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Nevada Doctors in the News, 2005-2010
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In 2007, when Public Citizen ranked the Nevada State Board of Medical Examiners (NSBME) among the five worst medical boards in the U.S., the distinction was nothing new for the troubled board. The NSBME's dismal record in fulfilling its mandate to protect patients from unfit doctors has been the subject of public controversy for years. In 2002, KVBC-TV reported that the legislature was about to "discipline the discipliners" after the station ran an exposé of the Medical Board's lax approach to physicians with multiple malpractice claims. Two years later, Reno Gazette Journal reporter Frank Mullen wrote a series of articles detailing the Medical Board's continuing failure to reign in dangerous doctors. As you can see from the summaries below of a selection of cases from 2005 to the present, the Board's long-term dysfunction has enabled crowds of physicians to keep on injuring patients despite multiple complaints against them.
In considering the Medical Board's mishandling of these cases, remember that the Board refuses to act on the overwhelming majority of complaints. In 2008, for example, the Board opened over six hundred investigations, mostly in response to complaints from the public. However, it took disciplinary action in only 27 cases, and these actions did not, for the most part, prevent the doctors involved from conducting their business as usual.
During 2008 and 2009, after a series of high-profile scandals, including the exposure of up to 50,000 patients to serious diseases at endoscopy clinics in Nevada, the state's historical indifference to health care regulation came under renewed scrutiny. It is too soon to tell if the Medical Board will change its ways in the face of public outrage. However, it is plain that Nevada has become a magnet for incompetent doctors, and it will take years for state officials to clean up the mess that developed over decades as lawmakers and regulators sought to promote the interests of profiteering charlatans rather than fulfilling their mandate to protect the public.
Dr. Conrad Murray, who served as the late Michael Jackson's personal physician, was charged with manslaughter on February 8, 2010 in connection with his role in the pop singer's death on May 25, 2009. Murray, who lives in Las Vegas, is licensed to practice in Texas, California, and Nevada. Noting that he had yet to be paid by the singer's estate after he reportedly provided Jackson with a fatal dose of propofol, a powerful anesthetic that is only supposed to be administered in a medical setting, Murray reopened his cardiology practice in Houston in November 2009 in order to meet his mounting legal bills.
On February 9, 2010, the day after Murray was charged in California, the Nevada State Board of Medical Examiners indicated that it would take no action against him even though the Medical Board of California had already initiated proceedings against his license there. According to Fox News, Douglas Cooper, Interim Executive Director of the Nevada Medical Board, said that no action was needed in Nevada because Murray's guilt had not been established, and it did not seem that Murray was treating patients in Nevada. However, Murray's lawyer almost immediately announced that Murray had recently returned to Las Vegas, where he planned to resume practicing medicine in another doctor's office.
Several weeks later, the Board backtracked from its previous announcement. Since it had long been public knowledge that Murray had fallen behind on his child support, the Board decided to file a complaint against him, not for his improper administration of a controlled substance, or for any other violation of standard medical care, but for failing to disclose that he had failed to keep up with his child support payments. Cooper reportedly said that Murray could lose his licence as a result of this complaint, but it unlikely that the Board has ever revoked a doctor's licence for a similar offense. In any event, indications are that Murray is continuing to treat patients in Nevada, and the Nevada Board's inconsistent response to his case will undoubtedly strengthen his lawyer's efforts to have the complaint dismissed.
If it turns out that Murray improperly prescribed controlled substances to Jackson, the case would not be unusual in Nevada. In 2008, the Las Vegas Sun reported that the number of deaths caused by prescription drugs in Clark County exceeds the number of deaths caused by street drugs, car accidents, or firearms.
In 2005, when homeopath James Forsythe, MD, was indicted by federal officials for drug-smuggling and other violations, the Reno Gazette Journal revealed that at least 19 people had filed complaints against him with the Medical Board, and a state investigator described him in a sworn affidavit as "one of the five most serious physician offenders known in the state of Nevada." At the time, Forsythe's record showed that only one disciplinary action had been taken against him. In 1995, he was fined $1,000 for overbilling for medical tests and was also forced to pay the Board $44,000 that was supposed to be "used by the Board for future protection and awareness," but there is no evidence that the Board made any effort to protect the public from Forsythe or to make anyone aware of the dangers he posed.
