Sham Peer Review: the Shocking Story of Raymond A. Long, M.D.

Lawrence R. Huntoon, M.D., Ph.D.

 It was a story that rocked the little town of St. Albans, Vermont: “Surgeon Accuses St. Albans Hospital of Deliberately Infecting His Patients.”¹

According to the statewide news website, VTDigger.org, “An orthopedic surgeon is suing Northwestern Medical Center in St. Albans for allegedly infecting his patients with bacteria in an effort to ‘destroy his career and falsely blame him for the infections,’ court records show…. Long says he told hospital doctors in 2002 that he was considering adding an MRI machine to his office. At the time, he alleges, Northwestern was involved in ‘an illegal kickback scheme with respect to X-ray facilities’ and the hospital was planning to have a new MRI machine built for its facilities.”¹

The “Factual Background” contained in a lawsuit, for which an Amended Complaint was filed on Sep 28, 2006, also contained hundreds of numbered paragraphs describing the nightmare of events that Dr. Long claimed he experienced at the hands of the hospital and other physicians on staff.² 

Northwestern Medical Center Enters into Settlement Agreement with Government

On Aug 16, 2007, the U.S. Attorney’s Office issued a press release stating: “The United States Attorney’s Office announced today that it has entered into a settlement with Northwestern Medical Center, the hospital in St. Albans, resolving the hospital’s potential liability for violating the federal anti-kickback and related laws.”³ Although the hospital faced a potential liability of having to pay triple the amount collected from federal health programs, the government agreed to settle for a mere $30,000.³ . . .

In 2011, Dr. Long hired a former Centers for Disease Control and Prevention infection investigator, William R. Jarvis, M.D . . . .On Aug 5, 2011, Dr. Jarvis issued his report¹¹concerning the unusual surgical site infections affecting Dr. Long’s patients. Dr. Jarvis reviewed four of Dr. Long’s cases.

In one case, Dr. Jarvis reported: “A nearly pan-sensitive (especially to penicillin) S. aureus strain like [patient’s] is exceedingly unusual. This is even more true of S. aureus strains causing HAIs [healthcare-associated infections] rather than community acquired infections.”^{11, p 5} . . .

The Jarvis Report also addressed cultures taken from an irrigation solution that was about to be used in a patient surgery on Feb 6, 2004:

Cultures obtained from previously unopened bottle of irrigation fluid (that was about to be hung in the NMC operating room for use in Dr. Long’s surgical patient) by Dr. Long on February 6, 2004 grew 800 colony forming units/ml of S. aureus (two morphologies). Given that this was a bottle of irrigation fluid provided by NMC operating room personnel for use by Dr. Long in that surgical procedure, it is highly suspicious. Intrinsic contamination (i.e., that occurring at the time of manufacture) of such manufactured fluids is < 1 in a million—an exceedingly rare and unlikely event. Since no other clusters of infections or outbreaks associated with this manufacturer’s irrigation fluid were reported at around this time and no FDA recall of these fluids occurred around this time, the likelihood of intrinsic contamination is very, very unlikely. In contrast, given that two different morphologies of S. aureus and 800 CFU/ml were recovered, I believe that the likelihood of extrinsic contamination (i.e., contamination after manufacture and most likely at NMC) is much more likely.^{11, p 10}

Dr. Jarvis also commented on the hospital peer review related to these highly unusual infections:

Given the circumstances occurring at NMC at around December 2003—February 2004 (i.e., the cluster of very unusual SSIs—both in terms of SSIs occurring in very low-risk arthroscopic joint procedures and the types of organisms involved in Dr. Long’s patients), the likelihood that these SSIs were caused by: a) the patient’s flora; b) contaminated surgical equipment, c) Dr. Long’s surgical technique, d) breaks in sterile technique by other operative room personnel, or e) contamination of Marcaine placed in pain pumps, as hypothesized by Dr. Corsetti in his peer review of these cases is exceedingly unlikely.^{11, p 12}

A much more likely explanation of how the operating room irrigation fluid became contaminated and how the 3-4 SSIs above occurred is that the patients were intentionally infected through extrinsically and intentionally contaminated irrigation fluid (or other fluids, medications, equipment or materials) provided by NMC personnel and used by Dr. Long in the surgical procedures of these patients.^{11, p 13}

