Kennewick obstetrician and gynecologist Dr. John C. Perry faces new state allegations of unprofessional medical conduct while still under probation for issues resolved last year.
Documents from the Medical Quality Assurance Commission, the state body overseeing medical licensing, claim Perry failed to properly treat a patient with a rare uterine cancer, and that his failure is likely to have had a negative effect on her prognosis.
Perry's office staff told the Herald he was unavailable to speak on Thursday.
In 2010, Perry agreed to four years of probation after being charged with unprofessional conduct in 2009 based on allegations he violated standards of care for six patients, causing complications for several of them.
He also was accused of performing surgery on a woman with whom he had a romantic relationship in order to get her pregnant.
He denied the charges, but opted to settle with the commission in March 2010.
Charges by the commission are not criminal, but can affect a physician's ability to practice in Washington.
Currently, Perry remains able to practice under probation until he gets a hearing, said Mike Farrell, the commission's attorney.
"He still has due process rights in this case, and it's possible he may be exonerated," Farrell said.
The 2011 claims allege Perry saw a patient in September 2009 and found a mass in her uterus. He surgically removed the mass and diagnosed it as a high-grade malignancy, documents said.
The commission claims Perry told the woman he was the best doctor to treat her and did not refer her to a gynecological oncologist for cancer treatment.
He performed a laparoscopic hysterectomy in December 2009 at Kennewick General Hospital -- the only hospital in the Tri-Cities that currently allows Perry privileges to practice.
Kadlec Regional Medical Center in Richland revoked Perry's privileges in 2005, and a spokeswoman for Lourdes Medical Center in Pasco said Perry also does not have surgical privileges there.
Commission documents said Perry also asked a general surgeon to perform a lymphadenectomy on the woman, but the surgeon had not performed that procedure for several years and had done relatively few in his career.
"The surgeon recovered only one lymph node, rather than the multiple nodes that commonly should have been recovered for staging," documents said.
Staging is the process of determining the extent and location of cancer in a patient's body, according to the American Cancer Society.
The woman reportedly told the commission she asked Perry several times if she would need chemotherapy and should see an oncologist. Perry told her she would get chemotherapy at KGH, but he never scheduled the appointments, documents said.
Documents say the woman immediately should have been referred to a specialist to discuss additional therapies.
The woman's daughter asked for a referral to a cancer specialist, but Perry told her no, documents said.
In January 2010, the patient reportedly asked why she hadn't been sent to Columbia Basin Hematology & Oncology at the Tri-Cities Cancer Center for chemotherapy. Perry allegedly told her he "did not like the people there and would not refer her to their care," documents said.
Columbia Basin oncology was co-founded by Dr. Thomas Rado, a physician whom Perry sued in 2007 along with Kadlec after his medical privileges were revoked at the Richland hospital. Perry lost suits in federal and state courts and Kadlec was awarded almost $400,000 in fees and costs.
In the current case, the patient went on her own in January 2010 to a gynecological oncologist in Spokane and reportedly asked Perry to send her records to that doctor.
Afterward, the patient received a call from the Tri-Cities Cancer Center to schedule an appointment on a delayed referral from Perry, documents said.
The 2009 charges claimed he reversed a tubal ligation for a woman with whom he was having an extramarital affair in 2002 so he and the woman could attempt to have a child together.
Other violations involve allegations that Perry lacerated the bowels of some patients when he performed surgeries for which he did not have the appropriate expertise and did so without consulting other surgeons.
The settlement imposed a $5,000 fine and probation. During that time, Perry is restricted from being the primary surgeon for any procedures involving the bowel. He also is required to consult with a general surgeon if a bowel injury is possible in a surgery.
The agreement also required Perry to refrain from providing medical care to family members and people of "significant personal interest" except in an emergency.
The 2011 charges do not allege that Perry violated any of those conditions.
Perry's website notes that he is a "non-preferred provider" for most insurance companies, and he primarily accepts Medicaid plans.