Evil OB

[Dayray, RN]

OK so I'm just trying to get perspective here. I’m supposed to be asleep and have to work tonight but can’t sleep because of nightmares.

We have an OB where I work that routinely will do this vigorous stretching of patient’s perineum. He also makes people who are 7-8 cm 10 cm. There have been some recent conversations on this board about ironing or stretching but this is far far far beyond any of that. This man will vigorously pull on a women’s perineum, you can see his biceps flexing. Patients will sometimes have pain even with an epidural. He puts both hands in the entrotus and you can see him straining to stretch it. Patients bleed from this. He also is just very rough in his exams. Patients have told me that they hope he isn’t on call when they come in to deliver because her hurts them so bad in the office.

Other nurses warned me about him when I first came to work at the hospital. Other nurses also feel that he is to rough and that he hurts patients. Some say he must hate women. I've heard some say that they feel like he rapes patients when he does these things. Still these actions are and have been tolerated by the nursing staff for many years and that is part of my dilemma

Another problem is that he is a long time attending at my hospital. He is very well respected by the medical staff. He was written up in a local medical magazine as #1 OB in the city. His partners are great OBs and don't do anything like this.

I remember the first time I saw him do this pulling and I was appalled, it was a fast delivery so there wasn’t allot of time for his to do it. Still it was enough that I have just always made sure that he didn’t come any sooner then when the patient was crowning. I haven’t had to deal with this accept for that first time and a few nights ago.

A few nights ago I had to very from this. My patient had a temp so I called him and rather then just giving me orders for antibiotics (as I had hoped). He came in because he wanted to do a C/S. I won't go into all the details but that would have been very premature. I was gearing myself up to stand up to him, to give her more time but when he came in he checked her and said that she was complete. I braced myself because I knew what was coming next and it did.

We set her up for delivery and he began the pulling and stretching he normally does (thank god she had a good epidural because she didn’t feel any pain). After about 5 min of this she started to bleed. She bleed allot, about 300cc. I thought he had ripped her cervix. Fast forwarding a bit she delivered and had a 3rd degree and 2 very deep tears internally.

Generally when doctors do inappropriate things to patient I don't have any trouble dealing with it. I have (in my short career) handled many situations some gracefully and others not but I have always been able to advocate for my patients successfully. In this case I was stumped. This man is mean as hell and any comment by me to him would cause a huge fight and not resolve a thing. So I went outside cried, and tried to think of something I could do but couldn’t.

So anyway here I am missing sleep and I thought "If this were a new doctor that had done this I would have stopped them and reported them for abuse". So I have to ask myself "what makes this guy different". The answer of course is that I was taught to accept it as something that he does. We as nurses have allowed this man to continue abuse. I was able to keep him away by timing my deliveries well and writing orders without talking to him thus protecting my patient. Now that I have seen this and it was my patient I have to do something.

I have searched and searched for information and studies on this type of pulling at the perineum, it doesn’t seem to exist. I doubt there are studies because I just don't think anyone else does this kind of thing. Without a study saying that it's harmful I can't report it to the chief of OB as an unsafe practice. My only choice is to report it as abuse but I have to wonder if it will fly. The patient didn’t know any better. She was upset because I explained the she would feel pain for a long time and that healing can be very long. She did ask me what caused the tearing and I said, "It just happens sometimes" (I left out "when your OB rips you apart").

Because she tore there was a verifiable harm done but the patient doesn’t realize it. another problem is that tearing isn’t all that uncommon in delivery so it can be dismissed as a normal tear. I'm ready to take the heat for turning him in if it means I can stop him but I fear it wouldn’t. I'm worried that I would go threw the hell (that is reserved for nurses who get uppity with physicians) and nothing would happen in the end.

Any advice would be greatly appreciated. Any stories about situations like this that have turned out with the physician loosing his license or at least privileges would be helpful (heck make them up if you have to). I have already pretty much decided that I'm going to report this as abuse tomorrow morning when my manager is in. I probably wont see replies until after that but still the info would help with the crap I’m going to have to take for this.

[SouthernLPN2RN, MSN, RN, APRN, NP]

Have you discussed this with the NM? Look at trends in pt satisfaction surveys, if available. When I worked on a surgical floor, we routinely called d/c'd pts and asked them about their stay and if they were still in pain, etc. This type of info could give you the needed ammo.

