A year ago, we discussed a bizarre case where a colonoscopy patient (identified only as “DB”) is suing over abusive comments made about him by his doctors . . . while he was under anesthesia. “DB” had failed to turn off his cellphone which continued to record comments of the doctors ridiculing him, his body, and his character. While the alleged defamation did not leave the operating room (that is until his lawsuit), he alleged that it was still defamation and Dr. Tiffany Ingham and others for $1.35 million in damages for defamation, infliction of emotional distress and illegally disclosing his health records. Well, after a three-day trial, a Fairfax County jury ordered the anesthesiologist and her practice to pay him $500,000.
On the tape, Dr. Tiffany Ingham is recorded addressing his unconscious body: “And really, after five minutes of talking to you in pre-op I wanted to punch you in the face and man you up a little bit.” She also reportedly called him a “big wimp” and a “retard.” In addition about ridiculing his alma mater of Mary Washington College, she is quoted as saying more menacing things about firing a gun up his rectum and suggesting that they falsely note on his chart that he had hemorrhoids.
The staff is portrayed as exhibiting all of the decorum and professionalism of an Animal House fraternity with Ingham as the resident Bluto. Some members reportedly jokes about a rash on DB’s penis and how he looks like he has syphilis. Ingham, who comes off particularly badly, is quoted as saying “It’s probably tuberculosis in the penis, so you’ll be all right.” They all discussed avoiding DB after the surgery. As discussed earlier, defamation does not require contemporary knowledge and indeed it is often discovered later by the victim. Moreover, it only requires publication to other individuals, not widespread disclosure or publication.
The jury appears to have rejected any argument that this was merely juvenile humor or even opinion. Clearly they are expressing their opinion as to his being a “wimp” or “retard.” Dr. Ingham, 42, could not be reached for comment and she no longer appears to work out of the Aisthesis anesthesia practice in Bethesda, Md. State licensing records indicate she has moved to Florida. The gastroenterologist who performed the colonoscopy, Soloman Shah, 48, was dismissed from the case, but he is shown engaging in the juvenile comments.
The jury awarded the man $100,000 for defamation — $50,000 each for the comments about the man having syphilis and tuberculosis — and $200,000 for medical malpractice, as well as the $200,000 in punitive damages.
I agree that doctors adverse comments do not amount to malpractice or defamation but could be regarded as serious professional misconduct.
@ MmeRose
1, June 26, 2015 at 2:21 pm
“I can assure you that these are by no means the worst comments made in operating rooms, doctors’ lounges and law offices.”
You sound like a conventional-medicine insider, MmeRose, and I, for one, am willing to take your word for it that Drs. Ingham’s and Shah’s vividly expressed contempt for their patient is by no means uncommon in operating rooms and doctors’ lounges.
Such contempt for their patients by conventional doctors certainly helps explain the “225,000 deaths due to iatrogenic causes” (not to mention non-fatal injuries) in the US each year.
http://www.jhsph.edu/sebin/s/k/2000_JAMA_Starfield.pdf
Thank you for contributing to our understanding of these mindbogglingly high incidences of iatrogenic morbidity and mortality.
There are many digressions from the topic.
To return to Drs Ingham and Shah…I fail to see how this is malpractice OR defamation. The comments, although childish, were not meant to be made public (it was the plaintiff who ensured that they were). I can assure you that these are by no means the worst comments made in operating rooms, doctors’ lounges and law offices. And, by the way, anaesthetists do not write a diagnosis in the medical record, so a false diagnosis was not made.
Second, as another writer above pointed out, it is odd that a cell phone would be in the room – patients are given a locker for their clothing and belongings. I suspect that this was a deliberate act on the part of the plaintiff and it smells of entrapment. He apparently claimed that he recorded his procedure so that he would miss none of his after-care instructions, but why would the physicians give instructions to someone under anaesthesia? Printed advice is always given at the time of discharge.
The physician rating websites have now been inundated with comments about both of the doctors involved, and, sadly, most of them are racist and sexist.
As far as Professor Pullicino goes, the article is just the kind of nonsense that I expect from the Daily Mail Online, which has now taken over the role vacated by the News of the Screws.
The Andrew Weil Clip is very interesting.
Of course he is right….. he does actually admit that you have a healthcare system and that it is failing. Even before Obama care it is failing. This is what I have been trying to explain whilst being shouted down. The system of healthcare provision or Disease Management or whatever you want to call it doesn’t work under the current system of private health insurance and can never work. The concept is a money making business and under this umbrella over investigation, over treatment etc are consciously or unconsciously promoted under the guise of “best practice”.
In the United Kingdom, at one time, we had an NHS System that did not work on a private insurance system but a National Health Insurance paid for through taxation. And it worked very well until it was reformed in the 1980s into what was called a “managed market” system with contacts and contracting out for services amongst other things. It was loosely based on the U.S. System and it basically ended socialised medicine. It was intended to rationalise healthcare and keep a lid on costs with the introduction of business concepts.
It had exactly the opposite effect which is there for all to see. It replaced a very successful yet imperfect socialised healthcare system, dubbed the “envy of the world”, and replaced it with a system of such ineptitude that it beggared belief. But the greatest damage was that it falsely portrayed that socialised medicine had been a failure.
