Former resident in Virginia suing residency program

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tibor75

tibor75

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http://www.nvdaily.com/news/2009/08/local-doctor-is-named-as-defendant-in-ci.html

FRONT ROYAL -- A Front Royal doctor has been named as a defendant in a civil suit brought by a former resident physician.

Dr. Claudine Nigro is suing Dr. Francis X. Dennehy of Front Royal for breach of contract, defamation and emotional distress, according to papers filed Aug. 3 in U.S. District Court in Harrisonburg.

The Appalachian Osteopathic Postgraduate Training Institute, Warren Memorial Hospital, Valley Health System and Virginia Commonwealth University Medical College of Virginia also are named as defendants in the suit.

The suit claims that all defendants unlawfully refused to allow Nigro to progress to the residency program's second year.

Nigro originally enrolled in the three-year residency program in March 2008 for the term of a one-year period lasting from July 1, 2008, until June 30, 2009, the document states.

The lawsuit claims that in December, Nigro reported in a survey conducted by a residency program accrediting agency that she was being asked by the physicians to work hours exceeding set limits. Nigro contends that she was subjected to a series of retaliatory actions as a result of the disclosure, including harassment and defamation, that culminated with her resignation from the program.

In February, Dennehy began admonishing Nigro's work performance and required her to be evaluated for depression, according to the documents. Nigro complied with the request, and a psychiatric evaluation showed Nigro was not suffering from any mental condition. The results of the evaluation were sent to Dennehy on March 24.

Nigro was informed on March 25 that her residency would not be renewed, according to the suit. Nigro appealed the non-renewal action and a procedural subcommittee overturned the decision.

Following the appeal, Dennehy officially placed Nigro on probation in April, stipulating that she repeat the first year of the residency program and that she undergo monthly counseling, the suit states.

Believing the defendants exhibited a pattern of conduct indicating Nigro would not be treated fairly, she resigned from the program, according to the lawsuit.

Nigro is seeking $500,000 in compensatory damages jointly from each defendant for the violation of due process, $500,000 in compensatory damages jointly from each defendant for the breach of contract claim, $500,000 in compensatory damages and $500,000 in punitive damages jointly from each defendant for the defamation claim, and $1 million total in compensatory and punitive damages jointly from each defendant for the intentional infliction of emotional distress.
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:thumbup:

I wish her the best of luck with this suit.
 
If she wins, I wonder if this will trigger a whole slew of copycat lawsuits with residents looking to cash in on their malignant residency programs.
 
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You go girl! I hope you take them to the cleaners.
 
asmallchild said:
If she wins, I wonder if this will trigger a whole slew of copycat lawsuits with residents looking to cash in on their malignant residency programs.
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I hope she takes them to the cleaners as well. Its about time we have MEDICAL education reform.
 
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i have a few years until i hit residency (if i make it that far), you guys think there will be change in how programs log hours or work their residents? im all for working hard and paying your dues but i also like not working too :D
 
iMD said:
i have a few years until i hit residency (if i make it that far), you guys think there will be change in how programs log hours or work their residents? im all for working hard and paying your dues but i also like not working too :D
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Not in your time frame. These changes take years to come about.

If this woman is successful (and I hope she is if there are not any "missing" facts), there may be great reform in how residents are terminated.
 
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I think more residents are expelled from residency programs than medical students from schools, is there any figures from AMA or someone?

How are the procedures different for a medical student vs a resident?
 
I'm rooting for her too, but I'm afraid these things are really hard to prove. Especially when it's her against an entire program. It's like trying to prove that you were passed over for a job because of your race/religion/gender, when there are a myriad of other reasons the company could claim. For her sake, I really hope she documented everything...
 
It's about time that residents are given due process instead of the whims of a few faculty members. Residents have given so much of their life, incurred debt, and lost income to have their careers end so ignominiously. We also need reforms in GME and resident protections.
 
Taurus said:
It's about time that residents are given due process instead of the whims of a few faculty members. Residents have given so much of their life, incurred debt, and lost income to have their careers end so ignominiously. We also need reforms in GME and resident protections.
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I hope she wins
 
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Lets say you are fired from one program but you manage to get in another program, then sue. Most law suits can be brought years after (depending upon state) event.

