Part two: Under the microscope

Patients weren't told about secret report reviewing their cases

Rachel Brand, Rocky Mountain News

Published November 3, 2003 at midnight

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University Hospital didn't tell 10 neurosurgery patients or their families that the quality of care in their cases was under review.

The patients weren't told because the peer review of neurosurgeon Dr. Issam Awad's medical practices was held in secret, as are all peer reviews.

The patients weren't told that an investigative committee recommended permanently revoking Awad's hospital privileges because it concluded that Awad gave substandard care in seven of the cases and committed "egregious" breaches of ethics.

Or that the hospital medical board rejected the committee's recommendation and instead voted on Jan. 25 to reinstate Awad's privileges, which had been suspended since November.

The legally mandated confidentiality that surrounds the peer review process is intended to allow medical experts and witnesses to talk freely, without fear of legal liability.

But Awad's tenure as chairman of the University of Colorado School of Medicine's Department of Neurosurgery became so tumultuous that the conflict has spilled into the public arena. A national accrediting panel put the neurosurgery residency program on probation this summer, citing the conflict surrounding Awad and other problems.

The investigative committee's secret report is now public, too - its contents published Saturday by the Rocky Mountain News after the hospital went to court in an unsuccessful effort this month to stop the story.

Eight of the 10 patients or their families who could be identified and located by the News now know that their cases came under scrutiny. In stories today and Tuesday, the News presents the committee's findings in each case and the stories of those patients or families who chose to share their personal histories.

Awad, who stepped down as neurosurgery chairman in February and recently accepted a position at Evanston Northwestern Healthcare, a hospital near Chicago, denies all the allegations in the committee's report. He said he presented witnesses, expert testimony and boxes of data to the medical board 10 days before its vote, which he says exonerated him.

Awad said the four neurosurgeons who instigated the peer review by complaining about him to the medical board conducted a campaign of slander and harassment that he said began even before he came from Yale University to accept the chairmanship at CU. He has sued the four - Drs. Robert Breeze, Kevin Lillehei, Glenn Kindt and Ken Winston - along with chief resident Sean Markey and hospital and university officials, claiming discrimination because he is Lebanese.

Awad also said in his lawsuit that the peer review process was corrupt and done in bad faith. Although he says confidentiality surrounding the peer review and patient privacy prevent him from commenting on the cases and allegations, he did comment on six patients. They or their families signed waivers requested by the News to allow Awad and the hospital to talk about their care. Awad also answered questions from the News in written responses from his lawyer, Paul Hultin. The hospital, the university and the four neurosurgeons have declined to comment on the peer review.

Awad said that since part of the peer review process has been made public, he wants to discuss all of it and defend himself fully. The News has filed a motion in Awad's discrimination lawsuit requesting that the judge remove a seal of secrecy on his allegations about the peer review process.

brandr@RockyMountainNews.com or 303-892-5269

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