Part Two: The Parent I Should Have/Could Have Successfully Sued For Libel & Slander - And Didn't

I am sitting here, finishing up this post (which has taken two days to write) after watching "The Doctors" take on the subject of ranking doctors online. How patient complaints are handled . . . online or off . . . how doctors are evaluated or "ranked" . . . is a subject whose time has come. Treating doctors fairly must be an integral part of any healthcare reform. I've only been waiting for the world to wake up for eleven years.

We're going to talk a about a patient complaint in a very personal way today.

Some people, when I talk about "entitlement" assume that I am talking solely about folks on public assistance.

Well, they are wrong.

The most entitled parent I ever encountered . . . a woman who did me great professional and personal harm . . . was a private dentist in Asheboro who, at the time, sat on the Randolph County Board of Health. I was her daughter's Pediatrician. And make no mistake, I was a good Pediatrician to her daughter.

I in NO WAY deserved what this woman would dish out . . . because she felt entitled to get what she wanted when she wanted it because of who she was and who she knew.

A few weeks back, a friend of mine told me that he had heard rumors about Dr. Cheryl Freeman being the catalyst for what happened to me in Asheboro. He asked me if the rumor was true. I confirmed the truth of the rumor and told him a very short version of the story that I am going to tell on this blog today.

Let's get something out of the way first. Before anyone starts wringing their hands and moaning about confidentiality or privilege . . . or about Dr. Freeman's "right" to privacy . . . this woman relinquished that right when she made ugly scenes in my office waiting room . . . bad-mouthed me all over Asheboro (it's a small town and things like that get around) . . . tried to draw other parents into her dispute with me, and wrote a letter to the CEO of the hospital where I admitted patients (by his own insistence much later - technically not my boss) accusing one of my partners of "malpractice". In her letter, she even cited her exalted position on the Board of Health.

As for "privacy", Dr. Freeman has plastered her credentials and her children's names and photos all over her own professional website.

The very clear message in her letter to Bob Morrison was that she was "right people". Of course, in that equation, as the lowly employee of a local "non-profit" hospital, I was a relative peon. It was all very mill-town, upper-crust Asheboro.

Here's the thing about Cheryl flinging the monkey-poo. She is a medical professional. And she should have known better than to throw around accusations she could not back up.

Or maybe not. In Asheboro, it did not matter she could not back them up.

I didn't practice in a vacuum (Dr. Kinlaw), I practiced in a fricking BLACK HOLE. And WHERE were YOU as a mentor or leader?

Moreover, some ten months after the damage was done (i.e. after I was fired and my practice absorbed & destroyed by RMA) . . . when I was finally free to respond to her slander and libel without worrying about being fired "for cause" or losing my house . . . I wrote Cheryl Freeman a letter rebuking her false allegations.

My life in shambles, I simply had to get it off my chest. You see, I had never been given the opportunity to defend myself in any kind of fair peer review or due process hearing (another IGNORED requirement of my National Health Service Corps contract) . . . before RMA's dipwad/doctor-wannabe Director started sending out "warning" letters based on the good dentist's nasty-gram.

In true, "I'm gonna get her" fashion, Dr. Freeman chose to release the letter that I wrote her to the hospital administrators I would subsequently sue . . . and they, in turn, released it to discovery.

It was a misguided attempt (on Bob & Steve's part) to further their argument that I was "disruptive". How DARE I talk back to a patient!?!.

And here's the thing about that: My letter was to Cheryl Freeman and no one else. I treated it as a privileged communication between a doctor and her former patient. When I mailed it, I was no longer employed by RMA and I was not seeing patients at the hospital. Bob and Steve were plainly & simply third parties. And blabbing and sharing your private business/medical information with third-parties (especially knowing that they plan to use it against someone . . . in other words, FOR REVENGE) pretty much negates your "right" to privilege. You can blab all you like . . . but it's not privileged anymore when you do.

Even the Medical Board says so . . . but that's an issue to be addressed in a future post in this series . . . when we take up the subject of the doctor I could have and should have sued for slander.

I kept my silence for a very long time . . . in deference to the relationship I once had with Dr. Freeman's daughter (a relationship that SHE ended - but we'll get to that). I played by all the rules, and I am here in this blogosphere . . . eleven years after this all happened . . . to tell you that the rules don't work.

So again, I do not owe Cheryl Freeman anything.

