Oscar Wilde wrote that every saint has a past and every sinner has a future.
The observation could be applied to Richard Kaul, M.D., a New Jersey anesthesiologist with a negligent manslaughter conviction in London in his past and future plans for treating spine patients in the Democratic Republic of the Congo and returning veterans from the wars in Iraq and Afghanistan.
But now the Attorney General in New Jersey is calling Dr. Kaul a, “clear and imminent danger” to the public and the state’s board of medical examiners has temporarily suspended his medical license. Dr. Kaul told our Elizabeth Hofheinz that he is caught in the middle of a scope-of-practice controversy in the state between board certified orthopedic spine surgeons and interventionists.
A Hopeful Future
Richard Kaul, M.D.We first reported on Dr. Kaul’s Spine Africa Project in our “On (and Off) the Record” column on May 8.
Dr. Kaul, founder of New Jersey Spine & Rehabilitation in Pompton Lake, New Jersey, told us he had been travelling to Africa and operating on patients since August 2011. He said patients travelled up to 700 miles to see him and he encountered “extremely advanced pathology.” He also told us about back injuries women sustained from the sexual violence that had spilled into the Congo from the Rwandan civil war.
It’s not unusual for OTW to highlight the good works of physicians and Dr. Kaul has aggressively promoted his humanitarian work while building a seemingly successful business.
Misrepresentation?
But what happened next was unusual. A reader and board certified orthopedic spine surgeon informed us that Dr. Kaul had not properly represented himself. That, in fact, Dr. Kaul has no privileges to admit patients or perform surgery in any hospital in the state. “The fact that [this] imposter has the gall to represent [himself] as a spinal surgeon and then prey upon the most unfortunate of humanity makes me physically ill, ” said the surgeon.
Jeffrey Chiesea
New Jersey Attorney GeneralWe did some checking.
It turns out the Attorney General for the State of New Jersey filed a complaint in April over Dr. Kaul’s alleged, “flagrant disregard of his own lack of training and expertise and his continuing performance of surgical spinal procedures for which he is not qualified.”
A hearing on the complaint took place on June 13 and the board voted to temporarily suspend his license. Dr. Kaul had earlier agreed to an interim consent order prohibiting him from performing any more spine surgeries until the board voted.
Checkered Past
But this was not the first time Dr. Kaul was in hot water with the state’s medical board.
In 2001, Dr. Kaul was convicted by a jury in London of negligent manslaughter after a woman he sedated during a dental procedure, went into cardiac arrest and died. Dr. Kaul had his medical license stripped in England and moved to New Jersey. He did not disclose the criminal conviction to the state’s licensing board and began practicing medicine. He was later given a six-month suspension and subsequent probation by the state.
Complaint
What is currently at stake is whether Dr. Kaul has the proper qualifications to perform spinal surgeries. The complaint states that Dr. Kaul did not receive any training in spinal surgeries during his residency at Albert Einstein-Montefiore Medical Center in the Bronx.
He later took continuing education courses on spinal surgical procedures, including some that involved cadaver training. He also studied minimally invasive spinal surgeries during a two-week fellowship in Seoul, South Korea, a trip that “falls far short” of the training needed for spinal surgeries, the complaint states.
The complaint says that Dr. Kaul’s facility in Pompton Lakes became “a one-room surgical office” in March 2011. He also has practiced medicine at a number of facilities across the state, including locations in Clifton, New Brunswick, Piscataway, Bloomfield, Elizabeth, Newark and Jersey City.
Officials say doctors who operate in one-room clinics must have hospital privileges or board permission to perform that surgery. Dr. Kaul has neither, according to the complaint.
After hearing from our reader and discovering these past and current disciplinary actions, we contacted Dr. Kaul again and asked him about the charges that he has and is currently misrepresenting himself as a Board Certified Minimally Invasive Spine Specialist.
Scope of Practice Controversy
Dr. Kaul told us that there is a hotly contested scope-of-practice contest going on in New Jersey and orthopedic spine surgeons and neurosurgeons do not look fondly on physicians with his training opening the door for interventional pain specialists.
He told us that he was trained in general surgery, anesthesia, and did a pain fellowship, as well as a spine fellowship in Korea and has 70-80 hours of CME in spine. He also said he has done about 800 spine cases.
