The disciplinary case of Dr. Johan Aerts of Des Moines highlights the manner in which patients, regulators and the general public are often left in the dark while hospitals and practitioners keep information about incompetence and malpractice to themselves. (Text messages and emails courtesy of Polk County District Court; stethoscope courtesy by Getty Images)
Four years after a fired Des Moines surgeon accused of incompetence informed the state that he was disabled, losing sight in one eye, and could not safely perform surgery, the Board of Medicine has ordered him to refrain from practicing.
In its order, the board indicated that it determined on Jan. 18, 2024, that it had “probable cause” to have Dr. Johan Aerts, a former transplant and vascular surgeon for Mercy Clinics, complete a comprehensive clinical competency evaluation. Two weeks ago, the board issued its order, agreed to by Aerts, terminating his ability to practice medicine in Iowa.
Aerts’ case highlights the manner in which patients, regulators and the general public are often left in the dark while hospitals and practitioners keep concerns about incompetence and malpractice to themselves.
The medical board’s action has no practical effect given Aerts’ voluntary decision, 55 months ago, to tell the board he would no longer be practicing due to a vision problem that left him functionally blind in his right eye.
“I voluntarily disclosed my disability to the board back in 2020,” Aerts told the Iowa Capital Dispatch. “And here we are four years later finally dealing with it? Really? What are we doing? The board’s stated objective is to protect the public from harm. They’ve known about this since 2020.”
Calls to the Board of Medicine were not immediately returned Wednesday. But in the past, the board has said it can take years for its staff to fully investigate a matter , with the board taking action taken only after the physician has retired, died or been sent to prison.
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Aerts says his vision problems began in February 2019 — the same year, he acknowledges, he had three patients go into cardiac arrest on the operating table. However, he says, the problem then was merely eye fatigue. It wasn’t until December of that year, just after he was fired from Mercy Medical Clinics, that he realized he couldn’t safely perform surgery and filed for disability benefits.
I considered them a private health matter that I was addressing, and I did not.
– Dr. Johan Aerts in a deposition, answering a lawyer's question about whether he reported any eye problems to Mercy Clinics before filing for disability.
Surgeon had issues at Mercy for years
Aerts has a history of issues at Mercy, some of which began in 2017 when he was the focus of staff complaints about his behavior.
In September 2017, Dr. William Vandivier, the president of Mercy Clinics, sent Aerts a letter, later made public in court records, warning him that his behavior — described as “yelling at staff, refusing to see clinic patients, throwing charts at staff, blowing up during Transplant Committee meetings at colleagues, and reducing transplant staff to tears” — amounted to grounds for termination.
Court records indicate Mercy did terminate Aerts in 2017, but only temporarily and for reasons Aerts says were never shared with him. But in a subsequent deposition, he testified that it was in 2017 that he informed Mercy he was so overcome by stress and depression he couldn’t safely provide patient care.
Before the year was over, however, Aerts was back at work at Mercy and consulting with a workplace coach who had interviewed Aerts’ colleagues about his conduct. The coach produced a report for Aerts, later used in court, that referenced the co-workers’ objections to Aerts’ characterization of Mercy’s transplant program as the “s— show” and their feeling that “swearing and throwing charts” were unacceptable behavior.
Surgeon was at his ‘breaking point’
In a deposition, Aerts acknowledged that he continued to be stressed in 2018. At the time, he was making $483,142 annually, according to court records, but he was, as he would later testify, near his “breaking point” due to personal issues in his life.
In June 2019, a Mercy patient went into cardiac arrest during surgery performed by Aerts. Dr. Greg Recker, of Medical Center Anesthesiologists (MCA), the organization Mercy hired to provide anesthesia services, sent a text message to Mercy officials including Diane Probasco, an administrator who helped oversee the operating rooms.
“Sorry to bother everybody,” Recker texted, according to court records. He informed them there had been a second Mercy patient who went into cardiac arrest during insertion of a dialysis catheter. “To be blunt,” he wrote, “this needs to stop.”
