Prognosis Guarded (eBook)

1
A Reason to Leave

The anxiety he experienced as he drove along desolate Highway 14 was making it difficult to breathe. It was only made worse by his inability to cast from his mind last week’s medical staff surgical committee meeting at Woodland Community Hospital. The sun drenched the opaque mountains splattered with patches of yellow and gold. Immediately, he found himself squinting in an attempt to hide from the sun’s blinding rays. His meeting was scheduled to take place in one hour with the owners of Palmdale Hospital. Dr. Mark Gaines was desperate to move away from the den of iniquity he had blindly entered.

Leaving the University Hospital in June 1995, only a few short months ago, he decided to enter the practice of internal medicine with the subspecialty of pulmonary medicine in the west San Fernando Valley. Never in his wildest dreams had he expected to witness the shocking state of the practice of medicine he had come to know so well.

He had rapidly become disenchanted with the practice of medicine in the Valley. Too often his ideals and moral fibers were tested and caused him to develop defense mechanisms and symptoms of anxiety in order to cope with these problems. What kind of people are these who hold themselves out to be healers and yet they march to the tune of Mammon, God of Money? They have no compassion and do not measure their self-worth by the satisfaction of their performance or the warm feeling that comes from helping the sick.

He made his decision to escape from that pit of hell because he could not stand to see the cheating games played out daily. The indignation and “holier than thou” attitudes, as well as the grandiose declarations and pontification by those doctors of medicine, were more than he could endure. They proclaimed innocence of their incompetence to their colleagues, who were just as inept. If you had a large patient base, then you were king because you controlled their referrals, and no colleague wanted to alienate you for fear of losing that source of patients. It was so bad that there were many physicians who found that the indication for a procedure, surgery, or test was entirely predicated on the type of health insurance. He had had it! Last week he had decided he would leave, although, despite his conviction, he continued to agonize over his decision.

How could he have stood silently by and allowed that young girl to undergo a needless thoracotomy by that so-called surgeon? When Dr. Kovacs had asked him to evaluate her for elective surgery because she had asthma, he never imagined the web of entanglement that would follow.

She could have physically undergone the surgery, but that wasn’t the point; her chest X-ray had revealed a six-centimeter cyst in the left lower lobe. The film, taken ten years previously, had shown the identical cyst. It had not changed in size; the girl was entirely asymptomatic, and her breathing tests were normal. After evaluating all the facts, he had concluded that this was a simple congenital lung cyst that required no surgical intervention. In his written consultation, he so stated this, which was interpreted by Dr. Harvey Kovacs as depriving him from a healthy four-thousand-dollar fee to carve open her chest, leaving a hideous scar.

After all, he told me he was the surgeon and the one who must accept the responsibility for this patient’s care. “I have asked you to evaluate her for her ability to undergo the anesthesia and to tolerate the surgery, and I am not interested in hearing what you have to say about the lung lesion.” Gaines was shocked that Dr. Kovacs was attempting to coerce him into removing his objection for this patient’s surgery. There was no doubt in this doctor that this caused him some element of financial distress.

Mark was adamant about his position, which he knew was correct, and he was incensed over the fact that Dr. Kovacs was so motivated by money. Then Mark said, “What you are planning to do is malpractice, and I will take this to the surgery committee.”

Dr. Cohen, the chief of surgery, was notified and was in accordance with Mark’s position. He felt the quickest way to deal with the problem was to select an ad hoc committee to hear the issues and decide on their merit.

The next day, the ad hoc committee for the Department of Surgery was called to order, and Gaines was requested to present his case in detail. When he finished, the floor was turned over to Kovacs for his presentation and rebuttal. If he had only known that what he had started was a holy political war, Mark might have elected to walk away from the confrontation.

Those doctors who derived referral patients from Dr. Kovacs were lined up on his side of the long table. They were showing their support for their colleague. The others were seated with Gaines on his side of the table. Honesty was defined here as not being in the referral pattern of Dr. Kovacs and his friends. The others, of course, looked at the good doctor as a continual source of revenue enhancement.

