How VA took years to disclose a troubled surgeon

A physicians’ assistant notifies the chief of staff at the Togus VA Medical Center in Augusta, Me., that veterans are complaining of failed surgeries by podiatrist Thomas Franchini and are refusing to see him again, prompting a review of Franchini’s surgical cases by Robert Sampson, chief of surgery.

The review of 25 random cases finds “significant documentation and quality of care issues,” and a subsequent review by the chief of orthopedics at the Boston VA confirms findings. A medical panel at the Togus VA suspends Franchini’s surgical privileges and he is placed on administrative leave.

After another review of Franchini’s cases by the VA chief of podiatry in Palo Alto, Calif., VA leaders in Maine move to terminate Franchini. He is given time to rebut the findings.

Franchini resigns under investigation, and begins looking for work in New York. The VA does not notify the National Practitioner Data Bank, a repository used by health care organizations in hiring. The agency's policy is to only report such adverse events involving medical doctors and dentists – not podiatrists, nurses or other providers.

The VA prepares an investigative file with the most serious findings to be included in reports to state licensing boards. But no reports are sent. Richardson, the chief of staff at Togus, said in a deposition this year that he wanted more reviews. He had asked Sampson to look at all of Franchini’s surgeries, which totaled 589 during his six years with the VA.

A new acting director at the medical center receives a briefing on the Franchini investigation, and, concerned by the lengthy delays in case reviews and telling patients, gets regional and national VA officials involved. They take over and add more reviewers to speed up the investigation.

Andrea Buck, a chief medical officer at VA headquarters, recommends that “because of an absence of ongoing harm” that the agency should plan to notify Congress and develop “communications plans” before telling Franchini’s patients.

Primary and secondary reviews of surgeries Franchini performed on 431 patients are finished. The results: 124 suffered potential harm and 127 were probably harmed by Franchini.

A 37-year-old Army veteran who had two failed Franchini surgeries chooses to have her left leg amputated below the knee because the pain was too much to live with.

VA informs five state licensing boards where Franchini has been licensed. To date, none has taken disciplinary action.

The VA starts informing patients, including Wood. After follow-up exams in the ensuing months, VA investigators find 88 patients suffered actual harm at the hands of Franchini.

In an interview with USA TODAY, Franchini denied making mistakes and said he never got a chance to respond to all of the VA’s findings. He said several doctors were in the operating room with him during six years of surgeries at the VA and none raised concerns. Since leaving the VA, Franchini said he has performed numerous surgeries without complications.

Franchini is in private practice treating patients at a Fifth Avenue practice in New York City. His current licenses in Rhode Island, Massachusetts, Connecticut and New York do not show any marks of discipline. His report at the National Practitioner Data Bank still has no record of the VA investigation or discipline because the VA never reported it.

In response to questions from USA TODAY, VA Press Secretary Curt Cashour said the agency is reviewing patient safety procedures and reporting practices to state licensing boards and the national data bank.