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G OVERNANCE
W. BEN BLACKETT,MD,JD,AND RUSSELL M. PELTON,JD
Two Disciplinary Actions Announced
AANS Board Approves Four PCC Recommendations
At its meeting April 21 in San Francisco,
the AANS Board of Directors
approved the recommendation of
the Professional Conduct Committee
that four members be disciplined for
unprofessional conduct while testifying as
expert witnesses in medical malpractice
lawsuits. Two of those disciplinary actions,
an expulsion and a six-month suspension of
membership, are being appealed to the general
membership of the AANS. The two disciplinary
actions that are not being
appealed are summarized below.
Edwin R. Buster, MD
In the underlying malpractice litigation, a
53-year-old man who experienced sudden
nontraumatic onset of back pain, sense of
leg heaviness, and leg pain was admitted to
a hospital through the emergency room in
January of 2000. The admitting neurologist
ordered that vital signs and neurological
evaluations be obtained every four
hours by the nursing staff during the night.
When the neurologist examined his
patient the next morning on rounds, he
found him to be densely paraparetic/paraplegic.
The ordered neurological checks
had not been documented and apparently
had not been performed during the night.
An emergency MRI of the thoracic and
lumbar spine demonstrated a large leftsided
disc herniation with cord compression
at T8–9. A neurosurgeon was then
consulted and performed an emergency
decompression with left posterolateral
excision of the herniated disc at T8–9. The
patient gradually improved from his essentially
paraplegic state to a paraparesis with
neurogenic bladder.
The patient sued the hospital, the nurse
who had been on duty the night of the
patient’s deterioration, and the neurosurgeon.
The neurosurgical expert witness for
the plaintiff testified to the hospital’s negligence
but was not at all critical of the surgery
for removal of the thoracic disc
herniation. Dr. Buster, the defense medical
expert for the hospital, testified in his discovery
deposition that the failure of the
ABOUT THE AANS PROFESSIONAL CONDUCT PROGRAM
The AANS Professional Conduct Committee evaluates complaints by one or more AANS
members about another member or members and makes recommendations to the Board
of Directors. Established in 1982, the PCC has served as a model for other professional
associations to structure and adopt similar professional conduct programs. In June of
2001, the AANS Professional Conduct Committee’s work was examined by the 7th Circuit
Court of Appeals in a landmark case for professional associations, Austin v. AANS. This
opinion strongly supported the AANS Professional Conduct Program and the importance
to a professional association of having an internal mechanism for self-regulation. The
program also received an honor roll designation from the American Society of Association
Executives in 2002.
The AANS rules for expert witness testimony are reprinted on page 37. These rules,
the AANS Code of Ethics and more information related to association governance are
available online at www.aans.org/about in the Governance and Leadership area.
nursing staff to check vital signs and neurological
function as ordered by the admitting
neurologist did not fall below the
acceptable standard of nursing care. Dr.
Buster further testified that the surgical
procedure was inappropriate and that the
defendant neurosurgeon could have been
“up to 50 percent responsible” for the
patient’s resulting neurological deficit.
During the Professional Conduct Committee
hearing, Dr. Buster stated that he
had not thoroughly reviewed the nursing
records prior to testifying in his deposition
and that “looking back on it now” the standard
of proper nursing care was not met.
The Professional Conduct Committee
concluded that Dr. Buster’s testimony as a
defense expert witness for the hospital
consisted of improper advocacy in denying
negligence by the hospital and in misrepresenting
the range of surgical standards
for excising thoracic disc herniations in an
attempt to shift responsibility for the neurological
deficits from the hospital to the
treating neurological surgeon. The AANS
Board of Directors agreed with the PCC’s
findings and voted to suspend Dr. Buster’s
membership in the AANS for one year.
William H. Bloom, MD
The underlying lawsuit in this case involved
a 44-year-old man who complained of a
history of right arm pain with numbness in
his right index and middle fingers. The
problem reportedly began when he awakened
one morning with scapular pain that
was soon followed by right arm pain. A CT
scan showed foraminal narrowing with
spondylosis and some spinal stenosis.
Approximately one month later the patient
reported having experienced some “electric
shock” sensations in his left arm. Surgery
was carried out in the lateral position with
bilateral laminectomies at C4, C5, C6 and
C7. The operative note describes decom-
36 Vol. 15, No. 2 • 2006 • AANS Bulletin