Contributed By Linda Brodsky, MD; Professor of Pediatric ENT; New York
Sometimes inspiration comes from the most unexpected people. I have to admit that being open to receiving such a gift, even from someone I would rather avoid, is not a practice I am particularly good at. But this week I let down my guard and listened intently to someone I could never imagine would suffer the humiliation of an unjust accusation. Someone who is being bullied in the healthcare workplace. She is someone I have known for 25 years and who might have a number of flaws (as do we all), but I know is not guilty as charged. These unfounded accusations are merely a smoke screen. These unfounded accusations allow hospitals a way to rid themselves of physicians they want to silence. Permanently.
Why? (you might ask disbelievingly). This physician dared to raise issues of quality control. She reported unnecessarily bad outcomes, mistakes that could have been avoided, safety issues not addressed. We doctors are told to speak up. To police ourselves. And when we do, if the wrong physician is scrutinized, that physician whistleblower becomes the target. That physician who reported becomes the problem. That physician is labelled “disruptive.”
Bullying in the healthcare workplace has reached new levels. In some hospitals merely raising one’s eyebrows or bringing forward any quality concerns could result in reprimand. Physicians who compete with one another. Physicians who walk to the beat of another drummer, sometimes making rounds at unusual times or asking for instruments and equipment that work properly..
One too many reprimands, or in the case of this hospital just two (probably unsubstantiated) reprimands, will result in a by-laws driven “trial” also called a “fair” hearing.
There is nothing fair about these hearings. The judge and the jury are mostly chosen by those who are involved with the hospital. The only limiting factor in how these people are chosen is that they not be in direct financial conflict with the accused. And how that is defined is very narrowly. The judge is paid by the hospital or the medical staff but shouldn’t have a “conflict of interest,” which means have substantial financial dealing with said institution. How about other conflicts such as personal relationships or previous or collateral relationships? In fact, doesn’t the source of payment, in and of itself, constitute a conflict of interest!. The process is a trial without the protections afforded the accused. Hearsay testimony, not so “expert” witnesses and fabricated “evidence,” sometimes from years past with little or no relevance to the problem at hand will be unearthed to make sure that the charges stick. And when found “guilty” (I have yet to hear of a peer review that ended with any other verdict), that physician may lose her privileges, be reported to the national data bank or even lose her practice, her livelihood. Sadly, more than one physician has committed suicide after such hearings.
I am not making up stories. And I am not making excuses for dangerous or truly disruptive physicians/nurses/pharmacists/administrators who make the workplace unsafe. I tell you this because I was a victim of such a procedure. And I believe it was done in retaliation for my gender discrimination litigation against the hospital. And even though it is four years since I was accused, the memories are still fresh; the wounds easily opened especially when I listen to yet another casualty in the making.. Are there alternatives? Sure there are. Objective, outside review with standards of behavior that conform to reasonable standards. Disparate treatment must be thwarted. Total immunity from unfair accusations, now enjoyed by medical staff officers and medical executive committees as well as hospitals, needs to be eliminated.
I hope my barely introductory post on this matter this interests some of you. And if it does, please visit Richard Willner’s Center for Peer Review Justice at PeerReviewjustice.org I probably don’t know enough about the law to say this, but I believe that our basic rights and civil liberties are being trampled. Due process is being kidnapped and is shrouded in a process that is called fair but is not fair at all. And it won’t end with physicians, and that is why it should be important to you.
Key words: National Practitioner Data Bank, NPDB, the Data Bank, Health Care Quality Improvement Act, HCQIA, Sham Peer Review, Bad Faith Peer Review, Physician Peer Review, Disruptive Physician, Due Process for Physicians