I’m happy to report that transplant surgeon Dr. Tom Diflo, my college and medical school classmate, was found not liable for malpractice. I’m outraged to report that after the trial was over, the plaintiff’s lawyer admitted that he had known all along that Dr. Diflo was not guilty of the charges he filed against him.

The case was a medical tragedy (Man dies of uterine cancer; who’s to blame?). Kenneth Liew had been on dialysis for years before he received a kidney transplant in 2002. The kidney came from a woman who had died of a stroke. Unfortunately, unbeknownst to her and everyone else, she also had uterine cancer. Seven months after the surgery, Mr. Liew died.

In an interview with the New York Daily News, the plaintiff’s lawyer, Daniel Buttafuoco, seeking to explain his loss of the case, made the outrageous claim:

Dr. Diflo had no idea the organ was bad … We were forced to try a case against the most innocent guy of all.

Parse those sentences and you will come face to face with what is wrong with the malpractice system in this country.

“the most innocent guy of all”

Buttafuoco acknowledges that he knew that Dr. Diflo had not been responsible for the tragedy because the doctor could not have known that that the organ was defective. The widow and her lawyers mounted a legal case that lasted eight years and surely cost hundreds of thousands of dollars for no better reason than because they could. It certainly was not because they believed Dr. Diflo was to blame; they knew all along that he couldn’t possibly be to blame. Nonetheless, they went before a jury and offered testimony that they knew to be untrue.

In other words cases of medical malpractice are knowingly filed against doctors who haven’t committed malpractice. It’s like a lottery ticket; you file suit and hope you’ll strike it big. Just the luck of the draw for the lawyer and the client; too bad for the doctor who just wasted eight years of his life in fighting the claim.

“we were forced to try a case”

No, no one forced Mrs. Liew to sue, and no one forced Buttafuoco to file the case. Indeed, ethically, Buttafuoco was obligated to refrain from filing because he knew the accusations to be untrue. So why do they feel they were “forced”? That speaks to the prevailing view of bad outcomes and the purposes of malpractice suits.

Americans seem to believe that when something bad happens, it must be someone’s fault. Nothing is ever attributed to bad luck. Blame must be pinned on someone, or, more accurately, on someone else. Although it was well documented that Mr. Liew made the decision to keep the kidney, his widow and her lawyer argued that Dr. Diflo should have pressured him to have the kidney removed. But a bedrock principle of informed consent is that the patient should NOT be pressured into any course of action. The patient should be offered all available information and left to make his own decision. No matter; someone else must be blamed.

It’s not enough merely to blame someone. They must be forced to pay millions of dollars. The progression of thought appears to be: something bad happened to me (in this case Mrs. Liew lost her husband); it was someone else’s fault; I deserve lots of money for no other reason than because something bad happened.

“We were forced to try a case against the most innocent guy of all.”

The determination of whom to sue had nothing to do with guilt or innocence. It was all about who had a “deep pocket” that could potentially yield millions. The lawyer didn’t sue Dr. Diflo because he did something wrong. He sued him because he had insurance that could potentially pay millions.

Indeed, the fact that Dr. Diflo had done nothing wrong probably figured into his calculations. He might have thought that he could get a quick settlement simply based on “nuisance value.” The insurance company might calculate that it was worth paying him and his client a hundred thousand dollars rather than spend many hundreds of thousands of dollars on a suit that they would ultimately win. The lawyer guessed wrong in this case, but many other lawyers have made quick money by accepting a settlement to make a case go away.

Is it any wonder than that doctors condemn the current medical malpractice system? Doctors get sued when they haven’t done anything wrong because patients believe that if something bad happens, someone must pay them money. Doctors get sued when they haven’t done anything wrong because the doctor has insurance that could pay millions. Doctors get sued when they haven’t done anything wrong because patients can make easy money if the insurance company settles because it is cheaper to settle than to defend a doctor who hasn’t done anything wrong.

It’s no wonder that most medical malpractice suits end in a judgment for the doctor. Medical malpractice suits are often filed against doctors who have done nothing wrong. Fortunately, juries, like the jury in this tragic case, can see that.

Why do they even publish these papers?

