Dispute with top surgeon throws UA's prestigous transplant programs into turmoil

2014-01-19T00:00:00Z 2014-02-15T14:29:06Z Dispute with top surgeon throws UA's prestigous transplant programs into turmoilBy Stephanie Innes Arizona Daily Star Arizona Daily Star

The hospital that shined so brightly during the darkness of the 2011 Tucson shootings is in a bitter professional dispute that has impaired its transplant services.

The University of Arizona Medical Center’s world-famous heart transplant program is on hiatus, as is its lung transplant program. Two other programs recently closed after the doctor who created them — department of surgery head Dr. Rainer Gruessner — was forbidden from setting foot in the hospital where he’d worked for the past six years.

Before his suspension, Gruessner had brought stability to a historically troubled department that’s vital to Tucson. He more than doubled the number of surgeons, added new transplant services and rebuilt Southern Arizona’s lone top-level trauma center for people with life-threatening injuries.

“A strong, multi-organ transplantation program requires large teams of specially trained physicians, surgeons, transplant coordinators and other personnel to be successful,” UA Medical Center spokeswoman Katie Riley wrote in an email. “The medical-surgical ‘bench strength’ in some of our transplant programs is not where UA and UAMC want it to be.”

Administrators suspended Gruessner with pay in September and banned him from going to the hospital campus without notifying security. In November he filed a 191-page lawsuit against his employers. UA officials won’t comment on pending litigation, though documents filed in response to the complaint call it “full of hyperbole.”

Court documents indicate the suspension was precipitated by an accusation that Gruessner either altered transplant records or directed others to alter them, including removing his name from records of surgeries that may not have gone as planned.

Gruessner denies any wrongdoing and says the administration invented a reason to get rid of him because he’s been critical of Dr. Steve Goldschmid, dean of the UA College of Medicine in Tucson. Goldschmid is part of the executive leadership team for the University of Arizona Health Network, which is the largest nonprofit health entity in Southern Arizona and includes both UA Medical Center hospitals — the university campus (formerly called University Medical Center) and the south campus (formerly UPH/Kino). The network also includes dozens of clinics, several health plans and University Physicians Healthcare, which staffs the hospital with physicians from the UA College of Medicine.

Gruessner filed a whistle-blower complaint with the UA on Jan. 9, saying administrators retaliated against him for exposing serious problems with transplant record-keeping. The complaint says University Physicians Healthcare sent Gruessner a letter of termination in December.

UA officials would not respond to the whistle-blower complaint.

Players loyal to coach

At an academic medical center, the chair of a department is like a coach, who recruits people to build the department. As with any coaching situation, the players — in this case doctors — often maintain a loyalty to that person, said Dr. Richard Carmona, a distinguished professor of surgery at the UA and a former U.S. Surgeon General.

Since Gruessner is a notable surgeon, doctors he recruited may leave, or go wherever he goes, said Carmona, who stressed that he is not involved in the dispute between Gruessner and the administration.

Gruessner came to Tucson from the University of Minnesota in July 2007 to rejuvenate a department that was flailing at every level — clinical, research and residencies. When he was hired, the department was in jeopardy of ceasing to exist, a 2010 surgery department review said. Problems included a loss of faculty, an erosion of services, operating losses and surgical residents who were failing their board exams.

A seven-member panel of doctors and professors from inside and outside the university, including Carmona, did the 2010 review. The panel predicted Gruessner “will take the department and institution to a level of distinction not previously achieved in Tucson.”

The review praised the development of a multiorgan transplant program under Gruessner’s leadership and the hiring of notable faculty. It predicted that failing to continue with his pattern of hiring would “not only perpetuate mediocrity of the department but may threaten the retention of the promising new faculty that has been recruited.” Reviews are mandated every seven years. The 2003 review was scathing.

A November 2012 administrative review praised Gruessner for building a “cohesive department that prides itself on hard work, academic productivity, innovation and clinical excellence.”

“This committee is greatly impressed by Dr. Gruessner’s accomplishments over the past five years and looks forward to his next five years,” the panel of five UA physicians wrote.

Heart, lung programs

Late last year the hospital suspended its heart transplant program. The program had developed a global reputation under Dr. Jack Copeland, who performed Arizona’s first heart transplant. In 1985, patient Michael Drummond became the first person to survive on an artificial heart as a bridge to a transplanted heart 11 days later. Copeland left the hospital in 2010.

