The Love Surgeon
Patients, for all practical purposes, are powerless to respond even to violent crime or its equivalent in medicine.
For 22 years in southwestern Ohio, James Burt, M.D., a gynecologist, not a licensed surgeon*, subjected thousands of women to bizarre, disfiguring operations involving clitoral circumcision and vaginal reshaping, which he called the Surgery of Love, sometimes performing the operation without their permission when they had been anesthetized for something else. He admitted in a book that he did it without their permission and yet was allowed to keep doing it for another 14 years after that admission.
Many of his patients never could have sex again. Marriages fell apart. Lives were ruined. Complaints were unheeded. But he was the hospitals cash cow. Year after year Dr. Burt was allowed to continue to perform these operations.
Plastic Surgical Postero-Lateral Refirection Extension Vulvo-Vaginoplasty
That’s what he called it. And not only did he, and everyone else, ignore the complaints of patients about it, but he wrote a paper in which he denied the problems. He said that not only were there almost no problems resulting from his procedure, but that this operation was so successful that prior to it 17.1% of his patients reported wife beating, but after it 0.0% reported wife beating. According to his paper, co-written with Arthur R. Schram, M.D. (who never was investigated and so continued being a menace for another twenty years after Burt was stopped), the way he cut up women’s vaginas eliminated the cause of wife-beating (click Vaginoplasty to see the paper on which I have highlighted some key sentences if you want to see for yourself).
Some of his victims found each other and collectively tried to get help from the police and the local prosecutor (but, of course, in medicine there are no witnesses – see survey) and anyone else who would listen, including the hospital and other doctors. It is normal, if not ubiquitous, for both the police and district attorneys to be unwilling to do anything for injured patients. When they got nowhere, they turned to the news media. When the local newspaper ignored them, they went to network television. A report on CBS broke the case open. Shortly after the network news coverage the Ohio State Medical Board took action, apparently in response to CBS’s investigation, not their own.
This is typical of state medical boards. Almost no complaints filed by patients result in anything other than the dismissal of cases for lack of evidence (see OSMB). How thorough can the investigations have been if they didn’t even discover that the Dr. James Burt didn’t even have a license? How much much better evidence of wrong-doing could there be than an admission by the doctor himself, in print in a book he wrote himself, that he performs the operations without the permission of the patients? That deserves repeating.
Without the permission of the patients
That alone should have resulted in the suspension of his license, if he had had a license.
Statute of Limitations
As a result of the news coverage, many others of his victims finally realized that all of the doctors who had been ignoring them or brushing them off (which is normal, see white wall all of silence) were not the last word. A superior court decided that the statute of limitations would start with the news broadcast, rather than at the time of the medical procedures, and patients who had been damaged years in the past were able to file suits. As with people who in childhood had been abused by priests, statutes of limitations are not written in stone.
One nurse who had helped with Burt’s surgeries commented later that nurses do not see how much pain patients are in afterwards. They don’t know there is anything to report. They forget about anything untoward they might have seen and move on to the next patient. She said she was dazzled by him and really didn’t understand what he was doing. However, other nurses tell a different story.
A police officer who worked on the case said that the break for law enforcement came when a nurse retired and finally confessed. It was learned that Burt chose victims who were weak and would be unlikely to retaliate. The socially connected wives of bank presidents were safe. But one time he made a mistake and operated on a woman who was rich enough to keep a private investigator on the case for as long as necessary to get justice. The break came when that one nurse retired. The private investigator was able to persuade her that now that she was retired, her career could not be effected by speaking. So she finally spoke.
In other words, she and other nurses allowed this to go on for decades in order to preserve their careers.
Wouldn’t it be nice if any of the thoughts or routines of nursing changed as a result of cases like this? Unfortunately, this continues to be an accurate portrayal of how nurses fail to protect patients when patients have problems (see loyalty and majors).
