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By Mark L. Plaster, MD, JD ON February 1, 2018
Without a doubt, it was the worst night of my entire life.
It had started out as the usual crazy busy Friday night shift. Our administration thought that 36 hours of physician coverage a day was enough to see over 40,000 patients per year. That meant that our ER docs were tasked with seeing three patients an hour, 24/7/365. That meant that during peak times we were usually 12 hours behind the curve of patients. But those were the good ol' days and patients expected it. They would wait indefinitely to be seen. Oh, they were all angry when we got around to seeing them. But at least they didn't leave. And so it was as I walked in to examine a young girl with her mom who had been waiting with an ankle injury all day.
I was showing the mom the ankle film and explaining the findings when I heard the phone ring in my office. I should have just let it ring. But I was the director of the ER, and who knows, it might be important. So I excused myself from the mom and patient and stepped into my office and closed the door. It was my brother-in-law. "What are you doing calling me at work?" He was my closest friend on earth, so it was hard to be annoyed at him, but he'd taken me off guard.
"Have you talked to your mom recently?" "What?" I had stepped out of the controlled chaos of the ER into a Twilight Zone of disorienting, seemingly inappropriate questions. "What are you talking about?" "We haven't seen her since Tuesday." "What…" "But the police have found a dismembered body of a woman." "Wha…
"They think it's mom," he said in almost a whisper. It took my breath away. I responded with the only emotion I knew at that time. "If this is some sort of prank call, I want you to know that I don't think it's funny," I spat out angrily.
My recollection of the subsequent conversation is cloudy, but he said something to the effect that is was not a prank and began sobbing uncontrollably. What I do recall is falling into a deep dark pit where time stopped. The nurses later told me that I walked past the mother and daughter with the ankle injury, approached the nursing station with a blank stare, and informed them that my mother had been killed and I would be taking a few minutes alone in the office to gather myself. I don't remember any of it.
In retrospect, I can only imagine the panic of the staff when they realized that their only doc was out of commission and the ER was packed. What I do remember was finding myself in my office surrounded by my wife and administration. Within minutes one of my colleagues came in to cover my shift. Though shaken, everyone proceeded as usual for the rest of the night. I went home to pack my bags for the hardest trip of my life.
The days and weeks that followed are a story unto their own that I may share in a future column. But as odd as it might seem, that isn't what this story is about. It's the very unique setting for what transpired next.
Not long after I returned from my mother's funeral I was called for a private meeting with the president of the hospital. When I arrived I was surprised to see the Chief of Staff in the office as well. Having returned to a full clinical load immediately upon my return, I was half expecting them to give me some paid time off to collect myself and adjust to the reality of what had happened. Instead, there was an ominous, almost threatening look on everyone's face.
"We can't tell you how sorry we were about the tragedy surrounding your mother's death," the president said with genuine sincerity. But then his eyes narrowed. "So you can only imagine our sense of betrayal when we became aware that you had organized a physician walk out during your absence."
The shift in gears caught me off guard. Did someone betray someone? Where was there a physician walk out? I was trying to take it all in before I responded. But I clearly wasn't understanding. "This kind of action deserves immediate firing," he said, looking at me intently. "But given the family tragedy that you have just been through, we've decided to allow you to resign immediately. Nothing further will be said. We will provide non-incriminating references, and there will be no notice placed in the National Practitioner Data Bank."
He pushed a piece of paper across the table that had "Resignation" in the title. "If you choose not to resign, we will have no recourse but to fire you and report the adverse action to the Data Bank."
Finally what was happening penetrated the fog. They were firing me for organizing a physician walk out while I was at my mother's funeral. If they hadn't been so serious I would have thought this was funny. The idea was simply ludicrous. Something else had to be going on here. But I wasn't going to figure it out in this office.
"I'm not saying anything further about this matter until I've consulted my attorney," I blurted out. It sounded good. And I just walked out of the room. When I got to the hall, I stopped. What just happened in there? Did I just ruin my career? Upon arriving home, I started making phone calls.
First to the ER head nurse. "What happened while I was gone?" I asked Evelyn. "It was a mess," she said. "I was going to tell you, but it seemed to work itself out." "You know they are trying to fire me, right?"
