Whistleblower Lawsuit Claims Misdiagnosis, Cover-Up At KU Hospital | KCUR

HM Epstein hmepstein at GMAIL.COM
Tue Aug 2 05:28:15 UTC 2016


I thought you might like to know the latest update on the original story.
Best,
Helene
Whistleblower Case Against KU Hospital Takes Unexpected Twist
http://kcur.org/post/whistleblower-case-against-ku-hospital-takes-unexpected-twist#stream/

*This story was updated at 2:16 p.m. to include the response of KU
Hospital.*

A University of Kansas Hospital pathologist’s lawsuit alleging the
hospital’s chief pathologist misdiagnosed a patient as having cancer and
subsequently covered it up has taken a strange new turn.

On Friday, the plaintiff, Dr. Lowell L. Tilzer, voluntarily dismissed his
whistleblower action against the hospital, saying he “believes further
litigation of this claim is not necessary to protect him from retaliation
at this time.”

But in an unorthodox addendum to the filing, Tilzer appended a statement
from the unidentified patient who was allegedly misdiagnosed.

The statement says that the patient believes he or she is the person
referred to in the lawsuit.

“I did not know about the lawsuit until Tuesday, July 26, 2016 when my
surgeon at KU called me and asked me to sign an Affidavit about my
surgery,” the statement says. “The Affidavit exonerated the hospital from
any responsibility for the actions alleged in Dr. Tilzer’s lawsuit.  I was
concerned about why I was being asked to sign the Affidavit, and my
subsequent research uncovered the existence of the lawsuit.

“I do not know who wrote the Affidavit, but I did not give the hospital
permission to share my medical information with the person who wrote the
Affidavit.  I have no direct knowledge of the actions of the physicians
alleged in the lawsuit, but I will not sign the Affidavit and I am
exploring my options regarding the circumstances of my diagnosis and
surgery.”

The statement goes on to say that the patient would not have known that his
or her surgery was unnecessary but for the filing of the lawsuit and the
presentation of the affidavit.

“I appreciate Dr. Tilzer’s concern for me and I wish him the best.  I want
to remain anonymous, but you may use this statement as long as my name is
not disclosed,” the statement concludes.

In a brief statement over the weekend, Tilzer said, “I just want to say the
patient’s gratitude is all I need. I just want to keep doing my job.”

Tilzer’s voluntary dismissal of his lawsuit came just a couple of days
after KU Hospital moved to throw out the case, saying it contained
“knowingly false statements regarding patient care at the University of
Kansas Medical Center.”

“Tilzer knowingly misrepresented facts regarding a particular patient’s
care in an effort to defame the Hospital Authority and his fellow
physicians, and to attempt to extract additional compensation or financial
benefits to facilitate his retirement,” the motion stated.

Beyond accusing Tilzer of defamation, the filing said that the case had to
be dismissed because a Kansas law exempts the hospital from the provisions
of the Kansas whistleblower statute – the law under which Tilzer filed his
lawsuit.

A statement released by KU Hospital this afternoon said, "As we indicated
from the start, there was no merit to the lawsuit. We are pleased it was
voluntarily dismissed by Dr. Tilzer after it was clearly demonstrated the
lawsuit had no factual or legal merit."

The statement said that the hospital had "followed our routine practice for
surgeons to fully inform patients of their diagnoses and treatments."

"In order to respect our patient’s privacy, it would be inappropriate for
us to discuss specifics of any patient situation," the statement said.

Tilzer filed his lawsuit just four weeks ago. A former chief of pathology
at KU Hospital who is still on staff, he claimed the hospital threatened to
retaliate against him after he tried without success to get it to
acknowledge its alleged error and then took his complaint to the Joint
Commission, the entity that accredits and certifies hospitals.

After he did so, Tilzer claimed that KU Hospital President and CEO Bob Page
asked him if he wanted to resign, berated him for contacting the Joint
Commission, accused him of lying to the commission and described his report
to the commission as “pitiful” and “despicable” behavior.

Tilzer said he learned of the misdiagnosis sometime in 2015 after the
patient’s organ was removed and an examination of tissue samples revealed
that it was not cancerous. He said the pathology chair, who had diagnosed
the patient, then proceeded to cover up her mistake.

The lawsuit does not identify the pathology chair, but the position is
occupied by Dr. Meenakshi Singh, who became chair in May 2015 when Tilzer
stepped down.

Nor does the lawsuit identify the organ that was removed, but its reference
to acinar cells and islet cells makes it clear that it was the patient's
pancreas.

Pancreatic cancer is often difficult to tell apart from chronic
pancreatitis, an inflammatory disease of the pancreas, and the misdiagnosis
may have had to do with confusing the one with the other. Both diseases
produce similar symptoms, but pancreatic cancer is life threatening.

