MAYSVILLE—At first glance, surgeon John Christian Gunn seemed golden.
A graduate of Yale Medical School, he was eager to join Maysville's Meadowview Regional Medical Center, an acute-care facility that couldn't wait to get him on staff, according to court documents.
But within months of his 2005 arrival in Kentucky from Hillsboro, Texas, two of Gunn's surgeries had gone dangerously awry, leading a Maysville physician to bluntly write to a hospital administrator saying that Gunn was a danger to patients.
Shortly after that warning, 71-year-old Herberta "Bertie" Lang was dead following one of Gunn's surgeries. Ironically, the physician who had warned the hospital was Lang's personal doctor.
A trial is scheduled to begin Monday in Mason County Circuit Court, where Lang's family has sued Meadowview, its former chief executive and the company that operates the hospital for corporate negligence.
Gunn's insurance company settled last year with the family. Terms of the settlement are confidential.
Todd Thompson, the attorney for Meadowview Regional Medical Center; its owner, Lifepoint Hospitals; and former Meadowview chief executive officer David Loving did not return phone calls requesting comment.
Gunn was granted temporary privileges at Meadowview even though he had taken and failed the General Surgery Board exams in 2002, 2003, 2004 and 2005. He also failed the exam in 2006.
Hospitals use their own discretion on whether to insist on board certification before allowing physicians to do surgery.
The case raises questions about how the Kentucky Board of Medical Licensure monitors and credentials doctors. When Gunn received his Kentucky medical license in 2006, his temporary privileges at Meadowview had already been revoked. The licensure board file notes that it did not know that.
It's unclear what Gunn did after he left Kentucky. He told the Kentucky Board of Medical Licensure that he was going to Miami for a fellowship, and Florida Department of Health records indicate an active resident's status.
But on Aug. 22, 2008, Gunn entered a bank in Austin, Texas, brandishing an air gun and wearing a paintball mask. He got away with $18,805, according to the FBI.
He was captured just a few minutes later in a black Ford pickup at a nearby car wash. Gunn later pled guilty to bank robbery and was sentenced to 51 months in prison.
He's now serving time at Louisiana's Oakdale prison.
Mason County Circuit Court shelves groan beneath the weight of more than three years of filings in the Lang case. The family's attorneys allege that Meadowview rushed through Gunn's licensing in 2005 so that it could attract more patients and perform profitable surgical procedures.
Meadowview is a 101-bed, acute-care hospital operated by Lifepoint, a Brentwood, Tenn.-based chain that also owns Kentucky hospitals in Georgetown, Lebanon, Mayfield, Paris, Russellville, Somerset and Versailles.
Small hospitals nationwide struggle to find niches of profitable medical service. The Georgetown Community Medical Hospital, for example, is regionally well-known for its weight-loss surgery services.
Because of the rush to find a surgeon in Maysville, the hospital hired Gunn, who was not qualified for the kinds of surgery he was doing, the lawsuit contends. Lang died when Gunn botched an operation on her carotid artery on December 6, 2005, the suit alleges.
Lang's surgery went so badly that medical sales representative Rhonda Rott, who was observing the surgery, was at one point asked to find help from a vascular surgeon in another city, according to court documents. She called a doctor in Ashland.
Sharice Lang Stafford, Lang's daughter, declined to comment for this story.
But "Bertie" Lang was beloved around Mason County, according to Ernie Hillenmeyer, who worked with her for more than 40 years. She always had time to help out her neighbors, and did volunteer work for St. Patrick's Church, senior citizens and the fire department, said Hillenmeyer, a part owner of the now-defunct Parker Tobacco Co., where Lang was a secretary.
She was devoted to her three children, including a daughter with permanent developmental delays.
"She was just a vibrant, wonderful lady," said Hillenmeyer.
Headhunting a surgeon
How did a Yale medical school graduate wind up at a small Kentucky hospital performing surgeries for which he was allegedly unqualified?
The lawsuit says that Gunn was located by a headhunter and was paid "substantial financial incentives" to start a surgery practice that would expand the range of services available at Meadowview.
While Gunn was hired to do general surgery, he also wanted to perform thoracic and vascular surgery, for which he would be the only surgeon on the staff at Meadowview, according to the lawsuit.
On September 22, 2005, Gunn was granted a temporary permit by the Kentucky Board of Medical Licensure, allowing him to practice medicine in the state pending review of his application. Just four days later, the hospital granted him temporary privileges to perform surgery.
The hospital contends in court filings that Gunn was interviewed more than once, that information about him was obtained from "multiple professional references as well as the National Practitioners Data Bank," and that Gunn was licensed to practice medicine in Kentucky.
William Schmidt, executive director of Kentucky's licensure board, said that had Gunn's three questionable surgeries at Meadowview been reported to the board, "we probably would have opened an investigation and canceled his temporary privileges."
Hospitals are legally required to report to the board, he said, "but we can't enforce that" because the board deals with medical practitioners, not hospitals.
The board issued an order of indefinite restriction on Gunn's medical license on Nov. 15, 2007, after reviewing his performance at Meadowview. By that time, he had not practiced in Kentucky for nearly two years.
