TX - Surgeon accused of manipulating medical records to make patients ineligible for liver transplants - April 13, 2024

[Diddian]

But from what I know about the listing process the chances of anyone with self-induced liver damage even being on the list is pretty small these days (whether the liver failure is from alcoholic cirrhosis or from a suicide attempt with Tylenol.)

I wonder if he was trying to keep up his supposedly stellar record of success in transplant surgery. Anyone who might be surgically difficult and/or might be less likely to survive he didn't want to be matched.
MOO

Based on what I saw in the program my friend was in, where transplant program clients get to know each other during frequent visits for medical monitoring, patients with liver disease as a result of abusive consumption of alcohol or Tylenol or Ibuprofen could be eligible once they completed a specified period of abstinence and provided they made a commitment to permanently abstain from those toxic substances.

So, the issue for the program team developing the criteria for gaining a spot on the list was NOT that they would punish someone whose lifestyle choices led to the liver failure by denying them access to a potential donor liver; it was that IF they were going to gain the opportunity for a donor liver (which are scarce), they would seriously commit to a lifestyle that excluded the substances that destroyed their own liver.

 

[NCWatcher]

Rsbm.

If the allegations are true that eligible patients weren't receiving livers because of Bynon's manipulation of records and then were dying during their futile wait, then IMO that's not negligence. It's straight-up murder.

Emotionally I feel that way too. But I'm not sure the law would. Keeping someone from having a chance at receiving a potentially life-saving transplant probably isn't murder under the law. That scenario would assume ALL the people who died without transplant at that center would have received livers (a murder charge requires identified victims and I'm not sure how one could say A but not B) and would assume ALL would have lived if but not for his actions. And I'm not sure that can be assumed given the scarcity of donated organs.

Based on what I saw in the program my friend was in, where transplant program clients get to know each other during frequent visits for medical monitoring, patients with liver disease as a result of abusive consumption of alcohol or Tylenol or Ibuprofen could be eligible once they completed a specified period of abstinence and provided they made a commitment to permanently abstain from those toxic substances.

So, the issue for the program team developing the criteria for gaining a spot on the list was NOT that they would punish someone whose lifestyle choices led to the liver failure by denying them access to a potential donor liver; it was that IF they were going to gain the opportunity for a donor liver (which are scarce), they would seriously commit to a lifestyle that excluded the substances that destroyed their own liver.

Sounds reasonable. But that's not what I've seen. Lifestyle choices have mattered. A lot. Especially for suicide attempts or very long-term alcohol abuse.

Perhaps centers vary. Once UNOS is involved, presumably things are equitable. But getting on the list may not be. For example, we saw SOME centers refuse to list (or to de-list) people who refused COVID vaccinations. But that approach definitely wasn't universal.
MOO

 

[ch_13]

Emotionally I feel that way too. But I'm not sure the law would. Keeping someone from having a chance at receiving a potentially life-saving transplant probably isn't murder under the law. That scenario would assume ALL the people who died without transplant at that center would have received livers (a murder charge requires identified victims and I'm not sure how one could say A but not B) and would assume ALL would have lived if but not for his actions. And I'm not sure that can be assumed given the scarcity of donated organs.

Well, the DA could certainly go back and figure out which patients would have actually received a liver had their criteria not been altered. That's not to say all those people would have survived but something like 3/4 of transplantees do live for at least five more years.

I was actually thinking about another recent case, where a plastic surgeon was charged with murder for refusing to call 911 after their patient's heart stopped. The situations aren't exactly the same, but in both cases the doctor violated their duty of care to their patient(s).

Plastic surgeon Dr. Carlos Chacon, 36, charged with murder for refusing to call 9/11 after patient Megan Espinoza, 36, had cardiac arrest - 4/12/23

https://people.com/crime/plastic-surgeon-charged-murder-allegedly-refused-call-911-patient-suffered-cardiac-arrest/ Authorities have charged a California plastic surgeon with murder for allegedly refusing to call 911 after a patient on whom he was performing a breast augmentation went into...

www.websleuths.com

 

[grannygates]

Well, the DA could certainly go back and figure out which patients would have actually received a liver had their criteria not been altered. That's not to say all those people would have survived but something like 3/4 of transplantees do live for at least five more years.