The June issue of Obstetrics and Gynecology leads with a paper entitled Vaginal Birth After Cesarean: New Insights on Maternal and Neonatal Outcomes. VBAC is currently an extremely controversial topic within obstetrics. The issue is whether an attempted vaginal birth after Cesarean poses greater risk to mothers and babies that a planned repeat C-section. VBAC is known to increase the risk of rupture of the uterus, a catastrophic complication that can lead to death of the baby, massive maternal bleeding, hysterectomy and even maternal death.

How would we study the relative safety of the two choices? We’d need to compare the mortality and morbidity of women who intended to have a vaginal birth after C-section with those women who intended to have a planned repeat C-section. In other words, the study groups should be based on intention to treat, not the eventual mode of delivery. This is an absolutely critical requirement. That’s because women who have a uterine rupture during attempted vaginal delivery after C-section are almost invariably delivered by C-section in order to save their babies’ lives and their lives. If the groups were based on ultimate mode of delivery, all the uterine ruptures and all the associated complications would end up in the C-section group, and not the attempted VBAC group.

So what did the investigators do:

All studies on maternal and neonatal outcomes reported on actual route of delivery rather than intended route.

In other words, the results of the study are USELESS for answering whether attempted VBAC or planned C-section is the safer mode of delivery. The study does NOT compare women who attempted a VBAC with women who chose planned C-section. It compares women who had a SUCCESSFUL VBAC with women who had chose a planned C-section PLUS women who had a C-section because they couldn’t deliver vaginally or because they had a serious complication like uterine rupture.

The authors then proceed to detail their useless results. Not surprisingly, since the women who experienced complications during attempted VBAC were included in the C-section group instead of the VBAC group, the risk of maternal mortality was elevated in the C-section group. Both perinatal and neonatal death rates were increased in the VBAC group possibly reflecting the fact that C-section is generally safer for babies.

In contrast, the studies that looked at uterine ruptures and classified patients according to intended mode of delivery demonstrated clear superiority of planned repeat C-section.

Uterine rupture is a potentially life-threatening complication that has been directly attributed to VBAC. By itself, uterine rupture is a visible or palpable anatomic finding rather than a health outcome. However, its association with perinatal and maternal morbidity and mortality raises substantial concerns among patients, clinicians, hospitals, and policy makers… Four studies reported uterine rupture outcomes for both trial of labor and elective repeat cesarean delivery. Among these four studies totaling 47,202 patients, there were 154 uterine ruptures; 96% (n=148) of which were incurred by the trial of labor group… The risk of uterine rupture in the trial of labor and elective repeat cesarean delivery group was 0.47% (95% CI 0.28–0.77%), and 0.026% (95% CI 0.009–0.082%), respectively, with trial of labor group having a significantly higher risk of uterine rupture (RR 20.74, 95% CI 9.77–44.02, P<.001).

The authors conclude:

One of the major findings of this report is that the best evidence suggests that VBAC is a reasonable and safe choice for the majority of women with a prior cesarean.

However, the report shows nothing or the kind because the wrong groups are compared. The authors acknowledge:

Importantly, studies of VBAC compared with elective repeat cesarean delivery have traditionally reported outcomes based on actual route of delivery rather than intended route, leading to misclassification of patients who intend elective repeat cesarean delivery but go into labor before their cesarean or women who intended trial of labor but who are delivered by cesarean.

Not only is this an important point, it is a critical point because it means that the studies cannot tell us how attempting a VBAC compares with a planned repeat C-section, the one thing that we most wish to know. So this study, designed to determine the safety of VBAC when compared to planned repeat C-section tells us nothing about the safety of VBAC when compared to planned repeat C-section.

Dr. Biter has resurfaced and he’s asking for money:

Dr. Biter has resigned from Scripps Encinitas with full OB, gynecological & surgical privileges! At this time, he still has the ability to do full inpatient & outpatient gynecological care & see patients for prenatal visits with a plan for individualized care…

Sure he got his privileges back … as a condition of his immediate resignation. Who benefited from this? Dr. Biter, of course, by avoiding a Board of Medicine investigation into the events leading up to the suspension of privileges including the 6 pending malpractice suits.

