BEFORE THE NORTH CAROLINA MEDICAL BOARD

Transcription

1 BEFORE THE NORTH CAROLINA MEDICAL BOARD In re: ) AMENDED ) NOTICE OF CHARGES John David Hamel, M.D., ) AND ALLEGATIONS; ) NOTICE OF HEARING Respondent. ) The North Carolina Medical Board ( Board ) has preferred and does hereby prefer the following charges and allegations: 1. The Board is a body duly organized under the laws of North Carolina and is the proper party to bring this proceeding under the authority granted it in Article 1 of Chapter 90 of the North Carolina General Statutes. 2. John David Hamel, M.D. ( Dr. Hamel ) is a physician first licensed by the Board on or about July 31, 1993, license number During the times relevant herein, Dr. Hamel practiced medicine in and around Nebo, North Carolina. 4. In August 2014, the Board and Dr. Hamel entered into a Consent Order ( 2014 Consent Order ) in which Dr. Hamel s medical license was restricted from performing surgery except in certain limited circumstances. The 2014 Consent Order resulted from findings by the Board that Dr. Hamel had performed cosmetic surgical procedures on five (5) patients and that his care had Amended Notice of Charges & Allegations John David Hamel, M.D. Page 1 of 16

2 failed to conform to the standards of acceptable and prevailing medical practice in North Carolina. 5. As a result of the Board s findings, the Board ordered that Dr. Hamel was restricted and prohibited from performing any elective surgical procedures which require more than topical anesthesia except for those cosmetic procedures listed in Appendix A to this Consent Order. However, Dr. Hamel may use a subcutaneous infiltrative local injection of not more than five (5) centiliters of one (1) or two (2) percent lidocaine solution for supplemental pain relief. 6. The 2014 Consent Order also provided that: If Dr. Hamel fails to comply with any of the terms of this Consent Order, that failure shall constitute unprofessional conduct within the meaning of N.C. Gen. Stat (a)(6) and shall be grounds, after any required notice and hearing, for the Board to annul, suspend or revoke his license to practice medicine and surgery and to deny any application he might make in the future or then have pending for a license." PATIENT A 7. In May 2016, the Board received a complaint from Physician A regarding a patient ( Patient A ) that he had treated in the emergency room after Dr. Hamel had performed several cosmetic surgeries on her. One of those surgeries led to an abscess that required a hospital admission and surgical Amended Notice of Charges & Allegations John David Hamel, M.D. Page 2 of 16

3 intervention by Physician A. According to Physician A, Dr. Hamel had allowed Patient A to insert a needle into her own thigh on multiple occasions to remove fluid out of her thigh. Physician A expressed concern that Dr. Hamel would eventually kill someone. 8. In September 2015, Patient A initially underwent a belt lipectomy. On the next day, Patient A underwent a bilateral thigh liposuction and thigh lift surgery. According to Patient A, Dr. Hamel performed the surgery on her right leg while another physician operated on her left leg. 9. Patient A also underwent a bilateral breast augmentation in October Again, Patient A reported to the Board that Dr. Hamel performed the operation on one side while the same second physician performed the surgery on the other side. 10. Patient A reported to the Board that, in March 2016, Dr. Hamel performed a scar revision on both of Patient A s thighs. The medical record reflects that another physician performed the surgery. Patient A was awake for the surgery and insists that Dr. Hamel was the only physician in the room. 11. The Board also sent the medical records for Patient A to an independent expert reviewer. The reviewing expert concluded that the diagnosis, treatment, and documentation of Amended Notice of Charges & Allegations John David Hamel, M.D. Page 3 of 16

4 Patient A s care all failed to conform to the standards of acceptable and prevailing medical practice in North Carolina. 12. Specifically, the reviewing expert commented regarding the September 2015 surgeries, By this point she has undergone 3 major surgeries in 6 days. This is highly unethical and exceedingly dangerous. The reviewing expert summarized his criticism of Patient A s care in the following manner: There was a lack of proper pre and postoperative evaluation by the operative surgeons, inadequate medical record documentation, poor surgical decision making and technique, mismanagement of multiple complications which were further compounded by additional surgeries that were not indicated, lidocaine overdose, and lack of informed consent. 13. The thigh lift surgery, the breast augmentation surgery, and the scar revision of the thighs that Dr. Hamel performed on Patient A are elective surgical procedures that require more than topical anesthesia and are not excepted from the 2014 Consent Order. Thus, Dr. Hamel violated the restriction of his practice contained in the 2014 Consent Order and such violation constitutes unprofessional conduct within the meaning of N.C. Gen. Stat (a)(6). 14. In addition, Dr. Hamel fraudulently entered the name of another physician on the medical record to obscure the fact that he was violating the 2014 Consent Order. Such fraudulent Amended Notice of Charges & Allegations John David Hamel, M.D. Page 4 of 16

