Why Me?

I have been asked, why has an oral surgeon become so involved with medical malpractice? One incident, which began in 1979 and continued for several years demonstrated the enormous void between the vocalized professionalism of the practice of medicine and the unprofessional reality of questionable patient care.

Patients only have the rights our medical profession can demonstrate to be in existence.

I was asked to assume the responsibility to treat a patient whose condition, after several months of treatment by two other surgeons, was worst than her original injury. After treating and stabilizing her shocking, doctor-induced disability, I reviewed the hospital records of her previous two hospital admissions and surgeries.

Medical incompetence is the most civil description one might apply to her previous surgical care. My conclusion was that those two surgeons, over a four-month period, had done nothing right and everything wrong. After a brief meeting, requested by me, the senior of the two surgeons announced, “We did nothing wrong.” A simple fracture of the lower jaw, which typically required six weeks for satisfactory healing, had turned into three hospital admissions, three surgical procedures, months of antibiotic therapy, and they had done “nothing wrong”.

As a member of that hospital medical staff I felt it my professional duty to present my concerns to the hospital medical director. My reward was to be asked, “Are you a trouble-maker?” So much for patient’s rights.

Despite the unprofessional slur, I demanded, without the patient’s knowledge, that a review of her care be accomplished. The term “circle the wagons” is appropriate with the findings of their surgical peer review committee. There was not a single positive factor related to her first two hospital admissions and surgeries, yet that peer review committee could find no evidence of unacceptable care. That hospital’s acceptable standard of care for the treatment of simple fractures of the lower jaw could only be breached, apparently, if the patient had died.

Additional patient care review of that case was forced, by me, through every level of medical staff review, including the medical staff executive committee and NO fault with her care was ever indicated. Subsequently, review of her care was also found acceptable by the hospital system’s board of governors and the JCAH.

I had listed several elements of clearly substandard patient care, all documented in the patient’s hospital record, for each of the medical staff committee reviews and each level of medical staff review found no evidence of unacceptable care.

I presented the detailed evidence of her care and a list of all of the medical staff committees’ reviews to the doctor in charge of the JCAH review of that hospital several months after the hospital system’s board of governors had also found her care to be acceptable. There is no evidence that the JCAH took notice of all of the questions arising from her previous care.

Both surgeons were later found guilty of negligent care regarding that case.

Why is an incident, even a shockingly horrible incident of inept medical peer review extending up to and including the JCAH, a worthy consideration? Medical peer review is one of only three systems with the “potential” for questionable patient care review, and one of those three systems, state medical examining boards, is shown to be of no value in that regard.

Medical peer review has been given the state and federal privilege of being secret for over twenty years. Every hospital medical staff has the presumed responsibility to provide a functioning system of medical peer review. Yet no community in America has ever been provided evidence that medical peer review exist, much less functions, in cases of questionable patient care.

Does anyone care?