Here are Exhibits A (Robert Scott), B (Randy McVeigh), C (Laurie Anderson), D (Nancy Toy), E (Jeff Bush), F (Todd Williams), G (John Redding), and H (Bill Pincus).
Here is Exhibit H, from Rob Robbins, of White Oak Family Physicians, dated November 6, 1998:
To Whom It May Concern:
I have had the pleasure of knowing and working directly with Mary Johnson, M.D. over the past three years. Mary has been invaluable as a consultant in managing and caring for complicated inpatient pediatric patients. She has also been invaluable in providing critical care to our premature newborns and sick term infants.
She is a very competent clinician. From my personal experience, she goes above and beyond what is expected in serving as a consultant for co-management of critical neonates and other pediatric patients. She will be an asset to any Pediatric program and comes with my highest recommendations.
It has been a pleasure to work side-by-side with Dr. Johnson over the past three years. Her shoes will be difficult to fill.
Sincerely,
Robert A. Robbins, M.D., PhD
I guess nobody in administration told Rob that good Pediatricians are "a dime a dozen".
Rob, another good egg that I think I could still call friend (if I ever saw him again), found out faster than most how difficult my shoes would be to fill. It happened shortly after I was given "notice" . . . and while I was still trapped inside the contractual "Catch-22" engineered by Elbin, Bridges and their slimeball lawyers . . . a windowless six-month box (again, not "severance") designed to keep me from being able to immediately transition into private practice and compete with RMA.
Bob and Steve have done nothing but lie to everyone about that since day one.
And the fact that they were able to get away with it demonstrates just how badly employment laws in this state pertaining to physicians need to be modified to accommodate the ethical obligations of the profession - and to protect medical whistleblowers. Because I am here to tell you that the suits just don't care.
On with the story behind the subtitle . . .
Rob called me late one night (in April 1998), in the middle of the night, after I was banned from RMA's offices - and asked me to come in and evaluate an extremely premature infant.
He had been told I was "free" to see patients at the hospital.
As described to me, the baby was borderline viable based on "dates" (i.e. gestational age) and estimated weight, but (as if often the case in these circumstances) Rob wasn't completely certain about the dates and wanted me there to make the call . . . because if the baby had any kind of chance at survival, the parents (I believe they had suffered previous miscarriages) wanted everything done.
Interestingly, Rob had by-passed Dr. Riley (that night on-call for RMA) in order to call me (I pause to wonder if Rob's partner, Bob Scott, remembers what he had to say before I was fired about calling Dr. Riley in situations like these?). Rob took a chance . . . hoping against hope that maybe that, just this once, I'd reinstate the 24/7 back-up he and his colleagues at White Oak had enjoyed for so long.
Bleary eyed and on the verge of tears, I explained to Rob that (1) I was banned from seeing patients at the hospital without the permission of Mike Bridges or Steven Eblin . . . (2) risked termination "for cause" if I did (especially if it pissed off Dr. Riley) . . . AND (3) Mike Bridges had stupidly cancelled my malpractice insurance (both in breach of my employment contract and in violation of hospital by-laws).
Mike Bridges was fundamentally clueless.
I had no written assurance that the insurance had been reinstated, ergo it would be professional suicide to go in on an extreme premie case unless I was covered.
I told Rob his only other option was to call Dr. Anderson, but I warned him that given what had been done to me in February for stepping on Mick Irwin's toes, Dr. Anderson would probaly not risk stepping on Dr. Riley's sensitive tootsies.
Laurie was now in the direct line-of-fire and she had a family to support.
I was correct. When he called her, Laurie told Rob he would have to call Dr. Riley. Even though she was already contemplating a move away from Asheboro, she could not take the risk.
Dr. Riley came in and consulted Neonatologists at Cone . . . as Mike Bridges had wanted us all to do (as opposed to Baptist).
The baby died . . . set aside without intervention after it was born because Dr. Riley judged the infant to be pre-viable (approximately 23 weeks, and forty grams short of 500 grams) . . . below the 24 weeks and/or 500 gram criteria that most small-town hospitals I work in now set as clear parameters for resuscitation. Those more black & white parameters were set because of situations just like this.
But eleven years ago, the guidelines were not carved in stone, and the decision was usually made by the person most qualified to make it. That would have been me or Dr. Anderson. I had previously resuscitated babies of similar gestational age and size. It's not ideal - and "successful resuscitation" is a relative term as these babies rarely do well. But it would have been doing what the child's Mother wanted. She wanted someone to try.
You can always stop a resuscitation. But you have to start.
Rob and I spoke afterwards. He was not happy. The baby was crying at birth, and had a good heart-rate and lived for approximately an hour and a half. It seemed to be paternalistic in the extreme . . . and a lie . . . to tell the Mother (who, by report to me, was not allowed to hold the infant until after it died - something I found personally unconscionable) that "everything had been done" when, in fact, nothing had been done . . . and when there were two Pediatricians in Asheboro who were qualified to try and who might have tried (because they were comfortable enough with their skills to try) . . . while the one who was there did not.
