Consultant review calls embattled Chiari Institute a 'jewel'

A consultant hired by the North Shore-Long Island Jewish Health System called the organization's embattled Chiari Institute "a jewel" and "the finest center of its kind in the world" in a report the health system is to release Tuesday.

State's health commissioner Dr. Richard Daines praised North Shore-LIJ for commissioning the review and described the institute as "highly respected in the medical community." Last month, officials said the institute's founder and leading surgeon remained under investigation by the health department.

Dr. James Ausman, a professor of neurosurgery at UCLA and editor of Surgical Neurology International, was paid an undisclosed amount by North Shore-LIJ "to conduct an independent analysis" of the institute, said the health system's chief medical officer, Dr. Lawrence Smith.

The institute, the largest in the world to treat Chiari malformation, a relatively rare brain malformation, came under scrutiny last April when two of its surgeons were accused of not showing up to operate on Jennifer Ronca of Tunkhannock, Pa., then 32, when she was under anesthesia. Five months later, the health department cited North Shore for 14 deficiencies in how it handled that case. The hospital was not fined but submitted a plan to address most of the state's concerns.

The health department's Office of Professional Medical Conduct - which conducts its probes in secret - is also investigating the two surgeons, Dr. Thomas Milhorat and Dr. Paolo Bolognese, two officials with knowledge of the investigation have said. The probe is focusing on a controversial surgery for Chiari malformation and related abnormalities. The health department would not comment on the investigation.

Close to 40 lawsuits have been filed against the institute charging that some surgeries at Chiari were unnecessary, said attorney Steven Knowlton, whose firm Goldsmith Ctorides & Rodriguez is representing the patients.

Questions about how and when to operate have prompted a national pilot study at 12 hospitals sponsored by the nonprofit American Syringomyelia & Chiari Alliance Project.

The report, which the health department examined, demonstrated that "the hospital takes a cautious approach to performing surgery," Daines said.

Ronca's attorney, Mark Bodner of Manhattan, said the report was "one-sided" because it failed to comment on patient safety issues raised by Ronca's case. "That's glaring if he is going to do a well-balanced report," Bodner said.

Knowlton declined to comment because he said he had not read the report.

Ausman, who could not be reached for comment, concluded that the institute thoroughly screened and evaluated patients; performed surgery on 30 percent of those evaluated, which Daines said showed the institute's caution before operating; and employed established treatments "used by others around the world." He also said the institute also saw improvements in more than 80 percent of those operated on, wrote off or discounted 50 percent of charges; and extensively published on its research.

As part of his review, he examined 15 randomly selected cases and one case requested by Dr. John Morley, medical director of the Office of Health Systems Management in the state health department. The case involved an operation on Katie Bryant, 4, from Hayden, Idaho.

Claudia Hutton, a health department spokeswoman, said Morley made the request because Bryant's case was identified in a news story that raised questions about how patients were identified for surgery. Ausman found that Milhorat and Bolognese had made "a compelling and objectively based case" for her surgery.