The incapacity or unwillingness of the Medical Board to take action against renegade physicians is evident in Forsythe's brazen manipulation of the media before, during, and after his trial in 2007. Contrary to a press release that he circulated among local news outlets and various "health freedom" web sites in August 2007, Forsythe was not cleared of drug-trafficking and other charges at that point, nor did the FDA ask him to author protocols for the proper use of human growth hormone. His trial began in Reno on October 23, 2007, and he was acquitted on November 1. While Forsythe skated away from the charges against him, the proceedings were significant because they revealed that he had improperly diagnosed a patient, who was actually an undercover FDA agent, with hypopituitism without conducting relevant tests, obtained human growth hormone by claiming in a letter to U.S. Customs that he needed it for "personal use," and sold it directly to the patient rather than writing a prescription that could be filled at an ordinary pharmacy.
Having ignored his questionable activities for years, the NSBME finally took action against Forsythe in January of 2009, charging him with malpractice after he began treating a patient for prostate cancer without performing any laboratory tests.
In September 2007, the Medical Board found homeopathic MD Frank Shallenberger guilty of one count of medical malpractice as a consequence of his mistreatment of David Horton, who died after Shallenberger misdiagnosed his colon cancer as hemorrhoids, treated him with witch-hazel and other ineffectual remedies, then, after the cancer had spread, unsuccessfully tried to combat the disease with Insulin Potentiation Therapy, a controversial treatment that has never been accepted by mainstream oncologists.
In contrast to what happens at most medical boards, where previous misconduct is usually taken into account, the NSBME ignored the fact that Shallenberger had been forced to surrender his license in California in 1995 after the medical board there found him subject to multiple disciplinary actions due to "gross incompetence," "repeated acts of gross negligence," and "acts of dishonesty and corruption which are substantially related to the qualifications, functions, or duties of a physician and surgeon." Consequently, for his direct contribution to Horton's death, the Nevada Board fined him only $5,000 and ordered him to pay $6,500 in legal costs.
At the same meeting, the Board dismissed a second complaint against Shallenberger, maintaining that it could not discipline him for mistreating a patient with severe cognitive impairments because he also holds a homeopathic license, and homeopaths in Nevada do not have to conform to ordinary standards of medical care even when they are also licensed MD's.
In August 2009, the Medical Board responded to yet another complaint against Shallenberger, charging him with two counts of malpractice for misdiagnosing and mistreating a patient by ignoring laboratory results and improperly prescribing medication. Since Shallenberger got off so lightly in the earlier cases against him, and since the Medical Board tends to overlook previous misconduct, it's unlikely that this latest complaint will put a dent in his lucrative practice. While Shallenberger specializes in helping people to stop or even reverse the "disease of aging," he attracts patients from around the world by offering seemingly magical treatments for other maladies such as diabetes and cancer. Some of his breakthrough nostrums include, along with Insulin Potentiation Therapy (IPT), ozone therapy, darkfield blood analysis, bioenergy testing, and Lifewave Energy Enhancing Patches.
Dr. Kevin Buckwalter's dangerous incompetence was first brought to the attention of the Nevada State Board of Medical Examiners in 2005. However, the Medical Board did not prevent Buckwalter from prescribing thousands of pain pills to known drug addicts over the next three years even though numerous complaints had been filed against him. In 2008, after the Las Vegas Sun reported on Buckwalter's dangerous practices, the Medical Board finally stripped him of his license. By that time, he had been implicated in the deaths of eight patients, including a newlywed couple who both died after Buckwalter prescribed them excessive amounts of painkillers without reviewing their medical records or subjecting them to any physical examination.
In November 2009, the Medical Board reportedly backed off an agreement it had reached with Buckwalter's lawyer that would have allowed him to reapply for his medical license after a two-year revocation. According to the Las Vegas Sun, "Board member Dr. Michael Fischer, who made the motion to reject the settlement, refused to say whether the panel viewed it as too lenient or too strict. Board officials said members could not comment on the case because it hasn’t been resolved."
On March 11, 2009, a federal grand jury indicted Dr. Mark Kabins in connection with his involvement in a complex conspiracy to defraud Melodie Simon, a patient who became paralyzed after routine spine surgery in 2000. The case, whose participants have come to be known as the "Medical Mafia," evolved from charges against attorney Noel Gage and medical consultant Howard Awand, who allegedly arranged secret deals with doctors, lawyers, and others that enabled the co-conspirators to siphon off millions from settlements at the expense of injured patients.
