Orin F. Guidry, M.D.

was asked to write a column describing the activities of the office of Immediate Past President. I am still not sure what those activities are, and since this is my last column, I will say something else that I think is more important.

My postgraduate medical education began 36 years ago as a general surgery resident. Mortality and morbidity (M&M) conferences were a major part of the teaching program and were quite rigorous (even malignant?). I have continued to enjoy M&Ms, though they have become more benign over the years.

I am sure that you have noticed a very consistent pattern in M&Ms — early in the presentation there is a seemingly minor error, omission or failure that inexorably leads to a bad outcome. You may have the same eerie sensation that I often do — that the slip up was one I could have easily made myself.

The rigor of M&M conferences isn’t the only thing that has changed in the last several decades; so has society’s expectations of medicine and our legal obligations.

This is a legal story that starts in Louisiana. It is not my intention to cause even more grief for the anesthesiologists involved, but it is important for all of us to know about these issues. All the facts are readily available in public documents.

An anesthesiology group at a private suburban hospital fired an anesthesiologist because he failed to answer his pager, was found asleep on duty and was suspected of stealing meperidine. The group’s letter of termination said in part, “As we have discussed on several occasions, you have reported to work in an impaired physical, mental and emotional state. Your impaired condition has prevented you from properly performing your duties and puts our patients at significant risk.” The suspected substance abuse was not reported. He was allowed to voluntarily resign from the hospital staff.

I have often contrasted the situation these anesthesiologists were in with my own. At the time, I was chair of a department in a large institution. The institution’s human relations department was heavily involved in every personnel matter. Any sensitive issue was quickly referred to outside counsel at a large and sophisticated law firm. I have come to realize how protected I was in that environment compared to the average anesthesiologist in a conventional private practice who has little or no support.

The story now moves to a small town in eastern Washington State where the terminated anesthesiologist began work at a second hospital. He was granted staff privileges based on letters of recommendation written by two members of the original anesthesiology group. One of the letters includes: “He is an excellent anesthesiologist with a pleasant personality. I am sure that he will be an asset to your anesthesia service.” No mention is made of the substance abuse issue. These letters could be interpreted as an effort to help a colleague.

The story takes a tragic turn in November 2002. There is a cardiac arrest during a general anesthetic for a simple procedure in a healthy patient. The patient remains in a persistent vegetative state. The anesthesiologist subsequently admitted to diverting narcotics.

The hospital settled a malpractice claim with the patient’s family for $7.5 million in May 2004.

The hospital and its insurance company then filed suit against the anesthesiologist who performed the anesthetic, the two anesthesiologists who wrote favorable letters and the first hospital that failed to fully respond to a credentialing request. In May 2006, the case was heard by a Louisiana federal court. The judge’s question to the jury was, “Do you find from a preponderance of the evidence that one or more of the defendants made a negligent misrepresentation to … [the] Medical Center and that the defendant’s negligent misrepresentation was a proximate cause of the damages to the plaintiffs?” The jury answered yes for both of the anesthesiologists who authored the letters of recommendation and assigned them responsibility for 5 percent and 20 percent of the $8,244,225.33 judgment.

The hospital that failed to disclose the adverse information has publicly said that it will appeal the verdict. My opinion, however, is that this judgment establishes a new duty as articulated by the judge in this case who said, “When it comes to something as important as the physician who will be administering anesthesia in an operating room, it appears to me that we have the right to know if that physician previously had his privileges revoked by a hospital. We should have the right to know that a physician was terminated from his previous practice because of drug-related issues and other misconduct.”

We may be concerned about hurting our colleagues’ careers or being sued ourselves if we are forthcoming about negative information. But as difficult as it may be, we must protect patients by responding with factual and truthful information.

All of us recognize our responsibility for the individual patients under our care. This case emphasizes that society expects us to assume this broader and more complex responsibility.

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