Dilema-need advice. Is Dr. misdiagnosing patients for financial gain?

Specialties Cardiac

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I am an RN with 13 years of med/surg and ER nursing experience. I don't claim to be an expert in cardiology, but I think that a cardiologist at my hospital may be misdiagnosing patients on purpose for financial gain. Here is the situation that keeps repeating itself. Our cardiologist is in the process of building a new home. He has asked his fellow Dr.s to refer more patients to him because he needs the extra income now. A patient comes into the ER c/o chest tightness and SOB. They have a long standing hx of COPD and/or CHF. EKG shows non-Q wave MI, age undetermined. Labs generally show essentially negative cardiac markers. Occasionally it may show mildly elevated troponin (well below AMI cutoff level), or mildly elevated CKMB with all other levels normal. The patient will automatically be refered to this Dr. for admission, and he will act as attending Dr. Even if CXR shows severe COPD, CHF or pneumonia, he doesn't treat them for this. His admitting dx is always the same- Acute non-Q wave MI. While he is concentrated on EKG's, serial cardiac markers, Heparin and Beta-blockers, the pt is in severe life-threatening resp distress. They are sometimes literally drowning. He usually refuses to order Lasix stating that they are dehydrated. In my opinion, they will sooner die from resp failure than from dehydration. He won't listen to us nurses when we request certain orders such as Lasix or Solu-Medrol. I have cared for 3 such patients who eventually had to be intubated when it could have been prevented if they had recieved the proper tx. All 3 did survive, but only because once intubated they were transferred to another hospital under a different Dr.'s care. In one case, when the pt's ABGs improved once on the vent, he said, "See, he didn't need to be intubated." Is he blind or just plain stupid and negligent. He has refused to let a pt's primary Dr. assume her care after she and her family requested it. I wasn't working that day, but 2 members of the Ethic's committee were involved in caring for this pt, and neither of them did anything about it. The problem we have had with incidences involving Dr.s in the past has been that administration has covered for them and threatened reprimands to anyone who speaks against these Dr.s. It is a very small rural hospital which has a hard time recruiting Dr.s, and they don't want to lose the few they have. I have to do something or else I won't be able to live with myself if someone dies because of him. Advice please.

I am an RN with 13 years of med/surg and ER nursing experience. I don't claim to be an expert in cardiology, but I think that a cardiologist at my hospital may be misdiagnosing patients on purpose for financial gain. Here is the situation that keeps repeating itself. Our cardiologist is in the process of building a new home. He has asked his fellow Dr.s to refer more patients to him because he needs the extra income now. A patient comes into the ER c/o chest tightness and SOB. They have a long standing hx of COPD and/or CHF. EKG shows non-Q wave MI, age undetermined. Labs generally show essentially negative cardiac markers. Occasionally it may show mildly elevated troponin (well below AMI cutoff level), or mildly elevated CKMB with all other levels normal. The patient will automatically be refered to this Dr. for admission, and he will act as attending Dr. Even if CXR shows severe COPD, CHF or pneumonia, he doesn't treat them for this. His admitting dx is always the same- Acute non-Q wave MI. While he is concentrated on EKG's, serial cardiac markers, Heparin and Beta-blockers, the pt is in severe life-threatening resp distress. They are sometimes literally drowning. He usually refuses to order Lasix stating that they are dehydrated. In my opinion, they will sooner die from resp failure than from dehydration. He won't listen to us nurses when we request certain orders such as Lasix or Solu-Medrol. I have cared for 3 such patients who eventually had to be intubated when it could have been prevented if they had recieved the proper tx. All 3 did survive, but only because once intubated they were transferred to another hospital under a different Dr.'s care. In one case, when the pt's ABGs improved once on the vent, he said, "See, he didn't need to be intubated." Is he blind or just plain stupid and negligent. He has refused to let a pt's primary Dr. assume her care after she and her family requested it. I wasn't working that day, but 2 members of the Ethic's committee were involved in caring for this pt, and neither of them did anything about it. The problem we have had with incidences involving Dr.s in the past has been that administration has covered for them and threatened reprimands to anyone who speaks against these Dr.s. It is a very small rural hospital which has a hard time recruiting Dr.s, and they don't want to lose the few they have. I have to do something or else I won't be able to live with myself if someone dies because of him. Advice please.

Wouldn't be the first time it has happen. Happen several years ago, in California, with a cardiac surgeon.. Suggest you contact you state's Professional Review Division.

Grannynurse:balloons:

Thank you for your response Granny. If I am seeing this, why doesn't someone else higher up see it. I wonder if I have read too many Robin Cook novels. I will do a search now for Professional review division.

Thank you for your response Granny. If I am seeing this, why doesn't someone else higher up see it. I wonder if I have read too many Robin Cook novels. I will do a search now for Professional review division.

Not necessarily. I reported a physician to Florida's Department of Professional Regulation, instead of th BOM. While they conducted an investigation, the day before her hearing, they reached a plea agreement. A plea agreement which essentially gave her no real punishment and her license was neither suspended or revoked.

Grannynurse:balloons:

Watch it, stray kitty ! ! !

YOU will end up getting fired for some inconsequential rap....

and, reported to the state board.

Doctors, nurse managers, hospital administration, nursing administration - - - DO NOT tolerate ""whistle-blowers."" ! ! ! ! !

You are risking your livelihood.....

Zip up now - - - if you want to keep working there..............

Specializes in Cardiac, Post Anesthesia, ICU, ER.
Watch it, stray kitty ! ! !

YOU will end up getting fired for some inconsequential rap....

and, reported to the state board.

Doctors, nurse managers, hospital administration, nursing administration - - - DO NOT tolerate ""whistle-blowers."" ! ! ! ! !

You are risking your livelihood.....

Zip up now - - - if you want to keep working there..............

Stray Kitty, I don't think I'd put too much faith in this above post. If you see this as a major issue, report him to the board. If he refused to let another doctor assume care even at the families request, you should reccommend they make a complaint to the board also. If you don't act, you'll live with the guilt. Follow your heart, but be cautious. Don't push the issue too far, and file a complaint with the ethics board as well as urging others to do the same when he doesn't meet the "standard of care" that should be met. Remember there is power in numbers, and trends. Good Luck, and if it comes down to leaving that facility, do what is best for your career and licensure.

Specializes in Internal Medicine Unit.
Watch it, stray kitty ! ! !

YOU will end up getting fired for some inconsequential rap....

and, reported to the state board.

Doctors, nurse managers, hospital administration, nursing administration - - - DO NOT tolerate ""whistle-blowers."" ! ! ! ! !

You are risking your livelihood.....

Zip up now - - - if you want to keep working there..............

Stray Kitty, First, does your state offer protection for whistle-blowers? Second, if I had to, I could live without my license. However, I could not live without my conscience...How about you?

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