According to LasVegasNow.com, other doctors who have been subpoenaed or targeted by the U.S. Attorney's office include Dr. Mark Kraft, Dr. Raimundo Leon, Dr. Brian Lemper, Dr. Jim Thomas, Dr. David Oliveri, Dr. Michael Prater, Dr. Witold Iglikowski, Dr. Benjamin Venger, and Dr. John Thalgott. Of these, two physicians, Venger and Thalgott, have testified for the prosecution, acknowledging that they participated in order to get kickbacks from Gage and shield themselves from potentially damaging malpractice claims.
Although Kabins pleaded guilty to fraud in November 2009, the Nevada State Board of Medical Examiners did not take action against him until February 2010, when it charged him with three relatively minor violations. Since doctors in Nevada who have engaged in serious wrongdoing typically receive inconsequential fines, it is highly unlikely that Kabins will miss a day of work as a result of his misconduct. The NSBME also filed a complaint against Dr. Benjamin Venger and found him guilty of malpractice in part for his untruthful testimony in the Simon case. But while Venger was put on probation, neither he nor any other doctor involved in the scheme has been prevented from practicing medicine. In keeping with this history, the Board filed a complaint against Dr. John Thalgott after he admitted offering false testimony in exchange for kickbacks in the Simon case. Then the Board resolved the matter by requiring Thalgott to make a $5,000 donation to an unnamed charity in addition to paying legal costs. While the Board failed to provide any rationale for this illogical agreement, it is certainly ironic that Thalgott could end up writing off his penalty on his next tax return.
Dr. Albert Yeh, a Las Vegas-based physician who runs clinics in Arizona and Nevada, was charged on July 14, 2009 with operating a massive illegal drug operation and insurance scam . According to DEA officials, Yeh wrote hundreds of illegal drug prescriptions and collected over $3.5 million in fraudulent insurance claims. Testimony provided by Yeh's medical assistant, Brian Espinoza of Henderson, indicated that Yeh typically wrote over 100 prescriptions every Tuesday, so many that Tuesday came to be known as "Yeh Day" at local pharmacies.
Dr. Depak Desai, who served on the Nevada State Board of Medical Examiners from 1993 until 2001, was ordered to pay $2,500 in 1996 to settle a complaint against him for falsely advertising that the doctors on his staff at the Gastroenterology Center of Nevada were board-certified. But the real threat that Desai posed to the public did not come to light until the Southern Nevada Health District announced on February 28, 2008 that as many as 50,000 people may have been exposed to hepatitis C and other blood-borne diseases due to widespread mishandling of syringes at the Southern Nevada Endoscopy Center over the previous four years.
Desai owns and manages the clinic along with other lesser partners. During the investigation into dangerous procedures at Desai's business, doctors, nurses, and other staff acknowledged that the improper use of syringes, as well as failure to clean medical equipment, was routine despite obvious risks to public safety. The Medical Board could have suspended Desai's medical license on an emergency basis, as it sometimes does when it receives reports that doctors have been engaged in reckless conduct or criminal activity. Instead, Board President Dr. Javaid Anwar, Desai's long-term friend and associate, and Executive Director Tony Clark brokered an agreement that allowed Desai to suspend his practice temporarily while keeping his license free from any record of disciplinary action. Anwar and Clark both insisted that the agreement reached with Desai had nothing to do with his previous service on the Medical Board or with the high-level political connections that earned him an appointment to Governor Jim Gibbon's healthcare advisory team.
Although nearly two years have passed since the endoscopy scandal broke, Desai has so far managed to stonewall the proceedings, in part by claiming that he suffered a stroke that has prevented him from testifying in his own defense. In 2007, in a malpractice case against him, Desai also claimed that the effects of a stroke had deprived him of his capacity to offer testimony. However, the tactic backfired when it was discovered that Desai was still at work performing endoscopy surgeries.
