Dr. Josh Smith
Dr. Josh Smith

February 11, 2016

A Carroll surgeon will be supervised and his work reviewed for the next five years as part of a settlement agreement he reached with a state medical board that accused him of professional incompetency.

Dr. Josh Smith, 48, who operates on patients at St. Anthony Regional Hospital and several other hospitals in nearby counties, “failed to provide appropriate surgical care” to nine patients over the course of five years starting in 2008, the Iowa Board of Medicine said in its settlement with Smith.

The board warned Smith that further mistakes might result in the suspension or revocation of his medical license, which he has had since 1995.

The board admonished Smith for surgeries he performed in Carroll, Manning, Ida Grove and Sac City, primarily for not identifying and treating injuries his patients suffered during the operations.

In one case in Manning in 2011, a child whose appendix Smith was attempting to remove suffered cuts to his intestines and his aorta — the human body’s main supply line of oxygenated blood, according to the board settlement and a lawsuit the patient’s family filed against Smith.

The child nearly died from significant internal bleeding that wasn’t diagnosed until the next day when he was taken by ambulance to an Omaha, Nebraska hospital, the lawsuit claimed. The suit was later dismissed, and it’s unclear whether there was a monetary settlement.

In a 2010 procedure in Sac City to remove an appendix, Smith “removed necrotic fat but not the appendix.” The patient underwent surgery with a different doctor after the patient’s condition deteriorated.

Smith was not available to comment this morning for this article because he was performing a surgery, but he later provided a written statement to the Daily Times Herald.

“Obviously I don’t agree with the board’s charges or the characterization of the surgeries or outcomes,” Smith wrote. “And unfortunately, because of the way Iowa statutes and the board rules are written, I am not even allowed at this stage of the proceedings to see any of the evidence against me so that I could rebut the same. Since my focus now and has always been on patient care, I decided to resolve this matter so that I did not have to spend any more time or money on fighting. I will continue to provide the high-quality surgical services that I have committed my life to in Carroll.”

Smith is part of a three-surgeon team that comprises Western Iowa Surgery, which has offices at St. Anthony Regional Hospital in Carroll. Smith is not a St. Anthony employee, but rather has an agreement with St. Anthony to operate on its patients.

“He’s an independent surgeon, privileged on our medical staff,” said Ed Smith, the hospital’s chief executive. “We’re aware of the action that the Iowa Board of Medicine has taken against Dr. Josh Smith. ... We’re confident that he has completed the education dictated by the board and that he is receiving attention from proctored services.”

Dr. Smith is now monitored by another surgeon, who provides written reports four times each year to the board of medicine and is required to contact the board “immediately if there is evidence that (Smith) has provided substandard care to patients,” according to the settlement.

Smith also must pay a $5,000 fine, and he took a competency evaluation in June 2015 in Denver, Colorado. His evaluators found that Smith’s surgical knowledge was “good, with a few gaps.”

“His clinical judgment and reasoning ... ranged from adequate to poor,” according to the settlement.

Smith showed a lack of cautiousness in some cases and made “relatively aggressive” decisions during his evaluation in Denver.

In another case that was not cited by the board of medicine, a Denison woman alleges in a lawsuit that Smith wrongly removed her thyroid in 2012 because he thought it might be cancerous. It wasn’t, and the woman says Smith did not perform enough tests to decide wether there was cancer before the surgery, the lawsuit alleges.

The case is set for trial in June.

The board of medicine approved its settlement with Smith last week.