Asked to respond to the lawsuit last month, KU Hospital initially declined,
then released a brief statement saying it did not believe the lawsuit “to
be grounded in truth.”

It said the patient was “fully informed of the diagnosis and treatment plan
after surgery and prior to leaving the hospital, and is pleased with the
care and clinical outcome.”

*Dan Margolies, editor of the Heartland Health Monitor team, is based at
KCUR. You can reach him on Twitter **@DanMargolies*
<http://twitter.com/DanMargolies>*.*


On Sat, Jul 9, 2016 at 6:29 PM, Sanders, Lisa <lisa.sanders at yale.edu> wrote:

> I think the difference between your and my perspective, Peter, and that
> which supports saying as little as possible comes down to the relationship
> between the doctor and the patient. As a primary care doc, we have an
> ongoing relationship with the patient and all the thinking we do about that
> patient is likely to come in handy at some future date.
>
>
>
> (And I love how you write your note with the patient in the office and
> share it with them both as you write it and as they are leaving. It’s
> something I am trying to incorporate into my own practice.)
>
>
>
> However, doctors who see a patient only once, or who never see the patient
> him/herself and only see the image, or the tissue, may feel comfortable
> documenting only the basics of what they did or didn’t see, what they did
> or didn’t do. Because there’s a good chance that they will never see the
> patient again. And they are usually not charged with the care of the entire
> patient but with a single problem or system.
>
>
>
> Beyond that, I don’t make choice about how to treat my patient or how to
> document them based on concerns about being sued. There about a 7% chance I
> will be sued for malpractice at some point in my career. As far as I can
> tell, evidence suggests that the best way to reduce that chance is to do as
> good a job as you can, be kind and speak honestly to your patient. As it
> turns out, all of those qualities are important to me because it makes my
> life as a PCP better. If (when?) I do get sued – something I’m not looking
> forward to by any means – I’m sure it will feel bad; my feelings will be
> hurt and may make me wonder -at least at that moment -  about my career
> choice.  But the risk of being sued is why we carry malpractice insurance.
> We cannot let it shape our relationship with our patients. Or their charts.
>
>
>
> We teach our residents to document not just their plan but their thinking
> in all their notes. The thought that goes into our decisions is part of the
> care we provide.
>
>
>
> Lisa
>
>
>
> *From:* Elias Peter [mailto:pheski69 at GMAIL.COM]
> *Sent:* Saturday, July 09, 2016 2:10 PM
>
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Whistleblower Lawsuit Claims Misdiagnosis,
> Cover-Up At KU Hospital | KCUR
>
>
>
> I strenuously disagree with this part:
>
>
>
>  In addition, I see no purpose in documenting  your own thought processes
> and explanations as to why you have decided to do,  or not to do,  in the
> way of treating patient Y.   *The less you write, the better.*
>
>
>
>
>
> Veni, vidi, vici is a great bumper sticker quote for the memoirs of a
> commander. It is not an appropriate mindset for recording a complex
> collaborative process between a patient and a clinician. The reason for
> documenting not just what the clinician does, but what information she
> uses, what decisions she made, and why she made them is simple: it is
> better care.
>
>
>
> I don’t think of the medical chart or EHR as my private journal or as a
> legal document for billing and litigation.I evolved in my primary care
> practice to using the record as a collaborative tool with patients to
> record the information (history, exam, other tests) we used, how we
> assessed the information, what we decided to do, and why. I gave them a
> copy at the conclusion of the visit.  The plan included ‘to do’ items for
> both of us. Patients remember ~ 50% of what they are told in an office
> visit. Our memories are incomplete and porous: we are more likely to
> remember what we wished we said or thought than what actually happened.
> (Ask yourself: what did you wear last Saturday and what did you eat for
> breakfast a week ago today? Do you really think you can accurately remember
> why you started Mr. Jones on lisinopril 10 mg rather than a different med
> or a different dose 2 years from now?) Our memories are not fixed, but are
> altered every time we access them. A patient may need the collaborative
> document to explain to a family member what they are doing and why. I know
> that **I** need it three months later to determine why I treated a given
> patient in a given way among multiple options. It also helps my nurse and
> my colleagues and consultants share in the care of the patient when I am
> unavailable.
>
>
>
> Advising clinicians to say as little as possible sounds frighteningly like
> the advice given before a deposition: “Answer yes, no, I don’t know, or
