Editor’s note: This story is the second part of a series about the state’s case against Dr. Steven Anagnost. Read part one here.
Settle the complaint or Dr. Steven Anagnost will probably sue, an assistant attorney general advised staff at the Oklahoma Board of Medical Licensure and Supervision during a 2013 meeting.
The board did settle its case against Anagost, prompted by complaints involving 23 former patients. Anagnost sued anyway.
The tangled web of lawsuits and investigations has cost millions in legal fees for the medical board, four Tulsa neurosurgeons and attorneys named in Anagnost’s complaints to the Oklahoma Bar Association.
The medical board alone spent nearly $600,000 to investigate Anagnost, who said he spent $1 million of his own money on legal fees. During an August hearing in Oklahoma County District Court, more than a dozen attorneys from some of the state’s top law firms represented various parties to the lawsuits.
The case also prompted intervention by two governors, legislative hearings, allegations of witness intimidation and disputes over documents the surgeon “purloined” from the Bar Association.
Anagnost’s former attorney, Barry Smith, summed up the ongoing battle between the surgeon and the state during a legislative hearing in January: “Wherever you are on the scale about Dr. Anagnost, you can’t help but draw the conclusion that the process here failed miserably.”
Patients’ paralysis, deaths ‘unfortunate outcomes’
The state’s allegations against Anagnost are among the most serious it has lodged against a doctor.
Its complaint alleged some patients were left with permanent injuries – including paralysis and one amputation – after Anagnost operated on them.
One patient died Aug. 8, 2008, six days after Anagnost placed a plate in his neck. Anagnost ordered him sent home the day after his surgery though he was coughing and choking, the complaint states.
Another patient experienced breathing problems and died following a similar neck surgery by Anagnost 10 days later, records show.
Several patients thought Anagnost had operated on their spines, only to be told by other surgeons there was no evidence of such operations, according to the complaint filed by the state against Anagnost.
Anagnost has said he is not responsible for any of the injuries or deaths involving his patients and that claims he failed to perform surgeries are also untrue.
“These are all unfortunate outcomes,” he told the medical board in a deposition.
He told one patient who complained of complications that she may have multiple sclerosis and concluded others had unrelated disorders that surfaced after surgery. Some patients were simply in poor health, he said.
Anagnost told The Frontier the Oklahoma medical board’s investigation was sparked by jealous competitors who worked with a state agency to ruin his prosperous practice.
“Their purpose was to exclude Dr. Anagnost from the spinal surgery market in Tulsa,” Anagnost claimed in a lawsuit against four Tulsa neurosurgeons.
Anagnost can no longer perform surgeries and admit patients to Hillcrest Medical Center, a defendant in many of the 45 negligence lawsuits filed in Tulsa District Court against him. He has recently shuttered a 20,000-square-foot surgery center he operated in southeast Tulsa.
A spokeswoman for Hillcrest declined to comment on Anagnost’s case. The hospital has fought attempts by the medical board and patients suing him to gain access to Anagnost’s peer review file and the outcomes of complaints, records show.
Anagnost now practices in Tulsa and treats patients at locations including the Northeastern Health System, a Tahlequah hospital operated by a city authority.
“I’d like to think that I’m my biggest critic. I take this very personally and I know that I’m not perfect. I know that I’ve never done a perfect job on any patient I’ve worked on,” he said.
Anagnost said the board — which investigated him from 2010 through 2013 — was focused merely on finding his “bad outcomes.”
“If you lined up any doctor’s bad outcomes, any doctor would (look bad). The truth is I was busy because I was doing good work.”
A review by The Frontier showed that of 45 negligence lawsuits filed against Anagnost in the past decade, 19 are listed in court records as settled and nine remain pending, as of September.
One patient who filed a complaint and lawsuit against Anagnost, Alyson King, said she was shocked at the outcome of the state’s disciplinary case.
King, a 45-year-old Tulsan, alleges that Anagnost caused permanent neurological injury to her leg and left her with a condition known as foot drop. Her lawsuit states she has frequent pain from the “multiple inappropriate and negligent” surgeries performed by Anagnost.
“When I found out that he was going to be able to perform surgeries again, my stomach was just sick. … I trusted him, I really trusted him and I believed 100 percent in him being competent and that’s what scares me for his current patients.”
