Hospital, docs responsible in impairment case
Doctor fired, then given glowing recommendations
In a first-of-its-kind court case, a jury held that a Louisiana hospital and two physicians intentionally misrepresented a former anesthesiologist's qualifications to a hospital in Washington state where he later was said to have botched a tubal ligation that left a 31-year-old woman with severe brain damage.1,2
According to court documents:2
- The anesthesiologist didn't monitor the 31-year-old mother of three properly.
- He allowed her blood pressure to drop dangerously low, and then he removed her breathing tube while she still was paralyzed from sedatives.
- The patient had a heart attack.
Two days after the surgery, the anesthesiologist admitted to hospital officials that he diverted narcotics meant for patients to his personal use for back pain following a car accident.1 He then immediately entered a physicians' drug treatment program, according to court testimony. The anesthesiologist no longer practices medicine.1
Court testimony indicates that the anesthesiologist's partners fired him in 2001 for working in an "impaired physical, mental, and emotional state."1 About two months later, two partners praised him as an excellent clinician in letters given to the Washington hospital before it hired him. Also, the Louisiana hospital did not disclose that a 2000 audit of his narcotic medication records raised concerns that he'd withdrawn a large amount of a drug from the pharmacy without proper documentation.
The jury ordered the hospital and anesthesiologists to pay $4.1 million. According to one of the lawyers, this is the first time that one hospital has held another one responsible for not disclosing information about a doctor.1 Also, the anesthesiologist's insurer paid $7.5 million to settle a malpractice claim bought on behalf of the disabled patient.
Fear of litigation is driving factor
Everyone has become terribly cautious in giving any recommendation for ex-employees, says Waldene K. Drake, RN, MBA, vice president of risk management and patient safety at Cooperative of American Physicians in Los Angeles.
"This is largely due to the fear of litigation alleging defamation of character, libel, or slander," she says. Many employers merely release dates of employment, title, and salary, says Drake, who expresses surprise that "glowing" letters of recommendations were sent in this case.
This verdict reinforces to everyone in the health care community that withholding information that might compromise a patient's safety is unacceptable, Drake points out. "The truth is that [the anesthesiologist] may have filed suit against the Louisiana group for defamation of character, libel, or slander had they told the truth as they knew it without proof to back it up," she says, "and, they might have won." Consider these lessons learned from the case:
- Don't rely solely on references.
When it comes to who is and who is not hired by or credentialed to practice in your facility, it generally is your facility's responsibility to perform due diligence on the person's qualifications and background and not simply rely upon the person's references, advises Edward J. Carbone, JD, shareholder with Buchanan Ingersoll in Tampa, FL. "In practical terms, most people do not use or name a reference that they believe would give anything less than a glowing report," he says.
Most jurisdictions have special programs for drug and alcohol abusing physicians and health care workers, Carbone points out. "Oftentimes, the specifics of those records are confidential, but it would behoove a potential employer to check the records from any jurisdiction where the practitioner was licensed or at a minimum point-blank ask the practitioner if there are issues that would interfere with their ability to perform," he says.
- Get a signed release from any problem physicians.
When you have a problem with a physician on your staff, obtain a signed release from that physician releasing you from any liability for providing true information about their time practicing at your facility, suggests Margaret Bastow, in charge of education matters for Horty Springer, a Pittsburgh law firm that counsels hospitals.1 If a physician doesn't provide such a release, a prospective employer can refuse to process the physician's application, she says.
The best time to get this signed release is at the time of initial appointment and every reappointment, some outpatient surgery experts maintain. If the release is not obtained then, the second best time is when the problem is being addressed, as part of the resolution agreement, they say.
Health care providers hurt their own interests when they seek to protect another provider by hiding damaging information about that provider from credentialing reviewers, Carbone says. "The providers' patients suffer in the short term, but the entire system suffers in the long term," he says.
References
- Finch S. Recommendation brings liability — Jury says problems should be disclosed. The Times-Picayune: June 08, 2006. Accessed at www.nola.com/search/index.ssf?/base/money-0/1149750793307650.xml?nola.
- Associated Press. Richland hospital wins $4 million verdict against Louisiana hospital. Seattle Post-Intelligencer. June 7, 2006. Accessed at seattlepi.nwsource.com/local/6420AP_WA_Malpractice_Case.html.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content