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When Linda Bajadali first saw Dr. Richard G. Buch, she thought he was a "rebel." The tall surgeon in scrubs and lab coat wore a red, white and blue bandanna around his head and a self-assured smile.

Buch examined Bajadali's shattered knee for a few minutes.

"We'll take care of this in the morning," he said, sounding confident, almost arrogant. During the surgery at Medical City, he would remove shattered pieces of bone; she might need an artificial knee.

Bajadali, a telecommunications manager, and her husband, Harold Bajadali, were relieved. After falling from a ladder in 2002, 57-year-old Linda had been in excruciating pain. A doctor in the emergency room at Baylor University Medical Center said her injury was so serious she needed an orthopedic surgeon. He gave them Buch's name, which the Bajadalis took as an endorsement of sorts.

Buch reinforced the feeling, saying that four other surgeons would be observing and learning as he worked on her leg the next morning.

"The inference was he was a hotshot," Harold says.

The Bajadalis now believe the "hotshot" botched the surgery, leaving her with a huge, infected open wound that required extensive treatment and repair by two other doctors. She lost mobility and her job.

Though the Bajadalis filed a lawsuit against Buch, the case was dismissed by a judge because medical charts did not indicate Buch had done anything wrong.

Lawsuits are a fact of life for doctors, especially someone like Buch, a highly trained physician in the high-risk specialty of orthopedic oncology and surgery. Now 54, Buch is perennially on D magazine's "Top Docs" list. His waiting rooms are packed with patients in need of knee and hip replacements or reconstruction of bones and joints.

Like television's Dr. Gregory House, Buch is a scourge of hospital administrators and underlings.

"The guy is one of the most brilliant surgeons that I've ever worked with in 25 years," says one former colleague, a nurse who asked not to be identified. "The guy can do things that most mortal doctors can't even dream of. He's also one of the most self-destructive, obnoxious, vicious people I've ever met."

Buch's medical license was suspended for unprofessional behavior in 2001. In a dozen medical malpractice lawsuits filed against him in Dallas County, his skills, ethics and personal behavior have been questioned. Some lawsuits have been dismissed; a few have been settled by his insurance companies. In the handful of cases that have gone to trial, Buch has won.

Lawsuits, even unsuccessful ones, can increase a doctor's malpractice insurance premiums, but far more damaging to Buch's career has been the controversy over his privileges at four of the largest hospitals in the Dallas area. As the result of negative peer reviews at St. Paul Medical Center, Buch was banned from performing surgery there. He resigned his "courtesy privileges" at Presbyterian Hospital and Medical Center of Plano under pressure. And Medical City suspended his privileges for 45 days pending an investigation

The doctor filed lawsuits against St. Paul and Medical City, claiming he was harmed by their revocation or suspension of his privileges and the hospitals' subsequent reports to the National Practitioner Data Bank.

Created in 1986 by the federal Health Care Quality Improvement Act, the NPDB is a central database that tracks health care professionals by "adverse action" reports. Its purpose is to solve the problem of doctors who go from state to state to avoid having their licenses revoked. The act also provides immunity from liability for doctors who participate on medical peer review committees, panels of doctors who evaluate other physicians' performance.

Suspensions of more than 30 days or lost hospital privileges trigger a negative report to the NPDB, as do lawsuits and investigations by health care agencies such as the Texas Medical Board.

The data collected is not available to the public. Reports of peer reviews by doctors at hospitals where Buch has practiced are secret. Hearings by the Texas Medical Board are secret. Reports to the NPDB are secret.

So, consumers have no way of knowing if their physician has zero "adverse action reports" or 20. Nor are they told a doctor has lost privileges as a result of negative peer reviews.

Such revocation—especially for an orthopedic surgeon who generates substantial revenue—is uncommon. "Hospitals now are less politically motivated and more quality-oriented when they dissociate themselves from a physician," says a board member of the nonprofit American Medical Foundation for Peer Review who asked not to be named. The foundation does independent peer reviews; since 1986, it has conducted reviews for 4,200 hospitals.

