Editor’s note: This is the first part of a two-part series on the state’s disciplinary case against Dr. Steven Anagnost. Part two will publish Thursday on The Frontier.
Texas Gov. Rick Perry wasn’t happy when Oklahoma authorities wanted to revoke the medical license of a Tulsa surgeon accused of performing operations that left patients paralyzed, in perpetual pain – or dead.
So Perry made a phone call to Gov. Mary Fallin and soon afterward, a three-year, $600,000 state investigation came to an end.
The surgeon, Dr. Steven Anagnost, still practices in Tulsa and other locations in the state. The Oklahoma State Board of Medical Licensure had been trying since 2010 to revoke his license. A memo recently obtained by The Frontier reveals that Perry called Fallin, a fellow Republican, on Anagnost’s behalf.
Perry was governor of Texas at the time and preparing for his second ill-fated run for the GOP presidential nomination. A few years earlier, Perry had received a campaign contribution from Anagnost and from the man who called Perry on the surgeon’s behalf.
When Fallin’s general counsel, Steve Mullins, met with key staff members at the Oklahoma Board of Medical Licensure and Supervision in March 2013, Perry’s intervention was part of the discussion.
“He (Mullins) told us that he wasn’t here to interfere with the work of the board but Gov. Fallin didn’t want any more calls from Rick Perry about this, that Gov. Perry said it was a travesty and what would it take to make it go away,” Dr. Eric Frische, the board’s medical advisor, later wrote in a memo.
The memo detailing Perry’s phone call was among thousands of pages of records obtained by The Frontier from Anagnost. It is among the records gathered by the state and Oklahoma Bar Association during its investigation.
A Perry spokesman did not respond to repeated requests for comment. Mullins, through a spokesman, declined comment.
The Oklahoma medical board first launched an investigation into Anagnost, 48, in 2010. It eventually filed a complaint accusing him of serious violations involving 23 patients: performing surgeries in which patients died or were paralyzed, or charging for surgeries not performed. Other accusations involved failed surgeries in which Anagnost implanted a spinal device that he was paid to promote.
At the time, Anagnost had been named in dozens of malpractice lawsuits and had settled several cases by paying out of his own pocket instead of through his medical liability insurance.
However he rejects all claims of negligence, saying a handful of bad patient outcomes were due to factors beyond his control.
Case ‘too far along to just go away’
For Alyson King, news of Anagnost’s settlement with the state was incomprehensible.
She didn’t know about the call from Perry or the visit from Fallin’s attorney to the medical board.
King said she awoke from a 2007 surgery by Anagnost unable to feel most of her left leg and foot. The 45-year-old Tulsan, a mother of three children, is among the patients who filed complaints with the state and among more than 40 plaintiffs who sued Anagnost for negligence.
The lawsuit 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 told recently of the involvement of two governors in Anagnost’s case, King said: “I’m sick to my stomach.”
“I feel like the medical board’s job is to protect patients, and I personally would like to know that future patients are safe,” she said.
King’s claims about Anagnost, 48, are not unique. At least five patients have claimed one or both legs were paralyzed after the Tulsa surgeon operated on them, records show.
Despite Mullins’ statements that Fallin didn’t want to interfere, the board’s investigation of Anagnost took a decidedly different turn after that 2013 meeting.
“After Mr. Mullins left we talked among ourselves and with reluctance we considered our options, realizing that we had been told to try and get rid of the case,” Frische’s memo states. “We began to work on an agreement that involved the doctor not agreeing to any guilt.”
Frische and other staff at the medical board declined to comment for this story.
Anagnost recently told The Frontier that he agreed to the settlement instead of demanding a hearing based on his attorney’s advice. He said he regrets that decision and has filed lawsuits to overturn the settlement, which are ongoing.
“The board has their tactics well sharpened,” Anagnost said. “They’ve done this many a time.”
Anagnost rejects the notion that his political connections and Perry’s intervention had anything to do with the outcome of the board’s investigation.
“If the board believed that to be true and the attorney general knows about that, then the attorney general has an obligation to pursue it. That’s borderline criminal,” he said.
Anagnost said the memo was written by officials trying to protect their political careers “because of this huge screwup” in how his case was handled.
Frische’s memo apparently was written to document the disciplinary case’s meandering path and what he viewed as political pressure to resolve it. His memo recounts the conversation Frische and two other board officials had with Mullins.
