Dr. Joel Singer, the sole owner and operator of the Center for Ambulatory Surgery (CAS), has voluntarily surrendered the facility’s license to operate its outpatient center at 32 Imperial Ave. in Westport, according to an affidavit filed with the state Department of Public Health.

The decision to surrender the license cannot be reversed and “constitutes disciplinary action,” the affidavit says.

Singer has agreed that he will not seek to reinstate the center’s license at any time in the future, according to the filing. He also agreed not to seek a new outpatient facility license, neither as an individual nor as part of a different corporate entity.

DPH inspections have revealed multiple violations at the center in recent years, which resulted in last year’s probation. They included rusty equipment, a broken fire alarm system, an unlocked refrigerator containing medications and worn-out brushes being used to clean instruments.

Among other issues, the center also could not provide proof that employees were trained in how to prevent infections, and investigations by state officials found that some patients were given post-surgery medications without a doctor’s order.

Reached by phone Tuesday, Singer provided a prepared statement that said he decided to relinquish the outpatient facility license for CAS “after much consideration and upon the advice of counsel.”

“He has agreed with the officials at the Department of Public Health that it is impractical to re-open the existing surgical facility because of regulatory issues, and particularly because the building requirements for an ambulatory surgical center could no longer be met at the existing location after physical damage from Superstorm Sandy,” the statement said.

Singer has previously said the damage to the center’s fire alarm system was caused during the October 2012 storm. He does not own the building in which CAS was located and said last year he had no control over when the landlord would fix the alarm system.

He maintains no patients were harmed as a result of any of the violations. “There was never a reportable incident involving any patient, nor did any of the issues directly involve patient care,” the statement said.

The affidavit filed with the DPH ends any pending matters against CAS’ license; state officials will dismiss their case against the center. It also has no effect on Singer’s individual physician’s license that allows him to practice medicine.

CAS’ license was granted in October 2009 and was set to expire Sept. 30, 2015, DPH records show. Singer’s license to practice medicine and surgery was granted in 1967, a year after he graduated from Yale School of Medicine, and is due for renewal next month, according to state records.

Singer, whose own medical license has been put on probation in the past, continues to practice medicine and plastic surgery in Greenwich and in Great Neck, N.Y. The Greenwich site operates under the name Imperial Plastic Surgery.

He has treated more than 8,000 patients in Connecticut and New York and “countless patients have been very pleased with the outcome of their procedures,” according to his statement. He claims he developed one of the first in-office surgical facilities in the state and was the first plastic surgeon in Connecticut to perform liposuction.

He has faced sanctions from the state, however, dating back to 1999 when he was placed on a year’s probation for inserting breast implants that were different sizes into a patient.
 

The Center for Ambulatory Surgery at 32 Imperial Ave. is run by Dr. Joel Singer, whose own medical license was placed on probation in 2011, when he was also fined $29,000 for sloppy record-keeping and other violations at the center.

The latest action by DPH is included in an Aug. 15 consent order was released this week. Under the order, the center must hire a consultant to monitor improvements in such areas as the operating room, nurse training and staffing, medical record keeping and infection control.

Administrators at the center will have to meet with DPH officials monthly for two years, the order states.

Singer said Wednesday that he is making all of the improvements required by the state so he can reopen the center soon. He added that the two-year probation on his medical license was recently lifted. William Gerrish, a DPH spokesman, confirmed that Singer’s probation has ended.

“All of this is very good, positive news,” Singer said. “We’re working closely with the state Department of Public Health to comply with their requirements and to make sure nothing will happen again.”

Earlier this summer, DPH had temporarily suspended the center’s license because of the violations found by inspectors in March. The violations included a broken fire alarm control panel, rusty instruments, an unlocked refrigerator containing medications and worn-out brushes being used to clean instruments, DPH records show.

Singer said the fire alarm system was damaged when the center was flooded during Hurricane Sandy in 2012. He said he had no control over when the landlord would fix the fire alarm.

