Doctor Penenberg defends orthopedic surgery decisions amid patient care scrutiny

In a pivotal hearing on May 14, 2025, the Medical Board of California scrutinized the actions of orthopedic surgeon Dr. Penenberg regarding a complex case that resulted in a patient's sudden cardiac event post-surgery. The crux of the discussion centered on whether Dr. Penenberg exercised adequate clinical judgment in the lead-up to the December 5, 2017, knee replacement surgery.

Key testimony revealed that Dr. Bamani, the referring physician, did not provide preoperative clearance, nor was she expected to. Instead, the patient underwent evaluations by internist Dr. Ishaya and cardiologist Dr. Geff, both of whom cleared the patient for surgery without ordering additional lab tests close to the procedure date. Dr. Ishaya had previously treated the patient and deemed him stable after a blood transfusion, while Dr. Geff cleared him just a day before surgery.

However, the board's expert, Dr. Keshigian, argued that the patient was medically unstable due to his complex health history, which included end-stage renal disease and a history of cardiac issues. He emphasized the necessity of updated lab work within 24 hours of surgery to monitor the patient's potassium levels, which can fluctuate rapidly and pose serious risks.

The defense maintained that Dr. Penenberg adhered to the standard of care, asserting that he relied on the evaluations of specialists and that the surgery itself proceeded without complications. They argued that the patient’s condition was stable during the procedure and that the subsequent cardiac event was unforeseen.

The hearing underscored the ongoing debate about the responsibilities of surgeons in managing patients with complex medical histories. The board's decision will likely hinge on whether Dr. Penenberg's reliance on prior evaluations constituted a failure to exercise due diligence in assessing the patient's current health status. As the case unfolds, it raises critical questions about the standards of care in orthopedic surgery and the implications for patient safety.