It was a typical weekend on call. The usual number of surgeries, ER calls and consults. I was called to consult on 47-year-old female who had been admitted with four days of left shoulder pain. She had gone through a cardiac workup and was cleared by her internist. So now, a consult was called to see if there was an orthopedic cause for the patient’s pain — not an uncommon scenario.
It was the middle of the day, and the patient was awake as I walked into the hospital room. The other bed was empty, so we were alone in the room. My first mistake. I introduced myself, explained why I was there and that her heart workup was normal. As is my custom I drew the curtain around us and proceeded with the history and physical examination. My second mistake. When examining a patient with shoulder pain I also examine the neck and both shoulders, laying hands on and putting each through a series of maneuvers looking for signs of conditions I expect. The most common diagnosis in this scenario is a simple shoulder bursitis that was the case here.
I reassured the patient it was nothing serious and discussed the various treatments including medication, physical therapy, and injections. She asked if she would need surgery, and I said only if all the other treatments failed. She asked when she would be discharged, and I said probably soon because her heart was OK — but that was up to her internist. She agreed to try the PT and to return to my office as an outpatient. I did the note and left. Easy-peasy!
About two weeks later, I was summoned to the hospital administrators’ office. Inside was the CEO, the head of nursing, the chief of staff and someone who I found out later was a hospital attorney. This was a time when my relationship with the CEO was, let’s just say, less than cordial. It was then I was informed that charges of sexual harassment had been filed against me. After getting over the initial shock and anger, I asked who it was and when had it allegedly happened. They said they were not going to tell me, but they were investigating. I asked how they could investigate without asking my side, and they said it did not matter.
Remember, I said my relationship with the CEO was less than cordial?
At this point, my alarm bells were going full blast. All I said was, “Fine, when you are done, let me know.” But I knew full well where this was heading. Charges like this do not stay secret for long. Fortunately, I had my own sources, so I was able to determine that it was the patient I had seen with the shoulder bursitis. So when I was called back to the administrator’s office, I was prepared. It was the same group of people only this time there were three attorneys. I realized I could use that to my advantage.
Right off the bat, the CEO said, “We have completed our investigation and feel we have no choice to suspend your hospital privileges and report you to the state medical board.”
Me: ” How could you have completed the investigation without hearing my side?”
CEO: “It does not matter.”
Me: “So I am to be tried, convicted and sentenced without a defense?”
CEO: “There is no defense to this.”
Me: “So this is a drumhead trial?”
This really got the attention of the three attorneys. One of them whispered something to the CEO. After whispering back, the CEO turned to me and said. “Can you leave the room for a few minutes?” I said “No problem.” About 15 minutes later, I was called back in. This time it was one of the attorneys who spoke. He did not say the patient’s name but informed me of the circumstances of the complaint. I played dumb and acted surprised. I said I did recall that patient and explained exactly how I had approached her. I admitted no guilt but apologized for any “misunderstanding.” I agreed that I would no longer examine female patients without another female in the room. I was then asked to leave the room again. I could not hear well, but there clearly was disagreement between the CEO and the attorneys.
After being called back, it was the CEO who again spoke. The others in the room were clearly uncomfortable.
CEO: “We have decided to proceed with the charges.”
Me: “Is there no further discussion on this matter?”
Me: “Very well then, but before I leave there is something that I feel I must tell you. I will be filing charges against the hospital for countermanding a physician’s orders and putting patients lives in danger.”
CEO: “What are you talking about?”
Me: “About three weeks ago I admitted a patient with severe low back pain. I left explicit orders that the patient was not to be given any blood thinners because he was hypersensitive to them. Because of your blood clot protocol, your hospitalist put this patient on blood thinners, and this is not the first time this has happened. This patient required large amounts of reversal agents because he was at extreme risk for bleeding.”
I reached into my pocket and pulled out a piece of paper.
Me: “Here is the patient’s name, medical record number, and admission dates.”
A stunned silence a few moments after which the chief of the medical staff spoke.
CMS: “We will have to look into this further. Will you agree to do nothing until we are done?”
Me: “If you agree to not file charges against me.”
To this day, I’ve heard nothing more.
Salem witch trials, McCarthy hearings, kangaroo court, drumhead trial. Just when we think we are beyond these things another highly emotional issue comes up like sexual harassment, and it starts all over again. Unfortunately for many, they do not have the means or the wherewithal to do what I did. The timeless genius and innate fairness of innocent until proven guilty and the right to face one’s accuser must be respected.
Thomas D. Guastavino is an orthopedic surgeon.
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