The Case Of The Trash-Talking Doctors, And The Price Of Trust

So, did you hear the one about why surgeons wear those masks?

So, did you hear the one about why surgeons wear those masks?

When I first heard about this case, I thought the jury award of $500,000 was ridiculous. The more I think about it, the more I begin to think it was appropriate.

Before his colonoscopy, a Vienna, Virginia patient pressed record on his smartphone, not intending to record everything that was said but ending up with the entire proceedings anyway. That was a half-million dollar stroke of luck for him, and the confirmation of dark suspicions for the rest of us. The resulting recording revealed that the surgical team amused itself by insulting and demeaning the semi-conscious anesthetized man throughout the procedure.

The anesthesiologist, Tiffany M. Ingham, was the ringleader and the primary offender.  Among her inspired bon mots

  • “After five minutes of talking to you in pre-op, I wanted to punch you in the face and man you up a little bit.”  
  • When a medical assistant noticed a rash, Ingham warned her that if she touched it, she might get “some syphilis on your arm or something.”
  • Later she quipped, “It’s probably tuberculosis in the penis, so you’ll be all right.”
  • When the assistant noted that the man reported getting queasy when watching a needle placed in his arm, Ingam said, “Well, why are you looking then, retard?”

There was more. The patient sued the gastroenterologist who performed the colonoscopy, Soloman Shah, and Ingam for malpractice and defamation. Though Shah was not guiltless, and did not attempt to stop the trash talk from Ingham or prevent her from writing on the man’s chart that he had hemorrhoids as a joke, he was dismissed from the suit. The jury hit anesthesiologist, however, with a $500,000 damages award. The jury awarded the plaintiff $100,000 for defamation ($50,000 each for the comments about the man having syphilis and tuberculosis), $200,000 for medical malpractice, and $200,000 in punitive damages.

I find the defamation claim to be a stretch at best, as demeaning as the remarks were. The tort requires that the party being told something false about an individual must believe it, and the comments recorded seem obviously facetious. The $100,000 is a gift. $200,000 for malpractice when a doctor intentionally writes something false on a patient’s chart just for giggles seems fair, and even too mild. That’s shocking. As for the $200,000 punitive damages to bring the cost to Ingham for her big mouth up to a nice, round $500,000, I see the jury’s point.

We are helpless under anesthesia, and we depend on medical professionals to be trustworthy when we are under their care. The thought that doctors are treating us as pieces of meat while we are unconscious, or worse,  like props or victims in a fraternity hazing stunt, is a horrible one that threatens the doctor-patient relationship at its core. Doctors don’t really mock our bodies when we are unconscious, do they? Do they? They are serious and professional, right? RIGHT? M*A*S*H was just a TV show, please tell me that! Doctors don’t really joke around while they have our lives in their hands.

Oh, I’m sure many of them do, if the surgeons in charge aren’t meeting their ethical obligations. All medical codes of ethics require that doctors, any doctor, respect patients at all times, treat them with dignity, and be advocates for patients’ best interests and rights at all times. This isn’t one of those breaches where an ethicist has to do extensive research about whether conduct nicks some obscure rule, item G, (34), (r) of a sub-chapter. You don’t lie on a patient’s chart. You don’t call him a retard and make fun of his penis while he’s sleeping. It’s wrong.

The incident in Virginia wasn’t just a case of one patient being abused, but one that threatens trust in the entire medical profession. Maybe $500,000 in damages is an appropriate sum to send a message to any doctors on the verge of forgetting that those are human beings in the operating room.

Earlier this month, state representatives in Wisconsin introduced legislation to mandate that any place where surgery is performed must “offer surgical patients the option to have their surgical procedures videotaped.” Good. That way, when the doctors put a clown nose on me while I’m out like a light, I’ll know about it, as well as all the nasty things they say about my…feet.

______________________________

Pointer: Rhonda Hill

Sources: Washington Post 1, 2

Ethics Alarms attempts to give proper attribution and credit to all sources of facts, analysis and other assistance that go into its blog posts, and seek written permission when appropriate. If you are aware of one I missed, or believe your own work or property was used in any way without proper attribution, credit or permission, please contact me, Jack Marshall, at jamproethics@verizon.net.

