Intuitive Salesman Says Robotic Surgeries Drove Salaries

A former Intuitive Surgical Inc. sales representative told a jury that two-thirds of his salary was based on how many robotic surgeries were completed in his geographic territory.

Damon Daniels, who covered the northwestern U.S. for Sunnyvale, California-based Intuitive, also testified yesterday in state court in Port Orchard, Washington, that he received bonuses for additional machines bought by hospitals.

Intuitive, whose robots were used in more than 300,000 U.S. operations last year, is in the third week of the first trial over claims that the company marketed its da Vinci surgical system too aggressively.

Josette Taylor alleged in her complaint that Intuitive’s training was simplified to sell more robots, which led to errors in removing the prostate gland of her husband, Fred Taylor, at Bremerton, Washington-based Harrison Medical Center. He died of heart disease in 2012, four years after the surgery, at age 71.

Daniels, who another witness said was in the operating suite during Taylor’s prostatectomy, testified that he often accompanied surgeons using the robotic system for the first time, assisting with the console set-up, the positioning of the specialized operating table and also answering questions.

Doesn’t Remember

Daniels testified that he doesn’t remember Taylor’s surgery, doesn’t recall discussing the patient’s obesity with the doctor who performed it, Scott Bildsten, and doesn’t recall hearing about the patient’s post-surgical experience, which included three weeks in the intensive care unit.

Daniels was also questioned by plaintiff’s attorney Richard Friedman about whether Harrison Medical Center administrators expressed concern about Taylor’s surgery and complications.

“I really don’t remember what happened after the case,” Daniels said.

Under cross examination, Daniels said he only saw surgical patients after they were “draped,” or laying on the table after being prepared for surgery. He told defense attorney Jeffrey Johnson he was unable to see or know a patient’s body size.

Lawyers for Intuitive have argued that Taylor never should have been a candidate for robotic surgery because of his obesity, and that he didn’t regularly take his prescriptions to control his heart-disease risks.

Simple Cases

Bildsten, a urologist, was specifically cautioned by Intuitive that for his early procedures with the da Vinci -- at least the first four to six surgeries -- he should choose simple cases and patients with a low body-mass index, Intuitive has said.

Taylor was 5 feet, 11-inches tall (180 centimeters), and weighed 280 pounds (127 kilograms), giving him a body-mass index of 39 -- a measurement that should have precluded robotic surgery according to Intuitive’s training, the company said in a court filing.

After seven hours of trouble with robotic surgery on Taylor in September 2008, Bildsten and other doctors turned to traditional surgery and then emergency care to repair a rectal laceration. While Bildsten had performed 100 successful prostatectomies using a traditional procedure, he hadn’t used the da Vinci system on a patient unassisted.

During his day-long testimony, Daniels repeatedly said it was up to a medical center to ensure its staff was ready to operate the da Vinci system without supervision from more experienced surgeons, called proctors.

During Bildsten’s two supervised prostate surgeries, the number recommended by Intuitive, Daniels said Bildsten performed the actual procedures while the proctor observed and made comments.

Daniels said he never discussed patient criteria with surgeons, saying that was a medical decision for physicians.

‘Stalled Surgeons’

Daniels also testified yesterday about “stalled surgeons” -- doctors who were reluctant to switch from traditional to robotic surgery, and how he was encouraged to pursue them.

Jurors were shown internal Intuitive e-mails, including one from Aug. 7, 2008, in which Daniels vowed to track down a doctor at Seattle’s Swedish Medical Center “like a blood hound” after the physician had turned down several dinner invitations and didn’t return phone calls.

Daniels said he was once the top sales representative for Intuitive in the world and that he was promoted to the position of Field Sales Trainer to train sales representatives during his last years with the company. He left Intuitive in September 2010. He now works for Neuronetics Inc., a medical-device company specializing in treating depression, according to his LinkedIn profile.

26 Lawsuits

Intuitive faces 26 lawsuits from people alleging injuries tied to its da Vinci system, according to a regulatory filing last month. The company also has entered into agreements with some plaintiffs’ lawyers temporarily suspending the statutory deadline for filing suits for other patients who say they were hurt by robotic surgery, it said. Intuitive has seen a “substantial increase” in such claims, according to the filing.

In robotic surgery, a doctor sits at console several feet from the patient and peers into a high-definition display. Foot pedals and hand controls maneuver mechanical arms equipped with surgical tools, guided by a 3D camera that shows the work as it is done inside a patient.

The case is Estate of Fred E. Taylor v. Intuitive Surgical Inc., 09-2-03136-5, Superior Court, State of Washington, Kitsap County (Port Orchard).

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