Ethics Dunce: Plastic Surgeon Dr. Costanza, I Mean Scott Green

Dr. Scott Green, a plastic surgeon, tried to appear before a judge during a remote video-conferenced traffic trial last week from his operating room, while he was working on a patient. This was not a reality show stunt: Green really attempted to do this. Saved time, you know. Busy, busy, busy. Sacramento Superior Court Commissioner Gary Link, presiding over a virtual courtroom at the Carol Miller Justice Center, couldn’t believe what he was seeing: a defendant in surgical scrubs, with his patient just out of view.

“Hello, Mr. Green? Are you available for trial?” asked a courtroom clerk. “It kind of looks like you’re in an operating room right now?” “I am, sir,” Green replied. “Yes, I’m in an operating room right now. I’m available for trial. Go right ahead.” The doctor had his head down, talking as he replaced a nose, pumped up some breasts, or something. Link was dumbstruck.

“So unless I’m mistaken, I’m seeing a defendant that’s in the middle of an operating room appearing to be actively engaged in providing services to a patient. Is that correct, Mr. Green? Or should I say Dr. Green?” Link asked. The video is on YouTube, and one can hear the sounds of medical devices at work, pumping and beeping.

“I do not feel comfortable for the welfare of a patient if you’re in the process of operating so that I would put on a trial, notwithstanding the fact the officer is here today,” the commissioner said.

Hey, no problemo, the multi-tasking doc assured Link. “I have another surgeon right here who’s doing the surgery with me, so I can stand here and allow them to do the surgery also,” Green said, reassuringly.

“I don’t think so. I don’t think that’s appropriate,” Link said. “I’m going to come up with a different date — when you’re not actively involved or participating and attending to the needs of a patient. Let me see if I can get a different date here…I’m concerned about the welfare of the patient based on what I’m seeing,”

The Medical Board of California is investigating. Ya think? It says it “expects physicians to follow the standard of care when treating their patients.” Wait—appearing in a trial while operating on a patient isn’t the standard of care? Was that wrong?

Prof. Turley points out what was wrong:

One of the nine core principles of medial ethics is “A physician shall, while caring for a patient, regard responsibility to the patient as paramount.” There is also the duty to put a patient’s interest before your own as a physician:

“The relationship between a patient and a physician is based on trust, which gives rise to physicians’ ethical responsibility to place patients’ welfare above the physician’s own self-interest or obligations to others, to use sound medical judgment on patients’ behalf, and to advocate for their patients’ welfare.

The problem for Dr. Green is multifold. First, the most serious consequence is if there were any complications or problems with the patient.  Second, there is the potential violation of the patient’s privacy (though the patient remains off camera). Third, there is the obvious medical practice and ethics issue. On the ethical issues, it is not just the Board but the hospital that will have to review the matter. I would be surprised if Green would keep his privileges at hospitals active during the review. While some of the circumstances of the surgery must be determined (like an unforeseeable delay), the key facts are open and obvious. He elected to appear in trial while doing surgery. Most hospitals would be leery of the potential liability in continuing privileges for a physician with such a lack of judgment. If he were later involved in another malpractice case (particularly involving a lack of focus or attention), this case would be raised in court.

Turley also alertly notes that the other surgeon was also failing his ethical duties by not objecting to the irresponsible multi-tasking, an intervention expressly mandated by the American Medical Association.

Doctors have an infamous reputation for being arrogant and overly confident of their godlike abilities, but the fact that this physician’s ethics alarms weren’t set to go off the second the little thought crept into his head, “Hey, why not operate on a patient while I’m in the trial?” is terrifying.

13 thoughts on “Ethics Dunce: Plastic Surgeon Dr. Costanza, I Mean Scott Green

    • When he/she/it does, and you know he/she/it will, there will be a settlement – in which case there will be at least five zeroes if there are no complications, and six or more zeroes if complications are successfully alleged.

      Here’s the reality. Nation of Assholes (copyright 2016 by Jack Marshall) notwithstanding, physicians and surgeons are not normal people and haven’t been for a long time. God bless them; I’m glad they’re all there, but it requires a rare combination of raw intelligence, drive, memory capacity, arrogance and hubris to successfully make it into medical school. It requires all of that on steroids to make it through medical school and the residencies that follow.

      We are all better for those who manage to do so, but personally, I don’t find it surprising that some of those who manage the gauntlet consider themselves Khan-like “superior intellects.” I say this having known a bunch of folks as an undergrad who managed to enter that gauntlet. Not all emerged, either as a doc or someone on the green side of the sod.

      There IS a difference between physicians and surgeons, and it surprises me none that a surgeon would assume that he/she/it could manage a surgery he/she/it considered routine while being pestered by a court proceeding. The only thing that’s changed is the technical capability and societal zeitgeist to do so.

      And that zeitgeist brings us squarely back to Nation of Assholes territory.

  1. “Doctors have an infamous reputation for being arrogant and overly confident of their godlike abilities”

    My late, older, DDS best friend’s favorite quip:

    The difference between God and doctors? God doesn’t think he’s a doctor

  2. I had absolutely no more difficult law clients to deal with than physicians. The worst one was an oral surgeon. Probably the last transaction I closed. Pretty much pushed me out the door. They know more than everyone else, certainly lawyers. About everything. But personally, I’ve known many great physicians as a patient and as classmates and friends. God bless ’em. Thank God they know all the stuff they do.

    • Why didn’t the Doctor just pay the fine? He really wanted to contest a traffic ticket? That’s just dumb whether you’re a physician or not.

      • Anyone arrogant enough to pull this little court-hearing-while-performing-surgery stunt is most likely not the sort of person who is going to accept being punished for breaking a measly traffic law. Of course he’s the kind of dick who would contest a ticket even if he was 100% wrong and caught red-handed.

  3. This is sadly part and parcel of the screw-ups resulting from having events out of context.

    I have had Zoom hearings where parties appear while laying on their couches. They appear at a court hearing, looking at a screen as if they were watching TV.

    They engage in sexual conduct on Zoom where they typically would without Zoom.

    Even I find myself multi-tasking in ways I could not normally do so if I were in the right context. For example, I have to report my continuing education credits in June. Usually, I go downtown to spend a day watching a lecture. Now, while watching the conference from the anonymous comfort of my basement, I get caught up on my push-up regimen—only during the ethics segments, though.

    -Jut

  4. Why are they having court by Zoom? It really reeks of the elitism found in our society. My grocery store checkers have to go to work every day and handle items random people picked up, sneezed on, etc. The same with the people who work at Lowe’s, Wal-Mart, etc. Just think what the school bus drivers and garbagemen have to deal with. I saw the most ridiculous sign yesterday, it asked anyone feeling ill to leave the hospital to protect the workers. Well, where are you supposed to go if you are sick? Why are judges and attorneys so much more important than everyone else that they need to have their business done badly over Zoom. You would think that this means the justice system is much less important than the grocery store or Lowe’s.

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