Carle Clinic Association / Chris Dangles, MD
I was Dr. Chris Dangles’ patient from October 2000 until he abandoned me as a patient in May 2002. During that period of time, Dr. Dangles performed unnecessary surgical procedures on my left and right ankles. (Two on my left ankle and one on my right ankle.) I have been left physically impaired by these unnecessary surgeries, including Dr. Dangles’ deviation from the appropriate standards of care and professionalism and unethical behavior towards me. In addition, I suffered from debilitating major depression and damage to my ability to earn a living, as a direct consequence of Dr. Dangles’ deviation from the appropriate standard of care.
I overcame the major depression and found an excellent orthopedic surgeon to correct Dr. Dangles’ surgical and consequential orthopedic injury to me. And, since my experience with Dr. Dangles, I have learned a lot about ankle surgeries, indications for the surgeries and the appropriate pre-surgical and post surgical standards of care and professionalism. But, at this point, I am left with continued physical damage, lack of trust towards the medical profession and a piercing concern that absent being held accountable, Dr. Dangles will hurt another trusting and vulnerable patient.
My request to the AAOS is not about me getting retribution from Dr. Dangles. My request is based upon my belief that every person (especially members of the medical profession and surgeons) must be accountable for personal injury and damage they cause to those under their trust.
As an attorney, I expected the place to request accountability would be to file a medical malpractice complaint against Dr. Dangles. Initially, I naively expected Dr. Dangles to admit he made a mistake and for us all to move on. But Dr. Dangles chose another tactic.
Dr. Dangles first violated my rights as a patient by disclosing and disseminating my mental health records to his defense counsel. Thereafter, in his discovery deposition, Dr. Dangles stated that I was over emotional and actually convinced Dr. Dangles to perform an otherwise unnecessary surgery. Dr. Dangles further stated under oath that his nursing staff was surprised that I would be undergoing a surgical procedure on my right ankle and, according to Dr. Dangles, his staff asked him not to perform the surgery because I routinely fell down.
Dr. Dangles committed the ultimate act of betrayal by a surgeon towards a patient when he stated under oath that he never knew why I (the patient) lost my balance after the surgeries but he suspected the falls were caused by alcohol abuse and the prescribed medications for depression in connection with prescribed pain medications. I have never suffered from an alcohol problem and Dr. Dangles never brought up any such suspicions about alcohol use or the medications for depression at any time during his treatment of me. Rather, instead of accepting responsibility, Dr. Dangles was making baseless attacks against my character and credibility.
Ultimately, my attorney, Michael Cogan had to withdraw as the attorney of record because my current treating orthopedic surgeon “did not want to get involved.” But, I firmly believe that somebody needs to get involved to get the attention of an out of control orthopedic surgeon that resorts to personal attacks on patients instead of accepting responsibility for his clinical and professional errors. Somebody needs to get involved in order to prevent Dr. Chris Dangles from causing similar harm on other unsuspecting and trusting orthopedic patients in Central Illinois.
HOW I CAME TO MEET AND BE TREATED BY DR. DANGLES
In August 2000, I was a runner who strained my left ankle when I stepped my left ankle into a bunny hole while running with my dog. I was a member of Health Alliance Medical Plans HMO (owned by Carle Clinic Association physicians, including Dr. Chris Dangles). As required by the terms of the HMO, I went to my Carle Clinic Association primary care physician to have the left ankle swelling checked. That doctor referred me to Carle Clinic Association orthopedic surgeon Robert Gurtler, M.D.
In September 2000, Dr. Gurtler advised against any surgery and recommended using an Air Cast. I was ambulating fine when I used the Air Cast. But after I lost my balance one day when not using the Air Cast, my Carle Clinic Association primary care physician referred me to a second surgeon at Carle Clinic Association. That second surgeon was Dr. Chris J. Dangles.
In October 2000, I first met with Dr. Dangles. At that time, I was a 38-year old athlete (former gymnast, swimmer, bicycle rider, runner) and I always had loose lateral ligaments. I had never suffered any ankle injury prior to August 2000. Without so much as a recommendation of physical therapy, MRI or additional flat film, Dr. Dangles immediately recommended surgery to tighten the lateral ligaments.
Dr. Dangles commented to me (in front of a witness) that the only reason that Dr. Robert Gurtler advised against the surgery was because Dr. Gurtler did not know how to perform the surgery. In the same visit, Dr. Dangles commented to my friend (who had just undergone surgery by Dr. Gurtler for a complete rupture of the Achilles tendon) that “ . . . Dr. Gurtler should not have operated on you. Surgery should never be performed on an Achilles tendon. The standard of care is to just cast the leg until the rupture repairs itself.” Dr. Dangles’ statements about a colleague during that office visit were gratuitous, unprofessional and manipulative.
