The state Department of Public Health has released documents providing additional details about an April 2010 procedure at New Milford Hospital that may lead to the revocation of a radiologist's license.

Dr. Michael Waldman of Northeast Radiology is facing possible revocation of his license because of the April 26, 2010, procedure.

Three days after the procedure, patient Thomas D'Amato died, according to DPH documents.

Dr. Waldman was found to have "immediately recognized he had perforated the spleen" of the 74-year-old patient but sent him home without telling him, the investigation found.

Mr. D'Amato returned to the hospital emergency room "six hours later" with shortness of breath and severe abdominal pains.

A CT scan dated April 27 revealed he was hemorrhaging, likely from the spleen, and Mr. D'Amato was transferred to Danbury Hospital, where he died two days later, according to the investigative report.

DPH records indicate Dr. Waldman followed standard New Milford Hospital practice for a "routine" thoracentesis, which is the insertion of a needle to remove fluid from the pleural space near a lung.

Dr. Waldman had performed a thoracentesis on the space near Mr. D'Amato's left lung.

A follow-up chest X-ray was done and the patient was kept in the radiology department for one hour with his vital signs monitored by radiology staff.

He was then discharged with instructions for after care at home, according to the report.

However, the investigation determined the thoracentesis done on Mr. D'Amato was "not routine" and further precautions should have been taken, DPH documents state.

The investigation found Dr. Waldman "never examined the patient and/or called any consulting physician prior to the patient being discharged."

Dr. Waldman left to perform another procedure.

He believes he conducted the D'Amato procedure and discharge correctly, his attorney, Jack D. Garamella, wrote in a Dec. 14 response to allegations he sent to the Department of Public Health.

"The patient was completely asymptomatic when discharged," Mr. Garamella wrote.

Dr. Waldman also believed the radiology department "was fully capable of performing the monitoring tasks. There was a nurse present at all times checking the patient," Mr. Garamella wrote.

Medical investigators interviewed two registered nurses about the incident: Kamala Basdeo and Linda Zaleta.

It was found the responsibility of monitoring Mr. D'Amato was passed from Ms. Basdeo to Ms. Zaleta at a shift change.

Ms. Zaleta told the investigator she was not told about a possible injury to Mr. D'Amato's spleen when she began her shift, according to the investigator's June 2, 2010 survey notes worksheet.

Ms. Zaleta, in turn, "left to assist with another procedure, and a radiology technician monitored (Mr. D'Amato's) vital signs."

Ms. Zaleta then returned to discharge Mr. D'Amato, the investigator's summary continues.

Since this incident, the hospital has put in place a strict protocol requiring imaging studies prior to any thoracentesis procedure. Dr. Waldman helped develop the protocol, according to the April 7, 2011, investigative report.

The hospital now also requires that a patient be transferred to the emergency department if complications require urgent medical treatment, the report says.

Dr. Waldman had reached a settlement with Department of Public Health attorneys concerning the April 2010 incident.

He was to be placed on supervised probation for a year, according to proposed consent order documents.

Dr. Waldman did not admit to allegations of negligence in the incident, but he agreed not to contest the department investigator's findings.

The state Medical Examining Board rejected that settlement, requiring a stronger sanction, its Aug. 16 meeting minutes reveal.

A hearing into the case is possible, if Dr. Waldman's and health department lawyers do not reach an agreement acceptable to the board, department spokesman Diana Lejardi said last month.

Mr. D'Amato's widow, Diane D'Amato, has hired an attorney, John Houlihan Jr., of RisiCassi & Davis, who is reviewing health department and New Milford Hospital documents to decide what action to take.