Doctor won't back up his telephone orders!

Daytonite, BSN, RN · Feb 11, 2008

This was happening with a physician at a hospital where I was working as a supervisor. The doctor ended up being denied admission and practice privileges when his renewal date came up, he contested it and a big hearing took place. The result was he was still denied privileges and was gone from the medical staff. However, the process took months.

With this guy, the following was done:

all telephone orders were witnessed by two nurses and both nurses signed their names to the telephone order
eventually, they started recording his telephone orders as well to prove that he made them as well as to prove the way he spoke to the nurses because his behavior also became an issue
whenever he made a denial of his orders, the manager or supervisor was immediately notified and an administrative report (not the same as an incident report) was generated. These reports were filed in his credentialing file in the medical staff office and were eventually used as documented evidence against him in his hearing later to renew his privileges to practice in the hospital.
the chief of staff of his service was notified of each incident

Interestingly, we nurses learned that during his hearing to renew his practice privileges at the hospital that denying telephone orders wasn't the only thing he had been doing. There were other things such as inappropriate touching of some of the nurses as well as assaulting nurses. He was a piece of work and they were glad to be rid of him.

FYI. . .most medical staffs credential docs for a two year period and it is contractual, so if you have a physician who has been granted privileges to practice, it takes at least that long before they come up for renewal of their privileges. If they are denied renewal the doc has the right to a fair hearing which is conducted just like a jury trial only it usually takes place in your hospital's board room and it can go on for months with both sides (the medical staff and the doc) calling all kinds of witnesses to prove their case. The organized medical staff of your hospital is not under the authority of your CEO; they answer directly to the Board of Directors. This is by law in all states.

Agnus · Feb 11, 2008

This needs to be put in writing. Doctors are an can be disaplined. The complaint should be made formally and in writing.

Agnus · Feb 11, 2008

If you were fired for one reason, and former staff members spread the false rumor that it were for some other (worse) reason, you would have every right to sue. In the case mentioned above, it is unlikely that the poster was privy to the actual proceedings that resulted in the physician leaving the hospital; I would be willing to bet that the "reason" was really just the rumor mill running at full speed like it does in every hospital.
But really, that's beside the point. You are an employee of the hospital. In most facilities, the physician is an independent contractor who has a contractual agreement with the hospital, and is not an employee. When physicians are "fired" from a hospital, they aren't really fired, their contract is dissolved. Depending on the nature of the discussions that lead to this relationship being terminated, there may be a nondisclosure agreement involved, or other legal requirements that could potentially result in a lawsuit if breached.
Don't see physicians as employees. Most of the time they are not. Physicians are a business entity, often a Limited Liability Corporation. If any employee of a hospital is spreading rumors that Dr. X was terminated from the Medical Staff for unprofessional behavior, and it is not backed up by documentation or by the administration, that is slander that harms future earnings, and therefore subject to a legal tort.
I'm not saying lawsuits like this are the rule; I'm saying that you don't want to be the exception.

This is why you document. Good documentation will hold up in court. He said she said will not. Additionally even with "non disclosure" statements anything that puts the general public at risk is not protected in most case by such a clause.

If a contract is broken because of unprofessional conduct there is documentation or else the contract remains.

Not all hospitals use exclusively outside contractor physicians. More and more are using Hospitalists. Some are trending toward exclusive use of hospitalists with the support of the ones in private practice. A hospitalists is not immune to having his contract terminated due to unprofessional conduct and the hospital is not immune to lawsuits by a terminated employee.

(In some areas the private paractice physicians prefer to turn pts over to hospitalists while in hospital because they make more money by remaining in their clinics and offices rather than spending time between clinic and hospital.)

TiredMD · Feb 12, 2008

This is why you document. Good documentation will hold up in court. He said she said will not. Additionally even with "non disclosure" statements anything that puts the general public at risk is not protected in most case by such a clause.

I wasn't referring to whether or not the physician engaged in the behavior, I was talking about whether or not the behavior was the cause of the termination. There is a difference between the two.

And arguing that a physician yelling at a nurse is "putting the general public at risk" is going to be a pretty hard sell. Plus you're going to have to make it court, and staying out of court is kind of the whole point in the first place.

If a contract is broken because of unprofessional conduct there is documentation or else the contract remains.

I'd be willing to be most of these contracts get dissolved by "mutual agreement", not for cause. Saves the worry of future litigation by either party.

Not all hospitals use exclusively outside contractor physicians. More and more are using Hospitalists. Some are trending toward exclusive use of hospitalists with the support of the ones in private practice. A hospitalists is not immune to having his contract terminated due to unprofessional conduct and the hospital is not immune to lawsuits by a terminated employee.

I don't have any numbers, but I would point out that just because the hospital has Hospitalists, that does not mean that they are employees of the hospital. In the same way that hospitals contract with ER groups, Radiology groups, and Anesthesia groups, I have also worked under Hospitalists who are independently-contracted groups with an agreement with their facility.

(In some areas the private paractice physicians prefer to turn pts over to hospitalists while in hospital because they make more money by remaining in their clinics and offices rather than spending time between clinic and hospital.)

A lot of the private clinic docs do that these days. IMO, it's pathetic. Further proof of the overall decay of our profession and our sad willingness to accept inferior applicants who lack dedication and work-ethic.

That's my vent for the day.

ShayRN · Feb 12, 2008

And arguing that a physician yelling at a nurse is "putting the general public at risk" is going to be a pretty hard sell. Plus you're going to have to make it court, and staying out of court is kind of the whole point in the first place.

