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Neurosurgeon Jeffrey Hatef, Jr. discusses his article “Guilty until proven innocent? My experience with a state medical board.” In this episode, Jeffrey shares the shocking story of how his medical license was summarily suspended without a hearing and how incomplete records, flawed expert testimony, and questionable legal tactics created a process stacked against him. He recounts how independent reviews from spine surgeons and letters of support from nearly sixty physicians affirmed his standard of care, yet the board pursued the case with relentless determination. Jeffrey emphasizes the dangers of a system that prioritizes winning over fairness, the impact on patient autonomy, and the need for transparency and accountability in medical board proceedings. Listeners gain an inside look into the high stakes of licensure defense and the importance of due process for physicians.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Jeffrey Hatef, Jr.; he’s a neurosurgeon. Today’s KevinMD article is “Guilty until proven innocent: My experience with a state medical board.” Jeffrey, welcome to the show.

Jeffrey Hatef, Jr.: Thanks for having me.

Kevin Pho: All right, so I think your story is articulated in your article, so why don’t we start from there? Just tell us a little bit about yourself and then your story that you shared with us on KevinMD.

Jeffrey Hatef, Jr.: Well, I’m a neurosurgeon. I have been practicing for just a couple of years. I finished residency in 2022, and the story I shared was about my experience with our state medical board. I was summarily suspended in February of this year and am telling the story of what’s unfolded after that.

Initially, I knew that some complaints had been lodged. I didn’t know by whom. But there were multiple of them on multiple different patients. I’ve since learned that it was an old colleague who was dissatisfied with me. But the summary suspension just came out of the blue.

They came to my house and served me with the suspension, and I had no idea where this had come from. Judging from what I wrote in the article, there were patients and they did have bad outcomes, but I didn’t think that there was any malpractice or issues with the standard of care.

Shortly after the suspension came, I got a lawyer. We started our defense, we subpoenaed our own records, and we soon found out what happened. That was that the medical board had subpoenaed incomplete records. They had only subpoenaed and reviewed just a few days of care focused right around the surgeries, and they didn’t see the entirety of the care.

For all of these patients, I’d known them for many months; for the two patients with the bad outcomes, for six months plus.

Initially, there were three patients on this complaint form for the suspension. For one of the patients, what the state’s expert with the state medical board had said was essentially that the whole procedure was indicated and unwarranted.

For that patient, they only had records from the very brief first hospitalization. I had done a staged procedure on him and even at the time of the suspension, he had completed his surgeries. He had completely recovered, and he’d gone from being on 30 to 40 milligrams of Oxycontin a day to being off pain meds completely. It was really a great success.

So, through my defense team, we’re sitting, we’re looking at these records and we’re saying, “This isn’t right. What happened?” And now we know they just had incomplete records, but we still had to go through the process. We got our own experts.

We had four different experts who all agreed with me that there were no issues with the standard of care whatsoever. We submitted this information to the board when it was required according to the timetables. And I anticipated that they would probably just dismiss the case. It was four to one.

There was this error with the records, but we never anticipated what they did, which was to vacate the suspension and dismiss one patient (the one where the most egregious errors were made, the one who did well) and then resuspend me for the other two patients and carry on as though nothing had happened.

Kevin Pho: Let me unpack some of the things that you said at the beginning. You said that initially some of these complaints came from patients with bad outcomes, but then also may have been initiated by a colleague that interacted with you in the past.

Jeffrey Hatef, Jr.: We know that now. Initially, I didn’t know who was submitting these complaints. The medical board had been in communication with me and said, “We have some complaints.” And that’s the way that almost all their investigations start: through complaints. Yes. By law, they’re confidential. They’re not allowed to tell me who submitted the complaints initially.

All the patients were discrete; many of them didn’t even have complications. It was really a random assortment of complaints and I was quite confused. Now, and it’s through the medical board that we know this, they were contemplating calling this individual as a witness, but I now know it’s a former colleague who had left the practice who was just submitting complaint after complaint.

Kevin Pho: So you mentioned that during the medical board process, one of the complaints was dismissed, but then the other two you were resuspended for. Tell us, when you were talking to your legal team, you mentioned that this was a complete surprise. What was their reaction?

Jeffrey Hatef, Jr.: They were absolutely astounded. My lawyer has been doing this. He started with the medical board as a medical board attorney himself 25 or 30 years ago, whenever he got started, and he has been on the defense side for decades. He said he’s never seen anything like this. So we immediately had to bring it into the courts, which is where it is now. But they said it’s really unprecedented and unusual to say the least.

Kevin Pho: And from the medical board’s perspective, what was some of the rationale behind their decision?

Jeffrey Hatef, Jr.: They didn’t list any rationale or describe anything. If you look online, you’re able to find some of these public record documents and it really just says that at the board meeting, they described needing to vacate the suspension and they just go ahead and do it. There’s not any discussion or rationale about it.