I wasn't happy either. I sincerely wish Rob had not called me.
Of course, while these kinds of things were going down, Bob Morrison, Steven Eblin and Mike Bridges were all at home in their beds. No worries.
As an aside, on the issue of confidentiality and privacy laws, it's been my observation that many hospitals hide behind these laws to cover up badness. It's not about protecting the patient or ensuring good medical care. For in this instance, this Mother - about to lose her child - did not know about all the drama behind the scenes. She did not know she had options that could not be explored because Randolph Hospital exectutives had taken to behaving like two schoolyard bullies.
And that was not right or fair to her. I expect she has no idea to this day.
After this incident, my malpractice insurance was reinstated for the duration of my employment contract at RMA. It was an empty, cover-your-ass gesture. I still could not independently see patients at the hospital - or anywhere else - without RMA's approval - because I was STILL an employee of RMA. And they were not going to let me out unless I capitulated to their terms and agreed to a gag.
Excuse my French: Foutaise to that (I asked a pal on Facebook for the French - French looks so much prettier).
In coming to a close, some of you with more knowledge of medical politics and the privacy/confidentiality laws previously discussed might be wondering why I am talking about some of this much more openly than ever before?
Well, you see, the complaint I filed with Randolph Hospital Peer Reveiw over this incident . . . a document that is supposed to be confidential and undiscoverable . . . was released to discovery by Bob Morrison & Steven Eblin . . . two executives who had no legal right to do that.
Eblin, in particular, was just not in any path of legitimate access to Peer Review materials.
What Morrison & Eblin had done was one small step away from bad faith (aka "sham" peer review). Simply stated, if I did accept the administrative status-quo and come back to Asheboro to rebuild my decimated practice, Bob & Steve could have (and no doubt would have) finished the job they started . . . by labeling me "disruptive". And if they used bad-faith peer review to do it, my career could be destroyed . . . they could really "kill" me (as opposed to make me miserable). Moreover, it was obvious to me that no one in the mill town of Asheboro . . no one on Randolph Hospital's "honorable" Board of Directors or exalted Medical Exectutive Committee gave a royal damn about what these two administrators did . . . or how. There was no executive accountability.
It's one of the primary reasons I decided I could not practice in Randolph Hospital in safety.
I will address this issue in more detail in the next post.
Update/Afterthought: Recalling the deflection tactics pulled by one of Randolph Hospital's lawyers when they were deposing me over this incident . . . ala, "Do you think it was ethical for you not to go in? . . . Was it ethical for you to put your financial concerns ahead of what you felt were legitimate patient care issues?" . . . I'd like to add a few thoughts.
HELLO LEGAL NIMROD: I've been through HELL for eleven years (back then, it was "only" a year) . . . my life & career in my own hometown disrupted beyond repair . . . BECAUSE I put a patient first in this incident . . . an incident I shall shortly blog my heart out about because Bob & Steve also released a confidential document to discovery.
AND YOU WANT ME TO DO IT AGAIN? UNINSURED? You must have had an early sample of the medical marijauna they want to grow in North Carolina!
How much is one physician supposed to BLEED or sacrifice for this two-bit hospital WHEN NO ONE HAS HER BACK?Bob Morrison and Steven Eblin and their lawyers with the cheek to ask me about "ethics" put me in that box (a box that was ALL about money). That was their decision. No one else.
A doctor cannot practice critical care medicine . . . especially in a case involving an extreme premie (with all of the risk that entails) . . . without malpractice insurance. In fact, Randolph Hospital by-laws require that all doctors on the medical staff be covered (that's about money - specifically liability) . . . and the hospital has since disciplined other doctors in town for lapses.
If I had gone in on Rob's premie, Dr. Riley would have had a cow, and Bob & Steve would have pounded some more. I could have been disciplined (reportable to the NPDB disciplined . . . career-ending discipline) for going in "bare".
Mike Bridges cancelled my malpractice insurance while I was still "employed". It was an IDIOTIC thing to do (just like firing me) and he spent months back-tracking/covering his tail. That too was about saving money. Mike was the man who had Bob Morrison and Steven Eblin's complete trust. That was their decision. No one else.
Moreover, Dr. Riley (the "chosen one") could have always consulted Dr. Anderson in Rob's case. Just like Mick Irwin could have consulted me in the case I rescued that got me fired.
So here's the thing. Don't preach to me about ethics . . . ESPECIALLY if you are one of the *&^%$#@ lawyers who put me in the lock-box (to save RMA's precious money) and then told the world I was greedy!
If the general public wants real healthcare reform . . . they're going to have to start taking the back of good doctors done wrong by horrible oversight and no law enforcement.
They could start in Asheboro, North Carolina!
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