The great man has a message for his supporters:

I am happy to say that I still am able to do 100% of my gynecological practice (see below for a complete list). As far as my OB practice goes, my staff & I are currently arranging the schedule only for pregnant women at this time. In many OB practices, a doctor sees a patient at some visits and a stranger delivers. You know that I do not practice that way. Everything that I have done has kept you, my patients, as first priority. This has cost me hospital privileges that I rightfully won back, a lot of money, and even more nights of lost sleep. I don’t know what to say to reassure you other than that. My commitment to you has never been up in the air. My refusal to allow your birth to be a political or financial deal has put me into this unwanted situation, but you and your baby are worth it. Ours is a huge trust of faith….keep the faith. Birth matters.

In other words, Dr. Biter has not been able to get privileges at any hospital. Possibly, Dr. Biter can no longer practice obstetrics at all, because his malpractice carrier refuses to cover him (OB and GYN coverage are separate) or is demanding an exorbitant fee since he has 6 pending lawsuits.

Dr. Biter details the services he will provide:

Full prenatal care with individualized delivery plans available

Gynecological Services:

1. Annual Pap Smear

2. Sexually Transmitted Disease Screening and Treatment

3. Breast Health

4. Treatment of Abnormal Pap Smears Including: Leep, Colposcopy, and Biopsies

5. Minimally Invasive Hysterectomies

6. Hysteroscopies to Evaluate Uterine Lining or Polyps

7. Adolescent Health

8. Ultrasounds for Pain, Abnormal Bleeding, and/or Ovarian Screening

9. Prenatal Ultrasounds for Home Birthers

10. Rectal Prolapse Reconstruction

11. Pelvic Prolapse Reconstruction

12. Vaginal Support Reconstruction

13. 3D/4D Ultrasounds

14. Surgical and Non-surgical Treatment of Abnormal Bleeding

15. Surgical and Non-surgical Treatment of Urinary Incontinence

Gynecological surgeries will be performed by Dr. Biter at Carlsbad Surgery Center located at …

Simply put, Dr. Biter offers prenatal visits, but cannot deliver your baby. He also offers routine GYN care and minor surgeries that can be performed at a surgi-center, but no major surgery.

But Dr. Biter wants your money. He wants it so badly that he hasn’t even bothered to set up a tax free foundation before asking for it. He wants it so badly that you must send it directly to his bank account.

Help us keep the dream of Babies by the Sea Birthing Center and its mission alive and well. Here is how you can help:

1. Use the DONATE NOW PayPal link on this website to make donations to the Birthing Center Fund. At the present time this fund is not tax deductible. Dr. Biter is not managing this account. Any monies spent must be approved by an independent Board of Directors. A 2.9% charge will be taken out of the donation if credit cards or debit cards are used on PayPal.

2. If you prefer to send checks please make payable to Robert Biter, MD and send to …

3. Deposits can also be made at any Chase Bank location. The account number is …

No one should be fooled; the chances that this birth center will open are slim since Dr. Biter must obtain obstetric privileges at a hospital and he must obtain obstetric malpractice insurance. If you donate money, Dr. Biter will be free to keep it whether he ever opens the birth center or not.

Dr. Biter, you should be ashamed. You have made fools of these women by encouraging them to protest on your behalf while withholding information about your malpractice history. Now you are trying to get these women to donate their money to YOU (you haven’t set up a tax free foundation) and there is a very real chance that you will never practice obstetrics in California again.

May you never be an interesting case.

That’s a cautionary proverb familiar to medical professionals. While it’s bad to get sick, it’s much worse to get sick with something uncommon or unusual. The more fascinating a case is for doctors, the more difficult it is for patients. Difficult to diagnose, difficult to treat, and often difficult to survive.

Kenneth Liew was doubly unfortunate. He was an interesting medical case and an interesting legal case. Now he’s dead and a jury is currently deliberating who, if anyone, is at fault.

Kenneth Liew was really, really unlucky. He was unlucky because he had serious kidney disease that necessitated debilitating dialysis treatments three times each week. He was unlucky because it took 10 years for a matching kidney to be found to give him in transplant. He was unlucky because after he received his kidney and after it was working well, an autopsy revealed that the kidney came from a woman who, though she died of a stroke, had unknowingly had uterine cancer as well. He was unlucky because there is not a single case like his in the whole world, so no one knew the odds that the cancer would be transmitted. He was unlucky because he died of cancer only seven months after receiving the transplant.

