Neurosurgeon Christopher Duntsch in surgical scrubs. (Credit: Wendy Young)

Local News

In Second Day of Testimony, Doctor Calls Neurosurgeon Duntsch’s Outcomes ‘Catastrophic’

Prosecutors used testimony from patients and the doctors who corrected their surgeries to argue that Duntsch's outcomes were more than mere medical error.

The headline-grabber on Friday was the phrase “I can fix you.” In the second day of testimony in the state’s aggravated assault case against the neurosurgeon Christopher Duntsch, prosecutors brought forth another pair of patients who told similar stories: referrals from a pain management doctor, an impressive initial visit with the charismatic Duntsch, a suggestion of surgery, and lifelong post-surgical pain.

The parrying between the state and the defense focused on whether his disastrous outcomes will rise to the degree of criminal. Prosecutors used testimony from two patients and the three doctors who corrected Duntsch’s errors, arguing to the jury that what happened in those operating rooms was never merely medical error, that this was a man who knew that he was likely to harm people as long as he was practicing and that he did next to nothing once his patients awoke to searing pain. Patient Barry Morguloff testified that Duntsch’s staff used his history of addiction to minimize the pain he suffered after awakening from a fusion operation in his lower spine, which one doctor characterized as “the easiest operation a spine surgeon can do.” Morguloff said he felt like he’d been hit by a truck, and it took days for Duntsch to order follow-up imaging to try to identify its source despite showing symptoms that pointed to possible neurologic damage. Morguloff testified that his wife was told by a nurse that Duntsch suspected him of lying about the pain to get more narcotics. He said he’s been sober for more than 10 years.

Duntsch has been jailed since July 2015 on five counts of aggravated assault causing serious bodily injury and one count of causing injury to an elderly person. The state will need to prove that he was operating with a reckless disregard for the accepted standard of care. The defense again questioned the patients about the consent forms they signed before undergoing surgery and attempted to establish as fact from the expert physicians that mistakes do happen during operations. But two of the three doctors called to the stand on Friday, the vascular surgeon Randall Kirby and the neurosurgeon J. Michael Desaloms, spoke of Morguloff’s result as a unique medical failure.

“He performed worse than any spine surgeon I’ve seen in the operating room,” said Kirby, who cut into Morguloff’s abdomen and helped move his organs and blood vessels away from the spine so that Duntsch could operate, a procedure that he said just four surgeons in North Texas perform. Desaloms, who performed Morguloff’s corrective surgery about nine months after Duntsch’s operation, called the result a “striking abnormality,” adding that it was “definitely an outlier” in his nearly two decades of practicing post-residency. Kirby called the results “catastrophic.”

Morguloff and fellow patient Lee Passmore, who finished his testimony on Friday after a judge recessed the court Thursday afternoon, told similar stories of how they wound up under Duntsch’s knife. Both had severe back pain, for which they did not want to use narcotics to treat. Each had a pain management specialist who essentially did all they could for them, and referred both to Duntsch. Morguloff, who’d had a successful fusion in 2006, first consulted Desaloms about another surgery. The surgeon told him he felt he did not need an operation and advised him to lose weight and follow a stricter diet. Duntsch, Morguloff said, was more than excited to do it.

“I can fix you,” Morguloff recalled Duntsch telling him. “Those were magic words. … Everyone wants to hear they can be fixed.”

It took months for the neurosurgeon to organize a surgical team to do the operation, which concerned Morguloff’s wife. But he did his research online and found a man who, on paper, appeared beyond qualified for the relatively common elective procedure. Duntsch earned an MD and a PhD from the University of Tennessee Health Science Center before serving a one-year minimally invasive fellowship at a highly regarded Memphis clinic. He was in charge of laboratories at the school, and Morguloff found white papers he’d written about stem cell research. He didn’t know that some of Duntsch’s former research partners have raised questions about his role in those findings, a concern raised in D’s November cover story.

Duntsch was excitable and confident, both to Morguloff and Passmore. Kirby, the vascular surgeon, had a different opinion. He recalled a brief meeting outside a scrub sink at Baylor Plano wherein Duntsch came off as “extraordinarily arrogant” and proclaimed that he was the only trained minimally invasive surgeon in North Texas. “He was bragging about his surgical skills,” Kirby said.

And yet Duntsch apparently struggled immediately. Instead of using a scalpel to remove the disc in Morguloff’s lower back — a method that Kirby says “99.9 percent” of neurosurgeons use — Duntsch used a grabbing device and began jabbing at the disc without cutting it out. Months later, Desaloms said he discovered a piece of bone had been knocked off the spine and was pushing on a nerve root. The surgical cage, meant to put space between the vertebrae, was “malpositioned” and the fusion did not take. Morguloff woke up with searing pain in his left leg. His toes went numb, and he could not move his left foot — that condition, called drop-foot, was also present in Mary Efurd, one of the victims Duntsch is charged with harming. On Friday, he walked with a surgical boot and a special brace, leaning heavily on a cane.

He had the most colorful testimony yet. At one point, he recalled when he realized something was truly wrong. It was during a followup, and he said Duntsch was acting erratically. He was denying that the pain Morguloff felt was because of the surgery; he wanted Morguloff to admit that his back felt better, and that his leg pain was a separate issue.

