In July 2024, a podiatrist in Bangor was scheduled to operate on a patient he’d been treating for months.
A nurse at St. Joseph Hospital remembered that morning as “hectic,” according to an investigative report. Surgeries were running late. Computer issues were preventing doctors from reviewing patient photos. But after a slight delay, the patient’s left foot was marked in preparation for a procedure to repair the Achilles and peroneal tendon surgery.
In the operation room a short time later, however, a stocking and tourniquet were placed on the right leg. The doctor, Adam Darcy of Acadia Foot & Ankle, didn’t notice until it was too late. He operated on the wrong foot.
And it wasn’t his first time.
Details about the 2024 botched surgery were included in a report filed last month with the Maine Board of Licensure of Podiatric Medicine, which investigates complaints against foot doctors.
Board members concluded Darcy “had been negligent in his practice,” by his own admission.
“Even during the surgery it did not occur to (Darcy) that he was operating on the wrong site,” the board concluded in its final report.
Though Darcy operated on the patient’s right foot, he wrote in an operating report following the surgery that it occurred on the left foot. He amended that report to reflect his mistake about a week later.
Darcy’s surgical privileges were revoked by St. Joseph Hospital in December last year and Northern Light Health the next month. The state’s licensing board issued lifetime restrictions on his surgical license and placed him on three years’ probation, but he is still allowed to practice non-surgical medicine.
Acadia Foot & Ankle’s website indicates Darcy is still working at the clinic. Darcy, who has been licensed in Maine since 2003, declined interview requests and did not answer a list of questions about the operation, citing patient confidentiality and an “ongoing lawsuit.”
Similarly, a spokesperson for Covenant Health, the parent company for St. Joseph Hospital, declined to answer specific questions.
“Our top priority is, and always has been, the safety and well-being of our patients. However, while litigation is pending, we are limited in what we can share about the specific circumstances of this matter,” Covenant’s chief communications officer, Karen Sullivan, wrote in an email.
Travis Brennan, an attorney who is representing the patient, described the ordeal as a “never event,” meaning the kind of thing that should never happen if proper medical protocols are being followed.
“What’s shocking here is that never events should never occur, yet Dr. Darcy and St. Joseph Hospital have had two never events,” Brennan said, adding that his client plans to “pursue all legal remedies.”
Kristina Lunner, deputy commissioner of the state Department of Professional & Financial Regulation, which oversees the state’s licensing boards, said actions like this are “intended to rehabilitate or discipline the licensee, not to make a consumer whole or order a licensee to pay monetary damages to a consumer.”
Lunner said the department does not keep data on medical malpractice or surgical errors, so it’s not clear how common wrong-site surgeries are in the state. There have been many instances where patients have sued doctors over mistakes, including last year when a Skowhegan woman sued a Northern Light Health surgeon who removed a woman’s bladder during a surgery to extract a benign ovarian cyst.
For Darcy, it was the second time in seven years he’s made the same mistake. He was previously reprimanded by the board and sued by a patient for amputating the wrong toe in 2017.
In the last 20 years, the Maine Board of Licensure of Podiatric Medicine has investigated 12 complaints, and two involved Darcy.
In the previous instance, Darcy was scheduled to perform a partial amputation on the patient’s right big toe. But he provided a consent form that mistakenly described the operation as an amputation on the left foot. That’s the foot he operated on.
“Darcy became aware of the error following the surgery and, with the patient’s consent, performed a partial first ray amputation on the patient’s right foot” the following day, an investigative report reads.
The patient, John Killinger of Corinth, sued Darcy two years later. Killinger said he later had to amputate much of his leg due to complications from the surgery.
Brennan also represented Killinger in that lawsuit against Darcy. He said the fact Darcy has conducted wrong site surgery twice indicates a “systemic breakdown” within his practice.
“It is important to have robust policies and procedures in place to prevent medical errors from occurring, but those policies and procedures are only effective to the extent that staff are trained in them and actually follow them,” Brennan said.
Killinger’s lawsuit was later dropped, and the state board formally reprimanded Darcy, placed him on an 18-month probation and required to complete six hours of continuing education. But he was still allowed to operate until the board’s recent decision.
This story was originally published by the Maine Trust for Local News. Dylan Tusinski can be reached at dtusinski@pressherald.com.