Bonati Spine Institute founder files $500M suit against state after shutdown

The founder of the Bonati Spine Institute in Pasco County filed a federal lawsuit Wednesday against state regulators, seeking more than $500 million in damages after they temporarily shut down his Hudson surgical center last year.

The lawsuit, lodged against the Florida Agency for Health Care Administration and three of its employees, alleges they defamed spine surgeon Alfred Bonati and his companies. The state regulators crafted a “false tale” of an external risk manager trying to stop the center from letting a certified surgical technologist perform “entire” spine surgeries, the 34-page lawsuit says. Then, the regulators ordered the center to temporarily cease operations, citing an immediate danger to patients, according to the lawsuit.

The health agency “leaked” its suspension order to journalists, the lawsuit says. But the order released is a public document that was published on the Agency for Health Care Administration’s website.

The order resulted in “dramatic patient cancellations,” according to the lawsuit, which accuses the agency and its employees of civil conspiracy and depriving Bonati of his right to practice medicine “without unreasonable, capricious interference by the state.”

“I cannot sit back and allow this type of targeted abuse, harassment and false allegations against myself, my team, or our patients to stand,” Bonati said in a statement sent to reporters Thursday. “It is the responsibility of all of us to hold our government accountable against malicious overreach, and we will pursue this case to the fullest extent of the law.”

The health agency in an email said it doesn’t comment on pending litigation.

Bonati, an orthopedic surgeon, has been licensed as a Florida doctor since 1981 and opened the spine institute in 1984. He developed minimally invasive instruments to perform back surgeries with only local anesthesia and conscious sedation so patients can stay awake and provide “direct feedback” during procedures, according to the lawsuit.

Bonati and the Gulf Coast Orthopedic Center Corp., a clinic known as the Bonati Spine Institute, have performed nearly 80,000 spinal procedures with a patient-reported satisfaction rate of more than 98%, the lawsuit says. Patients are evaluated at the clinic, and if surgery is recommended, they receive treatment at the Medical Development Corp. of Pasco County, Bonati’s for-profit surgical center, which is on the same property as the clinic.

The doctor has faced numerous state disciplinary complaints, including two filed last year alleging medical malpractice, and lawsuits from former patients since at least the late 1980s, according to previous Tampa Bay Times reporting and state health department records. In 2013, an arbitration panel ordered Bonati and his companies to pay $2 million to a woman who said in a lawsuit the doctor performed five unnecessary surgeries, the Times reported.

Bonati filed a $300 million libel lawsuit against the St. Petersburg Times in 1992 after it published a story about former patients’ lawsuits and his attempts to buy a local hospital. His lawsuit was later dismissed on technical grounds.

What do state regulators say?

In March 2023, the health agency alleged that Bonati’s center allowed a surgical technologist to do procedures even though he wasn’t licensed as a doctor — and despite other staff members raising concerns.

During an inspection, a state regulator saw the surgical technologist close a wound after a patient underwent a spinal procedure, according to the agency’s 13-page emergency suspension order. No physician was in the surgical suite, the order says.

A few days later, a regulator witnessed the employee treat another patient’s surgical wound, without a doctor present, following a spinal procedure, according to the order.

The center’s risk manager indicated that the employee, who was unnamed in the order, also “performed an entire spinal surgery on a patient in the recent past.”

The risk manager told the employee he wasn’t a licensed physician and couldn’t perform surgical procedures, the order says. In response, the unlicensed staff member argued he was doing procedures “under the surgeon’s license,” according to the order.

The order says the staff member performed surgical procedures for several years even when admonished multiple times by the risk manager not to do so.

At least once, the surgical technologist said the center’s surgeon was “no longer capable to perform these procedures due to the physician’s age and health status,” according to the order.

The surgeon dismissed the risk manager’s concerns and refused to take action, the order says.

The risk manager told the center’s medical director about the unlicensed activity on at least eight occasions and brought concerns to the center’s legal counsel in 2022, but the issues went unaddressed, according to the order.

A registered nurse, who was previously the center’s operating room director, told the surgeon about the unlicensed employee’s actions, too, and at least two staff members resigned from their positions after nothing was done to address the situation, the order says.

The center also “failed or refused” to provide some patients’ medical records to regulators, so the state couldn’t assess their surgical outcomes.

The health agency let the facility resume operations in July after reaching a settlement. The center agreed to pay a $50,000 fine; ensure that fully credentialed and qualified doctors and staff provide care; contract with a consultant and external risk manager to monitor whether it is following the law; and have its doctors and the risk manager meet every two months to review if procedures done at the facility comply with state regulations.

What does Bonati’s lawsuit say?

The state inspection was prompted by a confidential complaint about unlicensed employees allegedly performing “entire spine surgery,” according to the lawsuit.

It was apparent that regulators visited the center to “rubber stamp this as a conclusion,” the lawsuit says.

The lead investigator, identified as Tanya Ferrai in the lawsuit, a registered nurse specialist, “attempted to coerce information” from current and former employees, along with the center’s external risk manager, “through a deliberate campaign of threats, intimidation and innuendo,” the lawsuit says. Ferrai suggested that Bonati was under federal or criminal investigation and warned that employees’ association with him could have negative consequences unless they cooperated with the state agency, the lawsuit alleges.

The lawsuit named Ferrai and two other agency employees as defendants, Rachel Beane and Terry Moriarty, both registered nurse specialists. Ferrai on Monday said she had no comment. Efforts to reach Beane and Moriarty by phone and email were unsuccessful.

Regulators were unable to prove an unlicensed employee performed an “entire spine surgery,” according to the lawsuit, but “knowingly and intentionally conflated information they received, most generously described as rumor, gossip and rank hearsay, to create a fictional tale that would justify their failed investigation.”

Because patients are awake during spine surgeries, and because the center encourages family members to be present, too, if anyone other than a surgeon performed an operation, they would know it, according to the lawsuit. No patients or family members have alleged such activity, the lawsuit says.

Regulators wrote the suspension order “with the goal and intention of it being published in the media,” according to the lawsuit.

Bonati’s wife, Kimberly, a spokesperson for the spine institute, in a YouTube video compared the agency’s actions to the Nazi secret police.

“That unwarranted, Gestapo-like behavior is why we filed our complaint in federal court,” she said.

While the state order was in effect, Bonati’s clinic contacted a surgical center in Tampa, which “credentialed” several spine institute doctors to do procedures there, the lawsuit says.

The state inspected the Tampa facility to see if Bonati and his “primary” surgical technologist were practicing on-site, and after Ferrai couldn’t get information about the companies’ business relationship, she threatened to “expose” their connection, the lawsuit says.

The Tampa facility ended its agreement with the spine institute to avoid the agency’s “continued harassment,” according to the lawsuit.

“Those who were responsible for this gross devastation must face justice,” Bonati said in his statement Thursday.