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By James T. Mulder for Syracuse.com
Syracuse, N.Y. – The case of a Syracuse surgeon who the Onondaga County district attorney says slapped sedated patients on the buttocks and called them derogatory names illustrates a persistent problem at U.S. hospitals receiving heightened attention – bad behavior by doctors.
Experts say even though inappropriate behavior by doctors can lead to medical errors and patient harm, hospitals often turn a blind eye to it, especially if the doctor generates a lot of revenue.
A federal report says the butt slapping, name calling and use of sexually explicit language went on in the operating room at St. Joseph’s Hospital for at least a year because many of the employees who witnessed it were afraid to report it.
The Joint Commission, a national hospital accreditation agency, became so concerned about the issue it required hospitals in 2009 to adopt a code of conduct and procedures for addressing things like doctors berating nurses and other improprieties.
The American College of Physician Executives in a 2011 report said health care ” … is still plagued by doctors acting in a way that is disrespectful, unprofessional and toxic to the workplace.”
That report included a survey of 840 physicians, more than half of whom said they have encountered doctors yelling, making degrading comments or insults and refusing to cooperate or follow established protocols.
A 2013 report by the Institute for Safe Medication Practices said “little progress has been made in the last decade to eradicate intimidation and bullying” by doctors in hospitals.
Experts say the vast majority of doctors behave professionally. But hospital inspection reports, surveys and research show a small minority of doctors engage in misbehavior that ranges from yelling, swearing and insulting coworkers to throwing medical instruments and even assaulting patients.
Inspections show bad behavior by docs at other U.S. hospitals
St. Joe’s did nothing about the inappropriate behavior in its operating room until a complaint was filed with hospital administrators in December, according to a report by the federal Centers for Medicare & Medicaid Services.
The orthopedic surgeon slapped anesthetized patients so hard he sometimes left red marks or hand prints, that report says.
Onondaga County District Attorney William Fitzpatrick’s office investigated the physician, Dr. Michael T. Clarke, 47, of Manlius, but did not file criminal charges because it could not identify the patients who may have been victims. Fitzpatrick said the conduct by Clarke happened over an extensive period of time and involved “dozens” of surgeries.
Clarke, who left St. Joe’s in February and now practices at Crouse Hospital, has denied any wrongdoing. He’s under investigation by the state Office of Professional Medical Conduct and could be subject to disciplinary action. St. Joe’s also is being investigated by the state Health Department.
Although bad behavior by doctors can harm patients, hospitals often turn a blind eye to it, especially if the offending doctor is a big money maker, according to Dr. Michael A. Carome, director of health research at Public Citizen, a Washington, D.C.-based nonprofit consumer rights advocacy group founded in 1971 by Ralph Nader. He said many cases do not get reported to state medical boards that investigate doctor misconduct. When cases are reported, disciplinary action often amounts to little more than a slap on the wrist, Carome said.
William Martin, a DePaul University professor and expert on disruptive workplace behavior, said about 1 to 2 percent of workers in every industry behave badly in the workplace and health care is no different.
“The stakes are a lot higher when it’s in health care because of the negative impact it can have on a patient,” he said.
While bad behavior by doctors gets most of the attention, other health care professionals – pharmacists, nurses, technicians, etc. – also sometimes act inappropriately, according to Dr. Peter Angood, former vice president of the Joint Commission and now CEO of the American College of Physician Executives.
“There’s been anxiety in health care for years and a few manifest their anxiety with disruptive behavior,” Angood said. “I liken it to the anxiety that creates road rage.”
Disruptive behavior by a doctor can distract other members of the health care team to the point where they make mistakes that can harm patients.
“When we allow bad physicians to remain in practice, that can ultimately expose hundreds if not thousands of patients to substandard and unprofessional care,” said Carome of Public Citizen.
Bullying and intimidation by doctors and other health professionals can lead to medication errors, according to the Institute for Safe Medication Practices. In a 2013 survey of more than 4,800 hospital workers, most of them nurses, nearly one-third said they did not question medication orders prescribed by an intimidating doctor even if they thought the order might be incorrect.
Aside from patient harm, inappropriate behavior can create a toxic work environment that leads to high employee turnover, according to Angood. It also damages the credibility of the disruptive doctor and the hospital, he said.
Several St. Joe’s employees who witnessed inappropriate operating room behavior told investigators they did not report it because they doubted anything would be done, they feared their jobs could be jeopardized or they did not want to confront the doctor, according to the federal inspection report.
That type of response is common, according to Carome.
“If you have staff who are afraid to report serious misconduct or substandard care, if they believe they will be retaliated against, that’s a serious cultural problem within the institution,” he said. “What is needed is an institution that promotes confidence that whistleblowers can come forward and submit complaints without any fear of retaliation.”
Many hospitals also fail to report problem doctors, he said.
Public Citizen did a study in 2009 that showed nearly half of U.S. hospitals had never filed reports when they revoked or restricted a doctor’s hospital privileges for more than 30 days for problems involving medical competency or conduct. Federal law requires hospitals to file these reports with the National Practitioner Data Bank.
Martin of DePaul University said most patients are unaware of the inappropriate things that can happen behind the scenes at hospitals and other health care facilities.
“I think the general patient population may wrongly expect a higher standard in health care just because it is health care,” he said.
Martin compares disruptive physician behavior in a hospital operating room to a pilot and copilot arguing and fighting in the cockpit of an airplane. “Do I want to be in a plane where the pilot and copilot are arguing at 31,000 feet? I don’t think so,” he said.