Perhaps as a result of this failed legal strategy, Desai's lawyer submitted an affidavit to the Nevada Medical Board on February 5, 2010 stating that Desai was no longer "competent to safely practice medicine due to physical and mental impairments arising from a series of strokes." Confronted with this unequivocal statement, the Board apparently had no choice but to revoke Desai's license. The consequences of the Board's action remain unclear since Desai's lawyers could use it to counter doubts raised about his real condition. While his lawyers contend that the doctor is too disabled to "read a wristwatch," the Las Vegas Review Journal reported on Febrary 25, 2010 that friends and acquantances who had recently seen Desai at the Hindu Temple in Summerlin said that "he often shows up and seemed fine." Now that the doctors on the Medical Board have, in effect, corroborated Desai's claims about his inability to assist in his upcoming trial, the Board may be, once again, helping a colleague evade legal responsibility.
In the midst of ongoing investigations into Desai's clinic, other irregularities have come to light including possible insurance fraud. Testimony in a malpractice suit against Dr. Clifford Carrol, one of Desai's partners, revealed that the Nevada Endoscopy Center may have routinely overbilled for anesthesia during procedures while also failing to spend the time required to conduct adequate exams. In 2008, Carrol paid a $2 million settlement to Kevin Rexford, a patient who developed terminal colon cancer after the doctor failed to detect the disease in an earlier stage during a hasty exam. Although Carroll spent only a little more than three minutes on what should have been an eight-minute exam, he billed the insurance company for a much longer period of anesthesia, thirty-one minutes, in an apparent effort to maximize the revenue derived from the procedure.
According to the Las Vegas Sun, "The clinic committed three fundamental errors in the case, said Dr. Russell D. Yang, a gastroenterologist and associate professor at the Keck School of Medicine at the University of Southern California who is working on Rexford’s behalf: failure to identify the signs of colon cancer, technical failure in performing the endoscopy, and institutional failures in quality assurance." Carrol's errors were apparently due to his drive to perform as many profitable procedures as possible in the shortest amount of time. In his deposition, he acknowledged that he usually performed between 30 and 33 procedures each day and once managed to set a record of 50.
The lapse in quality assurance that occurred in the Rexford case was apparently missed in a review by Quality Care Consultants, which is co-owned by Dr. Ikram Khan, former Medical Board member and advisor to Governor Gibbons, and Dr. Javaid Anwar, former president of the Medical Board and a current Board member. Quality Care Consultants evaluated Desai's Endoscopy Center in 2007 to see if it measured up to industry standards. While acknowledging being "paid in full," Anwar did not disclose whether his company had detected any of the dangerous practices that health officials now say went on at the clinic for years, nor did he say whether Quality Care Consultants had given Desai any tips on reducing costs. Saving money was reportedly Desai's main reason for rejecting standard procedures despite the health risks involved.
Like Anwar, Medical Board member Dr. Stephen Daniel McBride was also forced to recuse himself from all matters related to the Endoscopy Center crisis due to his ties to Desai. As Paul Harism reported in the Las Vegas Review Journal, it turned out that one of McBride's links to Desai was that McBride was Chair of the Nevada Mutual Insurance Company, which provides malpractice insurance to physicians, while Desai served as a board member. Under a barrage of criticism for the obvious conflict of interest between his position on the investigatory committee of the Medical Board and his efforts to defend physicians against malpractice claims, McBride apparently gave up his seat at Nevada Mutual, as did Desai, who reportedly withdrew after charges against him were made public.
In light of McBride's leadership role in the malpractice insurance industry, it would be helpful to learn more about his input into in the Medical Board's 2005 decision to delete all information related to malpractice claims from its web site, as well as his connections to "Keep Our Doctors in Nevada," one of the leading groups lobbying for tort reform in recent years. And it would likewise be enlightening to find out how many of the doctors disciplined by the Medical Board during McBride's tenure signed up and paid for the continuing medical education courses offered on Nevada Mutual's web site.
McBride has much in common with Dr. Rudy Manthei, DO, former president of the Nevada State Board of Osteopathic Medicine. Like McBride, Manthei helped to promote caps on malpractice insurance claims while simultaneously participating in the investigation and determination of malpractice complaints against physicians. Manthei not only chaired Keep Our Doctors in Nevada, the principal group lobbying to reduce patients' rights, he also served alongside Deepak Desai on Governor Jim Gibbons' healthcare advisory team.
