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Dr. Paul MacKoul– Co-founder of The Center for Innovative GYN Care and minimally invasive gynecologist with fellowship training who uses advanced laparoscopic techniques like DualPortGYN and LAAM to treat challenging gynecological conditions.
Dr. Paul MacKoul- Introduction
On February 17, 2009, a Patient complained to the Board, alleging wrongdoing by the appellant Dr. Paul MacKoul. On January 17, 2012, the Board accused Dr. Paul MacKoul of engaging in improper behavior while practicing medicine in violation of Maryland law.
As expenses soar, healthcare has become one of America’s most divisive and challenging subjects. Many standalone ambulatory and surgery centers offer patients having routine surgery an economical and efficient option as a result of these escalating prices. Nearly 6,000 ambulatory surgery centers, or ASCs, are trusted with the lives of millions of patients.
Dr. Paul MacKoul claims to be a board-certified obstetrician and gynecologist who specializes in laparoscopic surgery. He was also charged under the same statute for alleged misbehavior towards another Patient.
After a two-day hearing, the Administrative Law Judge at the Office of Administrative Hearings (“OAH”) issued a proposed decision on March 12, 2013, concluding that Dr Paul MacKoul was guilty of unprofessional conduct concerning the Patient. Following a Board-approved Exceptions Hearing on July 24, 2013, the Board issued a Final Decision and Order on June 3, 2014, imposing a reprimand and requiring Dr. Paul MacKoul to complete a Board-approved intensive course on physician-patient interactions.
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Dr. Paul MacKoul’s Misbehavior- Story In Detail
Patient A was an 89-year-old woman with a uterine prolapse that could no longer be managed with pessaries. Patient A’s long-term gynecologist, Dr. Carolyn Harrington, had inserted pessaries and recommended a transvaginal hysterectomy.
Dr. Harrington referred Patient A to Dr. Paul MacKoul for a surgical consultation.
The consultation occurred on September 13, 2008, when Patient A and her son
met with Dr. Paul MacKoul. During this consultation, it is undisputed that Dr. MacKoul gave Patient A the name and number of Dr. Jonathan White, a urologist, for her to see before her surgery. Patient A and her family testified that Dr. MacKoul “advised Patient A to see a urologist for further evaluation of her bladder, as a second opinion, and to put her mind at ease if she had any concerns regarding potential incontinence.”
On October 20, 2008, the day of her scheduled surgery, Patient A arrived at the hospital at 2:00 p.m. and was prepared for surgery at 3:55 p.m. Anesthesiologist evaluated Patient A before her 5:00 p.m. surgery, which was planned at that time. Dr. Paul MacKoul participated in two other surgical surgeries during this period. Choosing to undertake this patient’s surgery at that time since it was a speedier, more routine procedure than Patient A’s, Dr. Paul MacKoul started his second surgery at 5:45 p.m.
Then, till 8:00 p.m., he went back to the first Patient’s surgery.
Reference- 2607s14.pdf (state.md.us)
Dr. Paul MacKoul- Allegations implied on Dr. Paul Mackoul
A Patient complained to the Board on February 17, 2009, alleging impropriety by the appellant Dr. Paul MacKoul. The Board charged Dr. MacKoul with improper conduct while engaged in medical practice in violation of Maryland law on January 17, 2012.
Laparoscopic surgery is Dr. MacKoul’s area of expertise as an obstetrician and gynecologist with board certification. Due to his inappropriate actions involving another Patient, he was also charged under the same legislation.
After a two-day hearing, the Administrative Law Judge at the Office of Administrative Hearings (“OAH”) delivered a proposed judgment on March 12, 2013, finding that Dr. Paul MacKoul had acted impolitely toward the Patient. The Board issued a Final Decision and Order on June 3, 2014, imposing a reprimand and forcing Dr. Paul MacKoul to undergo an intensive course on physician-patient relations. This came after a Board-authorized Exceptions Hearing on July 24, 2013, when the Board approved the exceptions.
Dr. Paul MacKoul- Court Reacts to Dr. Paul MacKoul’s Misconduct
Dr. Paul MacKoul was charged on January 17, 2012, by the Board with unprofessional
conduct pursuant to HO §14-404(a)(3):
(a) Subject to the hearing provisions of § 14-405 of this subtitle, the Board, on
the affirmative vote of a majority of the quorum may reprimand any licensee, place any licensee on probation, or suspend or revoke a license if the licensee:
(3) Is guilty of:
(i) Immoral conduct in the practice of medicine; or
(ii) Unprofessional conduct in the practice of medicine
Dr. Paul MacKoul was charged with unprofessional conduct due to his failure to communicate effectively and professionally with Patient A and her family. Dr Paul MacKoul claims that he was denied this “opportunity to present his objections” because there was only one issue to which he had to respond, and he had to respond to the issues as framed.
Dr. Paul MacKoul- A detailed description of the misconduct committed by Dr. Paul
Patient A, an 89-year-old woman, had uterine prolapse that was too advanced to be treated with pessaries. Long-term gynecologist for Patient A, Dr. Carolyn Harrington, implanted pessaries and recommended a transvaginal hysterectomy.
Dr. Harrington advised Patient A to see Dr. Paul MacKoul for a surgical consultation.
