Well, this story is not about patients. It’s about hospitals’ control over doctor efforts coupled with doctors’ ignorance about legal and business issues. Unfortunately for hospital systems, I wasn’t one of the ignorant ones.
I moved to a new city in a new state. When a doctor does that there are a lot of things that have to be done to actually begin to see patients. Back in those days (1990) that included getting privileges at at least one hospital. In order to get privileges, you have to file an application with the hospital to become one of the hospital’s Medical Staff. Initially the Medical Staff was exclusively doctors, but nowadays, that includes other licensed caregivers like Nurse Practitioners, Physician Assistants, Podiatrists, etc.
As the process went, you had to be licensed in the state, have medical malpractice insurance and have a valid place of practice. I had a license. I was employed by a large multispecialty group which supplied me with malpractice insurance. Since I would be on call as well, I had to live within 30 minutes of the hospitals in the hospital system. You had to fill out the application and request the types of things you wanted to do in the hospital. I’d done this several times before with several different hospitals with no problems.
At this new hospital system, there was, to me, a surprising last paragraph just above where you sign the application. Signing the application was the same as signing a contract. The paragraph said something similar to this: “If there was an adverse action taken by the hospital Medical Staff review process and the undersigned experienced an adverse decision, like being expelled from the Medical Staff, the undersigned will consider the Medical Staff decision as final and cannot seek deliberation in a court of law or any other legal venue.”
Now, for those of you who are knowledgeable in legal issues, this is called “signing away your rights”. Essentially, that paragraph was barring you from suing for an action that could put you out of business, since, back then, you really had to have hospital privileges to cover your panel of patients. That paragraph put you exclusively at the mercy of the hospital and its Medical Staff which could be significantly biased. There are many instances where hospital Medical Staffs have discriminated against doctors, sometimes for financial/competition reasons and sometimes for ideology reasons. For example, a hospital Medical Staff once refused to review applications for admission to the Medical Staff of physicians who were working for a staff model HMO, calling the HMO “pinko-communist”. The HMO doctors had to go to court to get hospital privileges. Do any of you think the “conservative” Medical Staff leaders might be headhunting the HMO doctors once they got privileges? There was also a case in Oregon where the surgeons on the hospital Medical Staff tried to force a new young surgeon off of the Medical Staff, leaving a paper trail in their committee minutes. The new surgeon won the court case. And if you were the new kid on the block, well, just think about that.
Soooo, I crossed that paragraph out and made a note in the margin saying I agreed with everything in the application except this last paragraph and by crossing it out I was not agreeing to its content.
About a week later I got a call from the hospital Medical Director asking me to fill out a new application and not cross out the final paragraph, as it was rejected by administrators of the credentials committee for not being “clean”. I told him I wouldn’t fill out a new one, and if I did, I would do the same thing again, and that they couldn’t legally make me agree to the content of that paragraph. I told him why and he said, “Well, all the other doctors have signed it.” I said I wouldn’t because I would be signing away my rights. He said he would take my application to the Credentials Committee for consideration.
About a month later I got a call from the Medical Staff Office administrator telling me the application was declined and I had to fill out a new one without crossing out the last paragraph. I said I wouldn’t do that, and if the hospital and its Medical Staff didn’t approve my application, I would have to take legal action. Two days later, the hospital lawyer called me while I was seeing patients. He told me that the hospital’s position was that all applicants had to sign the application with that final paragraph intact. I told him that the paragraph was signing away my rights and that I knew that no one can make me sign away my rights, it has to be voluntary. The fact that they were essentially holding me hostage by not approving my privileges for the only reason that I wouldn’t sign away my rights was illegal. He said, “But all the other doctors signed it for years and years”. I said, “Well, all of the other doctors are apparently ignorant and maybe even stupid. Unfortunately for you, I’m neither ignorant nor stupid.” At this point the lawyer went on a rant for about five minutes, calling me names, accusing me of all sorts of things, etc. When he finally stopped, I simply said, “I have to see my patients. You’ll be hearing from my lawyer about how you are restricting my ability to have a livelihood.” And I hung up.
Now it was time to actually do more than just talking. I researched which law firm in the city was the most intimidating. On the line was at least 25 years of me being able to practice. Assuming a salary of $150,000 for 25 years, the minimum I should sue for was 25 x $150,000 = $3,750,000. I was thinking $5,000,000 was a nice round number to go for. I found a high-powered law firm that was the only firm in the city that sued other lawyers for malpractice. I thought, “These guys must have balls!”, so I called them and described my situation. I could hear them drooling over the phone. They gave me an appointment right away. I went in and met with a lawyer who told me I had an excellent case. I had to pay him $750 for the consult, but it was worth it.
Now, during all of this, the Medical Director and Administrator of the medical group I was in kept asking me what was going on, so I had kept them up to speed. When I told them that I had hired the high powered law firm, they were taken aback. At the same time, I contacted the Medical Staff Affairs Office and told them they would be hearing from my lawyer from that high-powered law firm. I was trying to throw the name of that law firm around as much as possible. They had a reputation in the city.
Boy, did the wheels start moving after that! Within a week I was asked to meet with my Medical Group leaders at a conference room at the hospital at 6:30 AM. They had been immediately called by the hospital after my call to the Medical Staff Office. They had had an emergency meeting with the hospital administrators and their lawyers. They wanted to settle the issue ASAP without going to court. The deal was, I would sign a “clean” application but with a letter attached saying I did not agree to the last paragraph and if I felt I was being unfairly treated by the Medical Staff and Hospital, I retained my right to go to a court of law. The letter would be signed by myself and the hospital Medical Director. I told my group’s leaders that I would agree to that, but, I wanted one more thing…that the hospital had to pay my $750 legal bill because I never should have had to go to a law firm to retain something that was mine under the US Constitution (Seventh Amendment). My lawyer’s bill was paid. I’m not sure if the hospital paid it or the Medical Group, but it wasn’t me.So, the moral of the story is, never sign away your rights. No one can make you do that. Read the fine print because lots of people and corporations try to make you do t