Texas Medical Board alleges supervision issue during a surgery at Houston Methodist hospital

For the second time in recent months a Texas Medical Center teaching physician has been cited for not being present when trainee doctors were performing surgery, an issue that patient advocates say raises safety concerns.

The latest case involves Dr. Nathan Robert Starke, who was listed as a member of Houston Methodist’s urology residency program that trains new doctors. The Texas Medical Board announced this week it has temporarily suspended Starke’s license after he allegedly participated in “several surgeries” in August and September “while appearing impaired,” then in October tested positive for cocaine.

Houston Methodist suspended Starke on Sept. 6 after he “was absent for all but the last 3 minutes of a surgery for which he was the attending physician,” according to the board’s Dec. 20 medical license suspension order. Starke had faced “previous suspensions” and had undergone drug and alcohol screening from Houston Methodist since “at least 2023,” the board’s order says.

A spokesperson for Houston Methodist, Gale Smith, declined to answer questions from Houston Landing, saying in an email that “the only information we can share is that he is no longer employed at Houston Methodist.” 

Starke could not be reached for comment. The medical board said that a hearing on Starke’s temporary license suspension will be held “as soon as practicable.” 

The case involving Starke follows a $15 million joint settlement entered into last June that included federal whistleblower allegations of insufficient supervision of trainee doctors during “complicated and risky” heart surgeries involving Baylor St. Luke’s Medical Center, Baylor College of Medicine and a surgical group.

While Baylor College of Medicine disputed that any federal laws were violated, the U.S. Attorney’s Office alleged that physicians “knowingly left unqualified physician trainees (residents and fellows) alone in operating rooms to operate on unwitting patients so the teaching surgeons could run multiple surgeries simultaneously,” according to federal court records in the case. Baylor College of Medicine, at the time of the settlement, said no patients were harmed and disputed that any federal laws or regulations were violated.

Several patient advocates said these two recent cases involving Texas Medical Center teaching hospitals raise concerns about how closely hospitals are monitoring doctors undergoing training – as well as monitoring physicians that may have substance abuse issues.

“I believe the supervision of residents and those in training programs is probably more lax than any of us would like to admit,” said Lisa McGiffert, president of the Patient Safety Action Network, a national nonprofit advocacy group. “The onus is on the Texas Medical Center to come clean with the public and say: we have this problem and here’s how we fixed it.”

The Texas Medical Center, in a statement, said its hospitals are independent entities that are responsible for the care in their facilities. “Though we may collaborate on campus-wide issues, each hospital conducts its own patient care, research and teaching activities,” the statement said.

McGiffert said the case announced this week involving Starke raises questions about both the supervision of doctors undergoing training and also how well hospital officials and medical regulators supervised Starke.

According to the Texas Medical Board license suspension order, Starke had undergone drug and alcohol screening through Houston Methodist “since at least 2023” because of “previous suspensions due to issues with impairment.” 

The medical board’s order does not provide any detail about the reasons for Starke’s previous employment suspensions, nor does it give any indication of how rigorous the drug and alcohol screening had been by Houston Methodist since 2023. It also doesn’t provide any details about what kind of surgery Starke was allegedly absent from for all but the last three minutes, whether any complications arose when he wasn’t present, or what level of training the doctors performing the surgery had. 

The board’s order says that on Aug. 19, 2024 Starke “showed signs of impairment” when meeting with a patient prior to performing a surgical biopsy on a patient’s prostate. 

It wasn’t until Sept. 6 that Houston Methodist suspended Starke after he was absent from most of a surgery for which he was the attending physician. On Sept. 16, Starke signed a voluntary cease practice agreement with Houston Methodist, then in October he tested positive for cocaine and also Kratom, an herbal substance that can produce stimulant effects, according to the medical board’s order.

On Dec. 20, a disciplinary panel of the Texas Medical Board temporarily suspended, without notice, Starke’s license after determining his continued practice of medicine “poses a continuing threat to public welfare.” 

Houston Methodist’s spokesperson Smith would not answer questions about Starke’s suspension and the hospital’s supervision of him. Smith also would not answer broader questions about the hospital’s general policies for monitoring physicians who have substance impairment issues or its general policies for ensuring trainee doctors are adequately supervised during surgeries. 

Houston Methodist’s urology residency program, which featured Starke in a promotional video on its website, is accredited by the Accreditation Council for Graduate Medical Education.

Accredited programs “must demonstrate that the appropriate level of supervision in place for all residents is based on each resident’s level of training and ability, as well as patient complexity and acuity. Supervision may be exercised through a variety of methods, as appropriate to the situation,” the council said in a statement to Houston Landing late Thursday.

The organization said that confidentiality agreements it has with the organizations it accredits prohibit it from answering questions about whether it was aware of the allegations made by the Texas Medical Board against Starke.

Some patient safety advocates said the recent Texas Medical Center cases show why patients need to play a role in monitoring who is providing their care.

Sue Sheridan, president of Patients for Patient Safety US, said patients receiving care at teaching hospitals should ask about who will be providing their care and what level of experience and training they have. “I would point blank ask: Are you a resident or my attending? And how do I reach my attending when I’m concerned about my care,” she said.

Patients also can check out their doctor by going to the Texas Medical Board website to see if they have had any actions taken against their license, said McGiffert.

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