"Hospitals are reluctant to revoke privileges," the board member says. "It's usually either the mortality or infection rate, but it's something that's a serious quality issue."

According to statements in court documents by Dr. Kevin Gill, a spine surgeon and then-head of orthopedics at St. Paul, the peer reviews of Buch at St. Paul did not focus on patient care, but his behavior.

"The guy is brilliant," says one malpractice attorney, who asked not to be named, "but he's also an asshole."

————

Buch admits he's demanding when it comes to patient care, but he contends that the medical peer review process has been unfair, allowing his enemies to blackball him in the NPDB. Some call it being "databanked."

He believes his colleagues at various hospitals have been driven by petty jealousy and competitiveness.

Through his attorneys, Buch declined an interview request by the Dallas Observer. Many doctors associated with him and physicians who have treated his former patients refused to talk about him, referring requests to their lawyers.

But voluminous court records and interviews with former patients paint a picture of a highly skilled physician trained at some of the best hospitals in the United States.

And a jerk.

A former co-worker describes him as "Archie Bunker": blunt, condescending, prone to cursing and making sexist or racist comments. When things go wrong he's known for screaming and calling nurses "idiot" or "fucking stupid."

Write Your Comment show comments (15)

  1. interesting

    Comment by John — April 12, 2008 @ 08:36AM

  2. what was the point of this article other than defamation of a human being who has a family, wife and kids?

    Comment by anonymous — April 12, 2008 @ 04:34PM

  3. My husband went to this maniac about 2 years ago for some surgery. We knew right away that he was an asshole, but had we known all of the things in this article we would certainly have sought another surgeon.

    Comment by shocked — April 13, 2008 @ 11:44AM

  4. I think it's worth studying that bisexuals are born in that way. I know many ppl think so, especially on the site biloves.com. Even some celebrities think so.

    Comment by Cathy — April 13, 2008 @ 09:39PM

  5. What a one sided story. How about the thousands of patients that other ortho-docs have turned away in fear of lawsuits that Bush has worked on and been successful. How about the numerous unqualified nurses that have been sent to help Bush during surgeries, that the hospital knows that are inept, but refuse to take action against because they do not want lawsuits for discrimination. How much at risk was your plump patient, why did another orthopedic surgeon send her to Bush. How about the over booked cases that the hospitals are prone for, running late, no staff available, sufficient staff not scheduled, or no house keeping to turn over rooms, could this be a cause for Bush not being able to visit patients in office. How many patients has Bush seen from other doctors who have failed surgeries and infections. How many other doctors have the same work load that Bush has. What is his success versus failure rate. How many of these cases are more complicated than his colleges. I personally think that you have painted a very unfair picture of a doctor that goes beyond the call of duty. I would recommed him to any one.

    Comment by one sided — April 14, 2008 @ 04:37PM

  6. I know Dr. Bush very well. That part about a "Bush caning" in ten years, I have never heard that term. I will not put my name for fear of backlash from the facility I am employed by. Dr. Bush can be difficult and hard to work with but those of us that work for him frequently are not offended by his behavior and actually prefer to work with him. What you inaccuratly wrote as "fucking stupid" told anyone who knows and works with him regularly, that is not something he would say. He does have frequent comments but that is not one of them. This article seems vindictive and ill-written. I find it intresting that out of the thousands of patients he has cared for and cares for now you only had a handfull. Why don't you "research" the healing abilities of the morbidly obese or as you wrote "plump". Also infection is a risk for anyone with a break in the skin. Patient non-compliance IS the number ONE cause and effect of future problems with any suegery not just Orthopedics. If YOU had done any research you would know that. Dr. Bush works on people that no-one else will touch and frequently repairs the mistakes of many other surgeons. He treats infections and wounds that other doc's can not fix. In my facility alone the competition is fierce and very politically motivated. To think that other surgeons are not backstabbers or dishonest is ludicrous, surgery is a business. To imply that he is a bad surgeon is very poor investigative research on YOUR part. To dig up dirt on him is pathetic and obviously the best you could do. You have proven your newspaper is a rag equal to the Enquirer. The only reason I know about and read this article is because like the Enquirer it is a source of gossip. The only thing I regret is the fact the this comment, unlike your article, may as well be like "pissing in the wind" because only you will see it. This article angers me because most of his patients love him and those of us that work with have a great respect for him. We are a very racially diverse group, so to call him racist is also completly once again miswritten. You have shown that the only thing The Observer is good for is places to eat, events in the area and oh yeah escort services and any other illicit activity one may want.

