The board imposed a $25,000 civil fine against Schneider — the maximum allowed by law — and ordered him to pay more than $124,000 to cover the cost of the proceeding against him.
Schneider had performed back surgery at West Park Hospital in Cody in November 2011 on a man the board identified only as John Doe. The man — identified in separate court documents as 47-year-old Russell Monaco — died at his Billings home the day after his release from West Park.
The Yellowstone County, Mont., Coroner’s Office concluded Monaco died of a mix of pain-killing drugs he’d apparently taken as prescribed, according to the Board of Medicine’s order. The 111-page document says either Schneider or his physician assistant of five years, Harley Morrell, prescribed the respiratory system-depressing drugs and that Morrell directed a West Park nurse to discharge Monaco despite low oxygen levels.
Morrell told the board that Schneider had signed off on the prescriptions and Monaco’s discharge. Schneider initially told the board Morrell’s prescriptions followed “our protocol,” but the surgeon later said he hadn’t been consulted about the circumstances of Monaco’s discharge and didn’t know about all the pain medications prescribed by Morrell. In one statement, Schneider called him “a rogue physician assistant.”
“If the medication of which I was aware were the only medications that (Monaco) was discharged on, and if my specific protocols for (post-operative patients’ oxygen) levels had been followed, I believe that the tragedy of (Monaco’s) death would not have occurred,” Schneider wrote.
Schneiders’ attorneys blamed West Park staff and Morrell in their arguments to the Board of Medicine.
The board did not find Schneider’s testimony credible.
Monaco’s wife, Kathy Monaco, was an employee in Schneider’s office, and the board noted testimony that the staff of Schneider’s Northern Rockies Neuro-Spine clinic was close-knit.
“Against that backdrop, (Schneider’s) claims that he had little knowledge of PA Morrell’s action regarding his employee’s spouse’s treatment following an emergent surgery are not believable,” the board wrote.
Two outside physicians brought in as experts, doctors Saul Schwarz and Ken Kulig of Denver, said Schneider appeared to have been careless or reckless in managing Monaco’s pain. They specifically faulted Schneider for prescribing fentanyl — a drug that’s not supposed to be used to treat post-operative pain and whose box warns it can be fatal in patients whose bodies aren’t used to painkillers.
The two doctors and the board also criticized Schneider for not obtaining a new MRI or other image of Monaco’s back before operating, despite reporting the condition of the man’s back had deteriorated. Schneider argued he didn’t need new images.
Schneider called the procedure an emergency surgery that needed to happen that day, though the order indicates Kathy and Russell Monaco had apparently been planning for Schneider to perform the surgery in Cody.
The board’s investigators alleged the surgery’s classification as an emergency was part of an unsuccessful scheme to get Monaco’s insurer to cover the cost of the procedure; because Schneider was not in Monaco’s insurance network, the procedure would generally be covered only if it was an emergency, and not if it was elective.
The board said the evidence “strongly suggested the existence of a scheme to secure payment for (Monaco’s) surgery as emergent,” but that the board’s investigators hadn’t proven that by clear and convincing evidence.
Similarly, the board said the evidence strongly suggested Schneider manipulated medical records in the case, but it didn’t rise to the level of intentional falsification or fraudulent alteration.
“The board does find ... (Schneider’s) statements in those documents to be suspicious, inaccurate and a manipulation,” the order says.
Kathy Monaco and Russell Monaco’s brother are currently pursuing a wrongful death lawsuit in Wyoming’s U.S. District Court against Morrell, Schneider, West Park Hospital and others.
Schneider, West Park Hospital and a private company that contracts to provide senior management at the hospital all have filed legal responses denying responsibility.
The plaintiffs filed a notice in court last week in which Morrell acknowledges the lawsuit’s allegations against him and acknowledges that damages amount to at least $10 million.
Morrell states he was acting at the direction of Schneider in treating Monaco and that Schneider was responsible for Morrell’s actions — a contention Schneider rejects.
U.S. District Judge Scott Skavdahl of Casper hasn’t acted yet on the request from the estate and Morrell to accept the judgment. A pretrial conference in the case is set for Thursday.
The Board of Medicine temporarily suspended Schneider’s medical license on Jan. 28, 2012, after a preliminary investigation into the circumstances surrounding Monaco’s Dec. 1, 2011, death. The board reinstated Schneider’s license on March 20, 2012, after he took a course on prescribing controlled drugs, stipulated to having his cases reviewed by another doctor for six months and agreed not to prescribe fentanyl while the board continued to investigate.
Three weeks after the board reinstated Schneider’s license, board investigators filed a formal complaint against the neurosurgeon. A contested case hearing began last August and ended in January, when the board voted to strip Schneider of his license.
After learning of the board’s decision, Schneider asked if he could instead voluntarily give up his license for at least 10 years and — in exchange for giving up his right to appeal — pay partial costs of $90,000 and have his restriction from prescribing fentanyl removed from his license.
The board declined Schneider’s proposal, saying the offer wasn’t adequate to protect the public nor sufficient, and issued its order last week.
Schneider had been licensed to practice medicine in Wyoming since 1997.
At the time of the incident, Schneider was practicing medicine in Cody and Powell, including through the now-shuttered Northern Rockies Neuro-Spine as well as at West Park Hospital and Powell Valley Healthcare.
Schneider has 30 days to appeal the board’s order.
Morrell agreed to a suspension of his physician’s assistant license in April 2012 and hasn’t practiced since.
(The Associated Press contributed to this story.)