Dr. Dangles commented at the first visit that I had “loose ligaments generally.” In fact, Dr. Dangles commented that my right ankle was clinically looser than my left ankle. I assured Dr. Dangles that I had no complaints regarding the right ankle.
Despite Dr. Dangles’ obvious arrogance and the fact that my friend warned me against proceeding with Dr. Dangles, I was flattered that Dr. Dangles called me on the telephone personally shortly after my office visit. Dr. Dangles told me during that telephone conversation that he had been thinking about my case and he was sure that he could help me.
In November 2000, Dr. Dangles performed the first surgery to tighten my left lateral ligaments. The objective evidence during that first surgery revealed that the left ankle tendons and ligaments were completely in tact at the time of the November 2000 surgery. The ligaments and tendons were merely stretched and loose.
The November 2000 surgery to the left ankle failed. For reasons unknown to Dr. Dangles, I fell down after the cast was removed and the ligaments stretched out. Dr. Dangles told me that I must have a “re-do” surgery to the left ankle. (Ultimately, I learned in Spring 2004 from my current orthopedic surgeon that the surgery failed because the ankle surgery altered the anatomy of my leg and I required a high tibial osteotomy in order to protect the ankle surgery.)
In March 2001, I underwent that second surgery to my left ankle. Again, there was no tear or damage to the left ankle ligaments or tendons. The ligaments were again stretched out.
Dr. Dangles continued to make the comment my right ankle was actually clinically “looser” than my left ankle ever was (despite my advising him that I had no complaints about the right ankle) until he finally convinced me to allow him to “tighten” the right ankle. Dr. Dangles told me that by tightening the right ankle’s ligaments, I would be less likely to sprain my right ankle.
In retrospect, Dr. Dangles’ promise was an empty promise since I had never sprained or otherwise injured my right ankle. But, by Summer 2001 (when Dr. Dangles discussed the right ankle surgery with me), I was exhausted from the two left ankle surgeries and the pain and depression that resulted from those surgeries.
At that point, my frame of mind was such that the unplanned orthopedic issues (on the left ankle) had caused turmoil to my life and legal practice. At the moment that I agreed to surgery on an uninjured, normal (for me) ankle, I was hoping to be able to soon put an end to all of my orthopedic problems and bodily limitations and become a fully functioning professional person again.
In August 2001, Dr. Dangles performed what was, for all intents and purposes, prophelatic surgery on my right ankle. And, Dr. Dangles performed that surgery following two (2) surgeries to my left ankle without any physical therapy and relatively little recuperation time. Ultimately, my left ankle was so weakened by the surgeries that it could not hold my body weight when I was on crutches for the right ankle surgery. I fell, and the surgery on both my right and left ankles failed.
I asked Dr. Dangles whether I should have physical therapy and Dr. Dangles said “no.” According to Dr. Dangles, physical therapy is only indicated if the ankle is “stiff” after surgery. I have since learned that physical therapy is critical to a good clinically outcome. Even as late as January 2007 (when Dr. Dangles’ deposition was taken in the medical malpractice case), Dr. Dangles asserted that physical therapy is not generally necessary unless the ankle is stiff. Dr. Dangles failed to acknowledge that he erred in never prescribing physical therapy for me (either before, after or between the surgeries).
In addition, Dr. Dangles failed to recognize and appreciate the fact that by tightening the naturally loose ligaments (as opposed to repairing damaged ligaments) on my ankles, Dr. Dangles actually changed the anatomy of both of my legs. Physical therapists have described it to me as losing the sense of where my ankles and feet are in relation to my body – prioperception. And, according to several of my physical therapists and my current orthopedic surgeon, unless and until I am able to retrain the poor body prioperception, I will be doomed to continue losing my balance.
The multiple surgical procedures failed and I was left effectively crippled in the Fall 2001. At that time, Dr. Dangles assured me that he would figure out a plan for me. Despite all empirical evidence to the contrary, Dr. Dangles suddenly suspected that I suffered from Ehlers Danlos syndrome. I underwent the testing for EDS. The testing came back as negative. Dr. Dangles promised me that he would determine a plan. Dr. Dangles never contacted me after the EDS testing returned as negative.
DR. DANGLES BLAMES ME FOR HIS EVER HAVING PERFORMED THE SURGERY ON MY RIGHT ANKLE
Dr. Dangles’ discovery deposition was taken in January 2007. I was not present at the deposition because I was undergoing treatment for cancer. But, when I read the transcript, I was shocked and offended by Dr. Dangles’ attempts to disparage my character and deny responsibility for performing that surgery on me.
Question: Please tell me, Doctor (Chris John Dangles, M.D.), everything that you can recall about the conversation that you had with Miss Handy on July 9 of 2001 regarding doing surgery on the right side.
Dr. Dangles: Well, was moderately insistent upon it. She convinced me that she liked the left side much better than the right.