Anagnost has denied he was negligent in King’s case and in other complaints and lawsuits by former patients.
Anagnost settled at least five lawsuits out of his own pocket, rather than from an insurance settlement. He did not report the settlements to the medical board as required by state law or to the National Practitioner Data Bank, saying his staff was unaware of them.
AG’s office to board: ‘Just drop the matter’
Frustrated by a state investigation that had taken years, Anagnost sued the board in 2012.
The state Supreme Court voted 5-4 against hearing Anagnost’s legal challenge, but the four justices issued strongly worded dissents. They noted that a malpractice lawyer who was a member of the medical board, Gary Brooks, had filed lawsuits against Anagnost while on the board.
“At the very least Dr. Anagnost is correct that this creates the appearance of a conflict of interest,” the dissenting justices wrote.
The justices found other problems with the board’s investigation of Anagnost, including a lack of due process and failure to follow board rules.
“It may be that the board’s allegations against Dr. Anagnost have merit and it may be that they do not, but that does not mean the board is entitled to proceed in a manner which tramples over the requirements of due process,” the dissenting justices state.
Shortly after the Supreme Court’s decision, Gov. Mary Fallin’s office intervened in Anagnost’s case, dispatching her general counsel to talk to board staff, records show.
Fallin had received a call from Texas Gov. Rick Perry on the doctor’s behalf. Anagnost had a childhood friend whose father, Richard C. Powell, of Knoxville, Tenn., was a maximum contributor and member of the Perry campaign’s Tennessee finance team.
Anagnost also contributed the maximum to Perry’s failed presidential bid.
A 2013 memo written by the board’s medical advisor, Dr. Eric Frische, discussed the visit from Fallin’s general counsel, Steve Mullins, and advice from Attorney General Scott Pruitt’s office.
“Most of the conversation was from the AG telling us … all they needed to do was turn one Supreme court Justice from the earlier 5 to 4 decision and we would lose,” Frische’s memo states, “and if we didn’t lose and had a hearing with adverse action against the doctor there would be a ‘quagmire’ of court cases and depositions and that we should just drop the matter or settle it in any way we could.”
Anagnost said he settled the case on the advice of his attorney but he regrets doing so.
Anagnost kept his license while admitting no guilt. He paid a $10,000 fine and agreed to additional training on medical procedures and physician billing practices.
Five months later, Anagnost was back before the board, which found he had completed all requirements of the settlement and was competent to practice.
Medical board staff predicted Anagnost’s case wouldn’t end there, however. And they were right.
“Lyle doesn’t think his job is in jeopardy but as I consider the matter, there will be a need for a scapegoat,” said Frische’s memo, referring to medical board Executive Director Lyle Kelsey. The memo was dated Sept. 11, 2013, the day before the settlement was approved.
“I think the doctor will stay in Tulsa and be able to regain his hospital privileges. … Given the animosity … short of an actual hearing, I do not believe this will go away.”
Indeed, the settlement merely marked a new phase in a lengthy and expensive legal battle.
Two months later, Anagnost filed a new suit against the Medical Licensure Board trying to undo the settlement he agreed to, saying it was “obtained by fraud.” His suit also named four Tulsa neurosurgeons he claims assisted in the board’s investigation.
The suit names physicians Clinton Baird, Christopher Boxell, David Fell and Frank Tomecek individually. It also names the Tulsa Spine and Specialty Hospital LLC, a Tulsa hospital in which the doctors are or were involved.
The suit claims the doctors are “direct competitors of Dr. Anagnost who stand to gain financially from Dr. Anagnost’s destruction.” It states that Tulsa Spine and Specialty Hospital, where two of the surgeons still work, invited him to become a shareholder in 2004 or 2005 but he declined the offer.
The doctors did not return calls seeking interviews for this story. However in court filings, they have strongly denied Anagnost’s claims and say they were cooperating with a state investigation as required by law.
Anagnost’s “claim (that) appellants were out to get him because he was a busy surgeon is not supported by any fact,” a motion by Baird and Boxell states. “Appellants sincerely believed appellee (Anagnost) had committed repeated acts of negligence that harmed patients.”
In legal filings, they have said they were trying to protect patients and are protected by a new state law, the Oklahoma Citizens Participation Act.
