Medical College of Wisconsin knew doctor was accused of performing unnecessary surgery

A few days before cardiothoracic surgeon Christopher Stone was to begin treating patients for the Medical College of Wisconsin, one of his fellow doctors warned the dean that Stone had allegedly performed unnecessary surgery at another hospital, according to records in a civil lawsuit, interviews and a trail of emails obtained by the Milwaukee Journal Sentinel.

So serious was the charge that soon afterward, Dean Joseph E. Kerschner met with other senior staff, then sent an email saying: “We believe that the case brought forward suggests that Dr. Stone performed unnecessary surgery.”

But the dean’s email, sent to five other colleagues on Aug. 31, 2012, cautioned that if the Medical College terminated Stone’s contract, it risked losing the considerable amount of surgeries and income he had been bringing into his small group practice. Moreover, he could be hired away by a local rival, United Hospital System in Kenosha.

“We discussed the importance of ‘doing the right thing,’ ” Kerschner wrote in his email, “but we need to understand the financial implications of this.”

“There is a reputational risk to (the Medical College) with a quick termination,” the email added.

The day after Kerschner’s email, Stone began his job at the Medical College.

The school did not fire the surgeon that year, or the next.

Even as new complaints against Stone mounted — including some alleging unconventional surgeries that harmed patients — the Medical College continued to employ him and allowed him to treat patients.

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On Aug. 11, 2014 — five months after receiving two more complaints about Stone surgeries — the Medical College told the doctor his contract would not be renewed when it expired one year later.

He was allowed to treat patients for the Medical College right up to his last day of work, Aug. 31, 2015 — three years to the day after the dean’s email discussing the accusation of unnecessary surgery.

Stone’s departure occurred three months after the allegations against him appeared in a civil lawsuit filed by a doctor in U.S. District Court against Froedtert Hospital, the Medical College and several other doctors. Stone was not listed as a defendant in the lawsuit.

Former Froedtert and Medical College surgeon Robert Love filed the lawsuit, claiming his employers had retaliated against him for pointing out examples of “substandard care” and potential violations of healthcare regulations.

Love also claimed that after he left the hospital and Medical College in August 2014, some of his former colleagues made defamatory statements about him to potential employers which then rejected him.

Allegations in the wide-ranging lawsuit were initially kept under seal by the judge, hidden from public view. They were unsealed in April 2016.

Last fall, a court order allowing Love’s lawyers to amend his complaint and requiring the defendants to produce documents, sent the discovery process into high gear. The hospital and Medical College produced 120,000 pages of documents in January. Key staff at the institutions are now being scheduled to give depositions; the first took place Thursday.

Among other allegations, Love’s lawsuit contends that Stone carried out unnecessary surgeries in order to defraud the federal Medicare program.

In a joint statement to the Journal Sentinel, Froedtert and the Medical College said:

“The allegations in Dr. Love’s complaint are demonstrably false and unfounded. The complaint misrepresents and takes out of context significant facts and circumstances … Both Froedtert Health and MCW are vigorously working through the court system to dismiss the claims.”

While many of Stone’s surgeries were performed at other hospitals, such as Kenosha Medical Center, it was the Medical College that paid him during his employment there. Froedtert officials say he was never one of their employees.

The hospital and college are linked as partners in the Froedtert and MCW Regional Health Network, which includes five hospitals; nearly 40 health centers and clinics; and more than 1,600 doctors.

The Medical College of Wisconsin gained international attention in 2004 when its doctors became the first to help a human survive rabies without vaccine, and again in 2009 and 2010 when a team became the first to use DNA sequencing to diagnose and treat a patient with a new disease.

Stone, 60, continues to practice and lists affiliations with hospitals in East Chicago, Hobart and Munster, Ind. He remains licensed in more than a dozen other states, including Wisconsin; the medical board websites in those states list no disciplinary actions against Stone.