Frische told Mullins the board couldn’t abandon Anagnost’s disciplinary case, no matter who wanted that to happen.
“We attempted to discuss the case and express the seriousness of the charges and findings and that it was too far along to just go away,” his memo stated. Mullins, however, said Fallin was concerned Anagnost’s case “would result in some bad law and the governor didn’t want that.”
Soon after the meeting, the board began settlement talks that led to a deal.
When the settlement between the state medical board and Anagnost was finally ready for the board’s approval, Attorney General Scott Pruitt’s office — which handled the negotiations — was apparently concerned the board might not vote to accept it.
Frische’s memo states: “The plan is to frighten the Board members into voting for this settlement or otherwise they might be subject to lawsuits if this case continues.”
The memo also states that an assistant attorney general told medical board staff if they took action against Anagnost, there could be “a ‘quagmire’ of court cases and depositions and that we should just drop the matter or settle it in any way we could.”
“The guys from the AG’s office said he (Dr. A) would probably leave the State and go elsewhere,” the memo states.
Instead of going elsewhere, Anagnost stayed in Oklahoma, admitted no guilt and kept his medical license. 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. The board determined that he was competent to practice.
Alex Weintz, a spokesman for Fallin, confirmed the governor’s office intervened in the case but said Fallin was “agnostic” on its outcome.
“Our office, through Steve Mullins, communicated that basically they needed to either act against Anagnost or drop the case. … We just didn’t want a state agency to have a case that was open ended and went on for years,” he said.
Anagnost said he’s “not perfect,” but he has denied fault in all of the claims filed against him at the medical board.
Post-surgical injuries and poor patient health contributed to a few bad patient outcomes, he said. And Anagnost launched his own offensive, alleging the board’s investigation was biased and that several board members had conflicts of interest.
Doctor not given ‘minimal due process’
The board first tried to revoke or suspend Anagnost’s license in 2010 and its investigation continued for three years.
The Tulsa surgeon filed a lawsuit against the board in 2012 that ended up before the Oklahoma Supreme Court.
In a 5-4 decision, the court declined in 2013 to intervene in the medical board’s investigation of Anagnost, with the majority saying there was no reason to interfere with the administrative process.
However, the four dissenting justices noted apparent conflicts of interest and other procedural problems with the investigation. One dissenting justice stated that the board failed to give Anagnost “even the minimal due process” he was owed.
Anagnost said he believed it was the state Supreme Court’s criticism, not political pressure from Fallin or Perry, that prompted the settlement.
Anagnost said the investigation focused only on problem cases and didn’t look at his outcomes as a whole, which he said were better than average.
“I know that I’ve never done a perfect job on any patient I’ve worked on … but it’s not fair to look at anybody at a single point in their career,” he said.
Internal medical board memos support Anagnost’s assessment of how the state handled his case.
After the state’s first hearing in 2010, Frische wrote a memo noting that the board had failed to interview Anagnost beforehand.
“First of all, we should have interviewed the doctor,” states the memo dated June 20, 2010. “I think we felt that we wanted to catch him off guard but clearly he wasn’t. … In future cases like this one, we might consider an interview with multiple interviewers and do so on the record and probably in our Board office where we can record the interview. That should be adequate to catch doctors off guard.”
Exactly how much influence the intervention by Perry and Fallin had on the outcome of Anagnost’s complaint is unclear. However, a 2013 medical board memo does shed light on who prompted Perry’s interest in the first place.
After the March 2013 meeting, Mullins provided more details about Perry’s call to the medical board’s executive director, Lyle Kelsey.
“Lyle … discovered that the doctor had a benefactor by the name of Dick Powell who was very wealthy, a significant contributor to Rick Perry and also a surrogate father to the doctor and that he was behind the effort to get rid of this,” Frische wrote.
“Dick Powell” is Richard C. Powell, of Knoxville, Tenn. Records list him as an officer in a Texas company that owns a Fort Worth IHOP and officer of a Tennessee restaurant company.
Powell contributed $2,500 to Perry’s presidential campaign in 2011, the maximum amount allowed. A 2011 press release identifies Powell as a member of the Perry campaign’s Tennessee finance team.
Anagnost and Powell’s son, Richard C. Powell Jr., were classmates at The Webb School, an exclusive boarding school in Tennessee. Anagnost is from Knoxville and later graduated from the University of Tennessee’s medical school.
The younger Powell also has ties to Texas, and to Republican Party movers and shakers in the Lone Star state.
