Column for May 7, 2006

We don’t meet with doctors…"

How a personality conflict mutated into a medical disaster

I’ve spent the past few weeks rummaging through news clippings, press releases, court documents, official reports, "full and final" agreements and the assorted flotsam and jetsam of a seemingly senseless medical dispute, trying to make sense out of what went so horribly wrong between Dr. Gabrielle Horne and the Capital District Heath Authority.

Horne is the medical researcher whose “pioneering,” put-Dalhousie-on-the-world-map heart research program was cut off at the knees Oct. 21, 2002. That day the Capital District Health Authority, citing concerns about patient safety, research ethics and lack of collegiality, took the unusual “emergency” step of varying Horne’s hospital privileges, effectively cutting her access to patients for her studies, which eventually shut down her multi-million-dollar lab.

The reason? Well, forget concerns about patient safety and violations of research ethics. Those reasons — the only logical reasons —were debunked within days of the initial edict. In the three-and-a-half years since, no one has offered up any credible evidence to support either serious allegation.

Truth? It boils down to a case of professional jealousy goosed into a larger-than-life medical-legal drama by personality conflicts. Horne was under pressure to give a prominent role in her research to another cardiologist. She resisted. Things got ugly.

If the personality conflict was the spark, the gasoline-filled super tanker that has kept this fire burning out of control is the hospital authority’s gaggle of corporate ass-covering in-house and hired-gun lawyers who have run up millions of dollars in legal costs — your health care dollars at work — to wage a war that should have ended long ago with an apology and a restoration of Horne’s privileges and research.

Where is the hospital’s board of directors — the people who are supposed to be minding the store —in this?

According to Dr. John Sullivan, former head of the hospital’s cardiac surgery division and a member of an independent peer review committee that exonerated Horne, the board “has been in the dark completely until a month or so ago.”

Hard to believe. But consider. In June 2004, after authority management cenceled bridge financing to keep Horne’s lab operating until the dispute could be resolved, Horne’s lawyer wrote to the board, asking it to intervene. According to Horne, “their lawyer” — the board’s lawyer! — “returned the letter to us saying their clients were not concerned.”

When Sullivan was elected president of the Medical Staff Association in 2004, he asked for a meeting with then-board chair Bruce McLaughlin. McLaughlin, a Dartmouth lawyer, got the chair’s job in 2000 even though he conceded in his letter applying for it that “I have never been directly involved in the delivery of health care services.” McLaughlin’s response to Sullivan’s request for a meeting: “We don’t meet with doctors.’”

In December 2005, after a committee of four of the province’s most distinguished doctors filed its report exonerating Horne, the board chair “wouldn’t read the report.”

Ironically, while the health authority refuses to concede it’s badly screwed up the Horne case, there have been quiet changes to the way process works to prevent future crises.

The lay privileges review committee at the centre of the current dispute is being replaced by a sub-committee of doctors who will consider future disputes over a doctor’s hospital privileges. And the new board chair — Armand Pinard, a former deputy minister of health — has been “very available” to talk with the hospital’s medical staff, Sullivan says.

But Sullivan worries the lawyers are still running the show when it comes to Horne. The current privileges review committee has finally filed its report to the board — three-and-a-half years after the fact. Sullivan says the massive report is “a piece of junk… written by lawyers.”

The report, he says, focuses on “the big black box” of Horne’s alleged lack of collegiality to hide the fact “they’ve spent millions in legal fees on this, and they know they can’t win.”

It is long past time for the health authority’s board of directors to run the institution in the interests of health care and patients instead of letting its lawyers run up ludicrous legal expenses in a case it can’t, and doesn’t deserve to win.

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