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Lawsuit Targets Doctor’s Training

Tampa Tribune

TAMPA – Before he was involved in a fatal operation using a surgical robot, urologist Tod Fusia’s experience with the $1 million device was limited to a pig, a cadaver, three kidney removals and a complicated prostate surgery that left a man incontinent, a lawsuit alleges.The suit was filed Tuesday on behalf of the family of Plant High School science teacher Al Greenway, who died Oct. 13, 2002. The 53- year-old father of three died two days after his abdominal aorta and the inferior vena cava near his kidney were accidentally cut by robotic hands directed by Fusia, according to the lawsuit and autopsy report.

St. Joseph’s Hospital in Tampa is responsible for the death because supervisors there did not make sure Fusia was properly trained on the da Vinci Surgical System robot, the Greenway family’s attorney, Steven Yerrid, asserts in the lawsuit. The device has a mechanical arm guided by a surgeon seated at a control center with joysticks and a video screen, according to the company’s Web site.

St. Joseph’s spokeswoman Lisa Patterson declined to comment on the lawsuit. She did provide an Oct. 29, 2002, statement from the hospital’s president, Isaac Mallah, after Greenway’s death. Mallah had said all the doctors were required to be certified to perform advanced laparoscopic surgery to use the robot. Still, he said, surgeons would get additional training because of Greenway’s death.

Fusia did not return phone calls to his office, nor did his attorney, Joseph Diaco.

St. Joseph’s “had no training protocol for its surgeons or staff and no protocol in place whereby its surgeons or staff were credentialed to operate the robot,” the lawsuit states.

The robot is manufactured by Intuitive Surgical Inc. of Santa Monica, Calif. Fusia attended a three-day seminar in June 2002 hosted by the manufacturer. Fusia was to use the machine to remove a kidney from a pig, but he did not complete the procedure, the lawsuit states. He did remove a gallbladder from a dead body.

For that, Fusia received a certificate from the manufacturer. But the company estimated experienced surgeons needed to perform 18 surgeries using the robot before becoming proficient with the machine, the lawsuit states.

Yerrid isn’t suing the machine’s manufacturer. He places the blame on the hospital’s administration. “I don’t think this is about the machine malfunctioning. I think this is a malfunction of the health care provider,” Yerrid said.

Allowing the manufacturer of a surgical robot to declare a doctor “certified” in its use is irresponsible, said Jay Wolfson, director of the Suncoast Center for Patient Safety at the University of South Florida.

“The bottom line here,” Wolfson said, “is the hospital has a responsibility about what they’re going to unleash on their patients.”

Wolfson is a USF professor who was appointed by Gov. Jeb Bush as the guardian ad litem to represent the interests of Terri Schiavo.

Yerrid said St. Joseph’s administrators put financial interests ahead of their patients’ interests because they had to justify buying a $1 million surgical machine.

“No one told the Greenways that marketing concerns were a major driving force behind [St. Joseph’s] decision to pay $1 million to purchase the robot – and that at all times the surgeons and the hospital had an implicit agreement to maximize the use of the robot to defray and justify that expense as well as to market the hospital and generate profits,” Yerrid wrote.

Yerrid also claims doctors requested St. Joseph’s Hospital purchase the robot.

Before the hospital bought the robot, it likely conducted a “break-even” analysis to determine how often it would be used in surgeries and how long it would take for the machine to pay for itself, said Alan Sear, a USF professor who teaches classes on health care management.

But often, hospital administrators succumb to pressure from surgeons to buy new, expensive equipment.

“It’s political,” Sear said. “Hospital administrators often do that to keep the doctors happy. But they need to ask themselves: Is it in the best interest of the patients to be using this?” Yerrid also claims that Fusia told Greenway and his wife, Brenda Greenway, that he had used robots to remove kidneys “dozens” of times, though that wasn’t true with the da Vinci machine, according to the lawsuit.

Fusia told the Greenways using the robot for the surgery would involve a small incision, be less traumatic and quicken the recovery time, according to the lawsuit.

Yerrid did not say how much he plans to ask the hospital to pay for Greenway’s death. Florida’s new $1 million cap on medical malpractice lawsuits does not apply to the Greenway case because he died before the law took effect, Yerrid said.

Greenway is survived by his wife and three children, Gregory, 18, Elana, 16, and Kenny, whose age was not available.

“When you lose your dad, you lose a lot,” Yerrid said. “Sometimes, you lose your best friend. You lose your guide.”

Reporter Joshua B. Good can be reached at (813) 259-7638.

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