Probasco wrote back asking if the surgeon in this case, like the previous one, was Aerts. “Yes,” Recker responded.
According to court records, the two adverse outcomes prompted a review by Mercy’s Surgical Quality Assurance team and a decision was made to have Aerts modify his surgical technique — but that’s not something Aerts’ patients, including Linda Rogers of Dallas County, would have known.
On the morning of Sept. 27, 2019, Rogers was wheeled into surgery at Des Moines’ MercyOne Medical Center for placement of a dialysis catheter that would enable to her to receive dialysis treatments at home.
It was an outpatient procedure, and Aerts says he was confident enough in the outcome that he assured Rogers she’d be able to make a planned trip to the state fairgrounds the next day.
Linda Rogers’ husband, Randall, kissed her, and then Linda turned to her stepdaughter and said, “Amy, you make your dad buy you breakfast.”
As Randall later recalled in a court deposition, he and Amy were eating in the cafeteria when Randall received a call asking him to come back upstairs to the waiting room. When he arrived, he was ushered into a small room where a doctor soon appeared and told them there had been complications. Linda’s heart and her breathing had slowed, and the staff was now attempting CPR.
Minutes later, at 11:59 a.m., still on the operating table, Linda Rogers was pronounced dead. Aerts would later blame the anesthetist, saying she was clearly at fault. The staff at Medical Center Anesthesiologists saw it differently. They blamed Aerts. Within hours, Mercy had imposed a “precautionary suspension” of Aerts’ surgical privileges, according to court records.
Patient death swept ‘under the rug’
Several days after the operation, on Oct. 4, 2019, Recker sent his colleagues at MCA, the anesthesia group, an email, titled “Patient care concerns.”
He wrote: “I personally can no longer do cases with this surgeon, Dr. Aerts. I am happy to pay my fine for refusing an assignment. I am expecting the med exec committee to NOT revoke all of his privileges and instead limiting him to no longer to perform peritoneal dialysis catheter procedures.”
In the email exchange, preserved in court files, Recker proposed the group refuse any assignments to provide anesthesia for Aerts’ patients. “I feel we should take the high ground and do what is right for patients and our community. At what point are we complicit in turning a blind eye to the obvious issues going on?”
One of Recker’s partners, Dr. Justin Roenow, agreed, writing, “We will never be wrong by placing patients first.”
Dr. James Bartlett also responded, saying he, too, was in favor of “not doing his cases anymore” and he referenced a surgical complication in a case that he described as “inexcusable,” and Aerts’ “general incompetence.”
Dr. Kevin Percival emailed a response in which he voiced agreement with Recker, adding that he recalled an operation handled by Aerts that he said resulted in a brain injury that was likely to trigger a malpractice claim.
Dr. Roger Kinkor then weighed in with an all-caps bit of advice: “EMAIL IS NOT THE PLACE TO DISCUSS THIS!”
“They made up their mind,” Aerts later said of the anesthesiologists. “You know, they decided that I was unsafe. They didn’t look at the facts.”
Court records show that one week later, on Oct. 11, Mercy’s Medical Executive Committee reinstated Aerts’ privileges.
Anesthesiologist Dr. John Paszek at MCA immediately wrote to his partners and called for a meeting, stating that Mercy’s committee had “basically swept another incident under the rug.” Paszek observed that “many of us feel we that we should refuse to continue to work with him, which is the right thing to do to protect our patients but could have legal ramifications for MCA.”
Paszek wrote that he was going to speak with Vandivier, Mercy Clinics’ president, and to Mercy’s chief medical officer, and would “push them to do the right thing.”
Anesthesia group faced ‘crippling’ issues
Vandivier took the anesthesiologist’s concerns seriously. In a subsequent deposition, he spoke of how important MCA was to Mercy’s success. In recent years, he testified, Mercy’s interim chief financial officer had negotiated an “aggressive” new contract with MCA, reducing the anesthesiologists’ compensation by almost $2 million while burdening them with additional work.
