Health Care

Accusations mount against Fresno doctor accused of leaving surgery

A Fresno heart surgeon who two years ago allegedly left an open-heart surgery at Community Regional Medical Center before a patient was stable now is at the center of two lawsuits that allege he walked out of more than one operating room before procedures were complete -- and that hospital officials knew about it.

According to a wrongful termination lawsuit filed last month in Fresno County Superior Court, Dr. Pervaiz Chaudhry ignored a Fresno Heart & Surgical Hospital manager's plea to return to an operating room. The suit claims Chaudhry threatened he could get people fired and would stop doing surgeries at the hospital, which would result in a loss of "significant revenue."

The lawsuit brought by former manager Valerie Villalobos alleges she was among employees targeted for a layoff that was "aimed at removing any persons that would interfere with Dr. Chaudhry continuing to bring an unusually high number of patients and corresponding revenue to Fresno Heart." Villalobos was rehired after the layoff but later resigned, citing a hostile work environment and concerns about potential retaliation.

The alleged Fresno Heart incident occurred weeks before Chaudhry allegedly left a physician assistant to close the chest of Silvino Perez at Community Regional on April 2, 2012, according to a lawsuit filed by Perez's wife and stepson. When bleeding occurred, the Sanger man went into cardiac arrest. Perez, 72, has been in a vegetative state in a Fresno nursing home ever since.

In December, Perez's wife and stepson sued Chaudhry, Community Regional Medical Center and Valley Cardiac Surgery, the doctor's medical group, for unspecified damages.

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In an amended complaint filed Feb. 13, the family alleges the hospital knew or should have known that the doctor routinely "cut corners" in the course of surgery, including leaving the operating room while patients were under anesthesia and leaving chest closures to a physician assistant without a medical doctor to supervise.

In California, physician assistants attend a specialized program associated with a medical school and receive an academic degree or certificate. To practice, they must pass a national examination before receiving a license from the Physician Assistant Board. State regulations say they can act as first or second assistants during surgery, but surgical procedures requiring other than local anesthesia may be performed only in the personal presence of an approved supervising physician.

Chaudhry has not responded to numerous interview requests by The Bee, but his medical group spokesman said the allegations are baseless. His attorney denied the allegations in the Perez lawsuit and declined to comment on the Villalobos suit because Chaudhry is not a named defendant. The hospital said it could not comment on ongoing litigation, but stands by its cardiac surgery program.

The latest allegations raise questions about whether Community Medical Centers, which operates Fresno Heart & Surgical and Community Regional Medical Center, took action on complaints against Chaudhry before the Community Regional incident, or, as lawyers assert, stepped aside and gave him latitude because cardiac surgeries are one of the biggest revenue sources for hospitals.

Busy surgeon

What's certain is that Chaudhry, 53, is one of the busiest cardiac surgeons in California.

According to the Office of Statewide Health Planning and Development, he performed 345 bypass surgeries in 2009-10, making him "one of the top five" heart surgeons in total surgeries.

The report, the latest available, also showed that Chaudhry was listed as one of seven doctors statewide whose patient death rate was worse than the state average. The state took overall patient health into consideration in calculating the rates. Chaudhry's death rate was 3.62. The statewide rate was 2.0.

At the time of the report's release in April 2013, Chaudhry disputed the accuracy of the state data. Plus, he said, he operated on high-risk patients. When other doctors could not do anything for a patient, "that's when they call me," he said then.

On Thursday, Bruce Eliason, chief operating officer for Chaudhry's medical group, said Chaudhry's death rate for bypass surgeries was 1.6 in 2013, which is comparable to the national average of over 2%.

Chaudhry is a money-maker for the hospital, said attorney Jeff Mitchell, who represents Maria Arteaga Alvarez and Cristobal Arteaga, the wife and stepson of Perez, the Community Regional patient.

However, Perez's surgery did prompt the hospital to suspend Chaudhry for 14 days, Perez's family alleges.

Perez's case was investigated last year by the state Department of Public Health, which levied a $75,000 fine against Community Regional, Mitchell said. The state does not name patients and doctors in investigations, but Mitchell has said Perez's case led to the fine.

According to the state report, health authorities learned from an anonymous complaint on April 11, 2012, about the allegation that a surgeon had left the operating room before closing the patient's chest.

The incident occurred April 2, 2012 -- the same day as Perez's surgery. An "operative report" among documents from the state investigation that were obtained by The Bee through a Public Records Act request cites April 2, 2012, as the date of the surgery and names Chaudhry as the physician.

