The Virginian-Pilot
©
HAMPTON
When the Virginia Board of Medicine reprimanded Dr. David Ostman in 2004 for posing a danger to the health and welfare of his patients, it included one reassuring note.
He had closed his private practice and been hired by the Hampton VA Medical Center, where, the board noted, his work would be supervised and subject to strict quality assurance standards.
That was not, it turned out, enough to head off more trouble for Ostman.
A pending malpractice lawsuit against the Hampton veterans center alleges that the gynecologist negligently perforated a patient's large intestine and punctured her bladder during a hysterectomy in 2008.
That required a repair procedure that left her with a temporary ileostomy, a surgical opening in the abdomen that allows body waste to be collected in a pouch.
The lawsuit alleges that Ostman failed to properly identify the patient's anatomy or to consult a colleague with more surgical experience for assistance.
He is alleged to have used a "blunt dissection," pulling the patient's organs apart with his hands rather than using scissors, resulting in the injuries to her intestine and bladder.
The plaintiff, Miriam Cenedese of Portsmouth, is seeking $1.875 million in damages. She filed the lawsuit in federal court after an administrative claim for compensation was denied by the U.S. Department of Veterans Affairs.
The medical center has denied the allegations in court papers. No trial date has been set.
The principals in the case declined to be interviewed for this report.
Citing privacy policies, VA officials declined to say whether they knew Ostman was under investigation by the state Board of Medicine when he was hired in June 2003 as a staff physician.
He is still on the medical staff at the Hampton center.
In an order filed in October 2004, the state board found that Ostman had violated a variety of laws and medical regulations from December 2001 until he closed his private practice in May 2003.
During that time, the board found, he wrote 225 prescriptions for "Libido Lotion," a topical preparation containing testosterone, outside of a bona fide doctor-patient relationship. He took orders for the product through his website and sent the prescriptions to a pharmacy in St. Louis, where it was prepared and mailed to his customers.
Testosterone, while commonly thought of as a male hormone, has been shown to boost sex drive in some women. But it has not been approved for that purpose by the U.S. Food and Drug Administration.
The Virginia board also found that Ostman sold or dispensed thousands of doses of various prescription medications - the appetite suppressant phentermine, the narcotic pain reliever hydrocodone, and anti-anxiety drugs sold under the trade names Xanax and Valium - without holding a pharmacist's license.
In a drug audit of his office in May 2003, hundreds of doses of federally controlled drugs could not be accounted for.
The board also found that Ostman prescribed weight-loss drugs to five patients without performing appropriate physical examinations, recording a comprehensive medical history or documenting any diet or exercise program.
Ostman admitted the truth of the board's findings.
He was reprimanded, fined $2,500 and ordered to take a course in medical recordkeeping.
As a result of the Virginia action, medical boards in North Carolina and Georgia, where Ostman was also licensed, reprimanded him as well.
In November 2005, the Virginia board found that Ostman had fulfilled the requirements of the 2004 order and restored his license to unrestricted status.
VA officials declined to say when they became aware of Ostman's disciplinary record.
Jennifer Askey, a spokeswoman for the Hampton center, said the VA requires all of its doctors to have a full, current, unrestricted medical license.
Licenses are verified with the licensing agency at the time of initial employment, at license renewal times, and during periodic reappraisals by the medical staff, which occur at least every two years, Askey said.
All state medical board sanctions of VA doctors are researched by the center's medical examining board, Askey said. State board reprimands, fines and continuing medical education requirements do not bar a doctor from VA employment, she said.
Jim Strickland, a former Army medic and retired hospital administrator in Savannah, Ga., who runs the website VA Watchdog Today, said the Ostman case is not unusual.
"Doctors that have problems, that have had civilian issues, can get hooked up in VA hospitals," he said. "The real issue here, from my perspective, is that once they're entrenched, you can't get rid of them."
Bill Sizemore, (757) 446-2276, bill.sizemore@pilotonline.com
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puzzled
It is so amazing to me how the press thinks they know the whole story. I have been self employed for 20 years and from time to time things happen that the press thinks it is there business to get into my business. Most of the time the story was one sided, not factual and they never thought how they would hurt the people with in the story by not reporting the real story.