As I alluded in "Part One" of this series and at the beginning of this post, there's been some buzzing in the medical blogs on the subject of patient complaints - particularly as it pertains to the online "ranking" of doctors. We doctors are supposed to smile and absorb everything nasty thing and every vile insult that is thrown at us . . . and (because of confidentiality, privilege & the patient's right to privacy) never, ever talk back or defend ourselves . . . in an environment that is increasingly corporatized (i.e. micro-managed by medically-clueless idiots in suits), entitled, and sue-happy.

But I am sorry. THE "CUSTOMER" IS NOT ALWAYS RIGHT!

I am so DONE with that mindset. The biggest problem with medicine right now is that patients are not being held accountable for their words and deeds and choices. Moreover, "privilege" and "confidentiality" have become convenient firewalls behind which hospitals & Medical Boards can hide and shield themselves from ANY scrutiny.

And/so, as of right now, I am DONE with Dr. Cheryl Freeman. It's been a very long time coming. This post is all about accountability.

I think the story is best told by first posting the poisonous text of Cheryl's nasty-gram letter to Bob Morrison . . . followed by Mike Bridges' (then RMA Director) "warning" letter to me . . . and finally mine to Cheryl . . . all interspersed with clarative commentary. It's all from the legal files (as opposed to the medical record), and in light of Bob & Steve's as-yet-unaddressed-by-anybody perjury, contempt & fraud, it is fair game.

We're gonna do this all in one post. So you might want to settle down with a cold beverage before you continue;)

Let us begin by framing the letter. As will be detailed much later in this post (in a letter I wrote and Dr. Freeman released), the events that led up to this war of words began on December 1, 1997, after Dr. Freeman called the office (on a day when I was out of it) and asked for advice. She was concerned that her daughter may have been exposed to Hepatitis A while on a trip out-of-state. Her daughter was asymptomatic (and never got sick).

Answers to her questions were forwarded by Dr. Kathleen Riley (incidentally, my "representative" on RMA's physician Executive Committee) through front desk staff who were not nurses . . . in CLEAR violation of established office policy.

Somehow, Practice Director, Mike Bridges made that my fault when the crap hit the fan. And our Teflon-coated Kathleen, always gifted at starting fires that burned me, slithered through the embers unscathed.

Multiple phone calls ensued. As it pertained the the treatment Dr. Freeman wanted, the Health Department was involved (because Hepatitis was reportable and the possible exposure crossed state lines) and charged with making all of the decisions . . . and I was not going to override them. Moreover, I was not Cheryl's personal private medical investigator (although I did try) . . . and the out-of-state doctors taking care of the child who actually had Hepatitis were not going to breach confidentiality. Cheryl Freeman's concerns simply had to be handled through the Health Department, and this was made clear to her. My nursing staff and I spent considerable time and bent over backwards to answer Dr. Freeman's questions and accommodate her anxiety.

But my answer (in terms of giving a treatment her child did not need) was still NO.

Moreover (and I think most importantly) at no time did Dr. Freeman offer to bring her child into the office to be seen/examined or to discuss her concerns face-to-face.

Apparently, I was supposed to drop everything I was doing for all of my other patients and handle it all over the phone. You see, she was entitled to special treatment - she was a VIP in Asheboro.

This all culminated in a prolonged and ultimately rancorous phone conversation between the two of us on December 3th (thoroughly documented in the medical record).

A lot of this is going to be covered in my letter to Dr. Freeman, so I am not going to belabor points here.

After that phone conversation, Cheryl Freeman signed releases to transfer her daughter's records to White Oak.

She fired me/us. Any subsequent discharge correspondence that was sent out was merely a punctuation mark on the end of the physician-patient relationship.

The following is Cheryl Freeman's letter to Bob Morrison (I cringe as I type it). The names of other patients . . . or Dr. Freeman's daughter will not be published here. I have no legal obligation to exclude the child's name from the correspondence in the record, but am doing so because she is an innocent (this was never really about any care the child received - it was all about her Mother's behavior). Keep in mind that when you sit down and pen a letter like this . . . and mail it . . . you simply cannot then expect the doctors involved not to defend themselves (it's called due process) . . . or to be able to drape yourself in privilege and confidentiality.

