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Hamburg concedes that his use of the drug "was ill advised--I'm not going to argue that point." But he adds that he has not self-medicated himself since.
Because of the difficulties, Hamburg's supervisors ordered him to stop moonlighting--a common practice among medical trainees who work outside their residency, usually in urgent-care centers or emergency rooms, for extra money. Hamburg explains that he continued the extra work because he needed the cash to pay for a series of infertility treatments for him and his wife.
Worst of all, at least according to P/SL's administrators, Hamburg just didn't seem to be getting family medicine. According to evaluations presented at the trial written by Kasunic and Stephen Blythe, the residency program's interim director for several months, Hamburg's performance in his family-practice rotations was consistently "average" or "marginal." "This is the lowest evaluation I've given a resident," Blythe testified.
On January 27, 1993, the hospital's Medical Education Committee met in a special session to discuss Hamburg. Members were given a long list of instances which purported to show that Hamburg's knowledge of clinical medicine was inadequate. (In one, he examined a forty-year-old man complaining of impotence and quickly asked the nursing staff to order injectable testosterone shots--even though, Blythe testified, such shots are not called for 90 percent of the time. Later, an intern examined the man and determined that high blood pressure and other factors were responsible for his impotence.)
The committee voted unanimously to terminate Hamburg from P/SL's family-practice residency program for "failure to progress"--less than six months before he was to graduate. Hamburg says he was outraged. "It just doesn't happen," he says. "You just don't go ten and a half years in your medical training and then get told you're not qualified."
Two days after canning Hamburg, Kasunic sent Copic Insurance Company, which was carrying the P/SL residents' liability insurance, and the American Osteopathic Association (AOA) notice of Hamburg's dismissal. Later, when Hamburg applied for insurance from Copic on his own, a physician representing the company called Kasunic to ask about Hamburg.
According to notes the physician took, Kasunic didn't give Hamburg much of a recommendation. He told Copic that the former resident was less informed than other residents, had no clue of his limitations, had been referred to CPHP for a drug evaluation and treatment, and was narcissistic. The company denied Hamburg's application for malpractice insurance.
Since then, Hamburg has found an insurance company willing to cover his work. And because physicians can still practice medicine if they don't complete a residency (the one-year internship and a valid license are all that's required), he eventually found work in an Arvada clinic with Dr. Robert Simon, where he says he enjoys a bustling practice.
Still, Hamburg claims that Kasunic has continued to attempt to scuttle his career. For instance, he says that Kasunic eliminated Simon's office as a rotation site for P/SL residents after the Arvada physician hired Hamburg. Kasunic responds that he wouldn't want someone who'd flunked out of his program to supervise other trainees.
In October 1993 Hamburg filed suit against P/SL, Kasunic and Blythe (who lives down the block from Hamburg and who in the past hired Hamburg's daughter to babysit). In it, he claimed that they had breached his residency contract, defamed him by giving inaccurate progress evaluations to the AOA and to Copic, and cost him hundreds of thousands of dollars in lost income because he could not now become certified as a member of the American College of Family Practitioners--a credential that is a bargaining chip for physicians looking for work.
During the trial, Hamburg's attorneys charged that Hamburg's supervisors had it in for him. "Dr. Kasunic did everything he could to destroy Dr. Hamburg's career," Debra Smith, one of Hamburg's two lawyers, told the jury. As evidence, Hamburg presented several evaluations from other supervising physicians during his residency who found his work above average and, in some cases, "exceptional."
The hospital's lawyers countered by arguing that those evaluations were not from rotations involving the work of family practitioners. Rather, they said, the glowing report cards were from medical specialists overseeing work necessary to the residency program yet not directly applicable to generalists. "The important thing is family practice, because that's what we're trying to train here," Kennedy said. "If you want to be an ER doc, go to an ER residency."
Last week, the jury cast their votes for Kasunic, Blythe and P/SL, and without too much trouble. It took them less than two hours to find that the hospital and its residency program supervisors had not defamed Hamburg when they communicated his poor evaluations to Copic and the AOA.
Still, in winning the case, the defendants indirectly raised the question of how someone unqualified to practice medicine at P/SL is still able to work. In his summary to the jury, Kennedy observed, "Everyone wants not just average medical care. They have a right to expect someone who is not just marginally qualified."
During the trial, Blythe struck an emotional chord when he told the jury that he brought his family into the P/SL family medicine clinic and that he didn't want someone like Hamburg treating them.