In a Nov 6, 1988 article in the Dayton Daily News, one patient said that Burt told her not to allow any other physician to do a pelvic examine. He said they would not know what he’d done and they would cause her to bleed internally and she would bleed to death in the car on the way home. She believed him. He operated on her 18 times to try to repair the damage he had done.
Dr. Bradley Busacco, a physician an hour away in Cincinnati, said in court that he had treated 150 women for injuries incurred as a result of Burt’s performing his procedure on them without without their consent (footnoted on another site).
A December 1, 1988 article in the Dayton Daily News said that in 12 years Dr. Burt had been sued 10 times for the surgery. According to another article Burt had no insurance and his assets were in his wife’s name so all the suits were dropped.
Burt escaped to Florida where he lived until 2012 when he died.
The Hospital’s Cash Cow
According to the Dayton Daily News, November 20, 1988, one of Burt’s own forms, used to explain his surgery, defined it as “surgical redesign of the female coital area” and says that “more than 4,500 operations were done between 1966 and 1977.” That’s a span of 11 years. He operated for 22 years. He might have performed the operation as many as 9,000 times without a license to perform surgery. And yet neither the hospital nor the state medical board nor the police nor the press paid enough attention to the complaints even to discover that he wasn’t a licensed surgeon. When the hospital and the doctors around him became concerned about what he was doing, the action they took was to limit their own liabilities, not to protect patients. We continually are asked to believe that physicians place the welfare of patients first and foremost, but they simply don’t.
It is difficult to discuss this case without seeming to exaggerate. Cases like this routinely are dismissed by medical professionals as bizarre exceptions. The only thing exceptional about it is the numbers. Which is why he finally was caught. Doing it thousands of times finally generated enough vocal victims for them to find each other and launch an organized effort to get someone to listen. When someone did, it was someone out of state. There was no one in their community who would pay attention even to an organized and vocal group.
That is the landscape for most victims of adverse events in medicine. Of the patients with legitimate grievances only one in some thousands can find a lawyer. Filing complaints is no more productive either. If you think things must have changed since then, see Dr. Vikas Kashyap. As a result of the Burt case the Ohio State Medical Board reorganized and got more funding and more investigators and became a model for what it is thought that a state medical board should be, and yet, as the Kashyap case shows, they still do no better for patients than they did before. No matter how well organized a mission might be, when the people in charge do not believe in the mission, the mission does not get accomplished.
There are no advocates for patients.
*He was a gynecologist who was not licensed to perform surgery, and yet year after year the Catholic hospital in which he worked allowed him to perform surgeries that lasted for hours. Patients’ complaints were silenced and unheeded. Of concern is how much of the management style of the Catholic Church might be shared by the Catholic hospital network in protecting unfriendly behavior. Speaking out of office is grounds for excommunication in the Catholic Church. The extent to which the entire Catholic Community (lawyers, police officers, journalists, hospital administrators, etc.) may be disinclined to protect victims of abuses in Catholic hospitals cannot be discussed much on this site both because of the nature of jurisprudence in the country and because of the way that community retaliates against criticism, but the Burt case brings substance to the issue.
Dr. James Burt is an example of the way miscreants and incompetents can thrive in medicine, decade after decade, not only without being caught, but with automatic unquestioning support and protection from all other health care professionals. Add to that a hospital with the right religious connection and additional support and protection comes from factions outside of health care. There is an entire community outside of medicine in certain religious communities well practiced in silencing people who become victims of things like sex abuse in their institutions. With how adept health care is at that, mix those two together and you have created a perfect storm for injured patients.
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A reader of this site wrote that she wanted me to inform other readers of someone who might be able to help the victims of Dr. James Burt. She said that a Dr. Marci Bowers is skillful in this area because of her experience with gender-reassignment surgery in reconstructing victims of female genital mutilation in Africa. She might be able to help Burt’s victims put things back together. She usually spends a lot of time in Africa helping to build a hospital, but she is involved with www.clitoraid.org, a non-profit organization that helps with female genital mutilation.