In Louisiana, Larry Mitchell Isaacs, MD, in the face of discipline, after he removed an allegedly healthy kidney during what was supposed to be colon surgery.
In California, he mistakenly removed a woman's fallopian tube. According to medical board records, he thought it was her appendix -- which already was gone. More surgeries on the woman followed, including one in which he allegedly left her intestine unconnected.
Facing state sanctions, he surrendered his license there, too.
In New York, where regulators were moving to take action based on his California problems, he also .
But in Ohio, he has found a home.
There, , allowing Isaacs to work at an urgent care clinic in the Cincinnati area.
Surrendering a license is often done in the face of overwhelming evidence of unprofessional conduct. It can come after repeated surgical mishaps, churning out improper opioid prescriptions, or years of having sex with patients.
A license surrender can spare a physician the time, expense, and reputational harm that might come with formal charges and a hearing before a state medical board. Typically, it comes with no restriction on practicing elsewhere.
States can take action against physicians based on license surrenders in other places. But, as with other matters in the broken world of physician discipline, such a step is spotty. Some states don't even search a national database of troubled physicians.
What's more, voluntary license surrenders can mean the public gets no access to information about what happened, putting future patients at risk.
More than 250 physicians who surrendered a medical license were able to practice in another state, an investigation by the Milwaukee Journal Sentinel, USA Today and ľֱ found.
"It is very concerning to think a physician surrenders in one state and doesn't surrender in another," said John Harris, MD, an assistant professor of medicine at the University of Pittsburgh Medical Center, who has researched how physician discipline varies from state to state.
"There seems to be an inconsistency and danger. As a physician, I want our patients to be safe and I want these people not practicing."
In a third of the 250 cases, physicians who surrendered their licenses were able to practice elsewhere without any limitations or public disclosure, simply by changing their addresses.
In the other cases, they faced disciplinary action that patients might not be able find out about.
The analysis was done using data provided by , a private firm that compiles information on physicians from thousands of sources, such as state medical boards and local courts. Its information typically is used by hospitals and insurance companies. The analysis was limited to physicians who had action by a state board recorded since 2013. The real number of doctors who have surrendered their licenses, yet continue to practice is certainly higher.
Earlier, the Journal Sentinel and ľֱ used data from the firm to identify more than 500 physicians who had been disciplined in one state yet still were able to practice elsewhere with a clean license.
The news organizations also found 73 cases where the FDA sent warning letters to physicians alleging serious patient safety concerns, though only one had been disciplined by a state board.
The investigation found 216 physicians who collected a total of $26 million from federal taxpayers through Medicare despite losing a license or being excluded from state-paid health care rolls.
In theory, a surrendered license in one state should tip a second state to the fact that there are problems. Instead, for many doctors it amounts to a get-out-of-jail-free card.
In an interview, Isaacs said he gave up his licenses in California, Louisiana, and New York to avoid costly legal fights. In defending his actions, he provided letters from other physicians who said he had acted appropriately.
"I didn't do anything wrong anywhere," he said.
Isaacs' trail of alleged misdeeds was unusually severe among the cases examined.
But, in case after case, a license surrender in the face of discipline for bad behavior in one state was met with far more lenient discipline -- if any punishment at all -- in another.
Consider:
- Heart surgeon Sean Yetman, MD, performed just seven surgeries at Meriter Hospital in Madison, Wis. Two of those patients died. Malpractice lawsuits were filed in both cases. Yetman surrendered his Wisconsin license in 2014. He was able to continue practicing in New York, where he already had a license.
- In February 2015, cardiologist John Strobeck, MD, was charged by the Passaic County, N.J., prosecutor's office with criminal sexual contact, according to the state medical board. He allegedly had inappropriate sexual contact with six female patients in an exam room "under the guise of providing medical treatment." Six months later, Strobeck agreed to surrender his New Jersey license. California took action based on the case, and he surrendered his license there. In New York, he has no restrictions. The original charges are still pending.
- John Kidd, MD, a Wisconsin anesthesiologist, gave up his license rather than fight multiple allegations of negligence. He relocated to upstate New York where he currently practices. Click here for a detailed look at his case.
"All of those cases are troubling," said Michael Carome, MD, who heads the consumer advocacy group Public Citizen's healthcare division, which has studied state-to-state variation in physician discipline. "Actions should have been taken against them in the states where they remained licensed."