Let's call the product of Cheryl's poison pen Exhibit A:

December 16, 1997

Dear Mr. Morrison,

As a dentist and administrator or a busy practice myself, I know that it is difficult to know how your staff truly interacts with patients without feedback from those patients. I am going to provide you with some feedback about RMA-Pediatrics. I understand that Steve Eblin has spoken with Denise Gimenez about how I was treated by Mary Johnson. The basic facts of that situation are that I was given incorrect information by her staff, which led me to believe that I needed to gather information within a very limited time frame. Dr. Johnson was also given incorrect information by her staff about my daughter's exposure to a child with an infectious disease. When I tried to give Dr. Johnson and accurate account of the situation she had no time to listen to me. She was too busy telling me, in the one conversation I had with her, to paraphrase, to get over it and stop wasting her time.

I have since been contacted by Mike Bridges, who encouraged me to remain in the practice and see one of the other Pediatricians. While I had no intention of doing so, I find it interesting that the letter I just received from Mary Johnson, a copy of which I have enclosed, directly contradicts him. It is obvious that Mary Johnson feels my daughter is no longer welcome in that practice. I also find it very interesting that she rather promptly found the time to pen this letter, while she had very little time to discuss what I consider a very serious health concern. I find this letter to be a further rudeness and insult.

Not only am I a mother, I am also a member of the Board of Health and a professional in this community. If I am being treated this way, I wondered how others are being treated. In conversations with colleagues and friends it seems almost everyone has some degree of dissatisfaction with this practice. As one friend put it, Mary Johnson was "horrid" to her when her daughter had strep throat. Another friend, who sees Dr. Anderson had a particularly horrible experience. After repeatedly being refused an appointment for her sick -month old infant for two days, she was finally told in the late afternoon on a Friday to meet Dr. Anderson at the emergency room after hours. She was also chastised and told she could have made her child sicker by giving her a medication which had been recommended earlier by a nurse in the same practice! In my opinion, this case borders on malpractice. If you would like further information about this incident, you are more than happy to contact ** *** ***** at *** ****.

In closing, I would like to say that everyone was so excited to have this pediatric practice in Asheboro. What a shame for the children of our community and what a poor reflection on the hospital that it has turned out this way.

Sincerely,

Cheryl G. Freeman, D.D.S.

Let's move on to Exhibit B:

Once releases were signed and records transferred, a fairly generic "notice of discharge" letter was sent to the sub-specialists assisting with the care of Dr. Freeman's daughter. As a courtesy, the letter was copied to Dr. Freeman and to her new doctor at White Oak. Given the venom Dr. Freeman was very publicly spewing to anyone who would listen, I did not want there to be ANY confusion in the future about who was providing medical care for her daughter . . . and I certainly did not want to be in the position of forwarding records between practices.

Again, Cheryl Freeman had screamed to the rooftops that I was "horrid", our practice was "horrible" and a "poor reflection" on the community, and that she was not coming back. She signed releases requesting that her daughter's records immediately be transferred to While Oak Family Practice. And by God, we hopped to it because she made it crystal clear if we didn't we'd hear more from her.

Very honestly, we didn't want to hear from her anymore. I had heard quite enough already.

The discharge letter's content was approved by the Practice Director, Michael Bridges (this is a key point). Following the rules, I did not act without his consent.

Dr ****,

This letter is should serve as notice that the parents of ***** ***** *******, DOB ***, have transferred care of their daughter to White Oak Family Physicians here in Asheboro. Her records were sent to them last week.

Please also be advised that this practice considers ****** ****** discharged. Should Cheryl and Brian Freeman require specialized Pediatric services in the future, they should seek them elsewhere.

Mary H. Johnson, M.D.

Now, in hindsight, perhaps that last sentence was worded too bluntly. But again, one gets tired of holding one's tongue . . . of being dumped on and called names for doing the right thing.

The thing that really bugged me is this: Cheryl Freeman sent her letter to Bob Morrison on December 16th. But it was not brought to my attention until January 9th . . . when Mike Bridges plopped it on my desk and demanded an explanation.

So this vile nastygram was floating around God knows where - and between God knows who - for nearly a MONTH before I even knew about it.

To this day, I believe plans were being made to set up me for a "for cause" termination . . . on the bogus charge of being "disruptive". I had rattled some chains during a recent practice retreat (trying to re-emphasize the original "non-profit"/community-service "mission" of the practice), and as Chairperson of the hospital's Perinatal Committee, I was put in the middle of a lot of crap . . . clinical issues/nurses' complaints . . . much of it political and/or not-exactly flattering to other MD's or the hospital. Moreover, I saw my job as a patient advocate - not as a sycophant to the suits. Purely and simply, administrators didn't like it. And I believe Bridges had been given a directive to manufacture a reason to fire me.

