COLUMBIA, Mo. 鈥 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 鈥淏ioJoint鈥 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鈥檚 website calls a 鈥渂iological joint restoration,鈥 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 鈥渢he surgery he was proposing has a failure rate as high as 86%.鈥 Court documents argued the surgeries were 鈥渆xperimental鈥 and 鈥渦nproven鈥 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 says the program does not have 10-year data on effectiveness because the surgeries are 鈥渂ased on improvements to the traditional techniques.鈥 Unlike prescription medicines or medical devices, surgical procedures by federal or state agencies.
On Thursday, KHN obtained the settlement agreements, which were signed in February, through a public records request.
, 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.
鈥淥n a per capita basis, that seems like high damages, so there is something going on that鈥檚 not great for the university,鈥 Mello said.
鈥淲e are pleased to resolve this litigation,鈥 Jonathan Curtright, CEO of University of Missouri Health Care, said in a statement. 鈥淧roviding 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.鈥
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 鈥渨ithout appropriate medical direction and supervision.鈥
Some patients allege in court documents they did not know when they underwent the procedures that Cook was not a 鈥渕edical doctor or a licensed physician.鈥 In at least five of the plaintiffs鈥 cases, court documents say Cook was sometimes listed on medical records as 鈥渟urgeon 鈥 other.鈥
And documents in one case said he was listed as a 鈥渟urgeon.鈥 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 鈥溾 and that he joined the surgery team for the 鈥渕ajority of such surgeries performed by Dr. Stannard.鈥
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 鈥渟urgery commonly includes persons in the operative suite who are not licensed physicians.鈥
Many new medical techniques are tested on animals before they get to humans, so veterinarians may be involved in pioneering medical research, said Dr. , vice chairman of Houston Methodist鈥檚 orthopedic surgery department.
鈥淚t鈥檚 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,鈥 he said.
鈥淵ou have to be licensed as a physician to perform surgery on a human being,鈥 added Jeff Howell, executive vice president of the Missouri State Medical Association.
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 reported.
He holds the titles of William & Kathryn Allen distinguished chair in orthopedic surgery at the University of Missouri鈥檚 medical school, chief of the school鈥檚 orthopedic research division and director of operations and research for the Mizzou BioJoint Center. The state paid Cook in 2020.
, one of the highest-paid University of Missouri employees other than top athletic coaches, received a state salary of 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鈥檚 orthopedic surgery department. He鈥檚 also a team doctor for Mizzou athletes.
Stannard鈥檚 salary is nearly double that of Mun Y. Choi, president of the University of Missouri System. Missouri Gov. Mike Parson, meanwhile, .
A university spokesperson told the 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鈥 claims hinge on the university鈥檚 advertising of the novel procedures, which had aired locally in Missouri during a Super Bowl and appeared at Chicago鈥檚 O鈥橦are 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鈥 legal team to negotiate a higher settlement amount because of false advertising allegations in addition to the medical malpractice claims.