Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning, again, everyone. Now, we're going to spotlight some magnificent WNYC investigative reporting on how doctors who lose their licenses can sometimes continue to practice anyway. The story begins in the early 1990s when one OB-GYN in Upstate New York was stripped of his license to practice medicine. This is after a state investigation found that he was a "imminent danger" after a series of grave outcomes for mothers and babies in his care, but this doctor then went on to practice elsewhere and eventually regained his license here in New York.

WNYC has got this investigative podcast series called Imminent Danger, taking the story of this doctor and his patients in order to examine the gaps and the safeguards that are supposed to hold medical professionals accountable and protect patients systemically. Joining me now to discuss their reporting are Christopher Werth, senior investigations and narrative editor here at WNYC and Gothamist, and journalist Karen Shakerdge, who reported out the series. All five episodes of Imminent Danger produced in partnership with the Pulitzer Center are available now wherever you get your podcasts. Karen, welcome to WNYC. Chris, always good to have you on the show.

Karen Shakerdge: Thank you.

Christopher Werth: Good to be back.

Brian Lehrer: Before we start, we'll just give listeners a heads-up that the podcast and this conversation will discuss topics of medical injury, loss, and grief and so could be difficult to hear in that respect. Karen, the big question is really about the system more than it is about the individual doctor, but tell us a little bit about his story and how the credentialing worked in this case.

Karen Shakerdge: The story focuses on this one physician. His name is Thomas J. Byrne. As you say, we look at his career, but we also focus on his career as a way to understand the systems at play. He's an OB-GYN, who's also a maternal-fetal medicine specialist, which means that he's trained to focus on more high-risk or complicated cases. He currently has active licenses in New York and Texas and works with a practice in the Bronx that's part of the St. Barnabas Health System, and in Amarillo, Texas at a practice that's affiliated with Texas Tech University Health Sciences Center there.

Brian Lehrer: Well, I guess we should tell an individual story just so people know the kind of thing that prompted this. You tell in Episode 1, the story of Wai Chi Lam, a recent graduate of Columbia who went by the name Amy. She was originally from Hong Kong, I see, but moved to Harlem with her husband and first child to study journalism. Amy's story takes a tragic turn after she gives birth to their second child at home. Very briefly, how does that relate to this story?

Karen Shakerdge: Amy, arrived at Harlem Hospital not too long after giving birth at home unexpectedly. The way that her story and what happened to her relates to the podcast is that one of the physicians who took care of her after she arrived at Harlem Hospital was Dr. Byrne. She had a series of procedures that were done on her there. Unfortunately, over the span of several hours, she lost blood and none of the procedures that were done to try and stop the bleeding helped.

She died at Harlem Hospital about 11 or so hours after giving birth at home. Dr. Byrne is one of five physicians who were named in a lawsuit filed against him and Harlem Hospital for her death.

Brian Lehrer: For your reporting, you spoke to Susan Karten, an attorney here in New York who specializes in medical malpractice cases and who represented Amy's family in a lawsuit. There were five other physicians who were involved in Amy's wrongful death lawsuit, but to Susan Karten, Dr. Byrne stood out. We're going to play about a 45-second clip of what Susan Karten said when she deposed Byrne as a lawyer. We'll hear Susan Karten's voice first, and Karen asks her a follow-up question in this clip.

Susan Karten: I started to question with great detail what was your background? Then it came out that he had lost his license, it had been revoked, which is very serious, very serious in New York.

Karen Shakerdge: According to public records from New York State's Health Department back in the early '90s, the state investigated Dr. Byrne and found him guilty of things like gross negligence, gross incompetence, negligence on more than one occasion, incompetence on more than one occasion, obtaining a license fraudulently, and practicing the profession fraudulently. That last one is a reference to making a false statement in a patient's medical record.

Susan Karten: There was notations in his record from New York State that this man was an imminent danger to patients.

Brian Lehrer: Chris, there's the title of your podcast series, Imminent Danger. It comes from a finding about this doctor by the state of New York. What does it actually mean? I guess the question that the listeners who just heard that exchange will have on their minds is, "Wait, if they found all those things previously and had revoked the license how was he relicensed to practice in the state?"

Christopher Werth: To get to your first question, the state health department labeled him an imminent danger as a means of suspending his license. This was in 1990. The state had apparently identified a number of cases.

Brian Lehrer: Suspended, because I don't want to be inaccurate here. Suspended not revoked.

Christopher Werth: Yes. That was what allowed the health commissioner or the health department to suspend his license, keep him from practicing while the state conducted its investigation. Then it was a year later after that investigation concluded that his license was fully revoked.

Brian Lehrer: Okay.

