Does Medical Establishment Really Protect the Public?
By ron virmani
Does Medical Establishment
Really Protect the Public?
Ron A. Virmani, M.D.
Let us say that you get sick and go to the hospital. What is there to make sure that you get good care?
Hospitals will point to their quality control process. After a patient is discharged, every chart goes through this screening. Most charts pass this screening, but some charts get flagged according to pre-established criteria such as prolonged hospital stay, death of the patient, excessive bleeding and other adverse events.
These charts then go through a process called “peer review”. The medical establishment goes to great lengths to make sure that this is a secretive process. In fact, most states have passed laws to keep this process hidden from the public eye. In this process, a few physicians selected by the hospital administration pour over the flagged chart and decide if the chart met the accepted standard of care. If it did, fine. If it did not, the reviewed physician faces consequences. The consequence could be some advice, mentoring, being asked to take some additional training, a reprimand, a temporary suspension or complete termination of his privileges.
In theory, this is an excellent concept. What better way to police the health of the public but by the “peers” in the same discipline of medicine? But in practice, the “peer-review” process is where all dirty politics is played out. Why should a physician criticize the sub-standard care of his buddy? And what is there to stop him from criticizing the good care of somebody he does not like or care for? After all, the process is highly subjective and there are no effective checks and balances against abuse of the process. Once the peer-review committee has spoken, all “fair” administrative hearings are exercises in rubber stamping.
If a set of good old white boys of the hospital (many hospitals are ruled by such white power elite) want to get rid of a minority physician, it is simply a matter of giving him an unfavorable peer review and throwing him out on the street. Once labeled a “bad doctor”, this information gets entered in the National Practitioner Data Bank and the career of the reviewed physician suffers an agonizing premature death. This is exactly what happened in my case.
Born in India, I came to this country in 1976. I went to New Jersey Medical School from 1981 to 1985. I finished my ob-gyn residency from Temple University, Philadelphia in 1989. I heard about the growing city of Charlotte in sunny North Carolina. It was touted as a world class city.
I brought my family down to join a group practice in Charlotte in 1990, practicing at Presbyterian Hospital. I was the first ob-gyn of Indian origin to practice in Charlotte. I delivered hundreds of babies and performed hundreds of surgeries. All went well. I was never told I did anything wrong.
In October 1993, I started a solo practice. I was not under the “protection” of the group any more. I began to be treated differently from the other “native” doctors. Nurses gave me stern looks at times and they would drag their feet carrying out my orders at other times. They would write notes behind my back, with their prejudiced slant on ordinary events. These notes were quietly entered into my file, without any chance of defending any implied allegations.
As physicians, we all face occasional medical or surgical complications in our practices through no fault of our own. On December 1, 1994, I was performing laparoscopy on a patient and the trocar inadvertently injured the external iliac artery causing significant bleeding. I opened up her abdomen, called general and vascular surgeons and repaired her injury. She went home. Such incidents, though uncommon, are known complications of the surgery. Many other doctors have had such incidents and have gone on practicing without a hitch.
However, in my case, the hospital used the incident as a pretext and started doing a wholesale review of my charts from more than a year prior. These charts had already gone through the quality assurance process and had been filed away without any problems being noted. Dr. James Hardy, a Chapel Hill graduate, no more experienced than I, conducted this review, shrouded in utter secrecy. Nobody told me how many charts they were reviewing and what problems, if any, they had ostensibly found.
On September 1, 1995, the administration summoned me to the imposing large Board Room of the Presbyterian hospital in downtown Charlotte. Mr. Paul Betzold, the CEO and Dr. Ronald Brown, head of ob-gyn department were present to the results to me. The ambience was ominous.
They told me that the hospital was summarily suspending me as of 4 PM that day because of a “peer-review” of my 102 patient charts out of which 24 were found to be “problematic”. I was stunned by this revelation. I had assumed that the hospital would give me a chance to defend and explain anything that they considered “problematic”. This is how things are always done in the hospitals.
“No” said Mr. Betzold, “We do not have to tell you what charts are problematic or what the problems are.”
Suspension from the hospital like that is a kiss of death for any physician. I sought legal help. It took two months of wrangling before the hospital would even tell me what “problems” they had with the 24 charts. Turned out that the problems were everyday things that happen to all ob-gyn’s. Several independent ob-gyn’s reviewed my charts without any compensation and said the charts met the standard of care.
Over the years, it became clear to me that I was a victim of egregious discrimination based on my national origin. Doctors, under the control of white power elite of administration, were eager to find faults where there was none. And of course, they did not have the courage to sit me face to face and simply ask me questions about the cases, because they knew how foolish they would appear. A senior ob-gyn physician, appointed by the Medical Board of North Carolina, also found my charts to be within the standard of care.
The best ten years of my life have wasted away right in front of my eyes. My professional and personal lives have been devastated. I have vague memory of happy pregnant women coming to my office for their care. I faintly remember the last pink baby I delivered. The hospital has not budged from its clearly discriminatory and unconscionable position. They have dragged me from court to court and done everything to ruin my life. I am treated as a leper in the city of Charlotte.
After an unprecedented victory in the Fourth Circuit Court of Appeals in Richmond, VA, my lawyers obtained records of peer-reviews of other ob-gyn’s from the hospital, to compare with mine. The double standard is entirely clear from these documents. I was the first physician to be suspended from the hospital in 20 years!
Unfortunately, the judge handling my case in the district Court succumbed to esophageal cancer in 2004. Another judge took over the case and simply tossed my case out. I am in the process of appealing to the 4th Circuit Court of Appeals, I have no idea if I shall ever get my day in the Court.
I recall the case of Dr. James Jeghers at Duke university some years ago, where a patient died from the wrong heart lung transplant. I recall yet another case of Dr. Alice Teague of Charlotte, who had a 23.2 million dollar judgment against her in a botched delivery case. None of these physicians have been disciplined by the medical establishment of the state. In fact, Presbyterian hospital had no trouble giving privileges to Dr. Kenneth Baker, who had had two patient deaths from laparoscopy. There are dozens of other cases like that.
It is clear to me that the medical establishment does not really care about the public and abuses the “peer review” process to hide the bad doctors who are favorites of the administration. On the other hand, if the administration does not like you for whatever reason, they will give you a bad-faith peer review or label you “disruptive”. Your life is made hell from there on. This is an abuse of public trust and public ultimately suffers.
A proud citizen of the U.S. and a well trained Board certified ob-gyn, I do not deliver those pretty babies any more!
© ron virmani