Stone did not respond to numerous phone messages, or to registered letters with questions sent to the offices where he works in Munster and Hobart. A message was also left with a lawyer defending Stone in a different matter.

General responses submitted

Froedtert and the Medical College declined a request to provide specific examples of the “false and unfounded” allegations in Love’s lawsuit beyond the general responses submitted to the court.

In its filings, the Medical College said it has insufficient knowledge to either admit or deny the allegations against Stone; or to admit or deny that its senior management was aware of the allegations. The dean, who had been a defendant in the lawsuit, was dismissed from it by the judge in February 2017.

For its part, Froedtert “denies that its senior management was aware of any physicians providing grossly substandard patient care, performing unnecessary or non-standard operations, or engaging in fraudulent billing practices.”

But the initial complaint about Stone in 2012 was brought to the dean’s attention by Mark Lodes, then chief medical officer for the Froedtert & the Medical College Clinical Ventures Group.

In his email responding to Lodes, Kerschner also wrote that he “and Cathy Jacobson need to discuss” plans to lessen the risk that United Hospital System would hire Stone, if the Medical College terminated his contract. Jacobson was then and remains the president of Froedtert. The hospital and Medical College declined to say whether the meeting ever took place.

Medicare’s Office of the Inspector General told the Journal Sentinel it has no record of court cases, settlements or administrative sanctions against Stone. Nor has he ever been barred from treating Medicare patients.

Differing accounts of surgical work

Stone has been a practicing cardiovascular surgeon for more than 20 years. Years before joining the Medical College, he worked for Kenosha Medical Center, which was part of United Hospital System.

“Dr. Stone was an excellent cardiac surgeon,” Rick Schmidt, chief executive officer for United Hospital System, said in an interview with the Journal Sentinel. “I would easily let him operate on my family members or me.”

But Love’s lawsuit describes Schmidt delivering a very different message in 2012, claiming that the chief executive officer “had implored MCW to remove Dr. Stone and hire a replacement surgeon.” In the interview, Schmidt denied the claim.

After working for Kenosha Medical Center, Stone and a handful of other local doctors formed their own group practice, the Cardiothoracic Surgery Group. This is the group that joined the Medical College in 2012.

Emails from the time, obtained by the Journal Sentinel, show that some officials at the Medical College had “grave” concerns about Stone.

“In the initial negotiations, Dr. Stone was not part of the deal,” wrote James S. Tweddell, chairman of the division of cardiothoracic surgery.

“In the subsequent negotiations, Dr. Stone was somehow re-included. After finding out about this at the 11th hour, Dr. (Douglas) Evans and I strongly opposed Dr. Stone’s inclusion. We have never interviewed him, sought any information from his current practice hospital, or even letters of recommendation. The grave concerns we had concerning Dr. Stone during the original process have turned out to be true.”

Douglas Evans was the Medical College’s chairman of the department of surgery.

In his email, Tweddell warned the dean and four other officials:

“If we embrace as a colleague someone who has performed unnecessary surgery, we are also embracing that unethical and completely unacceptable behavior.”

The date was Sept. 3, 2012 — Stone’s third day as a Medical College employee.

The doctors quoted in the emails all declined to comment for this story. Several have left the Medical College and now work for hospitals and institutions outside of Wisconsin.

It is unclear how far up the leadership chain at Froedtert and the Medical College the complaints from Lodes and Tweddell went. An email from Evans on Sept. 27, 2012, told four colleagues, “apparently the Dean/legal is further investigating” the alleged unnecessary surgery. Evans added, “something may follow?”

More than five months later, the issue remained unresolved.

In an email to the dean on March 2, 2013,Tweddell wrote, “Bob Love has informed us that you are meeting with (General Counsel Sarah Cohn) and John Raymond tomorrow to discuss Dr. Stone and I won’t belabor that issue.” Raymond is the president and CEO of the Medical College.

Around the same time, Love wrote a letter to Cohn, calling Stone’s actions, “a clear and present danger to MCW.”