I was actually thinking about another recent case, where a plastic surgeon was charged with murder for refusing to call 911 after their patient's heart stopped. The situations aren't exactly the same, but in both cases the doctor violated their duty of care to their patient(s).

Plastic surgeon Dr. Carlos Chacon, 36, charged with murder for refusing to call 9/11 after patient Megan Espinoza, 36, had cardiac arrest - 4/12/23

https://people.com/crime/plastic-surgeon-charged-murder-allegedly-refused-call-911-patient-suffered-cardiac-arrest/ Authorities have charged a California plastic surgeon with murder for allegedly refusing to call 911 after a patient on whom he was performing a breast augmentation went into...

www.websleuths.com

Something is very wrong with this system if this Dr Chacon is still allowed to see patients while awaiting his court date for alledgedly murdering his patient (a kindergarten teacher!)

I will be watching this case closely and I am curious how the DA will approach the charges and I am very hopeful these victims that have died because of this Dr will get some justice.

 

[I am not Sherlock H.]

Rsbm.

If the allegations are true that eligible patients weren't receiving livers because of Bynon's manipulation of records and then were dying during their futile wait, then IMO that's not negligence. It's straight-up murder.

Yes, and sure also qualifies IMO as medical malpractice.

Have to wonder why any license(s) JBJr might have had have not been pulled or suspended indefinitely if not already the case.

And I shall not add here what my thesis advisor in graduate school for my Masters in Chemistry once said about a fellow lab mate’s qualifications for medical school. Best way I can say it…… he probably shouldn’t qualify to be a veterinarian. (And to be clear…… not wishing any ill on the animals!)

And sad to think of those possible recipient patients that might have missed their window. This case will IMO really be about them or their losses. MOO

 

[NCWatcher]

Well, the DA could certainly go back and figure out which patients would have actually received a liver had their criteria not been altered. That's not to say all those people would have survived but something like 3/4 of transplantees do live for at least five more years.

I was actually thinking about another recent case, where a plastic surgeon was charged with murder for refusing to call 911 after their patient's heart stopped. The situations aren't exactly the same, but in both cases the doctor violated their duty of care to their patient(s).

Plastic surgeon Dr. Carlos Chacon, 36, charged with murder for refusing to call 9/11 after patient Megan Espinoza, 36, had cardiac arrest - 4/12/23

https://people.com/crime/plastic-surgeon-charged-murder-allegedly-refused-call-911-patient-suffered-cardiac-arrest/ Authorities have charged a California plastic surgeon with murder for allegedly refusing to call 911 after a patient on whom he was performing a breast augmentation went into...

www.websleuths.com

BBM

Maybe. I'm not sure that it would be possible to say Patient X definitely would have gotten a viable liver except for the doctor's actions. We might be able to say the Patient X couldn't get a liver because of his actions...but that doesn't mean except for his actions that person would have gotten a liver. And as you say, even with a transplant some folks don't make it.

Certainly he was very wrong to do what he did if what we think we know is true. IMO, he shouldn't continue to hold a license if it's true. And he deserves to lose some big civil suits for malpractice. But it's a giant leap from violating normal standards of care/malpractice to murder. The other case, the 911/plastic surgeon case, involved not only harmful delay after a cardiac arrest, but care that caused harm in and of itself (the bagging) as well as using unqualified people to administer anesthesia. I know you didn't say they were the same but so far as murder goes, they are pretty different IMO.
MOO

 

[meanmaryjean]

As an Rn for over 4 decades, all I can say is this man is a serial killer in the truest sense of that terminology.

 

[ch_13]

Maybe. I'm not sure that it would be possible to say Patient X definitely would have gotten a viable liver except for the doctor's actions. We might be able to say the Patient X couldn't get a liver because of his actions...but that doesn't mean except for his actions that person would have gotten a liver. And as you say, even with a transplant some folks don't make it.

I'm not sure why they couldn't figure out who would have received a liver.

