Deputy medical examiner raised flag about former Duluth neurosurgeon

A deputy St. Louis County medical examiner was so concerned about the patient care provided by neurosurgeon Stefan Konasiewicz that he requested an investigation to determine “if Dr. Konasiewicz is incompetent or reckless.”

Dr. Donald Kundel wrote to the Minnesota Board of Medical Practice in 2008, detailing cases of alleged patient harm caused by Konasiewicz, who was then a neurosurgeon at St. Luke’s hospital. In the letter, the medical examiner told the board that more cases probably would be found if there was an investigation.

“Based on hospital corridor conversation by physicians, it is likely these three cases are the tip of an iceberg,” Kundel wrote.

More than two years after Kundel’s letter, in 2010, the medical board disciplined Konasiewicz for “unprofessional and unethical conduct.” By then, Konasiewicz had left St. Luke’s and Minnesota.

Outcomes ‘completely out of the range of what was to be expected’

Kundel’s letter detailed his first investigation into a Konasiewicz case, prompted by the 2005 death of 25-year-old Debbie Firn of Duluth, whose aorta Konasiewicz punctured during spinal surgery. Less than 12 hours later, she bled to death.

An autopsy conducted by Kundel discovered the puncture, he said.

Kundel wrote that in 41 years of hospital practice, 32 years of involvement with the St. Louis County Medical Examiner’s Office and more than 5,000 autopsies, he had never encountered a death like Firn’s.

“I had not previously known of a serious injury to vital, previously intact organs that were not part of the intended operative field or involved by a disease process,” he wrote.

In an interview with the News Tribune, Kundel said he interviewed Konasiewicz and other medical staff involved with the operation, as well as the hospital’s administration, including St. Luke’s CEO and President John Strange and Dr. Gary Peterson, the hospital’s medical director.

Kundel said the operating room staff and Konasiewicz told him that no one knew Firn’s aorta had been punctured during the surgery. While Kundel said it was an injury that Konasiewicz should have been aware of because of the bleeding it would have caused, he said the operating room staff told him they saw no excess bleeding from the puncture.

“The people in the operating room said there was nothing unusual about the procedure,” he said.

St. Luke’s administration assured Kundel during his investigation “that we were monitoring Konasiewicz and everything he did would be watched closely,” Kundel told the News Tribune.

Before Firn’s death, Kundel said that he knew concerns about Konasiewicz’s competence had been raised by other St. Luke’s doctors for several years, but that St. Luke’s response satisfied him the situation was being handled properly.

“Bad mistakes do happen,” Kundel said.

Kundel said concerns about Konasiewicz’s care were brought to his attention again in July 2007, after Konasiewicz performed neck surgery on 39-year-old Lorena LeBeau of Duluth. LeBeau’s spinal cord, which was supposed to remain still during the surgery, jerked during the procedure.

LeBeau was diagnosed with “persistent cervical quadriplegia” — paralysis from the neck down — after the surgery.

Kundel said when he was told about the case, he saw it as another instance in which the surgeon injured an organ not in the site of the operation.

“It was an outcome that was completely out of the range of what was to be expected,” Kundel said.

Kundel: Other physicians knew

Kundel’s letter described another incident of Konasiewicz puncturing a woman’s aorta during spinal surgery. “This lady’s life was saved by prompt repair of the aortic defect by (St. Luke’s surgeon) Dr. Brian Meyers,” Kundel wrote.

Kundel told the medical board that he knew of other St. Luke’s physicians who would speak about Konasiewicz’s care.

“I am able to identify for you a number of physicians who have treated operative complications following surgery by Dr. Konasiewicz and who should be able to evaluate his surgical judgment and technique,” he wrote.

Numerous physicians and hospital staff members who have worked for and with St. Luke’s have told the News Tribune that they brought concerns about Konasiewicz to the hospital’s administrators, including to CEO Strange.

If St. Luke’s did suspend Konasiewicz for two weeks or more, it would have to report that action to the National Practitioner Data Bank. An analysis by the News Tribune of the Data Bank shows that no action taken by the hospital against Konasiewicz was ever recorded.

The neurosurgeon indicated on his Minnesota medical license renewal applications each year from 2005 to 2008 that he had not been notified “of any investigations by any state medical board, medical society, or any hospital of any complaints against you relative to the practice of medicine.”

Konasiewicz has declined repeated requests for comment to the News Tribune.

Kundel said that after he sent his letter, the Minnesota Board of Medical Practice contacted St. Luke’s. Kundel said he was told that Konasiewicz was sent for training by the hospital and, upon his return, Konasiewicz had limited privileges at St. Luke’s and left the hospital shortly after.

By September 2008, Konasiewicz was listed as a practicing physician with the South Texas Brain and Spine Institute in Corpus Christi.

Konasiewicz and St. Luke’s have been sued for malpractice at least nine times. The News Tribune has found that six of those cases were settled for at least $3.2 million. Firn’s case was settled for about

$1.5 million. LeBeau’s case settled for more than $1 million. Two of those cases went to trial, where Konasiewicz was found not negligent. One case is still pending.

IN RESPONSE: St. Luke's statement

In a request by News Tribune Investigations Editor Brandon Stahl to St. Luke’s hospital for comment about the articles in the series, “The Case of Dr. Konasiewicz,” St. Luke’s provided the following response:

Statement of St. Luke’s
September 23, 2011
The questions you ask pertain to the subject matter of the defamation lawsuit St. Luke’s filed against you, Mark Stodghill and the Duluth News Tribune on September 19, 2011. It is inappropriate for St. Luke’s to provide you with additional information relating directly to this subject matter outside of the court supervised discovery process. Accordingly, please direct future inquiries relating to the subject matter of St. Luke’s lawsuit against you, Mark Stodghill and the Duluth News Tribune through your legal counsel to ours, Pat Tierney.

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