Part Three: A "Disruptive" Decision, The Faux Chairman Of Neonatology At Randolph Hospital That I Could Have/Should Have Sued For Slander

I have struggled with this post for quite some time. I hope when you read it that you simply cannot believe what you are reading.

I've lived it for eleven years and I still don't believe it.

First and foremost, I want you to put yourself in the shoes of the parents of this infant - people who believed the advertisng and put their trust in Randolph Hospital.

Then I want you to try and put yourself in my shoes . . . as a young professional who trained for a lot of years to be the very best doctor she could be . . . a home-girl who set aside a bad childhood experience, bought into the "new & improved" Randolph's "mission", and busted her tail to make it so.

If you can do these things, I think you will understand why I still seethe with white-hot rage that this ever happened . . . and that none of the checks or balances that one would expect a hosptial-charged-with-the-public-good to use were employed . . . and that those behind this professional rape of a good physician in public service have not been held accountable by ANY of the regulatory and/or law enforcement agencies whose job it is to protect both patients and doctors.

At first . . . after languishing in a jurisdictional never-never land where oversight is non-existant and laws are not enforced and the local "watchdog" press couldn't care less . . . I was resolved to release everything to the ether - my Peer Reveiw complaint against Dr. Mick Irwin (of Asheboro Family Phyisicians), the complaint I filed with the North Carolina Medical Board, the medical records of the baby, you name it.

If everyone else involved in this medico-legal fiasco could break all the rules . . . and fracture all the laws . . . and still sit so fat (look it up), happy and pretty, why couldn't I?

However, after considerable contemplation, I have decided to play by the rules. Medical records are going to be referred to but not published. Idenitities of everyone but the doctors involved will not be published.

Keep in mind that the incident I am going to describe happened just two days after I got then-Randolph Medical Associates (RMA) Director, Mike Bridges' nasty "warning letter".

To refresh everyone's memory, after Bridges was done hurling the distortions, flat-out lies, slurs & insults, this is the KEY directive in that letter:

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, or one other instance of the above noted behaviors will result in the termination of your employment with Randolph Medical Associates.

We've already covered "the dismissal" of a certain very important patient (a letter Bridges did, in fact, review). And I've previously alluded to (without publishing the reasons for ) my personal & professional differences with Dr. Kathleen Riley . . . my former "partner" at RMA . . . whose fingerprints I felt were all over this "warning". Bridges' message was crystal clear:

SHUT UP. "DROP IT". OR ELSE.

(As an aside, it has always amazed me at how much of what was offered as feedback to Clinton USDHHS Secretary Donna Shalala was NOT alleged to be false when Randolph Hospital unsuccessfully sued me for "libel" over selected excerpts.)

I immediately decided that I would not be communicating further with anyone in RMA or Randolph Hospital management without (1) a retraction, or (2) a lawyer present.

Why a lawyer, you ask? Well, in reducing what he did to writing, Mike Bridges had declared his inablility to be objective, and had lost ALL credibility as a third-party mediator between the Pediatricians.

Mike Bridges' memo is what I was sleeping on when I was rudely awakened by the LDRP (Labor/Delivery/Recovery/Postpartem) charge nurse at Randolph Hospital in the wee hours of a January 1998 morning.

As I've strolled down this particularly dark part of memory lane . . . as I've looked back upon the consult note I did on this case - and the medical records - and the subsequent incident reports (involving Dr. Irwin's behavior afterwards) - and even the "Shalala" complaint . . . I get the same sick, nauseous feeling in the pit of my stomach every time.

For a long time, I had nightmares.

To this day, I do not know what Dr. Irwin was thinking or why he did what he did. I still cannot wrap my head around it.

Nor can I fathom why RMA & Randolph Hospital executives ever DREAMED I would take what they did next lying down.

Before we really get started with the story, I'm going to jump ahead six months . . . in order to explain how I came to be here . . . telling this story in the blogosphere. You see, I filed a complaint . . . on what I've come to call "the Irwin incident" . . . with the North Carolina Medical Board after I was fired. For my own self-preservation, it had to wait six months . . . after my "notice" at RMA was up (again, we'll get to that later in the post) . . . when I could no longer be fired for cause for writing "inflammatory" letters or "disparaging" Randolph or talking back to the omnipotent (NOT) practice management "team" of Morrison, Eblin and Bridges.

The complaint was supported by the baby's parents. We were hoping the big bad North Carolina Medical Board would do something.

I was, in fact, SCREAMING for help. I had done my duty . . . I had put a patient above everything I had worked to build and held dear. But, as was its habit and nature at the time, the Medical Board ignored my plight . . . and merely slapped Dr. Irwin on the hand behind the scenes (taking another six more months to do even that).

The Board could not help me with "my problems".

And let's be crystal clear on what that translates to: The North Carolina Medical Board was absolutely a-okay with the concept of one of its licensees being professionally torn to shreds because she did the right thing. A hospital, even a "non-profit" (i.e. charged with the public good) hospital retaliating against a doctor for doing her duty (all the while hiding behind privilege and confidentiality and privacy) was no big deal.