5 behavior constitutes unprofessional conduct including a failure to conform to, the standards of acceptable and prevailing medical practice, or the ethics of the medical profession, or the committing of any act contrary to honesty, justice, or good morals within the meaning of N.C. Gen. Stat (a)(6) and grounds exist under that section of the North Carolina General Statutes for the Board to annul, suspend, revoke, or limit Dr. Hamel s North Carolina medical license or to deny any application he might make in the future for a license to practice medicine. 15. The diagnosis, treatment, and documentation of care provided by Dr. Hamel to Patient A, as described above, failed to conform to the standards of acceptable and prevailing medical practice, within the meaning of N.C. Gen. Stat (a)(6) and grounds exist under that section of the North Carolina General Statutes for the Board to annul, suspend, revoke, or limit Dr. Hamel s North Carolina medical license or to deny any application he might make in the future for a license to practice medicine. Amended Notice of Charges & Allegations John David Hamel, M.D. Page 5 of 16

6 PATIENT B 16. In May 2016, the Board received information from Physician B who indicated that Patient B had been seen in his office after she had undergone an abdominoplasty performed by Dr. Hamel. Physician B requested a copy of the medical record for Patient B. The medical record indicated that another physician had performed the surgery. Patient B, however, insisted that Dr. Hamel was the only physician in the room during her surgery. 17. Physician B indicated that she believes Dr. Hamel was in violation of his 2014 Consent Order and had engaged in falsifying the medical record. 18. During the Board s investigation, the Board interviewed Patient B who reported that she was conscious the entire time of her surgery and that Dr. Hamel was the only physician in the operating room and had performed her surgery. She also indicated she was surprised when she saw in the medical record that Dr. Hamel was not listed as her surgeon. 19. The Board submitted Patient B s medical records to an independent reviewing expert. The reviewing expert concluded that the diagnosis, treatment, and documentation of Patient B s care all failed to conform to the standards of acceptable and prevailing medical practice in North Carolina. Amended Notice of Charges & Allegations John David Hamel, M.D. Page 6 of 16

7 20. Specifically, the reviewing expert opined that [t]he preoperative history and physical exam is completely inadequate and [n]o preoperative lab work was done to ensure the patient was safe to undergo the procedure. The expert also criticized the lack of postoperative monitoring and explained that the high dosage of 50mg/kg of lidocaine used was beyond the standard of care for tumescent liposuction. The expert commented that: It is pure luck that she did not have an adverse event. 21. The expert also noted that Dr. Hamel did not have hospital privileges. As the reviewing expert explained: For major surgeries such as abdominoplasty and liposuction done in an outpatient facility, full operative privileges at a nearby hospital is essential for patient safety. The reviewing expert opined that it violates the standard of care to not have the ability to care for surgical complications that require inpatient hospitalization. 22. The reviewing expert summarized Dr. Hamel s care of Patient B as follows: The standard of care was violated... in the lack of pre- and postoperative evaluation, poor documentation throughout the chart..., poor surgical technique with a high abdominoplasty scar and lack of rectus plication, lidocaine overdose, and lack of documentation of informed consent. Amended Notice of Charges & Allegations John David Hamel, M.D. Page 7 of 16

8 23. The abdominoplasty procedure performed on Patient B is an elective surgical procedure that requires more than topical anesthesia and is not excepted from the 2014 Consent Order. Thus, Dr. Hamel violated the restriction of his practice contained in his 2014 Consent Order and such violation constitutes unprofessional conduct within the meaning of N.C. Gen. Stat (a)(6). 24. In addition, Dr. Hamel fraudulently entered the name of another physician in the medical record to obscure the fact that he was violating his 2014 Consent Order. Such fraudulent behavior constitutes unprofessional conduct including a failure to conform to, the standards of acceptable and prevailing medical practice, or the ethics of the medical profession, or the committing of any act contrary to honesty, justice, or good morals within the meaning of N.C. Gen. Stat (a)(6) and grounds exist under that section of the North Carolina General Statutes for the Board to annul, suspend, revoke, or limit Dr. Hamel s North Carolina medical license or to deny any application he might make in the future for a license to practice medicine. 25. The diagnosis, treatment, and documentation of care provided by Dr. Hamel to Patient B, as described above, failed to conform to the standards of acceptable and prevailing medical practice, within the meaning of N.C. Gen. Stat (a)(6) Amended Notice of Charges & Allegations John David Hamel, M.D. Page 8 of 16