Q. How do other residency program will know you are law suit plaintiff? Google search?
 
sam1999 said:
Lets say you are fired from one program but you manage to get in another program, then sue. Most law suits can be brought years after (depending upon state) event.

Q. How do other residency program will know you are law suit plaintiff? Google search?
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I'm sure it would be a routine part of the discovery process.
 
tibor75 said:
http://www.nvdaily.com/news/2009/08/local-doctor-is-named-as-defendant-in-ci.html

The suit claims that all defendants unlawfully refused to allow Nigro to progress to the residency program's second year.

The lawsuit claims that in December, Nigro reported in a survey conducted by a residency program accrediting agency that she was being asked by the physicians to work hours exceeding set limits. Nigro contends that she was subjected to a series of retaliatory actions as a result of the disclosure, including harassment and defamation, that culminated with her resignation from the program.
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Well, this says a lot, it seems like the case of that ER resident who reported work hours abuse, I forgot his name, but he got another residency somewhere else, so I don't think that this resident is necessarily dammed for life because of this. As she did complete PGY-1, there are always PGY-2 spots opening up, and she has a good reason for leaving her current program.

It is well known within medicine that retaliation and harassment ARE tolerated to a great degree, sometimes with a wink and and a nod. So, I think that she can make a very good case as some of the harassment we all see in academic centers would make non-medical people raise an eyebrow. We all know that retaliation for reporting work hours abuses does occur.

As to whether she was also incompetent? It doesn't really matter if she was or was not grossly incompetent at this point in terms of her legal case as her attendings will make it look like she was the worst resident in the world. Facing this sort of lawsuit they will be strongly advised by their lawyers to present her in the worst possible light possible and make it look like she was killing patients left and right. This is how the legal system works.

However, this is a civil trial, and I think that the burden of proof is such that she only needs to prove that it is more likely than not that she was fired for retaliation. Her case looks good to me, she was probably a good doctor who was trying to do the right thing.

I have heard of a couple of these cases, and believe it or not, some of them are probably settled out of court. There will be a lot more of the cases in the future too as resident realize they are getting the shaft in terms of abusive working conditions and retaliation. I bet a lot of these are settled out of court for undisclosed sums.

I hope she wins as the "intentional infliction of emotional distress" describes exactly how some attendings use abuse and harassment to beat people down. All of the residents in her program owe her a lot as perhaps these attendings will take it easy on them while the lawsuit is in court. Probably residents across the country owe her a debt of gratitude.
 
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tibor75 said:
Nigro contends that she was subjected to a series of retaliatory actions as a result of the disclosure, including harassment and defamation, that culminated with her resignation from the program.
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This part will be KEY to the lawsuit. Good luck!
 
Quote:
Originally Posted by tibor75
Nigro contends that she was subjected to a series of retaliatory actions as a result of the disclosure, including harassment and defamation, that culminated with her resignation from the program




lowbudget said:
This part will be KEY to the lawsuit. Good luck!
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Well, I don't know that she needs to prove per se that they are linked, though that is the obvious explanation.

Say that she subpoenaes the fellow residents, or other people, who might have seen her abused, and or if they have everybody testify and then the jury concludes that, yes, she was harassed and defamation occurred. Well, then I guess her firing was not legitimate.

As far as tracing it back to whether the harassment was motivated by such and such, I don't think it is like a murder where you have to explain motive. I am sure it will be brought up as the explanation as to why she was harassed though as it makes the residency program look bad
 
How bad is legal judgement in your record? Lets say you don't want money alone but want to break even with the PD or attending after all he/she has almost destroyed your career where you are less desirable to other programs and you may never get back into medical business.
 
It seems that systems don't change unless there is a large lawsuit brought upon it.

Doctors used to practice good medicine until ambulance chasers brought cases against them. Now we practice CYAism.

Resident work hours were seen as normal until that girl, whose name escapes me, died from an iatrogenic drug interaction as a result of a resident's exhaustion.