Moreover, the doctor who put a baby's life in danger . . . AND then trashed the Pediatrician who rescued him had to be protected. What he had done was "embarassing". And that, my friends, was ALL about the collegial wink & nod . . . "the White Wall".

I digress. Mick Irwin subsequently released the complaint I filed with the Medical Board to Bob Morrison and Steven Eblin during litigation, and they, in turn, released it to discovery. Morrison and Eblin (and apparently their trial lawyers), were clueless. Peer review and Medical Board documents were just something else to plunder and use to their own ends.

Dr. Irwin did not have my permission to release the complaint. He did not have the parents' permission to do that. And he never answered correpsondence from my lawyer inquiring as to his thinking.

I do not care what he - or anyone else - thinks now.

After filing yet another complaint with the Medical Board regarding Irwin's breach of confidentiality (that's me . . . I always go through channels), the NCMB's Chief Legal Eagle, Thomas Mansfield, said Dr. Irwin could do whatever he wanted with the complaint.

Ergo, so can I. And here we are. Heavy sigh.

Let me also establish that back in 1998, the relationship between RMA Pediatrics and Asheboro Family Physicians was strained. You see, it had been brought to our attention that when parents decided to take their children to RMA to see a Pediatrician (which involved a records transfer), Drs. Robert Dough/Fred Graham, & Lawrence Perry sent the family a letter discharging the child from their practice. Many parents took the letter (as it was written) to mean the entire family had been discharged.

Asheboro Family Physicians rarely, if ever, consulted RMA Pediatrics - even when the nurses thought they should. At the time, the practice was owned by LeBauer Healthcare, which was in turn, owned by Cone Hospital.

Cone Hospital being the hospital that Mike Bridges had recently "encouraged" the "ladies" at RMA Pediatrics to refer neonatal cases to . . . in the interest of furthering Randolph Hospital's "cooperative" ties to Cone.

Asheboro Family Phyisicians & Randolph Hospital had, in fact, recently published an ad in the Courier Tribune that touted the recently-recruited Dr. Irwin's abilites in neonatal resuscitation, (quoting Dr. Irwin): I especially like working with babies, younger children and young families . . . I'm a neonatal resuscitation regional trainer, so I'm comfortable working with sick babies."

Irwin also lauded Randolph's thoroughness in checking physician credentials.

Here's the thing about that: NALS (Neonatal Advanced Life Support), re-named NRP (Neonatal Resuscitation Program) is a several-hour course that many doctors and nurses take and then maintain in order to learn and/or refresh basic skills in neonatal resuscitation. I myself try to take the basic course every 2-3 years (as I do with ACLS and PALS) . . . just to see if there have been any changes. But it is a course that does not "certify" competence or experience in anything. People (doctors or nurses) who complete the course and score a certain score can become instructors after completing a training course.

Now, in Asheboro, being an NRP instructor apparently makes you more qualified to take care of sick infants than Board-certified Pediatricians who only lived and breathed critical care (NICU/PICU/ER) during their residencies.

But hey, the Pediatricians were only "arrogant and cliquish" girls . . . a "dime a dozen".

And obviously, in publishing this tripe, the Courier Tribune did not know or appreciate the difference between apples and oranges.

I've never been interested in becoming certified as an NRP instructor . . . I have plenty of letters behind my name already, and I teach staff as situations arise (I think that's how you learn best) . . . in fact, I'm very good at it. But I had enough on my plate.

However, at the time this ad ran in the Courier, Dr. Anderson, was an NRP instructor. She was not amused by Dr. Irwin's grandstanding.

But I took what I knew amounted to false advertising as par-for-the-course with Morrison and Eblin's public relations machine . . . pump up the qualifications of the male physician who was, in fact, a wannabe Neonatologist . . . and ignore "the girls" who had the training & experience in Neonatal & Pediatric critical care, and who were actually carrying all the water (uphill).

It was very "mill-town" Asheboro . . . where women are often treated as second-class citizens.

The following is the text of the complaint I filed against Mick Irwin with the N.C. Medical Board on August 3, 2008 (the names of the child/parents have been changed to Doe). The complaint will be in blue. Additional commentary (based on the actual medical record, which I cannot publish), will be inserted in red. Please keep in mind, that I was trying to briefly summarize a very complicated situation for the Medical Board, and "keep it short", ala the instructions I've often gotten here in the blogosphere from "helpful"/progressive types like Ed Cone of the Cones:

My name is Dr. Mary Johnson. I am a Board-certified Pediatrician formerly associated with RMA-Pediatrics, a controlled affiliate of Randolph Hospital in Asheboro, North Carolina. I am Fellow in the American Academy of Pediatrics and a section member of its committees on Child Abuse, Emergency Medicine and Children with Disabilities. I am also Chairman of the Perinatal Committee at Randolph Hospital.

