By Jonathan Saltzman

The longtime head of spine surgery at Boston Medical Center has been reprimanded by state regulators and fined $5,000 for leaving an operating room before the start of an emergency ankle surgery to go eat in his parked car, where he fell asleep and missed the procedure.

Dr. Tony Tannoury, 54, admitted that he woke up in his car that November night in 2016, called the teaching hospital, and was told that a chief resident had performed the operation he was supposed to oversee, according to a consent order released Monday by the Massachusetts Board of Registration in Medicine. Tannoury didn’t return to the hospital until the following day.

In a recent ruling, the state board concluded that Tannoury, who was the attending surgeon for orthopedic trauma emergencies that night and had escorted the patient with the resident into the operating room, had “engaged in conduct that undermines the public confidence in the integrity of the medical profession.”

The board also ordered him to complete five continuing education credits in “professionalism” and review regulations for supervising residents. It took nearly five years for the matter to be made public.

Before the board acted, Tannoury had received a written reprimand from the hospital for violating its policy requiring surgeons to be present for critical parts of operations, according to the consent order he signed last month. Federal law also requires surgeons at teaching hospitals to be present for the key part of a surgery in order to bill Medicare for the cost of the procedure.

BMC reported the matter to the medical board, said hospital spokeswoman Jenny Eriksen Leary, who did not specify when. The incident occurred amid heightened public scrutiny of surgeons who leave operating rooms before procedures are completed.

Leary declined to provide any details about the patient, but said the hospital was “fully transparent with the patient regarding the situation and who conducted the operation.” She added, “The surgical outcome was positive.” The hospital waived all fees connected with the operation, according to medical board records.

Tannoury, who is also licensed to practice medicine in Maine, did not respond to requests for comment.

George Zachos, the board’s executive director, said Wednesday that the hospital first contacted the agency about the incident in January 2017, two months after it happened. He said that a “number of factors” caused the matter to take more than four years to lead to disciplinary action and that the board has the burden to prove a physician violated regulations or the law by a “preponderance of evidence.”

Dr. James Rickert, who is president of the Society for Patient Centered Orthopedics and has criticized surgeons who fail to tell patients they might not perform parts of procedures themselves, said Tannoury’s actions were egregious. He also said the medical board reprimand and $5,000 fine were inadequate and came too long after the incident, keeping the public in the dark for nearly five years.

“That’s just the proverbial slap on the wrist,” said Rickert, an orthopedic surgeon in Bedford, Ind. “I can’t believe that if that was a board composed mostly of patients that they wouldn’t have had a much harsher penalty.” Four of the five members of the state board are physicians, according to the board’s website.

Rickert called for state medical boards to increase the number of patient representatives in an article published online in August in the journal Clinical Orthopaedics and Related Research.

Just a year before the episode, BMC officials had discussed Tannoury’s work in the operating room in a report that focused on a handful of orthopedic surgeons at Massachusetts General Hospital who juggled two operations at once without informing patients. The 2015 Spotlight report helped spur a national debate in the medical field about the controversial practice, sometimes called double-booking, at a number of US teaching hospitals.

At the time, BMC said Tannoury occasionally ran two operating rooms at the same time, with his cases overlapping by several hours. But the hospital described it as a tightly monitored program that enabled him to perform operations more safely, and during daytime hours.

On Tuesday, Leary said that after BMC made those 2015 comments about Tannoury’s surgical practices ― but before the incident involving the ankle patient ― the hospital updated its policies to prohibit concurrent operations by any surgeon.

Tannoury has directed spine surgery at the Boston University School of Medicine, with which BMC is affiliated, since 2006, according to his LinkedIn page. He specializes in minimally invasive spine surgery and on his practice’s website promises patients not to offer ”any treatment that I would not, or have not, used on my immediate family members and closest friends.”

The incident that got him into trouble occurred on Nov. 22, 2016, according to the consent order, after a patient came to the hospital needing emergency ankle surgery. Tannoury and the chief resident, who was not identified, took the patient to the operating room at about 9:30 p.m.

Tannoury “left the OR when the patient was being prepped for surgery and before the surgery began, intending to get something to eat prior to performing the surgery,” the consent order said. He left the hospital, “bought something to eat in his parked car, and fell asleep in the vehicle.”

For some, the episode may evoke memories of an even more startling case of a patient abandoned by an orthopedic surgeon nearly two decades ago. In 2002, Dr. David Arndt, a physician at Mount Auburn Hospital in Cambridge, walked out on a patient while performing complicated spinal surgery to go cash his paycheck. The patient was left lying on the operating room table, anesthetized and with an open incision. Arndt, who was grappling with a serious drug problem, lost his medical license. His life spun out of control, and he ended up facing a raft of criminal charges.

In 2019, the state medical board tightened regulations for surgeons who leave operating rooms before operations end, including when they are managing overlapping procedures. Though many surgeons at teaching hospitals schedule operations to overlap by a few minutes — letting trainees close the surgical wound of the first operation while the surgeon moves on to the second — the controversy at Mass. General focused on surgeries, mostly in orthopedics, that sometimes overlapped for hours.

The revised regulations, which medical experts described as among the most-far reaching in the country, require doctors to provide more information to patients beforehand about who will be participating in an operation. They also require hospitals to document each time a lead surgeon enters and leaves the operating room.