Secretive system hides problems
In some states, surrenders are particularly secretive -- leaving patients in the dark about what happened.
Records show that psychiatrist Robert Sack, MD, in 2012 rather than face discipline -- but his public file does not spell out what he did. It only references a line in state law relating to "unprofessional conduct in the practice of medicine."
Based on Maryland's action, neighboring Virginia quickly suspended him from practicing there.
In a 2012 letter to the Maryland medical board, Sack noted his license surrender was related, in part, to his "planned retirement from the practice of medicine."
Shortly thereafter, he opened a legal battle to be allowed to practice in Pennsylvania, where his license had just expired.
The Pennsylvania board eventually issued a reprimand, but it allowed Sack, who specializes in child and adolescent psychiatry, to practice.
In fact, by surrendering his Maryland license, the board said, he demonstrated "the good moral character and judgment the board expects from its licensees."
To try to determine what prompted the case, reporters filed a series of open records requests.
Maryland, where the matter began, refused to release any documents. Pennsylvania released several hundred pages of materials that showed the surrender stemmed from him having a romantic relationship with a former patient in Maryland.
The American Psychiatric Association views sexual contact with patients, including former ones, as unethical -- a standard many states follow in licensing.
The Pennsylvania records show that Sack's attorneys told officials that he had no plans to actually practice there. But, an Internet search found Sack listed as a practicing child and adolescent psychiatrist at T.W. Ponsessa & Associates, a Lancaster, Pa.-based counseling service.
CEO Cathy DeGuire told a reporter she was not aware of Sack's disciplinary background when he was hired. Before hanging up, she said that the listing online was an error -- stressing Sack only works with patients 16 and older.
Three days latter the website was changed to say he sees patients aged 16 to 64.
Sack did not respond to efforts to reach him through the attorney or his employer. His attorney declined to comment.
State hopping begins in California
For Larry Isaacs, records show that problems began in California. ( for a full timeline.)
On May 4, 2009, a woman identified in records only as "G.G." was admitted to the Henry Mayo Newhall Memorial Hospital in Valencia with abdominal pain.
Isaacs suspected she had appendicitis. However, a medical board document, known as an accusation, says he failed to perform the proper diagnostic tests.
Indeed, G.G. didn't even have an appendix.
Thinking he was removing her appendix, Isaacs instead took out a fallopian tube, according to the documents. Four days later, the hospital discharged her.
On Feb. 6, 2010, she returned to the hospital, again complaining of abdominal pain. A CT scan indicated she had a hernia in her abdomen. Another CT scan indicated a second hernia in her pelvis.
A hernia is when an organ pushes through the muscle or tissue that holds in it place. In hernia repair, physicians often use mesh instead of stitches alone to strengthen the area being repaired and to help prevent a recurrence.
In this case, Isaacs used the wrong size mesh.
The mesh Isaacs used was ½ inch wide, "whereas the standard of care requires that the mesh overlap the hernia by 3 centimeters (1.2 inches) on each side," the documents said. What's more, he used a synthetic, non-absorbable mesh, which increased the risk of infection.
An alternative would have been to use just stitches or a type of biological mesh that eventually dissolves into the body.
Six days later, X-rays showed a hernia in the same area. The documents say either there was a different, undiagnosed hernia, or Isaacs' previous surgery was inadequate.
A few days later, yet another CT scan showed a large hernia that involved the small intestine. Isaacs performed another surgery, removing part of G.G.'s small intestine. That same day, he operated on her again.
Over the next few days, CT scans showed that Isaacs had left a portion of her intestine unconnected, creating an environment that allowed infection to occur, documents say.
Finally, on March 2, G.G.'s care was transferred to another surgeon. Isaacs was relegated to an assistant role, explaining to the new surgeon what he had done.
California records do not indicate what happened to G.G.
In an interview, Isaacs said she is doing well. He acknowledged she later sued him and received a $310,000 settlement. He said he told the insurance company to settle the case.
Reporters could not locate the settlement in California court documents.
In December 2014, G.G.'s case wound up in front of the California medical board, when Isaacs was accused of gross negligence, repeated negligent acts, and incompetence in her care.
Isaacs only admitted to inadequate record keeping. He agreed to surrender his California license in 2016.
A serious matter
There are tools to help medical boards stay up to date on the actions of the physicians they license. The National Practitioner Data Bank was started by Congress in 1986 as a central repository for malpractice payments, state disciplinary actions, restrictions from health plans or hospitals, and other limits set for a healthcare professional.
