The U.S. Gave Troubled Doctors a Second Chance. Patients Paid the Price. - WSJ

The U.S. Gave Troubled Doctors a Second Chance. Patients Paid the Price. - WSJ

The U.S. Gave Troubled Doctors a Second Chance. Patients Paid the Price.

Indian Health Service hired dozens of physicians with trails of medical mistakes and regulatory sanctions—sometimes to disastrous effect

By 

Christopher Weaver, 

Dan Frosch and 

Lisa Schwartz | Photographs by 

Adria Malcolm for The Wall Street Journal

Updated Nov. 22, 2019 12:05 pm ET

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Henry Stachura’s surgical career at Memorial Medical Center in Las Cruces, N.M., ended the day a patient died after he operated on her abdomen. The case led to his fifth malpractice settlement in five years, court and licensing records show.

After Memorial officials suspended him permanently, citing “multiple serious deficits in judgment,” he tried to find work in Nevada, but a licensing board rejected his application.

Thrust into medical exile at age 52, Dr. Stachura turned to the Indian Health Service for a job. The federal agency, which provides health care to 2.6 million Native Americans, has given second chances to dozens of doctors with trails of medical mistakes and regulatory sanctions—sometimes to disastrous effect, a Wall Street Journal investigation found.

Before Dr. Stachura retired this August, the U.S. government made five malpractice payments totaling $1.8 million to settle allegations involving his care at the IHS, according to a Journal analysis of Treasury Department data and federal court records. Three of those patients died after he treated them.

Jeanise Livingston was in a coma after her bile duct was cut during surgery. PHOTO: ADRIA MALCOLM FOR THE WALL STREET JOURNAL

“We trust IHS as Native Americans, and they should hire the best people for us,” said Jeanise Livingston, who was in a coma after her bile duct was cut during a 2006 gallbladder surgery Dr. Stachura performed, medical records show.

Dr. Stachura didn’t respond to requests for comment. In correspondence with the New Mexico medical board, he said a medical review panel ruled he wasn’t negligent in some of his malpractice cases, including the one that got him suspended from the Las Cruces hospital. He said other patients who sued over his care, including Ms. Livingston, recovered well. The IHS declined to comment on Dr. Stachura, citing privacy rules.

The Journal examined 163 malpractice claims against the IHS that the government settled or lost since 2006. One out of four doctors involved in those cases worked for the IHS despite a history that should have raised red flags by the agency’s own standards, the Journal found. At least 66 of the patients died as a result of the alleged malpractice, the analysis found.

Insurance actuaries say U.S. doctors typically have one malpractice claim every 20 years or so. Surgeons and other high-risk specialists have twice that rate. The IHS was willing to hire doctors with many more lawsuits in their past, in some cases more than 10 in less than a decade.

“Our tribal members are at the mercy of these federal health facilities,” said Tori Kitcheyan, a Winnebago Tribe of Nebraska council member and the chairwoman of the nonprofit National Indian Health Board. “There is no other choice.”

The IHS’s chief medical officer, Michael Toedt, said in an interview that the Journal’s analysis wasn’t representative of a broader IHS workforce he said is composed of “top quality physicians.” Asked about some of the doctors the Journal identified, he said that “it’s never appropriate to make a compromise on quality to fill a vacancy.”

Like many IHS facilities, the Gallup Indian Medical Center in New Mexico had trouble recruiting doctors.

The Journal found that IHS managers didn’t always make basic inquiries about physicians’ work histories. An official who approved Dr. Stachura’s appointment at the IHS’s Gallup, N.M., hospital, Floyd Thompson, said he didn’t know of the surgeon’s malpractice history. The cases were logged in a government database that IHS managers are required to examine. Mr. Thompson said he relied on a secretary at the hospital to perform such checks.

It isn’t clear whether IHS ever contacted Memorial Medical Center about Dr. Stachura’s history there, either. MaryAnn Digman, the former CEO, said she didn’t know he had landed at the IHS until a Journal reporter inquired.

“Hank Stachura is a lovely human being, and I recall having a conversation with him and encouraging him to consider another field of medicine than surgery,” she said.

IHS officials hired doctors whom state regulators had punished for transgressions such as drug addiction or sexual misconduct. One doctor who was sanctioned by a state medical board after a patient accused him of sexually abusing her during a surgical exam found work with the IHS, records show. Three IHS managers later vouched for him when he successfully petitioned a licensing board to lift the restrictions.

The agency allowed doctors with checkered pasts to recruit other troubled providers. In one case, an emergency-department chief who was fined by a licensing board over alleged patient-care failings pushed to hire a doctor whose license was restricted for prescribing narcotics to her boyfriend, emails show. The ER chief said in a deposition he thought the medical board’s allegations couldn’t be accurate, because the amount of pills involved was so large.

IHS leaders have vowed for years to overhaul their process of credentialing doctors before they treat patients at the agency’s two dozen hospitals. U.S. regulators require all hospitals to verify that physicians are qualified, competent and safe.

The IHS’s network of hospitals and clinics treats some of America’s poorest communities, beset by high rates of diabetes, alcohol-related deaths and other chronic diseases. The agency for decades has been criticized by Native Americans and government watchdogs for lax and dangerous care, including by the main U.S. hospital regulator.

Such failures have left IHS leaders with a conundrum: how to recruit badly needed doctors—often into remote areas where pay is low compared with private practice—without hiring people so troubled they endanger patients. The vacancy rate for IHS doctors was 29% as of May, agency data show. The industrywide average is 18%, according to medical-staffing agency AMN Healthcare’s most recent survey, from 2013.