"I knew they were mad – but not that mad. Hal (the VP over our section), filled in the time sheets for the docs' pay, but he did it straight time. So they only got paid twothirds of their regular rate. So they all quit until they got their regular pay restored. It had to go all the way up to corporate."
"So that's what triggered all this? Corporate found out how we had been cooking the books." There was a long silence. "And the president wants to pin it on you. How convenient. You won't let them do it, will you?"
"Thanks Evelyn," I said, finally seeing the whole picture. "I'll take care of it." Hanging up the phone I recalled all of our conversations on this topic. You see, five years before, when I had taken the job of ED director, we had discussed the rate of pay for the ER docs. Being woefully low, I explained that they would not be able to attract skilled, experienced physicians.
Evelyn then explained the work-around that the former VP of the section had devised. Rather than battle corporate for an increase in the hourly rate he had just reported 50% more hours. I told her at the time that it felt like fraud to me. But she showed me the signature of the VP over the section on the time sheets. And since that former VP was now the president, that system was etched in stone. Until now. And now the hospital president was being considered as a rising star for the corporate management team.
The "doctor walk out" had uncovered years of time sheet misreporting that had been approved by the current president. The only question was who was going to take the fall for it. I had the moral and legal high ground had I insisted on an open, transparent due process of law to adjudicate this situation. But it would have been messy, with an unpredictable outcome. I suspect I would have never practiced medicine again. I was disgusted by the administrative team, but they had simply been trying to work with an out of touch corporate structure.
Then I had to deal with the guilt of going along with a corrupt system. There was plenty of blame to go around. I pondered what my response ought to be. Sometimes, I concluded, finesse is better than raw power. I collected years of time sheets and pay reports and walked into the office of the Chief of Staff.
"Let me explain the situation," I began. I knew that he knew everything I was about to tell him. But it gave him the room act as if it was new knowledge and could be acted upon appropriately. I also knew that this was a good way of telling the president indirectly that I would be more than happy to cooperate with a corporate auditor if it came to that.
"I'm really sorry for all the confusion that resulted from someone doing the time sheets who was not familiar with the system implemented by President Woodward so many years ago when he was Vice President over this section," I said with a generous smile. "But I had larger issues at the time to deal with. I'm sure you understand."
"Yes, I do understand," he said with a forced smile. He really did understand. Their reflexive power play had failed. And now they were facing a total fiasco. "How do you want to move forward on this?" It was essentially a total surrender. I was angry. I wanted revenge. But I was also totally emotionally exhausted.
I looked at him for a long time in disgust. Maybe I was enjoying seeing him squirm. Finally I said, "I don't want to work here any more." Slowly I continued, "Pay me my salary for a year whether I choose to find other work or not. Give me a glowing recommendation. We will both agree not to say bad things about each other. And I'll be out of here by Friday."
He slowly started to nod then more vigorously as he realized that a catastrophe had been averted. I'm sure President Woodward will agree to the terms," he said with relief. "And I am sincerely sorry about how this has turned out."
To be honest, I doubt if the Chief of Staff has ever been sincerely sorry about anything in his life. But after years of silence, the president and I rekindled a mutually respectful relationship. Nothing has ever been said about the circumstances of our parting.
Mark L. Plaster, MD, JD
FOUNDER/EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than 30 years, working exclusively night shifts for the past 20 years in emergency departments across the country. During that period, he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and the founder of Plaster Publishing.
Karen Morasco Sharkey on February 23, 2018 8:18 pm
Great article. I always knew you had a high degree of personal and professional integrity. I respected you immensely from the very first shift I worked with you at HUH in Philadelphia. Glad to see this has not changed.
Karen Sharkey, RN, MBA
Essa on February 24, 2018 6:19 am
Dear Mark, I am terribly sorry to read your story. I cannot even imagine the horror of receiving the news about your loved one being killed. And I absolutely refuse to imagine the atrocity of the management's decision. Unspeakable and inhumane.
How long did you keep the silence?
TS FNP on February 24, 2018 10:11 pm
Wow thank you for your honesty in a tough moral dilemma. Emergnecy medicine like all Medicine and health care has been forced into morally compromising situations over the last 30-40 years. Wishing you great things hoping you are electec and can begin to make the shift to better healthcare.
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