So when our modern NHS is rightly criticised for system failure, it needs to be understood that this is now a completely different business based system, whose sister versions have been tried an tested elsewhere in the world and suffered the same fate of failure.
So to introduce a system of Affordable Care based on the same or similar business concepts does not bode well.
On the other hand if Obama care is to be opposed, how is healthcare or Disease Management going to be accessed by Americans who cannot afford/access insurance? Are they to be ignored and excluded as in the past? Is so what does this say about National Empathy?
Dr Weil indicates that current lifestyles are responsible for the bulk disease and of course he is right again. Western economies are built on these lifestyles and are well described. This isn’t rocket science and is taught in primary school.
But changing society is a difficult thing. Powerful commercial lobbies with even more powerful lawyers can intimidate, delay and obstruct with great effectiveness in a Land of Liberty with obtuse entrenched arguments pertaining to freedom to be fat, slothful, drunk, and full of nicotine, and attitudes to firearms.
So a change in the culture of public opinion needs to be fostered, and you can see from the comments on this and other blogs how impossible this is…. America needs to start thinking collectively about its population and is being opposed by strong commercial forces with financial interests taking advantage of the population. Its all about responsibility and accountability.
I wrote a paper a few years ago based on recouping the costs of healthcare from the tobacco and alcohol industries that was based on action taken in Canada against the tobacco industry. I sent it to the British Medical Journal who liked it, wanted to publish it but wouldn’t publish it because they couldn’t find anyone who would agree to referee it ! I suggested they sent it to the Chancellor of the Exchequer who could referee it. Calculations suggested that £480bn could have been recouped with this programme. This would fund every hospital in England for 8 years.
I am suggesting that this kind of tactic could be used to break the vicious circle of commercial obstruction by ensuring some sort of responsibility with accountability.
There is no reason why food and beverages could not be targeted in the same way, and this might be a mechanism to promote more responsible manufacturing and a change in culture?
There are signs of change. The USA is going to ban the sale of trans fats http://rt.com/usa/267580-trans-fats-ban-fda/ and this is a step in the right direction.
So I think many of these things can be achieved if the will is there.
But in the meantime an effective programme of healthcare or disease management is required and the current system cannot provide this…..
Lest we get too far off track here…
All physicians supposedly utter the Hippocratic Oath at some point in their careers. It’s not binding, but methinks it should be repeated by practitioners more than once, if only as a reminder. For Drs. Ingham and Shah, perhaps daily, as it seems they’ve forgotten the majority of it.
Here are some excerpts from the Oath:
*…I will do no harm or injustice to them. (“them” is a reference to patients.)
*Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.
*So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate.
Sadly, “may the opposite be my fate” is not likely to be the case here.
@ Paul C. Schulte “I do not react well to anesthesia and have avoided taking a colonoscopy for that reason”
Good news: the average patient doesn’t actually need “twilight” anesthesia for a colonoscopy; it is administered primarily for the gastro doc’s convenience. (Please see my comment upstream about my experience. The prep was by far the worst part of the procedure.)
Here’s a link to a short interview of one of the leading integrative-medicine physicians in the world, Andrew Weil, M.D., who talks about the US disease management system and those who profit most from it and who do not want to see it change:
http://www.cnn.com/videos/bestoftv/2013/03/09/exp-erin-dr-andrew-weil-on-health-care-crisis-escape-fire-documentary.cnn
I. Annie … your explanation makes perfect sense. Thank you for the clarification.
Squeeky Fromm, Girl Reporter
1, June 25, 2015 at 7:28 pm
“Not only do hospitals and rehab places make us sick, I think sometimes they want to keep us sick as long as somebody is paying the bill.”
You’ve put your finger on the keystone of the allopathic medicine paradigm, Squeeky Girl, disease management, rather than disease prevention and health maintenance.
“The US does not have a health care system; we have a disease-management system that is dependent on expensive drugs and invasive surgeries. It’s a system rooted in an ideal of maximized profits, opposed to helping people maintain or regain their health.
“The US spends more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia, yet the US ranks last in a health and mortality analysis of 17 developed nations. [emphasis added]
“Integrative medicine (IM) is a [drastically] better alternative to the current system, as it offers a combination of conventional medical therapies and complementary or alternative therapies for which there is some high-quality scientific evidence of safety and effectiveness.
“The Affordable Health Care Act is likely to make matters far worse rather than better, as the Act does not include any strategies to prevent illness. Nor does it contain any measures to rein in or reduce out-of-control health care costs related to overcharges. Instead it expands an already flawed model of ‘care’ that has been and continues to be one of the leading causes of both death and bankruptcy in the US.” [emphasis added]
http://articles.mercola.com/sites/articles/archive/2013/03/18/disease-management.aspx
Aridog,
No. It would be antibiotics for a nosocomial infection. Anti inflammatories might be given as a pain relief med, but it would be antibiotics that would treat the infection itself, not antiinflammatories.
