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Stanford Report, November 8, 2000

Medical Center convenes panel to oversee reviews of gynecologic surgeons

BY RUTHANN RICHTER

Medical Center officials have taken the unusual step of convening an independent, "blue ribbon" panel to ensure the impartiality of the reviews being conducted into serious allegations against three voluntary clinical faculty members, gynecologic surgeons Camran, Farr and Ceana Nezhat.

The Nezhats, who have privileges to practice at Stanford Hospital, have been widely recognized and praised for their contributions in the field of laparoscopic surgery, a minimally invasive approach to treatment. But they have become the subject of wide-ranging allegations in the media, including charges that they misrepresented data and provided possibly improper care to some patients.

To assure the public of the integrity and impartiality of Stanford's review processes, the Medical Center has convened a panel of distinguished individuals from the medical and legal community. This panel will monitor and evaluate Stanford's review of the Nezhats and can make recommendations on how the review process might be improved, said Peter Gregory, MD, senior associate dean for clinical affairs at the School of Medicine and chief medical officer at the hospital and clinics.

"We are deeply dependent on the public trust," Gregory said. "The public has to have absolute faith that the care we are delivering and our scholarship are of the highest quality. The public confidence requires that we sometimes go the next step. It's the right thing to do."

The panel, officially called the Medical Center Panel on Academic and Clinical Integrity, includes the Hon. Edward A. Panelli, a retired justice of the Supreme Court of California; Mitchell T. Rabkin, MD, a professor of medicine at Harvard who has served as chief executive officer of Boston's Beth Israel Hospital and as chair of the Association of American Medical Colleges (AAMC); and Erich H. Loewy, MD, professor and chair of the Bioethics Program at UC Davis.

Camran Nezhat, MD, said in a statement that he is supportive of the effort. "I and my brothers greatly appreciate and welcome the extraordinary steps Stanford Medical School and Stanford Hospital are taking to review the integrity of their academic and clinical practices," he said. "The inquiries ... are a tremendous step in ending the smear campaign that has been smoldering since we were recruited to the faculty in 1993. We are sorry that Stanford has been forced to undergo this costly and lengthy process to uphold the integrity of its academic and clinical endeavors, but at the same time we look forward to clearing our name."

The blue ribbon panel will examine the quality-care review process in the Department of Gynecology and Obstetrics and the hospital's credentialing process, as well as the university's procedures for investigating the allegations of scientific and academic misconduct, Gregory said.

The panel's job will include a review of the findings of a separate, ad-hoc committee that is composed of three respected members of the medical staff who were appointed in the spring to look into questions about the quality review process in the Department of Gynecology and Obstetrics. The committee has met over the past six months to look at the procedures followed in reviewing various issues raised since 1994 about the Nezhats' care of specific patients. The committee is looking at whether the interests of patients were well-protected and whether the care-review process included any breach of integrity, such as undue pressure, lack of objectivity and/or breach of patient confidentiality.

Once the ad-hoc committee's review is completed, it is expected to forward its results to the blue ribbon panel, Gregory said. The panel then will issue its own findings and recommendations, he said.

"We intend to take their recommendations to heart and implement them," Gregory said. Gregory said the panel would be given access to whatever information or records it needs. "We believe a review of this kind should be no-holds-barred, absolutely thorough and comprehensive," he said. The panel's review is expected to take less than a year.

The Nezhats were recruited to Stanford in 1993 to share their widely recognized expertise in laparoscopic surgery, a treatment in which doctors operate through a tiny incision while monitoring their progress on a video screen. In 1995, Camran Nezhat was appointed medical director of the Stanford Endoscopy Center for Training and Technology, which brings physicians from around the world to train in this minimally invasive approach to surgery. Farr Nezhat later became associate director of the center.

The Nezhats have specialized in using laparoscopic procedures in the treatment of endometriosis, a pelvic disease. At the same time, they have worked closely with other physicians at Stanford -- including those in general surgery, urology, gynecologic oncology, neurosurgery, vascular surgery and cardiothoracic surgery -- to help them apply these minimally invasive techniques to other surgical subspecialties.

Gregory said the Medical Center takes allegations against the Nezhats -- or any faculty member or doctor admitted to practice in the hospitals -- very seriously. However, Gregory said, at this point the allegations are just that -- allegations -- and no judgment will be made until all reviews are completed.