A Screw Loose
It's a medical horror story that never happened as far as the State of Florida is concerned. And it began on New Year's Eve 2001 in the most mundane of places -- a living room.
Mary Emma Marshall thought she simply pulled a muscle in her left hip as she walked across her condo in Fort Lauderdale. The great-grandmother, then 81 years old, was suffering from osteoporosis, but the pain didn't seem that serious until two days later, when it became excruciating and she was taken by ambulance to Broward General Medical Center, the county's flagship public hospital.
The hip was broken. Her general practitioner, Charles Halfpenny, who has a public contract with the tax-subsidized North Broward Hospital District, recommended orthopedist Sein Lwin. Marshall took the advice.
She had no way to know at the time that Lwin, who has refused repeated requests for an interview, isn't board-certified -- the field's leading seal of approval for competency -- and had a growing list of malpractice complaints. The hospital district certainly wasn't doing anything about it. Lwin happens to be the darling of NBHD, which is overseen by a board appointed by Gov. Jeb Bush and supported with 174 million in property-tax dollars. Lwin, a 64-year-old native of Burma, holds a $1.7 million contract to provide orthopedic care at Broward General's emergency room but is known more for his political connections than for his medical expertise (see "All the Governor's Men," New Times, March 4).
Rather than perform a full hip replacement, Lwin secured Marshall's crumbling bones together with a pin, says her daughter, Jody Ledford. It didn't take.
From the beginning, Marshall, who was suffering from senility, complained of pain and, after weeks of rehab in the hospital, still couldn't walk. Perhaps most disturbing, her leg was receding into her torso. Within a couple of weeks, it was two and a half inches shorter than it had been.
Ledford, a Fort Lauderdale native who lives in Miami, says she knew something was terribly wrong. But Lwin assured her everything was fine. The solution, he told her, was to get her mom a special platform shoe, which Ledford did. "Even the man who came to measure her for shoe lift couldn't believe the difference in her legs," says the daughter. "He said he had to come back out and measure again, because it couldn't be right."
After a month in the hospital, Marshall was sent home, still unable to walk and suffering immense pain. Finally, Ledford requested that Lwin x-ray Marshall's hip to see what was wrong. An office appointment was scheduled. "Moving her was a major happening -- it was a huge ordeal getting her to the doctor's office," Ledford says. "We get her over there, and he says the machine isn't working. I was furious."
Lwin made a house call a few days later to Marshall's Fort Lauderdale condo, where he again assured the family all was fine, according to Ledford. But the daughter was desperate. She decided to get a second opinion. In mid-February of 2002, she took her mother to another doctor, Kevin Shrock, who quickly discovered that the screw had come loose in Marshall's hip. Worse, a look at Marshall's medical file revealed that the screw had been coming out two days after the surgery. "He didn't look at the x-ray," Ledford complains.
Shrock performed a hip replacement, and Marshall was soon walking. Her leg, fortunately, returned to near normal length.
But that didn't quell Ledford's fury about the six weeks of hell her mother had to endure and the fact that it took a second doctor to end the needless suffering.
Ledford is one of several of Lwin's former patients with a gripe. He's been the subject of at least four malpractice lawsuits -- which are public record -- during the past decade. That's a higher-than-average number, though it's not wholly unusual, other orthopedists tell me. There are plenty of dubious doctors in Broward County -- orthopedic care is a high-risk specialty, and not all claims have legal merit.
But Lwin is a special case: If you break a bone in Fort Lauderdale, you might not be able to avoid the guy. His contract gives him a virtual monopoly on emergency room care at Broward General. He also has two partners who thankfully are board-certified and don't have histories of malpractice.
The district compensates Lwin and his partners $4,650 a day for their services, but the orthopedist has subcontracted some of the work to other physicians for less than half that, according to several Broward surgeons. A former Lwin partner, Dr. Richard Goldstein, decried the practice of subcontracting ER work in a February 14, 2002, letter to district commissioners in which he asked that the emergency room be open to more doctors. He wrote that Lwin and other partners "recruited [outside doctors] to take their call for a day, or for several hours, or if there is a 'difficult' problem in the emergency room and reimburse these doctors with a fraction of the [district] funds they take for their call each day... the situation has been untenable."
