Knock LA

Early in the morning of December 16, 2021, I arrived at Specialty Surgical Center of Encino for an hour-long hand and elbow procedure. After I checked in, I had to sign a pretreatment arbitration agreement and an acknowledgement that my surgeon may have an ownership interest in the surgical center. A week before, after months of exclusively being seen in the UCLA system, I was suddenly informed that my procedure would be performed at a private clinic. 

I agonized over the red flags in the days before the procedure. Despite my concerns, I chose to go through with it for uniquely American reasons. It was the end of the year, I’d have the chance to recover over the holidays without missing work, and my deductible was about to reset, meaning the surgery would be much more expensive if I waited.

I rationalized my uneasiness because it wasn’t just some random clinic or some random surgeon. After being seen by a nurse practitioner in their orthopedic surgery department, I was referred to UCLA’s chief of hand surgery: Dr. Prosper Benhaim. I saw him for a consultation and we scheduled the surgery for the following week. It was supposed to be simple and quick. 

But by the evening, I would be unconscious on an operating table at Cedars-Sinai, my arm flayed open from palm to elbow, fighting against a life-and-limb threatening syndrome in an hours-long emergency surgery. I stayed in the hospital for three weeks, enduring multiple debridement surgeries, a skin graft, and blisters on my fingers and palm that a nurse described to me as “worse than radiation burns.”

Despite surviving these life-threatening complications, I was left with limited options for legal recourse because of the arbitration agreement that the Specialty Surgery Center made me sign prior to the procedure. That signature revoked my right to pursue a jury trial, made any further legal proceedings confidential, and terminated my ability to appeal any judgments made during arbitration.

As Faculty Operate at Private Clinics, Arbitration Agreements Shield UCLA from Liability

While Dr. Benhaim occupies the position of chief of hand surgery at UCLA, he confirmed that 15-20% of his surgical cases from the hospital are funneled to a privately run clinic — one that uses preoperative arbitration agreements. According to their own rules, UCLA regulates Benhaim’s ability to own and operate at outside organizations and private clinics. 

Per its medical school’s memo on “Conflict of Commitment and Outside Activities of Health Sciences Compensation Plan Participants,” all activities performed at nonuniversity sites must be formally approved by the Regents of the University of California. Furthermore, any outside activity requiring the utilization of professional skills related to a university appointment, such as performing an outpatient procedure, would have to be approved by the chancellor.

UCLA has not responded to multiple requests for comment about whether Benhaim’s work was covered under any Regents-executed agreement with Specialty Surgical Center of Encino, whether the income he gained from operating there was approved by his department’s chair, or whether the activities had been approved by the chancellor.

Dr. Benhaim initially responded to a request for comment, providing the aforementioned statistic on which of his cases are funneled from the hospital, but stopped responding when we followed up to ask if he was aware of the arbitration agreements patients are forced to sign. 

In 2021, Benhaim’s regular pay was $119,550 and his benefits totaled just over $35,000. However, his total pay was nearly $1.15 million, meaning the majority of his annual income was accrued from work outside of his regular duties, such as performing operations at private clinics like the Specialty Surgical Center of Encino.

The memo also states that a portion of this outside income generated by its faculty in addition to their base university salary is paid back to their department, which they then get a cut of. In 2012, then-chairman of orthopedic surgery Dr. Robert Pedowitz sued UCLA and the University of California Regents in a whistleblower retaliation case, alleging that some doctors were taking payments that could improperly influence patient care. He alleged that UCLA looked the other way because it profited from the success of its doctors. UCLA denied his allegations that patient safety had been compromised, but the university settled the case for $10 million in 2014. 

After contacting UCLA for comment, the university removed the memo from their website, but Knock LA obtained a copy prior to its deletion. Specialty Surgical Center of Encino did not respond to a request for comment about how long Benhaim has operated at the clinic or if he has an ownership interest. Neither did its corporate parent, Surgery Partners.

