Cyril Raben, MD, left a trail of dead or harmed patients across the Midwest.
Jerry Evans died in 2012 in Ohio after spinal surgery by Raben. lost more than 2.5 quarts of blood and bled to death when an artery was accidentally cut during surgery in Minnesota in 2009. was paralyzed from the chest down after spine surgery in Arkansas in 2007.
In all three cases, the physician and his insurance company reached settlements that paid out undisclosed amounts. Yet despite his troubled record, Raben received more than $1.3 million from Medicare from 2013 to 2015, the most recent year available, a 鶹ý/Milwaukee Journal Sentinel investigation found.
Most of that -- $874,000 -- came in 2015, the year after he in Ohio.
Raben died last year, but was seeing patients right up to his death.
He is one of at least 216 doctors who remained on Medicare payment rolls in 2015 despite surrendering a license, having one revoked, or being excluded from state-paid health care rolls in the previous five years. In all, those doctors were paid $25.8 million in 2015 alone.
"It makes no sense to continue enabling any doctor who is doing harm to patients," said , a professor of evidence-based medicine at Oregon Health and Science University in Portland.
Deyo, who has done research on back surgery using Medicare data, said Medicare may feel obligated to continuing paying licensed doctors -- but it also has a responsibility to reign in bad practitioners.
In a 2015 deposition in an Ohio malpractice case, Raben was asked how many times he had been sued in Ohio, Minnesota and Arkansas.
"More than 15, less than 30," he replied.
Raben agreed to surrender his Ohio license in the face of discipline there. What he did to prompt the action is not clear; the medical board won't release the records.
Because there was no hearing, by law, the details of his case must remain confidential, said Ohio board spokeswoman Tessie Pollock, who noted: "The permanent surrender is an effective and definitive tool to get doctors out of practice immediately."
But not to get them out of practicing everywhere.
Other states took action based on the Ohio discipline: His licenses in Pennsylvania and Missouri were revoked; he permanently surrendered his license in Texas; Illinois refused to renew his license; his license in Minnesota expired in 2011.
Arkansas, where he practiced for years, did not revoke his license, though there had been several complaints filed against him over the years.
In 2007, a physician who reviewed 15 of Raben's surgeries in Arkansas as part of a medical board complaint filed by another patient found a complication rate of 73% -- more than three times as high as would be expected. The review also raised questions about whether all the surgeries were needed.
"Dr. Raben recommends surgery with indications that are scant at best," the reviewer wrote.
Paulino, the patient who was paralyzed after Raben performed surgery in 2007, had just moved to Arkansas the year before. She had undergone surgery by another doctor in Montana to remove bone spurs in her neck.
Terry Paulino, of Arkansas, (center) who was paralyzed during spine surgery performed by doctor Cyril Raben. Paulino is shown with her husband Eddie (right) and her father Mike Renuart.
However, radiating pain returned. She went to Raben because she wanted to be less dependent on pain medication. He performed neck surgery in 2006, but she needed another operation in 2007, according to her lawsuit. After waking from that operation, she had extreme pain in her neck and shoulders and could not feel anything below her chest.
She was taken back to the operating room for emergency surgery that same day.
Paulino's lawsuit accused Raben and a nurse of medical negligence for failing to properly use equipment to monitor spinal cord activity during the surgery.
Despite intensive therapy, Paulino, 52, of Bentonville, Ark., never walked again.
"He ruined my life," she said. "I am usually in bed. I don't do anything. My husband has to help me dress."
Paulino and her attorney reached a settlement in the case in 2009, but under the terms cannot disclose the amount.
In August 2014, Raben appeared before the Arkansas board and said he would no longer perform surgeries. But data from Medicare indicates he was paid $44,000 in 2015 for various spinal injections, which are listed as "surgeries and procedures" by Medicare.
He died in Arkansas a year ago. An , including some thanking him for successful surgeries.
Raben's widow, Cindy, said he worked up until the time of his death.
She said he did a lot of good for his patients, noting that in some cases the harm to patients was caused by others, not him.
However, because insurance companies insisted on settling the cases, he went along.
"On paper it looks very bad," she said. "He was the victim of a lot of crap."
Kevin O'Dwyer, an attorney for the Arkansas board, said the board was satisfied by Raben's assurance that was not going to do surgeries anymore.
"Arkansas doesn't just do things just because another state does it," he said.