Dogs And Ponies: One Does Not Even Get Ten Minutes Of "Fame" With The NC Medical Board

Well, today was it. There was a hearing before the NC Medical Board this morning . . . regarding a rule proposing that malpractice judgments & settlements be published by the Board as part of a "Physician Profile". Patient & consumer advocacy groups - not to mention malpractice lawyers - are hailing the measure. And the Medical Board is toot-toot-tooting its own horn about the move towards "transparency."

The NC Medical Society is not so happy about it.

I think it's grandstanding.

I've been planning to attend the hearing since I first heard about it. I arranged to take the day off from work. I spent several hours last night drafting a prepared statement (which I actually timed to read in about ten minutes). And I got up at 6 AM this morning in order to drive to Raleigh and arrive by 9 (I was not exactly sure what time the hearing started . . . as I could not find that info on the Board's website . . . I called the Board en-route to confirm the time). The hearing started at 10 AM.

It was an amazingly easy ride into Raleigh. The traffic was not at all bad. I arrived at about fifteen minutes after nine, to find the tiny hearing room packed with people (the Medical Board had not made any effort to change the venue/book a larger room). Several TV cameras were set up. And chairs on the incoming aisle were reserved for reporters. I signed in to speak and claimed a seat in the hearing room. Latecomers spilled over into adjacent conference rooms - and relied upon piped-in audio.

When the meeting started, the President of the Board (Janelle A Rhyne) announced some "house-keeping" issues. One of those issues was a five-minute limit on the time presenters could speak. There was a intern on the far end of the lectern who was going to time the presentations - he actually would call a four-minute warning. This time-limit apparently had been a well-kept secret, because I saw several of the presenters suddenly tense and immediately begin reviewing their remarks - as did I. I resolved to do the best I could to pare down my remarks - and "wing it".

Alas, this morning was one of those mornings (thankfully rare these days) when my trigeminal neuraliga flared. Must have been the stress of biting the hand that feeds. Shortly before I hit the Raleigh city limits, I was jarred by the old familiar sensation of an ice-pick jamming through my right ear and settling into a throbbing white-hot burn behind my right eye. It was so bad, my eye began to tear. When I got inside the building, I ducked into the bathroom and dug 800 mg of Motrin out of my purse. I gritted my teeth (not exactly helpful when the neuralgia rages) and resolved to carry on.

At the podium, I parsed my statement down to try and make my points, but the presentation lost much in the cliff-notes version. I'm quite sure all the anger (at being forced to abbreviate a carefully prepared statement), emotion (from the events I was describing) and pain (the neuralgia) showed. When the intern called "time", I handed a staff member a copy of my statement, dropped a copy in the lap of the News & Observer reporter sitting in a chair behind me, and left . . . feeling fairly lost and dejected . . . on the verge of tears.

I had taken time off work. I had driven an hour to get there (and would be driving an hour back). And all I got was five minutes. It was crystal clear to me that the North Carolina Medical Board did not give a royal damn about what presenters thought. They're going to do what they want to do. Giving people their five minutes was just about going through the motions.

At least I have a blog. The following is the text of my prepared statement:

My name is Mary Helen Johnson. I am a Board-Certified Pediatrician who lives in Asheboro. I do not practice there. We will get to that momentarily. I am here to support the proposed rule that makes a physician’s “profile”, including malpractice judgments and peer review actions available to the public.

While I commend the Medical Board’s action, I believe it is far too little, far too late. I also believe the Medical Board is grandstanding - doing something relatively easy to appease the public (especially the newspapers) and appear “transparent”, while actually doing little to protect patients BEFORE they have to file a malpractice claim.

In supporting the rule, I realize I stand in the minority of my medical peers - and in opposition to the North Carolina Medical Society (an “advocacy“ organization to which I no longer belong).

I am a blogger and I have outlined my thoughts on this subject in several posts on my blog: www.drjshousecalls.blogspot.com.

We’re here to talk about malpractice. I have four vantage points from which to view this issue.

First and foremost, I was fired for intervening in bad medical practice and reporting it . . . my life and practice were then pulverized in a medical cover-up that ultimately led to the perjury, contempt and fraud for which the great state of North Carolina can’t seen to hold a “non-profit” hospital & its executives accountable.

In 1998, just weeks from completing a public service assignment with both the National Health Service and the NC Department of Rural Health, I was threatened by the executives of the non-profit hospital where I was employed. I was frustrated by (and had become very vocal about ) clinical problems at the hospital, and I was essentially told to “shut up or else”.

