Surgeon’s Suit Contains Link to Saint Agnes Infections

By Tracy Correa and Barbara Anderson, The Fresno Bee, Calif.

Jun. 10–A Fresno heart surgeon alleges in a lawsuit that he was disciplined after complaining about a doctor who was later linked to a high rate of infections in Saint Agnes Medical Center’s troubled cardiac unit — months before an outbreak peaked last year.

Dr. Paul Stefanacci says Stanford University officials suspended him as a surgeon with their cardiothoracic surgery program at Saint Agnes.

Saint Agnes has struggled with infection problems in its cardiac unit over the past year. Although state officials found no heath violations at the hospital following last year’s outbreak of chest infections, they shut down the cardiac surgery program for nearly a week in May after a second episode, this one involving leg infections.

In his lawsuit against Stanford’s board of trustees, Stefanacci said he first raised concerns about the competence and performance of a fellow surgeon at Saint Agnes in March 2007. He said that as a clinical instructor, he observed many surgeries and became concerned about the Stanford doctor’s technical abilities and surgical judgment. The doctor is not identified in the lawsuit.

Stefanacci said he complained about the doctor again in September 2007 after an increase in postoperative infections at the hospital. Stefanacci said the colleague had an infection rate “well in excess of the acceptable limits,” and he voiced concern about the quality of patient care being provided.

Stefanacci’s lawsuit raises questions about whether Saint Agnes and Stanford officials missed a chance to prevent the infection problem from worsening last summer.

Mathew Abraham, Saint Agnes’ president and chief executive, declined to comment on Stefanacci’s lawsuit. Saint Agnes is not named as a defendant.

Stefanacci filed his lawsuit Dec. 20, about a week after the state issued a report identifying possible causes for last year’s infection problem — including a Stanford surgeon who had a particularly high number of infections. The lawsuit did not attract news media attention at the time.

In the suit, Stefanacci alleged that Stanford had accused him of creating a hostile work environment and placed him on leave in October.

Stefanacci, a surgeon for about five years in Fresno, said Stanford put him on leave to punish him “for advocating for appropriate patient care.” Stefanacci declined to discuss the lawsuit.

Paul Costello, a Stanford medical school spokesman, said he could not comment on pending litigation, but added, “Stanford does not retaliate against anyone, especially someone who raises questions about patient safety.” Costello said Stefanacci no longer is an employee with the Stanford surgery program but wouldn’t say why.

Saint Agnes contracted with the Stanford group two years ago to do open-heart surgery. The surgeons operate exclusively on Kaiser Permanente patients referred to Saint Agnes. A majority of the heart surgery cases at the hospital are Kaiser patients, officials have said. Kaiser does not have a cardiac surgery program in Fresno.

In November 2007, Saint Agnes was investigated by the U.S. Centers for Disease Control and Prevention and state health officials after at least a dozen open-heart surgery patients developed life-threatening, deep-chest wound infections. Three patients died, two likely as a result of the infections, federal health officials concluded. At least two who died were Kaiser patients.

Last month, a second infection problem became public after state health officials forced a halt to cardiac surgeries after leg wound infections became a concern. Coronary artery bypass graft surgery often involves removing a blood vessel from the leg, arm, chest or abdomen to replace blocked coronary arteries.

The state suspended cardiac surgeries at Saint Agnes from May 23 to 29. Investigators were last at the hospital June 2 and have not made public a report on the leg-wound infections.

In last year’s investigation of mostly chest-wound infections, the CDC found no single cause for the outbreak and the state found no health violations. But the CDC did note that a single surgeon had an abnormally high number of affected patients.

E-mails between government and local health officials, obtained by The Bee, said the practices of the doctor in question “could be a major contributing factor” to the infections. Seven of the 12 infected patients were operated on by the same doctor.

A Stanford official confirmed last year that Dr. Douglas Wallace had the highest number of infections among surgeons operating at Saint Agnes. Wallace is an associate clinical professor with Stanford who has performed cardiac surgery at Saint Agnes since January 2007.

Calls to Wallace’s office were directed to Costello, Stanford’s spokesman. Costello said Wallace remains an active member of Stanford’s cardiac unit at Saint Agnes. He said that Wallace and his boss, Dr. Randy Bolton, head of the Stanford surgery program at Saint Agnes, “have our full support.”

The reporters can be reached at [email protected] or (559) 441-6378 and [email protected] or (559) 441-6310.

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