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Florida health agency stops surgeries at the Bonati Spine Institute

Hudson back surgery center’s license suspended. Founder Dr. Alfred Bonati faces other state complaints.
 
The exterior of the the Bonati Spine Institute is seen Friday, March 17, 2023 in Hudson. The surgical center at the institute has been shut down after Florida health care regulators suspended the center’s license.
The exterior of the the Bonati Spine Institute is seen Friday, March 17, 2023 in Hudson. The surgical center at the institute has been shut down after Florida health care regulators suspended the center’s license. [ CHRIS URSO | Times ]
Published March 17, 2023|Updated March 17, 2023

A Pasco County surgical center at the well-known Bonati Spine Institute has been shut down after Florida health care regulators suspended the center’s license.

Regulators alleged immediate danger to patients because a “certified surgical technologist” had performed multiple procedures even though he wasn’t licensed as a doctor.

The Hudson surgical center knowingly allowed the unnamed employee to conduct such procedures on patients without being licensed as a health care professional by the Florida Department of Health — and despite other staff members raising concerns about his actions, according to a 13-page emergency suspension order filed Wednesday by the Agency for Health Care Administration, or AHCA.

The for-profit ambulatory surgical center, called the Medical Development Corporation of Pasco County, has three operating rooms and five recovery beds, according to the Agency for Health Care Administration. The agency fined the center $1,000 last year after facility leadership took no apparent steps to alert the state health department to a COVID-19 outbreak in which seven employees were infected, state records show.

The surgical center was incorporated in 1983, according to state business records. It shares an address with the Gulf Coast Orthopedic Center, commonly known as the Bonati Spine Institute, according to state health department records. The Bonati Spine Institute’s website says it pioneered the use of laser spine surgery.

Dr. Alfred O. Bonati, 83, a surgeon, is the administrator of both Gulf Coast Orthopedic Center and the Medical Development Corporation of Pasco County, according to the Agency for Health Care Administration. Bonati, founder of the Bonati Spine Institute, has been licensed as a Florida doctor since 1981, according to the state health department.

The exterior of the the Bonati Spine Institute is seen Friday, March 17, 2023 in Hudson.
The exterior of the the Bonati Spine Institute is seen Friday, March 17, 2023 in Hudson. [ CHRIS URSO | Times ]

The problems at the surgery center “span perhaps years,” according to the emergency order. The center also “failed or refused” to provide some patients’ medical records to Florida regulators, the order said, so the state couldn’t assess their surgical outcomes.

The center “knew or should have known of alleged unlicensed surgical practice,” the order says, “but has demonstrated no action to even investigate the repeated allegations.”

The order, which took effect at 5 p.m. Wednesday, described the failures as “operational and management system deficiencies” that endangered “the health, safety and welfare” of the center’s patients.

Lawyers for the Medical Development Corporation of Pasco County late Thursday requested that Florida’s 1st District Court of Appeal stay the emergency order. They said the order shuts down the business “with nearly 100 employees losing their jobs.” In a separate filing, they also urged the court to quash the order.

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The attorneys said the emergency order “does not sufficiently allege that any future harm will occur.”

“We vehemently disagree with AHCA’s contentions,” said Scott J. Flint, a St. Petersburg attorney representing the business. “We look forward to vindicating Medical Development Corporation and its employees in court. Other than that, we won’t be commenting on any ongoing litigation.”

Bonati could not be reached for comment. Flint said the doctor would not comment.

Complaints against Bonati

The state health department has so far filed two complaints against Bonati this year alleging medical malpractice related to back surgeries. One complaint said Bonati performed six surgeries on a patient “without evidence of improvement.” The other said he performed multiple surgeries on a patient over a roughly three-month span without trying less invasive treatment.

Flint, the attorney, declined to comment on the complaints. The state health department confirmed the cases are ongoing.

Bonati has faced multiple disciplinary cases over the last two decades, according to a Tampa Bay Times article and state health department records.

Related: Doctor faces scrutiny again

In 2010, an arbitration panel awarded nearly $12 million to a couple who claimed unnecessary operations at the spine institute left the husband unable to walk, the Tampa Bay Times reported.

In 2013, an arbitration panel ordered Bonati to pay $2 million to a woman who alleged in a lawsuit that the doctor subjected her to unnecessary tests and performed five unnecessary surgeries, the newspaper reported.

The South Florida Sun Sentinel found in a 2017 investigation that the state had brought 24 disciplinary cases against Bonati since 1992 — more than any other doctor practicing in Florida at that time.

Related: Hudson surgeon is sued again

Latest inspection

The Bonati Spine Institute’s website says it has performed more than 75,000 successful procedures over 35 years and has a patient satisfaction rate of over 98%.

During an inspection that started last week at the Medical Development Corporation of Pasco County, a state regulator saw a staff member — whom the ambulatory surgical center described as a “certified surgical technologist” — close a wound after a patient underwent a spinal procedure, according to the Agency for Health Care Administration’s emergency order. No physician was in the surgical suite, the order says.

A few days later, a regulator witnessed the employee treat another patient’s surgical wound, without a doctor present, following a spinal procedure, according to the order.

The center’s risk manager indicated that the employee also “performed an entire spinal surgery on a patient in the recent past,” according to the order.

The risk manager said he told the employee he wasn’t a licensed physician and couldn’t perform surgical procedures, the order says. In response, the unlicensed staff member argued that he was doing procedures “under the surgeon’s license,” according to the order.

The order says the staff member performed surgical procedures for several years even when admonished multiple times by the risk manager not to do so.

At least once, the surgical technologist said the center’s surgeon was “no longer capable to perform these procedures due to the physician’s age and health status,” according to the order from state regulators.

The surgeon, who is unnamed in the order, dismissed the risk manager’s concerns and refused to take action, the order says.

The risk manager also told the center’s medical director about the unlicensed activity on at least eight occasions and brought concerns to the center’s legal counsel last year, according to the order, but the issues went unaddressed.

A registered nurse, who was previously the center’s operating room director, told the surgeon about the unlicensed employee’s actions, too, and at least two staff members resigned after nothing was done to address the situation, according to the order.

In court papers, attorneys for the business proposed that the 1st District Court of Appeal issue an order preventing the “certified surgery technologist” and all other employees from “performing anything outside the scope of their respective certifications or licensure,” instead of shutting down surgeries.

But state regulators said in the emergency order that the surgery center’s risk management and quality control processes, “if functional at all,” have not been effective or implemented.

“If the Agency does not act,” the order says, “it is likely that the (center’s) conduct will continue.”

Times staff writers Chris Urso and Veronica Gonzalez contributed to this report.