If Dr. Najam Azmat was not behind bars, he could still see patients in a hospital or clinic in Georgia.
Azmat's medical license is still active there, despite years of hopping from state to state, racking up reports and allegations of dangerous care in pain clinics and health systems as he went.
The vascular surgeon—known as “Dr. Hazmat” in his Feb. 26 indictment—has settled numerous malpractice cases, including one that involved a patient death. He had his medical privileges restricted by two different hospitals following reports of poor care. He was targeted in a scathing federal False Claims Act lawsuit. And reports show he was active in at least three pain clinics in Kentucky and Georgia that were accused of handing out dangerous narcotics without medical necessity.
The trigger that finally cost him his medical license in Kentucky, but not Georgia, was a report from a Kentucky emergency room doctor who notified authorities after treating a patient who saw Azmat at an alleged “pill-mill” operation in Lexington.
“Dr. Azmat committed serious acts that are grossly incompetent and grossly negligent,” a consultant for the Kentucky Board of Medical Licensure wrote last year after reviewing charts for 21 of Azmat's Lexington pain-clinic patients. “It is the opinion of this reviewer that Dr. Azmat represents an imminent danger to the citizens of Kentucky.”
The medical license for the surgeon-turned-pain-clinic doctor remains active in Georgia, according to the state's public website, even though he's in jail on charges of using his physician credentials to dispense dangerously addictive narcotic prescriptions to patients who were abusing the drugs or selling them to others.
The Georgia license is especially perplexing given Azmat's repeated problems with care as a vascular surgeon in the state—problems that were severe enough that his former hospital paid $840,000 to settle a Justice Department False Claims Act lawsuit that claimed his services were worthless to Medicare because he lacked training and was harming patients as a result.
Azmat's ability to crisscross the American landscape with an active medical license, even after two hospitals ran into serious problems with him dating back to 1997, raises troubling questions about the system of accountability that is supposed to protect the public from dangerous doctors.
“Something is wrong with that picture, needless to say. This is a long record, going back 16 years,” said Dr. Sidney Wolfe, longtime director of the Health Research Group at the not-for-profit advocacy group Public Citizen.
The story also highlights flaws in a system in which hospitals rarely file reports on problem doctors.
A 2009 report by Public Citizen found that nearly half of all U.S. hospitals had never filed a single report on a dangerous doctor to the National Practitioner Data Bank in the past two decades—a fact that critics say points to hospitals' reluctance to aggressively police medical staff members who are key to generating revenue for the organization.
The Justice Department alleged in its False Claims Act lawsuit that officials at the hospital in Waycross, Ga., then known as Satilla Health Services, forged a secret agreement with Azmat in 2006 not to report his episodes of poor patient care to the national data bank.
That allegation was made in a 2010 amendment to the 2007 False Claims Act case. Hospital officials paid to settle the lawsuit in January 2012 without admitting wrongdoing.
Azmat was also individually targeted by the same lawsuit, but prosecutors in the southern district of Georgia dropped the case not long after the physician—who represented himself without a lawyer—accused the government of botching their investigation. Prosecutors declined to say why they dropped the case against Azmat in July 2012, other than to note that cases are routinely withdrawn without explanation.
The Mayo Clinic Health System, which announced plans to buy the 200-bed Satilla hospital just two months after its 2012 settlement, declined to comment on Azmat, the settlement, or reports not made to the data bank.
“Dr. Azmat has not been associated with Satilla Health Services since 2007. We have no further perspective to offer,” wrote Clay Thomas, government relations administrator in Waycross for Mayo, in an e-mail.
The Kentucky hospital that restricted Azmat's privileges in 1997—Hardin Memorial Hospital, in Elizabethtown—did file a report with the data bank, which state boards of licensing and future employers are supposed to check when they evaluate a physician's credentials.
According to legal filings from the Justice Department, the 1997 restrictions came after hospital official discovered that 23% of Azmat's operations had resulted in complications for the patients. His privileges were restricted until 2000, and he left the hospital in 2002.
Wolfe noted that such discipline reports filed by hospitals ought to carry added weight in the medical community because hospitals tend to be reluctant to file in all but the clearest cases.
“When hospitals report someone, you know that's something massive, because doctors bring revenue into the operation,” he said. “The seriousness of the hospital actions is several notches above the state actions.”
Yet since that report was made, Azmat was recruited to the cardiac catheterization department at one hospital (Satilla), worked through temporary “locum tenens” staffing services at hospitals in other states (Louisiana and Maine), and used his medical license at several pain clinics, according to public disciplinary records and lawsuits.
By the time Azmat was stripped of his license in Kentucky in 2012 for suspicious narcotic prescribing activity, his indictment says he'd spent three weeks in Georgia in 2011 earning between $1,000 and $2,000 a day working for a pain clinic.
Officials with the Georgia Composite Medical Board did not respond to requests for comment on Azmat's past and continuing licensure in the state.
Suzanne Henry, an Austin, Texas-based policy analyst with the Safe Patient Project at the Consumers Union, said funding problems plague the system that is supposed to protect the public from dangerous doctors. Such boards are also generally staffed by physicians, and Henry said the community of doctors tends to “circle the wagons” and protect doctors with documented issues, rather than meting out career-changing licensing decisions.
“Which is puzzling to me,” she said. “We are not talking about most doctors. The majority of doctors are good at what they do. But it is amazing that a very small percentage of doctors have horrible records, and it is not easy to track them down.”
After a decades-long career in medicine, Azmat was arrested by U.S. marshals on Feb. 26 and jailed on 52 counts of unlawful dispensation of narcotics and conspiracy to launder money at the Georgia clinic, East Health Center in Garden City.
His court-appointed attorney, David Burns, said Azmat has not yet entered a plea, but he emphasized that Azmat was only employed for three weeks in 2011 at a pain clinic that wasn't raided by federal authorities until June 2012.
“It's safe to assume that he's going to defend himself to the hilt. Cases like this are always about evidence, and we just don't know what evidence they have,” Burns said. “A lot of people get scared. (The Justice Department has) the power to put people in jail for a long time … but Dr. Azmat does not strike me as someone who is going to be scared by that.”