Jan 08

Patients fared better with Anagnost than his surgical peers, independent report shows

by Tim Farley.


Editor’s Note: This is the latest installment in a series of exclusive investigative stories that focus on Dr. Steven Anagnost and his battle to retain his medical license while also trying to defend himself against allegations from the Oklahoma Medical Licensure Board, competing physicians and a group of medical malpractice attorneys in Tulsa.

OKLAHOMA CITY – Embattled Tulsa spine surgeon Steven Anagnost recorded better post-operative statistics compared to national and local peers, according to an independent research report that focused on a five-year time period.

The report, prepared by Oklahoma-based health care administrator and health policy researcher Michael Lapolla, centered its attention on complication and morbidity rates, length of hospital stays, costs and readmission rates from 2005 through 2009.

Anagnost, a pioneer in Minimally Invasive Spine Surgery (MISS) was the target of the Oklahoma Medical Licensure and Supervision Board for several years as staff members and board members sought to revoke the surgeon’s medical license. Secret files and emails meant to ruin Anagnost were obtained by Red Dirt Report as part of an exhaustive investigation into the case that started in 2005. Prior to the medical board’s investigation, Anagnost turned down an offer from competing surgeons to join their practice at Oklahoma Spine and Brain Institute and the physician-owned Tulsa Spine & Specialty Hospital.

Anagnost’s surgical practice had flourished because of the MISS procedure, taking patients away from other surgeons who used traditional spine surgery techniques that often resulted in longer hospital stays, higher readmission rates and continued pain.

After Anagnost rejected OSBI’s offer, solicited lawsuits from medical board staffers and unsubstantiated complaints from the competing surgeons began piling up. The medical board’s investigation continued for five years despite an admonition from four Oklahoma Supreme Court justices that Anagnost’s due process rights may have been violated.

Meanwhile, the Lapolla report clearly shows the allegations leveled against Anagnost were not true.

“The operative term I was paying attention to was the charge or allegation that he had a pattern of bad or questionable surgeries,” Lapolla said in a telephone interview with Red Dirt Report. “That doesn’t square up with someone who has a five-year record of excellence. A fair system would have put his (Anagnost’s) five-year record on the table while comparing it to the five-year record of those making the allegations.”

According to the report, Anagnost’s patients experienced fewer complications than the national standard for each of the 17 quarters from the third quarter of 2005 through the third quarter of 2009.

“These data demonstrate that Dr. Anagnost is practicing at a very high level compared to national peers and that his performance is not only consistent but also improving,” Lapolla wrote.

Much of the information in Lapolla’s report was taken from the Hillcrest Healthcare System Physician Quality Measure Report for January 2005 through July 2009. Lapolla acknowledged he was paid by Anagnost to conduct the research and write the report but that his findings were not influenced by the surgeon or other outside parties.

“It was raw data that I collected from Hillcrest and peer-reviewed publications,” he said. “I was never asked to make changes by Dr. Anagnost and neither he nor his legal team told me how to organize or prepare the report.”

Better than peers

As part of the report, Anagnost also was compared to eight other Hillcrest surgeons, including Dr. Frank Tomacek, who was one of the key players in the complaints and lawsuits filed against Anagnost. Tomacek, a partner in OSBI, was an expert witness in nearly two dozen of the lawsuits. Anagnost’s stats also were compared to Drs. Clinton Baird, Christopher Covington, Steve Gaede, Eric Sherburne, John Main and Greg Wilson. Baird, Covington, Gaede and Sherburne also are partners in OSBI.

According to the report, Anagnost’s patients experienced five-year morbidity rates 19 percent better than the national rate and his Hillcrest peers. His patients also had five-year complications rates lower than his peer group and 22 percent below the national average, the report shows.

Other metrics included length of hospital stays and hospitalization costs. Anagnost’s patients experienced hospital stays 45 percent better than the national standard while the length of stay for his local peer group was 16 percent below the national standard.

Financially, Anagnost’s patients were better off. According to the report, his competing surgeons charged 25 percent less than the national norm while Anagnost was 32 lower than that same standard. A typical cost, including hospital charges, for a minimally invasive decompression would be about $5,000, Anagnost said. That type of surgery would be an outpatient procedure. Conversely, the cost for a traditional open spine surgery with instrumentation, including hospital stay, would be about $50,000, he said.

“It is usually a factor of 10 times the cost for an outpatient minimally invasive procedure compared to a traditional open inpatient surgery such as a fusion,” Anagnost said.

The Lapolla report also illustrates that Anagnost’s patients were not as susceptible to hospital readmissions as his peers. Data for 2005-2009 shows readmission rates for Anagnost’s patients is 38 percent lower than his Tulsa surgical peers for the same diagnosis and 17 percent below peers for a different diagnosis.

Feeling redeemed

Almost defiantly, Anagnost said the Lapolla report is the defining litmus test that demonstrates the high quality of care he provided his patients.

“It is true data compiled over thousands of patients over many years,” he said. “As doctors, this is how we evaluate each other – by statistical outcomes data, not rumor and hearsay from competing spinal surgeons and medical malpractice attorneys with personal financial gain. The statistical data undeniably proves that my minimally invasive surgical outcomes are not only better than the competing Tulsa spine surgeons who made the false accusations to the board, but also prove that I outperform the Oklahoma state averages and the national averages.”

Lapolla, who has worked with the state medical board in the past, maintains his report was never accepted by the medical board.

“I’m fairly sure the actual board members have never seen it,” he said. “I was never contacted by the board staff or the members.”

Anagnost claimed medical board Executive Director Lyle Kelsey and the Attorney General’s office tried to keep Lapolla’s report hidden from the public.

“The board and the assistant attorney general do not exemplify transparency, but rather deception,” the surgeon said. “This is in complete contradiction to the Oklahoma Medical Board’s sworn mission statement, which is to protect the public. The medical board only seems to be protecting itself, not the public and not the doctors.”

Kelsey did not return telephone calls for comment in connection with this story.

Anagnost believes the Lapolla report refutes all of the allegations leveled against him during the last five years.

“The Oklahoma Medical Board attempted to line up all of my bad outcomes back to back, over my entire career, and falsely conclude that I am a bad doctor. This is completely illogical. No credible or competent agency would ever do this. Every doctor will have bad outcomes. The Oklahoma Medical Board refused to include the thousands and thousands of successful outcomes into my data,” he said.

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