Maybe now, if this lawsuit is successful, residents will be seen as valuable staff members rather than disposable fodder.
 
What's with getting psychiatry involved in everything? As if any resident who truthfully replies to work hours questions is psychotic, depressed, deranged, imminent danger to everyone in a 50 mile radius, etc.

Also, hope the resident wins this, even if she's somewhat to blame. Residents should not be abused for the irresponsible behavior of their superiors, such as violating work hours.
 
The real question is how do you violate work hours in family medicine?
 
mercaptovizadeh said:
What's with getting psychiatry involved in everything? As if any resident who truthfully replies to work hours questions is psychotic, depressed, deranged, imminent danger to everyone in a 50 mile radius, etc.

Also, hope the resident wins this, even if she's somewhat to blame. Residents should not be abused for the irresponsible behavior of their superiors, such as violating work hours.
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Disciplinary Psychiatry is a well-known tactic in medicine. Every single resident I know who was put on probation or had other disciplinary problems was made to see a psychiatrist with the report required to be submitted to the PD.

If there is documentation of a mood or behavioral disorder, it makes it very easy for faculty to claim that the resident couldn't do their job and to terminate them. Its just another piece of "evidence" for them.
 
mercaptovizadeh said:
What's with getting psychiatry involved in everything? As if any resident who truthfully replies to work hours questions is psychotic, depressed, deranged, imminent danger to everyone in a 50 mile radius, etc.

Also, hope the resident wins this, even if she's somewhat to blame. Residents should not be abused for the irresponsible behavior of their superiors, such as violating work hours.
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Guys this is just not getting psychiatry involve in case of residents but it is standard practice in all medical profession cases where your bosses want to fire you. I have not heard this thing in other professions except in medicine. I guess medical bosses use their medical knowledge for material gains.
 
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DarthNeurology said:
Well, I don't know that she needs to prove per se that they are linked, though that is the obvious explanation.
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I'm not a lawyer/judge whatever, but if I was sitting on this jury, I would want the resident-plaintiff, who has the burden to establish proof, to prove a cause-effect relationship between her filling out the survey and all the other stuff that came after. Because the defense-program will argue, no, she's a crappy resident anyways.

1. Previous reporting controls - What would be interesting to know (and missing in the OP) is if the resident had work hours problems, why didn't she take care of it internally before it went to the external survey level? Is there previous documentation of her work hours violation that the program ignored? Or, did the resident report that everything was a-okay, then suddenly reported externally that everything was in violation? And if she did that, why would you do that? Or, maybe the program doesn't even have a reporting mechanism... ah-ha! I think the answers would affect who's at fault here.

2. At-risk resident? - If her contract was July 2008 - June 2009, why would she originally enroll in March 2008? Are they referring to the Match? As in, Matched in March 2008 to begin July 2008? The wording "originally enrolled" confuses me in the OP.

Or, sometimes, residents who've taken a year off will be asked to do a couple of months before the interns start to get back into the swing of patient care. Did she start working in March 2008 before everyone else because she was an at-risk resident?


Winged Scapula said:
If there is documentation of a mood or behavioral disorder, it makes it very easy for faculty to claim that the resident couldn't do their job and to terminate them. Its just another piece of "evidence" for them.
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Well, in the OP, it says that Psych eval concluded she did not suffer from a mood disorder and was non-renewed on the next day and placed on probation a couple of weeks later to repeat 1st year. Seems like the committee already had their mind made up that Nigro was not up to snuff. I doubt the psych eval would have added anything to the final outcome, that she go on probation. Maybe it's the last ditch effort for the program to help the resident... or at least appear that way so that it looks good when it goes to court.
 
lowbudget said:
Well, in the OP, it says that Psych eval concluded she did not suffer from a mood disorder and was non-renewed on the next day and placed on probation a couple of weeks later to repeat 1st year. Seems like the committee already had their mind made up that Nigro was not up to snuff. I doubt the psych eval would have added anything to the final outcome, that she go on probation. Maybe it's the last ditch effort for the program to help the resident... or at least appear that way so that it looks good when it goes to court.
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Clearly. I think it didn't matter that the psych eval found no pathology but it was simply a hoop the program was either required to go through or had hoped that it would show something (after all, what resident isn't depressed or anxious).