In March, state officials found that one registered nurse, instead of the required two, were present at the center during plastic surgery procedures on Dec. 20, 2012. They also found cases in which patients were given painkillers and antibiotics after surgery without a doctor’s order, records show.

The center also lacked documentation to show that 10 employees had been trained in how to prevent infections, DPH records said.

Singer, a 1966 graduate of Yale University’s medical school, has faced sanctions from the state dating to 1999.

In that year, Singer was placed on one year’s probation for inserting implants of different sizes into a patient during breast augmentation surgery, records show.

Under a May 2007 consent order, the state fined him $5,000 for a case of “incompetence/negligence.” He admitted to lapses in documenting post-surgical conversations between himself and a patient after complications ensued following her breast reduction surgery. The patient required a second operation after failing to heal properly.

In December 2011, the state Medical Examining Board fined Singer $25,000 for operating the Westport center with sloppy record-keeping and rusty and dirty equipment.

In March 2012, inspectors who visited the plastic surgery center again found several violations, including unqualified nurses, slipshod record keeping, improper sterilization procedures and unsanitary conditions.

Based on Connecticut’s actions, New York and California officials have also reprimanded or fined Singer because he has licenses to practice in those states as well.

When an inspector from the state Department of Public Health visited Imperial Plastic Surgery for three days in March, the inspector found several violations, including unqualified nurses, slipshod record keeping, improper sterilization procedures and unsanitary conditions, such as an open bag of trash and an open container of soiled linens. These and other violations were delineated in a 58-page, Aug. 29 consent order signed by Dr. Joel B. Singer, the sole owner of the facility, which also operates under the name: Center for Ambulatory Surgery.

Singer says these most recent charges are “all part of an ongoing compliance matter. It’s all part of the same thing. Each time they come, they inspect, they find something else,” he said this week. “I’m sure if they came today, they’d find something.”

But the most recent inspection uncovered new violations. For example, a nurse told the investigator that she was the nursing supervisor, even though she had only started working at the center the day before. This nurse had graduated from nursing school 10 months earlier and lacked the training and experience necessary for that position, the consent order says.

In addition, a review of the clinical records revealed that the facility failed to ensure an accurate and complete clinical record for 13 of the 13 surgical patients whose cases were reviewed, according to the consent order. For example, there was no written record indicating whether most of those patients had received written discharge instructions that typically explain what to expect following surgery and what symptoms constitute complications.

Since then, Singer said, he has taken steps to address the concerns raised by state inspectors. “I have three full-time nurses,” he said. “That’s all in the past. That’s not true anymore. That was taken care of. …Pretty much what it amounts to now are regulatory compliance issues.”

Over the past several years, the state health department has cited Singer for multiple violations against his physician’s license and against his surgery center. Singer has two businesses licensed with the Secretary of State’s office – Imperial Plastic Surgery and the Center for Ambulatory Surgery. The former is the name for his practice and the latter is the name for the surgery facility, he said. For the past year, Singer also has owned and operated Imperial Plastic Surgery in Great Neck, N.Y.

The health department cited the Center for Ambulatory Surgery in May 2011 and imposed a $4,000 fine, a $25,000 civil penalty, a reprimand and two years’ probation. His facility license was suspended and the center remained closed for three months while he implemented state-mandated changes. That consent order was approved by the state Medical Examining Board in December 2011.

Singer, who graduated from Yale University medical school in 1966, has three prior Connecticut health department actions against his physician’s license. In a May 2007 consent order, the state health department fined him $5,000 for a case of “incompetence/negligence.” He admitted to lapses in documenting post-surgical conversations between himself and a patient after complications developed following her breast reduction surgery.  That patient required a second operation after failing to heal properly.

In a July 1999 consent order, Singer agreed to be placed on one year’s probation for inserting implants of difference sizes into a patient during breast augmentation surgery. The patient record was altered to read that the implants were the same size, the consent order says.
Following the unannounced inspections in March, conducted to see whether Singer and his facility were complying with terms of his probation, the health department issued an amended consent order. Singer has agreed to hire, at his expense, a health department-approved clinical consulting firm that has expertise in outpatient surgical centers.