I've since dropped being a section member. It's just more money on dues - and for a number of years after this happened, I just did not have the money.

It was in this capacity that I encountered Dr. Michael Irwin during his management of a newborn infant, Baby Girl Doe - on January XX, 1998. Dr. Irwin is a Family Practitioner.

I wish to file a complaint regarding Dr. Irwin's behavior. The baby's parents, John and Jane Doe, have indicated to me that they will support my complaint by releasing her medical records and cooperating fully with deposition and/or tesitmony if the need arises.

I have considered and discarded filing a defamation suit against Dr. Irwin.

To support my complaint, I have enclosed copies of Baby Doe's medical records - including Dr. Irwin's H&P and my consult note, as well as copies of the comments I submitted to the Peer Review Committee of Randolph Hospital. The nurses' notes and incident reports, which I believe are essential to your review of the care, are not in my possesssion. I have also enclosed ads that Dr. Irwin's practice (Asheboro Family Physicians) has run in the Courier Tribune (both before and after the incident in January) which I believe are misleading. Additionally, I have enclosed correspondence sent to LeBauer Healthcare in Greensboro (which owns AFP) detailing my objections to these ads. That letter was one of at least two sent to LeBauer by physicians in the community who objected to the ads for one reason or another. The ads were subsequently pulled.

This issues at hand are (1) medical competence - specifically in neonatal critical care, (2) inappropriate professional behavior - specifically the deliberate slander of one physician by another to a patients' parents, and (3) truth in advertising.

In the early morning hours of January XX, I was notified by the LDRP charge nurse that Dr. Irwin required assistance in the management of a critically-ill newborn. Dr. Irwin what not requested my assistance, but the charge nurse (whose clinical judgement I implicitly trust) felt that his management of the infant was inadequate. She was terrified that the child might die before help could arrive from Baptist. I asked the nurse to make Dr. Irwin aware of the fact that I had been notified and that I had offered assistance. Dr. Irwin declined. Several phone calls later (in a period of only a few minutes), I made the decision that I could NOT "not go in". I did not speak to Dr. Irwin directly because, based on past experience, I did not think he would be favorably inclined towards my offer to help, and I wished to minimize his opportunity to "turn me down". I also felt morally and ethically compelled to actually see the child for myself - in order to assess her condition and evaluate the appropriateness of the nurses' plea for help.

I've reveiwed my consult note and Dr. Irwin's H&P (in which he idenitfied the female infant as a boy), as well as comments I submitted to hospital Peer Review. Incredibly, Dr. Irwin's H&P states that there were no complications of the baby's admission prior to transport.

Baby Doe's entire course at Randolph Hospital was a complication!

The gist of the story is that, after a STAT C-Section for a suspected placental abruption, this newborn was misdiagnosed and woefully inadequately managed for the better part of 2 1/2 hours before the nurses had had enough and called me.

In the very first exchange with the charge nurse over the phone, I asked her to tell Dr. Irwin that I was aware of the situation, and to give him the opportunity to consult me. She informed me that he'd already said he did not want my help. But the charge nurse was desperate, "Dr. Johnson, he does not know what he is doing! This baby is going to die if you don't get here! Can't you come in and tell him you were in the ER or something - and just decided to drop by?"

In the wee hours of the morning, not having any reason to be up other than her phone call, I had no patients in the ED. I told the charge nurse to speak to Dr. Irwin again and call me back within 5 minutes. I got up, took a 2-3 minute shower, threw on some clothes, and called the nursery. Dr. Irwin was adament. He did not need my help.

But the nurses (who were good nurses) were just as adament that he did. And my decision was made.

When I arrived, before entering the nursery, I took stock of the situation. The nurses relayed the birth history and told me that the baby's Apgars had been "fudged" upwards (to 4 and 7). They also told me that Dr. Irwin had to be prodded to call Baptist . . . whose neonatal team was en route. He did not think the baby was that sick.

But at the nursery door, and even from across the room, the trained eye could tell that the baby was obviously critically-ill and on the verge of respiratory failure. Purely and simply, she was tired of working so hard to breathe. I quickly reveiwed what had been done. Despite heavy meconium at delivery (likely secondary to stress associated with the placental abruption), and her increased work-of-breathing/oxygen requirement, the baby was not currently intubated, her stomach had not been suctioned, and her peripheral IV was only running at @ 1/2 maintenance (i.e. inadequate fluid resuscitaion & volume support for presumed shock). The antibiotic doses she have been given were inadequate for presumed sepsis (she had a white count of 39,000 with a significant left shift/bandemia).

The infant was simply lying under an oxyhood, and Dr. Irwin was preparing to needle her chest to treat a "pneumomediastinum".

But one look at the child's chest X-Ray hanging on the lightbox in the nursery (revealing diffuse patchy infiltrates consistent with meconium aspiration/pneumonia) disproved Irwin's theory (there was no pneumomediastinum and no pneumothorax), and I stopped him from needling the child's chest.