9 and grounds exist under that section of the North Carolina General Statutes for the Board to annul, suspend, revoke, or limit Dr. Hamel s North Carolina medical license or to deny any application he might make in the future for a license to practice medicine. PATIENT C 26. The Board also received information from Catawba County Public Health for Women s Health Services ( Catawba Women s Clinic ) reporting that they had seen a number of patients from Dr. Hamel s clinics that were experiencing complications from surgeries being performed by Dr. Hamel. The Catawba Women s Clinic specifically identified Patient C as a patient that had experienced such complications. 27. The Board ordered Dr. Hamel to produce the medical records for Patient C. 28. The first surgery Patient C underwent at Dr. Hamel s clinic included liposuction of the abdomen, flanks, and back followed by an abdominoplasty and fat grafting of the buttocks. The medical record for Patient C reflects that a second surgeon ( Physician C ) was the lead surgeon and Dr. Hamel assisted the surgery. However, Physician C has indicated that Dr. Hamel performed all the liposuction and tumescence on the patient as well as the fat transfer. He also made the incision around the Amended Notice of Charges & Allegations John David Hamel, M.D. Page 9 of 16

10 umbilicus and sewed the umbilicus in and half of the abdominal incision. 29. Although Dr. Hamel s 2014 Consent Order allowed him to perform liposuction and fat transfer, he is not permitted to perform the abdominoplasty as described above by Physician C. 30. After the procedures described above were performed, Patient C began to experience complications. As a result, Dr. Hamel performed two (2) additional surgical procedures requiring more than topical anesthesia that were in violation of the 2014 Consent Order. 31. The Board provided Patient C s medical records to the Board s independent expert reviewer. The reviewing expert concluded that the diagnosis, treatment, and documentation of Patient C s care all failed to conform to the standards of acceptable and prevailing medical practice in North Carolina. 32. The reviewing expert summarized his criticism of Dr. Hamel and the second surgeon s care of Patient C in the following manner: There was a lack of a proper pre and postoperative evaluation, poor patient selection, lack of confirmation of quitting smoking, the poor judgment involved in repeat operations that were doomed to failure, improper selection of operations, poor documentation throughout the chart with lack of documentation of proper physical examination on multiple occasions and lack of documentation of informed Amended Notice of Charges & Allegations John David Hamel, M.D. Page 10 of 16

11 consent. This patient should have never undergone the initial procedures that were performed, nor should she have undergone either of the subsequent operations to fix the problems as a result of poor patient selection. 33. The abdominoplasty procedure and two (2) additional follow-up procedures performed by Dr. Hamel on Patient C are elective surgical procedures that require more than topical anesthesia and are not excepted from Dr. Hamel s 2014 Consent Order. Thus, Dr. Hamel violated the restriction of his practice contained in his 2014 Consent Order, and such violation constitutes unprofessional conduct within the meaning of N.C. Gen. Stat (a)(6). 34. The diagnosis, treatment and documentation of care provided by Dr. Hamel to Patient C, as described above, failed to conform to the standards of acceptable and prevailing medical practice, within the meaning of N.C. Gen. Stat (a)(6) and grounds exist under that section of the North Carolina General Statutes for the Board to annul, suspend, revoke, or limit Dr. Hamel s North Carolina medical license or to deny any application he might make in the future for a license to practice medicine. Amended Notice of Charges & Allegations John David Hamel, M.D. Page 11 of 16

12 PATIENT D 35. In August 2016, the Board received a complaint from Patient D about the care she had received from Dr. Hamel and Physician B. 36. The Board ordered Dr. Hamel to produce the medical records for Patient D. The Board provided Patient D s medical records to the Board s expert reviewer. The reviewing expert concluded that the diagnosis, treatment, and documentation of Patient D s care all failed to conform to the standards of acceptable and prevailing medical practice in North Carolina. 37. The reviewing expert summarized his criticism of Dr. Hamel and the second surgeon s care of Patient D in the following manner: It is my opinion that there were multiple violations of the standard of care in this patient. First, Dr. Hamel should have refused to do her surgeries given that the patient continued to smoke.... Additionally, she developed wound healing problems after all of her surgeries, yet Dr. Hamel continued to choose to do additional surgeries on her given her poor compliance and her continued smoking throughout her preand postoperative recovery. In the first surgery of augmentation/mastopexy, the implant was punctured and there was no backup available.... Additionally, doing the surgery under local anesthesia with Ativan is a violation of the standard of care, which is that the surgery is done under IV Amended Notice of Charges & Allegations John David Hamel, M.D. Page 12 of 16

