This story also ran on St. Louis Post-Dispatch. It can be republished for free.
COLUMBIA, Mo. — The University of Missouri has settled a collection of personal injury and false advertising claims over knee surgeries for $16.2 million, in what appears to be one of its largest public payouts in recent years.
The 22 plaintiffs, a handful of whom were minors, filed suits from 2018 through 2020 over “BioJoint” surgeries pioneered by two university employees, orthopedic surgeon Dr. James Stannard and veterinarian Dr. James Cook. The procedure involves a complex operation that the Mizzou BioJoint Center’s website calls a “biological joint restoration,” replacing parts of the knee with cadaver bones or cartilage to treat arthritis or joint damage. Some plaintiffs alleged in court documents that the procedure was sold to them as a way to avoid a traditional artificial knee replacement.
Plaintiffs alleged in court documents that Stannard did not advise plaintiffs that “the surgery he was proposing has a failure rate as high as 86%.” Court documents argued the surgeries were “experimental” and “unproven” and sometimes left patients requiring follow-up surgeries and even total knee replacements, including for young patients.
The defendants denied those allegations in the court filings and the university settled the cases without admission of liability or negligence after the claims against Cook, Stannard and another employee were dismissed. The Mizzou BioJoint website says the program does not have 10-year data on effectiveness because the surgeries are “based on improvements to the traditional techniques.” Unlike prescription medicines or medical devices, surgical procedures aren’t directly regulated by federal or state agencies.
On Thursday, KHN obtained the settlement agreements, which were signed in February, through a public records request.
Michelle Mello, a Stanford University professor of law and medicine, said settlement amounts often reflect the public relations value to those sued as well as the value of what the plaintiffs could have gotten at trial.
“On a per capita basis, that seems like high damages, so there is something going on that’s not great for the university,” Mello said.
“We are pleased to resolve this litigation,” Jonathan Curtright, CEO of University of Missouri Health Care, said in a statement. “Providing safe, quality care is always our top priority, and we remain committed to excellence in restoring joint health and function for eligible patients. We are confident in the expertise and dedication of our staff and the innovative, science-based services offered by the Missouri Orthopaedic Institute and the Mizzou BioJoint program.”
Stannard and Cook did not return requests for comment about the cases Thursday. Todd Hendrickson, an attorney for the plaintiffs, said the settlement agreements prohibited the lawyers and plaintiffs from speaking on the matter.
Central to the dispute in the consolidated lawsuits is how Cook was presented, given that veterinarians and veterinary surgeons are not generally allowed to perform medicine on humans. The lawsuits allege Stannard was negligent for allowing Cook to perform parts of the Mizzou BioJoint surgeries on plaintiffs “without appropriate medical direction and supervision.”
Some patients allege in court documents they did not know when they underwent the procedures that Cook was not a “medical doctor or a licensed physician.” In at least five of the plaintiffs’ cases, court documents say Cook was sometimes listed on medical records as “surgeon — other.”
And documents in one case said he was listed as a “surgeon.” The defendants deny Cook was listed as a surgeon in response to that case but said he was listed as part of the surgical team. An additional filing by defendants said Cook was “orthopedic technologist — surgery certified” and that he joined the surgery team for the “majority of such surgeries performed by Dr. Stannard.”
In one filing, the defending attorneys said Stannard and Cook had no obligation to tell patients that Cook was neither a medical doctor nor a licensed physician at any time prior to the operations because “surgery commonly includes persons in the operative suite who are not licensed physicians.”
Many new medical techniques are tested on animals before they get to humans, so veterinarians may be involved in pioneering medical research, said Dr. Patrick McCulloch, vice chairman of Houston Methodist’s orthopedic surgery department.
“It’s not uncommon to have vets as part of your research team, but it would be uncommon to have them as part of your clinical patient care team,” he said.
“You have to be licensed as a physician to perform surgery on a human being,” added Jeff Howell, executive vice president of the Missouri State Medical Association.
Cook is known as an expert on surgery for other species. He recently performed two operations on a tiger at a Chicago-area zoo, the second after the more ambitious initial procedure did not succeed, the Chicago Tribune reported.
He holds the titles of William & Kathryn Allen distinguished chair in orthopedic surgery at the University of Missouri’s medical school, chief of the school’s orthopedic research division and director of operations and research for the Mizzou BioJoint Center. The state paid Cook $301,892.04 in 2020.
Stannard, one of the highest-paid University of Missouri employees other than top athletic coaches, received a state salary of $981,977.52 for 2020. Among his titles are chief medical officer for procedural services, medical director of the Missouri Orthopaedic Institute and chairman of the medical school’s orthopedic surgery department. He’s also a team doctor for Mizzou athletes.
Stannard’s salary is nearly double that of Mun Y. Choi, president of the University of Missouri System. Missouri Gov. Mike Parson, meanwhile, earned $133,820.88 in 2020.
A university spokesperson told the St. Louis Post-Dispatch in August that Stannard had grown the Missouri Orthopaedic Institute from two surgeons to 30, and that only 2% of his salary comes from tuition dollars.
Part of the lawsuits’ claims hinge on the university’s advertising of the novel procedures, which had aired locally in Missouri during a Super Bowl and appeared at Chicago’s O’Hare International Airport. Some of the plaintiffs alleged the extensive advertising led them to reach out to the Mizzou BioJoint Center to seek relief for their knee pain.
Such direct-to-consumer marketing of medical devices and surgery has been growing in recent years, following the success of ads for pharmaceuticals, according to McCulloch.
Still, Mello said, it is relatively uncommon for a university to advertise the availability of these techniques or products. She said the advertising claims likely allowed the plaintiffs’ legal team to negotiate a higher settlement amount because of false advertising allegations in addition to the medical malpractice claims.