 

 

 

66 thoughts on “The Case Of The Trash-Talking Doctors, And The Price Of Trust

  1. Wow. Just wow.

    A. Your mother was right, always wear clean underwear.
    B. Doctors, the best malpractice insurance is cheap – just don’t do stupid things.

        • Joed,

          No problem, you’re hardly a dingus, and hope your friend is OK.

          Now, if I can just find it myself…let me see…Oh yes here it is

          http://securitydata.newamerica.net/extremists/deadly-attacks.html

          As I said, the good thing is they actually list events, so you can assess the data quite apart from the source. The source appears to be an “institute” allied with several name brand universities, including Syracuse University’s Maxwell School of Public Citizenship.

          Anyway, have a look.

          • Yeah, he’ll be okay. I feel terrible for him. Duplicitous soon-to-be ex who just pulled the carpet out from under him. He’s finding out she’s not at all who he thought she is. My buddy is a kind, gentle, honest, and generous soul, and he so very much didn’t deserve this.

          • My God, a Sikh temple? Who could have ill will towards those awesome people? That’s like killing Smurfs, or talking dolphins.

            • Just pure ignorance, Joe. Anybody who wears a turban is an A-Rab. Or a Moos-lum. Never mind that Muslim Arabs hardly ever wear turbans, but rather dress for the desert where they live.

          • Okay, at first glance: Under methodology:”The data on non-Jihadist extremists is less developed than the data on Jihadist extremists”, and they don’t go into a great deal more detail than that, such as what led them to believe right wing extremism was the motive behind the attacks. This is an absolutely vital piece of information, and considering the small data set under consideration, it seems like that would be easy enough to provide. How did they meet the criteria? Did they shout “death to liberals!”, or did they publish a manifesto, or did they merely vote along conservative lines? I also find it odd that there wasn’t a single “left-wing” terrorist in the group, especially considering how many shooters and bombers identified as democrats. Lastly; several of the authors are from Pakistan, a country known to harbor mixed sentiments towards the U.S., and one with a possible vested interest in downplaying the threat of Islamic terrorism. Don’t take my doubt as resistance to the truth. I want more than anything to know the truth, even if it completely turns over my little applecart. I’m a very secure man with a great deal of personal strength, and I could unmoor myself from my current worldview in a heartbeat. I’m just very careful about “scientific” papers dealing with social and political phenomena. More often than not, it’s snake oil being peddled by shysters with an axe to grind. (not saying this is the case here, at all. I will continue to peruse it).

            • Otherwise, if this is legit, I’m genuinely surprised at the number of right-wing terror incidents! I can definitely tell you that these people don’t represent conservative values at all. In fact, a primary conservative value is the social contract, and adhering to that contract primarily consists of not harming or burdening others, in exchange for all freedom that is practically possible.

              • I completely agree they don’t represent conservative values, just as leftist wack jobs don’t represent liberals, or Jihadists most Muslims.
                Still, I suppose each group has more than its share of responsibility to muck out the respective stalls to which our particular brands of idiots have been attracted.
                Muslims need to denounce jihadists; liberals need to denounce idiocies like trigger warnings and bombers like the old Weathermen; and right-wingers need to denounce the several varieties of terrorists listed in those incidents.

  2. This is not unusual and occurs in many work place environments at least the trash talking portion. As a former educator (teacher) the comments I would hear about students, administrators, parents and other teachers. Flight crews and cruise ship personnel and their “private” conversations about the cargo (passengers). And lawyers about clients, judges, police, social workers and just about everyone else.

    You can go right down the line….the comments around the water cooler…ouch! But in this instances they went so far out they were on the way back in. Just the thought of messing with a chart. Seems this surgical crew had cornered the “dickhead” market.

  3. … and make fun of his penis while he’s sleeping. It’s wrong.

    In case there was any lingering doubt about the magnitude of the award, it was more than just mockery; one of the doctors unnecessarily *handled* the patient’s penis (outside of the scope of the procedure). I would assume this was the bulk of the malpractice award.

