Brilliant surgeon or loose cannon?

Last month, as a Christmas party geared up inside a Roanoke hotel ballroom, longtime surgeon Bradley W. Nicholson munched pizza in the lobby and wondered whether his life’s work was facing imminent collapse.

For more than eight hours, he had sat before a humorless three-member panel of the state Board of Medicine and listened to a parade of witnesses challenge his ability to practice medicine.

“This case comes down to deciding whether this man is the Lone Ranger or a loose cannon,” Assistant Attorney General James E. Schliessmann told panel members, suggesting that Nicholson’s conduct rose to a level of gross negligence that endangered patient safety.

“Is he a misunderstood genius or a ticking time bomb?”

Weighing on Nicholson, a Hopewell native and graduate of Virginia Commonwealth University’s Medical College of Virginia, was a five-page list of alleged infractions dating back almost three years.

Watching silently in the rear of the room were family members of a patient who had died after Nicholson removed cancerous tissue from her lung.

A wrongful-death lawsuit in the case has alleged that the operation should have been done elsewhere by a certified thoracic surgeon. The patient suffered acute blood loss, her heart failed, and she never regained consciousness.

The medical board was concerned that Nicholson failed to cross-match the patient’s blood, making sure that reserve supplies were on hand. He also failed to note the heart attack in his operative notes.

There was more.

Nicholson, the board alleged, refused to enter and complete treatment for substance abuse through an intervention program; he declined treatment in a residential program for alcohol abuse and relational problems.

Board documents alleged a “pattern of chronic disruptive behavior” at Carilion Giles Memorial Hospital in Pearisburg, where Nicholson had spent most of his career. His privileges there were terminated last summer and he has resigned.

Now he is a surgeon without a hospital, but he still sees patients in his private office in Pearisburg, 80 miles west of Roanoke.

Nicholson, according to the allegations, had been verbally abusive to hospital staff, had thrown and damaged equipment, had circumvented operating-room procedures, did not provide adequate operative notes when failing patients were rushed to other hospitals, left the operating room in the course of surgeries without backup coverage from another physician and was chronically late in filling out patient records.

In another matter, Nicholson waited days to reposition a catheter that had missed a vein, according to board documents. He had not recognized that the catheter was misplaced.

Taken together, his actions “constitute a pattern and practice of acts likely to harm the public,” board documents alleged.

There was more.

A nurse recalled that Nicholson became upset one day when he could not find a rasp among those in the operating room that would be suitable for rounding off the bone left from an amputated leg.

He ordered the nurse to bring one from the hospital maintenance department.

“It may have been a Stanley or a Sears. The patient got a perfect result,” Nicholson testified.

Nicholson, his voice even and confident, addressed every allegation. Sometimes his lawyer, former state Attorney General Stephen D. Rosenthal, prodded him to be more direct and forceful.

He acknowledged that paperwork has never been his strong point; his operating-room manners were perhaps brusque but never threatening, he said. Transferring the patient to a thoracic surgeon was merely a recommendation — he had done dozens of similar operations before.

The alcohol issues were handled behind closed doors, but there were indications that assessments of Nicholson’s alleged dependency problem had been offset by other analyses.

When a board member asked if Nicholson had ever heeded a suggestion that he seek anger-management training, he said, “No. And I probably wouldn’t based on a five-minute evaluation by an RN.”

He conceded that he had cut administrative corners, but he said it was because of his feeling that some hospital procedures were inefficient and time-consuming. It was hard to get proper equipment, he said.

Rosenthal argued that none of the charges, even when taken together, amounted to gross negligence.

He called Nicholson “an intense, brilliant surgeon who loves what he does and is passionate about his patients and tends to get angry when things don’t go right. … This is a doctor who goes to the hospital every day and saves lives.”

Rosenthal acknowledged that Nicholson was guilty of one thing: “not finishing documents on time.”

But “he doesn’t deserve what he’s now facing. … What needs to be fixed should have been fixed at the hospital and kept at the hospital level.”

Instead, Nicholson became the target of a hospital that wanted him weeded out as a malcontent and took steps to chart Nicholson’s every misstep, Rosenthal said. While Nicholson may have left the operating room, it was only during usual breaks in a procedure, and Nicholson never was more than a few feet away.

The panel members deliberated for three hours.

Chairwoman Sue Ellen Rocovich, an osteopath from Roanoke, announced the findings: There was insufficient evidence that Nicholson is impaired.

There was a pattern that Nicholson failed to complete operative notes, placing three patients at risk of harm. More than 120 instances of failing to complete operative and discharge notes on time was “inconsistent with good medical practice.”

He circumvented various protocols and threatened the health of a patient, who later died, by not sending her to a thoracic surgeon and by not assuring that an adequate blood supply was available. His failure to correctly diagnose a misplaced catheter put a patient at risk.

Then came the disciplinary action.

The board issued a reprimand, its least severe penalty. Nicholson will be required to take 14 hours of classes in medical record-keeping.

“This is huge,” Nicholson told Rosenthal, pumping his hand in thanks.

The doctor still has a long road ahead of him.

He has to find another hospital where he can practice. There is the malpractice suit still looming.

The relatives of the deceased woman stayed for the board’s verdict, as did the half-dozen or so hospital workers who testified against the longtime surgeon.

They had no comment and silently left for home.

Bill McKelway is a staff writer for The Richmond Times-Dispatch.