From Look the Other Way
Robert Whitney of Attleboro, Massachusetts, suffered persistent and crippling stomach pain until his problem was finally diagnosed: During a hernia operation four years earlier, surgical mesh had been mistakenly attached to his bladder. The surgeon, Dr. Jose Veizaga-Mendez, was dunned $652,000 for that bit of malpractice, disciplined by his hospital and investigated by the state over the quality of care provided to seven other patients, two of whom died. In 2006 he surrendered his license to practice medicine in Massachusetts.But by then, Veizaga-Mendez was plying his trade at the VA Medical Center in Marion, Illinois. Supervisors had called Massachusetts state licensing authorities for references -- but weren't warned about the physician's history. In November the Department of Veterans Affairs announced it was investigating whether Veizaga-Mendez was at fault in the deaths of ten patients, including a 50-year-old Air Force veteran who died after what was supposed to be a routine gallbladder operation.
One of medicine's most cherished commandments is "First, do no harm." Most doctors take this admonition to heart, but when it comes to those who fail to honor this promise, the medical establishment resorts to another, less noble commandment: "Thou shalt not speak ill of thy fellow physician."
No one knows how many chronically bad doctors are out there. But a recent survey of 1,600 physicians by Columbia University's Institute on Medicine as a Profession revealed that 46 percent of the doctors in the survey had witnessed "serious" medical errors by their colleagues without reporting them. This was true even though 93 percent said they realized they should turn such doctors in.
Compounding this problem are doctors who give their colleagues lenient treatment in state disciplinary proceedings. "Doctors say, 'There but for the grace of God go I. Do I want to take away this guy's livelihood?'" says Arthur Levin of the New York-based Center for Medical Consumers.
It doesn't help that consumers have so little information. Only 16 states tally all malpractice payouts made by doctors on public websites. Says Dr. Sidney Wolfe of Public Citizen, a pro-consumer watchdog group: "There isn't an adequate system to catch these doctors after they've done one or two things, as opposed to just letting them go on and on."
In 2006 the state of Maryland employed only ten investigators to oversee 17,000 doctors, leading to a backlog of 400 cases. Complaints routinely take three years to resolve, a Baltimore Sun investigation showed. But even when doctors are sanctioned, they usually keep practicing. One Maryland physician continued to see patients after settling three malpractice claims in five years, including one involving a death. No information about his history turned up on the state's public database.
Historically, doctors are among those most trusted by Americans. To maintain that trust, medical reformers have launched an array of initiatives designed to bolster the integrity of doctor-patient relationships:
• Teaching doctors to admit fault and express remorse for mistakes. In our litigious society, this goes against doctors' instincts, but a 2006 study showed that doctors' apologies help reestablish a patient's trust.
• An early focus on problem physicians. Research shows that doctors disciplined by their state medical boards were three times as likely to have exhibited unprofessional behavior when they were medical students. "The tradition of professionalism must begin in medical school," says study author Dr. Maxine Papadakis, a professor of clinical medicine at the University of California, San Francisco.
• Continuing doctors' ethics education. Dr. Susan Dorr Goold, a pioneer of this trend, says conversations about ethics must occur in classrooms, examining rooms and even hospital hallways. "The more you make it separate, the more marginalized it is," says Goold, an assistant professor of internal medicine at the University of Michigan.
"The people who know what's going on are on the inside," says Rosemary Gibson, coauthor of Wall of Silence, a book about this phenomenon. "But there's more courage now. More of them are speaking out."
Meanwhile, families dissatisfied with their medical care are also prompting reform. In September 2001, Patty Skolnik's son, Michael, passed out suddenly. A Denver doctor said the young man had a tiny brain cyst that could be removed in a three-hour surgery. After a six-hour operation, no cyst was found -- and there were grim complications. Michael was left paralyzed, partially blind and psychotic. He spent 32 months in the hospital before dying at age 25.
State authorities didn't find the surgeon at fault, but Michael's family wasn't mollified. "The doctor basically killed Michael that day," says Patty Skolnik. Later she learned that the physician had a malpractice case pending against him in Georgia. Skolnik lobbied her state legislature, met with lawmakers and testified for a proposed statute requiring physicians seeking or renewing a Colorado medical license to report all malpractice settlements or disciplinary actions against them.
Skolnik found some solace last May when she stood behind Colorado Governor Bill Ritter at the statehouse as he signed House Bill 1331, known as the Michael Skolnik Medical Transparency Act. Skolnik is ready to take her crusade to the next level and is talking with other consumer activists about pushing legislation in Washington.
"I had to do something," she says. "My son's not coming back." Thanks to her, though, perhaps someone else's son won't be lost.
Make a Difference
For advice on monitoring problem doctors in your state, contact Patty Skolnik, a one-woman clearinghouse, at coloradocitizensforaccountability.org or 303-691-9339. Other resources:
• Consumers Union, now active in this field; consumersunion.org.
• Helen Haskell, Mothers Against Medical Errors
• Wall of Silence, a call to arms for more accountability in medical care. The book's authors donate its proceeds to patient support groups.
Michael Crowley is a senior editor at The New Republic.
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