    (He then joked he might get syphilis, and the other replied, nah probably just “tuberculosis of the penis”… )

    • That might be battery, but it’s not malpractice. A doctor can check out whatever is is front of him: if nothing is found, that’s moral luck. What if the handled penis had a cancerous tumor on it, only discovered because of the unwanted touching?

      • Ah, the distinction noted. The article I read did state that the penis is not *usually* handled, although given the proximity to the region in question during the colonoscopy, perhaps not unheard of in the normal course of examination. (I find it unlikely, though, they were truly examining for syphilis or tuberculosis.)

        • I remember this incident when I was working in the stabilization and transport area at the branch clinic, NAVSTA Mayport, Fla. We had a woman come in who was unconscious, covered in puke and piss, from acute alcohol poisoning. We had to put in a femcath, which is a temporary urethral catheter. There was this male nurse. Him and his wife were notorious pervs and swingers, even though they were both lieutenant commanders (O-5’s). For those not in the know, that’s a pretty high rank to be inviting teen-aged E-3’s like myself to orgies, but I guess it was a different navy back then. Anyhow, naturally he volunteers to do the honor. I swear to God, this guy was sweating and trembling like an epileptic on amphetamines, looking at this sloppy drunk’s vagina! I thought he was going to have a stroke! Another time, we had this DW (dependent wife) come in just barely able to walk. Her knees kept buckling, and she looked pretty unsteady on her feet. She didn’t want to tell us what the problem was, but we did manage to get out of her “female problems”, so we woke up the doc, a hip young resident who was my drinking and whoring buddy. He goes into the exam room with her. A few minutes later, he comes out, says to me “Joe, you have GOT to see this! Get the jewelers drills, and pretend you’re a professional”. I go in there, and God as my witness, she had a 1-liter bottle of soda completely buried in her vagina! Apparently, she tried some sort of trick with fizzy rocks and soda. It didn’t work out well for her. I’ll bet she still feels embarrassed. Sad thing is, she was hot, and nobody gave her my number. The drunk wasn’t, though. She looked like a tertiary- syphilitic crack-whore who had the misfortune of also having tuberculosis and leprosy, about to default on her cardboard box. God forgive me, but she was sloppy. I’m going to hell.

          • God, with my luck, she’ll be the only tertiary syphilitic TB patient who defaulted on her cardboard box, and also had a near-death alcohol (or hairspray) experience back in the 80’s with a trembling, sex-offending, fraternizing male nurse that damn near tore up her vagina, and she’ll just happen to click on this page while looking for the latest treatment for chloroquine-resistant falciparum malaria of the vagina, read it, and be cruelly robbed of the tread of hope she was clinging to, and kill herself by sniffing her shoes. I really suck.

      • And how would they inform the patient? “We checked your penis when you were out for your colonoscopy and found out you had a tumor” ??? Anyway,they didn’t do it to check him,they did it to make fun of him.

    • I had a kidney stone extracted and found out later that there were many comments about my penis. I sued….but the judge tossed it for “lack of evidence.”

  4. I have a brief possible thought to the contrary… working every day digging into human bodies, it may be psychologically necessary to resort as a defense against disgust or becoming morbid. I’d have to consider it more though.

    • You’re right. I’ve worked in the medical field in various capacities for most of my adult life, and “gallows humor” is a coping mechanism, especially in the ER, trauma centers, and pre-hospital life support.

      • My husband spent 22 years in law enforcement (as well as working ER security for that many years). Gallows humor is necessary for survival.

        • When I was doing clinical rotations at the end of paramedic school, one necessity was observing autopsies, in order to better learn gross anatomy, and be acclimated to gore. One time, there was a rather large woman who had been shot in the forehead by her husband. After the pathologist finished with the abdominal and thoracic cavity (everything is sliced, weighed, photographed, and histology samples taken from certain tissues), he inserted a metal wire probe into the bullet hole, in order to x-ray the wire, which would reveal the bullet path before opening the skull. After inserting the probe, he had to wait for the portable x-ray machine, so he busied himself with recording data. I’ll never forget this: a detective walks in, and says “hey doc, what the fuck’s up with the unicorn?” I just about pissed myself!