I was afraid the baby would crash/code if she was pushed much more. Then we would really have a mess - because if she coded, there was a good chance we would not get her back. In truth, I was scared to death the baby would die before the transport team arrived.

On exam, the child was breathing very shallowly at @ 100-110 times/minute (way too fast) on 100% oxygen. Her Pulse Ox was only 94%. She was flaring but not "grunting" (I believe because she was too tired). Her lungs sounded "wet" and awful. She was pale & ashen, and was actually fairly blue from about the waist down. Her capillary refill was 4-5 seconds (a blood pressure had not been taken). Her tone was poor, but she did respond to noxious stimuli.

But here's the thing - and it's a big thing. As I quickly examined her, this exhausted baby opened her eyes and looked at me . . . right into my eyes. And in that second, I KNEW that she was STILL THERE (i.e. she was neuorlogically intact), and that I was going to fight for her . . . and that Dr. Mick Irwin, faux Neonatologist, could kiss my ass. So could the clueless control-freaks, Mike Bridges and Steven Eblin.

The baby was very air hungry, and with even the minimal stimulation of an exam became very agitated. After she briefly locked eyes with me, her tiny little eyes began darting all over the room . . . like a trapped animal.

SHE NEEDED SOMEBODY TO DO SOMETHING!!!

Compounding the awful/dire clinical situation, her Father was in the room, pacing and worried and watching every move I made. Of course, his presence prohibited me from throttling Irwin and demanding that he explain just exactly what he had been doing for two hours.

Very politely and firmly, I told Dr. Irwin that the baby required immediate intubation, and I told the nurses (already scurrying around the room/warmer gathering the things I would need) to prepare for me to do that.

But Dr. Irwin objected and insisted that I call the Neonatologist On-Call at NCBH (Steve Block) . . . who had "approved" everything he had done (I thought it strange Irwin had called Baptist instead of Cone). Gritting my teeth, I immediately got on the NCBH PALS line (which at the time I on speed-dial), and told Dr. Block (someone under whom I had trained) what was going on.

Steve was operating on the diagnosis of pneumomediastinum/pneumothorax . . . not meconium aspiration . . . from information Irwin had given him in the ONE phone call he placed.

Dr. Block told me that the baby was in front of me . . . not him . . . and to proceed immediately with whatever I deemed necessary because he trusted my judgement. He didn't know who Irwin was. He would call the transport team, and tell them to punch it.

It took several attempts to get the baby intubated (mostly secondary to thick secretions & meconium oozing up from below her cords and from her stomach). The NCBH transport team arrived during these attempts and ultimately assisted me with a successful intubation. The baby's stomach was then suctioned of 20 cc of particulate meconium. She had been laying on that warmer for over two hours without an unprotected airway and inadequate ventilation literally choking on her own stool. And Irwin was going to stick a needle in her chest for a nonexistant pneumothorax!

But hey, he was "comfortable" seeing sick babies.

The NCBH transport team, being an astute bunch, quickly sized up the gravity of the baby's condition . . . as well as the political heat of the situation . . . and elected to "scoop and run" . . . without staying to put in central umbilical lines (something we might normally have done) or make the usual chit-chat. The baby, suffering from persistant pulmonary hypertension of the newborn, "crashed" shortly after arrival at NCBH and had to be manually-ventilated (bagged) for two hours before being stable enough to put back on a ventilator. She was subsequently placed on a Nitrous Oxide trial and managed to avoid ECMO (very loose translation: baby by-pass).

She "graduated" from the NICU to suffer no permanent sequelae of her ordeal, and to have a normal life. Her doctor was not so lucky.

As I watched that baby roll out the nursery door with the team - not knowing if she would live or die - I decided right then and there that Mike Bridges was a damned moron . . . I was NOT going to live/practice under Kathleen Riley's thumb . . . and that this kind of BULLSHIT (it's time to use English again) would not stand on my watch.

I did not bill for my services.

I filed a complaint against Irwin with Peer Review that morning.

I did not "clear" it with Mike Bridges - or Steve Eblin. It was not their business.

Of course, the nurses told me that Kathleen Riley was snooping around the next morning asking everyone but her "partner" what had "really" happened the night before. I knew who she was asking for.

For his part, Irwin and I had a brief encounter in the hall on Med/Surg/Peds very shortly after the incident. He told me that we needed to talk. I responded that yes, we did. But we were not going to do it in the hall and we were not going to do it that day. We've not spoken since.

Let's return to the Medical Board complaint:

When I arrived, it was very obvious that Dr. Irwin was operating on a misdiagnosis (pneumothorax instead of pulmonary hypertension secondary to meconium aspiration), and that they baby had been GROSSLY under/mismanaged. Baby Doe was VERY critically ill and literally minutes away from "crashing". I had not been that frightened about a child's outcome (before transport) in a long time.

