In light of a $24 million lawsuit filed by a doctor against Johns Hopkins Hospital in Baltimore claiming that he was unlawfully fired earlier this year, how can hospitals prepare for legal troubles?
Oscar Serrano, MD, a former surgical resident, says he was fired because he refused to lie on the ACGME Resident Survey, according to the Associated Press.
Serrano's lawsuit states the firing was unlawful because there's not enough evidence of poor performance as his evaluations only showed high marks, according to the Maryland Daily Record.
Unfortunately, lawsuits are unavoidable in graduate medical education (GME).
"Whether or not a person sues is outside of your control, but you can manage how you're going to deal with the lawsuit, take preventative measures, and anticipate certain problems," says Franklin Medio, GME consultant and former designated institutional official.
The best way to prepare for lawsuits is to ensure your policies, procedures, and documentation are in order. Competency-based evaluations and feedback are a key component to noticing red flags in resident performance. Evaluations should include objective and narrative components and should be viewed by relevant faculty.
"There should be documentation that the person had performance problems [and] they were counseled about those problems," Medio explains, adding that due process policies should be reviewed by hospital legal departments.
By the time you get to the point that you're firing a resident, he or she should not be hearing about problems for the first time. However because both faculty members and residents have little experience with giving—or asking for—feedback, performance problems are not always communicated effectively. Consider hosting educational sessions for faculty members that explain not only why feedback is important, but also how to make it effective. Similarly, they can teach residents how to request and receive feedback effectively.
Regarding the ACGME Resident Survey, programs can only go as far as helping residents comprehend the language used in the questions.
"You can make sure residents understand what certain words mean in their educational context, but nobody should be forcing residents to say certain things or lie," Medio says.
Additionally, site visitors question residents about problems identified on the survey or in anonymous complaints during a site visit to determine if they are real issues or just one resident's opinion or experience.
"The site visitors are pretty savvy about putting things into context," Medio says.
Julie McCoy is the associate editor for the Residency Department. For more residency information, visit www.residencymanager.com.