13 sedation or general anesthesia. There was no dimensional planning done for the implant selection, which is the standard for implant selection and augmentation. The postoperative management of the complications is additionally a violation of standard of care as she underwent multiple wound closures without allowing the areas to heal first The reviewing expert also criticized Dr. Hamel s selection of and performance of the vertical abdominoplasty on Patient D. According to the reviewing expert, Patient D was not a candidate for a vertical abdominoplasty because she had no midline scar and no laxity in the horizontal direction. The reviewing expert also opined that performing this surgery under local anesthesia was a violation of the standard of care. 39. The diagnosis, treatment and documentation of care provided by Dr. Hamel to Patient D, as described above, failed to conform to the standards of acceptable and prevailing medical practice, within the meaning of N.C. Gen. Stat (a)(6) and grounds exist under that section of the North Carolina General Statutes for the Board to annul, suspend, revoke, or limit Dr. Hamel s North Carolina medical license or to deny any application he might make in the future for a license to practice medicine. Amended Notice of Charges & Allegations John David Hamel, M.D. Page 13 of 16

14 DR. HAMEL S DWI AND ALCOHOL DEPENDENCE 40. On July 2, 2016, Dr. Hamel was charged with Driving While Impaired Motor Boat Vessel. Dr. Hamel refused, during his arrest, to a chemical analysis to determine the alcohol concentration or presence of an impairing substance. According to Dr. Hamel, he had consumed four (4) beers and three (3) liquor drinks on the evening of July 1, At the time that he was stopped, Dr. Hamel was operating the boat with seven (7) passengers on board. 42. During the Board s investigation, it was learned that Dr. Hamel had previously been diagnosed with alcohol dependence. 43. From 2006 to 2013, Dr. Hamel was monitored by the North Carolina Physicians Health Program for issues related to his alcohol dependence. 44. Dr. Hamel s history of alcohol dependence and recent alcohol related arrest are an indication that Dr. Hamel may be unable to practice medicine with reasonable skill and safety to patients by reason of illness, drunkenness, excessive use of alcohol, drugs, chemical, or any other type of material or by reason of any physical or mental abnormality within the meaning of N.C. Gen. Stat (a)(5). Amended Notice of Charges & Allegations John David Hamel, M.D. Page 14 of 16

15 NOTICE TO DR. HAMEL Pursuant to N.C. Gen. Stat , it is hereby ordered that a hearing on the foregoing Notice of Charges and Allegations will be held before the Board, or a panel thereof, at 8:00 a.m., Thursday, April 27, 2017, or as soon thereafter as the Board may hear it, at the offices of the Board at 1203 Front Street, Raleigh, North Carolina, to continue until completed. The hearing will be held pursuant to N.C. Gen. Stat. 150B-40, 41, and 42, and N.C. Gen. Stat , 14.4, 14.5, and You may appear personally and through counsel, may cross-examine witnesses and present evidence in your own behalf. You may, if you desire, file written answers to the charges and complaints preferred against you within thirty (30) days after the service of this notice. The identities of Patients A through D are being withheld from public disclosure pursuant to N.C. Gen. Stat However, this information will be provided to you upon your request. Pursuant to N.C. Gen. Stat. 150B-40(c)(5), it is further ordered that the parties shall arrange a pre-hearing conference at which they shall prepare and sign a stipulation on prehearing conference. The pre-hearing stipulation shall be submitted to the undersigned no later than seven (7) days prior to the hearing date. Amended Notice of Charges & Allegations John David Hamel, M.D. Page 15 of 16

16 The right to be present during the hearing of this case, including any such right conferred or implied by N.C. Gen. Stat. 150B-40(d), shall be deemed waived by a party or his counsel by voluntary absence from the Board s office at a time when it is known that proceedings, including deliberations, are being conducted, or are about to be conducted. In such event, the proceedings, including additional proceedings after the Board has retired to deliberate, may go forward without waiting for the arrival or return of counsel or a party. This the 24th day of March, NORTH CAROLINA MEDICAL BOARD By: Eleanor E. Greene, M.D. President Amended Notice of Charges & Allegations John David Hamel, M.D. Page 16 of 16