> could you please repeat the question. Don’t give them any extra information
> because they will use it to trip you up or undermine our case." It comes
> across to me (perhaps not meant this way) as ‘Here is what I think you
> should do and I don’t need to explain myself.’  I don’t see or do medical
> care as an adversarial or authoritarian process.
>
>
>
> I wouldn’t see or refer to a clinician who refused to document his or her
> thinking.
>
>
>
> Peter
>
>
>
>
>
> On 2016.07.09, at 1:38 PM, Leonard Berlin <lberlin at LIVE.COM> wrote:
>
>
>
> I agree with David Shapiro's comments, but would like to further address
> some thoughts to Lisa and Peter:
>
> Let's refer to the (alleged) famous words of Julius Caesar in 47 BC:  "*Veni,
> Vidi, Vici*:" " I came, I saw, I conquered."
>   Short, no more, no less,  to the point, sufficient!
>
> I suggest that the modern medical version of these words that are entered
> into an EHR should be similar:
>    "I saw Dr. X, I discussed patient Y with Dr. X, I treated patient Y."
> Likewise, short, no more, no less, to the point, sufficient!
>
> The *facts* are that  you saw Dr. X, you discussed patient Y with him (or
> her), and then you proceeded to treat patient Y.  End of facts. Stop
> there.
>
> I am very reluctant to disagree with Lisa, whose superb column I read
> regularly in the *New York Times Sunday Magazine*, but I personally do
> not see any need to include in the EHR   what Dr. X said, what you said,
> and what you thought; indeed, in my opinion doing so could be
> counterproductive. As I mentioned previously, Dr. X's memory of the
> conversation may well be different from your memory of the conversation.
> In addition, I see no purpose in documenting  your own thought processes
> and explanations as to why you have decided to do,  or not to do,  in the
> way of treating patient Y.   *The less you write, the better.*  Should
> there be an untoward result from your  treatment of the patient and a
> malpractice lawsuit is later filed, numerous experts will review the
> record, and likely several may, after reading every word that you wrote, in
> hindsight  be extremely critical of what you wrote.  By not having written
> your thought processes in the EHR at the time,  you can honestly
> explain several years later what you remember to the best of your memory
> your thought processes at the time of treatment.   The same relates to what
> you *remember * at best in retrospect exactly what consulting Dr. X said,
> instead of having actually written in the EHR what Dr. X said at the time.
>
> Anyway, these are simply my own thoughts and opinions.....
>
> Lenny Berlin
> ------------------------------
>
> Date: Sat, 9 Jul 2016 14:48:29 +0000
> From: lisa.sanders at YALE.EDU
> Subject: Re: [IMPROVEDX] Whistleblower Lawsuit Claims Misdiagnosis,
> Cover-Up At KU Hospital | KCUR
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>
> Peter,
>
>
>
> I am usually an avid consumer of these list serve discussions but I want
> to add my voice to this one. As a general internist, it is not unusual for
> me to seek specialist input on a diagnosis or plan of action. I agree with
> Lennie that it is appropriate and even necessary to include the fact that
> the advice sought and obtained before making a decision in the note.
>
>
>
> I would go further however. I think it would be useful to document what
> part of the discussion influenced the decision made. At least then it
> becomes clear what the thinking behind the assessment or the decision was.
> In doing this you are not reporting what the consultant felt or thought but
> what s/he said and your understanding of the recommendation. Any
> conversation with a consultant where the only take away is agreement with
> your existing assessment or plan was probably not very useful.
>
>
>
> At the very least the reason for seeking this other opinion should be
> documented. One of the most common reasons I have for reaching out to
> another specialist – particularly radiology or pathology - is to clarify or
> expand upon the written report. Presenting additional information about the
> patient and the clinical scenario has been shown to help the specialist
> make better recommendations. If the outcome of that interaction was simply
> a better understanding on my part of what the reading means, I think its
> sufficient to simply say that the results were reviewed with that
> consultant. If however the conversation prompts me, or the specialist to
> change our thinking, that needs to be documented. Preferably by both of us,
> but at least by me. Because it has played a role in what I’m thinking and
> what I’m doing.
>
>
>
> The purpose of a note is to not only document what is being done but why
> it’s being done. To the extent that the advice given shapes these component
> then that advice and thinking it should be documented.
>
>
>
> I haven’t been in the habit of cc’ing the consultant on my referral to
> his/her advice but perhaps I should be.
>
>
>
> Lisa
>
>
>
> Lisa Sanders M.D.
>
> Associate Professor
>
> Yale School of Medicine