Despite being exhorted by her dying husband to forgive the doctor, Mr. Liew’s widow ignored his wishes and sued just about everyone she could think of including the doctor and New York University Medical Center where the transplant occurred. Eight years after Mr. Liew died, the jury has finally received the case.

First and foremost, this case has been a nightmare for Mr. Liew and his family. But secondarily, this case also represents a doctor’s worst nightmare. The doctor, transplant surgeon Thomas Diflo, lost a patient through a freak accident that no one could have known about or predicted and now he’s being blamed. I would feel sympathy for the doctor no matter what, but I am especially saddened because the doctor was one of my classmates in medical school.

Mrs. Liew is sure that somebody is to blame for something and that she deserves $3 million dollars in compensation, but it is not clear who is to blame or what they are to blame for:

·         Did anyone know of the donor’s uterine cancer? Both sides agree that no one knew or could have known that the donor had uterine cancer.
·         Was the patient informed that the donor had cancer? Both sides agree that the transplant surgeon informed the donor approximately 2 months after the he received the kidney.
·         Should the kidney have been removed immediately thereafter? Both sides acknowledge that there was no way to predict the chances of Mr. Liew developing metastatic uterine cancer. There had literally never been a similar case in the history of medicine. Therefore, the doctor left the decision up to the patient, advising him that based upon what is known about transplants and cancer and based upon the fact that uterine cancer does not metastasize to the kidney, the chance that Mr. Liew would develop metastatic uterine cancer was low. Mr. Liew’s widow argues that the doctor should have advised that the kidney be removed immediately.
·         Would removal of the kidney have made any difference? It’s unlikely. Whatever was transmitted to Mr. Liew from the donor kidney had already been transmitted.
·         What caused Mr. Liew’s death? That’s not clear. Mr. Liew died of cancer, but the metastatic cancer was so poorly differentiated that no one can tell what type of organ it came from originally. It could have been uterine cancer transmitted by the kidney, but it also could have been cancer that developed spontaneously in Mr. Liew.
So if no one could have known about the uterine cancer in advance, if removing the kidney would not have made a difference and if it is not completely clear what kind of cancer killed Mr. Liew, why are Dr. Diflo and NYU being sued? They are being sued because something bad happened and someone must be blamed. It wasn’t anyone’s fault; no one did anything wrong, but you can’t get any compensation for bad luck. Therefore someone, anyone, must be blamed and must be made to pay.

The jury has the case now, and within a few days we will find out if they agree.

A new study being widely reported in the mainstream media has recommended delayed cord clamping. However, the authors acknowledge that there is no scientific evidence that delayed cord clamping provides any benefits for term infants; their recommendation is based on pure speculation.

The paper entitled Mankind’s first natural stem cell transplant appears in the Stem Cell Review Series of the Journal of Cellular and Molecular Medicine. The authors of the paper include the founder and chairman of Saneron CCEL Therapeutics, Inc. a company that harvests stem cells from umbilical cord blood to use in developing new treatments for neurodegenerative and other diseases. It appears that the primary purpose of the paper is to demonstrate that cord blood collection for banking or research does not require immediate clamping of the umbilical cord.

The authors acknowledge that there is no demonstrated benefit to delayed cord clamping in term infants. While some studies show a reduced incidence of anemia in the first 6 months of life, this is only clinically important in developing countries where anemia is common in infants and children. The authors focus instead on potential benefits of transferring additional stem cells from the umbilical cord blood to the baby’s bloodstream.

The authors make much of the fact that delayed cord clamping leads to the baby’s “first stem cell transplant.”

… autologous transplantation of stem cells naturally occurs in nature at birth in mammals via the umbilical cord. A delay in the cord blood clamping may increase the stem cell supply to the baby, thereby allowing an innate stem cell therapy that can promote acute benefits in the case of neonatal disease, as well as long-term benefits against age-related diseases….

Yet the authors don’t provide any reason why a term baby has any need of or derives any benefit from a stem cell transplant. There is no scientific evidence that early cord clamping leads to a deficit of stem cells in the neonate or that delayed cord clamping has any impact on any neonatal system dependent on stem cells. The purported benefits are all entirely theoretical.