Christopher Werth: In terms of what allowed him to keep practicing-- at the time all of these cases that we're talking about from the '90s happened up near Rochester. The Democrat and Chronicle paper up there actually followed this case fairly closely. There were several hearings that were held into Byrne's conduct as a physician. At the end of that process, once that license was revoked, Democrat and Chronicle quotes a spokesperson for the State Health Department who says, "It would be very difficult, not impossible, but very difficult for Dr. Byrne to get his license back in New York."

What we can see in the medical board records that Karen has worked so hard to obtain is that Byrne, within a year of fully losing his license in New York, had obtained a medical license in New Mexico and had gone on to practice there. He did so for several years, and then he went on to Oklahoma where he also obtained a medical license and practiced for several years in Oklahoma. Then he went back to New Mexico. Then it was about 20 years after that that he ended up back in New York and regaining his license.

Brian Lehrer: Did Oklahoma and New Mexico know what had happened in New York?

Christopher Werth: Yes, we can see that-- for example, you can hear this in the podcast that in New Mexico there's a letter that was generated by the medical board that did acknowledge the fact that it was aware of what had happened in New York and that Byrne's license had been revoked here.

Brian Lehrer: But?

Christopher Werth: But the state decided to grant him a license anyway. He went on to work, we know, in a fairly rural area of New Mexico near the US-Mexico border. This is something that we get into in a later episode, but what patient safety experts have told us is that Dr. Byrne is-- he's what's called an MFM. He's a maternal-fetal medicine specialist. Not only is he an OB-GYN, but he is trained to take care of high-risk cases.

There are hospitals and other providers in the country, particularly in rural areas, or maybe even also in urban areas that serve low-income communities that really struggle to recruit those kinds of providers, those kinds of specialists. Therefore, even when you look at a medical license application, you might be willing to overlook those certain warning signs or the fact that a doctor has had their license revoked in another state in order to bring those kinds of specialists to the state or to a specific hospital.

Brian Lehrer: I wonder if we have any listeners right now who can help you report this story even further. Do we have any medical professionals listening right now? Doctors, nurses, physician assistants, anyone else who's licensed to practice medicine who has a perspective on the licensing system? That's what this is most about.

In your experience, how easy or difficult is it to be professionally reprimanded for negligence or even actual abusive behavior? How big a deal is it to have your medical license suspended, or revoked, or anything else you want to share about the safeguards in place to keep patients safe? 212-433-WNYC, 212-433-9692. Or maybe you think it's too tough and people should be able to get their licenses back after a period of time for one reason or another. 212-433-9692, call or text.

Karen, I see that your research shows OB-GYNs are actually the most sued doctors of all the specializations, and lawsuits aren't necessarily an indication of a bad doctor. Right? Do you want to put this case into the broader industry context in that way?

Karen Shakerdge: Yes, I think it's important to keep in mind that lawsuits and perhaps the number of lawsuits can tell us something about a physician, but it really, I think, is helpful to think of it as one piece of a bigger picture. As you say, OB-GYNs are some of the most sued kinds of doctors. For physicians who've been practicing for a very long time, that can potentially mean more malpractice claims have been filed against them.

I did have two studies that were a helpful reference point on this one from the American Medical Association and another from the American Congress of Obstetricians and Gynecologists. They had found that all the OB-GYNs they surveyed had been sued, on average, about one to three times in their careers up until that point. That's a reference point there.

Brian Lehrer: Chris, the first two episodes are about this one specific doctor, but the five-part podcast series really uses this case to look at how doctors are vetted and how their work is monitored. Medical malpractice can be one of various factors. Can you talk about which systems, at least, in New York State, are charged with monitoring doctors and how a medical professional lands on their radar?

Christopher Werth: Yes. New York is unique in that the education department licenses physicians, the health department investigates those physicians. What we know is that that process, for example, for investigating a physician is largely complaint-driven. The health department receives complaints about a physician and can then initiate some kind of inquiry into that physician.

The other thing that we look at in the series is something called the National Practitioner Data Bank, which was created by Congress in the '80s. It started to collect data in the '90s. It's basically a compendium of various information about physicians. It's not geared towards the user or the patient. It's geared towards hospitals or medical boards. What it does is it requires medical boards or hospitals to report certain kinds of disciplinary actions against physicians.

For example, the suspension of hospital privileges, or some kind of disciplinary action that a medical board takes, or even malpractice payments. What we found is that there are loopholes into that system that actually allow hospitals, particularly, to circumvent reporting those kinds of incidents. We have an interesting stat in the series, which is that almost half of hospitals in the country have never reported a single physician to that data bank in the 33 years that it's existed.

I can get into some of the details about what kind of loopholes exist, but basically, what we found is that it does allow for hospitals to circumvent those kinds of [crosstalk].

Brian Lehrer: Is this underreporting that you're citing perhaps because hospitals don't want to look like they have doctors who are committing malpractice?

Christopher Werth: The various people who Karen specifically spoke to did say that hospitals, they have an incentive not to report because once it becomes clear that maybe they have a problematic physician, there are reputational risks involved in that.