>
>
>
> Clinician Educator
>
> Yale Internal Medicine Primary Care Residency
>
> Yale New Haven Hospital, St. Raphael’s Campus
>
> 1250 Chapel St.
>
> New Haven, CT 06511
>
> Office: 203-867-8117
>
>
>
> *From:* Elias Peter [mailto:pheski69 at GMAIL.COM <pheski69 at GMAIL.COM>]
> *Sent:* Friday, July 08, 2016 9:38 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Whistleblower Lawsuit Claims Misdiagnosis,
> Cover-Up At KU Hospital | KCUR
>
>
>
> As a PCP, it was not rare for me to discuss an issue with more than one
> consultant. They did not always agree.
>
>
>
> I was taught to phrase it: “After discussion with Dr. X (or Drs. X and Z),
> my plan is…”  I can’t claim I always did this.
>
>
>
> The times I felt it appropriate to specify the advice I received, were
> those occasions where the advice was what to do between the time of the
> discussion and the time the patient saw the consultant, in which case I was
> as specific as possible and made sure a copy was sent to the consultant.
>
>
>
> It’s hard for me to imagine a rule that will apply perfectly in every
> circumstance.
>
>
>
> Peter
>
>
>
>
>
> On 2016.07.08, at 11:19 AM, Leonard Berlin <lberlin at LIVE.COM> wrote:
>
>
>
> David,
>
>
>
> There may be some middle ground here.  *My objection  deals not with the
> first half of your sentence:* * "I **have reviewed the case with Dr X, Y,
> and Z*," which in itself does, as you say, documents what *YOU did *and
> with whom you consulted, in reaching *your conclusions.*  Up to that
> point, you are reporting actual facts.  I see nothing unethical or morally
> wrong with that.  *My objection deals with your additional phrase, "they
> agree with my assessment.”*  Here is where I believe we get into very
> questionable territory, as you are essentially putting words in their
> mouths that they may have,  or may not have,  spoken.  Two people can have
> a discussion, and can walk away with different opinions as to what was
> said, (see below) or what was meant by what was said; this happens not
> infrequently, and is not due to dishonesty:  it's due to human nature. We
>  talk to someone, and our interpretation and memory of what exactly was
> said simply differs from what the other party remembers and interprets what
> was said.
>
>
>
> In my opinion, there is nothing wrong in stating fact  number one  -- you
> spoke to Dr. X.  After speaking with X, you went ahead and did, or did not
> do, something medically.  That's fact number two.  Maybe Dr. X encouraged
> you to do what you did, maybe he agreed with you reluctantly, maybe he
> actually disagreed somewhat.  X's recollection of what he said or meant may
> well be different from you thought he said or meant.  You may be honest,
> but simply misinterpreted the meaning of his words.  Happens all the time!
>
>
>
> In short, mentioning that you spoke to Dr. X is factual and may well
> belong in the EHR.  But what Dr. X said, or inferred, or suggested, or
> meant, does not belong in the EHR, unless he himself co-signs the record.
>
>
>
> Finally, let me add the following for your consideration:
>
>
>
> From *Golub. JAMA 1998;280:929*. *Curbstone Consultations:* "A physician,
> who is in a noisy, crowded hallway enroute elsewhere, or is button-hold
> outside his office, i.e. "on the curb," may be distracted from offering the
> kind of thoughtful opinion that may come from a formal consultation or
> thorough discussion."
>
>
>
> From* Anonymous*:  First old gentleman:  Is this Wembley?
>
>                                     Second old gentleman:  No. Thursday.
>
>                                      First old gentleman:  You are?  Let's
> go and have a drink.
>
>
>
> Lenny
>
>
>
>
> ------------------------------
>
> Date: Fri, 8 Jul 2016 13:07:59 +0000
> From: d.katz at MAIL.UTORONTO.CA
> Subject: Re: [IMPROVEDX] Whistleblower Lawsuit Claims Misdiagnosis,
> Cover-Up At KU Hospital | KCUR
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>
> Helene - I am not aware of anyone who has abused this but would imagine it
> would be rather easy if one was dishonest.
>
> Leonard - I'm not really sure how as an MRP I could possibly avoiding
> putting other doctors names (either directly or indirectly i.e. Discussed
> with cardiologist on call) in my notes and have them be complete. I
> practice in Canada where the fear of lawsuit is much less but regardless we
> use notes primarily as a communication tool amongst physicians. When I
> consult other services not in house in the middle of the night and have a
> phone conversation I know that they are not going to have a dictated note
> in the system by the morning and the only way that the people taking over
> in the morning will be aware of this conversation is by including it in my
> note. In my opinion I would be unnecessarily compromising patient care to
> never document these conversations because it identifies another physician.
>
> Another example would be trainees who discuss with their staff over the
> phone. In my opinion it is very important to include in their notes that