Just days after the threat was issued, I was forced to choose between a patient’s life and my job - when, in the middle of the night I was paged by a terrified nursing supervisor who informed me that a newborn infant’s care was being horribly mismanaged by a Family Practitioner - who did not appear to know what he was doing. Without belaboring the specifics, this was a doctor who had been marketed by the hospital as having special abilities in neonatal care that he did not possess. I arrived to discover that he had made a misdiagnosis, was preparing to perform a procedure that might harm the child, and that even the very basic care that the baby required to treat her condition had not been provided. I immediately intervened and began a resuscitation. The baby was transferred to a tertiary care nursery - where she survived after a harrowing NICU course. She is ten years old - happy and healthy. And she is the best thing I ever did.

I reported the case to hospital peer review the next morning and found myself out of a job within two weeks of making the report (as hospital executives made good on their threats). In essence I was fired for preventing malpractice and blowing the whistle on bad care. Everything I had ever worked for was destroyed - in clear violation of the contracts and service agreements I entered into with both the hospital and state/federal entities. For the record, the hospital was Randolph Hospital in Asheboro, North Carolina. Asheboro is my hometown.

Since we are talking about malpractice, I was sorely attempted to include with this statement a copy of the complaint I originally submitted to the Medical Board (with the patient’s name blackened out, of course). The patient’s identity is hardly secret anymore, as the child’s Mother has discussed the case publicly. As Mr. Mansfield will recall, the doctor against whom I filed the complaint released it to hospital executives, who in turn, released it during discovery in subsequent litigation. I formally protested (based on privacy & confidentiality concerns), but Mr. Mansfield informed me that the doctor could do whatever he wanted to with the complaint. Therefore, so can I. I sat on no peer review committees.

I found myself mired in a medico-legal quagmire, with NO ONE in a position of oversight (be it the local hospital BOD, the state & federal programs I served, the Medical Board, or the Medical Society) moving to protect me. No one was interested in the truth - or in helping a doctor who went above and beyond in order to prevent malpractice. A year after I was fired, I sued the practice. I also filed a confidential complaint with the US & NC Departments of Health & Human Services (as feedback offered at their request). For my trouble, the hospital sued me for “libel” (in what is commonly called a SLAPP suit - i.e. a Strategic Lawsuit Against Public Participation). The local newspaper jumped all over the story - and I was humiliated in full view of my friends & family. However, hospital executives were forced to run from that lawsuit with their tails tucked between their legs when two of my former colleagues wrote letters to JCAHO and USDHHS supporting my version of events.

The lawsuits were settled in my favor in 2001. I received less than one year’s salary - after Randolph’s lawyers represented the hospital to be “nearly bankrupt”. Additionally, my own lawyer lied to me - telling me punitive damages were not taxable.

I came out of the lawsuit with next to nothing to show for three years of ABSOLUTE PERSONAL AND PROFESSIONAL HELL. I would not wish what I went through on my worst enemy.

I have since discovered that Randolph Hospital executives blatantly and knowingly lied under Oath about the “confidentiality” of their “non-profit” financial records and salaries (which are, in fact, public record - and were published on the Internet when the hospital’s lawyers filed these false answers on behalf of their clients). Moreover, they lied in defiance of a judge’s order to provide the financial information. They lied to minimize the damages they paid out at settlement. If you look at the records that were withheld, hospital executives who deemed good Pediatricians “a dime a dozen” compensated themselves very handsomely on the public’s dime.

I reported this perjury, contempt & fraud five years ago - to the Randolph County District Attorney, the offices of the US & NC Attorneys General (both of whom have jurisdiction by virtue of my service to the government), the NC State Bar and the NC Medical Board. For all of the noble talk in Raleigh about open government and transparency and accountability, I have been completely blown off by ALL of these offices/entities. There has been NO investigation . . . letters and e-mails are routinely ignored and unanswered . . . as if I do not exist . . . as if this situation never happened. In fact, last year the Medical Board changed the wording of the Medical Practice Act in a fashion that let the Board completely off the hook in terms of requiring the Board to report crimes about which it had knowledge to the appropriate authorities. God forbid that the Medical Board’s authority might be interpreted BROADLY to refer any evidence of ANY crime in the Board’s possession - including crimes committed AGAINST a licensee (in retaliation for adhering to the Board’s position statements and just doing her job) - to the NC Attorney General.