Patient A and her kid visited Dr. Paul MacKoul for a consultation on September 13, 2008. Unquestionably, at this consultation, Dr. Paul MacKoul provided Patient A with the name and contact information of urologist Dr. Jonathan White so that she might get in touch with him before having surgery. According to Patient A and her family’s evidence, Dr. Paul MacKoul “advised Patient A to see a urologist for further evaluation of her bladder, as a second opinion, and to put her mind at ease if she had any concerns regarding potential incontinence.”
Patient A arrived at the hospital at 2:00 p.m. on October 20, 2008, the day of her scheduled operation, and was ready for surgery at 3:55 p.m. Before Patient A’s scheduled 5:00 p.m. surgery, an anesthesiologist evaluated her. During this time, Dr. Paul participated in two further surgical procedures. Dr. Paul began his second operation at 5:45 p.m., deciding to operate on this patient at that time because it was a speedier, more routine procedure than Patient A’s. Paul then returned to the first Patient’s procedure till 8:00 p.m.
Dr. Paul MacKoul’s decision to take a course on doctor-patient relations was made by the Boards.
The daughter of Patient A brought a grievance against Dr. Paul MacKoul to the Board on her behalf. The Board charged Dr. Paul MacKoul with engaging in “unprofessional behavior in the practice of medicine” by Maryland Medical Practice Act Section 14-404(a) based on the following assertion:
“The elderly Patient, who had spent hours preparing for surgery, was not informed by Dr. Paul MacKoul that the surgery he was supposed to perform on her had been postponed.”
The Board decided to require Dr. Paul MacKoul to take a course on patient-physician relationships. The circuit court supported the Board’s judgment after Dr. Paul MacKoul requested judicial review, which prompted Dr. Paul MacKoul to file an appeal.
Dr. Paul MacKoul- Need to have access to the information inside the surgical centers
An investigation by Kaiser Health News and USA Today Network found that surgical centers operate in states across the country under a patchwork of varying standards, making it difficult to alert authorities in the event of fatalities or serious injuries, much alone potential patients. The oversight loopholes permit facilities that have gotten the heaviest penalties from federal regulators to continue operating, according to interviews, an analysis of hundreds of pages of court documents, and material obtained through open records laws. No legislation forbids a doctor who has been expelled from a hospital for misconduct from opening a surgery facility close by.
The KHN/USA Today inquiry raises questions about the need for more extensive oversight of surgery centers because hospitals often have more open access to vital information, such as data on surgical outcomes. The disparity persists even though the nation’s 5,600 operating rooms do increasingly complex procedures and are now more numerous than hospitals.
Leah Binder, CEO of LeapFrog Group, stated: “It’s shameful that there is so little information” about what takes place at surgery centers.
In American hospitals, scrutinizing unplanned deaths is standard practice. The Joint Commission, its primary accrediting agency, advises members to report any unexpected deaths to the accreditor to learn from one tragedy and prevent future ones. The leading accreditation body for surgery centers does not have a comparable policy.
Dr. Paul MacKoul- Medical facilities neglect to report fatal errors.
Due to the growing costs, healthcare is one of the most contentious and difficult topics in America. In response to these escalating expenses, several independent ambulatory and surgical clinics provide patients seeking routine surgery with an affordable and practical option. Millions of patients willingly trust the over 6,000 ambulatory surgery centers, or ASCs, with their lives.
ASCs are nevertheless subject to incredibly lax regulations, at the expense of patients. Hundreds of patients perished as a result of subpar care, faulty tools, and inadequate training many years ago. Problems, transfers to emergency rooms, or other serious mistakes need not be disclosed. When doctors publicly reveal that they hold stock in the hospital where they work, it poses a serious conflict of interest.
The death of a cancer patient whose lungs collapsed as a result of a gynecologist performing an illegal surgery was one particularly horrific occurrence. Dr. Paul Mackoul had his hospital privileges revoked before owning and running the surgical center where this incident took place after a committee review. Many people may also think of the late comic Joan Rivers, whose unreported routine surgery led to her public death, even though it took place in a New York surgical facility.
Summary
As a matter of law, the Board concluded that Dr. MacKoul acted improperly because he:
- Failed to inform Patient A of the need for a urological consultation as a pre-surgical requirement.
- Failed to review Patient A’s chart for pre-surgical clearance.
- Failed to inform Patient A or her family about the delay in her operation before 8:35 p.m. on the day of the procedure.
- Spoke to Patient A and her family in “insulting, combative, and false statements.“
In the present instance, Dr. MacKoul was accused of engaging in improper behavior by canceling the patient’s surgery after she had been adequately prepped. Because of this, Dr. Paul MacKoul overlooked the “charge” of not informing Patient A about the urological consultation as well as the defamatory and hostile language used to address Patient A and her family. He argues that the lack of such notification violated his right to due process.
Wrapping up with a few points to be kept in mind before selecting a surgery facility that is trusted:
- Check A list of facilities that have been approved is provided by the Centers for Medicare and Medicaid.
- Examine your surgeon’s credentials, paying particular attention to information like how frequently they have conducted this kind of surgery.
- In case of emergency, pick a surgical facility that is within 15 minutes of a hospital.
- Utilize the Internet to conduct research and locate consumer evaluations since, in an anonymous setting, individuals are more honest.
- Find out where the surgery was conducted and whether the patient was satisfied with the results if you know someone who underwent the same procedure.