> they have discussed a case with their attending. This information is key in
> both a legal sense and to relay to other services that this is more than an
> R1 opinion.
>
> I could come up with a million more examples. I don't see how mentioning
> other physicians and their opinions in notes is avoidable while maintaining
> a complete medical record.
>
>
> On Jul 8, 2016, at 8:31 AM, Leonard Berlin <lberlin at LIVE.COM
> <lberlin at live.com>> wrote:
>
> David,
>
> I'm sorry to say this, but in my strong opinion, your policy of writing a
> note that states “I have reviewed the case with Dr X, Y, and Z and they
> agree with my assessment,”  is unethical and morally wrong!  Your note (and
> it's the same thing when a radiologist renders a radiographic
> interpretation) should reflect YOUR opinion, and YOUR OPINION ONLY!  If Dr.
> X, Y, or Z want to join you in sharing a common opinion, fine, let them do
> so by co-signing the report or EHR entry.   Otherwise, I do not believe you
> have the right to use a colleague's name in YOUR note or report. Even if
> you ask a colleague's opinion as to whether you can include his or her name
> in one of your notes or reports, that colleague would be hurting him- or
> her self by saying "yes," because the words you use would be YOUR words,
> and not THEIR words, which may coincide or may not coincide (either
> deliberately or inadvertently) with each other's.
>
> As for EHRs, I believe every medical facility should establish a policy
> that prohibits a physician from stating that  another physician agrees (or
> disagrees) with the writer's opinion.  However, of course, should the other
> physician wish to be included by  co-signing the entry, that would be
> permitted.
>
>
>
> Lenny Berlin MD, FACR
> ------------------------------
>
> Date: Fri, 8 Jul 2016 00:03:54 -0400
> From: hmepstein at GMAIL.COM <hmepstein at gmail.com>
> Subject: Re: [IMPROVEDX] Whistleblower Lawsuit Claims Misdiagnosis,
> Cover-Up At KU Hospital | KCUR
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> <IMPROVEDX at list.improvediagnosis.org>
>
> Thank you, David. It's interesting because once something is in writing,
> it takes on a power that is hard to dispel. Think of all of the news
> articles that misstate studies, or overstate them and then the public
> believes them for years. A record that states that you discussed a case
> with Drs. X, Y & Z is admissible in court and probably more powerful than
> those doctors' memories that they did or didn't discuss it with you. While
> I'm certain you've never abused this kind of note-taking, do you think
> others have? Best,
>
> Helene
>
>
> hmepstein.com
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__hmepstein.com_&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=Z-Z9POVh49mMfKucjKB6-cJACEDwkUprJykZD3tO3Mo&s=N7TWfhhFN94umnAJR0smV90holBw3va3sXKBURfgb5s&e=>
>
> @hmepstein
> <https://urldefense.proofpoint.com/v2/url?u=https-3A__twitter.com_hmepstein&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=Z-Z9POVh49mMfKucjKB6-cJACEDwkUprJykZD3tO3Mo&s=1pYaHC9pgbgrx-L9-hpsQd2O2hwBfQtHVM-8Tm_lo28&e=>
>
> Mobile: 914-522-2116
>
>
>
> On Wed, Jul 6, 2016 at 10:54 AM, David Katz <d.katz at mail.utoronto.ca>
> wrote:
>
> Helene,
>
>
>
> While there is strong security to avoid people surreptitiously logging in
> as someone else, in the systems that I use there is nothing stopping you
> from dictating a note that says “I have reviewed the case with Dr X, Y, and
> Z and they agree with my assessment.” In fact I do this truthfully all the
> time. Those doctors are not notified in any way that their name is used and
> only if they happen to read my note would they know that I used their names.
>
>
>
> David
>
>
>
> *From: *HM Epstein <hmepstein at GMAIL.COM>
> *Reply-To: *Society to Improve Diagnosis in Medicine <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, HM Epstein <hmepstein at GMAIL.COM>
> *Date: *Wednesday, July 6, 2016 at 10:27 AM
> *To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>
>
> *Subject: *Re: [IMPROVEDX] Whistleblower Lawsuit Claims Misdiagnosis,
> Cover-Up At KU Hospital | KCUR
>
>
>
>
>
> Thank you all who addressed my questions about security in EMR's as
> related to the article I shared. Given the level of security and passwords
> that most of you have mentioned are in place at your institutions, I wonder
> how this pathologist at KU Hospital was able to add to the record that two
> doctors concurred with her diagnosis when they hadn't. And how they were
> cited in the record without knowing. If it's as difficult as most of you
> say, then I wonder whether or not the whistle blower is wrong about these
> two doctors and if perhaps they just changed their story when they realized
> the original diagnosis was incorrect.
>
>
>
> As to the question regarding whether this case was an outlier or a more
> common occurrence, my question was about the hospital's active role in
> denying any misdiagnosis and supporting the pathologist who covered her