I elected to intervene without Dr. Irwin's request. As I indicated before, what records and note I have ahre enclosed. Apart from a few cryptic comments about Baby Doe's deteriorating condition he made to me after the transport team's arrival and the baby's subsequent successful intubation (comments which he included in his H&P), Dr. Irwin's behavior towards me was restrained and polite. He left the nursery before we could speak to one another in private.

Late that evening, I returned to the hospital to give the baby's parents an update on her condition (I had just gotten off the phone with her neonatologist at Baptist). Dr. Irwin had apparently very recently spoken with the parents, and in that conversation had indicated that I was responsible for the baby's deterioration and critical condition. He has also given them the impression that his credentials, experience and skills in neonatal and pediatric critical care were "better" than mine. This, of course, was gross falsehood. The parents confronted me - her father was understandibly furious (Author's note: It was a restrained furious;). I did my best to explain the situation and my actions. I then notified Baby Doe's neonatologists about the incident. My notes about that encounter are enclosed.

And here is the text of that note:

Earlier this evening, I visited the parents of Baby Girl Doe to update them on her condition. I had recently spoken with Mamta Fuloria, Neonatology Fellow at NCBH who indicated that Baby Doe was critical but "brittley stable" on the conventional ventilator and aggressive support. Things could be worse.

Her Mother seemed pleased to see me, but her Father seemed distand and angry.

I advised them that it was important for them to know why I was at the hospital this morning - I was not Baby Doe's physician of record nor was I consulted by him. I was asked to come in by the staff - specifically the nursing staff. I told the parents I had never done this before or been put in quite this situation. I told them I wished I had the opportunity to come in earlier and that I really did not want to have the conversation at all. But I had to explain why I was there when they did not me and Dr. Irwin did not ask me.

Baby Doe's Mother seemed to absorb this information, but her Father (still angry) said, "That's interesting. Dr. Irwin was just in here and he told us that everything was fine until you came in."

I told the parents that Baby Doe was critically-ill with pulmonary hypertension secondary to meconium aspiration syndrome when I arrived and that babies frequently "look fine" to inexperienced eyes before they crash. I reiterated that I was unable to do much more than assist the transport team because of the delay in my arrival, and that I could have done so much more for Baby Doe had Dr. Irwin called me in earlier.

I told the parents to talk about it, pray about it, discuss it with the neonatologists tomorrow, and feel free to call me with any questions they might have. I told them that "the blame game" did not interest me but Baby Doe's best interests did.

I have advised Dr. Fuloria that she may be placed in a difficult situation tomorrow. She reports that she will be glad to answer any questions the parents have, and that she will advise Dr. O'Shea of the situation.

I remember feeling physically ill after the encounter with the parents - quite literally shaking & nauseous. I came out of the Mother's room and went straight to the desk . . . to ask the staff just what-in-the-hell was going on with Dr. Irwin? Where did he get off? Was he fricking crazy? The nurses advised me that Dr. Irwin had told the parents that he was "Chief of Neonatology" at Randolph Hospital (according to him, the medical staff had gotten together and elected him).

The nurses were reasuring . . . telling me that they were already "on it". The parents had made inquiries with the nursing staff, and had been informed that Dr. Irwin's claims were false, and that when the nurses needed help, they called the doctors at RMA . . . and that usually meant Dr. Johnson, who was Chair of the Perinatal Committee.

The parents were also told that Randolph Hospital did not employ Neonatologists.

My "incident report" describes the baby's Father as "angry". Although he later insisted that he was not "angry" (this makes me smile because of the kind of man I know him to be), that was my perception at the time . . . he was nursing a simmering, white-hot (albeit polite) rage. And he had every right to be angry. Had it been my newborn daughter who was desperately ill and tethered to a ventitlator in a NICU an hour away, and two different doctors were telling me two different stories, I'd be angry too.

In that regard, all ended well. The next morning, I received a message from the baby's Mother . . . delivered through office staff . . . that thanked me for my help. Someone, somewhere had set the parents straight.

Here's another thing about comparative credentials: Dr. O'Shea, the baby's attending Neonatologist of record at Brenner's, was my residency advisor (my friends joked that he deserved "combat pay"). The following is an excerpt from the letter of recommendation he wrote on my behalf:

Mary was one of our most knowledgeable residents. She is quite capable in handling nearly all types of pediatic problems including emergencies. She is particularly excellent in critical care and has considerably more than average experience in this area . . . (she) is an extremely determined individual and works hard to accomplish those goals which she regards as important to the health of her patients. She seems to me to be very genuinly excited about her work in primary care and in my experience, she is extremely diligent whenever she feels she is making a difference.

Back to the Medical Board complaint . . .

Fortunately, as the parents asked questions, the nursing staff on LDRP, and later, the neonatology staff at NCBH/Brenner's were able to gently and discretely correct the misinformation Dr. Irwin had given Baby Doe's parents. The parents subsequently apologized to me.

I APOLOGIZED TO THEM. I AM PROFOUNDLY DISTURBED THAT THEY (AND I) WERE EVEN PLACED IN THIS SITUATION.