The consent order outlines a detailed list of 14 systems that must be monitored and reviewed by the clinical consulting firm, pertaining to: controlling infection; medical documentation; nurse staffing, credentialing and supervision; physician and APRN credentialing; quality assessment; surgical services; medication storage; management; quality assessment and performance improvement; and matters pertaining to sterilization of instruments and the operating room.

The clinical consultant has to spend at least four hours a month at the Imperial Avenue plastic surgery center directly observing the staff’s performance and reviewing the staff’s credentials to be sure that they’re in compliance with federal laws. The consent order requires that the surgery center’s administrator and medical director meet quarterly with the health department during the period of the consent order.

Singer also has a license to practice medicine in New York and California. Because of the disciplinary actions and fines he’s received on his Connecticut license, both California and New York states have issued public reprimands.

New York’s health department issued censures and reprimands in 2000, 2007 and on Sept. 21, levying fines in the amount of $1,000, $5,000 and $1,000, respectively. California’s medical board issued public reprimands in 2000 and 2009. Awaiting a hearing before the California medical board is a petition by the California health department to revoke, suspend or place on probation Singer’s license to practice in California, based on Connecticut’s medical board sanctions on his and his facility’s licenses.

In addition, the board fined two other doctors $5,000 each for patient care lapses.

The plastic surgeon, Dr. Joel B. Singer, was also placed on probation for two years for the conditions at his Center for Ambulatory Surgery. Singer did not dispute the Department of Public Health findings and earlier this year he paid a $4,000 fine under a separate consent order with the board.

In May, DPH inspectors found that the center failed to keep records showing that nurses monitored patients for allergies or infections or kept track of sponges or needles used during operations.  The DPH report said that the center had dirty floors and rusty tweezers, an IV pole and scissors.  Singer declined to comment Tuesday.

The board also fined Dr. Tom Bell of Norwich $5,000 for removing a patient’s benign bowel lesion, while leaving a malignant lesion. The surgery took place in 2009.  In 2000, the board fined Bell $8,000 for a patient care lapse following an appendectomy, according to Matthew Antonetti, an attorney for DPH.  Bell’s lawyer, Don Leone, declined to comment on the consent order approved Tuesday but did say that Bell has retired as a surgeon.

Dr. David Kloth of Danbury was fined $5,000 for giving a patient an epidural shot on the wrong side.  Kloth’s attorney, Jason Prueher, declined comment.

In separate actions, the board approved consent orders that:

• Reprimanded Dr. Ellen Mascoli-Lanza of Waterbury for giving her husband 29 prescriptions for the painkiller Hydrocodone without maintaining medical records. Mascoli-Lanza declined to comment.

• Reprimanded Dr. Ross A. Glasmann of Burlington for giving 10 prescriptions of Vicodin, Percocet and a thyroid drug to a friend over 11 months without maintaining the patient’s medical records.

• Reprimanded Dr. John. A. Hallberg of Mystic for failing to disclose disciplinary action taken against him by Westerly Hospital in Rhode Island to regulators in that state.  In 2008, Rhode Island officials fined Hallberg $500 and placed him on probation for three years. The issue arose in Connecticut in March when Hallberg asked to have his Connecticut medical license reinstated.  A new state law gives the medical board the authority to discipline doctors based on actions by regulators in other states.

• Placed Dr. George Northrup of New Milford on probation for five years related to abuse of alcohol and painkillers. Northrup agreed to continue therapy and submit to random drug tests. He told the board that he became addicted to painkillers that were prescribed for back pain and spent six months in residential treatment for depression and addiction.

• Placed physician assistant Robert Lucas of Palm Desert, California on probation for four years related to disciplinary action taken against him by California regulators for a DUI conviction in 2009. His lawyer, Albert Danker, said outside the meeting that Lucas is now “clean and sober” and that “the board did the right thing.”  Lucas is licensed to practice as a physician assistant in Connecticut.