And I just remember being rather amazed that this woman wanted to subject herself to surgery on her right side now but she convinced me that it was in her best interest.
Question: When you say moderately insistent, can you expand on that?
Dr. Dangles: A little emotional about it. She says yes, it is really bothering my legs. I like my left side better than my right.
Question: And that you were slightly amazed that she wanted to subject herself to surgery on the right?
Dr. Dangles: Yeah. After having hand surgery and two foot surgeries in the course of the year, I was surprised that she wanted another surgery.
Questions: That she wanted another operation at all or that she wanted another operation five or six months following the previous one?
Dr. Dangles: I think you could phrase it either way and I would be surprised.
Question: And then she convinced you that she wanted the surgery?
Dr. Dangles: Yes. And my next recollection was both my nurses who have dealt with all the phone calls telling me how could you do this to us again?
Question: Subsequent phone calls?
Dr. Dangles: No. They anticipated more problems, my nurses.
Question: Problems in what regard? Problems with her?
Dr. Dangles: Falling.
* * *
Question: Did you offer [the patient] any other treatment options for her right ankle?
Dr. Dangles: Prolonged wearing of the brace and air cast.
Question: Is that the same thing?
Dr. Dangles: Yes.
Question: In your opinion did she have any other treatment options other than surgery or prolonged wearing of an air brace?
Dr. Dangles: Again, back to my original visit, wedges on her shoes that I offered her a long time ago.
Question: Anything else besides that, Doctor?
Dr. Dangles: Those were the options that I gave her.
* * *
Question: As of July of 2001 had Miss Handy received any treatment for these inversion injuries other than the air cast prescribed (by Dr. Dangles’ nurse)?
Dr. Dangles: And somebody ordered rocket socks for her.
Question: Other than the rocket socks and the air cast, Doctor?
Dr. Dangles: Not that I am aware of.
* * *
Question: . . . were there any contraindications in performing the (August 2001) surgery in your opinion?
Dr. Dangles: No.
* * *
Question: And again [Dr. Dangles’ nurse] is documenting the fact that [Miss Handy] had suffered another fall?
Dr. Dangles: Correct.
Question: Do you have any understanding as the circumstances surrounding the fall?
Dr. Dangles: No, I don’t.
Question: Do you have an opinion as to what caused her to fall?
Dr. Dangles: I have questions but I have no opinion.
Question: . . . Questions regarding the mechanism of the fall?
Dr. Dangles: No. I have questions concerning the impact of the medications she takes besides pain pills and I questioned whether or not she had an alcohol problem.
Question: These are not opinions that you hold to a reasonable degree of medical certainty that any medication use or alcohol use may have contributed to her fall?
Dr. Dangles: Well, she takes some psychotropic medications that can create dizziness and ataxis problems.
It was not just that Chris Dangles, M.D. failed to recommend conservative, non-surgical alternatives to surgery (as described in the AAOS website), failed to recommend physical therapy before and after two (2) surgical procedures on the left foot. It was also not just that Dr. Dangles performed surgery on a perfectly healthy right foot or that Dr. Dangles failed to ever watch me (the patient) ambulate in an effort to determine the cause of my instability or even that Dr. Dangles failed to ask me about the mechanisms of the post-surgical falls. The most disturbing fact is that Dr. Dangles became so desperate in his desire to quash my medical malpractice complaint that he stooped to the low of insulting and attacking me personally.
Dr. Dangles initially sought to introduce my mental health records into the medical malpractice case. In fact, the entirety of my mental health care was obtained at the same clinic where Dr. Dangles practiced (Carle Clinic Association). Through my mental health records, Dr. Dangles sought to label me as “mentally ill” and not worthy of being trusted. In fact, the significance of my being treated by a psychiatrist at Carle Clinic Association should have been that, if Dr. Dangles was ever concerned about the effect my psychiatric medications had on my ability to ambulate or make decisions, then he had knowledge of and access to that information throughout his treatment of me. There is no indication in the medical records or otherwise that Dr. Dangles ever mentioned a concern about medications prior to the commencement of the lawsuit against him.
Dr. Dangles also sought to label me as having an alcohol problem. Dr. Dangles even testified under oath “ . . . I questioned whether or not she has an alcohol problem.” There is no indication in the medical records or otherwise that Dr. Dangles ever mentioned a concern about alcohol prior to the commencement of the lawsuit against him. At no time in my life have I ever had an alcohol problem. That is a serious accusation or insinuation for Dr. Dangles to make against me. Making such baseless accusations against me could affect my possibility to ever practice law again.
Under any standard, it is wrong for an orthopedic surgeon to perform unnecessary surgeries on a patient, especially when the procedures ultimately cause the patient to suffer physically, mentally and financially for eight (8) plus years. It is wrong for an orthopedic surgeon to ignore the fact that his actions caused his patient the necessity of undergoing four (4) or more reparative, corrective surgeries. It is wrong for an orthopedic surgeon to blame a lay patient for talking the doctor into performing surgery.