During Manthei's term as president, the Osteopathic Board fell into disarray, due in part to fiscal problems that developed after its Deputy Assistant Director, John E. Delap, began to siphon funds to feed his gambling addiction. Dr. Larry Tarno, Executive Director of the Osteopathic Board, later acknowledged that the shortage of funds that developed between 2002 and 2005, when Delap had access to Board accounts, forced him to terminate the only investigator on staff. Two years later, after the charges against Delap came to light, Tarno was quoted in the Las Vegas Review Journal, "We have not had a formal investigator since then... This has put me in a position of having to curtail activities of investigations. We have gotten some complaints from people that we're burying things." Manthei apparently left the Osteopathic Board in 2007, but his brother, Dr. Scott Manthei, was appointed to the Board in 2008.
From news accounts, it appears that Rudy Manthei hasn't lost his political clout. In August 2009, Manthei was charged with two counts of contributing to the delinquency of a minor after he allowed underage partiers to drive away from his home after he had served them alcohol. However, in contrast to what normally happens in similar cases in Henderson, Manthei seems to have convinced police to let him off.
Dr. David Linden, who is licensed both in Nevada and in Oklahoma, was featured in a major story in the New York Times in 2007 after the FDA found that he had imprisoned a subject of a research study at his psychiatric clinic in Oklahoma City. The Times also reported that Linden's Oklahoma license had been suspended in November 2006 for three months by that state's medical board because two of his patients had contracted herpes from him due to improper sexual contact.
While Linden's 90-day suspension for such egregious misconduct might have seemed too light to most people, it apparently seemed too harsh to the Nevada State Board of Medical Board Examiners (NSBME), which elected not to prevent him from practicing psychiatry even for a day, but chose instead to place him on probation. Now it seems that the NSBME's efforts to protect Linden from himself, instead of protecting his patients, have backfired: He is back in the public eye after having been arrested on February 28, 2008 for passing over $300,000 in bad checks in Las Vegas casinos.
Dr. Kurt Buzard, an ophthalmologic surgeon, was arrested in Las Vegas in 2003 for cocaine possession. Travelling in a speeding convertible with an unidentified female companion, Buzard was wearing a dog collar, a sheet, and little else when he was pulled over by police on August 24. Apparently unaware that Buzard had faced similar drug charges in Colorado in 1985, the police ordered him to appear for booking three weeks later.
In June 2006, long after Buzard had cut a deal that allowed him to avoid jail time on the cocaine charge, the Nevada State Board of Medical Examiners publicly reprimanded him for bringing the medical profession into disrepute. Ultimately, having enabled Buzard to continue performing eye surgeries for almost four years despite his substance abuse problems, the Nevada Medical Board reached an agreement with him to inactivate his medical license. According to the agreement, Buzard's license has not been revoked or suspended, and he is free to apply to re-activate his license in the future.
In June 2006, the Nevada Medical Board revoked Dr. Harriston Bass's license at an emergency meeting. The Board had also revoked his license in 1993, after finding him guilty of gross and repeated malpractice that led to the deaths of two of his patients. However, the Board stayed the revocation, placed him on probation, and enabled him to continue treating patients in Nevada for more than a decade. Although the Medical Board removed information about malpractice claims from its web site in 2005, John L. Smith, a columnist for the Las Vegas Review Journal, reported that Bass, who became a prison doctor while under probation, was sued by an inmate at the Southern Nevada Correctional Facility in 2001.
Bass's troubled history again resurfaced after Gina Micali, a patient at his PT Cruiser-based mobile clinic, Doc's 24-7, died from a prescription drug overdose on October 6, 2005. Authorities alleged that Bass sold Micali 300 hydrocodone pills two days before her death and also wrote her a prescription for the drug even though he was not licensed to dispense controlled substances. Bass was found guilty of second-degree murder on March 5, 2008 in Las Vegas.
The Medical Board revoked Dr. Doyle Stuart Steele's license to practice medicine in November 2007, five years after it found him not guilty of medical malpractice in the first complaint filed against him. During that period, Steele was ordered to undergo a mental evaluation after questions were raised about his competency in 2004, and a second complaint was filed against him in January 2005. That complaint alleged that he had failed to report hospital sanctions against him and that he had engaged in sexual relations with one of his patients.