Dr. Kaul said his practice began to evolve starting in 2002 when he began doing endoscopic disc decompression; then he began doing cervical endoscopic decompressions and did multiple training courses on that; then he moved from endoscopic decompressions to endoscopic fusions. He told us that he is credentialed by the center that hired him and that he has a plenary license for medicine and surgery issued by the state of New Jersey. He said he agreed not to do these kinds of cases unless he gets hospital privileges.
His website includes a lengthy resume and video clips describing his charitable work in the Congo. Additionally, his website states he’s donated $500, 000 in services to The Spine Foundation for veterans of Iraq and Afghanistan.
According to a May 30, 2012 story in Pain Medicine News, expert reports for the Attorney General’s complaint were provided by former North American Spine Society (NASS) President Greg Przybylski, M.D., director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center, Edison, and professor of neurological surgery, Seton Hall University School of Graduate Medical Education, South Orange; and, Andrew Kaufman, M.D., assistant professor of anesthesiology and director, Pain Management Center, University of Medicine and Dentistry of New Jersey, Newark.
The article says the physicians provided details of five cases of complex spine surgery performed by Dr. Kaul, including a seven-hour surgery involving removal of old spinal hardware followed by lumbar interbody spinal fusion with mesh cages and bone allografts, and insertion of pedicle screws and rods. The complaint does not cite any adverse events from the surgeries.
David Solsberg, M.D., a Denver neuroradiologist who performs minimally invasive spine procedures, was asked by Pain Medicine News to review the New Jersey attorney general’s complaint. He said the charges appear to have a legitimate basis, although he says he may change his mind if more objective data are provided.
“These are not minimally invasive procedures—these are big operations, not short snappers—and this is way outside of what would be seen in most communities as the scope of practice of an interventional pain physician, ” Dr. Solsberg told the publication. “For example, lumbar interbody fusion and allografting are way outside what a non-surgeon would do.”
Patient Safety and Disclosure
In a letter to the editor on NorthJersey.com on May 27, 2012, Paul Kovatis, M.D., a foot and ankle specialist in New Jersey wrote that the medical and public communities should, “shake their collective heads in disgust and amazement concerning the allegations that a non-surgical physician, Richard A. Kaul, performed same-day neurosurgery.”
Kovatis pointed to “several troubling aspects” regarding the state Medical Board of Examiners’ deficient oversight of outpatient facilities and their definitions of scopes of medical practices.
“Compared with hospitals, ambulatory centers have fewer quality and patient safety checks and balances; most are owned or operated by those who perform procedures there. The surgeries noted in the article are not done at most hospitals due to scant peer-reviewed literature supporting their long-term success rates. They would not pass muster within their respective subspecialty hospital departments, ” wrote Kovatis.
Kovatis continued, “One should look askance at a physician who performs invasive procedures of this number but maintains no hospital privileges. It also boggles the mind that a doctor with such a checkered past was able to freely perform such high-risk procedures with no oversight.”
The fallout from Kaul’s behavior, says Kovatis, is ultimately not about trying him in a court of public opinion but about quality care and patient safety. “How many patients who have had outpatient spine surgery knew beforehand that it may be done by physicians who are not formally trained spine surgeons or surgeons at all?”
“This event is a clear and compelling example of why the state Board of Medical Examiners should mandate more stringent scope-of-practice regulations for medical professionals, ” concluded Kovatis.
An Example?
Following up on Dr. Kaul’s assertion that he is caught in the middle of a scope-of-practice fight, we asked him why, given his past criminal conviction in London and disciplinary problems in New Jersey, he made himself such a public target by widely publicizing his practice and charitable work? Surely he must have known his past would be used against him.
We also asked him that knowing he would be a target, why didn’t he get hospital privileges before performing surgeries he knew had that requirement?
We did not receive a response to our written questions.
The curious case of Dr. Kaul weaves together the drama of the past sinner, future saint and a professional fight over the practice of medicine in New Jersey.
If Dr. Kaul is an innocent pawn in this fight, he deserves his due. If, however the board agrees that he is a “clear danger” to the public and he used the debate over scope of practice as diversion to draw attention away from himself, then another famous saying by Samuel Johnson comes to mind. “Patriotism is the last refuge of the scoundrel.”