I. Annie … wouldn’t that be determined by what type of hospital infection was acquired. It is a rather broad term colloquially. I’d imagine that some infections could be inflammatory, but not generally so…as your “LOL” implies. You’ve seen more cases than I have, so the nod goes your way. Personally, I try very hard to pick physicians and facilities that won’t give me anything to take home I didn’t arrive with…although I am conscious that accidents can happen. No one holds higher esteem in my mind that the nurses, medics, and doctors I see…they’ve saved my life more than once. My gratitude is endless, as I suspect you know from other things I’ve written. I’m only asking for a clarification not trying to refute your response.
Squeeky Fromm, Girl Reporter
1, June 25, 2015 at 7:28 pm
“Well, when I was in the hospital, and then rehab, last year, I got a really bad case of nosocomia! I was hallucinating and all kinds of stuff! I think I got it off the bedpan??? But I digress. Not only do hospitals and rehab places make us sick, I think sometimes they want to keep us sick as long as somebody is paying the bill.”
Well, perhaps as in the case of the classy Virginia doctors, they simply had too much respect for you as a patient and human being and wanted to spend as much time with you as possible. 🙂
@I.Annie
The anti-inflammatories were for my back, you dingleberry! For my case of nosocomia, they hooked me up to something or nothing in my shoulder. Which cured me, but I couldn’t watch free movies on the ceiling anymore, or read the newpaper articles that were scrolling across the ceiling molding.
Squeeky Fromm
Girl Reporter
Antiinflammatories for a nosocomial infection? LOL.
@ Professor Ninianpeckittzzzzzzzzz
1, June 25, 2015 at 6:21 pm
“It needs to be understood that the vast majority of doctors do object to patient abuse and do speak out. “But those that do are usually senior and professionally assassinated.” [Who is it, then, who speak out, “the vast majority of doctors” or doctors who are “usually senior and are professionally assassinated”?]
“Murder of patients is clearly an obsenity [sic] and must be addressed.” [Really? You think?]
And what about all the patients who, as cited by IOM and Dr. Starfield, are injured or killed by routine and FDA-approved allopathic treatments?
“How can we stop this sort of thing? Well threatening or targeting doctors like Patrick Pullicino is not the answer. He needs public support.” [Really? You think?]
Are you trying to articulate some elusive salient point regarding the practice of allopathic medicine, Professor, or are you some frustrated amateur anesthesiologist who has missed his true calling?
Well, when I was in the hospital, and then rehab, last year, I got a really bad case of nosocomia! I was hallucinating and all kinds of stuff! I think I got it off the bedpan??? But I digress. Not only do hospitals and rehab places make us sick, I think sometimes they want to keep us sick as long as somebody is paying the bill. Because I should have been rehabbed within a week or two, but it was a frigging month or more before they even gave me some anti-inflammatories. Because I was in good health, and I should have been up pretty quickly.
Squeeky Fromm
Girl Reporter
Here is an example of what happens when doctors aren’t supported…..
http://m.cambridge-news.co.uk/Doctor-stages-hunger-strike-protest-NHS/story-22750108-detail/story.html
The story relates to allegations of abuse of the Liverpool Care Pathway for end-of-life care, which was phased out in 2014.
http://www.nhs.uk/news/2012/11November/Pages/What-is-the-Liverpool-Care-Pathway.aspx
I will try to research more information about the consequences of the allegations made by Professor Pullicino.
There’s probably a lot more to this story….
Professor Patrick Pullicino comments are truly shocking and his revelation should be the subject of a criminal investigation, if it isn’t already. I will make it my business to follow this up.
It will be very interesting to see if he is targeted by his employers and/or the General Medical Council which I think is yet to prosecute a medical director?
It needs to be understood that the vast majority of doctors do object to patient abuse and do speak out. But those that do are usually senior and professionally assassinated.
Murder of patients is clearly an obsenity and must be addressed.
How can we stop this sort of thing? Well threatening or targeting doctors like Patrick Pullicino is not the answer. He needs public support.
And that’s the key – support your doctors. This is of the greatest assistance in the goal of provision of high quality services. If the doctor patient relationship is confrontational it is the recipe for disaster.
This data confirms that current medical regulation in the U.S. is not effective in promoting medicine of the standard you are seeking. Some 40,000 deaths would appear to be related to malpractice?
In the UK”s NHS adverse events occur in around 10% of hospital admissions amounting to 850,000 cases a year and costing the nation £2 billion per year to fix.
The issue is that current strategies for healthcare improvement don’t appear to be working despite guidelines, protocols, informed consent, CPD training and points, clinical audit hospital legal expertise and prosecution of doctors in court.
You need to think about how these figures can be improved.
It’s all very well being indignant about adverse events but how do you stop it? You haven’t suceeded as yet….
Prescription of more of the same medicine hasn’t delivered a cure to date.
Einstein defined insanity as “doing the same thing over and over again and expecting different results.”
Maybe now is the time for a second opinion?
Maybe we should move to the vaunted NHS ‘death pathway.’
http://www.dailymail.co.uk/news/article-2161869/Top-doctors-chilling-claim-The-NHS-kills-130-000-elderly-patients-year.html