          • Just remembered; my first official 911 call after school with Jax Fire/Rescue: a domestic incident, with “injuries” (or so they said). Turns out, this poor woman had been shot at point-blank range in the head with a shotgun. All that was left of her head was the bottom half of her occipital skull. The rest was on the wall. We had clean-up duty.

    • I commented on this before. While I acknowledge that the field can be traumatic, and such comments might understandable in the heat of the moment, they are subject to strict liability if the patient or another third party becomes aware.

      I would think that if the clinical environment become so stressful that these comments become *necessary*, there are likely other organizational factors that ought to be addressed to allow a more comfortable, functioning professional environment.

  5. I hate to tell you all, but right or wrong, this is very, very commonplace. I think the record falsification, by itself, justified the suit, but the other stuff, I’m really on the fence. What these people said was terrible, granted, but imagine that you work in retail, or wherever, and it becomes illegal to not talk about your customer or client once they leave, or are around the corner out of earshot in your store. In a perfect world, this never happens. We want everyone to never utter harsh words about us to anyone else ever. When you are under general anesthesia, we have effectively “left the room”. How is compulsory taping of surgery is much different than having a recorder in your office, running for the duration of your professional interaction with a client?

    • Comparing doctors to retail employees is a poor example. Retail employees receive little formal training and often face abusive customers. and brain-dead managers may enforce the “customer is always right” beyond reason. Doctors, meanwhile, take years of coursework on ethics and psychology, and have access to numerous resources to improve their bedside manner and patient interactions. They even have the option to enter private practice for themselves if they feel their bosses are not responsive to their needs.

      But even in retail, customers still overhear occasionally, complain to management, and employees get fired. Or the customer never returns.

      • Yeah, we’re pretty frickin’ awesome ! I still haven’t mastered walking on water yet, having not yet graduated.

  6. Ah, so many thoughts about this one.

    First of all, I’ve had colonoscopies. When you are wheeled into the procedure room, you are laying on your side in a fetal position. The idea that the patient’s penis was in close proximity doesn’t hold together under these clinical conditions. (Of course, there are other anatomical items in close proximity, but these didn’t seem to interest the medical personnel. Go figure.)

    Secondly, I applaud the effort to require taping of medical procedures if requested. Maybe the medical personnel will be more diligent if they are under the videographic “microscope.” And for those patients who will suffer any kind of malpractice, this video could be key evidence, I would think. Also, once you find out that a particular medical practice, clinic, hospital, etc. treats patients so poorly, you can just change to a different medical institution. (Unless, of course, you live where these are few and far between, and laws could help prevent this kind of problem.)

    Third, the examples of the water cooler, the retail world, etc. don’t hold up in this case. Medical personnel are engaging in a truly intimate relationship with patients. The only people other than medical personnel whom we rightly allow to be so intimate with us are family members and close friends. (No, I’m not implying that ALL family members and friends are THIS intimate with us, but even a friendly hug is part of the intimacy spectrum.) This puts the handling of our physical persons on a different level. (Frankly, this is the same with psychiatrists and therapists who handle the intimate details of our psyches.) As far as I’m concerned, these medical personnel were AT THE VERY LEAST unethical.

    Granted that I work for the Catholic Church, I am expected to treat all with whom I come into contact with compassion, respect, and love. Do people have the right to let off steam in the workplace? Of course. These medical personnel chose the wrong way to let off steam. IMNSHO, this was an incident of abuse, pure and simple. No less than if a dentist fondles a patient who is under anesthesia. Or any number of other abuses inflicted when we are vulnerable.

  7. Just had a radical prostatectomy (sp?) last October. Now I’m wondering what the surgical team was doing while I slept through it.

  8. There are two different issues here: (1) whether the doctors’ conduct was ethical and (2) whether the plaintiff should receive a pile of money.

    I listened to the excerpt that the Washington Post article linked to. The discussion centered around the doctors’ opinion that the patient had been an obnoxious jackass in pre-op (apparently that he was a hypochondriac and a bossy know-it-all who did not in fact know what he was talking about) and their expectation that he was going to be an obnoxious jackass again in post-op. If he was in fact as bad as they thought, I don’t think it was wrong of them to say so to each other.

