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DOCTOR VS. DOCTORS

A PHYSICIAN IN TRAINING SUES AFTER GETTING THE BOOT.

When he was booted from school, Terry Hamburg did what any student these days would do. He sued his teachers.

Except that Hamburg was no ordinary student. At the time he was shown the door, he was in the final months of the family-practice residency program at Presbyterian/St. Luke's Medical Center--on the home stretch of an exhaustive eleven-year odyssey through his medical training.

In a trial that ended two weeks ago, Hamburg, 42, charged that his teachers' evaluations were overly harsh and motivated by a personal grudge. When those poor evaluations were communicated to various agencies, Hamburg claimed his professional reputation was irreparably harmed, that he was denied all-important malpractice insurance and that he lost hundreds of thousands of dollars in potential income. (He has since found a job.)

This is not the first time somebody has sued over getting a bad rap from his bosses. Yet it is rare for a physician to be fired from postdoctoral specialty training, for several reasons.

Hospitals receive federal money for each resident they employ; fewer residents mean fewer dollars. In addition, there is an understanding among program directors--generally sympathetic doctors themselves--that terminating someone after a decade of specialized training can be extremely harmful to a doctor's career.

As a result, programs are reluctant to give their residents the boot, particularly as late in the game as Hamburg's dismissal. It is even rarer for a physician to work himself up into a lawsuit. P/SL's lawyer, Frank Kennedy, says Hamburg's lawsuit represents the first time ever that a doctor of osteopathic medicine has sued for getting booted from his residency.

Apart from being merely unusual, however, Hamburg's firing from P/SL's raises uncomfortable questions about how hospitals prepare physicians for their careers. Hamburg says his superiors had too much control over his career. On the other hand, if Terry Hamburg was as lousy a physician as his supervisors claimed, what's he doing practicing medicine?

According to the lawsuit filed in Denver District Court last year, Hamburg, a friendly man with a Roman profile and salt-and-pepper hair and mustache, graduated with a medical degree from the College of Osteopathic Medicine of the Pacific in 1990.

He was admitted to the P/SL Center for Health Sciences Education's family-medicine residency program in the summer of 1990. Like most other family-practice residencies, the program consists of a one-year internship followed by two years of more specialized residency training.

Hamburg completed his internship--an intensive year of frantic, hands-on learning about general medicine principles--in 1991. Nothing in the lawsuit suggests that he had particular difficulty completing the work.

In January 1992, however, Hamburg ran into his first problem with P/SL's director of family medicine, Dr. Louis Kasunic. That's when it came to Kasunic's attention that Hamburg was, in fact, not eligible to become a licensed physician.

In order to get a license to practice medicine, physicians must pass a series of national tests. Parts one and two are taken during the third and fourth years of medical school. Part three is administered during the first year of residency.

When it came time for Hamburg to take part three, however, he revealed that there was a small problem: He had not yet passed part two, even after taking it twice. Worse, he hadn't told anyone in P/SL's residency program. (Hamburg explains that when he filled out forms for his P/SL residency, he misunderstood the question about his board exams; he disclosed the exams he had taken, not those he had passed.)

Kasunic opted not to boot Hamburg from P/SL, even though at least one member of the hospital's Medical Education Committee testified at the trial that the omission was reason enough to fire Hamburg right then. Instead, Kasunic placed Hamburg on academic suspension--with his full pay of about $2,500 a month--and confined him to the library to study for the test.

Hamburg subsequently passed parts two and three. According to the state Board of Medical Examiners, he received his license to practice medicine in Colorado on July 16, 1992.

In the meantime, however, the directors of P/SL's family-residency program say that Hamburg continued to give them headaches. Charles Stephens, a Capitol Hill physician and member of the hospital's education committee, testified that reports to the committee about Hamburg's missteps represented "a continuance of problems" and "seemed to be a matter of discussion many times more than most other residents."

Medical records and testimony presented by the hospital showed that Hamburg occasionally didn't show up for rotations through training programs and that his documentation of patient treatments was inadequate. In addition, he was way behind on the academic thesis paper that all residents were required to complete. And when the paper eventually was turned in, "it probably wouldn't be acceptable at the high school level," said P/SL's Kennedy.

Other problems cropped up as well. In early 1992 Kasunic discovered that Hamburg was self-medicating himself with a narcotic and referred him to the Colorado Physician Health Program (CPHP). A psychiatrist there determined that Hamburg's home use of Percodan didn't represent any ethical lapses and that he didn't have an addiction. But she did conclude that he was using the drug for a medical condition that it was not intended for.

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