Dr. Irwin later filed a formal complaint with the Peer Review Committee regarding MY behavior - specifically intervening in Baby Doe's case without his request. I was exonerated (see enclosed). I have no idea was specific action was taken by the Committee with regards to Dr. Irwin's behavior.

Dr. Irwin's allegations were that (1) I treated the baby without his consent, (2) the nurses were wrong to call in a Pediatrician, and (3) my conversation with the family after his hatchet job was "inappropriate".

Please remember that this so-called peer "review" came AFTER I had already been fired. AND, I was never notified that my actions that night were under review. The Peer Review was over and done - without anyone interviewing me - without any kind of due process - before I was even notified!!!

The Peer Reveiw Committee very bravely and generously concluded that, "If nurses or physicians have reason to believe that a patient is critically-ill and not receiving adequate care, then they have a DUTY to intervene in the care of that patient."

OH REALLY GUYS (although I do not have an inclusive list, at the time the Medical Executive Committee would have included prominent Department-chair names like Juberg and Teague and West and Helsabeck)???

Did ANY of you bother to SHARE that opinion (anchored in a little thing called MEDICAL ETHICS) with the neanderthal executives at your hospital-owned, "safety-net" practice that fired me?

Knowing that I had been fired - and that the circumstances SMELLED - did ANY of your recommend a hearing or review?

I later heard, through the grapevine (nothing is "secret" at a small-town hospital), that as a result of my complaint on Dr. Irwin, Randolph Hospital charged him to do some more CME.

Ooooooo . . . ahhhhhhh.

A short while after that, Randolph Hospital allowed him to teach an NRP class!?!

And a few years later, he was later promoted to Chief of Staff.

Meanwhile, Mary Johnson thrown out on the street like garbage after busting her tail for three years to build a practice she could be proud of, was embroiled in litigation, making a meager living on the road, fighting tooth and nail for vindication and the chance to come back home.

Say it with me, "Care you can trust".

Back to the Medical Board complaint:

Very shortly afterwards, my contract with RMA-Pediatrics was abruptly terminated "without cause". For the Board's information, RMA-Pediatrics is a "controlled affiliate" of Randolph Hospital. Randolph Hospital and Cone Hospital in Greensboro have recently begun a "cooperative relationship" for referrals. If I am not mistaken, Cone either owns LeBaeur Healthcare or has made overtures towards "buy-out". LeBaeur owns Asheboro Family Physicians.

My privileges at Randolph Hospital were not affected by RMA's actions. I remain a member in good standing of the medical staff. I have unresolved contractual disputes with RMA (and by extension, Randolph Hospital). Notice that my contract had been terminated was served on February 2. I was given five days to complete charts and vacate the office. For the balance of the notice, I was not allowed to see patients. My salary was paid on the condition that I did not "disparage" RMA/Randolph Hospital and thereby "hamper" its mission in the community. I was essentially kept from practicing in Asheboro or competing wiht RMA for the balance of my notice. I refused to "settle" for a lump sum pay-out (the only offer RMA made was woefully inadequate fiscally and on terms that were personally and professionally unacceptable). The situation is quite complicated (my description here is simplified for brevity) and lawyers are involved. If the Board requires additional information, I or my attorney will be most happy to provide it.

My actions in Baby Doe'se case were obviously no "politically correct". It is my opinion that my intervention is Baby Doe's case was a contributing factor to my termination by RMA (management denies this). Of course, I probably will never be able to prove it.

My future plans in Asheboro are uncertain at the time of this writing. I am considering opening my own Pediatric practice in Asheboro with another Pediatrician who recently served RMA notice.

Asheboro Pediatrics never opened (although I remain incoporated for purposes of the work I now independently contract). There was simply no way to overcome what Morrison and Eblin had done.

This "incident" has caused me considerable personal (and professional) distress. I have literally agonized over what course of action to take - this complaint to the Board was delayed considerably because I did not feel comfortable incurrring the further "wrath" of RMA or of Randolph Hospital until my contract expired on August 2.

As I alluded to before, I strongly considered legal action for defamation against Dr. Irwin.

However, I do not wish to "drag" Baby Doe or her parents through a legal process that in the end (if it were successful) would only benefit me. Her parents have confided to me in the past that they "are not the type of people" who pursue malpractice claims (that in and of itself is admirable - I do not think I would be as charitable if I were in their shoes). And Baby Doe, after all, did recover and is thriving. In the end, that is all that really matters.

I submit the case to the Board for investigation because I do NOT want another baby, another set of parents, or another Pediatrician to go through ANYTHING like this again. I would like a neutral third party without any "interests" in Asheboro to evaluate the case. I will be most happy to provide more informaiton upon request.

For the Medical Board's information, Baby Doe's neonatologists at NCBH/Brenner's were Mamta Fuloria (a fellow) and Mike O'Shea. Also for your information, I trained at Brenner's. Dr. O'Shea was my residency advisor. He can provide feedback as to my credentials and abilities in neonatal and pediatric critical care.