The Jarvis Report goes on to state:

Personnel from NMC have acknowledged that personnel at NMC had purchased ATCC [an organization that provides standard reference micro-organisms to labs] strains of S. aureus, coagulase-negative staphylococci (CNS) and Pseudomonas aeruginosa isolates for quality control purposes for the NMC laboratory. In addition, they testified that they also obtained S. marcescens isolates that were used in the microbiology laboratory for quality control purposes. Therefore, all the bacterial species that caused SSIs [surgical site infections] in Dr. Long’s patients were available in the NMC microbiology laboratory. The S. aureus strain (ATCC #25923) was purchased in November 2003 [see Ref #8], days to weeks before [patients’] surgery. Furthermore, the ATCC #25923 S. aureus strain has an antimicrobial susceptibility to all agents commonly tested, including ampicillin, penicillin, cefazolin, clindamycin, erythromycin, cefoxitin (methicillin), tetracycline, and sulfamethoxazole similar to the susceptibility of the S. aureus isolated from [patient’s] SSI…. In addition, the quality control P. aeruginosa isolate was purchased in August 2003, before [patient’s] surgery on December 23, 2003. Interestingly, the antibiotic susceptibility pattern of the ATCC strain #27853 (P. aeruginosa), which was purchased by NMC, supposedly for laboratory quality control purposes, had the same antibiotic susceptibility pattern (of the agents to which both isolates were tested) as that of the P. aeruginosa strain recovered from the SSI of [the patient].^{11 pp. 9-10}

The Jarvis Report also addressed cultures taken from an irrigation solution that was about to be used in a patient surgery on Feb 6, 2004:

Cultures obtained from previously unopened bottle of irrigation fluid (that was about to be hung in the NMC operating room for use in Dr. Long’s surgical patient) by Dr. Long on February 6, 2004 grew 800 colony forming units/ml of S. aureus (two morphologies). Given that this was a bottle of irrigation fluid provided by NMC operating room personnel for use by Dr. Long in that surgical procedure, it is highly suspicious.

Dr. Jarvis concluded that patients were intentionally infected through the use of deliberately contaminated irrigation solutions:

2005 Lawsuit Settles for $4 Million, Hospital CEO Moves on to Another Hospital

The lawsuit filed by Dr. Long in 2005 eventually settled in 2008 for $4 million, and shortly thereafter NMC CEO Peter A. Hofstetter moved on to a new job as CEO of Holy Cross Hospital in Taos, New Mexico,⁹ and, according to Dr. Long, subsequently to Willamette Valley Medical Center in McMinnville, Oregon. . .

Conclusions

In the words of the 2006 Amended Complaint,^{2,  p 92} Defendants engaged in “extreme and outrageous conduct, which was beyond all possible bounds of decency, and which may be regarded as atrocious and utterly intolerable in a civilized society.”

Lawrence R. Huntoon, M.D., Ph.D., is a practicing neurologist and editor-in-chief of the Journal of American Physicians and Surgeons. Contact: editor@jpands.org. To access the entire article including the 17 supporting bibliographic documents, and to see the entire sordid story of the hospital hiring 19 private investigators, with one following Dr. Long day and night, breaking into his home, a brick through his car window, stealing a laptop from his car, deactivating his remote car door opener, finding his door panel on his car had been removed, that his tires have been slashed with the same instrument that the Muslims used to slash the throats of the American Airline Pilots on Sept 11, 2011, spiking his drinks with mercury and amphetamines, harassing him and his wife when they were driving or walking, requesting him to be seen by a psychiatrist who was a Peer Review Specialist for hospitals, etc., et.al.

Read the entire document . . .

Why is the threat of a surgeon setting up his own Surgicenter so threatening to a hospital’s finances that they will infect, harm and possibly kill his and their patients with serious staph organisms that were purchased, spend such astronomical sums of money to discredit him?  Is the cash flow from CMS so lucrative that administrators are willing to take the risk of killing patients to get rid of a doctor that may compete?

How prevalent is Hospital Homicide or Medical Murder?

Is there any data out there?

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