By Howard Koplowitz
A neurosurgeon from UCLA Medical Center wrote a report in defense of an embattled institute run by the North Shore-Long Island Jewish Health System that treats a rare brain condition known as Chiari malformation. The hospital, which asked for the review, said it would expand the center based on the findings.
Chiari malformation is diagnosed when excess brain tissue pushes against the cerebellum and the spinal cord.
North Shore-LIJ opened The Chiari Institute in 2001 under its director, Dr. Thomas Milhorat. Milhorat and Dr. Paolo Bolognese came under fire in May 2009 after Milhorat reportedly refused to perform a brain operation on a woman who had been anesthetized for surgery because she was not his patient.
Bolognese was scheduled to perform the surgery, but he could not be reached by the hospital and the hospital could not find another surgeon to perform the surgery.
The patient, identified by Newsday as Pennsylvania resident Jennifer Ronca, was prepped for surgery, including having her head shaved, but she had to be awakened from the anesthesia and was told the operation had never taken place.
North Shore-LIJ spokesman Terry Lynam said the surgery was eventually performed and it was a success.
Manhattan lawyer Lee Goldsmith is representing 11 patients in a case against Milhorat and Bolognese, including a $60 million claim filed on behalf of a 7-year-old Idaho girl who he said was used as a “human research subject” because the institute performed “experimental” surgery” on the girl.
“Over the past year, the North Shore-LIJ Health System’s Chiari Institute has been the focus of considerable scrutiny, most of it fueled by lawsuits initiated by a single attorney representing patients — many of whom had undergone previous surgeries at other hospitals — who say they did not benefit from surgeries performed at North Shore University Hospital,” said North Shore-LIJ Chief Medical Officer Dr. Lawrwence Smith. “Based on the [report’s] findings, the North Shore-LIJ Health System reaffirms its support of The Chiari Institute and plans to continue and expand the program under the existing model.”
Milhorat retired after the cases were made public last year, but Smith said the neurosurgeon’s retirement had been in the works for months because of his age — 73.
Bolognese’s clinical practice privileges were on hold following the allegations. It was unclear whether he has resumed those privileges.
Dr. James I. Ausman, a neurosurgeon and professor of neurosurgery at the University of California, Los Angeles, wrote a report released Tuesday by the health system that called The Chiari Institute “a jewel for New York state and the New York metropolitan area.”
“It is the finest center of its kind in the world treating Chiari deformities consistent with the high standards of the arts and sciences exemplified by New York,” Ausman wrote.
He said more than 80 percent of patients seen at the institute leave the center in an improved condition.
“One cannot reasonably expect that a treatment of any medical condition has a 100 percent good outcome, particularly the Chiari malformation family of disorders in which the diagnosis and treatment are so complex and variable,” Ausman said. “It is remarkable that 50 percent of those patients are seen at TCI, who have failed previous therapy, are improved after treatment there.”
Ausman also found that allegations that the institute was performing unnecessary surgeries so the center can make money were unfounded, saying only 21 percent to 30 percent of patients at the institute are actually operated on.
“Thus, it would be totally incorrect to believe that TCI doctors are performing work for the purpose of financial gain,” he said.
State Health Commissioner Dr. Richard Daines applauded the health system for initiating the review.
“The Chiari Institute is highly respected in the medical community and provides valued treatment to patients who seek assistance there,” he said in a statement.
Reach reporter Howard Koplowitz by e-mail at hkoplowitz@cnglocal.com or by phone at 718-260-4573.
