Is Dr. misdiagnosing pts on purpose for financial gain. Advice please.

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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.

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Kitty,

I would suggest that you notify your hospital's Risk Manager. I would summarize your concerns (anonymously if you have to) and submit them to him/her and request the records be reviewed. Any Risk Manager worth their salt would have the cases peer-reviewed if there is a significant concern regarding the quality of care administered.

If the RM determines that there may be quality of care issues, he/she should direct the cases to be reviewed by a second, non-partial cardiologist or internal med physician. Being in a rural hospital, this might be problematic though...all the docs tend to know each other and don't like to speak ill of one another. :o

If you decide to submit, I would focus on what you consider to be medical management problems and leave out the physician's financial situation. Stick to the clinical management of the patient and leave the assumptions out (that's really all they are, no offense).

That's the best advice I can humbly offer.

Good luck!

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There are scumbag md's all over. In CA, a cardiac surgeon just lost his license because he operated on hundreds of patients that did NOT need bypass surgery. Many staff knew or suspected what he was doing. I don't see how they sleep at night! Be careful how you tread. Sometimes it is easier to fire a nurse than investigate an MD. Jobs can be scarce in rural areas.

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I agree with your other 2 replyers somewhat to a point......but dont contact risk mngt................key word....small rural hospital.....who do you think will win?????? You can notify the medical board and ask for annononomy...........thats about your only recourse without demise...........An old E.R. Nurse...................with alot of legal background....good luck

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Specializes in PeriOp, ICU, PICU, NICU.
There are scumbag md's all over. In CA, a cardiac surgeon just lost his license because he operated on hundreds of patients that did NOT need bypass surgery. Many staff knew or suspected what he was doing. I don't see how they sleep at night! Be careful how you tread. Sometimes it is easier to fire a nurse than investigate an MD. Jobs can be scarce in rural areas.

Wow, how terrible. :uhoh21:

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Does he have any actual rationale that he provides for not rx'ing the furosimide or what not? If he is giving appropriate treatment, then he should be glad to explain himself. If not, then, he may not really be doing the patient any good. I believe you can make an anonymous complaint to the AMA, just as you can to the BON if you suspect an RN of doing a poor job...

I'm currently in a small rural hospital and I know the politics and strange games...good luck.

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Wow, how terrible. :uhoh21:

If this is the surgeon and cardiologist in Redding, California then the story is a bit more complicated.

Dr. Moon (a cardiologist) and Dr. Realyvasquez (surgeon) agreed to settle all civil and criminal allegations against them in one settlement. In exchange, they will pay $1.4 million each and lose their ability to treat Medi-Cal, Medicare and TRICARE patients. TRICARE is federal insurance for members of the military. They did not lose their licence to practice medicine.

If not and is another doc, then I apologize. This just runs close to those of us who knew these fine doctors and feel they were treated shabbily. This community is divided over whether the docs did anything wrong. Most of the medical folks who worked with them are on the docs' side. Nurses included. There was a large protest outside the hospital during the beginning of this controversy in favor of both docs and attended by staff of the hospital, including nurses.

The District Attorney didn't file charges afterall. The docs just decided that it was better to settle the lawsuits than keep fighting. Sometimes you can't fight the government.

Thanks.

steph

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Thanks so much for all of the advice. I was informed just this morning that a meeting between us nurse supervisors and the new CEO is being scheduled. This will give us an opportunity as a group to voice some of our concerns. Our county is still somewhat involved in the management of our facility. Just this past weekend one of the county commissioners received a complaint about this Dr. (He also works as an ER doc some nights and weekends :o ) Maybe this will help get the ball rolling. I will try to keep you posted.

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