The database now has more than 1.3 million records of "adverse actions" going back to 1990.
It's open to hospitals, insurers, and state medical boards, but it is not available to the public. What's more, medical boards often don't even use it. Last year, 30 medical boards performed fewer than 100 searches; 13 didn't perform any at all.
Some defenders of the system note that physicians make mistakes, and there are cases when a license surrender shouldn't automatically keep them from practicing medicine.
For example, many states have programs to help physicians deal with substance abuse issues.
Attorney Eli Stutsman of Portland, Ore., specializes in representing physicians and other medical professionals. He said he had represented at least two people who got the help they needed and are now back at work, without any new problems.
"Do they have some history? Yes. Did they make some compromises to return to work? Yes. Are they reinstated? Yes, and I wouldn't be afraid to see either of them," he said.
"Good practitioners have been caught up in this. I'd be careful to not paint with such broad strokes."
Stutsman started practicing law in the early 1990s. At the time, he said, physicians could take advantage of the gaps in information between states. Some states were notoriously slow when it came to staying up-to-date on physicians' transgressions.
Given all the information available today, he was surprised that a case like Isaacs' -- involving multiple surrenders and actions in multiple states -- could exist.
He noted that physicians routinely have to report disciplinary actions, revocations and surrenders to various regulatory bodies. Omitting such a report, can be cause for serious disciplinary action on its own. Indeed, some medical license surrenders analyzed by the news organizations came as a result of failing to report the discipline in another state.
A second chance; then a third
In January 2012 -- as Isaacs faced potential discipline in California -- he moved to Bastrop, a city of about 11,000 in northeast Louisiana.
His first day at work was Jan. 12, six days after he was issued a license in the state.
According to newspaper, Isaacs went to work at Morehouse General Hospital as a surgeon. Among other things, his specialties would include hernia repair and appendectomies, the story noted.
Shortly thereafter, Isaacs informed the Louisiana board that a hospital in the state had suspended his privileges. Publicly available documents don't name the hospital or say where it was located. The board started its own investigation.
The Louisiana board eventually accused Isaacs of failing to recognize that he had removed a healthy kidney from a patient during colon surgery.
Isaacs denied the allegation, saying that the removal of the kidney was warranted. But, in the fall of 2013, he agreed to surrender his Louisiana license.
He told the board that he had moved to New York, where he also had a license, and had no plans to continue practicing in Louisiana.
In New York, Isaacs worked in 2013 and 2014 as assistant director of trauma services at a hospital in Middletown, about an hour and half north of Manhattan, according to his résumé.
While in New York, the state Office of Professional Medical Conduct twice investigated allegations against Isaacs. It closed those cases without action, according to letters sent to Isaacs by the board.
However, the New York board cited his 2016 California license surrender as evidence of professional misconduct.
This led Isaacs to agree to permanently give up his license in New York in 2017.
He went to Ohio.
A confederation of boards
There is a flip side to this scenario: In some cases, the state where a physician runs into problems will allow the physician to keep practicing, but the same information results in a license surrender elsewhere.
Consider obstetrician Christopher Shay Driskill, MD, who in 2015, agreed to permanently surrender his California license based on what happened in New Mexico.
According to , Driskill allegedly:
- Had sexual relationships with several patients, including one to whom he improperly prescribed a tranquilizer
- Wrote inappropriate personal notations on charts
- Was not in attendance on multiple occasions when his patients gave birth, though he had been called by nurses and admitted the patients into the hospital
Once, the records say, he missed a delivery because he was having sex with another patient.
He also was found to be under the influence at work, where he kept a personal cache of alcohol.
Driskill denies the allegations. He said he surrendered his California license because he did not think he'd be able to keep it while practicing in New Mexico.
"I had no interest in working in California," he said. "I didn't need my California license anymore."
New Mexico still allows Driskill to practice, though he must be chaperoned and can't contact any patients with whom he had sex with.
He said he agreed to work under various stipulations in New Mexico, calling them "things I do to make sure everyone is comfortable and happy."
