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In Duntsch’s Assault Trial, Questions About His Role After Patient Deaths

Unequivocally, testified an expert witness, a neurosurgeon should stop practicing after incurring multiple patient deaths and severe outcomes. Christopher Duntsch didn't.

Christopher Duntsch, the former neurosurgeon being tried for assault related to his egregious patient outcomes, continued to practice after a patient died. He continued after another died. He continued after a patient woke up unable to move his arms and legs. He continued after misplacing hardware in a patient’s soft tissue, after damaging the vertebral artery that carries blood to the brain.

Thursday marked a week since testimony began in the case (which was the focus of our November cover story), and today prosecutor Michelle Shughart riddled expert witness Dr. Martin Lazar with a bevy of hypotheticals structured to mirror Duntsch’s outcomes: “Would a trained neurosurgeon know,” she’d begin, her query filled with things like whether an educated, board-certified neurosurgical physician know the complications of significant blood loss during surgery. Or whether hardware left in the wrong spot would cause some sort of disorder. By the end of the day, she grew more pointed, asking Lazar the ethics of a surgeon continuing to practice after multiple patient deaths and paralyses.

“It’s inconceivable. How can you not know that you’re going to cause a disaster?” Lazar asked, adding later: “If you have a conscience, that’s when the conscience tells you, ‘Stop!’”

He said a neurosurgeon practicing in spite of outcomes that severe would point to the individual being in “massive denial,” or showing signs of “some psychopathy,” “a disorder with thinking.”

In order to get a guilty verdict on a charge of aggravated assault, the state needs to prove that Duntsch acted recklessly and provided care that was far beyond the accepted standard. Other surgeons who corrected Duntsch’s errors have already called his outcomes “catastrophic.” Lazar, a practicing neurosurgeon for more than 40 years, walked through four of the patient outcomes he analyzed via medical records, including Mary Efurd, the woman who Duntsch is being tried for harming. He analyzed three of those records on behalf of civil lawsuits, while Dallas County asked him to analyze Efurd’s.

Two of those patients, Kellie Martin and Floella Brown, died after Duntsch damaged their vertebral arteries. Martin bled out, Brown suffered a massive stroke. Another, Jerry Summers, woke up a quadriplegic. Efurd’s nerve roots were damaged by a rogue screw, fusion hardware sat in the muscle that makes her able to raise her knee, and the other side of her spine was pockmarked by false-starts with the screws. Lazar said these errors were all visible in imaging taken after the surgery, and should’ve been caught by Duntsch and immediately corrected. Instead, his post-operative report showed that he was “quite pleased.” And, besides, Duntsch shouldn’t have begun the elective procedure anyway—Brown lay dying from her surgery as he began operating on Efurd.

“Do not go in the operating room,” Lazar said. “You do not start another case.”

He said that the medical records indicated that Duntsch did not perform the correct tests to identify where Efurd’s pain was originating from, and instead just “guessed.” He wound up operating at the wrong level. In Brown, Summers, and Martin, Duntsch removed too much of the bone that protects the vertebral artery, exposing it to damage. Lazar noted that each case incurred significant blood loss—up to a third of their blood volume in their bodies—and showed evidence of mistakes in surgical technique.

On Thursday, the jury heard from an office manager who testified that she called Centennial Surgery Center in Frisco and asked that they not grant Duntsch privileges. They heard from Kimberly Morgan, Duntsch’s surgical assistant, who Skyped in from a military base. (Morgan and Duntsch also had a sexual relationship, a fact I include because it helps make sense out of the information below.) Prosecutors read the infamous email sent by Duntsch to Morgan at 4 a.m. in 2011., an email that months ago helped convince a judge that his bond needed to stay at $600,000. Here’s what I reported in the November cover story about that email:

It was sent on a Friday at 4 am. The message alluded to a week where “everything unraveled” with their relationship. Duntsch suspected that this had something to do with his “vodka bottle” and “neurostimulants.” It said he was $1 million in debt. It said, “Anyone close to me thinks that I likely am something between god, einstein, and the antichrist. Because how can I do anything I want and cross every discipline boundary like its [sic] a playground and never ever lose.”

Duntsch also said he was prepared to embrace the very darkest part of himself. “You, my child, are the only one between me and the other side,” he wrote. “I am ready to leave the love and kindness and goodness and patience that I mix with everything else that I am and become a cold blooded killer.”

Testimony continues Friday, with closing arguments expected to come on Monday.

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