CNY malpractice case reveals 'assembly line': 14 operations a day, 3 at one time
Updated: Jul. 30, 2019, 5:21 p.m. | Published: Jul. 30, 2019, 6:00 a.m.
Dr. Brett Greenky
By James T. Mulder | jmulder@syracuse.com
SYRACUSE, N.Y. – A recent trial resulting in a $2 million malpractice verdict pulled back the curtain on a Syracuse orthopedic surgeon's routine of doing 14 operations in a single day.
A state Supreme Court jury in Syracuse unanimously found Dr. Brett Greenky and his practice, Syracuse Orthopedic Specialists, negligent July 2 for his handling of a hip replacement surgery performed six years ago. The lawsuit says the operation permanently injured Dorothy G. Murphy, 63, who is still limping, using a cane and in pain. She is a former Camillus resident who now lives in Florida.
The trial shined a light on a controversial hospital practice in which a doctor leaves the operating room after completing the most critical part of an operation to start surgery on another patient in a second room.
Murphy was the sixth of Greenky's 14 patients on Sept. 9, 2013 at St. Joseph's Hospital Health Center.
Greenky, 61, of Manlius, started doing surgery at 7:22 a.m. and finished at 9:40 p.m., more than 14 hours later, according to trial testimony reviewed by Syracuse.com/The Post-Standard. Greenky said during the trial he puts in a 14-hour surgery day every week. He testified his fee can range from $1,200 to $4,000 per operation depending on insurance.
During the trial Robert Lahm, Murphy's attorney, likened Greenky's surgical approach to an "assembly line." A copy of Greenky's schedule for that day shows most of the operations were total knee and hip replacements.
Patients were staggered across two operating rooms. Greenky would cut open a patient, put in an implant, close up part of the incision, then leave before the operation was over to start surgery on another anesthetized patient in a second room. Meanwhile, a resident physician in training or physician assistant closed the previous patient's wound and applied a dressing.
Sometimes Greenky does overlapping surgery in three operating rooms. In a deposition, he said he performs about 600 knee and hip replacements annually and each operation takes, on average, 45 minutes.
The use of two or more operating rooms so surgeons can perform multiple overlapping operations is common in many hospitals. Several studies say it is safe. But an expert on physician performance told Syracuse.com doing surgery for 14 hours in one day could be hazardous for patients.
The suit accused Greenky of fracturing Murphy's femur, or thighbone, during surgery and not informing her of the fracture until six weeks later. The lawsuit also accused him of removing too much of the bone. Greenky denied any wrongdoing and said the fracture did not happen during surgery.
Murphy said she was told prior to surgery she was one of Greenky's first patients that day, but had no idea she was one of 14.
Murphy said she cannot understand why surgeons performing complex operations are allowed to work more than 14 hours a day when bus drivers are prohibited by federal regulations from driving more than 10 hours.
She said she would have had a better outcome if Greenky had spent more time on her surgery.
Lahm said Greenky probably would have had to cancel some of the other surgeries on his schedule that day if he spent extra time on Murphy.
Greenky said in a deposition if a surgery was taking much longer than expected he would tell OR staff not to bring in the next patient.
In a prepared statement, Syracuse Orthopedic Specialists called Greenky "… one of the most well-respected joint replacement surgeons in the country." He has been practicing in Central New York 29 years.
Syracuse Orthopedic Specialists, SOS for short, is one of the area's biggest orthopedic practices with 27 doctors. It recently opened a $16 million surgery center in Cicero where it performs joint replacement surgery on an outpatient basis.
Greenky grew up in Buffalo, went to medical school at Upstate Medical University and also did his orthopedics residency training there. In a YouTube video produced by SOS, Greenky said about 95 percent of joint replacement surgeries are successful.
"With joint replacement almost everybody gets better," he says in the video. "It's really nice to play in a game you almost always win."
