A patient died after a consulting Veterans Affairs hospital doctor decided to perform an unnecessary procedure, possibly to give experience in the operation to his wife, one of two residents he was supervising in the operating room.

Besides a temporary suspension, the doctor's only punishment was a letter in his personnel file and having to give a talk about the role of medical consultants. He was subsequently promoted to chief of his medical department at the hospital.

Carlos Rosado is a liver doctor at the VA Caribbean Healthcare System's veterans hospital in Puerto Rico. He was called to consult on another doctor's patient when he decided to perform an unrelated lung operation without asking the primary physician.

"Dr. Rosado, without communicating the plans to the primary team, performed the procedure in which the patient died three hours later, due to complications. The primary provider was not in agreement with the procedure and unaware of it at the time," according to notes from an emergency medical board meeting, obtained by the Washington Examiner.

The lung operation was "not related to the nephrology medical specialty evaluation for which" Rosado was consulted, the notes said.

Most troubling was the concern about the potential motivation for why a liver doctor might perform a lung surgery that didn't appear to be needed.

Some doctors at the hospital said they believed that he was attempting to provide experience in a particular type of operation to his wife, Viviana Valle-Cancel.

"An additional factor in this event is the fact that the procedure was performed by two residents under the supervision of Dr. Rosado, one of which is his spouse. This raised a flag as to Dr. Rosado could be acting out of the scope of our bylaws. It also creates concern from the service in the following areas: patient care, professionalism/interpersonal and communications skills," the notes said.

The hospital declined to comment on the Rosado case or discuss its nepotism policy.

The death occurred in 2012. The emergency meeting led to a professional standards board review, which found that "there is no evidence that this was an emergency procedure which necessitated being performed without the discussion with the primary attending physician. At most, this was an elective procedure."

It found that the procedure, a thoracentesis, "is not considered within the scope of a nephrology consultant" and that he "was told previously not to supervise [his wife] in any clinical activities."

A thoracentesis is a procedure for removing fluid near the lungs. He also inappropriately discarded the yellow fluid drained from the lungs, which should have been analyzed to help doctors diagnose him.

Rosado told the board "he believed that his role as a physician allows him to provide any medical care that he thinks the patient requires."

He "does not appear to fully understand that his role as a consultant is to provide advice," the board wrote. It found that he broke the hospital's bylaws and operated outside of its "standard of care," violations for which other doctors have been fired.

But the board only recommended that "a letter be placed in Dr. Rosado's records indicating the failure to act within the appropriate role as a consultant" and he should give a "talk on the subject of the appropriate role of a consultant."

Since then, he has been promoted to chief of nephrology, one of the top positions at the hospital.

"She was a resident, she was in training, so he was showing her how to perform this procedure," a doctor at the hospital told the Examiner on condition of anonymity. "He's the chief of nephrology at the VA currently, so there were no consequences for his actions."

The Rosados are among numerous married couples who work together at the Puerto Rico hospital, whose director, DeWayne Hamlin, was arrested in Florida with painkillers and refused to tell police their source.

Hamlin later worked to fire department whistleblowers who complained about that and other incidents. In addition, a convicted sex offender is in charge of disciplining poorly performing employees there.

Rosado's case is only the latest in a growing list of examples of VA officials being promoted despite performing poorly on the job or being implicated in wrongdoing. Not infrequently, such officials are promoted to supervisory positions in which they are supposed to make policy or guard against misconduct.

The director of a Vermont hospital who misled Sen. Kelly Ayotte, R-N.H., about having given recalled drugs to a patient and covered it up for five years is currently in charge of investigating the department's troubled Tomah, Wisc., facility.

And, as the Examiner reported Thursday, only hours after an inspector general reported that the Philadelphia benefits office manipulated data to hide its abysmal administration of pension benefits, its pension manager was promoted to a policy position in Washington.