There is no state or federal law requiring public hospitals to disclose to patients sent to private clinics if the doctor or hospital has a financial interest in that clinic, or if it will require them to sign an arbitration agreement. 

Carmen Balber, the executive director of Consumer Watchdog, laid out a few of the major implications of these contracts. Since arbitration proceedings are confidential and final, patient safety suffers. “That has a huge impact on patient safety … because if you see the news of a repeat lawsuit against a private surgery center, you might think twice before going. But you’ll never see the news if arbitration is forced and the entire process is conducted behind closed doors with no public records of what might have happened.”

Despite their legality on paper, California courts have held that similar arbitration contracts are unenforceable because they’re “unconscionable” or “oppressive” to patients, such as in the 2020 case of Swain v. Laseraway Medical Group. 

Although UCLA may not be the institution requiring patients to sign pretreatment arbitration agreements, the documents ensure that any incidents that occur at private facilities where their physicians operate do not result in public litigation. Additionally, revenue generated by these kinds of activities is reinvested back into UCLA departments, producing financial incentive to allow these kinds of agreements while simultaneously being shielded from any legal risk.

“What Keeps Orthopedic Surgeons Up at Night”

After my procedure at the Specialty Surgical Center, I awoke with a splint and bandages from my palm to my elbow. I alerted the nurses to a tingling, prickly feeling throughout my hand and was given IV painkillers. The arm was very swollen, which Benhaim assured me was fine, and I left the clinic with my roommate around 2 PM. 

We stopped at a pharmacy to get the painkiller prescription that Benhaim had sent and then went to eat some lunch. At 4 PM, we were leaving Encino and got stuck in heavy traffic on the freeway. Pain clawed at me through my Oxycodone haze. I noticed my fingers swelling and hand blistering open, bubbles of flesh starting to expand outward. 

Every cell in my body screamed that something was wrong, so I called the center to put me through to Benhaim. I explained what was happening: the pain, the increasing swelling, the blistering on my hand. After sending photos to his personal cell for evaluation, he gave me his assessment: “normal inflammation.”

Benhaim told me he would write a steroid pack prescription. I attempted to collect myself as my fingers burst open, knowing we would not reach the pharmacy near my apartment for another hour. Desperate, I pushed one more time for guidance: “OK, but if something is really wrong, is there anything I should look out for in terms of ER-worthy symptoms?” 

“Oh, nothing like that. You can call me tomorrow if it’s still bothering you,” Benhaim told me. 

I chose to disobey him — and in doing so, saved my arm and my life. My roommate dropped me off at Cedars-Sinai later that hour. A triage room was cleared and I was immediately taken back. A flurry of doctors and nurses appeared and were trying to get my bandages off. They kept asking me one question over and over. Who did this to you? Who wrapped this arm? Who did this surgery? 

A nurse had to cut me out of my clothes because of the immense swelling. My whole arm was extensively bruised, and the blisters on my fingers were molting like burns.  Over the next few hours, I got a vascular ultrasound and multiple doses of IV painkillers to try to cope with the agony while I waited for an update. An orthopedic surgeon delivered the news: I had nontraumatic acute compartment syndrome, a rare and life-threatening condition that occurs when a limb is violently constricted from oxygen as increased pressure suffocates tissue inside of a muscle compartment.

Many of my own doctors and nurses expressed how stunned they were, as well as a generalized disbelief that a medical professional could miss this. Other orthopedic professionals, doctors, and nurses, stressed that acute compartment syndrome is a well-recognized and life-threatening condition. 

“Medical professionals, especially surgical teams, are trained to identify the early symptoms of compartment syndrome. They know to look out for pain, swelling, and other signs of poor circulation,” said Nancy Mitchell, a nurse who has 37 years of experience as a director of care on wards. She added that intervention to relieve the pressure “could be the key to saving a limb or the patient’s life.” 