> tracks. Retaliation is a big juicy topic but is just one more example of
> how a hospital or medical center can cover their tracks.
>
>
>
> Peter Dayton's reference to the CRP and the subsequent change in captain
> and copilot culture brings up an excellent point. That happened because
> there were too many instances of danger to passengers because of pilot
> error or misbehavior.
>
>
>
> Does medicine needs a similar change in culture when it comes to openly
> admitting mistakes, changing the processes by which staff can report these
> mistakes and the administration investigate and improve procedures? Or, for
> the most part, is the culture already changing and KU Hospital is an
> outlier?
>
>
>
> Best,
>
> Helene
>
>
>
> *-- *
>
> *hmepstein.com
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__hmepstein.com_&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=Z-Z9POVh49mMfKucjKB6-cJACEDwkUprJykZD3tO3Mo&s=N7TWfhhFN94umnAJR0smV90holBw3va3sXKBURfgb5s&e=> *
>
> *@hmepstein*
>
> *Mobile: 914-522-2116 <914-522-2116>*
>
>
>
> *Sent from my iPhone*
>
>
>
>
>
>
> On Jul 4, 2016, at 5:12 PM, Peter Dayton MD <pdayton at COMCAST.NET
> <pdayton at comcast.net>> wrote:
>
> Ed you are right ! Ego and the old code of silence is part of our culture.
> Hope we can change that like they did in the airline industry. After the
> disaster in Tenerife the industry got serious about cockpit resource
> management or CRP. That changed the Captain- Co Pilot role interaction
>  which helped in great part to make airlines a high reliability
> institution.
>
>
>
> Peter M. Dayton MD
>
> Medical Director of Patient Safety and Quality
>
> Martin Health Systems
>
> 1815 Kanner Highway
>
> Stuart FL 34994
>
> 772-285-4020 cell
>
> 772-288-2999 fax
>
> 1 Peter 3:15
>
>
>
> *From:* Edward Winslow [mailto:edbjwinslow at gmail.com
> <edbjwinslow at gmail.com>]
> *Sent:* Monday, July 4, 2016 3:04 PM
> *To:* Society to Improve Diagnosis in Medicine <
> IMPROVEDX at list.improvediagnosis.org>; Peter Dayton MD <pdayton at comcast.net
> >
> *Subject:* Re: [IMPROVEDX] Whistleblower Lawsuit Claims Misdiagnosis,
> Cover-Up At KU Hospital | KCUR
>
>
>
> As Peter noted, if passwords are kept private (A Cultural norm?), adding a
> signature is impossible in most EMRs. In the "big" EMRs, I think that every
> time a chart is accessed the accessor and time of access are stamped.
>
> While I would hope that systems and physicians are above retaliation I
> have seen several instances where people who place an institution in an
> unfavorable light are retaliated against. Even in systems that are supposed
> to be well-intentioned and patient centric, instances come about. One
> physician who presented a paper on a single institution errors in
> echocardiographic diagnoses was let go. The institutional reps said that
> there were multiple reasons why she was let go, but the ball dropped very
> shortly after the ASE presentation. (
> http://www.medpagetoday.com/cardiology/atherosclerosis/24337
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.medpagetoday.com_cardiology_atherosclerosis_24337&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=Z-Z9POVh49mMfKucjKB6-cJACEDwkUprJykZD3tO3Mo&s=ez9AI7IMAEuiPcp4dBhzD_YzfyJBwDgkYPTehpbFz28&e=>).
>
>
> I would estimate that, unfortunately, retaliation is not as uncommon as we
> would hope it would be. Certainly the lay public doesn't know if, or how
> often it occurs.
>
>
>
> On Mon, Jul 4, 2016 at 9:08 AM, Peter Dayton MD <pdayton at comcast.net>
> wrote:
>
> This whole line of discussion seems to be at odds with a Just Culture. Sad
> to see administrators and colleagues behaving in such a way.  The EMR
> secures physicians signatures and if there are appropriate security measure
> where passwords are not know by anyone but the licensee it should not be
> possible to sign someone else’s signature on a report. Again that is more a
> function of password security and security policy than the EMR. Our IT
> people force a reset every 90 days for access to our EMR which drives me
> nuts but it is a necessary evil.
>
>
>
> I am very aware of Dr. Rand’s case and the issues of expert testimony in
> med mal cases. I have been doing expert work for many years and the
> disciplinary process the respective professional societies are imposing is
> designed to stop egregious statements made in front of lay juries by expert
> witnesses.  The position of the societies is that their reputation is on
> trial as well as the experts always are certified by their respective
> boards and present their opinions to lay juries as a member of the
> respective societies. After practicing OB for 27 years and looking at
> dozens of cases some experts give a fair and honest opinion and some say
> outrageous statements inconsistent with medical evidence. I was once
> accused of missing the diagnosis of IUGR on a 16 week ultrasound,
> understanding that fetal growth is very uniform in the first half of
> pregnancy so a supposed missed diagnosis is in fact an appropriate
> assignment of gestational age in a patient with irregular menses. There are
