Cardiac surgeon’s suspension puts UA patients in limbo

2014-03-09T00:00:00Z 2014-03-09T18:03:07Z Cardiac surgeon’s suspension puts UA patients in limboBy Stephanie Innes Arizona Daily Star Arizona Daily Star

A highly specialized cardiac surgeon has been suspended from the University of Arizona Medical Center, leaving patients scrambling for alternatives.

Hospital officials confirm that Dr. Robert S. Poston is not performing surgery because he does not currently have clinical privileges. Poston, who came to Tucson from the University of Chicago in 2011, is the hospital’s director of adult cardiac surgery. He has a national reputation for specializing in minimally invasive robotic coronary-bypass surgeries that don’t require splitting the sternum.

UA Medical Center officials say Poston is suspended with pay. UA records as of November listed his salary as $400,000.

Poston would not comment. A complaint he filed against the hospital in Maricopa County Superior Court on Feb. 5 describes a political and unjust peer review process. It says some of his colleagues were not receptive to the new, innovative cardiac surgery he brought to the hospital, which is why they maligned him.

Poston’s seven-page lawsuit is not clear, however, as to the reason he was given for being suspended, and his Phoenix-based attorney Calvin Raup would not provide additional detail. A UA Medical Center spokeswoman also would not comment, citing the pending litigation.

A Maricopa County judge recently told Poston that he would have to exhaust the appeals process at the UA Medical Center before she would consider his request to have the suspension lifted and his name cleared.

Raup says the hospital has made a settlement offer but no agreement has been reached.

Poston’s sudden absence means patients like Tucson business owner Jim Viberg aren’t getting the robotic surgery they expected. Viberg, 65, says he’s hoping to get the same robotic bypass surgery in Los Angeles. He was referred to Poston by his Tucson cardiologist, did some research on his own, and had his plans gone as anticipated, he’d already have his surgery by now.

A liver transplant recipient with hepatitis C, Viberg says a traditional cardiac bypass would put him at too much risk for infection and blood loss. And the traditional bypass surgery of cracking the chest would require a longer recovery time that would put him out of work for an extended period of time and hurt both his business and employees, he said.

Normally, a coronary bypass requires undergoing what’s called a sternotomy, in which the sternum is split midline to give surgeons access to the heart. The resulting incision is so prominent that it’s referred to by many patients as “the zipper,” and the healing time is a minimum of eight weeks, more typically three months compared with two to three weeks for the robotic approach.

Viberg worries the extra time it’s taking to set up a surgery in Los Angeles rather than getting it locally is putting his health in peril.

The UA Medical Center is “is choosing to not perform” robot-assisted cardiac bypass procedures at this time, department of surgery spokeswoman Jo Marie Barkley wrote in an email Friday.

Poston’s lawsuit says his hospital peers made a politically motivated effort to “destroy the robotic cardiac surgery program and Dr. Poston’s career.” It says that he was criticized by doctors whose income would be affected if he succeeded.

Indeed, patients who qualified for robotic cardiac bypass surgeries did not need traditional options — a bypass with a sternotomy or stents placed in the arteries of the heart.

Poston’s complaint states that he was subjected to retaliatory investigations, a “purported peer review that is fundamentally flawed,” and that the acting head of surgery — Dr. Alexander Chiu —withdrew his right to perform robotic surgeries at Northwest Medical Center.

“Really, not many surgeons in the U.S. do robotic bypass, so there are not a lot of other options for where to send patients,” said Dr. Jose González, a Sierra Vista cardiologist who has sent more than 200 patients to Poston in the last three years.

“They’ve driven away someone with a unique ability and patients really like him. A lot of people are good at what they do, but not nice to patients. Rob is a good surgeon but also a good guy and he treats patients well. Right now I have a couple of patients waiting to have surgery with him,” González said.

In the nearly three years since he came to Tucson, Poston became an extremely busy surgeon and performed more than 500 procedures here, most of them robotic surgeries.

“Dr. Poston’s clinical privileges have been suspended at University of Arizona Medical Center with pay. He retains his status as a member of UPH (University Physicians Healthcare),” UA Medical Center spokeswoman Katie Riley wrote in a recent email.

“As you know, UAMC does not comment publicly on pending litigation.”

Rosemarie Lee, a 72-year-old Sierra Vista resident, had robotic cardiac bypass surgery with Poston scheduled for Feb. 3 at UA Medical Center. But the hospital called on Jan. 31 to say Poston would not be available to do it, her husband said.

“My wife doesn’t want open-heart surgery at 72,” William Lee said. “My understanding of doctors is that the patient comes first. I don’t know the whole story, but because of the doctors fighting or whatever they are doing, it does affect patients.”

Poston performed a successful robotic cardiac bypass on William Lee earlier this year.

Sierra Vista anesthesiologist Dr. Jim Buttke says he cycled 450 miles in Italy five weeks after getting robotic cardiac bypass surgery from Poston in April 2012.

Buttke, 67, said he didn’t miss any work for the surgery or recovery, either.

“A lot of my friends down here have gone to see Dr. Poston and they have never been disappointed,” he said.

Poston was recruited by surgery head Dr. Rainer Gruessner, a prominent transplant surgeon hired by the UA from the University of Minnesota in 2007. Gruessner rebuilt a weak department by hiring surgeons with national reputations and adding transplant services.

Gruessner was suspended with pay in September after an administrative dispute and has since received notices of termination, though he continues to receive a paycheck. He filed a lawsuit in November citing discord, low morale, and a climate of fear and intimidation at UA Medical Center.

Attorney Raup said he filed the case in Maricopa County to get out of the “politically charged environment that led to this problem in the first instance.”

“Maricopa County is largely unaware of the decline in the Department of Surgery at UAMC or the politics involved in that most unfortunate situation,” Raup wrote in an email.

Prior to his position as a cardiac surgeon in Chicago, Poston had been chief of cardiac surgery at Boston Medical Center and Boston University. He earned his medical degree from Johns Hopkins University, completed a residency at the University of California at San Francisco, a fellowship at the Stanford University School of Medicine, and has authored more than 100 scientific papers and abstracts.

The Society of Thoracic Surgeons maintains a national database of quality performance measures for cardiac bypass surgery centers. The database, which measures such factors as mortality and complications, represents 94 percent of centers nationwide. The program at the UA Medical Center’s university campus has had the best overall quality rating in the state for the two most recent years available, beginning in 2011, the year Poston was hired.

The national data does not separate robotic from traditional cardiac bypass surgeries, and UA Medical Center would not provide information about Poston’s cases. But González, the Sierra Vista doctor, says he monitors Poston’s results closely and says that Poston has lower mortality and complication rates than the UA’s cardiac surgeons as a whole.

His records show Poston’s bypass mortality rate as 1.1 percent and complications at 8.4 percent. His readmission rates have been overall slightly higher than average — 17.9 percent versus 15.8 percent for all UA heart surgeons.

Larry Fish, a resident of Rhode Island, traveled to Tucson for robotic cardiac bypass surgery in 2011 because of Poston’s reputation in the Boston area. Since the surgery he’s been to three of his children’s weddings and is now a grandfather of five. On the occasion of each wedding and birth he’s sent a text message of thanks to Poston.

“I am healthy because of one guy. He is a genius. You are blessed to have him there,” Fish, 59, said last week. “This is the most down-to-earth surgeon that you could ever meet. I am not a wealthy guy but I’d get on a plane tomorrow, fly to Tucson and testify for him if it would help.”

Contact reporter Stephanie Innes at sinnes@azstarnet.com or 573-4134.

Copyright 2014 Arizona Daily Star. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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