My doctors and nurses pointed to my tight bandages as the defining factor in my compression and noted it in my file. With acute compartment syndrome, there is no other option besides an emergency fasciotomy surgery, which cuts the affected compartment open to relieve the pressure. Without this intervention, the limb will die, and, if the procedure isn’t done urgently enough, then so will the patient. Fasciotomies are ideally performed within the first six hours — after that window, the lack of blood flow leads to necrosis, which causes permanent damage that can lead to amputation or fatal complications. 

It was nearly eight and a half hours after the initial surgery when they got me onto the operating table at Cedars-Sinai. Benhaim had seen the photos I sent him around hour three, labeling the swelling as normal inflammation. His words are etched permanently into my brain, because I wonder what damage I could’ve avoided, what necrosis wouldn’t have formed, and what pain I wouldn’t be enduring if he had caught it at hour three like so many people insist he was trained to do. 

I heard disbelief everywhere in the hospital. A plastic surgeon who consulted on my case in the hospital simply shook his head and said “I just don’t understand why he didn’t at least tell you to turn around and have him look.” 

In between peeling Xeroform off my blistered fingers and changing my wound dressing, an orthopedic surgery fellow told me that “what happened to you is what keeps orthopedic surgeons up at night.” 

The morning after my fasciotomy, Benhaim called me on my cell. Dazed and confused, I listened to him say how devastated he was and he assured me that this had never happened once in his 28-year career. However, Benhaim has previously been sued twice for medical malpractice.

Patients with Post-Surgery Complications Left with Pain and Little Recourse

In 2019, one ex-patient sued Benhaim after alleging that a March 2018 procedure led to a result so unsatisfactory that Benhaim had to operate on her again to fix the problem. She revealed that Benhaim broke her finger during one procedure and only confirmed it after she pressed him repeatedly for postoperative X-rays. In the first four days after her original procedure, her hand became constricted in its bandaging. 

“When I tried to reach Dr. Benhaim during the weekend, he was not available and did not return my call. My cast had become severely compressed and my hand turned very green, as well as all shades of red and purple. Because of the lack of timely intervention, by the time my cast was replaced, the damage to my hand was immense,” Karen Laner wrote in a sworn declaration to the Los Angeles County Superior Court on November 3, 2020. She noted that during subsequent consultations with multiple medical professionals, she was told she would never regain full use of her hand. 

Benhaim’s legal records show at least one other medical malpractice lawsuit was filed against him in 2004, listing him, the UC Board of Regents, and UCLA Medical Center as defendants, since the incident happened at their facilities. 

Even if I could pursue civil damages, I could never quantify this. I could never dream up adequate financial and injunctive relief to ask for. I will never forget the smallness and indecisiveness I felt as I weighed whether to go to the emergency room, followed by the gutting heartbreak when I was rushed to the OR. I didn’t have time to say my maybe-goodbyes. I just remember closing my eyes as the surgery team wheeled me down the hallway into the unknown, conjuring some kind of hope and defiance in the face of horror because I didn’t want the potential last thing I felt to be fear. 

More than a year later, my life is not the same. I’ve done extensive therapy to be able to bend my hand, make a fist, and straighten my arm. I had to do painful wound care and hyperbaric oxygen therapy to battle the necrotic blisters on my fingers.

I lost my middle fingernail and the tissue didn’t grow back correctly, leaving it bent, raw, and vulnerable to infection and injury. I developed complex regional pain syndrome, infamously known as “the suicide disease” due to its horrifically painful, disabling, and gravely psychologically challenging nature. A lot of the time, I feel like my right hand is made of exploding stars, or it’s hot, inflamed, and seems electric. I do weekly ketamine infusions to manage the pain.

There should never be another story like mine; and yet, the conditions for such an event still exist for patients at UCLA and elsewhere. California doesn’t have to keep letting for-profit entities take away the rights of patients with shadowy agreements. And institutions like UCLA don’t have to continue the status quo, either. We sorely need patient-centric policies that promote transparency, ethics, and accountability in both our medical and legal systems. It is clear that there remains critical work to do in order to protect patients from profit-driven danger and to empower transparency in all operating suites and exam rooms here in California and beyond.