As any doctor knows, the history of medicine is littered with ideas that seemed to be great in theory, but surprisingly turned out to be dangerous in fact. Consider the use of 100% oxygen in the first incubators of the 1930’s. Reasoning that if some oxygen is good, more must be better, premature infants having difficulty breathing were treated with pure oxygen. It may have been better from a respiratory point of view, but it unexpectedly rendered many of the infants blind. That’s because the sensitive tissues of the retina develop best in a low oxygen environment, but no one knew this until they learned of the damage that resulted from exposure to 100% oxygen.

The reasoning behind delayed cord clamping is the same: adequate red blood cells are good, more must be better; adequate umbilical stem cells are good, more must be better. But we really don’t know whether either of those claims are true. As the authors acknowledge:

One important point to consider is the long-term effects of delayed cord clamping. The present authors are unaware of any studies in either animals or human beings that followed the organism to adulthood. In human beings the longest studies go to 6–7 months and some benefits can still be observed with respect to iron status and motor disability. It is crucial to perform long-term follow-up studies to determine whether the reported benefits of delayed cord clamping are long term, or whether additional benefits may become apparent.

It never even occurs to the authors to investigate whether there might be harms from delayed cord clamping. After all, some umbilical cord blood is good, more must be better, right? Wrong. Without studying the matter we have no idea of the long term benefits or risks. It is irresponsible to recommend delayed clamping as the standard until we have scientific evidence that it provides benefits without leading to unexpected harms.

Over the last few years, the public has been treated to the spectacle of prominent politicians facing serious allegations staging photo ops with a supportive wife at their side, such as the one of the former New Jersey governor and his wife above. And at many such photo ops, the wife is acting as enabler. She stands at the politician’s side implying that she believes his denial (of an affair or a visit to a prostitute or similar behavior) even though she knows or ought to know that he is not telling the whole truth.

Perhaps she truly doesn’t know; or maybe she knows but believes she is saving the marriage; or maybe she knows but is as invested in saving the political career as he is. In any case, she is an enabler in her own humiliation, standing before the public and pretending that the fact that she was betrayed is untrue or irrelevant, as if her feelings don’t matter, as if her job is to support her husband right or wrong.

Evidently that phenomenon is not restricted to marriages. NCB advocates seems to have no trouble standing by the side of the various “Dr. Wonderfuls” supporting them as if their deeds don’t matter, and as if it the job of the “little woman” to always support the man.

Witness Rixa Freeze’s outrageous claim after learning that Dr. Stuart Fischbein had been convicted of sexual exploitation of a patient (in the comments section of Another Dr. Wonderful needs your help!):

Regarding the controversy about the consensual sex issue: I see it as irrelevant to the issue at hand. Dr. F’s regrettable mistake in the past is being used as classic ad hominem and red herring arguments. It’s a way of distracting people away from the real issue at hand (women’s right to choose VBAC or vaginal breech birth, and physician’s right to support them in those choices) by attacking Dr. F’s character.

The conviction of sexual exploitation of a patient is irrelevant when determining whether other women should support this doctor? Only if you believe that turning a blind eye is an appropriate stance.

Barb Herrera, Navelgazing Midwife, has just written an astounding post that sets a new standard in enabling a “Dr. Wonderful”. You can read the piece here. Barb acknowledges that Dr. Biter is currently facing 6 malpractice lawsuits; she confirms that Dr. Biter was reinstated only so that he could resign and avoid the consequences of a suspension; she glosses over the fact that Dr. Biter, her friend and colleague, never bothered to tell her about those lawsuits or the truth about the reasons for his suspension; she proudly declares that Dr. Biter is giving his approval to what she writes on his behalf. And then … she ignores that information in order to continue to support the man that just abetted her public humiliation.

Several days ago, Barb wrote a long post in support of Dr. Biter which alleged a giant hospital conspiracy to get rid of Dr. Biter because he is “unconventional” and “non-conforming” in his support of natural childbirth. Barb had absolutely no idea whether her claims were true; she provided no facts to support her claims and obviously she was unaware of the actual facts of the case. In light of the information she has learned in the last few days, Barb now writes … EXACTLY THE SAME THING.

