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Fine $10,000 in gangrene case

By Christine Giordano
4/6/2009 © Florida Health News

Fort Myers plastic surgeon Marc Schneider accepted a reprimand and $10,000 fine as a “fair” end to state charges that he neglected a breast-reduction to the point that the patient got gangrene.

Members of the Board of Medicine, which heard the five-year-old case on Friday afternoon, faulted Schneider for leaving too much responsibility in the hands of office staff and for doing an unessential operation on a high-risk patient.

The patient, identified only by the initials M.B., ended up with “significant disfigurement,” according to a complaint filed by the Florida Department of Health.

M.B. was not a good candidate for surgery, the complaint said, being an obese smoker with high blood pressure and diabetes. Schneider was out of town when she developed an infection that led to gangrene, the records showed.

Schneider said the case had “severely affected” him. “I not only felt great remorse, but great pain,“ he said.

Board member Steven Rosenberg questioned Schneider’s decision to allow his office manager to check the patient’s wounds and take cultures while he was out of town instead of referring her to the surgeon on call.

The doctor said he realizes he made a mistake and now refers patients to another physician when he’s out of town.

His attorney, Gregory Chaires, noted that the board’s main complaint was that Schneider did not get clearance from the patient’s family physician. But he argued that that’s who referred the patient to Schneider in the first place.

Board member Donald Mullins questioned why the doctor would operate on a smoker who had rolled her eyes at the idea of giving it up, if quitting was essential to her recovery.

Schneider said the patient had quit smoking immediately following the operation, but after her wounds had showed significant healing, had started smoking again.

“In fact, this is the first case that I have seen where the patient has completely healed, has started smoking, and has then had wound breakdown,” he said.

Chaires added that the doctor had waited to leave the state until he was satisfied with the patient’s progress, 17 ½ days after surgery.

According to DOH records, the 59-year-old patient asked Schneider to reduce the size of her large, heavy breasts. He made vertical incisions in both breasts and removed about six pounds of tissue, records say. In the week after surgery, Schneider met with M.B. three times and noted no complications, records show. Three weeks after the operation, he told her to return in three weeks. He was going away.

A week and a half later, while Schneider was still out of town, M.B. returned to his office complaining of redness in the left breast, the complaint states. The staff examined her chest and noted that both incisions were separated and the left nipple had turned black. These were indications of a serious infection, the complaint says.

Consulted by phone, Schneider ordered the antibiotic Cipro for M.B, the complaint says. Three days later, she returned to the office, where the staff noted no improvement. Three days after that she came back, and still there was no improvement, the records say.

The next day – a week after M.B. had come to the office showing signs of infection – Dr. Olga Freeman, M.B.’s primary-care physician, called Schneider’s office and said that the on-call surgeon should see her immediately, records say.

That surgeon, Gregory Dowbak, found M.B. was in serious condition with gangrene and admitted her to Gulfcoast Hospital in Fort Myers. Over the following six days, she underwent four procedures to remove dead tissue.

According to records at the Florida Office of Insurance Regulation, the patient in this case received a settlement of $250,000 from Schneider’s malpractice insurance carrier in October 2006 without having to file a lawsuit. That amount constitutes the limit of his policy for a single event.

In addition to the fine and reprimand, Schneider will have to pay $6,700 in investigation costs, do 75 hours of community service and serve a year of probation with another surgeon indirectly monitoring his practice.

--Contact Christine Giordano.