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

[Stray Kitty]

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.

[gr8rnpjt, RN]

I would just document like crazy, everytime you called this doc to ask for an order and document his reply. Continue to advocate for your patients, and make sure that you are doing everything within your scope to keep your patients safe. Next time this occurs, have your patients respiratory rate, pulse ox, abg's if you have them. Tell this dr your pt is in resp distress can I have an order. give him all information. then if he refuses to give you an order I would page the supervisor and give her your information, your rationale for pt needing treatment, and let her know verbatum what the dr said. Then document in the pt record, his response, and the supervisors response. Then when you all get hauled into court, you have your documentation and your integrety to speak for your side.

[nialloh, RN]

He has refused to let a pt's primary Dr. assume her care after she and her family requested it.

In this the Dr. has no say. If the pt and family want the primary Md to assume care, and the primary Md accepts, the cardio must sign over. Or they can simply fire him. If he refuses, he is treating without permission. The pt always has the right to refuse.

I have seen some bad Dr's in my time, but never this bad. I think I would rather shoot myself then be seen by him.

And as the last poster said, CYA. You know who's lap this will land on if someone dies. "I wasn't called!!!, My orders weren't carried out!!!", etc. You know that's where he'll go.:angryfire

[Cute_CNA, CNA]

I like your name, Stray Kitty

This is a very scary situation to me. As others have said, document as much as possible.

I see you live in North Carolina. Here is a way to file a complaint: http://www.ncmedboard.org/Clients/NCBOM/Public/PublicMedia/comp.htm

Another interesting link, though limited: http://www.ncsl.org/standcomm/sclaw/statelaws2.htm

Please report this man, it could save someone's life. I would also mention that your place of employment has threatened other employees for not acting as patients' advocates. When you're at a hospital that covers up or ignores potential problems just for the sake of staying staffed, that is very dangerous. I would pull up roots and go somewhere else, if I were you. When it hits the fan, it's gonna hit you, too.