[MagicalThinking]

don't be afraid. you are doing the right thing by standing up for your pt's :yelclap:

[babyktchr, BSN, RN]

I work with a doc who does just that very same thing. He has even gone so far as "POP" the perineum open like a midline with his fingers. It is a god awful sound and it is really all out of his impatience for delivery. The other thing he does is cut a midline before the perineum is even thinned out...talk about another horrifying sound. He too is a well liked and seasoned OB in our unit and thank God does not do many deliveries (because of midwife first call)

[SmilingBluEyes]

Had a guy like that in a hospital I used to work at. Same thing, long-standing doc, rooted in the town and hospital. Documentation is all that can save you------keep on documenting and reporting what you see. Eventually, this doc went down for some dangerous practices that could not any longer be overlooked.

It's horrible to see people like this get away with horrendous practices. I like the idea of following up w/his patients to see how they are feeling/doing. Keep a running documentation of what you see. OUCH is all I can say. I am so sorry. You are an excellent patient advocate, Dayray. I know the position you are in---how untenable.

[BabyRN2Be]

I don't know if this is a situation in which you could compare documentation with others, as they say, always document what you see. The nurses where I work were quite successful in getting the anesthesiologists to stop doing a practice in which pts weren't receiving adequate labor pain control. It was only one group of anesthesiologists doing this (I can't remember what it was), but the nurses were able to change things because they got together to stop whatever they were doing.

I have heard, and know of male OB's who are misogynists. They like control over women and they are not fond of them.

Best of luck to you! I hope that you are successful in getting this doc to modify his technique!

[Marie_LPN, RN, LPN, RN]

Are any of the pt. complaining (formally) about this doc.?

[RaeT,RN]

Dayray, I have seen you mention in a post before about your wife and her experience with an inappropriate doctor - just think if this was YOUR wife this doctor was doing that crap to. That's what always drives me - I think, "what if this was me/my family member/my friend?"

Not a situation that anyone likes to be in. What really stinks is that none of the other nurses have taken initiative in this matter before.

YOU'RE DOING THE RIGHT THING. NURSING IS PROUD TO HAVE YOU.:icon_hug:

[psalm, RN]

...for more nightmares, read Jack Olsen's "Doc- The Rape of the Town of Lovell". Different evil, but very evil. I am praying you and others will write this guy up.

[Dayray, RN]

So I talked to my manager today and I think we might be able to do something. After I posted this thread I had some time to think it over and decided against reporting it as abuse. I wish I could report it that way because it clearly was abuse but I think it would only cause trouble and he would get out of it.

So what I proposed was that we talk to the chief of OB about it and have him talk to the doctor. I also suggested that as a unit we come up with a set protocol for dealing with this. Once the chief has warned him, we could have predetermined steps to stop it. #1 ask him to step outside and warn him that he is acting inappropriately #2 take the tongue-lashing that he will give and return to the room. #3 inform him (in the room) that you are instituting the chain of command and that the chief of OB will be called in to assess the situation. #4 write an incident report. His charts will be flagged once the chief OB gets involved so that should scare him a little.

I appreciate the suggestions made here. Unfortunately my hospital doesn’t do follow up calls.

Although it went against what I was taught in nursing school, I did document this in a way that implicated him as causing the tear. I didn’t attack him directly I simply charted exactly what he did and what I saw. I didn’t go so far as to say he caused the tears but it would be easily pieced together. I think this would be enough to make a case should the patient ever choose to peruse it legally.

Someone had asked if patients complained. I doubt they have ever formally complained. Although I can call him allot of things this doc is not a stupid man he covers himself very well and explains things in way that makes patients feel that "doctor knows best". He has a strong air of intimidation and you can see that in his patient’s reactions.

It takes a whole lot to intimidate me and as much as I hate to admit it, I am intimidated by him. At times I have stood up to him and even reversed the intimidation at times. What makes me leery in this situation is that allegations of this magnitude would make him fight hard and I think He would be able to bury me in politics. He is a whole lot meaner then me and he would fight dirty.

If I can get all the charge nurses and the chief OB on board I think we might actually stop this. Maybe I'm being overly optimistic but I think it is defiantly the most likely way of getting this to stop.

[SmilingBluEyes]

That was what it took for me....to type up a very specific report, naming names, times, dates etc. and specific of the situation and having it presented to the OB committee by my manager. Between what I wrote, and what others reported, he was finally relieved of his OB priveleges at our hospital. It was not ME who did it, but many things together. Having rock-solid documentation and a bit of guts helps. HE threatened me with my job. I told him, if I had to be party to the things he was doing, I would gladly hand it to him on a silver platter, and gave him my manager's home number.

You have guts and heart, Dayray. I admire that----it was not easy for me to go head-to-head w/this situation a year out of school----nor is this situation easy for you. But you are doing the RIGHT thing. LET US KNOW what happens ok???

[indigo]

Thank you for pursuing this and for your bravery and for being the ultimate patient advocate and woman's advocate. Please stop that monster.