When you don't have it on the record, you make it up.

Fortunately (or unfortunately) for me, fate would intervene, and a fake neonatologist named Mick Irwin would put a crimp in administration's plans. But that's a subject for an upcoming post in this series.

Back on track. I told Mike Bridges that the situation was documented thoroughly in the medical record. Dr. Freeman's account was self-serving and inaccurate - and I had discharged her from the practice only after she fired me. Did he really want someone who had accused one of his doctors (not me) of "malpractice" hanging around? Were we really so desperate? Was he that fundamentally clueless and stupid? I reiterated that Dr. Riley had started the entire mess by violating office communication protocol, and not asking Dr. Freeman to simply schedule an appointment to discuss her concerns.

And OBTW, the GUYS downstairs in Internal Medicine (and in Randleman) could discharge a patient for the simple sin of missing a scheduled appointment. On the other hand, according to Mike Bridges, Laurie and I had to tolerate being insulted and falsely accused of malpractice.

Incredibly, Mr. Bridges told me that I did not have the right to discharge patients from the practice . . . that only he could "assign" patients to doctors (the ex-respiratory therapist apparently thought a lot of himself). And he wanted the care of Dr. Freeman's daughter to be transferred to Kathy Riley (it was not lost on me that the doctor who started the mess was now riding in on administration's white horse - but then again, Dr. Riley spent a lot of time whining in Mike's office with the doors closed - while Dr. Anderson and I did everything thing we could to just do our jobs and avoid him). And OBTW, when it came to Kathleen's role in the debacle, I needed to "drop it". I told Bridges that Dr. Anderson and I covered call for Dr. Riley, and his "solution" was not going to work for anybody.

I also reminded him that he had reviewed and approved the discharge letter to Cheryl Freeman (something that seemed to have slipped his mind).

As far as I was concerned, it was done already. Cheryl Freeman had had much more than her fifteen minutes and she was where she said she wanted to be. And I was not sorry.

The conversation deteriorated, Mike began slinging accusations and innuendo (related to problems we were having in the office) that clearly had Dr. Riley's fingerprints all over them (no doubt borne of all the time she spent in his office). He told me not to do anything about Dr. Freeman's letter - and actually refused to leave a copy with me.

Keep in mind that this was all going on while I was trying to see patients. Mike had a habit of staging his confrontations at very inconvenient times.

After Mike left, I instructed the staff to contact the Mother(s) Cheryl Freeman identified (in her phone calls and letters) as been unhappy or dissatisfied in her phone calls and letters. None of them wanted any part of the dispute or her vendetta. They did not think I was "horrid" or "horrible". They did not think Dr. Anderson had committed "malpractice". They were not leaving the practice.

It should have been over.

But the next day, while pottery-hopping together in Seagrove (it used to be one of my favorite things to do on a Saturday), Dr. Anderson told me that when she had confronted Bridges about the letter, he had told her my job was in jeopardy if I did not show him more respect and become more cooperative with administration's agenda.

I was more than a little put out. It really wasn't appropriate for Mike to be saying something like that to Dr. Anderson.

And, of course, neither one of us really knew what that the hospital's agenda was anymore.

That brings us to Exhibit C, where the agenda reared its ugly head. Before we proceed, let me say that the allegations made in the following letter were either distorted or exaggerated (again, with a certain someone's fingerprints all over them) or just patently false. And our Mike was clearly on a power trip. Important excerpts are in bold:

January 12, 1998

Dr. Johnson,

I am writing this letter to serve as a follow-up to the discussions we had on Friday, January 9th. The seriousness of the issues requie a clear understanding of my expectations from this point forward.

The primary issue is the approach you take with colleagues, both inside and outside of our practice when you express your concerns or opinions. There have been numerous occasions where your critcisms of others were destructive in nature and reflected poorly on our entire practice. Let me be clear in stating that the issues you address are not in question. It is the way in which you approach them. There are more appropriate ways to address your concerns than writing inflammatory letters, publicly berating your colleagues, or belittling parents who seek a better understanding of their child's condition.

The most recent event involved Dr. Cheryl Freeman, but this is only one of several instances that are concerning to me. Other instances, include openly criticizing your physician partner both inside and outside the practice, and discouraging patients from seeing physician extenders who are employed by our practice.

