Several years ago, a complaint was filed against my license to practice medicine in the state where I was working at the time.
As I’m sure you can imagine, when I first received the notification about the complaint it was quite unnerving. My head swam trying to guess what I had done to warrant it. When I picked up the certified letter from the board of licensure, I tore into it as quickly as I could to find out why someone had urged them to consider action against me.
To say that the substance of the complaint was frivolous would be an understatement. It would be imprudent to go into much detail, but I am not being unfair when I describe the complainant’s case against me as ridiculous. It was weightier than “I didn’t like his smile,” but only just barely. The board dismissed it as without merit by unanimous vote at their first opportunity.
However, I was still made to submit a written response to the complaint and provide the patient’s complete medical record for scrutiny. The board still reviewed the materials and took the trouble to vote on it. As preposterous as the complaint itself was, it was still treated with seriousness.
And I will never be totally free of it. Every time I apply for privileges at a new hospital, I complete a lengthy questionnaire that includes some question or another about whether any formal complaint has ever been submitted against my license in any state where I’ve ever practiced. Ditto every time I apply for licensure in another state. And I must provide documentation that verifies the board’s decision, and that no discipline was enacted against me. (I keep copies of these materials on hand so I can just photocopy them when need arises.) It is remarkably tedious.
All for a complaint that was wholly devoid of merit, and that any layperson would have been able to recognize as such on its face. (I hope I always practice in a way that obviates any potential for more complaints.)
This is in addition to all the hoops I must jump through in order to maintain my license, my board certification and my privileges at the hospitals where I am on staff. On a periodic basis I have to submit a tally of the ongoing medication education I have received to all the various entities that supervise my capacity to practice, and must be able to provide documentation if necessary. Every few months I have to take some online learning module or another to confirm that I know how to competently handle some aspect of hospital practice. And of course I must take re-certification exams every decade in my specialty and subspecialty in order to keep the American Board of Pediatrics’s imprimatur.
Keeping all of that in mind, perhaps you will understand my utter and appalled bafflement at the grisly crimes of one Kermit Gosnell. (Thanks for the topic suggestion, Alexios.) For those of you unfamiliar with his ongoing trial, Dr. Gosnell (it pains me to type his title) is accused of running an abattoir of an abortion clinic in Philadelphia. You can read about details from Conor Friedersdorf here, but before you click the link you should be aware that those details are incredibly gruesome and disturbing. Some of the less grisly charges:
One woman “was left lying in place for hours after Gosnell tore her cervix and colon while trying, unsuccessfully, to extract the fetus,” the report states. Another patient, 19, “was held for several hours after Gosnell punctured her uterus. As a result of the delay, she fell into shock from blood loss, and had to undergo a hysterectomy.” A third patient “went into convulsions during an abortion, fell off the procedure table, and hit her head on the floor. Gosnell wouldn’t call an ambulance, and wouldn’t let the woman’s companion leave the building so that he could call an ambulance.”
Much of the conversation surrounding Gosnell’s serial crimes (and I use that term advisedly) has focused on the meta-narrative and why it hasn’t garnered more attention in the national media. I have no interest in discussing that aspect of things. I’ll leave it to another post of Conor’s and to Kevin Drum, for the interested.
What I cannot fathom is how he was able to do what he did to those people (infants and women alike) for so long. Via the link to the first Friedersdorf piece:
The Department of State, through its Board of Medicine, licenses and oversees individual physicians… Almost a decade ago, a former employee of Gosnell presented the Board of Medicine with a complaint that laid out the whole scope of his operation: the unclean, unsterile conditions; the unlicensed workers; the unsupervised sedation; the underage abortion patients; even the over-prescribing of pain pills with high resale value on the street. The department assigned an investigator, whose investigation consisted primarily of an offsite interview with Gosnell. The investigator never inspected the facility, questioned other employees, or reviewed any records. Department attorneys chose to accept this incomplete investigation, and dismissed the complaint as unconfirmed.
There is much more depth to the litany of abject failures described in the grand jury report. Every single one of them stupefies me, and in aggregate they represent one of the most monumental failures of regulatory bureaucracy I have ever seen.
Gosnell’s crimes are ghastly, and beggar my attempts at commentary. I hope they find an appropriately deep pit into which to cast him. I have no special insight as a physician into what he did. Monstrosity requires no expertise to recognize.
But one reason I hope this story gets lots and lots of attention, in Pennsylvania if not the nation as a whole, is that I hope many, many, many people lose their jobs. I hope some are brought to trial for their own negligent, incompetent and/or indifferent contribution to the mutilation and murder of women and infants. I hope that the brightest glare of media scrutiny shines on every single person who was charged with overseeing the practice of medicine in that city and state, and that a full accounting of their failures is made.
Do I find it terribly wearying to comply with the rules and regulations and bylaws that prescribe and proscribe my professional activities? You bet. Do I think there is some room for making it less tedious, onerous and time-consuming? Indeed I do. (I question whether I really need to pass annual online exams about the proper storage of chemical materials, for example.) Do I have my gripes with the ABP about its new maintenance of certification process? I will gladly enumerate them over a friendly beer or two.
But I dot every last “i” and cross every last “t” demanded of me, knowing that doing so is my part in keeping the patients in my and my colleagues’ charge safe. I comply not only because I must, but because at heart I know that my compliance is part of a system dedicated to securing the well-being of people who make themselves vulnerable in our care. I photocopy the report from the board of licensure when asked because I know I’m being asked for reasons more important than my convenience, no matter how nettlesome I find it at times.
I do my part because I take seriously my obligations. And from within this system of regulations and guidelines I raise my finger in angry condemnation at those who so blatantly failed in theirs.