In July 2005, Steele and his colleague, Dr. Richard Groom, were sued by the family of a man who was killed when one of their former employees, for whom they had reportedly prescribed over 5,000 painkiller pills during the previous year, ran him, along with a woman who was seriously injured, down on June 6, 2004 as they stood on the side of a Las Vegas highway. Meanwhile, on July 1, 2005, the Medical Board suspended Steele's license pending the outcome of an investigation into whether he had improperly prescribed controlled substances to three patients, including one with whom he had allegedly had sexual relations.
In December 2005, Steele was arrested for writing Oxycontin prescriptions for drug dealers in Virginia and for trading drugs for sex in Las Vegas. Late last year, after Steele was sentenced to seven years by a Virginia judge, the Nevada Medical Board finally stripped him of his license. However, in a statement to the press on Steele's case, a Medical Board spokesperson stressed that the revocation was not necessarily permanent: ""People who redeem themselves and re-educate themselves and pay their debt to society would be welcome to re-apply," the board spokesperson said."
In June 2007, Dr. Stephen Seldon and his wife, Deborah Seldon, received national attention when they were charged on various counts by federal authorities after they allegedly injected patients with a cheap substitute for Botox that is not supposed to be used on human beings. Two years later, Stephen Seldon was sentenced to 46 months in prison, while Deborah Seldon received 30 months after the two were found guilty of multiple counts of mail fraud and one count of improper sale of adulterated drugs.
In a departure from its usual practice of treating these types of violations extremely lightly, the Nevada State Board of Medical Examiners revoked Seldon's license in December 2008. The difference in the Seldon case could have been media coverage or the fact that the couple faced federal charges. Seldon was, however, clearly treated much more harshly than other physicians similarly charged. For example, in March 2007, after finding Adelaida Resuello, MD guilty of similarly substituting an unapproved botulism toxin for Botox, and also for assisting an unlicensed person to inject the poison into patients, the Board fined her a paltry $2000 and placed her on probation. And when the Board found Gregory Bryan, MD guilty of injecting people with fake Botox, and of improperly supervising a physician's assistant, it fined him a mere $1,000 and ordered him to take a few courses on charting and medical ethics.
Likewise, in contrast with its historically lackadaisical attitude, the Medical Board went so far as to have one of Seldon's medical assistants arrested for providing Botox injections even as Board members acknowledged that the practice of allowing assistants to perform the procedure was widespread in Nevada. The Board's inconsistent enforcement of existing statutes backfired when the arrest caused general confusion about whether medical assistants could provide flu shots, a question that became especially pressing since it arose at the very moment that public health officials confronted the challenge of distributing H1N1 flu vaccine. The Board then went on to exacerbate the problems caused by its incompetence by attempting to adopt an emergency regulation that was later overturned because the discussion had been cut short by members' desire to break for lunch.
Among other problems, Dr. Anthony's record includes a conviction for negligent homicide in Utah in 2002 in the death of a woman from Bunkerville, Nevada after she received a liposuction treatment from him. Anthony caused the woman's death when he provided injectable painkillers to her husband, who had no medical training, and advised him to inject his wife at home because she did not want to return to Anthony's office. That same year, the DEA revoked Anthony's registration on the grounds that he was not authorized to handle controlled substances in Utah. In December 2009, after Utah's Medical Board revoked Anthony's license, the Nevada Medical Board filed another complaint against him. However, it is not clear from public records whether he is continuing to practice in Nevada or any other state.
The NSBME's Faulty Radar
The recent cases summarized above only include those in which the NSBME took some sort of disciplinary action against physicians whose subsequent wrongdoing landed them in the news. But since the Medical Board addresses only a tiny fraction of the hundreds of complaints that it receives each year, it is virtually impossible to gage how many incompetent doctors are currently treating patients in Nevada. Nonetheless, having come under scrutiny, former Board President and current member Javaid Anwar justified making malpractice information more difficult for the public to obtain. According to the Las Vegas Sun:
Dr. Javaid Anwar, president of the State Medical Examiners Board, and fellow board member Donald Baepler both said malpractice claims and settlements are misleading barometers of a physician’s competence. Insurance companies often will settle malpractice claims for hundreds of thousands of dollars even if the doctor wasn’t really at fault to avoid the possibility of losing millions of dollars at trial, Baepler said...And Anwar said a physician with only one malpractice case could have been involved in a far more egregious situation than a doctor with 10 claims...“The number of lawsuits is not a good way to judge how good a physician is,” Anwar said. “Sometimes they simply go after the doctor with the deepest pockets.”
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