The handwriting was on the wall LONG before her contract wasn't renewed. The psych eval was just another way to try and gain some "evidence".
 
I hope for the sake of all residents in the country who had to and continue to lie about work hours, that justice will prevail. Residents have almost no power. We constantly are reminded that we are just harming ourselves if we are too truthful.

Although my own program has made great effort to comply with work hours, and has succeeded for the most part, we still have violations here and there, especially the 10 hours in between shift rule. Even a program like mine, that works diligently to be compliant, we are constantly reminded that reporting this violation would do us more harm than good.

I can't even imagine what it must be like at a place that makes no real effort to reform work hours.
 
Winged Scapula said:
Disciplinary Psychiatry is a well-known tactic in medicine. Every single resident I know who was put on probation or had other disciplinary problems was made to see a psychiatrist with the report required to be submitted to the PD.

If there is documentation of a mood or behavioral disorder, it makes it very easy for faculty to claim that the resident couldn't do their job and to terminate them. Its just another piece of "evidence" for them.
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Well, one of my big problems with psychiatry is its punitive aspects and its potential for abuse by employers, family members with ulterior motives, and government. Communists threw political dissidents into asylums, so I'm not terribly surprised that this is being done on a smaller scale to residents.

Academic psychiatrists should know better than to play this foul game, especially with stressed and cornered residents.
 
mercaptovizadeh said:
Well, one of my big problems with psychiatry is its punitive aspects and its potential for abuse by employers, family members with ulterior motives, and government. Communists threw political dissidents into asylums, so I'm not terribly surprised that this is being done on a smaller scale to residents.
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It certainly has some corrollaries to communism or at the very least, narcissism where the problem is always YOU not them. It certainly is done punitively in residency.

Academic psychiatrists should know better than to play this foul game, especially with stressed and cornered residents.
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I'm not sure we should be assuming that the academic psychiatrists are in on the fix. First, you aren't always required to see someone at your home program. Secondly, as far as they know, they are being asked to see a troubled resident. In this case, and many others, they report their findings which may or may not vindicate the resident.

I know a former resident who failed her in training exams miserably every year. The PD made her see a psychiatrist, in hopes of labeling her learning disabled (or that was the impression of the resident) and getting her released from her contract. Of course, she wasn't and the psychiatrist actually made a recommendation that the resident be allowed some sleep from time to time to maximize her learning potential and study time. :p

I suppose the psychiatrists could refuse to see the residents, but who better to understand the pressures of residency than someone who works with residents on a daily basis. It sounds like, in the OP's story, that the psychiatrist didn't find any evidence of depression in the resident here either. So he/she was doing their job and not working as a shill for the program.
 
Pir8DeacDoc said:
The real question is how do you violate work hours in family medicine?
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It seems from the first post that her attendings were asking her to work extra hours, I could see this happen such as in a clinic that keeps chugging away an extra two hours a day or so.

The attendings have a financial motive for doing this as they get basically "free" work out of residency who are paid a fixed salary for 80 hours or less per week on average. I could see this happen in a busy family practice clinic or on a busy ward service. This residency program is in the Appalachian mountains, where they don't have a lot of doctors, so I am sure that the work was there.

That is what else she could file a lawsuit for, making somebody work without pay, i.e. working an extra 5 or 10 hours a week outside of what her contract says (if the whole 80 hours work rule is in the contract).
 
lowbudget said:
. . .who has the burden to establish proof, to prove a cause-effect relationship between her filling out the survey and all the other stuff that came after. Because the defense-program will argue, no, she's a crappy resident anyways.

1. Previous reporting controls - What would be interesting to know (and missing in the OP) is if the resident had work hours problems, why didn't she take care of it internally before it went to the external survey level?
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Well, I think that the resident is filing a lawsuit for harassment and defamation. If she can prove that she was harassed on the wards, i.e. subject to intentional emotionally abusive comments, then she would presumably win the lawsuit, or that part of it. There is a feeling that it is OK in medicine to harass someone that purportedly is not up or snuff or in retaliation. But work place rules can and should be used against the residency program in this lawsuit.