Concerns about Medicare billing

The faculty, Love wrote, “have knowledge of multiple cases that he has performed and subsequently sent here for complications or further surgery where the surgery was either not indicated, was clearly out of the bounds of clearly established practice, or where those practices have resulted in direct harm to the patient … MCW cannot be partner to allowing this to go on and be a haven for the continuation of this activity.”

Love also said he was concerned that Stone was defrauding Medicare, according to allegations in the civil suit.

Love claimed that in a single year, Stone had recorded about 24,000 RVUs, a measurement used to bill Medicare. Interviews with other doctors indicate 24,000 RVUs was almost double the amount recorded by the Medical College’s busiest surgeons.

Love called the figure “unprecedented, incredible and in my opinion impossible to achieve through lawful documentation and billing practice.”

In 2015, the median number of RVUs for cardiac/thoracic surgery across the country was less than half the number claimed for Stone, according to Becker’s Hospital Review, which gathers legal and business information for the healthcare industry.

A later email by another doctor alleged that Stone performed some of his surgeries in increments, breaking up what should have been one procedure into two or more, each performed on a different day.

“You can charge more for the same work,” Gary R. Seabrook, senior medical director of surgical services at Froedtert Hospital, wrote in an email to Tweddell, Evans and Love. “Of course, the patient must endure several procedures.”

Roughly a year after Love’s letter to the general counsel, doctors at the Medical College exchanged a flurry of concerned emails about two of Stone’s surgeries.

The subject heading for the first email read “Christopher Stone Case of the Day.”

One of Stone’s patients had come to the hospital with complications related to a Teflon graft used to replace diseased tissue in the aorta, the body’s main artery. The graft had been infected “at least since October,” Seabrook wrote in March.

“The attached images show a graft of unusual size coursing in a very unconventional tract perhaps through the colon,” Seabrook wrote, “with an (operative note) that describes a completely different and more extensive operation.

“Unfortunately we are accustomed to this practice of Dr. Stone performing unnamed operations.”

The operative note — a written account of the surgery, findings and complications — provides information for all other nurses and doctors caring for a recovering patient. Surgeons typically submit their operative notes within 24 hours of a procedure.

Stone’s operative note was dictated more than three weeks after the surgery.

In an email, Jonathon Truwit, enterprise chief medical officer for Froedtert and the Medical College, suggested “this is an opportunity for a joint quality review.”

“I think this is more than a quality issue,” Tweddell, the head of the cardiothoracic surgery division, emailed back. “The procedure described in detail in the operative report is not the procedure that was performed.”

Less than one week later, Seabrook emailed five of his colleagues:

“Another patient was admitted yesterday with serious complications following surgery performed by Dr. Christopher Stone.”

Seabrook said a CT scan revealed “a completely unconventional surgical operation” not justified by the woman’s symptoms. “She is now in a very debilitated state. This patient should have been treated with exercise therapy and a medical regimen or at most an iliac artery stent — an outpatient procedure” that provides excellent blood flow with very low risk.

The Medical College would not say why Stone departed more than a year later, only that it had “made a decision not to renew his contract.”

Wisconsin law states that doctors have a duty to report “unprofessional conduct,” to the Medical Examining Board. Moreover, failing to report such conduct is itself considered “unprofessional conduct.”

State law also requires all regulated health care facilities to report misconduct by caregivers to the state Department of Health Services.

State records show that between 2012 and 2016 one complaint was filed against Stone. It was filed by a patient — not a doctor, or hospital — and was closed without an investigation.

Mark Johnson is a health and science reporter. Bruce Vielmetti covers legal affairs. Contact Johnson by email at markjohnson@journalsentinel.com, or by phone at 414-224-2149. You can follow him on Twitter: @majohnso. Contact Vielmetti at bvielmetti@jrn.com. You can follow him on Twitter @ProofHearsay.