Indeed, no patient should ever be capable of talking a competent orthopedic surgeon into an otherwise unnecessary or inappropriate surgery. That wrong is compounded and contradicted by the surgeon’s claim that the patient had mental health issues (for which she was taking prescription drugs) and had alcohol problems. No surgeon who truly believes that his patient might have an alcohol problem or might have difficulty ambulating after surgery (because of prescribed drugs for depression) should ever perform unnecessary or even elective surgical procedures.
DR. DANGLES ABANDONS ME AS A PATIENT AND
DR. DANGLES’ FINANCIAL CONFLICT OF INTEREST
Following the negative EDS test, Dr. Dangles simply ignored me as a patient. There was never a referral to physical therapy. There was never a referral to another orthopedic surgeon. I could not obtain a second option because Dr. Chris Dangles (and the other Carle Clinic Association physicians) actually owned my then medical insurance provider (Health Alliance Medical Plans). Dr. Dangles had an obvious financial interest in my remaining his patient at CCA. Dr. Dangles would benefit financially both by performing surgery on me and by my being an HMO patient in a medical plan that he partially owned. Since the physicians and surgeons at Carle Clinic Association maintain an ownership interest in Health Alliance Medical Plans, it is not surprising that Dr. Dangles never referred me (as a HAMP HMO patient) outside of Carle Clinic for evaluation after the three (3) surgeries failed.
If Dr. Dangles referred me to a non-CCA physician or surgeon than the HAMP HMO would have to pay more money on the out-of-network claim. Since Dr. Dangles is a partial owner of the HAMP HMO, payment to a non-affiliated surgeon would effectively be money out of Dr. Dangles’ pocket. Therein lies a financial interest that inherently creates a conflict of interest for the orthopedic surgeon.
Before I could find another orthopedic surgeon to evaluate my ankles, I had to change my health insurance plan.
THE CHANGE FROM HAMP SO THAT I COULD OBTAIN SECOND OPINION WITH MARK EASLEY, M.D. (DUKE)
I switched my health insurance from HAMP HMO to Blue Cross/Blue Shield of Illinois in order to be able to obtain an orthopedic second opinion.
In September 2002, I first met with orthopedic surgeon Mark E. Easley, M.D. (Duke University Medical in Durham, NC).
Dr. Mark Easley evaluated, diagnosed and corrected both of my ankles. Unlike Dr. Dangles, Dr. Easley actually watched me walk after the first repair to the right ankle. Dr. Easley also asked about the details and mechanisms of my post-surgical instability and falls. At that time, Dr. Easley determined that I needed a high tibial osteotomy procedure in order to maintain the alignment of my tibia and protect the ankle surgery. Indeed, the ankle procedure performed by Dr. Easley did not fail (as the procedures had with Dr. Dangles) because Dr. Easley performed bilateral high tibial osteotomies.
At that first meeting, Dr. Easley verbally expressed (to me and my family) surprise that I had never undergone physical therapy before or after the surgeries performed by Dr. Dangles. Dr. Easley acknowledges to me that I would have never needed the high tibial osteotomies if the initial ankle surgeries had not been performed. Dr. Dangles’ surgeries on my uninjured left and right ankle effectively altered the anatomy of my legs. To date, Dr. Easley has performed a total of four (4) surgeries after Dr. Dangles’ three (3) failed surgeries.
Dr. Easley performed the following surgeries on me:
1. September 2003: Lateral ligament repair on right ankle (Unlike the August 2001 surgical procedure, there was actual damage to the ankle. Dr. Easley did more than simply tighten an otherwise healthy ankle.)
2. March 2004: High tibial opsteotomy on right leg (in order to protect the right ankle surgery until the HTO could be performed, I remained in a short leg cast and full metal leg brace from October 2003 until March 2004)
3. December 2004: Lateral ligament repair on left ankle and HTO on left leg
4. May 2005: Repeat surgery on peroneal tendon of left ankle (Medical records indicate that I reported to Dr. Dangles a “popping” sound and sensation to my left ankle in March 2001. Dr. Dangles never examined the left peroneal tendon. According to Dr. Easley, by December 2004, the peroneal tendon had been subluxing for an extended period of time such that there was no groove for the peroneal tendon. The repeat surgery in May 2005 was for the purpose of Dr. Easley creating an extreme groove for the peroneal tendon where non existed.)
To date, I am still treated by Dr. Easley. Despite the four (4) corrective surgeries at Duke, I am still unable to use my left leg properly. Dr. Easley is in the process of determining a course of action. I hope someday that I will be able to ride a bike, walk or even endure the physical requirements of caring for my elderly father without pain and swelling.