Oh, wait, not exactly the same thing. Yes she repeats the unsubstantiated claims of an elaborate conspiracy to remove Dr. Biter, but now she includes the deal apparently struck by Dr. Biter so that he could avoid further investigation and blames … THE HOSPITAL. Barb twists herself into a pretzel to generate this mind boggling conclusion:

… If Dr. Biter did something egregious… something dangerous… why didn’t Scripps Encinitas revoke his privileges and throw him to the dogs (the Medical Board)? In fact, it’s been brought up that Scripps Encinitas is named in four of the six Biter lawsuits out there (and remember, a suit does not infer guilt!) and if Scripps Encinitas’ lawyers felt that Dr. Biter was negligent, isn’t it negligent of them to “let him go?” It is because of this that I believe he did nothing illegal or outright dangerous, but that they had a philosophical (and financial?!) issue with his being there…

So let me see if I get this straight: the hospital is “negligent” if it let Dr. Biter weasel out of a more thorough investigation of his competence to practice obstetrics. But the hospital couldn’t be “negligent” so that must mean that Dr. Biter is competent and his suspension was a giant conspiracy to punish his practice style.

Barb starts with a fixed conclusion and fabricates backward from there. The fixed conclusion is that her Dr. Wonderful is worthy of her adulation, and anything else is unthinkable. Dr. Biter couldn’t have struck a deal to escape further investigation because … well because he just couldn’t have done so. Yes, he let her speak on his behalf without warning her that there were critical facts that she didn’t know, but that’s okay. The facts are irrelevant when the great man needs support.

Barb ends with another dollop of the gushing adulation that she’s been displaying all along:

He’s thanking me for my support, letting me know I am saying the right things, defending him appropriately and reminding me of the variation in the standards of care between providers while remaining within ACOG Guidelines. Dr. Biter is hardly alone, this Doctor-as-Renegade persona.

If that’s not enabling, I don’t know what is.

Dr. Robert Biter, an obstetrician at Scripps-Encinitas, recently resigned within hours of having his OB privileges restored, thereby avoiding a Board of Medicine investigation into his practice. Dr. Biter has been less than forthcoming about the circumstances surrounding his suspension (he failed to inform his supporters about the 6 pending lawsuits that have been filed against him in the past 5 years). In investigating Dr. Biter’s background, I have come across repeated mentions of the charities that he has started.

Dr. Biter’s boutique, Babies by the Sea, proudly claim to donate revenue to two charitable organizations:

Babies by the Sea Boutique will donate a portion of net revenue to non-profit organizations developed by Dr. Robert Biter called Her Hearts Wish and Seaside Giving. Her Heart’s Wish is a national organization dedicated to granting the wishes of women facing terminal illness. Seaside Giving provides medical care to pregnant women who cannot afford medical services.

Over the years, Dr. Biter repeatedly mentioned his involvement in Her Heart’s Wish such as in this 2005 profile of Dr. Biter by San Diego Magazine:

Six years ago, Biter was completing his residency at Penn State Hershey Medical Center when he met Beth, a young mother dying of ovarian cancer. After coming to terms with her condition, Beth expressed two final wishes: to bake cookies with her children one last time and take a weekend trip with her husband. Biter mobilized other residents and nurses to make Beth’s wishes a reality just days before her death. But before she died, Beth revealed another wish: for other terminally ill women to enjoy the same opportunity to fulfill one last desire of the heart.

In 1999, Biter founded Her Heart’s Wish, a charitable organization that has granted hundreds of wishes in nearly all 50 states…

As far as I can determine, neither of Dr. Biter’s charities currently exist.

Her Heart’s Wish was a Pennsylvania non-profit organization that granted wishes to dying women. It was established in 1999 and is officially located in Hershey, PA. It maintained a website and was mentioned in a variety of print and web publications. Dr. Biter may have been a founder, but according to the patient Beth’s husband, HE founded the organization:

Shortly after Beth’s passing, Jim rolled up his sleeves and spent the next two years creating an organization that would grant last wishes to other women. Navigating his way through the difficult legal and tax aspects involved in establishing a non-profit organization, he never gave up. Finally, in 2001, he launched Her Heart’s Wish, which in the following years has grown from a regional to a national wish-giving organization for women over 18.