From the UNOS.org website:
When a deceased organ donor is identified, UNOS’ computer system generates a ranked list of transplant candidates who are suitable to receive each organ. UNOS matches individuals waiting for a lifesaving transplant with compatible donor organs.

Maybe I'm missing something obvious, but It seems to me they could run a simulation using the same algorithm and see who the computer would have awarded the livers if the victims' eligibility criteria had been input correctly. It might be a bit complicated to set up, but it should just be a matter of time, effort and cost if the DA wishes to go that route.

 

[neesaki]

According to this article, the data that was manipulated included specifying impossible criteria for donor characteristics for particular patients (such as “liver donor must be a 300 lb toddler”), effectively eliminating ANY possibility that the patient would ever be chosen for transplant. The patient would be on the transplant list and would believe themselves to be waiting for a possible donor, but given the impossible criteria specified on their record, there would NEVER be an acceptable donor organ for that patient.

Texas surgeon accused of secretly blocking patients from getting transplants

The motive for the alleged data manipulation is unknown.

arstechnica.com

This is a truly terrible betrayal, if it has been accurately presented. Patients would have been led to believe they were among those approved to be waiting for a donor when in fact there could not possibly be a donor who would match the criteria specified in association with them. They were effectively EXCLUDED from the list by the criteria specified.

While of course necessary, offering patients the service of helping them find another transplant program does not return the months or years and the quality of health lost to the time some of them were on the list with no chance they’d find a donor, courtesy of this betrayal. According to the article, some of these patients died while in that state of betrayal.

Assuming the manipulation has been accurately reported, this seems very serious medical malpractice.

HOW could this manipulation of criteria NOT have been detected before now?

He’s a serial killer, IMO.

 

[Bodine]

I haven't read up on this case but have to wonder if there is a socioeconomic angle to the exclusions.

No idea how these transplants work, but I'm sure they are expensive and this wouldn't be the first time I've heard of patients being refused proper treatment due to their ability to pay. Eliminating those from the waiting list that might not be able to pay the bill before they pass would be a way to ensure profits stay high.

Disgusting, but wouldn't surprise if these exclusions turn out to be financially motivated.

Just a thought without knowing much about this.

 

[NCWatcher]

I'm not sure why they couldn't figure out who would have received a liver.

From the UNOS.org website:
When a deceased organ donor is identified, UNOS’ computer system generates a ranked list of transplant candidates who are suitable to receive each organ. UNOS matches individuals waiting for a lifesaving transplant with compatible donor organs.

Maybe I'm missing something obvious, but It seems to me they could run a simulation using the same algorithm and see who the computer would have awarded the livers if the victims' eligibility criteria had been input correctly. It might be a bit complicated to set up, but it should just be a matter of time, effort and cost if the DA wishes to go that route.

Maybe you are right. But I'm just not sure the UNOS database would be available to be used that way for a criminal prosecution. And it's not just the general algorithm. Person A may reach the top of the list in terms of need, but whether she gets an organ depends on her health status on the day a matched organ is available. She might be highly ranked but be showing possible signs of a respiratory infection, for example. So the team might turn down that organ and it might go to a lower-ranked person closer to where the donor is because geography also matters. And once that lower ranked person is out of the pool, people below him/her will rise. I'm just not sure that sort of dynamic process can be simulated in a "this is what would have happened" simulation especially without having access to private health information about other people listed, especially those who did get livers. And each year, more than 2500 persons on the list die without getting a liver. So being listed properly is obviously no guarantee.

I am certainly not saying that what this doctor did was acceptable in any way. I will be very surprised though if there is an attempt to prosecute him for murder much less prosecute him as a "serial killer." (For the ones who didn't get a liver and died. It's not clear to me how many died with weird donor information listed.)
MOO

 

[Diddian]

Maybe you are right. But I'm just not sure the UNOS database would be available to be used that way for a criminal prosecution. And it's not just the general algorithm. Person A may reach the top of the list in terms of need, but whether she gets an organ depends on her health status on the day a matched organ is available. She might be highly ranked but be showing possible signs of a respiratory infection, for example. So the team might turn down that organ and it might go to a lower-ranked person closer to where the donor is because geography also matters. And once that lower ranked person is out of the pool, people below him/her will rise. I'm just not sure that sort of dynamic process can be simulated in a "this is what would have happened" simulation especially without having access to private health information about other people listed, especially those who did get livers. And each year, more than 2500 persons on the list die without getting a liver. So being listed properly is obviously no guarantee.