I often think how the reporters would react if a story about him was published in the paper one sided, not factual or with disregaurd to how it can hurt his reputation, credibility and his respect of his fellow writer!!!!!
smut sells and i guess as long as there are onesided sensonalized stories in the press it will sell.
It's a marketing thing
puzzled
Physician
Unfortunate circumstances. First let us not be too hasty to blame the Veteran's Administration, his conduct is not the result of being employed by the VA. Second, his license is regulated by the Commonwealth of Virginia. Third, his conduct is not representative of all physicians. In the same manner that there are bad, crooked, irresponsible, incompetent, and unethical teachers, firemen, CEOs, Bankers, investor, lawyers, plumbers, drivers, electricians, meat cutters, trainers, policemen, governers, presidents, senators, pipe fitters, painters, horse trainers, dentists, nurses, writers, photographers, day care owners, etc,. there are also some physicians.
Two things
First, a newspaper located in VA should not abbreviate the Veterans Administration as 'VA' or worse, 'Va.' as it might be confusing to those who live in Va. Beach, VA.
Second, this is why professionals should be certified by their insurers rather than licensed by the State. A malpractice insurer has its own funds at risk if it insures an unqualified or impaired professional and will, at the least, demand an extraordinarily high premium to insure him.
What we should be doing is to demand to see a copy of a professional's insurance receipt rather than a license, and going elsewhere if he has a surcharge that cannot be adequately explained.
And we should demand the same of professionals practicing in a government institution.
Surely you jest
Respectfully, we are on the razor's edge between vertically integrated medical systems blending with vertically integrated financial systems. This has been inching along from "smoke-filled rooms" for the last 30 years. All it would take is for insurance companies to provide professional certification, and government allow banks to become insurers rather than just brokers, and all heck would break loose. Our local scenario could be Sentara Towne Bank Medical System with the mayors of several HR cities on the board. Of course, you would get light rail to the hospitals.
Not joking at all.
But I suggested certification by the malpractice insurance providers, not the health care insurance providers.
Very different incentives.
The malpractice providers only concern is safe practice, the health insurance providers have an interest in the cheapest doctors.
That idea reminds me of the investment houses on ...
... Wall Street (Bears Stearns, Lehman Brothers, etc) paying the ratings companies to rate their own junk investments which imploded the economy. Now, lets have docs paying the people who would turn around and certify the docs. Different incentives indeed.
We desire the same thing, but I fear the slippery slope.
Only a state can prevent an insurance company from offering health insurance along with medical malpractice insurance (and I don't think they have done that). You can't mandate judgement, and changing the law instead of making certification organizations accountable to follow the laws they are mandated to enforce does little to resolve the problem. The mistake we make is when we believe that only doctors can define and enforce medical ethics, that only lawyers can define and enforce legal ethics, and that only accountants can define and enforce accounting ethics. A corrupt doctor is, in fact, corrupt, and we need to deal with that. What we don't need is a group with a financial stake in the outcome determining compliance.
Toasters and airplanes
Certification by insurers is a proven success.
Look under your toaster and you will see a UL certification. Underwriters Laboratory is financed by the product liability insurers who are at risk if your toaster harms you.
If you know a private pilot who owns his own airplane, ask him whose requirements for ongoing training and experience are higher, the FAA's or his insurer's.
You will find that insurers with funds at risk are far better at protecting us from incompetence than regulatory agencies. We have just become accustomed to licensing and don't realize certification works better every place it is in effect.
insurance
The problem is malpractice insurance. That is why we pay so much for medical care. Doctors have that safety net. This one may be allowed to get away with this because now, instead of working in the public, he works for the VA. Obama had a great idea, rework the medical program. He just kicked it off wrong. Cap charges, cap insurance amounts, open more options, and get rid of HMO's. They really do not cover the important issues.
Not Really....
A number of studies out there show that malpractice costs are a very small fraction of total healthcare costs. The figures hover around 2% or about $50 to 60 billion annually. When you consider the fact that a large percentage is paid out for actual valid cases of malpractice the % that is on unjustified cases is much smaller than 2%. And our system is so difficult that many true cases never even get to court. Malpractice costs will always have to be here so any tort reform will be negligable-as proven by states like Texas that have adopted strict malpractice limits yet see costs rise like everyone else.