DOUBLEBOOKED Brett Greenky, MD, of Syracuse Orthopedic Specialists routinely staggered joint replacement patients across 2 (and sometimes 3) ORs.

Is 14 overlapping joint replacements in a single day excessive? Most likely, yes, according to a $2 million malpractice verdict against orthopedic surgeon Brett Greenky, MD, of Syracuse, N.Y., who routinely staggered hip and knee arthroplasty patients across 2 — and sometimes 3 — ORs, syracuse.com reports.

Overlapping surgery was the backdrop to a New York State Supreme Court jury unanimously finding Dr. Greenky and his practice negligent last month for his handling of a 2013 hip replacement that a 63-year-old woman's lawsuit said left her permanently injured. Dr. Greenky would place an implant, partially close the incision, then leave before the case was over to start surgery on another anesthetized patient in an adjoining OR while a resident or physician assistant closed the previous patient and applied a dressing — a practice the woman's lawyer called "assembly line" surgery.

Overlapping surgery was harshly criticized a few years ago when investigators found patients waiting under anesthesia for prolonged periods and absentee surgeons who forced residents or fellows to operate on their own. The American College of Surgeons issued guidelines that said overlapping surgery is OK as long as patients are informed prior to surgery. Fourteen procedures a day is not unusual, according to Dr. Greenky's attorney, who says his client plans to appeal the verdict.

Adam Taylor