This is the story of Doctor X, who cannot be identified any more
particularly than that. This is also the story of the medical
practice that Doctor X very nearly ruined, and may still ruin. And
this is, most important, the story of the patients Doctor X treats,
and of the mistakes that Doctor X makes in treating those patients
— careless, stupid, criminal mistakes that cripple those patients.
And of how Doctor X is still practicing, still making mistakes, and
of how nobody seems to be able to do anything about.
Doctors form specialty practice groups. You can find them by
category in the Yellow Pages, ranging from Allergy, Asthma, and
Immunology through Otolaryngology through Nephrology to Vascular
Surgery. A group of three, four, five, or more doctors with the
same skill join together, form a partnership, open an office, and
capitalize on their expertise and on their combined connections to
hospitals in their area. The arrangement serves patients well, and
should make the practice of medicine better, as the partners
consult with one another and perfect their practice.
In the case of Doctor X, it didn’t work.
Doctor X came along and joined five other similar specialists
with a thriving practice. Doctor X brought some apparently valuable
attributes to the business — some characteristics that suggested
more patients would be attracted to the practice. And at first
everything looked fine, absolutely normal. Of course some patients
had complications; some patients always have complications.
But this group of doctors, who were surgeons, and who performed
operations in a number of local hospitals, began to get disturbing
information back from the hospital operating theaters. At first, it
just looked like patient complications were becoming more frequent.
Then it became more obvious that the increased complications could
be traced to surgeries performed by the new partner, Doctor X.
The most common post-op problems were misplaced stitches,
resulting in torn tissues, and requiring repeat surgeries. The
misplaced stitches caused infections, too, and often permanently
damaged tissues that surgery was supposed to repair. As the
partners investigated, they found the same patient names showing up
for post-op complications again and again — Doctor X’s patients.
They questioned their office staff. The patients complained of
similar problems. They checked the charts. Doctor X had falsified
the patients’ charts, indicating in the written record that there
were no problems. And Doctor X was covering up mistakes by removing
the offending stitches in the offices, without recording it.
The picture got worse. Because the partnership practiced in
several hospitals, Doctor X was able to take the worst of the
patient problems to different hospitals from those where the
original surgery had been botched. That way, the patchwork
operations wouldn’t be compared, in hospital records, to the
documentation for the original surgery.
As competent and accomplished as doctors are, there are some
things they don’t do well at all. Management or employee
confrontation rank right up there among the things that doctors
really hate, and do very badly. These partners consulted a lawyer.
They eventually asked Doctor X to stop doing surgeries. They
eventually asked Doctor X to leave the practice.
But here’s where the story gets maddening. You’d think it would
be pro forma for the partners to register a formal complaint with
the state medical authorities, who would obtain some kind of
injunction to suspend Doctor X from the practice of medicine
pending a full inquiry.
But no. The prospect of expensive lawsuits freezes the doctors
in place. The partners fear Doctor X may sue them for defamation of
character if they bring complaints. Further, they fear suits by
patients against the practice itself. They cannot buy more
malpractice insurance to cover the time when Doctor X practiced
with them; they’re stuck. The hospitals involved have made a few
careful reports to state authorities, but Doctor X could sue the
hospitals, too. The state medical authorities have been informed,
but have taken no action yet. A few hospitals have suspended Doctor
X’s operating room privileges. But that’s as far as it has gone,
and this situation has gone on for years.
Doctor X left the partnership, true, but promptly set up a new
practice. Doctor X is still making mistakes, still hurting
patients. And the partners are prohibited by law from informing any
new or existing patients of Doctor X’s incompetence. If someone
calls up asking for Doctor X, the partners must simply refer that
person to Doctor X’s new office and new phone number.
Ironically, that’s how the partners themselves got stuck with
Doctor X in the first place. Doctor X has been hurting patients for
years. Other doctors knew about it. But, when the partners phoned
for Doctor X’s references, former associates didn’t say anything.
In effect, they were forced to cover up for Doctor X, to lie by
omission.
Over this entire situation, and over a growing population of
chronically injured patients, looms the threat of lawsuit, and the
structure of tort law in the United States. The trial lawyers may
say they stick up for patients’ rights when they resist any limits
on punitive damages. But clearly, it is patients who end up getting
punished by the system, not doctors.