If she has convincing testimony, and maybe some good witnesses, all she needs to prove is more likely than not in this civil matter. Of course this will include retaliation as a motivating factor to explain why the attendings treated her in such a manner.

Say that a drunken driver runs you down in a crosswalk, and you are paralyzed, and the drunk driver is a multi-billionaire or something and you decide to file a lawsuit for say three millions dollars in civil court. Say you can prove that the driver ignored the traffic signal and that you had the right of way, does it matter that they were drunk?? Say you can't prove that they were drunk, but you can prove that they broke the law and drove in a wreckless manner in a pedestrian crosswalk, you can still win, you don't need to prove "causality" this isn't a scientific study.

From the first post it seems that she was asked by attending to break the work hour rules, i.e. work extra hours each day in clinic or on the wards, she obviously couldn't go to any internal process as the program was apparrenlty knowingly doing this.
 
There are 3 types of defendants, program/hospital, PD, and attending. Who will pay legal costs and any judegment/settlement $$ of attending and PD?
 
WS -

Your question piqued my interest. My contract does state that I have to work within duty limits (although I admit I had no idea it did so until I looked just now)

My program does state (under section of resident responsibilities) that I will "abide buy the overall rules, regulations, and practices of the residency program, e.g. Duty Hours...", and (under section of obligations of program to residents) they will "...assign resident responsibilities based on ACGME Duty Hours requirements."

I'm at a huge center with a billion residents; I know my anesthesiology department has been very very diligent about our hours. There are, um, other departments that might not be as "restrictive".

dc
 
Thanks guys. Of course, in the old days, the contracts mentioned nothing about work hours. I still find it laughable when Human Resources reviewed our salaries, or "about $17/hour". Calculated on a 40 hr work week of course.:p

So if she has documented that she worked over hours and there was a contracted agreement, she at least has a case that they violated her contract.

Proving that there was a designed practice to terminate her because of her complaints will be much harder, I would guess.
 
Winged Scapula said:
So if she has documented that she worked over hours and there was a contracted agreement, she at least has a case that they violated her contract.

Proving that there was a designed practice to terminate her because of her complaints will be much harder, I would guess.
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I don't think the residency program would document their work hour violations, for example, they probably had their residents fill out the same time when finishing something like clinic, i.e.5 pm, when really a good number had to stay for extra hours. However, her testimony could help, and they could get medical records, especially EMR which might be time stamped, which could show that she was in the hospital working at say 8 pm when she should have been off.

In short, I don't think she needs documentation that explicitly says that she was over worked, as this will be generated by the court case, and her own testimony will be compelling if this was true, and if is a civil case all she needs to do is show that most likely she was overworked.

While the being terminated is very bad for her, she isn't per se arguing that she was unfairly terminated, although this may be in the lawsuit somewhere. Remember, she quit due to a hostile work environment, nobody fired her.

Anybody can file a lawsuit if they have been harassed and been made to suffer emotional abuse on the job. Even if say she finished her residency, then she could go back and file a lawsuit for emotional distress and harassment.

Most people don't as the implicit deal with residency is that one hand washes the other, you temporarily waive your human rights and get abused in return for being able to practice medicine. Problem is is that the abuse and harassment may be too high for a person to do their job and attendings may use this privilege to punish people for reporting important things like work hour regulations.

But really, only in medicine are people so indignant when they are told that they are abusing their residents or medical students. It is like telling the plantation owner that maybe they shouldn't whip their slaves so much, people in the South hated being told that they couldn't have slaves, almost as though it was a right.

Similarily so, attendings feel that they have the right to "own slaves", in a matter of speaking, without being offensive to much more serious physical abuse that occurred int this country's past. I think that in a way, residents civil and human rights are violated during residency, and this is why the issue of resident abuse sparks such heated opinions.
 
sam1999 said:
There are 3 types of defendants, program/hospital, PD, and attending. Who will pay legal costs and any judegment/settlement $$ of attending and PD?
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If it was found in a court of law that the PD personally used emotional abuse to inflict pain in this resident, then this is a criminal work place matter, and if found guilty the PD would have to pay both their legal costs and the settlement. The program wouldn't be required to pay it, and couldn't for obvious reasons as it would make the program appear that it condoned this treatment or knew about it.