> several notorious “experts” well known to both the plaintiff and defense
> bar. Tort lawyers have a short list of go to experts on various cases. That
> is why my work has evolved into 10% plaintiff and 90% defense work. I call
> it as I see it. Defense counsel like me to look at cases so they know it
> their client has exposure and should settle because in my experience a lot
> of cases have real standing unfortunately. The American Congress of OB/GYN
> has a “Witness Affirmation Statement “ and has a code of ethics :
>
>
>
> *Expert Witness Conduct and Responsibilities*
>
> Fellows who serve as expert witnesses for either the plaintiff or
> defendant are expected to adhere to the professional principles outlines in
> ACOG's *Expert Witness Affirmation*, available on the ACOG website.  In
> brief, ACOG expects Fellows testifying as expert witnesses to:
>
> ·        Tell the truth.
>
> ·        Evaluate all facts and medical care thoroughly, fairly, and
> impartially.
>
> ·        Include all relevant information.
>
> ·        Limit evidence and testimony to subjects about which they have
> knowledge and relevant experience.
>
> ·        Refrain from criticizing or condemning care that meets generally
> accepted standards in use at the time of the incident.
>
> ·        Refuse to endorse practice that does not meet generally accepted
> standards.
>
> ·        Ensure that testimony is complete, objective, and scientifically
> based.
>
> ·        Strive to provide evidence that will help the court achieve a
> fair outcome.
>
> ·        Distinguish between an adverse outcome and substandard care.
>
> ·        Make an effort to determine whether alleged substandard care
> caused the adverse outcome.
>
> ·        Submit testimony for peer review if asked.
>
> ·        Refuse to accept compensation that depends on the outcome of the
> case.
>
> If you are currently involved in litigation or if you are sued in the
> future, be sure your attorney knows about ACOG's *Expert Witness
> Affirmation*.  If an expert witness testifies on your behalf, he or she
> should sign the affirmation.  Your attorney can use the affirmation to
> bolster the expert's qualifications and credibility.  If the plaintiff's
> expert witness has not signed the *Expert Witness Affirmation*, your
> attorney can raise this in cross-examination.  If the plaintiff's expert
> witness has signed the affirmation, your attorney can, nevertheless,
> cross-examine on the expert's failure to adhere to the affirmation's
> requirements.
>
> Other societies have similar processes. This does break down when a formal
> complaint is made by members to the college about an expert’s testimony. A
> formal sanction or reprimand for egregious statements will hold physicians
> accountable and in effect take them out of the “hired gun loop” . I files
> such a claim many years ago and it went nowhere.
>
>
>
>
>
> Peter M. Dayton MD
>
> Medical Director of Patient Safety and Quality
>
> Martin Health Systems
>
> 1815 Kanner Highway
>
> Stuart FL 34994
>
> 772-285-4020 cell
>
> 772-288-2999 fax
>
> 1 Peter 3:15
>
>
>
> *From:* Lee Tilson [mailto:lee.tilson at GMAIL.COM]
> *Sent:* Sunday, July 3, 2016 6:37 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Whistleblower Lawsuit Claims Misdiagnosis,
> Cover-Up At KU Hospital | KCUR
>
>
>
> No, not that I know of.
>
> Have you heard of how the American Assoc of Neurosurgeons retaliated
> against Dr. Robert Rand? Or other neurosurgeons? Or how a chair that tried
> to get rid of a fraudulent doctor was punished? Retaliation occurs all the
> time. Details and circumstances are different. The goal and effect is the
> same: silencing whistleblowers.
> Feel free to call.
> Lee Tilson.
> 313 550 7500
>
>
>
> On Sun, Jul 3, 2016, 6:24 PM HM Epstein <hmepstein at gmail.com> wrote:
>
> Thanks, Lee. Beyond the retaliation angle, how easy is it for one doctor
> to insert the names of other doctors into an EHR indicating they "concur"
> with a Dx without the other doctors knowing or agreeing? Has anyone heard
> of this happening before?
>
>
> hmepstein.com
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__hmepstein.com_&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=Z-Z9POVh49mMfKucjKB6-cJACEDwkUprJykZD3tO3Mo&s=N7TWfhhFN94umnAJR0smV90holBw3va3sXKBURfgb5s&e=>
>
> @hmepstein
> <https://urldefense.proofpoint.com/v2/url?u=https-3A__twitter.com_hmepstein&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=Z-Z9POVh49mMfKucjKB6-cJACEDwkUprJykZD3tO3Mo&s=1pYaHC9pgbgrx-L9-hpsQd2O2hwBfQtHVM-8Tm_lo28&e=>
>
> Mobile: 914-522-2116
>
>
>
> On Sun, Jul 3, 2016 at 5:25 PM, Lee Tilson <lee.tilson at gmail.com> wrote:
>
> I am familiar with a few instances of retaliation against people  who
> attempted to expose misdiagnosis or mistreatment.
>
>
>
> The circumstances were somewhat different. The underlying story is the
> same.
>
>
>
> Feel free to contact me if you think this would be helpful.
>
>
>
> Lee Tilson
>
>
>
> On Sat, Jul 2, 2016 at 2:34 AM, HM Epstein <hmepstein at gmail.com> wrote:
>
