Dallas Has a Real-Life Dr. Gregory House in Dr. Richard Buch

The Texas Hospital Association does not keep statistics on or track doctors who have had privileges revoked by hospitals, says Charles Bailey, general counsel for the association. Before allowing a physician privileges, all hospitals have a thorough credentialing process, which includes contacting the NPDB, Bailey says.

But Buch's operating room antics, his treatment of subordinates and the revelations about his personal life built to a storm within the St. Paul community of physicians. St. Paul had been named with Buch in several malpractice lawsuits, but that wasn't the only issue. Administrators were also concerned about potential lawsuits from nurses over a hostile work environment.

In May 1999, when Buch signed his reapplication for privileges—attesting incorrectly that he had no current or pending malpractice claims, suits or settlements, and had no investigations by a hospital, state licensing agency or NPDB the previous two years—he stepped into a trap.

At first it looked as if his reapplication for privileges at St. Paul was perfunctory. An initial peer review panel issued a recommendation to the hospital's Medical Executive Committee that Buch's privileges be renewed for one year and that he be given a formal reprimand for the inaccuracies on his application.

Noticing that Buch had not included in his reapplication a malpractice suit that had also named St. Paul, the credentials committee requested that he provide detailed information about new or pending malpractice suits and any state, health care agency or federal investigations, required under hospital bylaws to be reported to the administration within 15 days of filing.

Dr. Kevin Gill, who considered Buch a good physician, had received a visit from an FBI agent, who said the agency was investigating Buch for alleged Medicare fraud—specifically billing Medicare for a certified physician's assistant though someone unlicensed did the work. Gill gathered surgical charts and made them available to the FBI. Buch's assistant was removed from the staff. (The fraud investigation ended with no action. The assistant was charged with one felony count of forging Buch's name to a prescription; it was reduced to a misdemeanor.)

In a long, rambling, almost incoherent letter dated August 16, 1999, "to whom it may concern," Buch defended his assistant and brushed off their concerns as much ado about nothing.

He noted that the hospital and malpractice insurance companies were settling the 1997 Russell lawsuit "against my advice."

In trying to "clean up this continued fire storm that I have undergone these last two years," Buch outlined three lawsuits he had not mentioned on his application for privileges: Terry Perkins, a total hip replacement, which Buch called "a nuisance suit"; Mary Sue Britton, "easily defensible"; and Ronnie Vest, also a "nuisance" case.

He hadn't mentioned them because they were not important, he rationalized. The only one "outstanding" was filed by Patrick and Starlinda Sanders, also a nuisance case, Buch claimed.

But in addition to pending malpractice claims, Buch had not disclosed that he had been the subject of an investigation by the Texas Medical Board in 1998. (The investigation had been closed with no action.)

Citing Buch's inaccuracies as "serious and substantial," the executive committee in October 1999 submitted a recommendation that the board of trustees deny Buch's application for privileges. Buch appealed, and in a three-day evidentiary hearing before a five-physician panel, Buch brought in witnesses and documents.

Perhaps without the trail of disrespect and grandiosity Buch had left in his wake, the misstatements on his application would have been forgiven and his privileges granted. He even submitted affidavits from nurses and doctors that his "behavior and self-esteem" were similar to other orthopedic surgeons they had observed. All the affidavits used virtually the same phrases. (According to Healthgrades Inc., an online physician referral service, 99.6 percent of physicians specializing in orthopedic surgery do not have disciplinary actions.)

Calling the process a "witch hunt," Buch argued that with his loss, St. Paul would no longer have a bone tumor specialist.

The executive committee did not change its recommendation. For his "failure to be forthright and direct" on his reapplication for appointment, Buch was denied privileges. The hospital's board of trustees agreed and permanently severed his relationship with St. Paul in May 2000.

St. Paul reported its action to the Texas Medical Board, which opened another investigation of Buch. In March 2001, Buch's medical license was suspended for improper supervision of his physician's assistant and unprofessional conduct by omitting information from his application for his medical license, including a conviction for disorderly conduct when he was 17, and later failing to disclose the arrests for solicitation of prostitution.

The suspension was stayed for five years and Buch was ordered to obtain 10 hours of ethics training, attend at least 50 hours per year of continuing medical education, with at least 10 hours in risk management. He also was ordered to pass the Medical Jurisprudence Examination given by the board, fined $5,000 and required to give a copy of the order to all health care entities where he practiced. After successfully completing his probation, Buch is no longer under board order.