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Doctor accused of palming bullet may not face jail time

TAMPA — Even if prosecutors prove that Dr. David J. Ciesla concealed evidence from law enforcement, he isn't likely to receive jail time.

The head of Tampa General Hospital's trauma center, accused of removing a bullet from a suspect and keeping it as a souvenir, faces two misdemeanor charges that each carry up to a year in jail. But a prosecutor said Friday he thinks a plea agreement with no jail time has already been worked out.

"I think the offer is out there already, and I think the plea's been accepted," said Assistant State Attorney Douglas Covington, who is the misdemeanor bureau chief in Hillsborough County but isn't handling the case. "I don't think he's going to jail."

Covington would not discuss the terms of the plea offer, and the prosecutor assigned to the case could not be reached Friday. Ciesla's attorney, John Fitzgibbons, also was unavailable.

Ciesla, 42, was charged this week for his actions during an operation performed in April on a fugitive who had been shot twice by a deputy U.S. marshal trying to take him into custody.

Ciesla was able to extract one of the two bullets. But authorities say that instead of turning it over to the two Florida Department of Law Enforcement agents waiting outside the operating room, he slipped the bullet under his rubber glove and told the officers he was unable to retrieve the evidence from the suspect.

However, a medical resident who witnessed the surgery reported Ciesla to a supervisor. After being confronted by officials from the University of South Florida, Ciesla hired an attorney and turned the bullet over to FDLE.

Authorities have accused him of providing false information to law enforcement during an investigation and obstructing or opposing an officer without violence. He is set to make his first court appearance Aug. 17.

It is not unusual for first-time misdemeanor offenders to avoid jail. Yet little about this case, in which the whistle-blower was a surgeon-in-training in the surgery with Ciesla, amounts to business as usual.

Dr. Sergio Alvarez, who reported the incident to a supervisor at USF, just began the second year of a six-year residency in plastic surgery. He is way below Ciesla in physician hierarchies.

Alvarez has not responded to interview requests by the Times.

"The profession has not been particularly forgiving or supportive of people who have questioned more senior people, whether they steal bullets, or whether they come into the hospital drunk, or whether they have affairs with the patients," said Dr. Michael Wilkes, a professor of medicine at the University of California at Davis, who focuses on how doctors are educated about ethics.

"Not very long ago, the only surgery (Alvarez) would have would be cutting the eyes out of potatoes in the back room or something," he added. "What he did was notable."

Wilkes noted that the trauma surgeon is traditionally a very powerful figure in a hospital.

And the medical resident is somewhere between an employee and a student, noted Dr. Timothy Flynn, who oversees the residency program at the University of Florida.

Residents have their medical degrees, but practice under supervision during a period of intensive on-the-job training. It is a world in which many consider the relatively new requirement limiting residents to an 80-hour workweek to be humane.

For this, Alvarez, earns an annual salary of $45,600, according to USF.

Ciesla, medical director of the region's only Level I trauma center, is a figure already known in state trauma circles, although he has practiced here for only about 18 months.

His annual salary is $485,604, according to the university, where he also serves as division director for trauma/critical care.

Surgery, in particular, emphasizes supervisory roles in the operating room, where decisions can be a matter of life or death.

Yet as a resident specializing in plastic surgery, Alvarez may not have expected to work directly under Ciesla for the duration of his training. In general, plastic surgery residents spend a four-week rotation in trauma in their first year, according to USF.

"Even though resident physicians are in training, it's important to keep in mind that they've assumed the full mantel of the profession and take that very seriously, and particularly their obligations to patient safety," said Alexis Ruffin, director of resident relations at the Association of American Medical Colleges.

The resident's whistle-blowing has prompted wide-ranging response. USF has started a disciplinary process, which will not be public until concluded.

In court, Ciesla's lofty position could be a double-edge sword, said defense lawyer Robin Fuson, a former misdemeanor chief for the Hillsborough State Attorney's Office.

On the one hand, he has saved many lives and done a lot of good in the community. On the other, people in authority are sometimes held to a higher standard.

"I would give any first-time offender the same options, whether he was a doctor or a dockworker," Fuson said.

Times researcher Shirl Kennedy contributed to this report. For more health news, visit www.tampabay.com/health.

Doctor accused of palming bullet may not face jail time 07/17/09 [Last modified: Friday, July 17, 2009 10:34pm]
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