> Please read the following summary and I'd appreciate the group's feedback.
>
>
>
> The former chair of pathology at KU Hospital filed a whistleblower lawsuit
> against his current hospital claiming the current head of pathology
> misdiagnosed a patient with a lethal form of cancer, surgeons removed an
> unidentified organ, the lab discovered that the removed organ was
> essentially cancer-free, and then that the pre-surgery sample was also free
> of cancer, covered it up and never told the patient who still thinks they
> have to be on guard against a lethal form of cancer.
>
>
>
> The paragraph I would like your opinion on is deep in the article:
>
>
>
> "In September, Tilzer informed KU Hospital’s chief medical officer and
> risk management officer that the hospital needed to conduct a “root cause
> analysis” of the mistake to make sure it wouldn’t happen again. The chief
> medical officer responded that the original diagnosis was correct because
> two other pathologists signed the report. But Tilzer says the two other
> pathologists did not agree with the original diagnosis, “and the chair
> simply wrote their names in the electronic medical record.”"
>
>
>
> First, is it easy for one doctor to fake the signatures of other doctors
> in the EMR without being discovered? And while the accused pathologist
> finally admitted her error, it appears the hospital hasn't done so nor had
> the patient been notified. Therefore no root cause analysis has been done.
>
>
>
> So, is this a crazy outlier situation or is it a common occurrence?
>
>
>
> Thank you.
>
>
>
> Best,
>
> Helene
>
>
>
>
> http://kcur.org/post/whistleblower-lawsuit-claims-misdiagnosis-cover-ku-hospital#stream/0
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__kcur.org_post_whistleblower-2Dlawsuit-2Dclaims-2Dmisdiagnosis-2Dcover-2Dku-2Dhospital-23stream_0&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=Z-Z9POVh49mMfKucjKB6-cJACEDwkUprJykZD3tO3Mo&s=Ucb2zBo73lnUyObvqWnvOSXR-NVgU5iD0TdEF8LzRDU&e=>
>
>
>
> *-- *
>
> *hmepstein.com
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__hmepstein.com_&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=Z-Z9POVh49mMfKucjKB6-cJACEDwkUprJykZD3tO3Mo&s=N7TWfhhFN94umnAJR0smV90holBw3va3sXKBURfgb5s&e=> *
>
> *@hmepstein*
>
> *Mobile: 914-522-2116 <914-522-2116>*
>
>
>
> *Sent from my iPhone*
>
>
>
>
>
>
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> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.improvediagnosis.org_&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=Z-Z9POVh49mMfKucjKB6-cJACEDwkUprJykZD3tO3Mo&s=rdUYUv1VRfC4jwc1Fpnyf8958nIZQ4J7ORkI_VaQCZM&e=>
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>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.improvediagnosis.org_&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=Z-Z9POVh49mMfKucjKB6-cJACEDwkUprJykZD3tO3Mo&s=rdUYUv1VRfC4jwc1Fpnyf8958nIZQ4J7ORkI_VaQCZM&e=>
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> To unsubscribe from IMPROVEDX: click the following link:
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>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.improvediagnosis.org_&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=aHG6XseIYSAre4Ep31qeod0zvRpz2Q57dzQao2hjo0c&s=l7iKOvPRGVsbxM67I1HvA67-jcbMfm5Jjd9D_gk4P1Y&e=>
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> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
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> <https://urldefense.proofpoint.com/v2/url?u=http-3A__list.improvediagnosis.org_scripts_wa-2DIMPDIAG.exe-3FINDEX&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=aHG6XseIYSAre4Ep31qeod0zvRpz2Q57dzQao2hjo0c&s=1cKJSGct9NsxWDSlCmQ28hw-l7osJQVtFZ5MIHUvi_I&e=>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.improvediagnosis.org_&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=aHG6XseIYSAre4Ep31qeod0zvRpz2Q57dzQao2hjo0c&s=l7iKOvPRGVsbxM67I1HvA67-jcbMfm5Jjd9D_gk4P1Y&e=>
>
>
> ------------------------------
>
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> To unsubscribe from IMPROVEDX: click the following link:
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> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
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> <https://urldefense.proofpoint.com/v2/url?u=http-3A__list.improvediagnosis.org_scripts_wa-2DIMPDIAG.exe-3FINDEX&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=aHG6XseIYSAre4Ep31qeod0zvRpz2Q57dzQao2hjo0c&s=1cKJSGct9NsxWDSlCmQ28hw-l7osJQVtFZ5MIHUvi_I&e=>
>
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.improvediagnosis.org_&d=CwMF-g&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=qOcjXoLquAiyCvucIiL4ttjm8kuIbsKo_DB0ogtr4hc&m=aHG6XseIYSAre4Ep31qeod0zvRpz2Q57dzQao2hjo0c&s=l7iKOvPRGVsbxM67I1HvA67-jcbMfm5Jjd9D_gk4P1Y&e=>
>
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>
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
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>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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