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Gastric Bypass Surgeon Cited as Remiss

State medical board accuses the Riverside doctor of mishandling six fatal cases and five others. Experts found no neglect, his lawyer says.

August 07, 2005|Rong-Gong Lin II | Times Staff Writer

A gastric bypass surgeon in Riverside has been accused by state medical regulators of mishandling the care of 11 patients, including six who died, casting a harsh spotlight on the possible risks of a burgeoning -- and lucrative -- enterprise embraced by many California hospitals.

Dr. Terry Sanderfer exhibited gross negligence and incompetence by failing to properly care for leaking organs, severe infections and other post-surgical complications, according to the accusation filed earlier this summer by the Medical Board of California.

The case comes as the popularity of weight loss, or "bariatric," surgery is surging and more hospitals and surgeons are rushing to offer the procedures. Some surgery experts and insurers are concerned that inexperienced hospitals and inadequately trained surgeons are taking on the operations, which even in skilled hands can result in complications.

"We need to brace ourselves as a surgical community for the chance that we're going to see more and more adverse outcomes as more and more people come to the field with varying levels of training," said Dr. David Flum, a gastrointestinal surgeon at the University of Washington School of Medicine in Seattle.

Shortly after the deaths among Sanderfer's patients, which occurred after operations at three Riverside County hospitals between 2000 and 2003, one of the hospitals -- Riverside Community Hospital -- canceled such operations altogether, citing the risks. Another, Corona Regional Medical Center, has not done such surgeries for months, although it has not formally ended the practice.

And Sanderfer himself, who had performed hundreds of gastric bypass procedures for 14 years and is the subject of some glowing testimonials on the Internet, has quit doing them. Through his attorney, he denied wrongdoing but said he couldn't afford an increase in his malpractice premiums.

Sanderfer, a general surgeon who continues to perform other types of abdominal operations, has faced 21 malpractice suits in recent years alleging deficiencies in gastric bypass surgeries, his attorney, James Kjar, confirmed. In three cases, his insurance has paid a total of $1.3 million in settlements, without admitting any wrongdoing. Thirteen cases are pending, and other cases have been dismissed, Kjar said.

"Dr. Sanderfer does not believe there was any delay or any substandard care" in any of the cases, Kjar said, adding that experts have reviewed Sanderfer's care and found that his actions were "appropriate, within community standards and not negligent."

"Bariatric patients, because of their morbid obesity, have one of the highest complication and death rates of any elective surgical patients," Kjar said. "And all of these patients signed documents indicating that they ... accepted those risks."

The procedures do come with established risks. Flum and his colleagues published a study last year looking at bariatric surgeries in Washington state over 15 years, finding that one in 50 patients died within 30 days.

"People who are considering the surgery have to go in with their eyes open," he said. "This is not a cosmetic operation by any means. It's major abdominal surgery performed on patients at high risk."

Several hospitals have stopped or suspended the procedures after high-profile deaths, including, last year, Iowa Methodist Medical Center in Des Moines and the University of New Mexico hospital in Albuquerque.

Bariatric surgeries are still performed relatively infrequently compared with other types of operations, Flum said. About 140,000 were done in 2004, according to the American Society of Bariatric Surgery, compared with between 700,000 and 800,000 gallbladder operations annually.

The procedures are for patients so obese that they are unable to consistently lose weight by dieting and exercise alone. Gastric bypass, one of the more popular approaches, involves creating a small pouch out of the stomach, and directly attaching it to the small intestine. The new stomach can't take in as much food, and the intestine can't absorb as many calories.

But the number of bariatric surgeries has nearly quadrupled since 2000, their popularity fueled by high-profile successes such as that of pop singer Carnie Wilson, who had her procedure broadcast on the Internet, NBC "Today" show weatherman Al Roker and "American Idol" judge Randy Jackson.

The procedures -- which cost an average of about $25,000, not including treatment for complications -- have also become profit centers for financially strapped hospitals. Nationally, some health and malpractice insurers have balked at coverage, citing costs and risks, but HMOs in California are required to cover operations that doctors deem medically necessary.

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