‘Dr. Death’ Condemns Christopher Duntsch, But the Real Culprit Is Texas’s Broken Health-Care System

by 24USATVJuly 16, 2021, 2 a.m. 25
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Midway through Peacock’s new eight-part show Dr. Death, Dallas County assistant district attorney Michelle Shughart (AnnaSophia Robb) tries to wrap her mind around one of Texas’s most horrifying malpractice cases. It’s 2012, and for two years spine surgeon Dr. Christopher Duntsch has been cutting his way across North Texas operating rooms, injuring, paralyzing, and occasionally killing his patients in surgeries of such staggering ineptitude that, as one assisting nurse describes to a doctor, “It was like he learned what to do just so he could do the opposite.”

Shughart—and the show as a whole—wants to answer a big question: was Duntsch alone at fault for maiming, and in some cases killing, 33 people? She tells doctors Randall Kirby (Christian Slater) and Bob Henderson (Alec Baldwin), who have lobbied hard for, and are now assisting, her criminal investigation: “I’m going to tell a jury both that Christopher Duntsch is so, so bad . . . and that nobody”—not Dallas hospitals, not the Texas Medical Board—“did anything,” despite knowing about his incompetence.

It’s a condemnation that lies at the heart of the Duntsch story, which I helped break for the Texas Observer back in 2013. (Our story, “Anatomy of a Tragedy,” on which current Texas Monthly editor Forrest Wilder did the final edit, plays a brief cameo.) Duntsch, we found, was bad, yes. But the true scandal is that some of Texas’s leading hospitals, such as Baylor Scott & White Medical Center in Plano and Dallas Medical Center, quietly passed him on—letters of recommendation in hand—to other clinics, where he could continue to solicit and harm other patients.

Dr. Death—like the 2018 Wondery podcast of the same name on which it was based, and the Texas Observer piece on which that was based—sets out to chart this systemic scandal. As Henderson, Kirby, and Shughart retrace Duntsch’s movements across Dallas—following surgeries that, thanks to the series’ looping timeline, we first hear about, then are forced to sit through—they are treated to cheerfully digressive, unabashedly wonky explications from tort lawyers, medical professionals, and administrators of just how Texas’s regulatory state allowed this to happen.

What they learn confirms and builds upon reporting done in the Observers (Texas and Dallas) and by Laura Beil in the original Wondery series. One key factor: the private equity–funded Dallas hospitals have a profit motive, which incentivizes doing as many surgeries as possible. And patients hurt by Duntsch had limited recourse, because in Texas, two decades’ worth of tort reform (thanks to a mendacious conservative campaign) both slashed the maximum amount of damages malpractice victims could receive and, worse, insulated hospitals from responsibility for the doctors they hired. “Slick Rick Perry stuffs his war chest and lines his pockets with donations from Baylor,” a plaintiff’s attorney complains to Henderson. “I can’t believe I voted for that asshole.”

These were ramparts that prevented any meaningful regulation—including from the Texas Medical Board, which, in any case, functions less like a supervisory agency and more like a guild determined to protect doctors from oversight or consequences. An administrator there is skeptical when Henderson suggests suspending Duntsch’s license: Isn’t there more ambiguity in the case than that? Can Henderson say that he, himself, has never made a mistake? Except, according to the series, Duntsch’s mistakes didn’t come from nothing. The series contends that he was able to skip huge swaths of surgical training and apprenticeship typically required of a spine surgeon.

Joshua Jackson’s Duntsch is an effective, chilling villain—brittle, striving, yet charismatic and even charming. Duntsch knows he isn’t prepared, but nonetheless doubles and triples down on his “fake it till you make it” ethos. As his failures mount and threaten to expose his lack of training, he begins abusing drugs to cope with the pressure. The scenes of him flailing inside a patient’s spinal canal, his panic barely suppressed by the cocaine and Ritalin coursing through his body, are horrifying.

Dr. Death wants to be The Wire of Texas’s medical system, but the show is less convincing as a systemic critique than it is as a morality play. During Shughart’s investigation, the narrative holds up the idea that Duntsch was one element of a massive systemic failure—only to resoundingly reject that idea in the courtroom. When Duntsch’s defense attorney, Robbie McClung (Carrie Preston) argues that her client, in effect, was allowed by his residency program, Baylor Plano, and Dallas Medical Center to perform surgeries for which he was dangerously unqualified, Shughart narrows the fault back down to Duntsch.

For all the failures of the system, she argues to the jury, he was the one who injured and killed people, and he should have known better. After the mealymouthed corporatese from Baylor and the Texas Medical Board witnesses on the stand, Shughart’s plain, outraged language is bracing and refreshing. The jury convicts Duntsch. Dr. Death ends, as history did, with Duntsch in prison. The final episode ends with the chilling words “This will happen again” in white text across a black screen.

But what is the “this” that will happen again? Dr. Death is a story of a haunting in the house of medicine, and of two good, honorable doctors—and one plucky prosecutor—who set things right. Like so many such stories, it titillates and terrifies only to land on a generally happy ending: the monster kills and wounds, but the monster is put away. The actions needed to defeat him are obvious and successful, even if institutional cowardice and institutional inertia delayed those actions too long.

I was left with the uncomfortable feeling that my own reporting nearly a decade ago helped establish this framing. In the Texas Observer story, I compared Duntsch to a hundred-year storm that swamps a seawall. But after watching Dr. Death, I think I chose the wrong analogy, because it suggests that the danger is the category 5 hurricane—the singular bad doctor—and not the rising floodwaters we’re already wading through: in-network hospitals that put unwitting patients under the scalpels of out-of-network surgeons who charge astronomical fees; the ever-growing administrative burden that makes doctors and nurses watch screens and not your face. Or the possibility (too humdrum to be worth a dramatic miniseries) that you will receive lackluster and substandard care from a bloated, profit-maximizing system. American health care conscripts nurses and doctors—not just bad apples like Duntsch, but great ones too—into a machine that treats human lives as a resource to be mined for shareholder profit. That’s the real horror story here.

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