secretary, Gail Ellen and said, “Gail, is there a hematologist on the internal medicine peer review committee?”
“Yes there is.”
“Good. What does the committee feel about Jim’s suggestion?”
Heads nodded affirmatively.
“All right. Do I have a motion to accept Dr. Phillips amendment?
“I so move, said the young surgeon.”
“I second.”
“All in favor raise your hand.”
Seeing the vote was unanimous, Dr. Lassiter turned to Gail. He said, “I’ll dictate a letter to you for the chairperson of the internal medicine committee requesting that this case be placed on the agenda of their next meeting. Also request that a hematologist be available to review the case and report his findings to the internal medicine committee and then back to the surgical committee. If we are all in agreement we’ll take up this case again at next months meeting after hearing from the internal medicine committee. Do I have a motion to that effect?”
“I so move,” said a committee member.
“Any second?”
“Second.”
“All in favor raise your hand.” All hands went up.
“Motion carried.”
Dr. Harris’s case was referred to the internal medicine peer review committee and so documented as part of the minutes. In a case where a committee felt that there was a question of substandard care, it would be reported to the department chairperson with a recommendation for appropriate action. Such actions could range from a caution or mandatory consultation on future cases to revocation of hospital privileges for an especially egregious offense.
All peer review activities carried out under hospital committee sanction are exempt from legal discovery and the minutes are so stamped. There have been complaints from lawyers on both sides of courtroom battles who objected to this attempt by physicians to police themselves without having their actions open to public scrutiny. If this were not the case, doctors would be loath to function in a review committee, when what was said might later be used adversely in either a civil or criminal case against them. In addition, few physicians would willingly serve on such a committee, which is voluntary and unpaid, and perhaps, leave themselves open to a suit for damages by a physician who feels he has been wronged.
Cliff was informed of the committee’s action and for the next month Cliff and Laurel were left anxiously awaiting the decision of the internal medicine peer review committee. Cliff felt frustrated at the time it was taking to resolve the question of his surgical care and tried to console himself with the knowledge that the alternative was an absence of the peer review process and the perpetuation of inadequate care whenever it occurred. He accepted that the committee needed to perform its responsibilities in a prudent and thorough manner but it was difficult to continue to work day after day in the operating room knowing his future was under a cloud.
Checking the OR schedule the day after his appearance before the review committee, Cliff saw that Dr. Madhava who had been assigned to two of his cases had been replaced by Charley Pease, one of the other anesthesiologists on the staff. Cliff walked into the scrub room to see Dr. Pease already there. “Hey Cliff, how you holding up?” he asked, his usually cheerful face showing concern.
“I’m okay,” Cliff replied, “but what happened to Sanjay? He call in sick or something?”
Dr. Pease laughed slightly. “Not quite. The Mahatma asked me to switch cases with him and I said, okay. I guess he didn’t want to be in the same OR with a naughty surgeon who might yell at him.”
Cliff managed a small laugh. “I suppose he’s not the only one who feels that way.”
With a cheering smile, Pease said, “Don’t worry about it. No one can really blame you for what happened. A case of runaway DIC is almost always going to be fatal no matter what the surgeon does.”
With a sorrowful look, Cliff said, “I suppose you’re right Charley.”
With a sly smile, Pease said, “Just say to yourself he didn’t die. He just had a less than successful recovery.”
Cliff managed a small laugh. “Okay Charlie, you made me laugh so it’s time to get back to work. We’ve got a couple of easy ones this morning so let’s get this first guy under anesthesia and I’ll try to repair his hernia without yelling at you. You sure you don’t mind switching with Madhava?
”Hell no. What about you? We haven’t worked together that much. Are you sure you wouldn’t rather have someone else?”
Cliff laughed, “No. One gas passer is just like another to me.”
Charley laughed in return. “You got that right. We’re all drones with no people skills. That’s why we went into anesthesiology, we like our patients to be comatose.”
Cliff laughed, knowing that Charley Pease was one of the more personable doctors on the staff. Cliff’s surgeries that morning proceeded uneventfully and he was grateful for the opportunity to lose himself in the work that had engrossed him for more than a decade.
A month of waiting and then, after careful review of the case of Victor Wallberg, the internal medicine peer review committee, led by hematologist Alfred Koenig, approved Dr. Harris’s action in using heparin as meeting the standard of care. In fact the hematologist had the minutes reflect his admiration for the quick thinking displayed by Dr. Harris in so difficult and so rare a case. It was also recommended that the education committee prepare a lecture for the medical staff on this rare topic so that all physicians on the staff could benefit from this unusual case. The surgical peer review committee, armed with the internal medicine peer review committee’s report, cleared Dr. Harris at their next meeting. For what seemed to be the first time in a long time, Cliff and Laurel could relax. Their lives began to resume a more normal routine and they found new pleasure in one another’s company and that of their two daughters.
CHAPTER 5
One week after the funeral Marilyn Wallberg was at home sitting alone with her brother. Seeking his advice she said, “I figure with the life insurance, and the three months of my husband’s salary, the next year should go pretty well for me but then I’m in trouble unless the vesting of the options comes through.”
Spehn said, “I don’t want to throw a damper on your hopes, but I wouldn’t count on that money. There are all sorts of tax ramifications if they do that.”
“But then what do I do?”
“You will need to prepare a budget to fit within your income,” Spehn said. “In the meantime what will you do for money after the first year is over?”
“I don’t know,” she said slumping in her chair.
“Well I know. I see the way you live. This is some fancy house. Even without a mortgage, the taxes and upkeep will be enormous. There are three cars in the garage. I’ve seen cleaning women and lawn care people bouncing in and out. You have lots of expenses here.”
“I know. I know. I would consider moving to
