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Physicians at such hospitals are not subject to mandatory review by their peers. "You can own your own clinic and do all your procedures there, and there is no peer review process," Robinson says.
On October 29, 2001, when attorney Steve Nagle received a packet from the lawyer representing Lou Ann Tipps, he got a nasty surprise: a sworn "secret statement" by Dr. Buch blaming the loss of Tipps' leg on three nurses.
A Sherman woman, Tipps had sued Buch and St. Paul after a total knee replacement by Buch on December 3, 1998, ended in the amputation of her leg. In return for being dismissed from the lawsuit, Buch submitted his statement, which exonerated himself and got back at St. Paul at the same time.
Early on December 3, 1998, Buch performed a total knee replacement on Tipps, a woman from Sherman. On December 5, Tipps' lower leg developed "compartment syndrome"—essentially dying from lack of blood. Buch blamed the nurses for not notifying him until 11 p.m. Buch operated again two days later. Tipps' leg had to be amputated below the knee. A jury found that negligence by the hospital caused her injuries and awarded her $1,801,505. (The case ended with a confidential settlement.)
Tipps wrote to the judge: "For us, this was about truth and taking responsibility for your actions. If our actions can save another, then it is worth the heartache of a couple of weeks."
Regardless of the outcome of the Tipps case, Buch eventually won his battle with St. Paul over privileges, settling out of court. Buch's attorney Hopkins says that after "re-consideration," the hospital "unconditionally approved" his application for privileges in 1999 and has "rectified" its earlier report to the NPDB.
After that victory, Buch resigned his privileges.