Thank you, in advance, for your kind attention to this matter.

Mary Helen Johnson, M.D., FAAP

Later that week, Mike Bridges stopped me in the hall outside my office in the middle of the day . . . just as I was scheduled to see patients. He had not made an appointment. I already had three patients in rooms. They were not going to wait. Bridges wanted to talk. I told him, "NO!", and moved on to my first patient.

Bridges never made another attempt to talk to me. It apparently never occurred to him that in light of what had happened, it might be a good idea to formally retract the accusations he made in his letter . . . or rescind the threats he made.

And he styled his actions to the hospital lawyers and the BOD as, "Mary has a lawyer, Mary won't talk to me." Insert his lip quivering.

Jeez, I wonder why she won't talk to you? YOU PUT HER THROUGH HELL!!!

The following is Mike Bridges' "notice" of "voluntary terminination" delivered two weeks later on February 2, 1998. Please note that it was important to fire the oh-so-disruptive Dr. Mary Johnson and get her out of RMA's offices . . . but not important enough to do so until she had covered one more week of vacation for Dr. Kathleen Riley:

Dear Dr. Johnson,

Pursuant to paragraph 25 of the Employment Agreement between Randolph Medical Associates ("RMA") and you, dated January 12, 1995 ("Agreement"), we hereby give you notice of voluntary termination of such agreement by RMA. According to the provisions of paragraph 25, your employment relationship with RMA will end one hundred eighty (180) days from the date of this letter, August 2, 1998. We expect you to complete all pending chart documentation for patients, as well as to cooperate fully in a smooth transition of patients primarily seen by you to other physicians employed by RMA within the next five (5) days. Following that time and for the balance of the notice period, you may not see patients or come to RMA's offices except for reasons approved my me in advance. If you do come to RMA"s offices for reasons approved by me, you must be accompanied at all times by me while you are in the office. RMA hopes that you will make use of this time to find employment which best meets your needs.

Although your employment relationship with RMA will by ending in accordance with this letter, you should be aware that this action does not affect your continued medical staff membership and clinical privileges at Randolph Hospital.

If requested, RMA will provide a neutral reference for your future employment. If however, during the notice period referred above, RMA determines that you have disparaged or defamed RMA, Randolph Hospital, or any of the employees or business of RMA and Randolph Hospital in the community, RMA will consider you to be in breach of the Agreement, it will immediately sever the employment relationship, and it will terminate the Agreement for cause, thereby discontinuing any further obligation of RMA thereunder.

If you have any questions regarding the above, please call me,

Sincerely,

Mike Bridges
Executive Director

cc. Mr. Steve Eblin

So ladies and gents, between the "letter of warning" and the "notice of voluntary termination" that Mike Bridges sent to me (with Steve Eblin's approval), let's review the terms of my "notice".

(1) Under threat of termination "for cause", I cannot open my mouth about anything going on at the practice or the hospital . . . be it Mick Irwin's incompetence, Breton Juberg's open zipper, Kathy Riley's misrepresentations of my conduct & character . . . or any of the clinical issues warranting my attention in the nursery or on the floor.

(2) I don't have the right to defend myself. I am tossed out on the streets of my own hometown . . . in full view of my mortified parents . . . condemned without ANY kind of due process or hearing.

(3) I can only talk to Mike Bridges or Steve Eblin. I cannot talk to RMA or Randolph Hospial Board members. I cannot talk to colleagues. I cannot talk to patients.

(4) Instead of being allowed to work out the six month "notice" (as any physician signing one of these contracts might expect) and smoothly transition my practice, I am to leave the office in five days and hand everything over to Kathleen Riley (because let's be clear, that's where the patients were going to be assigned unless they objected). I am thereafter banned from coming to the office.

(5) I can "look" for employment, but no provision is made to allow me to take it. For the uninformed, North Carolina employment law is crystal clear that if, while under exclusive contract to RMA, I accept employment anywhere else . . . without specific permission from the RMA Board of Directors . . . with whom, by Mike Bridges' specific instructions, I CANNOT communicate . . . I can be fired "for cause" with complete loss of salary & benefits.

(6) Moreover, staring a practice in Asheboro (i.e. self-employment) would be competing with RMA . . . interferring with its business . . . in violation of my employment agreement and grounds for involuntary dismissal (i.e. "for cause" termination).

(7) Speaking of benefits, the "severance" offer that Bridges wants me to accept only offers a payoff of the salary RMA owed me the second Bridges threw me out of the office and banned from doing the job I was contracted to do. It does not address insurance, healthcare, sick leave, malpractice or any of the other benefits that are part of my employment arrangement.

Moreover, Mike's plan most certainly does not honor the agreement RMA had made with the National Health Service Corps in order to secure my loan-repayment-for-service deal.