    Comment by get your facts right — April 14, 2008 @ 05:40PM

  7. What an pathetic article can't you find anything better or more current to write about. This seems like a smear job.

    Comment by Wished I hadn't read this — April 15, 2008 @ 01:37PM

  8. What an pathetic article can't you find anything better or more current to write about. This seems like a smear job.

    Comment by Wished I hadn't read this — April 15, 2008 @ 01:37PM

  9. VERY UNFAIR ARTICLE. DR. BUCH TAKES CARE OF PATIENTS WITH VERY COMPLEX PROBLEMS. FEW ORTHOPAEDIC SURGEONS ARE WILLING TO TAKE ON THE TASK OF CARING FOR THE PATIENTS THAT DR. BUCH ROUTINELY TREATS. HIS SUBSPECIALTY IN ORTHOPAEDICS, ORTHOPAEDIC ONCOLOGY AND TREATMENT OF INFECTIONS, IS KNOWN TO HAVE A HIGHER COMPLICATION RATE THAN A SURGEON WHO DOES ONLY ROUTINE CASES. MANY PATIENTS ARE REFERRED TO DR. BUCH BECAUSE HE IS WILLING TO TAKE CARE OF THESE PROBLEMS THAT OTHER ORTHOPAEDIC SURGEONS CANNOT, AND DO NOT WANT TO, CARE FOR.

    IN CASE SOMEONE DOESN'T REALIZE... INFECTION IS A RISK OF ANY SURGERY. INFECTION HAPPENS AFTER ELECTIVE HIP OR KNEE REPLACEMENT SURGERY ON AVERAGE 1 TO 2% OF THE TIME (CERTAINLY EVEN HIGHER IN THE MORBIDLY OBESE). ALL ORTHOPAEDIC SURGEONS WHO DO HIP AND KNEE REPLACEMENT SURGERY HAVE TO DEAL WITH INFECTION AT ONE TIME OR ANOTHER. THIS ARTICLE UNFAIRLY POINTS BLAME TO DR. BUSH FOR POSTSURGICAL COMPLICATIONS THAT ARE COMMON AND KNOWN TO HAPPEN WITH FREQUENCY.

    AS AN ORTHOPAEDIC SURGEON MYSELF, I KNOW THAT DR. BUCH'S SKILLS AND PRESENCE IN DALLAS ARE AN ASSET TO THE COMMUNITY. THIS ARTICLE FOCUSES ONLY ON THE NEGATIVE. WOULDN'T IT BE A SHAME IF ARTICLES WERE WRITTEN ABOUT EACH OF US THAT ONLY FOCUSED ON THE BAD CHOICES WE HAVE MADE AND THE POORER RESULTS THAT WE HAVE EXPERIENCED IN LIFE?

