Monday, June 6, 2005 | 11:10 a.m.
The state Board of Medical Examiners on Friday took away the medical license of a Las Vegas doctor who is in prison for violent crimes, but declined to discipline three other Las Vegas-area doctors accused of malpractice.
The board dismissed charges against a Henderson orthopedic surgeon who allegedly knew a patient's broken arm was developing serious complications but failed to treat them; a Las Vegas lung specialist accused of giving a medicine she shouldn't have to a stroke victim who later died; and a former Las Vegas pediatrician who allegedly didn't come to the hospital to treat a dying 3-year-old.
The board also decided the cases of three Northern Nevada doctors. A Gardnerville orthopedic surgeon's case was dismissed; a Reno trauma surgeon was found guilty of malpractice and fined; and a former Incline Village family practitioner pleaded guilty to malpractice and settled with the board.
The disciplinary decisions came at Friday's quarterly meeting of the medical board, which has been criticized for disciplining what some say are too few physicians and for operating largely out of the public eye.
But in many of Friday's cases, the board said there simply wasn't enough evidence to discipline the doctors.
Henderson orthopedic surgeon Dr. Craig Clark was charged with malpractice for allegedly neglectful care of an arm fracture that led to nerve damage in the patient.
In September 2001, Clark put a cast on the patient's right arm and told her to come back in a week. When she returned, her fingers were swollen.
In subsequent visits, Clark noted concern about "compartment syndrome," but he did not act on those concerns, according to the medical board's complaint filed against Clark.
Compartment syndrome is a serious medical problem that occurs when swelling constricts body tissues. If not treated immediately, it can lead to the death of muscles and nerves.
By November, Clark's patient's right hand had become a rigid claw, and she could barely flex her fingers. Much of her arm was numb, according to the complaint.
In late December the patient had surgery to address the nerve and muscle damage she had suffered. Clark's treatment of her fell short of medical standards, the board's investigators charged.
But the expert who testified that Clark's actions constituted malpractice changed his mind on the stand, Board President Dr. Stephen Montoya said at Friday's meeting.
"The girl was problematic. She was not very compliant," Montoya said of the patient. "The doctor had good reasons to keep the cast on." The board voted unanimously to dismiss the complaint.
Las Vegas pulmonologist Dr. Angelica Honsberg was also accused of malpractice, for allegedly administering to a stroke victim a drug that conflicted with another medicine.
On April 3, 2004, a 74-year-old woman who was visiting from California was admitted to the emergency room at University Medical Center, according to the board's complaint. The right side of the woman's body was weak and nearly paralyzed. Around noon, she was treated with tissue plasminogen activator or TPA, a common stroke medication that dissolves blood clots.
Tow and half hours later, Honsberg ordered that the woman be given heparin, an anticoagulant also common in stroke treatment. The woman's condition then "deteriorated significantly to the point that the patient's family authorized withdrawal of all medications and further efforts to prolong life," the board complaint states.
According to the American Stroke Association, heparin, an anticoagulant also common in stroke treatment, must not be administered within 24 hours of TPA. Honsberg "knew or should have known" that the patient had recently received the contraindicated medication, according to the complaint.
But the conflict between TPA and heparin was not established at the time of the woman's treatment, board members said.
"The question is, did she breach the standard of care at the time of the occurrence?" board member Dr. Cindy Lamerson asked. "There was no standard of care at the time of the occurrence. It was controversial ... The treatment of stroke has changed very rapidly."
Board members said evidence was presented at Honsberg's hearing that showed that, while some studies at the time had posited a contraindication for the two drugs, there was no established protocol.
"You cannot fault a doctor for not following a protocol that doesn't exist," board member Dr. Javaid Anwar said. The board voted to dismiss the complaint.
The complaint against former Las Vegas pediatrician, Dr. Bruce Ogden, who has since left the state, was recommended for dismissal by the board's lawyers, who said the key expert witness had changed his mind about the merit of the case.
Ogden was called to Lake Mead Hospital in March of 2000 to operate on a 3-year-old whose condition was worsening. When Ogden didn't appear at the hospital after several hours, a nurse called him again.
Ogden then said he would come, but after 45 minutes he called the hospital again, this time from the road, and said to transfer the child to University Medical Center. Ogden then went home. At UMC, the child went into cardiac arrest and died.
The board's deputy general counsel, Edward Cousineau, said new information had come to light about the events surrounding the incident. He did not say what that information was, but he said it was undisputed and cleared Ogden of wrongdoing.
Board members agreed that they could not proceed on a case where the prosecution had no witnesses. The case was dismissed.
Ogden is now working at a hospital in Provo, Utah, and did not renew his Nevada license, according to the board's Web site. Reached by phone, Ogden said he left Nevada to pursue "a better job in my field," not because of the investigation.
Also dismissed was the case against Gardnerville orthopedic surgeon Dr. Scott Southard, who operated on the ankle of a man who later died of a blood clot in his lung.
Board members said they couldn't say for sure whether Southard should have ordered more tests, and it wasn't clear from the patient's autopsy whether the deadly blood clot came from the leg Southard had treated.
Another Northern Nevada physician, trauma surgeon Dr. Alvaro Devia of Reno, was found guilty of malpractice and given a $5,000 fine.
Devia ordered an X-ray for a man who had broken a rib in a motorcycle accident and then discharged the patient without looking at the X-ray. The man died two days later.
Board members found that Devia committed malpractice but said they didn't want to give Devia a public reprimand or stiffer penalty because it could cause him to lose his insurance and hospital privileges. In addition to the fine, he was ordered to reimburse the board for the cost of prosecuting him.
The board had no problem revoking the license of Juan Manzur, a former Las Vegas allergist now serving nine to 33 years in prison, according to court records.
In late 2002 and early 2003, Manzur stabbed, kicked, shot at and threatened to kill his wife, prosecutors charged. He also abused his two sons, aged 12 and 14, according to court documents. Manzur pleaded guilty to reduced charges including kidnapping, battery and assault with a deadly weapon, and child abuse.
In correspondence with the medical board, Manzur claimed to be the cousin of Jesus Christ, Montoya said. At his disciplinary hearing, he said he was enjoying life in prison and tried repeatedly to surrender his medical license to the hearing officer, who refused to accept it.
The board voted to revoke Manzur's license, finding that he brought the medical profession into disrepute and that he was unable to practice medicine because of psychological and possible drug problems.
The board agreed to a settlement with Elliott Schmerler, a former Incline Village family practitioner whose license had already been revoked based on his conviction for felony income tax evasion.
It was not clear why Schmerler's case was still pending. The board indicated there was a complaint of malpractice. Cousineau, the lawyer, said Schmerler wanted to put the whole thing behind and avoid the expense of a hearing by pleading guilty and accepting a public reprimand.
The board accepted Schmerler's guilty plea and ordered him to reimburse the costs of the prosecution.
That brings to six the number of actions the board has taken against the doctors it regulates so far in 2005. Earlier this year it suspended two doctors and fined another.
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