    The answer to the second question ought to depend on whether or not the plaintiff was harmed. Being angry or offended by the doctors’ comments does not qualify as harm in my view of things. Eavesdroppers always face the danger that they learn that other people have unflattering opinions of them. He could have stopped listening to the recording at any time.

    • It is not “eavesdropping”, because the doctors had no reasonable expectation of privacy during the surgery. In addition to the patient, regardless of his state of consciousness, surgeries are often open to various students and third parties. That no such third parties were known to be present is not relevant; it is a grossly inappropriate forum for the material discussed. If they had a legitimate need to reflect on what a jerk the patient was, they had a duty to do so in private.

      The patient was objectively harmed by their unprofessional conduct. To say that he could have “stopped listening at anytime” is false; as soon as he became partially aware of the doctor’s conduct at the beginning of the recording, he had an ethical obligation to himself and any loved one to listen to the whole thing to check for any evidence of physical harm. Their lack of professionalism negates the presumption of competence ordinarily afforded doctors.

      How else would he become aware of the FALSE diagnosis of hemorrhoids, had he not listened to the doctors discuss writing the false entry on his records. That, as you have now made me aware, the doctors believed he had HYPOCHONDRIAC tendencies would almost guarantee that he seek UNNECESSARY treatment by simply reading his post-op charts! hat they, in fact, caused no physical injury is of little credit; their conduct was malicious and grossly disturbing.

      The additional information you have provided would only seem to further implicate the offending doctors, rather than negate the legitimacy of the patient’s complaint and subsequent award.

      • Just the fact that they made a false entry/diagnosis on his medical chart is worthy of a malpractice suite. Might want to check into how seriously the AMA takes this. All parties involved could lose their licenses to practice over that, alone. This is serious stuff…it is NOT a joke. Just for instance, what if further surgery was scheduled to deal with the non-existent hemorrhoids? And the poor fool died on the table. Still funny? Still just black humor? I don’t think so.

      • Yeah, but I think intent matters here. The docs had no way of knowing he was recording, and I’m sure they wouldn’t have said this stuff if they did, in order to not hurt his feelings. Other than gun-decking the records (which justified all awards, IMHO), it sounds like this dude just needs some Vagisil.

        • See several posts on styrict liability, which applies here. You have every right to call anyone anything you like oin private, including racial slurs, mean personal remarks, the works, as long as it is restricted to the audience you intend and trust. Bad habit, that’s all. But if through chance or error, those words get to the wrong ears, you are just as accountable and just as legitimately held so as if you shouted the same bile using a megaphone. Bottom line, the insults hurt the doctor/patient relationship as well as the profession. You can’t blame the patient because he never suspected that he would be treated like this when he was helpless and unhearing.

          The rule of manners, fairness, respect and civility is not to say anything about someone that you wouldn’t say to his face.

          • “. Bottom line, the insults hurt the doctor/patient relationship as well as the profession”. No doubt about that, unfortunately. I also understand your point about the Golden Rule, and how it applies here.

    • In my opinion, it’s essentially eavesdropping, in that the bitchy, sexually-frustrated anesthesiologist had no idea, the guy was OCD and would record this, to be filed away with his nail clippings and such. Also, it’s safe to assume that whiny hypochondriasis will be potentiated by ketamine and Innovar (or Halothane, or Versed, or chloroform or diethyl ether on a rag or whatever). The award for butthurt seems disproportionate as hell.

  9. I’ve never falsified records, but I had a cure for crabs that I shared with my marines that wasn’t exactly from the Merck manual. I told them if they ever got crotch crickets, what they needed was a razor, lighter fluid, a lighter, and a fork. What they needed to do was shave half of their pubes off, then spray the lighter fluid on the other half. Next, they set their pubes on fire, and as soon as the little bastards come running out, start stabbing them with the fork. I promised them it would work every time.

    • Can you just imagine this: jarhead shaves his bush, lights it on fire, sound of burning bush crackling, smoke, jarhead sees crabs and starts furiously stabbing himself.

  10. Sorry about commandeering your sandbox tonight, Jack. I’m up catching up on overdue projects. Feel free to delete.

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