A cardiac physician and the chief of surgery, "John Wesley," practices at a community medical center
on the Virginia coast. He has been refusing surgeries and then
re-assigning them to the other two cardiac surgeons at the hospital.
As chief of surgery, Dr. Wesley claimed that it was his
responsibility to decide who needed surgery and which surgeon should
perform the operation. One of the other two surgeons, "Dr. Frank
Yoder," got the bulk of the chief surgeon’s declined cases. He also had
a 25 percent mortality rate among his patients, the highest at the
mid-sized community hospital. Because Dr. Yoder’s high mortality rate
was beyond acceptable benchmarks, the hospital conducted a preliminary
review of his cases internally.
Following hospital policy, a quality
care nurse randomly pulled a dozen of Dr. Yoder’s cases for review.
Before the review however, hospital policy required that the chief of
surgery sit down and discuss the cases with each doctor reviewed,
allowing the doctor could present his perspectives on the cases.
During the preliminary face-to-face review of the cases, Dr. Yoder
pointed out that half of the cases under review were ones that Dr.
Wesley had declined and sent to him. He questioned Dr. Wesley’s motives
in sending the cases, because all but one patient had died shortly
after surgery or after sudden readmission to the hospital for
complications.
The hospital decided to send the dozen cases out for an external peer review because of the multiple conflicts of interest around them. The external review determined that the patients who had died were at high risk
for recovery and that these cases in part accounted for the high
patient mortality among Dr. Yoder’s patients. The report further
suggested that this would have been true regardless of the surgeon. The
review of the cases reflected Dr. Wesley’s pattern of shifting higher risk cases to a subordinate. Now the hospital is sending more cardiac cases out for external review to determine how long Dr. Wesley has been using this practice.
