Emergency Meeting

what-is-the-14th-amendment-due-p-760x507The vice CEO- a short woman with short curly hair who always wore tight skirts and high heels- called me on a Monday morning to schedule an urgent meeting in the board room on Wednesday evening. I told her my son has a soccer match. “It’s very important. This is concerning your career, after all.” she snorted.  I’m sorry, I said. I can come Thursday at the earliest. So Thursday rolled around and I entered the conference room where there was a rather large file in front of each chair around the table, a total of a dozen or so chairs. The room slowly filled with doctors and administrators. I opened the file. It was all about my time at the hospital- all nine years. My heart sank. I knew what was about to happen. They were about to end my career.

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The Peer Review Committee chair then began the meeting by saying that we have been called to meet because one of the other obstetricians- the only other female on a staff of four obstetricians filed a formal compliant that I mismanaged one of her patients over the previous weekend when I was on call. She didn’t call me to discuss her concerns or ask questions regarding her patient. This is rather non collegial and unusual, especially since I had never had any issues or run ins with this doctor before. Oh and the nurses in the emergency room also reported that I told a different  patient that she should sue the emergency room doctor for mismanaging my patient. When I started to ask him to explain he raised his index finger and shook it in my face and saying no further questions and that I’ll receive information about it at a later date.

It was May 2011 and I’d been in Texas for nine years at this point. I had been on and off administrative probation signing off on my charts late. I had several nurse complaints for missing an occasional delivery or an “unprofessional” comment over the course of nine years. I had no malpractice cases or bad outcomes. I had no patient complaints.  I had two malpractice cases in the six prior years I worked in California. I joined the American College of Legal Medicine and attended several of their conferences as a result of these cases.  It was there I learned about Sham Peer Review years before it happened to me. I met doctors who had to stop practicing medicine because of a sham peer review. Several had become lawyers. I had attended a lecture on how administrators attend conferences on how to get rid of unsavory doctors through sham peer review. So as soon as I walked in the conference room, I knew exactly what was going on.

The Executive Committee of the hospital issued a Summary Suspension after the Peer Review committee grilled me with numerous questions about minor incidents that they had diligently documented over the course of nine years. The actual patient case wasn’t even discussed.  A summary suspension is issued when a doctor is considered an immediate risk to the public and she is walked off the hospital premises and is forbidden from setting foot on the hospital grounds again. I was  forced to relinquish my hospital privileges and was unable to deliver my patients’ babies. The next nearest hospital was thirty minutes away. I was treated like a criminal. I couldn’t even get my favorite blue clogs from my locker. The head of the executive committee was an Orthopedic surgeon who also sat in the role of administrative/physician liaison. He had recently divorced his wife and married the vice CEO  of the hospital who had also recently divorced her husband to marry the surgeon. The orthopedic surgeon recently formed a group specialty practice in which he hired several physicians two of whom sat on the peer review committee- one was the chair. The female physician who entered the complaint was his latest, newest employee. Also, in a moment of seriously bad judgment, I went out on a couple of dates with the vice CEO’s ex husband almost a year after her divorce. I figured she’s remarried and wouldn’t care. So why did I so urgently lose my hospital privileges? Competition, petty female jealousy? I’ll never know.

I was told I had until Monday morning to resign my privileges and immediately close my practice or they would report me to the National Practioner Data Bank. The data bank is basically a black list similar to the McCarthy era regarding physician bad behavior or drug and alcohol issues. It is a career kiss of death to be on this data bank and hospitals will hold this over doctor’s heads. It was obvious I couldn’t continue working in such an environment, so  I wrote a letter asking to resign in three months in order to deliver the numerous patients I had that were pregnant and due to deliver.  They refused. So I decided not to resign, but instead went through the hospital’s appeal process which was what we call a Kangaroo Court.

I had to hire a lawyer that dealt with peer review and medical board cases. We had a “mini trial”. I was asked to defend issues, comments, complaints or anything else that had been placed in my file over the course of nine years. Big brother was closely watching, listening and taking notes. It was dizzying to say the least. Interestingly enough, I had literally no bad outcomes. No malpractice cases, no patient deaths, nothing. I was very careful to practice within the scope of my skills. I didn’t do any risky surgeries or complicated cases without adequate experienced backup surgeons.