You are required, until further notice, to reveiw with me any letters you write regarding the dismissal of patients from our practice, or your concerns about the behavior or actions of others. I do not expect you to discuss this action with anyone other than myself. It is, however, appropriate for you to address my decision with Steve Eblin if you disagree. Failure to comply with this requirement, of one other instance of the above noted behaviors will result in the termination of your employment with Randolph Medical Associates.

I wish to work with you to improve these behaviors, and find more appropriate ways to address your concerns to others. You are excellent clinically and have made a significant and positive impact on the care of children in our community. Let me know if you have any questions or need additional clarification of the issues.

Regards,

Mike Bridges

Executive Director

How did I get this letter, you ask? Did Bridges deliver it himself - at an appropriate time of the day when its content might have been calmly discussed? Well, no. The Assistant Director's assistant presented herself in the door of my office bright and early on a Monday morning - right before I was scheduled to see patients. Clearly knowing what was in the letter, and with a look of abject terror on her face, she literally leaned forward and threw the letter on my desk . . . then high-tailed it out.

Mike Bridges sent a minion to do his dirty work. He was a coward.

And I was supposed to digest these vile/false accusations and this threat, put on a smile and see my first patient. And (of course) keep my mouth shut. The doctor was in the box.

I immediately showed the letter to Laurie, whose first comment was something to the effect, "Is he crazy? This is just slander . . . it is not even ethical, he cannot do this," . . . and I called Steve Eblin.

Eblin, President of RMA, said he was aware a letter was going out, but he was not aware of its content. He wanted me to read it to him over the phone. I told him that he was President of RMA and his Director had just threatened the founding Pediatrician of his Pediatric practice with termination. He needed to get his butt to my office and read the letter.

I had to see patients. I wasn't coming to see him.

In my office, Eblin was angry and not at all apologetic. He was a hospital VP and he did not like being "summoned" to my office. I told him I did not like being threatened with termination. I was tired of the libel and the slander (where was the evidence in my personnel file that backed ANY of this garbage up?) and I was going to hire an attorney to make it stop.

I let him have it. What had happened to all of the flowery assurances that physicians were "valued employees" and would have input and representation? He did not know what was in this letter? How could that be? How could the RMA Physician Executive Committee and/or the RMA/Randolph Hospital Boards not be involved in an action like this? It was clear Bridges was playing favorites and blowing a number of things out of any reasonable proportion. Moreover, by Bridges' own admission, the issues I (and others) had raised were LEGITIMATE. But I was supposed to sit down and shut up?

How could Mike Bridges be allowed to act on his own initiative when it came to the hiring and firing of physicians? Mike's signature was not on my contract . . . hell, he had not even moved to Asheboro!

I railed at Steve. Everything Randolph Hospital and RMA had told me during recruitment was a lie. The medical community only wanted us there to see the poor kids and clean up the dumps - otherwise we "girls" were to be seen and not heard. And the focus of the practice had clearly changed to making money and sucking-up to people based on who they were . . . while mine had not.

Alarmed, Eblin started to back-track. He wanted me sit down with him and with Mike and "clarify" problems.

But Steve Eblin was just CRAZY if he thought I was going to do that with what amounted to a gun to my head! I told him that I was not going to meet with anybody until I got some legal advice and/or there was a mediator present. I was done with cleaning up everybody's messes . .. . and all of the back-stabbing at the office . . . only to be rewarded with trumped-up/bogus accusations of misconduct (ESPECIALLY given the way other doctors on-staff were acting). The letter/threat was unacceptable. I required an immediate retraction.

Then he said it, "I really wish you sould stay in Asheboro, but break off and form your own practice."


And, ladies and gents, that's where we have to stop and and take a broad leap into the future.

Mike Bridge's letter was delivered on January 12th. Two nights later I had to make a choice . .. a choice that had to be made in a matter of minutes . . . a choice that put me in the position of ignoring Bridges' threats . . . of defying Eblin . . . of challenging a medical colleague whose actions were actively/directly putting a child's life in danger . . . and of reporting what had happened to Peer Review.

What happened . . . why it happened . . . and how it happened . . . was NOT something I could just ignore or drop. Dealing with these things was my duty as a physician. And Mike Bridges was just not in that equation. For that matter, neither was Steven Eblin or Bob Morrison.