Gunn received early sterling reviews from Yale that seemed to promise a solid future in medicine. But his career faltered after he left.
After finishing his medical degree at Yale, Gunn completed a residency in General Surgery at Wayne State University, where he was placed on probation in 2001 based on concerns that included "inappropriate behavior" with patients and hospital personnel.
An evaluator at Wayne State described Gunn as "clueless on patient care issues, no operative skills, needs to a) repeat a year, b) be dismissed."
Gunn also finished a 2002-2004 fellowship in cardiovascular and thoracic surgery at Loyola University Medical Center.
Gunn later landed as a surgeon at Hill Regional Hospital in Hillsboro, Texas. There, a prickly personality asserted itself. He compared working with operating room nurses to working with a barrel full of monkeys, as noted in a deposition by Jan McClure, chief executive officer of the hospital. Patients complained of rudeness.
Gunn departed Texas for Kentucky in 2005.
Still, in 2006 Gunn called McClure and asked if he could return to Hill Regional, saying the move to Kentucky had been a mistake.
"He said he had learned his lesson," McClure said in her deposition, "that if I would allow him to come back ... he would do whatever he needed to do."
He wasn't invited back.
Standard of care
On Nov. 21 and 22, 2005, court documents from the Lang family's attorneys allege that during two laparoscopic gallbladder removal surgeries at Meadowview, Gunn caused life-threatening bile duct injuries to his patients — mistakenly tying off the common bile duct. Both patients were transported to the University of Kentucky Hospital for emergency corrective surgery. Separate lawsuits for each of those cases are still pending, according to Mason Circuit Court records.
On Dec. 3, 2005, Maysville physician Dr. Leroy Gallenstein, who had been alerted to one of the failed gallbladder surgeries by the mother-in-law of one of the patients, sent an e-mail to Loving, the Meadowview CEO, demanding immediate suspension of Gunn's privileges until an investigation could be done, adding that if there are "further bad outcomes ... the lion's share of the liability will (and should) be your responsibility."
Gallenstein referred to a gallbladder surgery in which the patient "is now at UK in the ICU (intensive care unit) because Dr. Gunn stapled her common duct instead of the cystic duct. A liver transplant surgeon is trying to fix the mess."
Wrote Gallenstein: "I was surprised that this was not the only case."
"I can understand a physician making a mistake but this is over the top," Gallenstein wrote. "... I am afraid for the safety of the patients in this community. I will no longer refer patients to him."
On Dec. 6, 2005, Gunn performed surgery on Lang at Meadowview.
Legal filings from the family's attorneys claim that Gunn should have used a shunt, a small plastic tube that diverts blood flow around the surgically opened carotid artery and assures adequate blood flow to the brain, before attempting to clear the artery. According to court documents, he did not use one.
Gunn's operative report describes "a complete disintegration of the internal carotid artery that did not allow the hold of stitches in any form."
In a later deposition, Gunn said that "the vessel wouldn't hold stitches, the vessel disintegrated, the vessel was weak, the vessel wall was mushy, the vessel wall was like wet toilet paper."
Lang was later emergency airlifted to Saint Joseph Hospital in Lexington. She suffered a stroke and severe respiratory distress and died Dec. 8.
A doctor's notes on Lang's arrival at St. Joseph Hospital say that Gunn noted a "friable carotid artery" — one that had degenerated and was prone to disintegration — and had had to ligate, or tie off, the artery.
Gunn's temporary privileges at Meadowview were suspended on Dec. 7, 2005.
Gunn was later asked in a deposition if there was anything he could have done to have changed the outcome of Lang's surgery.
His response: "I don't think there's anything that would have changed the outcome. The only thing I could have done was not do the operation."
A January 2006 independent "quality of care peer review" requested by Meadowview and on file in Mason Circuit Court concluded that "the standard of care was not met, with injury occurring or reasonably probable. In all probability, the injury/ligation caused the permanent stroke and death."
In 2007 the Kentucky medical licensure board asked Gunn to submit to a clinical skills assessment. It concluded that Gunn's "medical knowledge in the surgical areas discussed ranged from marginally adequate to poor." Overall, his knowledge was "marginally adequate to poor." It recommended that he retrain with "full supervision while updating his knowledge base."
Gunn told the board that he intended to enroll in a one-year fellowship program in cardiothoracic transplantation and mechanical assistance devices at the Miami Transplant Institute at the University of Miami. Florida state records show that Gunn was granted a clear and active residency status there on Feb. 5, 2008.
Meadowview Regional Medical Center in 2008 announced that it was providing new cardiac care services, including angioplasties, procedures in which a cardiologist inflates a tiny balloon inside an artery to clear a blockage.
The Texas Medical Board suspended Gunn's medical license on July 7.
According to Texas board notes, "The action was based on Dr. Gunn's incarceration in a federal correctional institution."
Lexington attorney Robert F. Houlihan Jr., who is representing Lang's family in the lawsuit against the hospital and its parent company, says the case is about "whether the Maysville hospital met the standard of care and complied with its own policies in granting privileges to Dr. Gunn."