I am certainly not saying that what this doctor did was acceptable in any way. I will be very surprised though if there is an attempt to prosecute him for murder much less prosecute him as a "serial killer." (For the ones who didn't get a liver and died. It's not clear to me how many died with weird donor information listed.)
MOO

I also think it unlikely he’d be charged or prosecuted for murder. However, I could see the program with which he is associated suffering serious consequences from insurance providers whose clients were being essentially lied to. Those patients were not receiving the “standard of care” they and their insurance provider were led to believe they were and because this was artfully concealed from them, they did not seek out alternatives that would have provided that standard of care. And throughout the period of time those patients were “on the list, but not really,” their insurance providers were paying for services.

I would expect that providers might decline to support the program AND might seek reimbursement for services that were provided under fraudulent conditions.

I’d also expect that folks exist (the patients or their loved ones) who might have a case for fraud perpetuated against them that caused them harm and if there are many, there might be cause for a class action that challenges in such a way that the program is forced to expose the decision making behind their selection process as well as every case in which this manipulation of criteria resulted in exclusion from selection.

 

[NCWatcher]

I also think it unlikely he’d be charged or prosecuted for murder. However, I could see the program with which he is associated suffering serious consequences from insurance providers whose clients were being essentially lied to. Those patients were not receiving the “standard of care” they and their insurance provider were led to believe they were and because this was artfully concealed from them, they did not seek out alternatives that would have provided that standard of care.

I would expect that providers might decline to support the program.

I’d also expect that folks exist (the patients or their loved ones) who might have a case for fraud perpetuated against them that caused them harm and if there are many, there might be cause for a class action that challenges in such a way that the program is forced to expose the decision making behind their selection process as well as every case in which this manipulation of criteria resulted in exclusion from selection.

Absolutely. I expect the program WILL suffer and I'd expect civil suits for malpractice. But not prosecution for murder.
MOO

 

[whinewiththegravy]

Anyone remember the ProPublica / MLK50 / Commercial Appeal series last year on the downfall of the James D Eason Transplant Institute at Methodist in Memphis?

Parts One, Two.

One of the underlying faults did appear to be with improper patient selection protocols, coupled with an absence of nationally-regulated standards and mandatory reporting guidelines and data-tracking that plagued other countries with similarly lopsided systems lacking oversight, driving transplant programs towards private/public funding schemes that spurred more surgeries with less certain outcomes.

 

[GoBuckeyes]

Thank you Diddian for that helpful research. And as noted, that makes this all the more appalling and IMO medically and ethically wrong, as well as criminal IMO.

I imagine being on some of these recipient lists is not cheap or free? And add in the medical insurance angle too. And how was this individual JSBJr or others choosing who ‘gets the goods’ or doesn’t? And how as you question weren’t the discrepancies and manipulations found sooner? I can’t believe the records are kept in a 3x5” file card in a file index box in a key-locked drawer? Something seems rotten deep.

I hope some investigative journalists in TX and / or the medical community get on this and quickly. IMO perhaps 60 Minutes ought to take this on? MOO

I do believe it's free to be on a list; although, the testing and appointments to get on the list aren't free. Also, Insurance does have to approve the transplant. imoo My Uncle just went through a heart transplant almost 1 year ago to the day.

Has this so called doctor been arrested yet?

 

[GoBuckeyes]

Absolutely. I expect the program WILL suffer and I'd expect civil suits for malpractice. But not prosecution for murder.
MOO

I don't see how it's not murder or attempted murder.

