Doctors Behaving Badly: Dr. Anand Dhanda

It sounds like a line a standup comic might use while flailing for a laugh: "What's a guy gotta do around here to get arrested? Steal somebody's kidney?"

If you are a doctor in a hospital in most of the United States, the answer is: yes.

I wrote last week about a Public Citizen report that found that as of December
2007, almost half of U.S. hospitals had never reported a case of doctor discipline to the National Practitioner Data Bank and that, overall, about 650 reports are made every year - meaning about one bad doctor for every 1,000 doctors in practice.

While we don't know for certain that Dr. Anand Dhanda (Maryland License No. D20147, California 50297, Florida ME0078407) was reported to the NPD, we do know that he was among the unlucky few to have actually been disciplined by his hospital. His screw-up was simply too big to ignore. He took out a perfectly healthy kidney out of a patient and left the diseased kidney in.

This is the reason that many surgeons have taken to having patients make a mark themselves on the surgical site, showing which leg, which arm, which side of the body should be cut. The American Academy of Orthopedic Surgeons in 1997 set up a task force specifically to find ways to cut down the number of wrong site surgeries. One of the results was the Sign Your Site campaign, encouraging doctors to actually sign the surgical area.

This was all 10 years ago. But apparently the message only partially filtered down to Dhanda, according to the Maryland Board of Physicians. The Baltimore urologist and surgeon saw a 65-year-old woman in 2003. Morbidly obese, the woman had been suffering from hypertension and kidney problems for four years. Her right kidney had "chronic obstruction" and "marked reduction of function." As a result, she was having frequent urinary tract infections and pain in her side so severe that she ended up in the emergency room. In January 2004, Dhanda performed a surgical examination on the patient at Harbor Hospital in Baltimore. His conclusion:"left retrograde is normal and obstructed right ureter." The right kidney was so badly blocked that "he could not get the guide wire to pass," the board wrote.

So, he should operate on the right kidney, right?

Not so fast says Dr. Nelson De Lara, a radiologist who took a look at the patient's kidneys and wrote a report that, according to the board, "confuses right and left and is inconsistent on its face."

On Feb. 6, 2004, according to the Maryland board, Dhanda marked the patient's left side "in front of the patient, a nurse, and her two adult sons." They would not have been alarmed by this. According to the board, the patient told the nurse that she was there to have her left kidney removed.

As is customary in a surgery like this, the radiographs that were taken of the kidneys were placed on a light box. This should have set things straight, showing that the right kidney was bad and the left one was good.

But the X-rays were placed in the box backward, seeming to confirm Dhanda's initial confusion. He took out the healthy left kidney and left the right one in.

Even though Dhanda had marked the wrong side of the patient to begin with, he blamed De Lara, saying he had failed to mark the X-rays correctly.

No one would have immediately been the wiser had it not been for the surgeon assisting Dhanda. He noticed the x-rays had been flipped. After the surgery was over.

Some people eventually get used to dialysis. Others find it to be the worst kind of torture. I interviewed a woman once who could not take it any longer, chose to go off and died not long thereafter. We don't know if this patient ended up getting a transplant. We do know that the number of people waiting for a new kidney grows every year.

Is it too much to ask that a doctor take care to tell right from left when the consequences could be life or death?