West Virginia ER doctors OD'd on doctor's reckless treatments

An accurate curriculum vitae for Dr. Louis John Del Giorno would show a 20-year history of missed diagnoses, multiple overdoses and avoidable patient deaths.

In that time, medical boards have documented lapses that have led to injuries or deaths in 35 patients, and those are just the ones the regulators caught.

For references, Del Giorno could list some of the eight medical colleagues of his who, in an act of courage the likes of which Antidote has never seen, spoke out against him in public testimony, telling board investigators that Del Giorno was "prescribing excessive amounts of controlled substances" and that he was "a danger to the public."

Because he has made a habit of skipping from state to state, though, Del Giorno has been able to stay in business.

In Florida, one of his patients, a 70-year-old with a history of heart attacks, was admitted to the critical care unit at Humana Hospital-Northside. Del Giorno did not bother to examine him until after four hours after the patient's admission. Del Giorno did not ask a cardiologist to examine the patient. Had he done so, the patient may have been saved. Instead, he died. Another patient complained of rectal bleeding but was sent home without a colonoscopy and without a consultation with a gastroenterologist.

In June 1995, the Florida Board of Medicine forced Del Giorno to surrender his license.

He kept his license in New York, though. Regulators caught up with him there a year later. In April 1996, New York revoked his license. Del Giorno appealed that decision and lost when, in September 1996, the Professional Medical Conduct Administrative Review Board upheld the decision by the New York medical board.

So it was on to West Virginia, where he went to work at City Hospital in Martinsburg.

West Virginia's documents prove to be a frustrating experience for patients (and reporters). They often allude more than they elucidate. Because Del Giorno fought the administrative actions against him there, the records provide plenty of details. For example, one patient alone received more than 7,000 Methadone tablets per year. Del Giorno continued to prescribe opiates to a woman despite the fact that she was pregnant, and kept doing so until she was six months along. When the West Virginia Board of Medicine reviewed 31 of Del Giorno's patient charts, the board found that 17 had been admitted to the emergency room because of an overdose. One ended up committing suicide.

As the board noted, "there were almost never a urine drug screens at baseline. There was never a Board of Pharmacy query" to see how frequently these patients had been buying drugs.  And there was "no effort by Dr. Del Giorno to get local hospital records for his patients. Almost every patient was given a prescription for opiates or controlled substances at the initial visit. Opiates were started even when the patient admitted diversion or abuse of illicit substances, such as cocaine."

Del Giorno could have been stopped earlier. West Virginia could have taken action, as New York did, based on the surrender of his license in Florida. The board also could have probed more deeply into Del Giorno's records when the board received a complaint about him in 2004. Instead, the board "did not find any improper action" but "did suggest that he attend additional training."

The problem with the training was that Del Giorno was learning the rules to find ways to game the system. He had not treated patients for pain in Florida or New York. In 1999, as the West Virginia board explains, he "took over the practice of a local neurologist" and because "pain management was not within his realm of practice, Dr. Del Giorno called the West Virginia Board of Medicine for guidance and attempted to educate himself on this area through a review of the Board rules, information received from pharmaceutical companies and attendance at conferences and seminars."

For a decade, he was able to prescribe massive amounts of painkillers and other addictive drugs and somehow avoid the wrath of the regulators. It took Dr. Daryl M. LaRusso, the medical director for the group of physicians who staffed the ER at City Hospital, to finally stand up in 2007 and say, "Enough." But even with the evidence and testimony that he and the other ER doctors provided, Del Giorno kept his license for nearly three more years.

By the time the West Virginia board revoked his license in May 2010, Del Giorno's CV was a stunning example of how a doctor can wreak havoc, cause untold harm and yet continue to have patients' lives placed into his hands.

Final question: Where was the evidence against Del Giorno? In plain sight. When the West Virginia board received that 2004 complaint, the board could have reviewed patient records and asked City Hospital for the list of patients treated for overdose there or the Board of Pharmacy's report on his prescribing practices. All of these documents became key pieces of evidence in the board's case against him in 2010. Many of the 31 patients cited in the board's action against Del Giorno had been seeing him prior to 2004.

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