“Defendants … have been sued for no other reason than the fact that they voiced their opinions and concerns about Dr. Anagnost and his practice of medicine,” states a motion filed with the Civil Appeals Court in August.
Anagnost also sued three malpractice attorneys involved in the board’s investigation: former board member Gary Brooks, Randy Sullivan and Dan Graves. His suit claimed they used confidential information gathered during the board’s investigation to further lawsuits against him on behalf of patients.
Records show Brooks was a member of the medical board during a time when he sued Anagnost on behalf of former patients.
In court filings, Brooks denies conflicts of interest in Anagnost’s case. The malpractice attorney served as a member of the medical board from 2003 until 2011 but claims he had no role in the hearings or outcome of Anagnost’s case.
“While the amended petition makes obvious the defendant’s animosity toward Brooks, and trial lawyers in general, that animosity is not a sufficient substitute for legally significant factual allegations,” his motion states.
Sullivan and Graves were both prosecutors for the medical board and denied in legal filings that they acted improperly while involved in Anagnost’s case.
In August, an Oklahoma County district judge dismissed all plaintiffs except for the neurosurgeons. The neurosurgeons and Anagnost have filed appeals of the lower court’s rulings with the state Court of Civil Appeals.
‘Another neurosurgeon who will implode?’
In addition to his claims against the neurosurgeons, Anagnost has also sought court approval to use records he obtained from the Oklahoma Bar Association.
Anagnost filed complaints with the Bar Association against three attorneys involved in his case.
As part of its investigation, the Bar subpoenaed the state medical board’s investigative file on Anagnost, including internal emails among board staff.
Such records are confidential by law unless the Bar takes public action against an attorney. Nonetheless, portions of the file have made their way into a state legislative hearing, court filings and an Oklahoma City news website.
In a letter attached to court filings earlier this year, the Bar Association’s general counsel states “to evaluate Dr. Anagnost’s grievance, the OBA needed Dr. Anagnost and his lawyers to review some of the subpoenaed documents.”
“It was made clear that none of the documents could be produced to anyone, since all OBA investigations are confidential,” the letter states.
After the meeting at the Bar Association in April 2014, Anagnost called Assistant General Counsel Debbie Maddox. Anagnost told Maddox “he had accidentally taken some of the documents he had reviewed during the meeting and that he wanted to return them in person,” the letter states.
Anagnost returned the CD and paper documents days later and Maddox followed up with a call to his attorney, reminding him that “the documents could not be used for any purposes.”
The following month, an Oklahoma County District Court judge ruled against Anagnost’s request to subpoena the Bar Association’s file.
In objecting to Anagnost’s use of the “purloined” documents, Medical Board Executive Director Lyle Kelsey said Anagnost had “misappropriated the documents …. falsely representing to the OBA that he did not copy the documents.”
“Plaintiff, in this motion, seeks to profit from his wrongdoing in misappropriating the documents from the OBA. In supporting this attempt, his attorneys risk committing an ethical violation.”
So far, judges have rejected Anagnost’s request to use the Bar Association records. And while they may not prove his allegations, the documents are embarrassing to the medical board.
In one 2012 exchange, the board’s medical advisor discusses the status of Anagnost’s case with a board investigator, Gayla Janke.
“So is this another neurosurgeon who will implode?” Frische asked Janke.
“Hopefully!!!! I shouldn’t say that,” Janke replied.
Despite the warning to Anagnost not to use the Bar Association records, portions were used during a legislative hearing in January chaired by Rep. Richard Morrissette (D-Oklahoma City). Records show Morrissette then supplied the records to Anagnost’s attorneys, who have referred to the records in his lawsuit.
During the legislative hearing, attorney Barry Smith called the legal actions in Anagnost’s case “some of the most unusual that I have ever been involved in.” Smith, who represented Anagnost, is a former president of the state Board of Health and an attorney for nearly 30 years.
He echoed a common statement by those who have been drawn into Anagnost’s case.
“If you’re one of those people that believe that the board’s accusations were accurate, then you can’t be happy with what happened because never, not once, did the board limit his practice. If you’re on the other end of the spectrum … then you can’t be happy with what happened because the process literally destroyed a man’s career and his reputation.”
Kassie McClung, a correspondent for The Frontier, contributed to this story.