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Robert Iacono, 55; surgeon performed radical procedure on Parkinson's patients

June 23, 2007|Thomas H. Maugh II | Times Staff Writer

Dr. Robert Iacono, the troubled neurosurgeon who was one of the first practitioners of a radical form of surgery for Parkinson's disease but whose personal behavior derailed his career, has died in a plane crash. He was 55.

Iacono was flying alone from Los Angeles to Mississippi in a twin-engine Beechcraft Baron 58 to visit family when the plane crashed into the western face of the Sandia Mountains in New Mexico on June 16.

Rescue efforts began after satellites picked up a signal from the plane's emergency transmitter about 8 p.m. The body was recovered Monday.

Iacono made a national reputation for himself during the 1990s while he was at Loma Linda University Medical Center, performing a controversial surgical procedure called a pallidotomy on patients with Parkinson's. The neurological disorder is characterized by tremors, rigidity in the limbs and a loss of muscle control.

Pallidotomies involve destruction of a small part of the globus pallidus, a region of the brain involved in the control of movement. Destroying part of the globus pallidus restores balance in that part of the brain, and Iacono was one of its early promoters.

In the surgery, a probe is inserted into the brain while the patient is awake so speech and other functions can be monitored. When the probe is positioned correctly, a radiofrequency current is passed through it, producing heat that destroys nearby tissue.

The effects are almost immediately apparent and include a dramatic reduction in tremors and rigidity and a decreased need for levodopa, the drug most commonly used to treat the disorder.

Iacono performed hundreds of the operations during the 1990s. In a 1995 report in the journal Neurosurgery on his initial 126 patients, he claimed an 85% success rate in improving the patients' mobility and a surgical complication rate of only 6.3%.

Critics were brutal, however. Dr. Roy A. E. Bakay of Emory University said at the time that "Dr. Iacono and his colleagues have undoubtedly overestimated their surgical success and underestimated their surgical complication rate."

In a 1995 Wall Street Journal article, Dr. Robert Feldman, a neurologist at Boston University, said he "wouldn't refer patients to Iacono. I don't think he is thinking critically. He's thinking surgically."

The American Parkinson Disease Assn. also refused to refer patients to Iacono on the advice of its medical board, although the group did not explicitly say why.

Many of his patients praised him effusively for the benefits they received from the surgery. But Iacono and the hospital also had to defend themselves against several malpractice lawsuits resulting from operations gone awry.

By the end of the decade, most neurosurgeons had switched to an alternative procedure called deep brain stimulation, in which the destruction of tissue is not necessary.

Electrodes are permanently implanted in the brain, and passing a small current through them produces similar benefits as pallidotomies, but without the risk.

Meanwhile, Iacono's career began to deteriorate.

In 1992, he was accused of using sexually inappropriate language and touching a female staff member.

In 1994, he was accused of prescribing drugs that had not been approved by the Food and Drug Administration.

On at least two occasions, he was accused of verbal or physical abuse of staff, and in 1999, the hospital suspended him for 20 days and ordered him to complete anger management therapy.

After two subsequent charges of abuse, the hospital's executive committee began making plans to terminate Iacono's privileges. He resigned before his privileges were revoked.

Two months later, he applied for privileges at Desert Regional Medical Center in Palm Springs but he marked "no" on a box asking if he had ever been in trouble at any other hospital.

As a result, he faced a formal accusation of wrongdoing by the Medical Board of California and surrendered his license to practice medicine, effective on Sept. 19, 2005.

His license was also suspended in Arizona and North Carolina as a result of the California action.

Before the suspensions, Iacono had established a private practice in Loma Linda, where he treated brain tumors and continued to perform pallidotomies, ultimately performing more than 2,000, which he argued were beneficial for patients.

At the time of his death, he had written a book called "Reversing Parkinson's Stress and Aging," which is expected to be published soon.

Robert Paul Iacono was born April 7, 1952, and was raised on the Palos Verdes Peninsula, where he graduated from Miraleste High School. He received his undergraduate and medical degrees from USC and performed his residency in neurosurgery at the Duke University Medical Center in North Carolina.

He was chief of neurosurgery at the Veterans Affairs hospital in Tucson from 1984 to 1990, then joined Loma Linda.

He is survived by his wife, Dr. Grace Oh; a son, Robert; a daughter, Rose; and his father, Paul E. Iacono.

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