Kevin Pho: And in terms of the incomplete medical records that the board reviewed, what was the reason that it was incomplete? Was it just simply an oversight or was there any reason why they subpoenaed incomplete records?

Jeffrey Hatef, Jr.: Well, at the hearing, we were able to call one of the main board attorneys who investigated the case, and she did divulge that. She just didn’t know that my employer was not the hospital. My employer was a different legal entity.

So, I did these cases at a hospital, but I was employed through a separate medical group that employs a couple hundred physicians. Throughout the course of investigating me, she just didn’t know that.

And they submitted the subpoenas to the hospital, but the hospital is only in possession of the hospital records and so they didn’t get the records they needed. The neurosurgeon who reviewed them, the expert witness, he knew they were incomplete and didn’t tell anyone about that. But we presume that no board lawyers read the records at all. They just compiled them and then passed them off.

Kevin Pho: So you’ve been going through this ordeal. You said it started earlier this year. We’re now speaking in October, so about eight months. Tell us what your professional life has been during that time.

Jeffrey Hatef, Jr.: None whatsoever. I was suspended in February. Initially, I was placed on administrative leave because part of the summary suspension is they say there’s clear and convincing evidence, but it hasn’t been adjudicated. I didn’t have my say yet, my hearing. But shortly thereafter, some of the newspapers covered this and then my employer decided to terminate the relationship. Since then, I can’t practice medicine. I don’t have a license.

As physicians, we don’t have much training to do anything else, so I’ve been occupying my time. We had a new baby. I’ve been coaching my kids’ teams, I’ve lost some weight, things like that. But professionally, there hasn’t been much besides keeping up with CME.

Kevin Pho: So before this incident, have you had any experience with bad outcomes, medical malpractice, or patient complaints?

Jeffrey Hatef, Jr.: Never. The only complaints were the ones we now know are from this individual. I had never been sued. No malpractice, nothing like that.

Kevin Pho: Now, as you reflect on this, and I’m sure you have had a lot of time to reflect on this, is there anything you think that you could have done differently to avoid a situation like this?

Jeffrey Hatef, Jr.: Well, I could have not taken on the complex cases. But I don’t think ultimately that’s the answer.

When the complaints came in, a board investigator spoke with me. I presumed that they would have a little bit more due diligence. Maybe I shouldn’t have had that presumption and should have been a little bit more aggressive on my end with legal counsel ahead of time. But even with that, I don’t know if anything would’ve changed.

Kevin Pho: You mentioned that physicians don’t get a lot of training for this, and that’s absolutely true. So tell me, what kind of support have you had and what kind of support would you like to have had?

Jeffrey Hatef, Jr.: Well, I’m lucky to have a really good family. My wife has been completely supportive. She’s a doctor as well, a radiologist. This is one of those things. It’s not the most egregious accusation that the medical board could levy, but it was pretty bad.

And I’m lucky that friends and colleagues have been supportive. Part of the process of going through the hearing was getting letters of support from the community. We were lucky; 60-plus members of the community wrote letters of support.

And that’s not even including what I’ve since learned through some other people: that my former employer was discouraging anyone from speaking out. So most of my colleagues in the medical group weren’t able to write letters of support when I know that they would have. And many of them had a very close relationship with me.

Legal-wise, there’s no training whatsoever. I consider myself someone that has an interest in this. I’ve written some papers on medical malpractice issues when I was in residency and had an interest in the legal aspect, and that’s let me work well with my attorney, understanding some of what’s going on. But I never anticipated something like this happening.

Kevin Pho: So currently the case is tied up in the courts. Just outline what are some potential paths forward.

Jeffrey Hatef, Jr.: Currently, the legal aspect of that resuspension that they did is in the courts. The merits of the case are working their way through the medical board process. We had our hearing. The hearing examiner recently produced a report, and this coming Wednesday, so I believe it’s the eighth, at the medical board meeting, it will be decided.

Kevin Pho: And from what you anticipate, is there a possibility of a favorable outcome? Is it 50/50? What is your legal team preparing you for as potential outcomes?

Jeffrey Hatef, Jr.: What the hearing examiner said was that his opinion was that one of the patients was within the standard of care, one of the patients was not, and he recommended a reprimand: basically the minimum fine and minimum punishment.

What we think is that these issues with the process of the medical board and also some of the issues with the board’s expert himself were not well accounted for by the hearing examiner. And we think the board members themselves, the voting members, are likely to pay a little bit more attention to that. Now, is it going to be a dismissal? I don’t know. I hope, and that’s what I think is the just outcome. But ultimately we’ll have to wait and see.

Kevin Pho: So through this whole ordeal, tell us some of the things that you’ve learned about medical board politics and the patient complaint process that you didn’t know before.