It would be like if you worked for Coke bottling, and a supervisor harassed you each day, and eventually you filed a lawsuit for harassment, if Coke management didn't know about the abusive supervisor, and didn't have policy where it was OK to do this, then the supervisor gets in trouble not the company.
 
I don't know much legal matters esp. medical law suits as they are rare. Most companies like finance, or banks pay for the misdeeds of their executives like Enron guys etc. so I thought program will pay for damages caused by its management while on duty or hospital matters.
 
sam1999 said:
I don't know much legal matters esp. medical law suits as they are rare. Most companies like finance, or banks pay for the misdeeds of their executives like Enron guys etc. so I thought program will pay for damages caused by its management while on duty or hospital matters.
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Yeah, but, if the residency program paid for the legal bills of an attending who was proved in court to have emotionally abused a trainee, ouch, I don't the program (which probably wouldn't have enough money) could ethically bail out this physician as that would condone this sort of treatment.

Say a hospital employee, like a scrub tech, was convicted in court for harassing a resident, would the hospital pay their bills? No. So, I think a higher standard would be held to the physician, even PDs can be easily replaced. They would let them pay their own legal bills and any settlement as the hospital would be destroyed in the press for paying the settlment of a physician who "inflicted emotional harm" on a resident.
 
DarthNeurology said:
Yeah, but, if the residency program paid for the legal bills of an attending who was proved in court to have emotionally abused a trainee, ouch, I don't the program (which probably wouldn't have enough money) could ethically bail out this physician as that would condone this sort of treatment.

Say a hospital employee, like a scrub tech, was convicted in court for harassing a resident, would the hospital pay their bills? No. So, I think a higher standard would be held to the physician, even PDs can be easily replaced. They would let them pay their own legal bills and any settlement as the hospital would be destroyed in the press for paying the settlment of a physician who "inflicted emotional harm" on a resident.
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Person like scrub tech has no authority/management over resident so he/she has to pay any legal bills if there is any legal recourse. It is clear.

But PD is part of management, he did this harm while in his/her official position for the benefit of hospital so I have to assume hospital will pay his/her legal bills. On the other hand I am not sure about attending but they can make similar argument that they are pressurized by hospital. I would think hospital would rather pay PD and attending's legal bills than having them join the law suit of resident or initiate their own law suit as whatever they did just to cover up for the hospital's own good.
 
First of all, let's remember that this piece is written from a lawsuit filing. It only displays a highly biased, one sided viewpoint. For example, I received a notice that I was being challenged for "age discrimination" for not interviewing a certain residency candidate. I reviewed their file, and they had failed Steps 1 and 2 a total of 4 times. Our acceptance criteria clearly state this would be unacceptable. Their complaint of course didn't mention this at all.

That being said:

The lawsuit claims that in December, Nigro reported in a survey conducted by a residency program accrediting agency that she was being asked by the physicians to work hours exceeding set limits. Nigro contends that she was subjected to a series of retaliatory actions as a result of the disclosure, including harassment and defamation, that culminated with her resignation from the program.
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Much of the truth regarding this statement will depend on whether the program documented problems in her performance before December.

In February, Dennehy began admonishing Nigro's work performance and required her to be evaluated for depression, according to the documents. Nigro complied with the request, and a psychiatric evaluation showed Nigro was not suffering from any mental condition. The results of the evaluation were sent to Dennehy on March 24.
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As others have mentioned, this was done poorly by the PD and, regardless of the PD's intention, could actually sink their case. Here's how this should happen:

A. PD tells resident that their performance is unsatisfactory, asks for resident's opinion.

B. The PD decides if they are concerned about the resident's "fitness for duty". Note that the PD does not decide that the resident is unfit for duty, they simply review the concerns raised and decide whether there is concern.