Crimes were committed against a physician in public service who was retaliated against for preventing malpractice. I should not have to hire more lawyers and sue again in a court system that has proven itself beyond corrupt. If the case were properly investigated and prosecuted, I could be fairly compensated as a victim of the white-collar crimes Randolph Hospital executives committed - the crimes everyone everywhere in a position of oversight seems to want to downplay and/or ignore.

My second vantage point is that of patient. I’ve been on the receiving end of bad surgical practice (at the same hospital that professionally raked me through the coals) not once but twice . . . requiring MORE surgery to repair the damage both times. A tonsillectomy badly botched when I was five, required palatal reconstruction when I was in college. Sinus surgery in 1997 had to be revised in 2006 - as it was described to me, I had a “surgical orifice” bored into the wrong place in my face/skull. It is therefore my opinion that patients going under the knife cannot have too much information about their surgeons. My family and I did not have enough. And please note. I did not sue.

So by all means, publish malpractice judgments and settlements - but be fair - and do it in a fashion that lets doctors liberally explain their actions, the situation and the circumstances.

My third vantage point is that of a physician unsuccessfully sued for malpractice. I am familiar with all of the emotions - the angst and self-recrimination - associated with a lawsuit I believe to have been unfounded and filed by a lawyer just shaking the tree - a lawsuit which was ultimately summarily dismissed. I believe very strongly that we are in dire need of tort reform, but I do not believe we are going to get it until doctors start doing a better job of policing their own. We need due process in peer review - we need whistle-blower protection. We need rules in place that allow doctors to communicate with patients and say they are sorry without being afraid of getting sued for saying so. We need hospital & insurance executives held to the same exacting standards doctors are. They are not. The Medical Board and Medical Society are not doing anything about these things.

And that brings me to my fourth vantage point: that of a physician profoundly frustrated by the Medical Board’s slower-than-the slowest turtle pace of discipline . . . especially when it comes to putting a STOP to the practice of doctors who have proven themselves to be medically dangerous.

The Medical Board likes to tout its website as a resource for patients looking for information about their doctors. I am following a case that speaks to what a farce this is.

I have been waiting for the Medical Board to do something - ANYTHING - about an Ob-Gyn I reported over two years ago - a physician who inflicted horrific injuries on a newborn infant (via the abuse of a vacuum extractor) that, in any other setting, would have warranted charges for child abuse. It was the only time in my fourteen years as an attending physician that I have had to transfuse O Negative blood in a case that was essentially a trauma code in the nursery. This is a baby who should have delivered without complication - had the (poor, Hispanic) Mother been allowed to labor normally - instead of having her child ripped from her womb by someone who was impatient and wanted to be somewhere else.

The Medical Board’s public file on this physician (i.e. the legal complaint on the Medical Board’s website) does not do justice to what this doctor did . . . to the baby . . . to the Mother (who suffered complications of the delivery herself). . . or to the Pediatrician (that would be me) and nurses who had to scramble to clean up his PTSD-generating mess.

The complaint on the Board’s website (which cites two nursery cases) is stale and sterile, and does not speak to the abject terror I and the nurses felt that night as this child’s life nearly slipped through our fingers. My patient, “Baby Boy A“ survived, and the last I heard, was developing normally despite his head injury. But what is really sad is that “Baby Girl A” . . . in the second case cited by the Medical Board (a horrific incident that occurred AFTER the case I reported) DIED. These Mothers and their children are NOT the only patients who have been injured or harmed by this doctor. Yet he is STILL practicing without so much as a slap on the hand by the North Carolina Medical Board (despite the best efforts of the doctors and nurses and small-town hospital doing everything they can to record & report his transgressions and reign him in).

As bad as my own experience at Randolph Hospital was, I’ve come to realize that not all hospitals are run by greedy profit-mongers, and I really admire the small rural hospital caught up in this particular mess for doing what it could to STOP this OB from hurting anyone else. I commend them - these people really care about their patients. They have agonized over this doctor and his cases. They have bent over backwards to be fair to the doctor. But the simple fact is that sometimes small hospitals in these kinds of situations need HELP from the “big boys” at the Medical Board. And in this case, they have not gotten it. The case has been continued over and over again - it has not even been heard. Now, according to the latest posting on the Board’s website, they’re talking about a “settlement”. What does that mean? That this doctor will be allowed to keep practicing obstetrics? How can anyone at the Medical Board then talk about medical accountability with a straight face?

If it takes over two years to bring a case like this . . . one literally SCREAMING for strong discipline . . . to a hearing, does anyone really believe that the Medical Board can take on MORE work to do . . . i.e. reviewing malpractices cases that have already been vetted & adjudicated for “accuracy”?