Lwin has denied responsibility in other complaints:
A malpractice claim was settled with undisclosed terms in 1996 after a 24-year-old man complained that a 1991 surgery at Broward General to fix his broken femur was botched. The man, who had been in a car accident, alleged his leg was further damaged as a result of Lwin's mistakes.
On June 10, 1997, Lwin treated 57-year-old Carol Meister of Fort Lauderdale for a complex forearm fracture at Broward General. According to state records, he used an improper plate in the surgery that caused her arm to become deformed. Meister also claimed he'd left broken hardware in her elbow. She was forced to have another major surgery to fix the problem. Lwin's insurer settled for $250,000 in 2002.
A 2000 lawsuit alleging that Lwin failed to diagnose a broken neck while treating a patient at Broward General. Robert Cameron suffered the injury during a car crash. Lwin missed the fracture even though it was evident, according to Fort Lauderdale malpractice attorney Jeff Fox. "He never looked at the x-ray," Fox alleges. Lwin treated Cameron with a hot pack and released him from the hospital. It wasn't until months later that the fracture was discovered and Cameron had to undergo major surgery. That claim is still pending.
Yet another case involves a complaint by 58-year-old Fort Lauderdale resident Frank Crane. He filed a lawsuit against the doctor back in 1997, but his attorney abandoned it after several months of litigation. Crane, however, still insists that Lwin's incompetence almost cost him his life.
In 1995, Crane suffered a chronic bone infection, called osteomyelitis, in his leg. He says Lwin knew he had the condition -- which can lead to loss of limb and even death -- but never told him about it. Though the pain was severe, he claims Lwin prescribed him only ibuprofen.
After several months, his wife, Jane, noticed the term "chronic osteomyelitis" in her husband's medical records. She asked her gynecologist about it. "He said, 'You're husband could lose his leg. He could lose his life,'" she recalls. "Thank God for my gynecologist. Dr. Lwin said nothing about it. This went on for a year, and my husband was in terrible pain."
The couple found a new doctor in Miami who performed a complicated surgery that the couple is convinced saved his life. Frank Crane says he sued Lwin for malpractice because of one recurring fear: that a friend or family member might come under the doctor's care in the future. "You want to see the SOB lose his license and emptying bedpans for a living," he says. "That would be his just punishment. I'd like to ring his throat."
Adds his wife, "All I really want is to take that man somewhere and beat the hell out of him."
Like Crane, Ledford was left with more anger than satisfaction. Ledford chose not to file a lawsuit on her mother's behalf but instead sent a detailed complaint to the state Agency for Health Care Administration.
The complaint was apparently investigated by the Probable Cause Panel of the Florida Board of Medicine, which is made up primarily of fellow doctors. On June 25, 2003, the Department of Health sent Ledford a letter informing her that no probable cause had been found to discipline Lwin. "I just threw my hands up in the air when I got that letter," Ledford says. "It's shocking to me that he's allowed to continue to practice. It's just incredible. But what can I do?"
The board is notoriously easy on doctors. After investigating the agency last year, the consumer group Public Citizen called it "dangerously lenient." Under Florida statutes, however, Ledford's complaint isn't even a matter of public record -- it's as if none of it ever existed. I only happened to get hold of it while investigating Lwin's political activity. So there's no way to know how many serious complaints the Florida Board of Medicine has failed to act upon.
But the district itself is ultimately responsible. Several doctors, including Goldstein, complained back in 2002 that Lwin shouldn't be awarded the district contract. But the commission nonetheless approved it even though Lwin's poor medical and business practices made it evident that he shouldn't be Broward General's chief emergency room orthopedist.
The contract, as it happens, comes up for renewal in April. If the district board truly cares about patient care and fair business, it's time to end Lwin's involvement with the district and open up the ER to all qualified surgeons. Our very bones might depend on it.
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