C. If the PD is concerned the resident is unfit for duty: Then they are 1) removed from all duties effective immediately, 2) referred to another physician, preferably an occ med specialist for evaluation. This evaluation is completely protected from the PD, all they are told is whether the resident is fit for duty, needs accomodations, or is unfit. If the former, then the resident is returned to duty and given full credit for all time (even any time they were pulled). If not, then they cannot return to work until they are cleared by Occ Med.

D. If the PD is not concerned about fitness for duty (or if they were, the resident was tested and passed), then the PD tells resident that an unsatisfactory performance like this, when a resident's prior track record has been otherwise unblemished is often difficult for a resident to understand, process, and address. Situations like this can 1) be caused by underlying psychiatric or social issues, or 2) can trigger psychiatric or social issues. The resident is offered confidential psychiatric assessment. The PD is never told of the outcome of such assessment, or whether it even happened. The resident is told that they will be assessed based on their future performance, but that excuses later that they were depressed, or had a learning disability, will not be acceptable.

The key is to keep both medical and psych evaluations separate from the PD, to make decisions based on resident performance, and to offer support.

Nigro was informed on March 25 that her residency would not be renewed, according to the suit. Nigro appealed the non-renewal action and a procedural subcommittee overturned the decision.

Following the appeal, Dennehy officially placed Nigro on probation in April, stipulating that she repeat the first year of the residency program and that she undergo monthly counseling, the suit states.
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This all looks bad for the PD (again though, we only have half the story). PD's should not require monthly counseling IMHO. We should assess how a resident's performance is going. We can suggest counseling. If we suggest counseling, the resident does not follow through, and their performance does not improve, then they cannot claim later that they were "depressed".
 
sam1999 said:
But PD is part of management, he did this harm while in his/her official position for the benefit of hospital so I have to assume hospital will pay his/her legal bills. On the other hand I am not sure about attending but they can make similar argument that they are pressurized by hospital. I would think hospital would rather pay PD and attending's legal bills than having them join the law suit of resident or initiate their own law suit as whatever they did just to cover up for the hospital's own good.
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Well, say that the resident "wins" and that the attending is found to be criminally responsible, in a civil court, for intentionally inflicting emotional abuse on the resident. Some states like MA, actually have laws against work place harassment and abuse, wich apply for residents.

The question is, then, does the hospital pay the legal bills and/or the restitution against the resident. IF they did, in such a highly publicized case it could really harm the reputation of the hospital, basically saying that inflicting emotional abuse is part of the job of being an attending at said hospital.

The hospital would more likely settle out of court with the resident for the sake of the attendings, but once they are found guilty of harassing subordinates, the hospital has nothing to gain by helping them out financially, and would be within their rights to fire them.

Remember that even a scrub tech in many ORs has the right to point out when something is going wrong with patient care, and a resident is trainee, whereas they aren't in training anymore.
 
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There are probably multiple things going on here.
The resident was probably not very good, because it's generally pretty hard to get booted from a residency like fp or IM (I can say that b/c I did IM residency...LOL). Programs of course hate people who rat them out for duty hours violations, but I doubt that was enough for them to try and fire her. She really ticked some people off - that is clear.

I do think the disciplinary psych stuff is BS and somebody should put a stop to it. I just don't get why this is tolerated. It seems like the academic psychiatrists, for one, should take some sort of stand against this. I know someone who was forced to go see a psychiatrist, and it had to be a certain one that the PD wanted, and the records were not really kept confidential...some parts were but some were not. I also think that psych is inherently subjective and if you want to look for some psychopathology in probably 90% of residents you can probably find something...I'm talking about minor anxiety, dysthymia, minor personality issues, etc. You could find these in attendings as well but they are usually shielded from this.
 
dragonfly99 said:
There are probably multiple things going on here.
The resident was probably not very good, because it's generally pretty hard to get booted from a residency like fp or IM (I can say that b/c I did IM residency...LOL). Programs of course hate people who rat them out for duty hours violations, but I doubt that was enough for them to try and fire her. She really ticked some people off - that is clear.