The mini trial consisted of an Ad Hoc Committee of three physicians- two of who the hospital picked, and one who I picked. The committee members after hearing my “defense” of the issues that were raised wrote a letter recommending unanimously that I be allowed to resign and resume my career elsewhere and that reporting me to the Data Bank would be an unnecessary hardship and it could permanently damage my ability to practice my trained specialty. They did say that even though I at times was unprofessional in my speech and manner in how I conducted myself at the hospital, my patient care was never substandard.  I was relieved. This committee sent its recommendations back to the Executive Committee which was headed by the orthopedic surgeon. The response was- we don’t care- we’re not going to let her resign and we will report her to the Data Bank. I appealed to the Board of Directors of the hospital who kept the ruling the same with no further explanation.

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I received no due process. So much for the United States Constitution. So much for years of sacrifice and thousands of dollars of student loans and a greedy, power hungry couple can virtually wipe out my career. I cannot sue any member that sat on that committee. No judge will hear the case due the HCQIA law. Until this law is amended we will lose many doctors to this abusive system. The really sad thing is that most doctors don’t know this can happen, and the ones that do, don’t care or don’t think it can happen to them.  All of my colleagues knew what happened to me. With the exception of the doctor that I asked to serve on the ad hoc committee, no one spoke up for me.

Gregory R. Piche has an excellent book, “Sham Peer Review- The Power of Immunity and The Abuse of Trust”. In it he outlines those who are typically victims of the inappropriate exercise of institutional power. He states they tend to be new members of the medical staff, women, minorities and foreign born physicians. Doctors that are making significantly more money than their peers in the same specialty or a doctor who is an innovator/inventor is commonly a target.

Basically, if you veer away from the herd you are easy prey.

Welcome to my Blog

My name is Aysun Alagoz, MD.  I am an Obstetrician/Gynecologist living in  Corpus Christi, Texas. I’ve been practicing medicine now for twenty-one years. The last four years I have been doing primarily Family Medicine due to a Sham Peer Review case in a small town about forty minutes east of San Antonio, Texas.

So what is Sham Peer Review?  It is an adverse action taken in bad faith by a professional review body for purposes other than the purpose of quality health care and it is disguised to look like legitimate peer review.

So to further clarify:

Peer Review- defined as the evaluation of scientific, academic or professional work by others working in the same field.

Sham- defined as something that is not what it seems to be and is intended to deceive people or someone.

So a Sham Peer Review is a method unscrupulous hospital administrators and physicians use to discipline,  then subsequently cancel a doctor’s hospital privileges mortally wounding her ability to practice in the community.

So, historically, it was always thought that doctors should police themselves. Medical Boards of each state are set up to make sure this gets done. Medical Boards exist to “protect the public” from bad, incompetent and otherwise unsavory doctors. Which of course used to mean doctors that abuse drugs or alcohol and scrub into surgeries “under the influence”. This has changed to the extent that multiple different behaviors- constituting a “Disruptive Physician”  can result in a Peer Review case.    All doctors that have hospital privileges are required to follow the hospital bylaws. If they deviate from these bylaws, they are subject to a Peer Review. Peer review members are other physicians with privileges at the hospital. In 1986 the HCQIA law was passed which stated that all members of the peer review committee shall be immune to lawsuits. Predictably, this has led to all types of abuse and corruption with those in positions of power.

The following is an excellent article about Sham Peer Review by Dr. Lawrence Huntoon who works tirelessly for the Association of American Physicians and Surgeons.

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Unfortunately most physicians don’t really care much about Sham Peer Review or really understand the ramifications of what can happen to their career if they are sucked into a peer review. Hospitals use peer review to silence potential whistleblowers within a hospital system as well.  So basically doctors just turn away from dangerous or inappropriate care for fear of endangering their careers.

Patients need to care that this is happening to their caring and ethical doctors. Patient safety should be paramount. After all, these are HOSPITALS!! I hope to educate doctors and patients about this epidemic of physician silencing! I was silenced along with hundreds of doctors across the country. I have survived the colossal hit and am continuing on with my life- not my specialty though. That has come and gone. I have now survived two malpractice cases- one resulting in a  malpractice trial, a medical board inquisition, where I some how managed to avoid a physician health program, and a Sham Peer Review. And yet all I ever wanted to do was take care of patients. I never imagined I would have to fight so hard to hold on to the only career I ever wanted.