Anagnost, who also contributed $2,500 to Perry’s campaign, said he asked his friend’s father for help getting the attention of a state agency he believed was hell bent on taking his license. He said he sees nothing wrong with calling on powerful friends to correct what he viewed as an injustice.
‘I can’t feel my privates’
Though he agreed to settle the investigation in 2013, Anagnost’s case is far from over. It has moved back to the courts, with Anagnost suing four Tulsa neurosurgeons who took part in the board’s investigation, the state medical board, several board staff members and attorneys who helped the board.
At one recent hearing in Oklahoma County District Court, 17 attorneys from some of the state’s top law firms appeared before an exasperated judge to represent Anagnost and all of the parties he is suing. The judge is the third to handle Anagnost’s lawsuit seeking to throw out his settlement agreement.
In court filings, attorneys for the board and the neurosurgeons who took part in the investigation have denied Anagnost’s claims of a biased process.
Meanwhile in Tulsa County, Anagnost continues to fight and settle negligence lawsuits in which he is a defendant. Out 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.
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 Practitioners Databank, saying his staff was unaware of them.
Lawsuits against doctors are not unusual if they practice long enough. However, records show two of Anagnost’s competitors who also practice spine surgery had 10 lawsuits combined filed against them during the same period, settling four.
In a motion, attorneys for one former Anagnost patient remarked on the number of lawsuits: “A casual review of OSCN public court filings does not reveal the name of any other physician who has been sued more often in such a short period of time than has Steven Anagnost. This is, at best, an extraordinary record of unhappy patients.”
In fact, the Orthopaedic Center Inc. asked a judge to seal public access to lawsuits in which it was a named defendant while the lawsuit was pending “based on the prejudice that would result should a potential juror review the OSCN docket sheet.”
Anagnost performed surgeries at the center, a subsidiary of Hillcrest Medical Center, which is named as a defendant in many of the lawsuits against him. A spokeswoman for Hillcrest declined to comment for this story.
That lawsuit is among several suits Anagnost settled related to his use of a medical device called the Danek Satellite ball. The device was designed to be inserted between the vertebra, holding them in place while they heal and fuse together.
In a deposition with the medical board, Anagnost states he had a financial relationship with Medtronic, the company that made the device, that began in 2004 or 2005.
“I was part of the panel to get that ready. … We were designing the study itself,” he said. “But the device got recalled before the study was fully underway. … We got no results out of that study so we did a pilot study but the FDA study was eventually shut down.”
Records show the FDA approved the device for use in specific types of spinal surgery in 2005, with restrictions warning of a risk to patients if implanted in other ways. The company signed consulting agreements with Anagnost and other doctors that year.
According to the medical board’s complaint, Anagnost taught and lectured on behalf of Medtronic in locales including the Bahamas.
The FDA issued a warning letter in 2007 ordering Medtronic to stop distributing marketing materials instructing doctors to use the Satellite in a way that was not approved.
In his deposition, Anagnost states he had implanted the device in patients during 50 to 100 surgeries. He said he did not recall when he became aware of the FDA’s limitation on use of the product.
FDA records show the device was recalled in October 2007 and surgeons who had implanted the devices were notified by letter.
In an interview with The Frontier, Anagnost said he didn’t know how much Medtronic paid him as a consultant.
In one of the suits settled by Anagnost over the Satellite device, a former patient alleged the doctor failed to inform him about the FDA limitations and how he planned to use the device.
“Anagnost never told his patient he was then a paid consultant for Medtronic who travelled around the country promoting the Satellite device … and that Anagnost’s first experience with the device was implanting it in the lumbar spine of a cadaver a mere 24 days prior to Anagnost and the plaintiff meeting each other,” states a filing in the lawsuit.
The patient, a man identified only as RMM in the medical board investigation, allegedly awoke from lower-back surgery with numbness and weakness in his legs. Anagnost returned RMM to surgery but his symptoms continued, with the patient telling nurses: “I can’t feel my privates.”
The medical board’s complaint states RMM suffered permanent neurologic injuries as a result of the surgery. Anagnost attributed the complications to an unrelated post-operative injury, though an MRI did not support that diagnosis, the complaint states.
Court records show the case was settled just before a trial was to begin in 2013.
Kassie McClung, a correspondent for The Frontier, and Brandi Grissom, Austin Bureau Chief of the Dallas Morning News, contributed to this story.