wrote: “MMC has been aware of the 2009 closed case regarding Dr. Anil Dutt. Dr. Dutt, who is currently employed by St. Vincent Hospital, in Erie, remains in good standing with both the Pennsylvania State Board of Medicine and the TAH medical staff. MMC performs continuous exclusion checks to ensure physicians at MMC and TAH are in good standing with government programs, conducts routine background checks, and continually monitors physicians’ licensure in Pennsylvania. MMC began these monitoring procedures at TAH in October.”

Rhoten wrote that the hospital would have “no further comment regarding Dr. Dutt at this time.”

While Dutt was employed by TAH at the time of Parker’s surgery, there was a span of time when he was employed by Saint Vincent Medical Group. This was the case when Rhoten responded to The Herald.

At one point, Saint Vincent and Titusville were “closely aligned,” explained a Saint Vincent spokesperson, and a few practices and physicians were offered positions with Saint Vincent Medical Group. Dutt’s employment with Saint Vincent Medical Group ended in February of this year, and he returned to being an employee of TAH.

Titusville hospital IRS filings from 2014, posted online by CitizensAudit.org, indicate that Dutt made approximately $360,000 in reportable income from Titusville Area Hospital and its related organizations.

Dutt was listed as a 2015 member of the TAH Board of Directors, and a past president of the hospital’s medical staff, according to materials handed out at an April advisory board meeting of MMC and TAH leaders and community members.

Medical malpractice suits in the U.S.

An article in the May 2016 issue of Consumer Reports reported that less than 2 percent of the nation’s doctors have been responsible for half of the total medical malpractice payouts since the government began collecting malpractice data in 1990.

A man named Robert E. Oshel, who was an associate director of research and disputes at the National Practitioner Data Bank for nearly 15 years until his 2008 retirement, told Consumer Reports that even the best doctor can face lawsuits.

However, he told the magazine: “Still, when doctors have multiple large settlements against them, it can be a warning sign… suggesting that if licensing boards and hospital peer reviewers were willing to either get these doctors to stop practicing or get retraining, we’d all be better off.”

Since 1990, when the National Practitioner Data Bank opened up, there have been about 1.25 million doctors who have practiced medicine in the United States.

In that span of time, 192,000 doctors, roughly 15 percent, have had at least one malpractice payout, and 50,000 have had an “unfavorable adverse action” taken against them by a state medical board or other entity.

The database only lets the general public look up generalized information, and doesn’t allow access to reports on individual doctors. As stated previously in this article, that kind of information is only available to hospitals, doctors, law enforcement, insurance companies, and a select few others.

Without a tool like the database, patients regularly turn to online doctor ratings on sites like Healthgrades.

If you look up Dutt on Healthgrades, and click on a “sanctions” option, you’ll find a note about the surrender of his New York license.

Healthgrades also notes that New York had been concerned that Dutt had “been disciplined in the state of Pennsylvania for the unusual high number of injuries and deaths in his twenty year practice.”

However, if you click on the “Malpractice” button, the website says that it does not collect malpractice information for Pennsylvania.

Who does surgery for Titusville now?

After The Herald confirmed Dutt’s departure from TAH, Lee Clinton, who began as the Titusville hospital’s new CEO this spring, emailed the newspaper with information he said “may be pertinent to mention” about surgery at Titusville.

He wrote, “The general surgery program at Titusville Area Hospital is evolving to better meet the needs of the community.”

He said the hospital still employs general surgeon, Dr. Dwain Rogers, on a full-time basis, and, this month, MMC board-certified general surgeons Michael Wingate and William Nelson join Rogers at TAH.

Wingate and Nelson have Titusville area patients who had been seeing them in their Meadville clinic.

“With these physicians having a clinic locally it not only saves the existing patients travel time, it also gives new patients three options for general surgery instead of just two.

“[Doctors] Rogers, Wingate, and Nelson will make a strong team, and collectively they will be able to care for more of our community here locally in Titusville,” Clinton wrote.

The board

of medicine decision

After the newspaper reached out to the state to inquire about the Pennsylvania Board of Medicine’s decision to give Dutt his license, we were contacted by Wanda Murren, press secretary for the department of state.

Murren said she was not familiar with Dutt’s case, however, she told the newspaper that to take away a medical license is to take away someone’s livelihood.

She added that public safety is of utmost importance to the state.

 

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