“With my past drug history, I knew what was going on,” he said, turning his gaze to Duntsch. “Sorry, man, you looked high as a kite.”

Duntsch has never tested positive for drug use, although allegations have peppered depositions filed in civil lawsuits, along with declarations that he ducked a number of drug tests ordered by hospitals and by his medical school.

In Passmore’s surgery, Duntsch performed a “sub-optimal” placement of a surgical cage on his spine and stripped a screw, preventing it from being moved in the future. Dr. Luis Mignucci, the spine surgeon who went back in to correct what he could and stabilize the spine, said the procedure was a bad outcome but would not characterize it as a mistake. “Bad outcomes happen all the time,” he said, adding that as much as 30 percent of his Plano practice is corrective procedures. Today, Passmore walks with a severe limp, cannot feel his feet, struggles with incontinence, and lives with pain that radiates between a level four and a level 10. He said it hits the most severe degree “once or twice a month.” Neither Passmore nor Morguloff can run or play with their children; both were physically active before their surgeries. Passmore was a field examiner with the Collin County Medical Examiner, while Morguloff helped unload trucks for a family business. He also loved the outdoors and said he was a nationally ranked skier.

“The pain is horrible, not being able to run, not being able to play [with his 7-year-old]. It’s crushing,” Morguloff told reporters after his testimony. “Nobody should have to go through pain and suffering like this. Nobody. But let God’s will be done.”

Testimony continues on Monday.

Comments

  • Happy Bennett

    Excellent series Matt. The Texas Medical Board shows unusual deference to surgeons–even those with long histories of drug abuse (Hinckley, etc). The board trends towards enforcements against “easy” targets such as busy family practitioners, for fairly trivial “offenses” such as CME reporting. One wonders how Duntsch , his original spinal group employers, or Baylor,etc “marketed” to pain management physicians in order to secure their referrals of vulnerable patients to an (initially) unknown surgeon such as Duntsch.

    • Snicker Doodle

      Do doctors give “kickbacks” for referrals, perhaps?

  • Snicker Doodle

    This is an excellent series that took a lot of time and effort by the author, Matt Goodman.

    I’m a former journalist turned spine patient due to advanced degenerative disc disease (DDD). I’ve had laminectomy and fusion surgeries of C4-C5-C6 (with plate and screws) and L3-L4-L5 (with rods and screws). These were NOT “minimumly invasive” procedures. My spine problems continue to worsen, so I get frequent MRIs and continue regular consultations with pain doctors and spine surgeons.

    These articles have not pointed this out, but spine surgeries (with some exceptions) are usually considered elective no matter how much they’re needed. Though I could barely walk due to nerve compression, my lumbar fusion was “elective surgery.” My neck surgery was not elective. It was emergency surgery because I had spinal cord involvement and was on the verge of paralysis by then.

    Additional surgery has been recommended to me more than once, but so far, I’ve avoided it due to the unimaginably painful aftermath of my lumbar surgery. The neck surgery recovery was a breeze compared to the lumbar surgery, and the post op neck pain was easily controlled with pain pills (Percocet at first, then hydrocodone for a few weeks).

    But I woke in searing pain from my lumbar surgery, and also had a “spinal headache,” so my spinal canal sac must have been breached during surgery, causing a spinal fluid leak. My blood pressure was very low, I suppose due to blood loss, and that may have been the reason I was given NO PAIN CONTROL for the first 2 or 3 days post op. I had an IV port inserted for attaching a pain pump, but there was no pain pump. My doctor didn’t check on me because he’d gone out of town after my surgery, and the nurses said he had not ordered any pain medicine for me, before leaving. No, this was NOT Dr. Duntsch; it was a different Texas spine surgeon.

    I didn’t sue, so I don’t know if my experience involved negligence or if giving no pain medication was the normal thing to do under the circumstances (my BP was about 50/30, I think).

    Here’s what I want all doctors to know — The pain following lumbar surgery is REAL, and probably exceeds childbirth pain several times over. It’s about a 20 on a pain scale of 1 to 10. My post op pain was so severe I worried that I might die, just from the pain itself. My dead Grandma even came to me in a vision — or perhaps a dream — to offer comfort, which made me even more certain the pain was putting me close to death.

    I barely remember those first 2 or 3 post op days, which I spent in the ICU. They were just a haze, blurred by searing, nearly unbearable pain and the fact that I was going in and out of consciousness. I wasn’t paralyzed but could not move a muscle because even the smallest movement made the pain much worse — not just the “back pain” but also my severe headache. I put the words “back pain” in quotes because the pain felt like it went through my whole torso as though I’d been skewered on a spear.

    Unwilling to be moved, I ran off the physical therapist and refused to let the nurses change my bed sheets. From laying in one place for so long, I soon developed a bedsore. Then one day a doctor (not mine) came in, took one look at me, and ordered the ICU nurses to give me pain killers, which finally ended my agony.

    If you’re a spine surgeon reading this, please stop thinking your patients are merely “drug seekers” when they complain of post op pain. Even if they are former addicts, they do not deserve to suffer in the way that I did.

    I’ve been needing more spine surgery for years, and it hasn’t necessarily been considered elective surgery because I’ve developed cauda equina problems (which can require emergency surgery). But I have continuously avoided additional surgery because of the experience I just described.