In a separate narrative of the state's investigation, which does not name the surgeon or others interviewed, the cardiac surgeon said he allowed the physician assistant to close the chest with wires but was "always there when she did this, until this time."

Community Regional, in a written response to the state's investigation, said that an investigation was authorized on April 2, 2012, by the president of the hospital's medical staff and the chair of surgery. On Aug. 15, 2012, a doctors' committee met to review the findings of the investigation.

The committee sent the case to an outside expert with cardiovascular surgery experience for review. The committee's actions included suspending the surgeon, who was not named, from the medical staff for 14 days and ordering the surgeon to undergo additional training.

All surgeries under the care of the physician also were monitored from April 3, 2012, through June 1, 2012, to ensure his "compliance with surgeon attendance during surgery." And beginning on Aug. 15, 2012, cases were randomly selected and reviewed, and monitoring continued through November 2012, the hospital response said.

Mitchell, attorney for the Perez family, said the hospital was compelled to take corrective action by the state.

Chaudhry has no suspension or disciplinary action against his license, according to the California Medical Board. Doctor peer review committees are not required to report suspensions of 14 days or fewer.

Chaudhry continues to perform surgeries at Community Regional and Fresno Heart, said Mary Lisa Russell, a Community Medical Centers spokeswoman.

On Friday, Russell said Community had not received the amended complaint to the Perez lawsuit that alleges the hospital was aware of Chaudhry routinely leaving the operating room. Russell would not comment on the allegations.

But to the extent that the legal complaints raise quality issues, she said, "it should be pointed out that we monitor and benchmark our programs against the highest standards, and recently received notice from the Society of Thoracic Surgeons National Adult Cardiac Surgery Database that Community Regional's cardiac surgery performance ranked in the top 15% of hospitals nationally."

The Perez lawsuit also alleges that hospital and medical staff knew that Chaudhry has a substance abuse problem, which includes alcohol, "sufficient to impair medical judgment and surgical acumen."

Chaudhry's lawyer, Andrew Weiss of Fresno, said Feb. 20 that he had not seen the amended complaint, but the allegations against the doctor are false. "We deny that Dr. Chaudhry has any kind of substance-abuse problem," he said.

Chaudhry did not leave surgeries before they were complete, Weiss said. And the allegation that he left the operating room with Perez's chest still open "is not true," he said.

Eliason of Valley Cardiac Surgery said in emails last month that allegations in the Perez lawsuit are "baseless and unsubstantiated."

As to the lawsuit alleging a substance-abuse problem, Eliason said, "we can state unequivocally that the unsubstantiated allegations of substance abuse are completely false and without any basis in fact."

The medical care provided by Valley Cardiac Surgery and Chaudhry at Community Regional have been recognized by the Society of Thoracic Surgeons as among the best in California, Eliason said. "This recognition comes after years of practice and consistent success for our patients, and has resulted in a higher than national average of successful outcomes for extremely complicated, high-risk heart surgery."

Complaints surface

Allegations of misconduct involving Chaudhry began to surface in late 2011 at Fresno Heart, according to Villalobos' wrongful termination lawsuit.

She began receiving complaints from nursing staff and others about Chaudhry, including how he would routinely leave the operating room before heart surgeries were completed and would leave the hospital premises before patients were stabilized in the post-anesthesia care unit, the lawsuit says. Villalobos, 53, was director of cardiology, surgery and outpatient services and managed the surgical staff.

Among the complaints cited in the lawsuit:

-- Chaudhry made discriminatory comments to a homosexual staff member, telling her "she was not wanted in the operating room because she wasn't 'a real woman.' "

-- He threatened staff members that if they "reported him for any malfeasance, he would find out their identity and they would be fired."

The lawsuit also says Chaudhry sometimes failed to respond to pages in a timely fashion when his patients required immediate attention. On at least one occasion, a patient with no heart rhythm "flat-lined" for 40 minutes before Chaudhry responded and returned to the bedside, the lawsuit says. He began "futile lifesaving efforts in order to conceal" his neglect and the patient's death, and "blamed subordinate nursing staff for the demise of his patient, despite his 40-minute delay in returning to the patient's bedside," the lawsuit says.

Villalobos encouraged nurses and staff to report complaints through the hospital's confidential reporting system, the lawsuit says, but she had reason to believe that on at least one occasion Chaudhry learned the identity of a complainant.

According to the lawsuit, Villalobos had a personal run-in with Chaudhry around February 2012 when she learned from a physician that a doctor was not present in an operating room and the operation was still in progress. It was Chaudhry's operating room, the lawsuit says. Villalobos found him at hospital elevators.