So there you have it. A Board-Certified Pediatrician in public service at her hometown hospital stands up to the threats of hospital executives in order to STOP someone else’s malpractice - and, by all accounts, saves a child’s life. She is fired in retaliation. The doctor she rescued barely gets slapped on the hand by the NC Medical Board - which does NOTHING to help her. Her practice is destroyed, her life and reputation are pummeled - in terms of getting a job anywhere close to her home, she’s black-balled and radioactive.

When she fights back and seeks justice in the North Carolina Court system, she is ultimately swindled by blatant perjury, contempt and fraud on the part of those same apparently Teflon-coated executives. NO ONE in a position of oversight will give her the time of day (least of all the NC Medical Board). They’re sorry they cannot help her with her “problems".

In stark contrast, the actions of a non-Board certified OB-GYN have literally terrorized a small town nursing & medical staff FOR YEARS . . . He has callously inflicted injury on newborns & women alike . . . yet he is still skipping right along.

Meanwhile, the NC Medical Society is clearly more concerned about protecting doctors who’ve lost or settled malpractice judgments - than they are about doing anything to help a doctor who intervened to prevent malpractice and suffered horrific consequences.

Something is WRONG here. I’ve got news for everyone in this room. We on the front lines of medicine need some help. In terms of “transparency“ and accountability, publishing malpractice judgments & settlements is akin to putting Band-Aids on cancer.

It is not nearly enough.

Thank you for your time and attention.

Mary H. Johnson, M.D.


That is the statement I wanted to read to the Medical Board and for the TV cameras. Ah well. The day was not a total loss. I stopped at Crabtree Valley Mall on the way out of Raleigh. After not finding the bookcase that I've been looking at online on the sales floor of the Pottery Barn, I stopped to have coffee & Lemoncello cake at "The Cheesecake Factory". Yum.

The waiter (a student) was very nice. It was a small order, but I gave him a big tip.

Actually two big tips: Don't go into medicine.

These days, the second tip is worth more.

7/1/08 Update: The News & Observer's story (already buried) is here. Not much to it. Not "fresh" enough I guess. Cue Brangelina and the twins.

There's a point I did not make in my statement. Might as well make it here. In the two years since I reported the Ob-Gyn refenced in my planned presentation to the N.C. Medical Board (which did not get presented as planned), many women and their children have been under his care - most of them poor, many of them without access (or only limited access) to the Internet (which really is the only place one can access what the Medical Board does publish). And, as I pointed out, at least one Mother lost her child while under his care. Until very recently, this doctor did not have a public file.

There was nothing to find.

I don't know if any lawsuits have been filed. That would take some legwork at the courthouse - the local "jurisdiction". I'm pretty sick of the "jurisdiction" thing.

So tell me. How are these patients supposed to know what is going? How can they make an informed choice about where - and from whom - to seek their care, if information is so hard to get? And while many of these women may be poor/from bad circumstances, and/or under-educated, and/or even illegal, shouldn't they have the right to make an informed choice - instead of settling for care from someone that I personally (as someone "in the know") would not let anywhere near me or someone I loved?

All of the "negotiations" are taking place behind the scenes - and it's being done by lawyers (in fact, I've never seen a more "over-lawyered" situation). Even the doctors and nurses who have worked with this man (who have first-hand knowledge of his behavior, and who have suffered much with/for these patients) have little input to . . . or feedback from the Board. We're not supposed to have opinions or strong feelings. "It's complicated".

No. Actually, it's not.

Publishing information on malpractice judgments is AFTER the fact of iatrogenic injury or death. But our primary tenant, in fact the Board's motto (published on the seal I looked upon as I made my abreviated statement on Monday) is "Primum non nocere" . . . in simple English, "First Do No Harm".

There's a lot to fix in medicine. Doctors must be FIRST in stepping up to the plate. We're about fifteen years behind the curve.

We're dead last.

7/2/08 Update: Carolina Journal Online linked the N&O story. The thing about CJO is that while they link newspaper stories, their link does not allow you to view comments that have been made on the story. Just another frustration on the the journalistic "transparency" train.

There is also an interesting discussion thread at triangle.com.

7/2/08 PM Update: This post was submitted to Kevin MD, to be considered for inclusion in his "MedBlog Power 8". It was a no-go.

I guess it just wasn't "powerful" or "provocative" enough. I really don't know what this backwards southern girl has to do to impress Kevin.

Damned Yankees.

So much for lifting that veil and "telling it like it is".