In April 2020, hospitalist Samantha Houston, MD, lost her job at Baptist Memorial Hospital–North, in Oxford, Mississippi, after she publicly campaigned to get donations of N95 masks for nurses. Houston filed a lawsuit against the hospital, saying she was improperly fired for speaking out. The lawsuit has not yet gone to trial.
In January 2017, emergency physician Raymond Brovont, MD, was fired by EmCare, an emergency physician staffing company, after reporting understaffing at hospitals with which it contracted in the Kansas City, Missouri, area. Brovont sued EmCare, and the company lost the case. In February 2019, it was ordered to pay him $13.1 million in damages.
These are just two of several cases in recent years in which physicians have spoken out about problems involving patient care and have been sanctioned. Other physicians who see problems choose to stay silent.
Doctors often hesitate to speak out because of the prospect of losing their jobs. A 2013 study of emergency physicians found that nearly 20% reported a possible or real threat to their employment if they expressed concerns about quality of care.
When physicians do not speak openly about important medical issues, the quality of care in their institutions suffers, says a co-author of the study, Larry D. Weiss, MD, JD, a retired professor of emergency medicine at the University of Maryland School of Medicine, Baltimore, Maryland.
“Physicians can’t effectively represent patients if they are always thinking they can get fired for what they say,” Weiss says. “If you don’t have protections like due process, which is often the case, you are less likely to speak out.”
The COVID-19 pandemic put to the test physicians’ ability to speak publicly about troublesome issues. In the first few weeks, healthcare facilities were struggling to obtain personal protective equipment (PPE) and to create policies that would keep patients and caregivers safe.
Doctors such as Houston took the initiative to make sure their institutions were taking the right steps against COVID-19 and found themselves at loggerheads with administrators who were concerned that their organizations were being portrayed as unsafe.
The Case of One Physician Who Spoke Out
One of the highest-profile cases of a physician speaking out and being removed from work during the pandemic is that of Ming Lin, MD, an emergency physician who lost a job he had held for 17 years at St. Joseph Medical Center, in Bellingham, Washington. Lin lost his job after he made a series of Facebook posts that criticized the hospital’s COVID-19 preparedness efforts.
In an interview with Medscape Medical News, Lin discussed the details of his situation to a degree that rarely occurs in such cases. This is one of the most extensive interviews he has granted.
Postings on Facebook
Lin says that on the basis of an intense study of the virus at the onset of the pandemic, he developed many ideas as to what could be done to mitigate its spread. He could see how others dealt with COVID-19 while working as a locum tenens physician on his time off.
Lin says from past experiences, he did not feel that he could present his ideas directly to administration and be heard, so he decided to air his ideas about how his hospital could handle COVID-19 on his Facebook page, which drew a large audience.
Lin says he was certain that hospital administrators were reading his posts. He says receptionists at this hospital were advised not to wear masks, evidently because it would alarm patients. Lin says he posted concerns about their safety and called for them to wear masks. Soon after, the hospital directed receptionists to wear masks.
Lin’s Facebook posts also criticized the hospital for taking what he felt was too long to get results on COVID-19 tests. “It was taking them up to 10 days to get test results, because samples were being sent to a lab in California,” he says. Lin says he suggested it would be faster to send samples to the University of Washington. Soon after, the hospital started sending samples there.
In just a couple of weeks, Lin says, he voiced almost a dozen concerns. Each time the hospital made changes in line with his recommendations. Although he didn’t get any direct acknowledgment from the hospital for his help, he says he felt he was making a positive impact.
How Employers React to Physicians Who Speak Out
Physicians who speak out about conditions tend to deeply disturb administrators, says William P. Sullivan, DO, JD, an emergency physician and lawyer in Frankfort, Illinois, who has written about physicians being terminated by hospitals.
“These physicians go to the news media or they use social media,” Sullivan says, “but hospital administrators don’t want the public to hear bad things about their hospital.”
Then the public might not come to the hospital, which is an administrator’s worst nightmare. Even if physicians think their criticisms are reasonable, administrators may still fear a resulting drop in patients.
Houston, for example, was helping her Mississippi hospital by collecting donations of N95 masks for nurses, but to administrators, it showed that the hospital did not have enough masks.
“It is not helpful to stoke fear and anxiety, even if the intent is sincere,” a spokesperson for the hospital said.
Administrator Fires Back
Lin’s posts were deeply concerning to Richard DeCarlo, chief operating officer of PeaceHealth, which runs St Joseph Hospital. DeCarlo discussed his concerns in a video interview in April with the blogger Zubin Damania, MD, known as ZDoggMD.
Comments on Lin’s Facebook posts showed that people “were fearful to go to the hospital,” he told Damania. “They were concluding that they would need to drive to another hospital.”