Dr. Harvey Kovacs was a man about fifty-five years old, five feet ten inches tall, with shocking white hair much more extreme than a man his age deserved. He had a fair complexion and piercing light blue eyes. He was revered by many of his colleagues and loved every minute of it. Harvey spoke with deliberate purpose and a slight New York accent, sounding like a charming politician exemplifying the classic con man. Mark was convinced that Kovacs might have missed his calling. He explained away his rationale for wanting to operate on his patient with total disregard for anything even slightly resembling the truth. His opinions were bathed in untruths, omissions of facts, and innuendos, and like an artist, he produced a picture that only could have been created by his dishonest mind. It was his intention to sway and lead his supporters in his direction. “After all,” he said, “this may be a malignancy; one can never be sure.”

Dr. Mark Gaines interrupted, “But there are no risk factors, and her entire evaluation is normal.” Harvey’s eyes scanned each of his friendly colleagues seated at the conference table. He attempted to transmit the dollar signs that referral patients signify. “I have been doing chest surgery for twenty-five years,” he said using his soft-spoken convincing voice. “I strongly object to you questioning my opinion.” Mark asked, “Why haven’t you done a lung scan, which would easily answer this question? This is a simple lung cyst requiring no surgical intervention, and, if you are wrong, you will only inflict upon your patient a large, hideous scar forever. I can’t let you do this to her,” Mark said. Harry Cohen, chief of surgery, called for order, and after he had asked a few choice questions of his own, he then allowed the discussion to continue. He then called for a vote on the issue. Mark’s position was affirmed by the committee, and the good Dr. Kovacs was ordered to cancel the surgery for the lack of an appropriate indication.

Dr. Kovacs, upon hearing this decision, ejected himself from his seat by throwing his chair back against the wall and began a barrage of self-serving statements. He shouted, “I have never been so humiliated before my colleagues! I have been a surgeon for more than twenty-five years, and you have prevented me from performing a needed surgery on my patient.”

Dr. Gaines got up and left the room. In seconds he was confronted by Dr. Kovacs. “You will never see another patient in this valley, I’ll see to that,” he snarled while positioning himself between the hospital entrance and Gaines. “You’ll regret this, you son of a bitch!” he shouted, shaking his long, delicate surgical finger in Mark’s face. “I’ll get you one day, you bastard. You’ll be blackballed in this town. I know everybody, and you will pay for this.” Kovac told him much more than his verbiage.

For but a fleeting moment, Mark again felt the fear of losing a practice that he had only just begun to build. “You money-grubbing incompetent. Go screw yourself.” Dr. Gaines stormed out of the hospital.

The freeway sign read “Avenue S Exit.” Mark entered the right lane without signaling, feeling that it was unimportant since he had only seen three other cars on the freeway the entire time. As he approached the stop sign, he saw strange plants along the adjacent hillside. They were five to seven feet tall, were very straight, and their leaves were long and stiffly pointed. He dimly recalled that a small town in the desert was named after the plant: Yucca Valley, he thought. The sign pointed to the right for the hospital. He turned right and traveled the road about a mile to the stop sign. Carefully looking both ways, he scooted across the intersection and drove another mile, where he noted an American flag waving from a flagpole. The flagpole was situated in front of a low-profiled building that was sprawling on two sides. As he turned right to approach the building, he drove through a barren desert for a quarter of a mile. This hospital seemed out of place, situated right in the middle of the desert surrounded by junipers, yuccas, and jackrabbits. To the right of the hospital was another single-story rambling building that extended along the street to the main road he had just turned from. He walked into the small entrance and approached the telephone switchboard operator who was sitting behind an enclosure.

“May I help you?” she asked.

“Why, yes. I am Dr. Gaines, and I have an appointment with Dr. Small.”

“Very well. If...