“So they were doing a lot more work for the hospital and getting a lot less pay,” Vandivier testified. “It was crippling the anesthesia group because it was really hard to recruit and get anybody in to help grow the practice.”
At the same time, he said, there had been a few bad patient outcomes tied to different surgeons, and each case had an impact on the cost of MCA’s malpractice insurance.
“There was concern around (of) anesthesia losing their malpractice,” Vandivier testified, and so the opinions of the anesthesiologists weren’t taken lightly at Mercy.
After Vandivier heard from the anesthesiologists, he met with Aerts, who secretly recorded their conversation. A partial transcription of the tape was later filed in court.
During the meeting, Vandivier told Aerts he had talked to Karl Keeler, the president of Mercy’s parent organization, Catholic Health Initiatives, who had made it clear he wanted Aerts gone.
“Karl is like, well, you know: ‘I don’t want to talk to a family about somebody that — their person — dying on the table and, you know, that’s what happens when Aerts does the surgery,’” Vandivier told Aerts. “And I’m like, ‘I’d have Aerts do surgery on me any day of the week. I wouldn’t, I wouldn’t hesitate.’ And he’s like, ‘Well, I just don’t want to have that conversation with families.’ I’m like, ‘But they’re already high-risk patients.’”
In a sworn affidavit, Keeler stated he wasn’t one to tell the medical staff that he wanted a specific practitioner fired.
“Although I remember there were multiple cases that caused (Aerts’) peers concern,” Keeler stated, “there was one death in particular that stood out because it was not a particular risky or difficult procedure, and the death was very hard to explain. Around this time, anesthesiologists from Medical Center Anesthesiologists said they would not handle Dr. Aerts’ cases due to quality concerns.”
On Oct. 31, 2019, Mercy fired Aerts. According to court records, Mercy then reported to the National Practitioner Data Bank that prior to his termination, Aerts had been placed on “mandatory proctoring or monitoring during procedures” because of “patient care concerns.”
Linda Rogers’ family went on to sue MCA and the anesthetist, but a jury found no fault with their care. In October 2021, Aerts sued Mercy Clinics and Catholic Health Initiatives for defamation and disability discrimination.
In that case, which is still pending, Aerts alleges he was fired because Mercy was trying to save money by getting him “off the books” so it could relieve itself of the obligation to provide costly medical coverage for Aerts’ son — charges that Mercy has denied. Court records indicate a confidential settlement is now being finalized.
Regulators, families left in the dark
Over the past four years, litigation over Rogers’ death and Aerts’ firing has revealed that physicians who are willing to question their colleagues’ competence in private are not always willing to voice those concerns to regulators or patients’ families.
John Paszek, the MCA anesthesiologist who had complained about Mercy sweeping matters under the rug, was asked in a deposition why, if he was so concerned about Aerts’ competence, he had never complained to the Iowa Board of Medicine, which investigates complaints from patients, practitioners and the general public.
“If you have concerns regarding whether or not a physician is competent, you’re required to make a complaint to the Board of Medicine, correct?” Paszek was asked.
“I’m not sure about the Board of Medicine,” he replied.
“You’re not aware, as someone who holds a medical license in the state of Iowa, whether or not you’re required to raise concerns or make a complaint with the Board of Medicine if you believe a physician is incompetent?”
“I guess I would,” Paszek replied.
During Aerts’ deposition, a lawyer asked Aerts several times to confirm that just a few months before filing for disability due to vision problems he’d been performing surgery and had never reported any eye-related problems to the hospital.
“I just want to make sure I understand,” the lawyer said. “Did you ever report these eye issues to anybody at Mercy?”
“I considered them a private health matter that I was addressing, and I did not,” Aerts testified.
In speaking to the Iowa Capital Dispatch, Aerts admitted that while he feels strongly that the anesthetist assigned to Linda Rogers’ surgery caused her death, he never shared that information with Rogers’ family.
Asked why, Aerts said, “Because that is not appropriate. That is not what you do. I was totally distraught. The thing that people are completely oblivious to is the secondary trauma that happens to the health care providers — the secondary trauma to the surgeon of losing a patient.”
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