Brian Lehrer: I see you also reported that there's a financial aspect there. Typically, when there's a malpractice case against a doctor practicing in a hospital, it's the hospital that makes those payments on a doctor's behalf.

Christopher Werth: Yes. In the podcast, we call this the corporate shield. That's what it's known as. It's that a lot of times, what will happen is that when a patient does sue a physician, they'll also sue the hospital. We're told that sometimes attorneys often, or sometimes at least, encourage a patient to sue the hospital. It's a faster route towards a settlement. Even in cases where a physician is named, once it gets to the settlement process, the physician can be removed.

In fact, in Amy Lam's case, the patient at Harlem Hospital, who you talked about at the beginning of this segment, that's what happened when her husband sued Byrne and Harlem Hospital. It was Health + Hospitals that ultimately settled that case.

Brian Lehrer: One other loophole, if loophole is the right word, Karen, you key in on doctor resignations. Basically, if a doctor resigns, then there isn't really a need for a paper trail. Do I have that right?

Karen Shakerdge: It depends on the circumstances. If they are resigning specifically to avoid an investigation, that is supposed to be reportable to the National Practitioner Data Bank. It depends a little bit on the details, but yes, often, doctors will be tipped off that an investigation may be starting on them, and they will be given the opportunity to resign instead of having their clinical privileges restricted or taken away.

Brian Lehrer: Let me get one caller in here. Here is Mercedes in Brooklyn, who says she worked in a hospital for 40 years. Mercedes, you're on WNYC. Thank you for calling.

Mercedes: Hi. I'm just saying that it's a big thing for the public, but having worked in more than one hospital, these things happen. What the head of department, whether director of surgery, the administrator, would do is just let the guy or the woman out, dismiss them, and let it go quietly. Then the staff who works in the operating room or wherever, who knows what went down, will kind of hush, hush and tell others.

A typical case, we had a gentleman who worked at Brooklyn Jewish Hospital as an anesthesiologist very well. Then he went to Walter Reed Hospital, and one of the top officers developed some complication with the surgery and whatever. Oh, now that was a big thing. We have another case of a woman who came in pregnant to have cesarean section. The anesthesiologist didn't notice that the endotracheal tubes in the lady went towards the stomach, not her lungs. When the surgeon took the blade and cut, he cursed every four-letter word in there. The woman went into-- What do you call it? Oh God, the [unintelligible 00:18:19].

Brian Lehrer: Cardiac arrest?

Mercedes: She died. The baby died. They lied to the parents, to the family. They never said what exactly happened. I understand all the hoopla, but you call in-- I called in. I was out with an injury, workmen's compensation. The doctor that the organization sent me to to examine me, after he examined me, which he was very hostile, I put his name into the system. This guy was under suspension when he examined me and wrote that I did not need surgery. I caught up 278 patients in the air and saved the hospital from a lawsuit and ripped up my wrist.

Brian Lehrer: Mercedes, thank you for telling those-- Thank you, I guess, for telling us those horrible anecdotes. Karen, very briefly, especially those first one or two in Mercedes calls, they seem like part of the pattern you reported on.

Karen Shakerdge: I don't know all the specifics of what Mercedes was just explaining, but generally speaking, unfortunately, experts that I've spoken with and people who are working in hospitals did talk with me about a tendency to not necessarily always do the right thing, and so this idea of--

Brian Lehrer: To hush things up, basically, right?

Karen Shakerdge: You said hush, right?

Brian Lehrer: Yes.

Karen Shakerdge: Yes, exactly. That's exactly what I'm talking about. It's a hard thing to accept and understand, but that is something that experts I've spoken with have talked to me about seeing happen at the hospital level.

Brian Lehrer: Chris, last question. As you say in the podcast, this is about classic failures to implement policies that are in place. What are some solutions? Is anyone in the government putting forward anything that could help stem further cases of malpractice? Because it sounds like it's about enforcement rather than what the laws are.

Christopher Werth: Yes. Some of the patient safety experts that we talk to in this series do talk about giving more resources towards medical boards so that when they do get complaints, they can adequately investigate cases, for example. I think one of the biggest areas that we really get into is that National Practitioner Data Bank that I talked about.

The experts that are in our series say closing these loopholes would really go a long way towards improving patient safety and making sure that that information is actually making it into the data bank so that when a hospital or a medical board goes to make a decision about hiring or granting a license, that information is there.

Brian Lehrer: There we have to leave it. My guests have been Christopher Werth, senior investigations and narrative editor at WNYC and Gothamist, and journalist Karen Shakerdge, who reported out the series called Imminent Danger. All five episodes of this podcast series produced in partnership with the Pulitzer Center are available now wherever you get your podcasts. Thank you for such excellent public service journalism. Thank you very much.

Christopher Werth: Thank you, Brian.

Karen Shakerdge: Thank you. Thanks.

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