VERY SPECIFICALLY, RMA is not supposed to interfere in ANY way with my continued practice in the area during or after I leave the practice. If RMA were playing by the rules, I would work out a six-month notice and smoothly transition my practice (as Brad Thomas and Sid Blake were later allowed to do).

And clearly, adequate quality assurance protocols and peer reveiw (required by the site agreement) are not in place.

But Mike, you see, is trying to get out on the cheap by ambushing me . . . and putting me in a box. He has even cancelled my malpractice insurance despite the fact that I am still technically employed (something that will become problematic a short while later).

Mike Bridge, Steven Eblin and Bob Morrison wanted silence above all else. Nothing else mattered.

(8) There's a reason Bridges makes the point that my hospital privileges are not affected by RMA's action. You see, a physician's hospital privileges are a protected property right, and Morrison/Eblin/Bridges could attack them without just cause. And, as we've established, they didn't have anything remotely resembling just cause.

But here's the thing about that: Bridges says I can still see patients at the hospital, but I can't really. Because my patients are RMA's patients (Bridges will not provide a list and is fordamnedsure not going to give me permission). Once again, I cannot interfere with RMA's "business", or I will be fired "for cause".

That, and I'm not insured. And medical malpractice insurance is REQUIRED in order to practice at the hospital (else I could be disciplined for practicing "bare").

(9) And, OBTW, if I play this stupid, sick, warped game, and take their "generous" deal (Eblin's words), I can have a "neutral" reference from Mike Bridges . . .

. . . . Mike Bridges, who is not a doctor . . . Mike Bridges who has not even moved to Asheboro . . . Mike Bridges who is incapable of entertaining an idea that isn't Kathleen Riley's . . . Mike Bridges, whose name is not anywhere on my RMA employment contract . . . Mike Bridges, the little tin god who doesn't think firing the Pediatric practice's founding member deserves a little thing called due process - or the attention & approval of the RMA Board of Directors (who all say they don't know what's going on) . . . Mike Bridges is the guy making this decision!

Randolph Medical Associates was created . . . as a wholly-owned "controlled affiliate" of "non-profit" Randolph Hospital to be the "safety-net" practice in Asheboro . . . to see the kids who were falling through the cracks . . . and to do the Pediatric "dirty work" & heavy-lifting at the hospital . . . to "clean things up". Board members no doubt had considerable input into the process - including the recruitment and hiring of physicians. I knew it was going to be difficult and I was assured that hospital administration would have my back.

By law, the Boards of Directors were/are charged with oversight. It's not just about a free retreat twice a year.

But instead of taking my back, Bob and Steve put knives in it . . . and after I was fired, the oh-so-"honorable" RMA & Randolph Hospital Board members . . . like Jim Kinlaw and Charles Stout and Bill Redding and Ted Matney and Jim Culberson and Joe Bossong . . . had the unmitgated gall to write to angry parents and tell them they had no repsonsibility for what had happened (admitting that they had no knowledge or input into the decision to fire me) . . . and that they really wanted me to stay in Asheboro . . . and that I was "free" to start my own practice.

I think we've established that these men were (1) being led around by the nose and (2) LYING THROUGH THEIR TEETH. And I can guarantee you that if this baby had been one of their children - or grandchildren - Mike Bridges/Steve Eblin/Bob Morrison would have not dared touched Mary Johnson. But in our fair mill town, the patient, her parents and the doctor who intervened to help her were "nobodies and nothings" compared to the Cone-owned Mick Irwin . . .

. . . or Cheryl Freeman who sat on the Board of Health. I wonder if the good dentist wants to lecture the "dime-a-dozen" Pediatrician on how she treats patients now? I wonder if Denise Gimenez (wife of a surgeon - with all "the right" connections) understands how fundamentally INAPPROPRIATE it was to butt into (and chat up Steven Eblin about) a medical matter in which she was not involved? I wonder if Craig Gaccione still believes that Anesthesiologists are more important than Pediatricians in the equation of taking care of his patients?

That's the way things work in Asheboro.

CALL ME A "WACK-JOB" ALL YOU LIKE, BUT THE MANAGEMENT OF RANDOLPH HOSPITAL IS JUST SICK AND WARPED IN TERMS OF THE WAY IT DOES "BUSINESS"!

AND IF YOU'RE A PEDIATRICIAN, PLEASE JUST STAY AWAY FROM THIS PLACE!

I also think this is a good place to stop. I've more than made the case for wrongful termination. I was threatened . . . based on trumped-up accusations. I ignored those threats to do my duty. Hospital executives retaliated because they could not be "embarrassed". No one on the Board or Executive Medical Staff could be bothered to step outside of their comfort zones to stop what was going on.

And I long ago made the case for perjury, contempt and fraud . . . crimes which have yet to be punished.

I am going to let this post stand for a while and take a break.

Then I am going to start publishing the letters of parents who objected to my termination . . . letters that Board members ignored and the Courier Tribune refused to publish.

I'm very tired. But tonight it's a good tired. It's good to finally get this off my chest. It's been like a lead weight.