Longform

Missed Diagnosis

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Laurel fired off a four-page letter to the board, criticizing it for not reviewing her doctor's court testimony or having an ob/gyn on the inquiry panel to review her complaint. She was also angry about the possibility of a conflict of interest because of Kimbrough's presence on the board. "As things stand right now," Laurel wrote in her February 17 letter, "this has the appearance of a whitewash.

"What is more troubling for me," Laurel continued, "is that Colorado State law has been written in such a way that Dr. Kimbrough, rather than her victim, enjoys the protection of silence and secrecy. As a patient I have no right to know what the response from her attorney contained.

"Patients like me don't bring spurious lawsuits," wrote Laurel, whose brother and ex-husband are both doctors. "I am going to die; nothing you do here will help me. However, you have the opportunity to help other women and their families."

"It was a very moving letter," says Republican state representative William Sinclair of Colorado Springs, who along with dozens of other state legislators and the governor received a copy addressed and stamped by Laurel. Sinclair took particular interest in Laurel's case because his wife had also battled breast cancer; he's asked his staff to look at board policy, he says.

Marcy Morrison, a Manitou Springs Republican and chair of the House Health, Environment, Welfare and Institutions Committee, also received a copy of the letter. Morrison sent her concerns back to the board--and on May 28, Laurel received a letter saying the board had reopened her case, sent it to an investigator, and would contract with an independent ob/gyn expert to review the medical records. But last week, the board again dismissed Laurel's complaint.

Until recently, it was board practice to send complaints against sitting members to the opposite inquiry panel (in other words, a complaint against a physician on panel A would go to panel B). But at its May 20 meeting, at Miller's urging, the board voted to adopt a formal policy on how to handle this sort of uncomfortable situation. The policy, now in draft form, states that a complaint against anyone who is serving on the board, acts as an adviser to the board or has served within the past five years will automatically be sent to an outside consultant--usually another Colorado physician--for evaluation.

Miller admits the change will draw "scrutiny" but insists it didn't grow directly out of Laurel's case. "Quite frankly," says Miller, "it gives the board some protection from concerns that they're just trying to protect their own."

"I support the change," says Kimbrough, who has served on the board for three years. "We don't want the public to feel there has been any preference given to boardmembers or past boardmembers." Kimbrough has sat on an inquiry panel that handled complaints against her colleagues, "and no special consideration was given," she says.

"I believe I gave good care to Ms. Laurel," says Kimbrough, who adds that being drawn into court by a patient is a difficult experience. Even now, she says of Laurel's case, "It still is a difficult time."

"Being a doctor is a tough job--but it's a closed club," adds Randy Paulsen, Laurel's attorney in the lawsuit. "Doctors are sort of like buffalo. You wound one and the others gather around to protect it."

But Marcy Morrison, who's been involved in health-care issues throughout her seven-year tenure as a state legislator, says she rarely hears constituent complaints about the board. "I have been told the Colorado Board of Medical Examiners is kept to very high standards," says Morrison.

She has taken on the health-insurance industry in recent legislation and worked with the medical board to write guidelines for pain management, says the proof of the board's objectivity may lie in its reputation. "It's interesting to talk to doctors about the BME," she says. "They are terrified."

Indeed, each certified letter from the board reporting a patient complaint lands on a physician's desk with a horrifying thud. "This is a group that has the power to stop your career in its tracks," says board veteran Louis Kasunic. "The good news is that this is the same group that oversees my license. I believe it is made up of very reasonable people."

Like administrator Miller and other members of the board, Kasunic insists that the board puts patients, not doctors, first. "I don't think this is a sissy board," he says.

Stephen Fries, Greg Randel's former pediatrician, says that he dreaded going through his mail every day for a year and a half while the Randels' complaint was pending. "This is basically a guilty-until-proven-innocent situation," he says. "It's like an IRS audit. The onus is on the physician. You have to get an attorney, you have to notify your malpractice insurance carrier." No other profession is under such public scrutiny, he says.

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Gayle Worland