A teaching physician at Texas Medical Center has been fined for the second time in as many months for failing to be present during surgery by trainee physicians. Patient advocates claim that this creates safety issues.
Dr. Nathan Robert Starke, who was named as a participant in Houston Methodist’s urology residency program, which teaches aspiring physicians, is the subject of the most recent instance. This Monday, the Texas Medical Board said that it had temporarily suspended Starke’s license due to allegations that he seemed intoxicated during multiple surgeries in August and September and tested positive for cocaine in October.
According to the board’s Dec. 20 medical license suspension order, Starke was suspended by Houston Methodist on September 6 for missing all but the final three minutes of an operation in which he served as the attending physician. According to the board’s order, Starke had previously been suspended and had been subject to drug and alcohol testing at Houston Methodist since at least 2023.
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In an email, Houston Methodist spokesman Gale Smith said, “The only information we can share is that he is no longer employed at Houston Methodist.” Smith failed to respond to Houston Landing’s queries.
Starke was unavailable for comment. A hearing about Starke’s interim license suspension will take place as soon as is practical, according to the medical board.
The Starke case comes after a $15 million joint settlement reached in June of last year, which included federal whistleblower claims of inadequate oversight of medical trainees during complex and dangerous heart surgeries involving Baylor St. Luke’s Medical Center, Baylor College of Medicine, and a surgical group.
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According to federal court records in the case, the U.S. Attorney’s Office claimed that doctors intentionally left unqualified physician trainees (residents and fellows) alone in operating rooms to perform operations on unwitting patients so the teaching surgeons could perform multiple surgeries at once. Baylor College of Medicine denied that any federal laws were broken. At the time of the settlement, Baylor College of Medicine denied that any federal laws or regulations had been broken and claimed that no patients had been harmed.
The two recent occurrences involving Texas Medical Center teaching hospitals, according to a number of patient advocates, raise questions about how carefully institutions are keeping an eye on training physicians and those who could be struggling with substance misuse.
According to Lisa McGiffert, head of the Patient Safety Action Network, a nationwide nonprofit advocacy organization, “I think the supervision of residents and those in training programs is probably more lax than any of us would like to admit.” It is the Texas Medical Center’s responsibility to inform the public when they have a problem and explain how they resolved it.
According to a statement from the Texas Medical Center, its hospitals are separate organizations in charge of providing treatment within their buildings. According to the statement, each hospital carries out its own patient care, research, and educational initiatives, even though we might work together on campus-wide concerns.
According to McGiffert, the Starke case that was made public this week raises concerns about how successfully hospital administrators and medical regulators oversaw Starke as well as the supervision of physicians completing training.
The Texas Medical Board license suspension order states that Starke had been screened for drugs and alcohol by Houston Methodist since at least 2023 owing to prior suspensions for impairment-related reasons.
The medical board’s order doesn’t explain why Starke was previously suspended from his job or how stringent Houston Methodist’s drug and alcohol testing has been since 2023. Furthermore, it doesn’t specify what kind of surgery Starke was purportedly missing for all except the final three minutes, whether any issues occurred during his absence, or how much training the surgeons had.
According to the board’s order, Starke displayed symptoms of impairment on August 19, 2024, during a consultation with a patient before doing a surgical biopsy on the patient’s prostate.
Houston Methodist suspended Starke on September 6th after he missed the majority of an operation that he was the attending physician for. According to the medical board’s order, Starke signed a voluntarily cease practice agreement with Houston Methodist on September 16; nevertheless, in October, he tested positive for cocaine and Kratom, a natural substance that can have stimulant effects.
After ruling that Starke’s continued practice of medicine constituted a continuing threat to public welfare, a disciplinary panel of the Texas Medical Board temporarily and without notice suspended Starke’s license on December 20.
Smith, the spokeswoman for Houston Methodist, declined to comment on Starke’s suspension or the hospital’s oversight of him. Additionally, Smith would not respond to more general inquiries concerning the hospital’s basic procedures for keeping an eye on doctors who struggle with substance abuse or for guaranteeing that resident physicians are properly supervised during procedures.
Starke appeared in a promotional film on the website of Houston Methodist’s urology residency program, which has been certified by the Accreditation Council for Graduate Medical Education.
Programs that are accredited must show that the proper amount of supervision for each resident is determined by the patient’s complexity and acuity as well as the resident’s training and skill level. In a statement to Houston Landing late Thursday, the council stated that supervision might be carried out in a number of ways, depending on the circumstances.
The organization stated that it is not allowed to respond to inquiries regarding whether it was aware of the accusations filed against Starke by the Texas Medical Board due to confidentiality agreements it has with the organizations it accredits.
According to some patient safety advocates, the recent incidents at Texas Medical Center highlight the importance of patients keeping an eye on the people who are treating them.
Patients seeking care at teaching hospitals should inquire about the experience and training of the healthcare provider, according to Sue Sheridan, president of Patients for Patient Safety US. I would ask directly: Are you my attending or a resident? “And when I’m worried about my care, how do I get to my attending?” she said.
Additionally, patients can visit the Texas Medical Board website to verify if their doctor has been the subject of any license-related actions, McGiffert added.
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