The website went off line in late 2008 and the charity appears to exist no longer. Nonetheless, Dr. Biter continues to solicit donations for Her Heart’s Wish now located at a residential address in Encinitas, CA.

How about Seaside Giving? As far as I can determine from public records, there is no charitable organization registered in California under the name Seaside Giving and there has never been such an organization. There is no website, no list of beneficiaries, indeed no mention of it anywhere except on Dr. Biter’s own website.

It appears that Dr. Biter is soliciting funds for two charities that don’t exist. Of course,I’m not expert in researching charitable organizations, and it is possible that I overlooked sources of information. So I would welcome everyone’s help in finding information that would demonstrate that Dr. Biter’s charities are real, and are dispersing funds to needy individuals.

Dr. Robert Biter, known to his supporters as “Dr. Wonderful,” has voluntarily resigned his privileges at Scripps Encinitas Hospital two weeks after the hospital initially suspended him.

According to the San Diego Union-Tribune:

Less than a day after officials at Scripps Memorial Hospital Encinitas reinstated baby delivering privileges to Dr. Robert Biter, the natural birthing method advocate voluntarily resigned from the staff late Friday afternoon, hospital officials said.

The turn of events capped off a standoff between Biter and the hospital’s medical staff that had lasted for two weeks and had generated daily protests by his supporters in front of the Encinitas medical center.

Scripps officials suspended Biter’s obstetrics privileges on May 7 without offering a public explanation for the action. They left his gynecological privileges in place.

The doctor also declined to say why he was disciplined.

It may seem confusing, but it actually makes perfect sense.

Apparently, there was never any chance of Dr. Biter continuing to practice at Scripps Encinitas. The hospital is bound by confidentiality agreements and cannot reveal the allegations, but it is likely that the 6 pending lawsuits filed within the last 5 years had something to do with it. That is an extraordinary number of lawsuits for an entire 40 year career, let alone the first decade of practice.

But Dr. Biter was able to negotiate something other than the worst possible outcome for himself. By law, the hospital was required to notify the Board of Medicine within 15 days if his privileges were suspended or revoked, automatically triggering an investigation by the board that could lead to the loss of Dr. Biter’s license. However, he managed to avoid that investigation by promising to voluntarily resign if his privileges were reinstated.

It’s a win for the hospital, because they have successfully severed their relationship with Dr. Biter. Obviously it does not protect the hospital from the lawsuits that have already been filed, but it ensures that the hospital will face no further liability. It is a win for Dr. Biter, because he has avoided the most serious possible consequence of the allegations, an investigation that could lead to the permanent loss of his license to practice medicine.

It is emphatically not a win for the women of California. Because of the deal struck between Dr. Biter and the hospital, all the allegations remain confidential. A hospital has severed its relationship with a doctor because it considers him a serious liability, but it has released him to set up shop elsewhere and continue doing whatever got him into trouble in the first place.

The supporters of Dr. Robert Biter, the San Diego obstetrician whose privileges have been suspended by Scripps Encinitas can’t seem to figure out why this has happened. They ought to check the public records of the San Diego Superior Court website. Evidently Dr. Biter has been sued 6 times in the past 5 years! That must be some sort of record, especially when you consider that he has only been in practice since 2001.

For perspective, consider that almost all obstetrician are sued once in their career and many are sued twice, but being sued three times or more is far less common. Scripps Encinitas has been named as a co-defendant in 4 of 6 lawsuits including 2 lawsuits filed within the past 5 months. It’s hardly surprising that the hospital has taken the opportunity to review Dr. Biter’s status as an obstetrician at their hospital.

Correction: a previous version of this post reported 7 lawsuits. There appear to be only 6 lawsuits with one listed twice in the public record.

Can you still be Dr. Wonderful if you are engaged in inappropriate physical contact with patients? Evidently you can. Dr. Stuart Fischbein is still receiving the support of natural childbirth advocates even after being convicted of sexual exploitation of a patient. Now another “Dr. Wonderful” is facing disciplinary action and natural childbirth advocates have rushed to his defense without knowing the accusations.