It's bad enough I had to make that choice at all . . . that the doctor involved could not admit he was in over his head or ask for help. But I had to do it with Bridge's threats hovering over my head . . . knowing I was putting my livelihood on the line.

But the events of January 14th, 1998 and afterwards must wait for another post in this series. We've actually gotten through about half of a circle of events during six weeks in early 1998 that would constitute a claim for wrongful termination . . . if the state of North Carolina and its Medical Board had ever seen fit to put into place ANY real safeguards for employed physicians or medical whistle-blowers. At the time this happened, that claim would have been fairly experimental (as it would not have been about gender or race or any of the other usually heavily-protected civil rights). As far as I know it still is.

As I said, to close out this part of the story, we're going to skip WAY ahead . . . to my response to Dr. Cheryl Freeman . . . mailed eleven months after the fact . . . after all the damage was done.

And/so, here is Exhibit D:

Cheryl Freeman, D.D.S.
205 East Wainman Avenue
Asheboro, N.C. 27203

October 19, 1998

Dr. Freeman,

As my employment relationship and any contractual obligations I had with RMA Pediatrics ended in August, I am now completely free to address the accusations you made in a December 1997 correspondence to Randolph Hospital CEO, Robert Morrison.

As a pediatrician, my primary responsibility is to the child. Sometimes the responsibility clashes with what a parent immediately wants.

With deep regret and a heavy heart, I am leaving Asheboro. As you might know, it is my hometown. However, before I go, I will defend my actions as well as the actions of my former staff. This letter is a privileged communication and has not been shared with anyone - including Robert Morrison.

First, let me point out that RMA and Randolph Medical Associates are separate corporate entities. As a “practice administrator” and health-care professional, you are (of course) aware that by writing to Mr. Morrison (a third party/non-medical corporate officer), and by making otherwise public disparaging statements about a problem you had with me (particularly after you had terminated our relationship), you essentially waived the right to privilege.

However, after considerable reflection, I have elected not to disregard that right. I respect the relationship I once had with your daughter.

While I am no longer associated with RMA Pediatrics (and would not presume to speak for them), in my opinion, at the time your comments about the practice were grossly unfair and colored by what appeared to be an agenda to get even with me.

You certainly have the right to your opinion. As a Mother, you have the right to express it . . . to complain. But you also had the responsibility to express that opinion to me . . . not Mike Bridges, not Robert Morrison. If you were still not satisfied, you then had the right to seek medical care elsewhere. My discharge of ****** from the practice was simply a completion of an action you initiated. That is where it should have ended. As a health-care professional and a representative of the Board of Health, it my position that you considerably over-stepped your bounds.

The initial "incorrect information" you say you received from the office was actually relayed to you through a receptionist by Dr. Kathleen Riley. As you might remember, she is the only Pediatrician you did not criticize by name in your letter. I was not even in the office when your first call was received. I have no way of knowing exactly what you were told, but chart notes indicate you asked for the symptoms of Hepatitis A and that you were given accurate information. You indicated that ****** may have been indirectly exposed.

Over the course of several days, my staff had several conversations with you regarding ******'s alleged exposure. At my direction, you were told that we did not keep Hepatitis A immunoglobulin or vaccine in the office, that I would not authorize treatment without a CONFIRMED exposure, and that all "exposures" had to be evaluated through the Randolph County Health Department. This is standard procedure. No exceptions.

I knew that any attempts to contact the out-of-state physician treating the infected child to whom ****** was allegedly exposed would be futile. You seemed to expect me to do this, so I did try. The physician in question, when I finally did reach him, could only confirm the case and refer me to the local health department. He could not discuss particulars or breach confidentiality. As a health-care professional, you should have realized this. Nevertheless, my nurse did attempt to explain it to you.

My own subsequent conversation with you was witnessed by a medical student and partially overheard by Dr. Anderson.

Your "paraphrase" of that conversation (as described in your letter to Robert Morrison) was, by my best recollection, grossly misstated. In that conversation, you stated that you felt you were being "treated like an over-reactive Mother". I did respond that if you felt that way, perhaps it was because you had over-reacted (something I've had to tell more than a few Mothers). While I was firm, I was not rude. I did not raise my voice. I did not tell you that you were "over-protective". The statements to "get over it" and "stop wasting my time" were not made. My advice was medically sound and correct, taking into account information YOU HAD PROVIDED both to the office and the Randolph County Health Department. My final answer to you was unchanged from my original answer (relayed to you previously through staff). That answer was supported (in "curbside" consults) bu the Randolph County Health Department, a Pediatric Infecious Disease specialist at Brenner's/NCBH, AND the State Coordinator fr Communicable Disease in Raleigh.