Among the other physicians who fit this pattern:
- In 2012, Abdus Lakhani, MD, an internist in Indiana, pleaded guilty to battery of a nurse, and was given a suspended sentence of 12 months in jail. The Indiana medical board put his license on probation, allowing him to keep practicing. In response to Indiana's action, the California medical board sent Lakhani a letter saying that it planned to hold a hearing about the incident that could result in the revocation of his license. Instead of facing a hearing, Lakhani surrendered his California license.
- Pain clinic physician Basim Elhabashy, MD, allegedly prescribed excessive amounts of opioids to patients in Florida without justification, according to a 2012 complaint issued by the Florida Department of Health. A report from the U.S. Drug Enforcement Administration listed him as the 48th largest purchaser of oxycodone in the U.S. in 2010. That amounts to 283,000 units of the drug, or 776 per day. Elhabashy was allowed to keep his Florida license with a reprimand and probation. But, he surrendered his New York and California licenses due to Florida's complaint.
Last stop
Larry Isaacs now works at Tri-State Urgent Care in Cincinnati.
Tessie Pollock, a spokeswoman for the Ohio medical board, would not say why the board has not taken action against him.
"Even if the State Medical Board of Ohio had opened a complaint against Larry Isaacs to learn more about the allegations in California and Louisiana, I would not be able to disclose that or the findings," she said in an email.
She said that the board takes allegations of "compromised patient safety and actions by other states very seriously."
In an interview and emails, Isaacs offered a detailed defense of his conduct in the three states where he no longer is allowed to practice.
"I always went by the textbook," he said. "Sadly, some doctors don't know what is in it."
He said a big reason he gave up his licenses in California, Louisiana, and New York was the cost of defending against the allegations, including paying attorneys who charged hundreds of dollars an hour. He also claimed that the system was rigged against him.
He said he did not leave G.G.'s intestine unconnected, as the medical board alleged. He said sutures broke down, which allowed the California patient's intestine to leak.
As for the medical board, he said it goes after physicians to get revenue from fines -- though a spokesman for the state's medical board said it took only 450 actions last year, while the state has 113,000 licensed physicians.
The settlement of G.G.'s lawsuit?
He said it was because it would be hard to win a lawsuit, since many of the jurors would have been Hispanic and identified with the patient.
In the Louisiana case, Isaacs denied the allegations made by the board and said he had simply improperly dictated the surgery into the medical record. Had he dictated it properly, he said, it would have described a procedure and condition for which removing the kidney was warranted.
Records show an outside consultant hired by the board who found his care of the patient substandard. An independent peer review done for the hospital reached the same conclusion.
The surrender agreement itself includes this summary: "There was no evidence in the medical record that Dr. Isaacs recognized that he had removed a healthy kidney during the operative procedure or in the immediate postoperative period."
Isaacs also said the case resulted from a contract dispute with the hospital that hired him. What's more, he said, the hospital's attorney was the nephew of the medical board president.
Actually, the two are father and son, said the attorney, Bill Bourgeois, who said it was sad Isaacs was raising that as an issue.
"Hospitals really don't relish terminating a physician's privileges," he said in an email. "It costs money to retain an external peer reviewer, a hearing officer, and an attorney. In my opinion, terminating privileges is probably the last thing that a rural hospital would like to do with its limited financial resources."
Aside from the kidney case that went to the medical board, there was a second problematic one.
The family of Lynn Hill, a 63-year-old Louisiana woman who Isaacs operated on in 2012, filed a lawsuit that alleged several negligent acts, including removing a non-cancerous kidney during a surgery to remove a tumor that was attached to the kidney.
Hill endured a variety of complications and other surgeries and died a year later.
Isaacs noted that a $133,000 settlement in the case was paid by a malpractice insurance trust fund, not him. He said he acted appropriately and that the kidney needed to be removed.
Isaacs said Ohio is the only state to fully investigate all of the cases, and it concluded that he should be allowed to practice.
Still, he said, he no longer is doing surgeries.
"This was my last stop," he said. "I'm going to be 64 years old. I am just working as a physician and trying to live out my last years in peace."
John Fauber is a reporter for the Milwaukee Journal Sentinel. Matt Wynn is a reporter for USA TODAY. Stacey Barchenger of the USA TODAY NETWORK-New Jersey contributed to this report.
This story was reported as a joint project of the Journal Sentinel and ľֱ.
Note: this story was updated Dec. 7 to delete an incorrect reference to a physician who had pleaded guilty to criminal charges in New Jersey. That physician does not have an active license in California, as we erroneously reported. We apologize for the error.