I do think the disciplinary psych stuff is BS and somebody should put a stop to it. I just don't get why this is tolerated. It seems like the academic psychiatrists, for one, should take some sort of stand against this. I know someone who was forced to go see a psychiatrist, and it had to be a certain one that the PD wanted, and the records were not really kept confidential...some parts were but some were not. I also think that psych is inherently subjective and if you want to look for some psychopathology in probably 90% of residents you can probably find something...I'm talking about minor anxiety, dysthymia, minor personality issues, etc. You could find these in attendings as well but they are usually shielded from this.
Click to expand...

While there is no way to know the specifics of this case, I do think that this case will shed some light on the massive maldistribution of power currently in medical education.

Right now, if a PD wants to get rid of you, they will find a way to. Not only that, they can ruin your career for the rest of your life, because it is very difficult to get funding, or get into another program without a positive reference letter from your first program.
 
I don't agree with this dragonfly. I know several FM & IM programs that are malignant.

dragonfly99 said:
There are probably multiple things going on here.
The resident was probably not very good, because it's generally pretty hard to get booted from a residency like fp or IM (I can say that b/c I did IM residency...LOL). Programs of course hate people who rat them out for duty hours violations, but I doubt that was enough for them to try and fire her. She really ticked some people off - that is clear.

I do think the disciplinary psych stuff is BS and somebody should put a stop to it. I just don't get why this is tolerated. It seems like the academic psychiatrists, for one, should take some sort of stand against this. I know someone who was forced to go see a psychiatrist, and it had to be a certain one that the PD wanted, and the records were not really kept confidential...some parts were but some were not. I also think that psych is inherently subjective and if you want to look for some psychopathology in probably 90% of residents you can probably find something...I'm talking about minor anxiety, dysthymia, minor personality issues, etc. You could find these in attendings as well but they are usually shielded from this.
Click to expand...
 
Real world:

Contract says it is illegal for me to work more than 80 hours. My company makes me sign a document stating it, and then they expect me to work more than 80 hours. And, they threaten to ruin my career if I dare report the violation.

I sue the company and win.

Medicine:

Same scenario as above, but if I dare suggest that what's happening is wrong, it means I'm "not a good doc, I don't put the patient first, what's the matter, can't you take it?"

This is the system because WE LET IT BE THE SYSTEM.
 
bythesea said:
Real world:

Contract says it is illegal for me to work more than 80 hours. My company makes me sign a document stating it, and then they expect me to work more than 80 hours. And, they threaten to ruin my career if I dare report the violation.

I sue the company and win.

Medicine:

Same scenario as above, but if I dare suggest that what's happening is wrong, it means I'm "not a good doc, I don't put the patient first, what's the matter, can't you take it?"

This is the system because WE LET IT BE THE SYSTEM.
Click to expand...

Only solution would be for residents to unionize. If one gets penalized for whistleblowing, other residents apply repurcussions to the program, such as cutting hours from 80 to 75. Work won't get done, so attendings will have to do it or program continues penalizing, leading to a downward spiral. In the end, patients will suffer and the program will look idiotic.
 
Pir8DeacDoc said:
The real question is how do you violate work hours in family medicine?
Click to expand...


You'd be surprised. I am in a program where we are on call with fp floors all 12 months of the year. And it's Q3 not even Q4. We also take extra ER call Q4 on top of regular FP-assigned patients and routinely get 9-10 admissions overnight when that happens.
 
mercaptovizadeh said:
Only solution would be for residents to unionize. If one gets penalized for whistleblowing, other residents apply repurcussions to the program, such as cutting hours from 80 to 75. Work won't get done, so attendings will have to do it or program continues penalizing, leading to a downward spiral. In the end, patients will suffer and the program will look idiotic.
Click to expand...

you're absolutely right---residents need to be unionized. But, it'll never happen, and my guess is that it's because residency is a finite time period. how can union leadership develop when people are residents for only a few years of their career?

This leaves the programs in a position of total power. They hide behind the standard physician martyr arguments, that it's all for the patients, blah blah, but that's not what it's about.
 
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