It was the opinion of one of those specialists that if a parent insisted upon treatment for their child in the form of immunoglobulin or vaccine, and if that treatement was deemed unnecessary by the Health Department, then that parent should have to pay for it - not have it provided at County expense.

Staffers at the Health Department had determined, after an interview, that NO significant exposure had occured. I was told they also attempted to reassure you that Hepatitis A in children is acutally almost always a relatively benign, self-limited disease which resolves without permanent sequelae. A good many children who are exposed never come down with the illness, and if they do, only have mild or even sub-clinical course.

I submit that you received timely and appropriate advice - not once, but several times - from the office. You received the same advice from the Health Department. For the record, I do NOT "over-ride" medically-correct decisions made by the Health Department (someone apparently gave you the impression I could). I do not give unnecessary immunoglobulin treatments or vaccines (both have risks - including anaphylaxis). I am sorry you did not like my answer (or the way in which it was delivered), but my answer was the only one I could give. That answer was, "No".

You made no further attempt to discuss the matter with me. I was told by staff that you made no secret in the waiting room (and apparently elsewhere according to Mr. Bridges) about how you felt about me after our phone conversation. According to Mr. Bridges, when you e-mailed (and subsequently spoke with) him, you made it very clear that you had "no intention" of keeping ****** with the practice. You requested an immediate record transfer to another physician. I complied and notified other physicians involved in ******'s care. For your information, Mr. Bridges was shown the notice I sent to those physicians before it was sent out and did not object to its content. I apologize if the wording of that notice was offensive to you. However, the nature of your statements to Mr. Bridges made it clear to me that it was in the best interest of both parties to cleanly sever the relationship (not only from you side, but from mine), and to also make it clear to ******'s other providers that I would no longer be involved in her care or accept records.

I would remind you that it is a physician's (or dentist's) right to accept or discharge patients as he or she sees fit - as long as continuity of care by another qualified physician is assured.

I also submit that you completely disregarded many months of excellent pediatric care the patient provided ****** on the basis fo your dissatisfaction with one phone call. That is, of course, your prerogative.

I was profoundly disturbed, on a personal as well as professional level, by your attempt to draw other patients into the situation to support your complaint. However, when the parents you actually identified by name were contacted, they all indicated a desire to stay with the practice. Not one of them indicated they had a problem with me.

I would strongly counsel you to avoid tossing around the term "malpractice" in the future. It is an accusation that most physicians (and dentists I would presume) take VERY seriously. When you make such accusations, you should avoid the use of "paraphrase". Your statements about Dr. Anderson (based on telephone conversations in which you were not involved - and which had absolutely nothing to do with your daughter) were unfounded, ill-advised and way beyond "out-of-line" for a health-care professional who should know better. You should be aware that your comments made Dr. Anderson just as uncomfortable with continuing to provide care for ****** as I was. I doubt ANY physician would be comfortable in that situation.

Your disparagement of the practice in general (implying wide-spread community "dissatisfaction" as well as the comment that RMA Pediatrics was a "poor reflection" on the hospital) was, in my opinion, self-serving gross exageration and completely unfair. The feedback I have received about the care provided while I was at RMA from parents as well as the colleagues I respect in the community has been universally positive - especially since my abrupt departure from RMA in February.

Perhaps what disturbed me the most was that you appeared to give the Board of Health's endorsement to your statements by identifying yourself as a member of that organization.

Ordinarily, I would NOT have responded to your actions beyond transfer of records and discharge from the practice. As you no doubt know, patient complaints are an occasional (rare actually) occupational hazard of my job (and yours) even when I do the right thing. I am human and sometimes when I am tired or over-worked (very much the case in a busy Pediatric office in December), I may not have just the right "inflection" in my voice or "twinkle" in my eye. Excepting life-threatening emergencies, I attend to my patients in the office before I personally handle phone consultation. Nurses "triage" calls. On that particular day, I had spent a good deal of time counseling a Mother who had been battered by her husband and was leaving him with nothing but the clothes on her back to protect her child. I was not, perhaps, in the right frame of mind to appreciate the "advice" you gave me on how you dealt with your patients. I believe I exercised considerable restraint (indeed, I vividly remember silently counting to ten at that point in the conversation). While we both may be health-care professionals, our job descriptions are not remotely similar. I would not presume to tell you how to practice dentistry.

