HEALTH CARE Paper: Doctors who tell invite discipline

One survey shows 23 percent of doctors were disciplined for whistle-blowing.
PITTSBURGH (AP) -- Reports of hospital administrators and boards' disciplining physicians after they warn of unsafe conditions have become more common, health-care industry experts and doctors said.
Doctors interviewed by the Pittsburgh Post-Gazette for a series that began in its Sunday editions said that after they reported a poor level of care, a colleague's poor performance or some other area of concern, officials at their hospitals disciplined or dismissed them for being "disruptive."
Other physicians told the paper that hospital officials threatened to launch internal investigations into the complaining doctor's performance.
The newspaper reported that most hospital administrations do not retaliate against whistle-blower physicians, but even a few cases discourage more doctors from coming forward.
"If you want your life to go on without disruption, then that's what you do," said John Blum, a Loyola University of Chicago professor who has written about hospital credentialing.
"There is a real public health threat there. There has to be some kind of immunity to those who are presenting allegations of quality problems."
Undetermined
No one knows exactly how many physicians have been targeted or disciplined after they reported a problem with health care quality.
But a 1998 survey of 448 emergency physicians from around the country found that 23 percent had been fired or threatened with termination after complaining about an issue.
"We're the only people who can stand up for patients," said Dr. Scott Plantz, an emergency room specialist who led the 1998 survey.
"The nurses can't because they're employees of the hospital. But doctors aren't, or at least they weren't in the past. With managed care, and doctors working for hospitals, it gets worse and worse and worse."
But attorneys for hospitals, including John Horty of Pittsburgh's Horty Springer and Mattern, don't believe it's common for health-care institutions to retaliate against whistle-blowing physicians. Horty's firm has represented as many as 500 hospitals.
Economics and outside pressures have taken their toll on the relationship between doctors and hospitals, Horty said. However, "most disruptive physicians are, in fact, disruptive. If it's nothing but whistle-blowing, the hospital almost never acts," he said.
Here's an example
Dr. Thomas Kirby, a transplant surgeon at Cleveland's University Hospitals, said he was alarmed by mounting deaths and complications among intensive care patients after heart surgery and took his concerns to hospital administrators and board members.
After he listed his concerns about the program, he said, hospital officials accused him of being "disruptive and abusive."
The hospital suspended the doctor, and he has not operated on a patient in nearly 18 months as he fights the accusations.
According to the American Medical Association, physicians are defined as disruptive when their behavior disrupts patient care. The code also notes that criticism offered in an effort to improve patient care should not be viewed as disruptive.
"There are cases where physicians have raised legitimate concerns about other physicians, or hospital staffing, and in retaliation, they have been subjected to threats that they are disruptive," said Ed Kabala, an attorney with the Pittsburgh law firm Fox Rothschild, which represents physicians.