An anesthesiologist and 2 orthopedic surgeons are facing stiff fines and license suspensions after they allegedly performed diagnostic tests that led to immediate plasma disc decompression on 7 patients — none of whom had spinal abnormalities that justified performing surgery, according to the North Carolina Medical Board.

The physicians, anesthesiologist Neal Michael Goldberger, MD, and orthopedic surgeons Chason Spencer Hayes, MD, and Seth Lewis Jaffe, DO, have received fines of $85,000 each from the North Carolina Medical Board. The fines are the largest amount the licensing agency has levied since being granted authority to issue fines in 2006, according to a published report.

The board also suspended the 3 physicians' licenses for 18 months. However, the board stayed the suspensions immediately, which will let the doctors continue work at Carolina Bone & Joint in Monroe, N.C., and Charlotte, N.C.

Board documents indicate that the process worked like this: Dr. Goldberger performed the diagnostic test, called a discogram, and that most results were positive, indicating patients needed surgery. Either Dr. Hayes or Dr. Jaffe would then perform the procedure. The board raised several objections to the practice, saying it's better to "not have the operating surgeon do both the diagnostic test and the surgery" because it could be a conflict of interest. The board also said none of the 7 patients had spinal abnormalities that justified performing surgery. From August 2006 to September 2008, the board said the doctors performed 900 such procedures on patients who suffered from neck and back pain, typically as a result of motor vehicle or workplace accidents.

The doctors are also accused of unprofessional conduct for sending solicitation letters to personal injury lawyers, advertising the benefits of decompression surgery for people injured in automobile accidents. The board alleges that ArthroWand, makers of the device the surgeons used to vaporize vertebral disc tissue with electrical current, provided the letters. Calls to ArthroWand seeking comment were not returned.

"The board has evidence from which it could conclude the physicians' utilization of the procedure fell below acceptable and prevailing standards of medical practice," the orders said. "Discograms that produce nothing but positive results are invalid."

Robert Nantais, MD, president of Carolina Bone & Joint, disagreed with the board's conclusion. He told the newspaper that the decompression procedure has been used around the world with "excellent results," adding that the doctors' acceptance of the consent order "was a business decision."

"We wanted to get it behind us and get back to doing what we do best, which is patient care," the newspaper quoted Dr. Nantais as saying. "This was not related to patient complaints. The vast majority of our patients did very well."

Insurance companies with "financial responsibility for accident-related injuries," however, did have an issue with the procedures, according to comments the newspaper attributed to Joyce Fitzpatrick, a communications consultant representing the doctors. The doctors billed an average of $74,500 for each 30-minute procedure, and were reimbursed an average of $5,642 per patient, board documents indicate. The doctors stopped performing the surgery in September 2008, after Medicare stopped reimbursing for minimally invasive decompression procedures, says Ms. Fitzpatrick.

Mark McGraw