DeCarlo said he was also unhappy that Lin did not directly contact administrators about his concerns. “He didn’t communicate with his medical director,” DeCarlo said in the interview. “The ED staff had been meeting three times a week with the chief medical officer to make sure they had everything they needed, but he only attended one of these meetings and didn’t ask any questions.”
Lin maintains he did ask questions at the first meeting but stopped attending because he felt he wasn’t being heeded. “I found their tone not very receptive,” he says.
Doctor Allegedly Offered “Misinformation”
At the start of the pandemic, some hospitals made it clear what would happen to doctors who brought up lack of PPE or other problems to the media. For example, NYU Langone Medical Center, in New York City, sent an email to staff warning that speaking to the media without permission “will be subject to disciplinary action, including termination.”
PeaceHealth took a different tack. “It’s not that we have a policy that says don’t ever talk to the media,” DeCarlo said in the ZDoggMD interview, but in Lin’s case, “what was at issue was the misinformation. His leader went to him and said, ‘Look, you’re posting things that aren’t accurate.’ “
Lin disputes that he provided any misinformation. In the interview, DeCarlo cited just one example of alleged misinformation. He said Lin called for a tent outside the emergency department (ED) to protect patients entering the department from aerosol exposure to COVID-19. DeCarlo said the tent was not needed because fewer people were using the ED.
“To put it in an extreme way,” DeCarlo said of Lin’s posts, “it was like yelling fire in a theater where there is not a fire.”
Lin says the hospital did briefly erect a tent and then removed it, and he still insists that a tent was a good idea. He adds that DeCarlo never mentioned any of the other suggestions Lin made or state that the hospital adopted them.
Doctor Gets a Warning
Lin says after he started posting his concerns, he got a call from the emergency department director who worked for TeamHealth, an emergency medicine staffing firm that contracted with PeaceHealth and employed Lin, too.
Lin says his immediate supervisor at TeamHealth told him the hospital was unhappy with his posts and that he should take them down and suggested he might be fired. Lin says the supervisor also asked him to apologize to the hospital administration for this posts, but he refused to do so.
“Retracting and apologizing was not only wrong but would have left me vulnerable to being terminated with no repercussions,” he says.
“At that point, I realized I had crossed the Rubicon,” Lin says. He thought he might well be fired, no matter what he did, so he took his story to The Seattle Times, which had a much wider platform than his Facebook page had.
Lin lost his job at St. Joseph a week after The Seattle Times story about him appeared. “About 10 minutes before my shift was supposed to start, I received a text message from TeamHealth saying that someone else would be taking the shift,” he says.
In a release, TeamHealth insisted Lin was not fired and that he was scheduled to be reassigned to work at other hospitals. Lin, however, says he was not told this at the time and that he only found out later that the new assignment would involve a pay cut and a significant commute. He says he has not taken any new assignments from TeamHealth since he lost his job at St. Joseph.
Lin has filed a lawsuit against PeaceHealth, TeamHealth, and DeCarlo, asking for his job back and for an apology. He says he has not asked for any financial damages at this point.
Since leaving St. Joseph, Lin has been working as an administrator for the Indian Health Service in the upper plains states. He says he can do some of the work at home in Washington State, which allows him to be with his wife and three young kids.
Lin no longer sees patients. “I feel I have lost my confidence as a clinician,” he says. “I’m not sure why, but I find it hard to make quick judgments when taking care of patients.”
He says many doctors have told him about their own troubles with speaking out, but they did not want to come forward and talk about it because they feared more repercussions.
Do Doctors Who Speak Out Have Any Rights?
Because TeamHealth, Lin’s actual employer, asserts he was never actually terminated, Lin has not been able to appeal his case internally in accordance with due process, an option that allows doctors to get a fair hearing and to appeal decisions against them.
The American Academy of Emergency Medicine pointed out this problem. “Dr Lin, as a member of the medical staff, is entitled to full due process and a fair hearing from his peers on the medical staff,” it said in a statement supporting him.
The Joint Commission, the hospital accreditor, requires that hospitals provide due process to doctors before they can be terminated. However, Sullivan says employers often make physicians waive their due process rights in the employment contract. “The result is that the employer can terminate doctors for no reason,” he says.
In the 2013 survey of emergency physicians, 62% reported that their employer could terminate them without full due process.
When Weiss, the Maryland MD-JD, advises doctors on their contracts, he says he generally tells them to cross out the waiver language. The applicant, he says, may also tell the employer that the waivers are considered unethical by many physician professional societies. In some cases, he says, the hospital will back down.
Conclusion
To maintain quality of care, it is essential that physicians feel free to speak out about issues that concern them. They can improve their chances of being heard by working directly with management and attending meetings, but in some cases, management may be unwilling to listen.
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