When Villalobos asked Chaudhry to return to the operating room, he refused, the lawsuit says, and when Villalobos persisted, he threatened: "Don't you know I can wipe you all out? I can have you all fired, including your stupid doctors."

According to the lawsuit, Chaudhry also threatened to stop scheduling surgeries at the hospital and told Villalobos "to inform the CEO of Fresno Heart, Wanda Holderman, that it was all plaintiff's fault that he would not be performing further surgeries there and the hospital would therefore lose significant revenue." Holderman's assistant referred calls seeking comment to Community Medical Centers' communications department.

The incident was reported, the lawsuit says. But approximately two weeks later Chaudhry allegedly left an operating room at Community Regional before Perez's surgery was completed.

Villalobos believes that Chaudhry "continued to leave the operating room before cardiac surgeries were completed, despite the reporting of this conduct to Fresno Heart and Community Medical Centers," the lawsuit says.

Villalobos' lawyer, Maureen Harrington of San Francisco, said that the issue was raised at Fresno Heart "up to the corporate level."

Weiss said it would be inappropriate for him to provide a comment about the Villalobos lawsuit because Chaudhry, his client, is not a defendant. But, he said, "I would make the general observation that allegations in a complaint are just that, mere allegations, and are not proof of anything. Oftentimes, they are intentionally exaggerated and phrased in inflammatory terms to support a particular type of recovery sought, and ultimately prove to be untrue and without any basis in fact."

Cristobal Arteaga, the stepson of Silvino Perez, said he had been unaware of Villalobos' allegation that Chaudhry left a surgery at Fresno Heart before his stepfather's surgery at Community Regional.

"I'm so happy she's coming out and making this public," he said. "Ultimately, it's to everybody's benefit that this doctor be exposed."

Hospital layoffs

Villalobos was laid off on June 14, 2013. The lawsuit alleges the layoff was in retaliation for her participation in reporting Chaudhry's harassment of employees, lapses in patient care and his creation of a hostile work environment, and her insistence that the lapses be corrected by the hospital.

The lawsuit says Villalobos was targeted for a layoff that was "aimed at removing any persons that would interfere with Dr. Chaudhry continuing to bring an unusually high number of patients and corresponding revenue to Fresno Heart."

In late August 2013, The Bee reported that 25 employees had been laid off at Fresno Heart. Holderman, the hospital's CEO, said the layoffs included some management jobs. She said the layoffs were necessary to lower costs in the face of declining revenues "and pending legislation that would negatively impact hospitals, especially ones of our size."

The hospital also was re-evaluating merit and other pay increases, delaying or not filling certain jobs, reducing some services and decreasing other operational costs by centralizing some administrative functions, she said.

Villalobos, a longtime Fresno Heart employee who had been on medical leave after being diagnosed with Stage IV breast cancer, contested the layoff and got her job back. But the lawsuit says she "had no choice" but to resign on Aug. 6, 2013, to escape a hostile workplace.

She declined to comment on the suit and referred questions to Harrington.

For a long time, Villalobos "believed the hospital would do the right thing in relation to the issues related to Dr. Chaudhry," Harrington said. "But she came to the realization that that wasn't going to happen, and she didn't have any choice other than to resign her position because things weren't going to change."

The suit alleges that Villalobos' resignation was a "necessary resignation," sparked by concern about retaliation she might suffer after returning to work.

In February, she filed a complaint with the California Department of Fair Employment and Housing for discrimination and received a right-to-sue letter on Feb. 13, the lawsuit says.

Villalobos has suffered financial loss and severe emotional and physical distress, the lawsuit says.

She is suing Fresno Heart for wrongful termination, discrimination, retaliation, unpaid wages, declaratory relief and fraud. She is asking for unspecified damages, including punitive damages.

Community received the Villalobos lawsuit on Thursday.

Officials said they could not comment on personnel matters, but Community is not responsible for physician oversight, said John Zelezny, Community Medical Centers senior vice president of communications. Doctors are self-governing "and have the responsibility to monitor and enforce rules of conduct and oversee medical quality of their staff members' practices," he said.

Actions taken by doctor committees, called "peer review actions," are confidential, Zelezny said. The hospital can only become involved if there is evidence that the medical staff is not fulfilling its duties, he said. "Community Medical Centers has a very active and committed medical staff that carries out its responsibilities in an appropriate way," he said.

Harrington said she disagrees. "The hospital is responsible for the working environment of all its employees, and doctors are obviously part of that working environment."