UA officials say the heart transplant program, which had both adult and pediatric patients, is on hiatus while they hire more experienced surgeons. That leaves one heart transplant program for adults in Arizona — at the Mayo Clinic in Scottsdale. Phoenix Children’s Hospital is the only remaining center for pediatric heart transplants.

The UA Medical Center has also put lung transplants on hiatus. That program was one of two in the state and leaves St. Joseph’s Hospital in Phoenix as the only Arizona program. The intestinal transplant program, which Gruessner created, is inactive. So is the auto islet cell transplant program for people with acute pancreatitis.

The auto islet cell transplant, a rare procedure, attracted patients from across the country. Gruessner created that program, too. It ideally prevents the severe diabetes typical after a pancreatectomy. “Auto” refers to the use of the patient’s own insulin-producing beta cells, contained in clusters called islets, to reduce the risk of rejection.

To build the program, Gruessner hired Dr. Horacio Rilo as director of cellular transplantation and invested in a $1 million “clean room” necessary for the procedure. Rilo had built an internationally recognized program at the University of Cincinnati.

While the hospital is still doing kidney and liver transplants, it has not done any pediatric liver transplants since 2012, when gastroenterologist and transplant specialist Dr. Khalid Khan left the hospital.

“We had a great start. For pediatric liver transplants we quickly became one of the top 25 percent of programs in the country, not only in numbers, but survivors,” said Khan, who came to Tucson from the University of Minnesota and now is an associate professor of pediatrics at Georgetown University.

In 2007, there was just one pediatric liver transplant at the UA Medical Center, according to the federal Organ Procurement and Transplantation Network. With Khan in place, that number spiked to 13 in 2008.

The hospital performed 36 pediatric liver transplants while Khan was on the staff. There hasn’t been another since he left, and UA Medical Center officials said on Friday that both the pediatric liver and kidney transplant programs are inactive.

“I have never seen anything like the way it was allowed to collapse,” Khan said. “We were not always working toward common goals. I feel like it was kids in a schoolyard at times. We could point fingers, but the question is, where is the UA going from here? How are they going to go forward?”

UA officials say they are committed to providing core transplant services and that this year they will strengthen the programs “through strategic recruiting of experienced transplant physicians and surgeons.”

Doctors he hired

Doctors whom Gruessner hired said they were drawn to the UA because of his willingness to support cutting-edge medicine.

He sought doctors with more than 10 to 15 published articles, real academic interest and good pedigrees, meaning they came from well-regarded fellowships and medical schools. His stated goal was training the future leaders in surgery.

One of those recruits was Dr. Mitchell Sokoloff, hired from Oregon in 2008 to head the urology division. Sokoloff had earned international recognition for his treatment of urologic cancers, and his research has received support from the U.S. Department of Defense and the National Cancer Institute.

Shortly after Gruessner was suspended, Sokoloff accepted a job as the inaugural chairman of a new department of urology at the University of Massachussetts. He will leave the UA in the spring.

Sokoloff says the suspension is not the main reason he’s leaving, since the new job is a promotion. But it did play a role in his decision.

“Many faculty in the department of surgery have expressed a tremendous amount of discontent to me,” he said.

Dr. Robert S. Poston, director of adult cardiac surgery at the UA Medical Center and a specialist in robot-assisted heart surgery, was another top-flight surgeon recruited by Gruessner.

He’s been here three years and doesn’t see how he can stay without Gruessner’s leadership. He’s already looking elsewhere and says he’s surprised the administration did not seem to make an effort to keep a valuable employee like Gruessner.

“He’s an inspiring, visionary person,” Poston said. “When I started in 2011, it was so hopeful then and exciting that he was bringing in a lot of talented people.”

Poston, a specialist in minimally invasive, robot-assisted heart surgeries that don’t require splitting the sternum, was recruited from the University of Chicago in 2011.

Level-One Trauma

The UA Medical Center is the region’s only Level One Trauma Center — the highest level of surgical care, with 24-hour in-house general surgeons and prompt access to specialties like orthopedic surgery, neurosurgery and anesthesiology. Injuries are the leading cause of death for Americans ages one through 44, and trauma centers save lives.

The first person Gruessner hired in 2007 was Dr. Peter Rhee, who had worked for the military on the battlefields of Afghanistan and Iraq. He’d worked at busy trauma centers in Seattle and Washington, D.C., and was director of the Navy Trauma Training Center at Los Angeles County-University of Southern California.