 

[GoBuckeyes]

I have a very close friend who was on the liver transplant list in another program than this Houston one, and who eventually was fortunate to receive a liver transplant. She had become quite ill, and was wasting away by the time she was blessed with the gift of a liver. I was one of a few members of her “caretaking team” - attending meetings with her and the social worker, driving her to medical appointments, being on call to help as needed if and when she got the call for a transplant, and assisting with home care after she returned home after she’d stabilized after the surgery, and providing moral support to keep her spirits up as she waited for a donor. The process is so life-encompassing that the programs encourage patients to have a team (whether family or friends) made up of members who have been made fully aware of and are prepared for the commitment and who are willing to be on call when the patient receives the call that a donor is available and they need to report for the presurgical prep.

A person doesn’t pay a fee to be on the list; it is their medical condition that puts them into the transplant program and their insurance that covers it, after they are referred by the doctors who have been treating them for the health impacts of their failing livers. Once in the program, they undergo not just medical testing, but also counseling with a social worker as the treatment is a lifelong change, requiring antirejection drugs, regular testing, and a commitment to certain lifestyle changes (such as avoidance of alcohol as well as certain foods) even after stabilizing post-surgery. Besides determining that a patient is well enough to survive surgery, tests also produce something called a MELD score that involves various factors that determines whether a patient’s condition has reached the point where their medical need is so great that they can be placed on the list. So, as I understand it, to be placed on the list, the patient has to be sick enough to warrant transplant but well enough to survive surgery and there has to be a donor who is a match (I’m not sure of all the requirements for a match, but size is one of them…my friend is quite petite and it was an older child’s liver that was determined a good match for her.)

The patient works with an entire team of medical professionals, before and during the transplant, and for the remainder of their life, with the frequency of visits declining after the patient stabilizes, but increasing again if stress or illness or other conditions upset stability and require closer monitoring and/or medication changes.

Having seen the huge commitment of time and trust involved through my friend’s experience, it sickens me considerably to consider what has been alleged in this case. This should never happen.

Exactly, it's not as if this doctor never met the patients he essentially black balled. He would have gotten to know them, details about their life, probably 1 or more of their family members. How this wouldn't me considered murder, and why he's not in jail awaiting trial, is beyond me.

 

[GoBuckeyes]

Emotionally I feel that way too. But I'm not sure the law would. Keeping someone from having a chance at receiving a potentially life-saving transplant probably isn't murder under the law. That scenario would assume ALL the people who died without transplant at that center would have received livers (a murder charge requires identified victims and I'm not sure how one could say A but not B) and would assume ALL would have lived if but not for his actions. And I'm not sure that can be assumed given the scarcity of donated organs.


Sounds reasonable. But that's not what I've seen. Lifestyle choices have mattered. A lot. Especially for suicide attempts or very long-term alcohol abuse.

Perhaps centers vary. Once UNOS is involved, presumably things are equitable. But getting on the list may not be. For example, we saw SOME centers refuse to list (or to de-list) people who refused COVID vaccinations. But that approach definitely wasn't universal.
MOO

There were tremendous inequities in healthcare during the vaccination push. imeo

 

[neesaki]

I do believe it's free to be on a list; although, the testing and appointments to get on the list aren't free. Also, Insurance does have to approve the transplant. imoo My Uncle just went through a heart transplant almost 1 year ago to the day.

Has this so called doctor been arrested yet?

If not, he needs to be. Just because he’s an MD doesn’t make him above the law. I really hope this doesn’t become one of those cases, where he is being sheltered by his profession. Let’s not forget, the Hippocratic Oath…. First do no harm.

 

[NCWatcher]

I don't see how it's not murder or attempted murder.

Exactly, it's not as if this doctor never met the patients he essentially black balled. He would have gotten to know them, details about their life, probably 1 or more of their family members. How this wouldn't me considered murder, and why he's not in jail awaiting trial, is beyond me.

Probably he's not in jail because 1) it's very early in the process and 2) even after time passes, it's going to be very hard to prove he killed people and intended to do that. (We don't know for sure the patients all died either.) We don't know that all the patients were his patients, do we? There must have been other transplant surgeons on staff. So I don't think we can safely assume this particular doctor-- as despicable as he seems to be--spent time with all the people whose records were changed, much less that he had met their family members.
MOO