    A COLLEAGUE IN DALLAS

    Comment by ORTHO COLLEAGUE — April 16, 2008 @ 01:44AM

  10. Once again The Observer is raking the smut. I echo the comments from two other orthopedists in the metroplex. Dr. Buch has always accepted any difficult case I had without ever asking if the patient had insurance. I have known him for almost twenty years and the article rehashed everything that Channel 5 and Jay Gray said back in 2001. Your mention of Dr. Buch leaving rods in the patient's wrist is misleading. That patient had two pins in his wrist which are routinely used for temporary fracture fixation. Office staff are trained to remove them. I was interested to read that your "source" was a nurse who worked with Dr. Buch. That's funny because in the past 10 years he has had 2 nurses work for him and I know neither of them would have said anything negative to anyone in the media. Dr. Buch offices at Medical City and the orthopedic department there has been run by one group forever. They kept rotating chief of orthopedics throughout their group and continue to rule the department. They also have controlled hospital staff for years by having one of their members be on the board as well as president of the medical staff. None of them were even half as busy as Dr. Buch and jealousy was well known. If Dr. Buch ever criticized an OR nurse they would write him up and the next thing he would get a nasty letter from the chief of orthopedics. I do agree with one part of your article, he is an asshole. I have told that to his face many times.

    Comment by DFW Orthopedist — April 17, 2008 @ 02:16PM

  11. I find it funny that the man is a well documented, walking malpractice suit, just waiting to happen... but it looks as if all his current employee's are here defending him. What's next, his Minister telling us what a fine Christian man he is... so what if he has mangled a few people?

    Comment by Too funny — April 20, 2008 @ 05:58AM

  12. Patients must give ALL THEIR INFO FOR DOCTORS FOR FINANCIAL REASONS (ok I am fine with that) but doctors ARE PROTECTED WHEN IT COMES TO THEIR INFORMATION.

    LAZY PEOPLE OF THE WORLD UNITE AND DEMAND THAT THE LAWS BE CHANGED SO THAT DOCOTRS MUST POST ALL LAWUSITS, PAST& PRESENT AND THEIR OUTCOMES SO WE CAN MAKE INFORMED INFORMED CHOICES

    No excuses No justifications by lawmakers will do anymore POST THAT INFORMATION ON THE FRONT DOOR OF ALL DOCTORS OFFICES NOW!

    Comment by franklin — April 20, 2008 @ 11:58AM

  13. To the person who wrote comment #6. You said its not like him Dr Buch to say "fucking stupid", Well it is cause I heard him say it to me. In fact he was standing one day at the nursing screaming obscenities to the nurses. I was dumbfounded. The nurses from the OR told me he does that all the time.

    Comment by facts straight — April 30, 2008 @ 09:39PM

  14. I have worked with Dr. Buch as well; I will not defend his personality, because he is an asshole, which he readily admits. My problem with the article is that it implies that the reason he is so busy is that it's all about the money. Dr. Buch NEVER turns down a patient due to lack of funding; furthermore, the article should have emphasized the fact that Dr. Buch is a specialist in ortho-oncolgy: he routinely operates on very sick patients with either primary or metastatic tumors to areas like the hip--i.e., bloody and difficult, high-risk surgeries that most other orthopods would turn down. Regarding the patient that had to wait forever in his office: Dr. Buch is busy b/c he is in demand, but also because he will schedule in a patient in clinic and the OR in very short order: it is routine for him to have a patient present to him in clinic on a Wednesday and be scheduled for surgery the following Saturday (it is not uncommon for him to have 12-14 hours of scheduled, elective cases, plus any add-ons or emergencies).

    Lastly, the term "fucking stupid" is incorrect; anyone that has worked with him knows that his preferred term is "fucking moron."

    Finally, lastly: in the photo insert of D Magazines top doctors cover, that photo is not of Dr. Buch (I guess you were trying to show what D Magazines cover looks like, but it's confusing to readers, and perhaps embarrassing for the bearded doctor pictured with this article).

    Comment by MD — May 5, 2008 @ 09:33AM

  15. I like how number 6 says they know "Dr. Bush" very well. Since the article is about "Dr. Buch", I guess we can assume they know someone else very well and not the Dr. Buch who should not have a medical license...I also find it funny that Dr. Kevin Gill commented in this article. If anyone knows him--he is an a**hole also. He pretty much told me I was stupid if I didn't have back surgery first to reduce my "bulge" and then again next summer when my insurance "might" cover artificial disks.

    Comment by Candy — May 8, 2008 @ 01:14PM

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