In 2009 Rhee and Gruessner brought Dr. G. Michael Lemole Jr., from the University of Illinois at Chicago to be the new chief of neurosurgery. Lemole, a leading authority on skull base surgery, earned an undergraduate degree from Harvard, graduated medical school from the University of Pennsylvania and completed his residence in neurological surgery in 2002 at Barrow Neurological Institute in Phoenix.

Both Rhee and Lemole sprung into action on the morning of Jan. 8, 2011, when the hospital’s trauma department was notified of a shooting on Tucson’s northwest side. The rampage was an assassination attempt on then-U.S. Rep. Gabrielle Giffords, and she was among the injured. She and 10 other victims were brought to UA Medical Center that day.

Gruessner recruited four of the six lead physicians who treated the Jan. 8 victims. Lemole performed the surgery on Giffords and, along with Rhee, became a household name, with some media dubbing them “rock star surgeons.”

“The expert clinical care performed and deft dealing with the media and community during and following the Giffords shooting in 2011 brought unprecedented prestige and internal pride to the University of Arizona College of Medicine and UAMC,” the November 2012 administrative review of Gruessner says.

“This could not have been achieved without the leadership of Dr. Gruessner and the two division chiefs that he personally recruited to rebuild the trauma and neurosurgery programs (Rhee and Lemole) as well as the other surgery division programs that were consulted in the care of the shooting victims.”

Tensions began in 2009

Under Gruessner’s direction, transplants at UA Medical Center peaked in 2011 at 163, data from the federal Organ Procurement and Transplantation Network show. At that time, the federal data say, the UA Medical Center offered eight types of organ transplants. Now it offers four.

The islet cell transplant program is not on that list because it is not monitored by the federal transplant network.

Tension between the department of surgery and the UA College of Medicine administration began shortly after Goldschmid was appointed dean in 2009, legal documents say. The lawsuit says a climate of fear and favoritism took root, support for surgery waned, and morale dipped.

A common thread in a 2012 survey of 40 percent of the UA Health Network’s doctors, obtained by the Star, was that doctors felt they had little voice and were not respected by the administration.

As part of the November 2012 administrative review included in court documents, staff, residents and faculty gave Gruessner an average score of 4.37 out of five, with five being the highest possible score. He was widely praised for inspiring staff and being a good ambassador for the surgery department and the UA.

His weakest scores were in conflict resolution, and one comment said he created conflict with other departments. But the review panel said even his lowest scores were generally positive.

The Star’s public records request to see Goldschmid’s most recent administrative review was denied.

Gruessner’s lawyers say that in December 2012, he told a university committee he didn’t think Goldschmid was capable of leading the medical school to a national reputation. The lawsuit says Gruessner believes his comments got back to Goldschmid. It says Goldschmid called Gruessner from his vacation home in Canada in July 2013 and asked the department chair to step down, citing a “record of poor performance.”

Court files say Gruessner initially refused. But he eventually agreed to transition out of his role, and, as part of that process, he requested a count of liver transplants he’d performed at the UA, the lawsuit says. The data showed he was the primary surgeon on 12 transplants. Gruessner believed he’d been involved in about 75, mostly as the primary surgeon.

Gruessner thought the transplant coordinator on call must have entered data incorrectly, the suit says. It says that can happen because several surgeons are present for a transplant and all contribute to operating room notes. Those notes are the basis for what is entered in the records system.

Court documents say Gruessner asked the business manager for transplant services to change data in the computer system, and said hospital administrators needed to be informed of the inaccuracies. He met with a hospital administrator Sept. 11, and, on Sept. 16, he received a notice of his suspension, the lawsuit says.

“In the rare circumstance that any changes to data are made, proper checks and balances are in place to protect the integrity of our data,” hospital spokeswoman Riley said.

He Wants Job Back

Gruessner’s lawsuit does not seek money. He wants his job back.

But the chances of that happening appear to be dimming. The UA has formed a search committee to look for a new surgery head.

Whether it’s under the leadership of Gruessner or someone else, Carmona said, he hopes the standard Gruessner set will continue.

“He brought in excellent, academically gifted professors to build transplant services and the whole department of surgery,” Carmona said. “He made it better than the way he found it.”

Contact reporter Stephanie Innes at sinnes@azstarnet.com or 573-4134.

Copyright 2014 Arizona Daily Star. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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