It is my opinion that management's reaction to your letter seemed to have more to do with who you were and who you represented rather than the complaint itself. But I expect you know that. It is also my opinion that your letter was one of several catalysts for a series of events that led to my abrupt departure from RMA in February. I hope that gives you the satisfaction you sought.

It has been brought to my attention that at least one other health-care worker in another office has been the unfortunate recipient of your "wrath" and lost a job for it.

As I understand it, the mission of the Randolph County Board of Health is to promote the general public health and welfare. I fail to see how your letter to Robert Morrison promoted anything more than your own personal agenda. You apparently confused that agenda with your public position and responsibility as a member of the Board. Your "professional" behavior in this situation was irreparably damaging to me personally and professionally.

I maintain that you received timely, sound and medically correct advice regarding your daughter's alleged exposure to Hepatits A. It was, in fact, for all practical purposes and based on the evidence provided, a "non-exposure". If she is still with White Oak, I know that she is receiving excellent care. That was ALWAYS my primary concern.

I hope, in the future, you discuss any problems you may have with a physician face-to-face WITH THAT PHYSICIAN before you reduce your complaint to writing or share it openly with others. I also hope that if you ever find youself in a similar situation with one of your own patients, they afford you more courtesy than you afforded me.

I do not expect or require a reply. Again, I wish your daughter all the best. Asheboro is a nice place to grow up.

Respectfully submitted,

Mary H. Johnson, M.D., FAAP

Sometimes I regret not talking more openly about this long ago (particularly after I found out she had given my letter to Bob & Steve) . . . and for not suing Dr. Cheryl Freeman, former patient and professional "colleague", for libel. I think it would have been an easy enough case to win. And at the time, my life really could not have gotten much worse - so why not?

It just wasn't done back then. But something has to change. Patients simply cannot continue to be allowed to say or do whatever they want when they are angry or want something . . . they ARE NOT ENTITLED to slander/libel and hurt the careers/reputations of good physicians . . . without any consequences.

Dr. Cheryl Freeman, dentist and local businesswoman , big fish in the little pond of Asheboro, has moved on beyond the wreakage she helped make of of my life and my dreams in/for my own hometown. She has gone on to build & administrate a very successful practice . . . in what I hear is a very swanky office. She's the Courier's darling, remains on the Board of Health and hangs with all the right people.

I'm sure she's very proud of herself.

You will forgive me if I'm not a fan.

And Pops, this one was for you.

Author's Note/Evening Update: This post was tweaked/slightly edited tonight (to clarify a few points). An alert reader caught a name in correspondence (that I intened to omit and had missed). It was removed.

10/28/2009 Update: According to StatCounter, someone from the US Department of Health and Human Services is spending quite a bit of time on this post. I sincerely hope they are learning something that might be used in healthcare reform (before we give the government MORE to do and oversee) . . .

For let's review what happened to Dr. Mary Johnson, in public service to a Federal program . . . events that were triggered by Dr. Cheryl Freeman's vile nastygram (and let's reiterate that by every law that's on the books, Dr. Freeman gave up her "right" to privacy when she first whipped out her poison pen, and later shared Dr. Johnson's personal rebuttal with third parties).

HIPAA does not give patients the right to slander/libel physicians.

Moving on along, Dr. Johnson's job was threatened . . . based on false/trumped-up/bogus accusations. There was NO peer reveiw. NO due process. She was then FIRED for doing her duty by a patient who was been mis-managed by another doctor - a doctor who had been advertised by the local "non-profit" hospital as having skills in Neonatology that he did not possess.

To add insult to injury, Dr. Johnson was sued for "libel" (after she dared fight back), for telling the government she served THE TRUTH about what happened. The legal system was used as a weapon against Dr. Johnson. And she was all on her own because the Federal government took a damned dive! Ultimately, Dr. Johnson was swindled at settlement by perjury, contempt and fraud.

It has yet to be prosecuted. You see, what happened to Dr. Johnson is not deemed "important" enough to pursue by the U.S. Attorney's office.

Like I said. I hope USDHHS is learning something. For I gotta say, until now, they've been UTTERLY WORTHLESS.