In a deposition, Greenky said prior to the Murphy case he was sued for malpractice five times and none of those cases resulted in verdicts or settlements.
Greenky is appealing the verdict in the Murphy case. He was advised by his attorney James Lantier not to provide any comment for this story.
Lantier said Lahm did not prove that using two operating rooms is negligent or that it caused the patient's injury. Lantier said the testimony about Greenky's use of more than one operating room should not have been allowed and probably influenced what he called the "excessively high verdict."
He also criticized Lahm for not showing how Greenky's schedule of 14 operations in a day compares with other surgeons' caseloads. Lantier said two of Greenky's surgeries that day were emergencies.
"The number (14) was thrown out to the jury without saying if that is good, bad or indifferent," Lantier said.
Staggering patients in more than one operating room is not unusual.
"It's very common especially in surgery centers that do a lot of orthopedic surgery," Lantier said. "It's very efficient." He said Greenky completes the critical parts of the operation before leaving the room to start another surgery.
The use of multiple operating rooms for surgery gained a lot of attention in 2015 after the Boston Globe investigated the safety and propriety of the practice.
After the newspaper's report came out, the American College of Surgeons issued guidelines that said overlapping surgery is OK as long as patients are informed prior to surgery.
Earlier this month, Massachusetts enacted a rule requiring surgeons to document each time they enter or leave an operating room and who took over in their absence. The rule requires surgeons to tell patients the names of any resident doctors, physicians or advanced practice nurses involved in the operation.
St. Joe's said its surgeons tell patients before their operations if others may be involved in the surgery.
But Murphy said she was not informed before her surgery that anyone other than Greenky would finish the operation.
St. Joe's does not limit the number of surgeries a doctor can do in one day.
In a prepared statement, the hospital said it " … allows its surgeons to perform the appropriate number of procedures that the surgeon deems safe and acceptable based on the type of cases and resources available within their designated block time in the OR."
A study of 66,000 overlapping surgeries published earlier this year in the Journal of the American Medical Association found no increase in death or complications in most of the operations when compared with non-overlapping surgeries.
But Dr. John Santa, former director of health ratings at Consumer Reports, said performing surgery for 14 hours in one day could lead to fatigue and be hazardous for patients. Santa directed Consumer Reports' health ratings center where he focused on physician performance and other issues.
While doing a lot of procedures improves a surgeon's skills, at some point high volume can make it difficult to provide adequate pre- and post-operative care to patients, he said.
Santa said most of the surgeons he knew who did high volume surgery "made a lot of money for a while but eventually suffered in terms of relations with patients and colleagues."
During the trial, Lahm said Greenky could make as much as $56,000 in one day doing 14 operations. He based that estimate on the $4,000 Greenky billed for Murphy's operation. Greenky testified the amount he makes depends on the patient's insurance. Greenky said his payment for a surgery is $1,200 if the patient is insured by Medicare.
Murphy said she didn't know the extent of what went wrong with her operation until she visited out-of-town orthopedic surgeons. She said their X-rays showed part of her femur near the hip implant was missing and her right leg was about one-quarter inch shorter than the left leg.
A doctor at the Hospital for Special Surgery in New York that specializes in orthopedics told Murphy he could not repair the problem because there was not enough bone left in her femur. "I started crying in his office," she said.
Murphy worked 34 years as a federal bank examiner. She retired in 2017 because work-related travel became too difficult.
Murphy was athletic before she developed hip problems. She was a gymnast, runner and high jumper in high school. As an adult she played softball and participated in a women's soccer league until she was in her 50s. She water skied and was an avid downhill and cross country skier.
She hoped a hip replacement would let her resume some of those activities. Murphy said Greenky told her before the operation she would be able to water ski again.
Instead, Murphy said she cannot walk more than 25 feet without using a cane, has trouble climbing stairs and has to be careful about lifting boxes and other items. She frequently suffers from soreness and leg cramps.
"It's not the life it used to be," she said.