Dr. Robert Biter, the “Dr. Wonderful” who worked with Barb Herrera (Navelgazing Midwife) has had his obstetric privileges at Scripps Encinitas suspended. Natural childbirth advocates have held marches, begun a letter writing campaign, and have blogged in support of Dr. Biter, all without having any idea of the charges against him.

Now Barb Herrera comes to his aid, and with friends like that, you don’t need enemies. Barb, a personal friend of Dr. Biter’s, believes she knows what is going on. You can read her post So, What’s the Deal with Dr. Wonderful? for yourselves, but the message I took away from it is that Dr. Biter has been accused of:

1. Failing to be available when his patients need him.

2. Repeatedly violating hospital policies and placing the hospital and its staff at risk of malpractice claims. Barb has written elsewhere that Dr. Biter confided to her that he expected to lose his privileges. That suggests that he was warned and placed on probation, but ignored the warnings.

3. Most disturbing, Dr. Biter has been accused of inappropriate physical contact with patients.

Now you or I might consider inappropriate physical contact utterly incompatible with being “Dr. Wonderful.” Natural childbirth advocates don’t see things the same way. Their heroes can do no wrong. Barb actually goes so far as to justify Dr. Biter’s alleged behavior with classic sexist excuses:

A common [comment] was that he was too chummy, too huggy. His physical kindness is a hallmark in Dr. Biter’s care and is welcomed by those that adore him. I’d almost forgotten the snarky things people had to say about how he hugged them too much until a Biter Rally attendant ran into a couple of RNs that alluded to the reason behind his expulsion was because he was too “friendly” with his patients and their families. When she mentioned it on-line, the topic quickly blossomed into “I noticed his affection for his clients in the photos you took,” and “At first I was taken aback by how he touched the women in the pictures.” Upon examination, we were able to see the sexism in the equation, that if he were a female OB, it wouldn’t seem out-of-place at all. I countered that I don’t often see female OBs hugging their patients, either. But, I suggested we exchange his male OB-ness for a midwife and the “ah-ha!”s had the picture. It isn’t inappropriate for a care provider to hug a client, it’s just crazy bizarre to see an OB doing it!

In the photo spreads I’ve done, I noticed that I took the pictures because Dr. Biter was doing something so unusual, so beautifully different than every other obstetrician –and many of the midwives- I’ve worked with in my life. I went over the photos again and smiled at the love that man has for life. I look and remember every moment of the births with him. Dr. Biter is so present with his clients. No matter how tired he is, no matter how much he still has to get done, he is there with whomever is in front of him. And women/clients/families feel that kind of adoration. It is returned to him a million-fold.

That’s a fairly good compendium of sexist excuses for inappropriate physical contact: She misunderstood. No one would have minded if he were a woman (well, duh!). No one would have minded if he were a midwife. The second and third reasons are really just variations of the first: “Don’t worry your pretty little head about it, young lady. It’s your fault because you misunderstood.”

Why do natural childbirth advocates put certain male obstetricians on a pedestal? The heroes of the natural childbirth movement are all men, but that’s probably because there were very few female obstetricians until recently. How can we explain the current tendency of NCB advocates to idolize male obstetricians who share their philosophy? I don’t know the answer, but I do know that female obstetricians and midwives are not recipients of the gushing adoration and the willingness to forgive all that are directed toward certain male obstetricians.

I commented on Barb’s blog, and of course she refused to post it. [addendum: my commented was posted on 5/19.] I commented on Rixa’s blog about her support of Dr. Biter in the absence of any information on the specific allegations. She removed my comment despite the fact that another commenter (an NCB advocate) agrees. That tells me two things: They found my criticism personally embarrassing so they removed it. In addition, they feel compelled to protect Dr. Biter by keeping the truth, or even speculation about the truth, from women.

The problem, though, is much bigger than this episode. NCB advocates need to ask themselves why they have made a cult of the male obstetrician, why they can forgive him anything, and why they respond with sexist putdowns to women who have observed or experienced inappropriate physical contact from certain male obstetricians.

addendum: According to the San Diego Union-Tribune, Dr. Biter has been served with 4 malpractice lawsuits just in the last 13 months. A search of the San Diego County Court webiste shows that there are another 3 lawsuits suits that have been filed between 2005-2008. Scripps Encinitas was named as co-defendant in 4 of the 7 suits including 2 suits filed in the past 5 months.