Maybe not a risk to the general public, but to his own wallet as well as that of the hospitals. There are federal laws regarding hostile working environments. Throwing charts, chairs, surgical equipment is all grounds for a lawsuits, esp if someone gets hurt. I bet every nurse on this board has a story about MD abuse. 99% of the doctors I have worked with in my career are wonderful, it is that 1% that makes life awful at work. The same ones, day in and day out. Nothing ever gets done about it. Please don't tell me its like that everywhere, I know better. My husband works at the post office, if there is a tone used to speak with a CO-WORKER that someone doesn't like, an EEO can be filed and management takes this very seriously. I think it is going to take one big case to make it public for this to be taken seriously by hospital administrations around the country. It is a shame, really. All it would really take is for a CEO to tell a doctor "this behavior is not acceptable. For one month you don't have use of our facilities." There are 30 surgeons waiting everyday to use the suites, the hospital won't lose money by doing that, but you can be darn sure the doctor will. Lets see what happens when he comes back, I bet the surgical equipment stops flying. :smokin:

TiredMD · Feb 13, 2008

All it would really take is for a CEO to tell a doctor "this behavior is not acceptable. For one month you don't have use of our facilities." There are 30 surgeons waiting everyday to use the suites, the hospital won't lose money by doing that, but you can be darn sure the doctor will. Lets see what happens when he comes back, I bet the surgical equipment stops flying.

Personally, I think you're being overly optimistic about the power of CEOs, and their relationship with physicians (especially surgeons). But hey, if it works and it improves your work environment, more power to you and your facility.

GrumpyRN63, ADN, RN · Feb 13, 2008

I'm curious as to his pecking order, I would refuse to take a telephone order from him, at my facility, we aren't suppose to take them anymore, there are computers everywhere, sure I still take T.O.'s, but their always put in right away anyway, in this case, for him, I would refuse, and go above to the senior or chief in house, if his colleagues have to clean up after him maybe he would straighten out, also nsg should back you up , bring it up to the fellow-- I wouldn't hesitate

time4meRN · Feb 13, 2008

How do you deal with a surgeon who is angry when you call him in the middle of the night and just as angry when you don't... When he gives a telephone order, and then comes in the next day and denies that he ever said anything written in the order although he does sign off on it... won't even back up orders he wrote in the chart himself, calling you a "liar" until he's shown the page? FYI, this guy has made several big errors ( like complete transecting the bowel during a colonoscopy) causing us to already worry when we see that a post-surgical patient is one of his. How do you protect yourself and your license when dealing with such a weasel. HR says taping his telephone orders would be "too disruptive to the work process" and having two nurses listen to him on speaker phone and co-sign the order hasn't helped as he just says that both of us are idiots. Any and all advice will be appreciated!!

Try putting the phone on speaker, have other nurses listen in.

allnurses Guide · Feb 13, 2008

Try putting the phone on speaker, have other nurses listen in.

Ah, look at the next to last line in her post... they're already doing that.

OP, I'm with the rest, keep documenting! Will your hospital back you up in refusing phone orders from him at all?

Indy, LPN, LVN · Feb 13, 2008

Speaker phone is great. Let me throw in a little thing we haven't discussed yet. We have to sign the orders "read back and verified" so make sure one of the two nurses listening in, reads the order back. Also, if the doctor happens to hang up on you in the middle of that or before you can read it back, document that in your incident report (at this point just copy and keep a few on your clipboard).

This protects you from hearing "the orders weren't read back, if he/she had read the order back I'd have wokeup/realized yaddayadda etc." So if the process takes a heck of a lot more paper, just make sure that you are attempting to do what we're normally supposed to to, and do the incident reports that show all the abnormal stuff, including the inability to read back due to being hung up on.

Now I'm preaching what I ain't doing, but it's because I haven't run into a doc yet who didn't sign a phone order. I did have one nice cardiologist talk about the purple donkey while on the phone and I had to wake her up, and an internist order an insane amount of ativan who promptly realized her mistake and we read it back and forth to each other at least twice because it freaked her out. Then there was the cardiologist whose verbal order in a cath lab was misunderstood and the patient had 4 inches of nitropaste on her when she got back from the procedure. Hm. So since it was written the doc had to write an actual note on the order that "not my order, I said full inch not four inches". That's the only order I've seen denied and that was VERY interesting, but no one was trying to be malicious, just CYA'ing.

As for the business with gossip, trust that you're getting good advice and stay out of it. Especially within a mile of patients or their families, even if you think the surgeon decapitates people for fun, you don't wanna be in that storm. Your paper trail of real facts will serve you nicely.

In_Chantress · Feb 14, 2008

Thanks to all who have responded... Theres has been a lot of great advice! First off, a little background... I'm a night charge/floor supervisor (which only means I hold the keys to the facility ;-) in a 22-bed VERY rural hospital. So yes, physicians are like cleanliness; that is, next to godliness here. Any direct confrontation with any physician will likely not come out well for me unless taken outside the facility. So this is my game plan... I've discussed the situation with the Chief of Staff, DON, and HR to make them aware that there have been issues with this particular surgeon. I've also observed this guy acts as if all women are idiots. As most men who are abusive to women, I don't think he'll have the courage to treat a MALE nurse the same. So while 2 nurses listen to the his orders, a male wil be the one initiate the call whenever possible. And finally, I'm keeping a log of all calls to the doctors in the middle of the night, to prove that our judgement is sound when we do call for orders and will also use it as a factual tool to document his idiocy in caring for his patients (i.e. no pain meds for a post surgical patient?)

Thanks to all of you!