Jeffrey Hatef, Jr.: I think the main thing I’ve learned is that at least in our state, if you imagine this as a criminal scenario where there’s a prosecutor and there are grand juries and judges, and there are a lot of people at play. In our state, there’s the board staff, and there are two board members who are the investigative members, that’s the secretary and the supervising member, and they’re the ones who make this determination that I should have been summarily suspended. They’re the ones who made the determination to vacate the suspension and resuspend me.

The other board members aren’t able to review any evidence until now, until the case is over. So it’s really a lot of power entrusted to just two individuals without any other checks, so to say.

Kevin Pho: And these two individuals, do they have training in what you do, in neurosurgery? They’re both physicians?

Jeffrey Hatef, Jr.: No, they’re not neurosurgeons. They’re both physicians.

Kevin Pho: And in one of the cases where they said that what you did fell outside of the standard of care, are you at liberty to talk about more details and whether you agree with that assessment?

Jeffrey Hatef, Jr.: Everything is public record. We just can’t use patients’ names. So anything you’d like to talk about, I think we can.

Kevin Pho: Sure. So tell us about the clinical case where they accused your conduct as being outside of the standard of care.

Jeffrey Hatef, Jr.: Both were elderly ladies with spinal issues. The first one was in her late seventies and I’d known her for some time. She had undergone a previous spinal surgery for a spinal fracture that did not stabilize the fracture, and so she had an unhealed fracture and she was developing spinal stenosis at that level.

I first met her in spring of 2024, and at that time she was in pain, but she was walking. Over the course of about six months, it became progressively more painful with progressively more deformity, and ultimately she presented back to my office in a wheelchair.

We brought her to the hospital and obtained pre-op clearance, and it was basically noted that this is a high-risk patient. She’d had minimally invasive heart surgery before; she had a left bundle branch block. She had a number of comorbidities. She was a tough patient, a sick patient. But she had severe spinal stenosis and was barely able to move her legs.

So we talked to her and said basically, “If we want to try to preserve ambulation, we have to attempt surgery.”

And I did the surgery with my partner. We had a bit more blood loss than expected, but even the state’s expert agreed that every aspect of the surgery was within the standard of care: the blood loss, what I did, all of those things. The state’s own expert agreed that that was all to the standard of care.

She, unfortunately, did have a cardiac arrest shortly after we finished surgery. We finished it successfully, but her potassium was very high. And she did have a cardiac arrest, so it was a bad outcome. A very unfortunate outcome, though. Not at all what I anticipated, not at all what I wished for. But it was really the rationale and the argument that the board made that was confusing to me.

Initially, they said that their expert said I needed to transfer her to another hospital. When we provided our reports, we thought, “That doesn’t make sense.”

I did two fellowships in spine deformity. I’m in the Scoliosis Research Society. This is what I do with my practice. I’m early in my practice, don’t get me wrong. I’m not the senior guy in the country, but it doesn’t make sense that I would have to transfer. We’re doing it at a major urban trauma center.

After the state saw those reports, they changed their argument and they said, “Well, you didn’t need to transfer. But you just shouldn’t have done the surgery. No one should have done the surgery.” And the state’s expert even said, “Worse things in life than being in a wheelchair. You should have not done surgery, should have allowed her to progress to become paralyzed.” Which is just really unusual; it goes against everything that you think about when you think about patient autonomy and medical decision-making.

Kevin Pho: So you obviously shared your story on KevinMD. You’re appearing on this podcast to share your story. In your own words, what’s the goal of sharing your story, and for the other physicians who are listening to you, what kind of message do you want them to come away with from hearing you?

Jeffrey Hatef, Jr.: The goal of sharing the story is just that: to let people hear what’s happened, hear what’s continuing to happen. I feel I’ve been treated unfairly and unjustly, and I have all faith that the board members are going to make things right come next week. But it’s just about getting the story out there.

As for what recommendations I would make to people, it’s hard. If you’re going to take on cases like this (frail, old patients who have comorbidities but are facing paralysis), unfortunately, we all know in neurosurgery it’s such a high-risk field that not everything is going to go well. Not every field has those risks, but in neurosurgery, we know that very well. Not every case is going to go the way you hope.

So the question is, do you not do these for fear of the medical board? I don’t think that’s fair to patients. I have faith that the system is going to make things right and that the right answer is going to come down. But ultimately I think that you have to do what you believe is right for the patient.

Kevin Pho: We’re talking to Jeffrey Hatef; he’s a neurosurgeon. Today’s KevinMD article is “Guilty until proven innocent: My experience with a state medical board.” Jeffrey, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Jeffrey Hatef, Jr.: Just what I was speaking about, which is for clinicians to always do what’s right for the patient. Keep that in mind first and foremost, and then what happens afterwards, you can deal with it. As I said, I have faith that things are going to be made right and the just outcome is going to come. But we’ll take it one step at a time.

Kevin Pho: Jeffrey, thank you so much for sharing your story, time, and insight. Thanks again for coming on the show.

Jeffrey Hatef, Jr.: All right, thank you.