Bad Blood. James Baehler
of two things: he has a superior knowledge base from which to draw, or he doesn’t know what the hell he was doing. You couldn’t get vindication of his action from me and I’ve been around longer than any surgeon on the staff with the exception of our good chairman here. None of us have enough foundation upon which to make an educated judgment, and if we are given the responsibility to judge our peers we better make that judgment a sound one.”
Another surgeon who had not participated spoke up, “I am concerned about the fact that the anesthesiologist refused to administer the heparin until he was literally forced to do so by Dr. Harris. There must be some basis for Dr. Madhava’s refusal.”
There were nods of approval around the table. Dr. Lassiter said, “I also have a bit of concern about that episode and I agree with Dr. Philips that our judgment must be sound, but that’s why we have seven of us on committee. We should be able to come to a conclusion.”
“Is this committee ready to come to a conclusion after the discussion we’ve had?” asked Dr. Phillips in a skeptical voice.
“Let me ask this,” Dr. Lassiter said. “Given the unusual use of heparin and the dispute with the anesthesiologist, does this committee feel that this case should be cleared and there was no deviation from the standard of care?”
With some hesitation, the majority of the committee members present nodded in agreement.
“Are you willing to make a motion to that effect?”
“I so move.”
“Any second.”
“I second the motion.”
“Any more discussion?”
“Yes, I have something to say,” said Dr. Phillips.
“You have the floor, Jim.” Replied Lassiter.
“I move we table the motion until we get some help on this one. I’m suggesting we forward this case to the internal medicine quality committee, and defer judgment until we hear from them.”
“Do you think the average general internist has any more knowledge about DIC than a surgeon does?” asked Lassiter.
“You beat me to my next suggestion,” said Phillips. “That is, that we insist on a hematologist on the internal medicine committee to be available to review this case.”
Dr. Lassiter turned to the surgical committee’s confidential secretary, Gail Ellen and said, “Gail, is there a hematologist on the internal medicine peer review committee?”
“Yes there is.”
“Good. What does the committee feel about Jim’s suggestion?”
Heads nodded affirmatively.
“All right. Do I have a motion to accept Dr. Phillips amendment?
“I so move, said the young surgeon.”
“I second.”
“All in favor raise your hand.”
Seeing the vote was unanimous, Dr. Lassiter turned to Gail. He said, “I’ll dictate a letter to you for the chairperson of the internal medicine committee requesting that this case be placed on the agenda of their next meeting. Also request that a hematologist be available to review the case and report his findings to the internal medicine committee and then back to the surgical committee. If we are all in agreement we’ll take up this case again at next months meeting after hearing from the internal medicine committee. Do I have a motion to that effect?”
“I so move,” said a committee member.
“Any second?”
“Second.”
“All in favor raise your hand.” All hands went up.
“Motion carried.”
Dr. Harris’s case was referred to the internal medicine peer review committee and so documented as part of the minutes. In a case where a committee felt that there was a question of substandard care, it would be reported to the department chairperson with a recommendation for appropriate action. Such actions could range from a caution or mandatory consultation on future cases to revocation of hospital privileges for an especially egregious offense.
All peer review activities carried out under hospital committee sanction are exempt from legal discovery and the minutes are so stamped. There have been complaints from lawyers on both sides of courtroom battles who objected to this attempt by physicians to police themselves without having their actions open to public scrutiny. If this were not the case, doctors would be loath to function in a review committee, when what was said might later be used adversely in either a civil or criminal case against them. In addition, few physicians would willingly serve on such a committee, which is voluntary and unpaid, and perhaps, leave themselves open to a suit for damages by a physician who feels he has been wronged.
Cliff was informed of the committee’s action and for the next month Cliff and Laurel were left anxiously awaiting the decision of the internal medicine peer review committee. Cliff felt frustrated at the time it was taking to resolve the question of his surgical care and tried to console himself with the knowledge that the alternative was an absence of the peer review process and the perpetuation of inadequate care whenever it occurred. He accepted that the committee needed to perform its responsibilities in a prudent and thorough manner but it was difficult to continue to work day after day in the operating room knowing his future was under a cloud.
Checking the OR schedule the day after his appearance before the review committee, Cliff saw that Dr. Madhava who had been assigned to two of his cases had been replaced by Charley Pease, one of the other anesthesiologists on the staff. Cliff walked into the scrub room to see Dr. Pease already there. “Hey Cliff, how you holding up?” he asked, his usually cheerful face showing concern.
“I’m okay,” Cliff replied, “but what happened to Sanjay? He call in sick or something?”
Dr. Pease laughed slightly. “Not quite. The Mahatma asked me to switch cases with him and I said, okay. I guess he didn’t want to be in the same OR with a naughty surgeon who might yell at him.”
Cliff managed a small laugh. “I suppose he’s not the only one who feels that way.”
With a cheering smile, Pease said, “Don’t worry about it. No one can really blame you for what happened. A case of runaway DIC is almost always going to be fatal no matter what the surgeon does.”
With a sorrowful look, Cliff said, “I suppose you’re right Charley.”
With a sly smile, Pease said, “Just say to yourself he didn’t die. He just had a less than successful recovery.”
Cliff managed a small laugh. “Okay Charlie, you made me laugh so it’s time to get back to work. We’ve got a couple of easy ones this morning so let’s get this first guy under anesthesia and I’ll try to repair his hernia without yelling at you. You sure you don’t mind switching with Madhava?
”Hell no. What about you? We haven’t worked together that much. Are you sure you wouldn’t rather have someone else?”
Cliff laughed, “No. One gas passer is just like another to me.”
Charley laughed in return. “You got that right. We’re all drones with no people skills. That’s why we went into anesthesiology, we like our patients to be comatose.”
Cliff laughed, knowing that Charley Pease was one of the more personable doctors on the staff. Cliff’s surgeries that morning proceeded uneventfully and he was grateful for the opportunity to lose himself in the work that had engrossed him for more than a decade.
A month of waiting and then, after careful review of the case of Victor Wallberg, the internal medicine peer review committee, led by hematologist Alfred Koenig, approved Dr. Harris’s action in using heparin as meeting the standard of care. In fact the hematologist