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PALM BEACH, Fla. - A West Palm Beach surgeon has agreed to pay a $3,000 fine - among other penalties - for accidentally removing a woman's kidney, thinking it was a cancerous mass, according to the Florida Board of Medicine.
Dr. Ramon Vazquez, a West Palm Beach surgeon, was tasked with opening up Maureen Pacheco on April 29, 2016, at Wellington Regional Medical Center. Orthopedic surgeons were then scheduled to perform a spinal fusion to alleviate Pacheco's lower back pain.
But Pacheco had a condition from birth in which her kidney never ascended into the abdomen and was located in her pelvic region. Vazquez saw the undeveloped but functioning organ as cancer and removed it only to find out later from a pathologist that it was, in fact, an intact pelvic kidney.
The Florida Health Department filed a complaint in December 2017, saying the cancer diagnosis was not related to the patient's medical condition and 'therefore medically unnecessary.”
The Board of Medicine initially rejected a settlement with a $1,500 fine.
Under the final settlement, Vazquez must also give a one-hour lecture on wrong-site surgery to the entire medical staff of a hospital where he maintains staff privileges. Vazquez must also complete three hours of medical education on preoperative evaluation of surgical patients and pay $4,800 in costs.
'Dr. Vazquez is an excellent surgeon who has been providing exemplary, often life-saving services in our community for many years,” said the surgeon's attorney, Michael Burt.
'In this instance he, in collaboration with other members of the surgical team, exercised professional judgment.”
Burt said the settlement is minimal because it reflects Vazquez's role in the accidental removal of a kidney.
The Health Department in documents stated that the fact that Vazquez had no prior discipline and that two other surgeons agreed the mass should be removed 'due to potential malignancy” reduced the harshness of the discipline.
'Postoperatively, the patient informed respondent (Dr. Vazquez) that she had forgotten to tell the doctors of the known issue with a pelvic kidney,” the Health Department stated in support documents.
That did not sit well with Pacheco's attorney, Donald J. Ward III.
'It's a sad day when a doctor places blame on his patient after needlessly removing one of her vital organs,” Ward said.
He added that prior to her surgery, Pacheco's orthopedic surgeons were well aware that she had a pelvic kidney, and it was well-documented in her medical records.
Pacheco was first introduced to Vazquez when she was being prepped to go into surgery, shortly before receiving anesthesia, Ward said.
'She had the expectation that any physician operating on her would have familiarized himself with her medical records, both prior to surgery and as necessary during the surgery,” he said.
An expert brought in to look at the case, Dr. Christian Birkedal of Daytona Beach, wrote in August that 'the surgeon should have reviewed the X-rays before surgery and should have biopsied the mass prior to removal.”
Vazquez told the Florida Board of Medicine on Dec. 7 that he now makes sure to review all films of patients and will only work with a limited number of orthopedic surgeons. He said the radiology results for Pacheco, however, were not at the hospital at the time of the surgery.
'I'm definitely working from a blind perspective,” he told the board.
The malpractice insurers for Pacheco's primary surgeons, Dr. John Britt and Dr. Jeffrey Kugler, settled for $250,000 apiece, according to the state Office of Insurance Regulation.
Vazquez does not carry malpractice insurance and settled the case for a nominal amount, his attorneys have said.
Neither Britt nor Kugler face disciplinary action in the Pacheco case - though the Board of Medicine inquired about it during Vazquez's hearing.
A physician removing a functioning kidney by mistake is rare but not an unknown medical error. The consequences for the patient, however, can vary.
Ward said Pacheco's body is able to function with one kidney, but she is now more susceptible to chronic kidney disease and renal failure.