Doctor Examines a Patient in the Lobby of the Hospital; Nurse Reports the Incident
	Doctor Threatens: "Something's Going to Happen to You"
	Staff Privileges Suspended, Doctor to Undergo Behavior Modification Doctor's Improper Conduct and Hospital's Improper Procedure

What would you do if you observe a doctor doing something improper, something that's against the policies and rules of the hospital? Would you be inclined to overlook the incidence so as not to cause ripples knowing that the doctor would probably lose his staff privileges, or would you notify the authorities to protect the life or well being of patients? Such a dilemma is not uncommon for many nurses. Very often it is a call of conscience, a call to professional responsibility and, of course, a call of judgment.

Read on to find out what a nurse did in one situation.

Facts : On February 28, 1987, Sandra Taylor, a registered nurse employed by the hospital, wrote a memorandum to Dr. Celso Chavez, chief of staff, stating that on February 23 she saw Dr. Huang examine a patient in the hospital lobby and that such conduct was "totally unacceptable medical practice." Nurse Taylor subsequently wrote another memorandum (to Dr. Chavez and Sister Elizabeth Keaveney, president of the hospital) complaining that Dr. Huang had threatened her, telling her that "something [was] going to happen to" her if she refused to retract the charge made in her first memorandum.

On the evening of March 26, Dr. Huang attended a meeting of the hospital's medical executive committee at which he was allowed to give his version of the events about which Taylor had complained to the chief of staff and the hospital president.

On March 27, 1987, the medical executive committee summarily suspended Dr. Huang's medical staff membership and clinical privileges at the hospital for six months at the conclusion of which he was required to provide evidence of having completed a behavior modification program approved by the medical executive committee, followed by two year's probation. Written notification of the medical executive committee's action, sent to Dr. Huang, stated that the suspension was imposed "as a result of the recurrence of your disruptive behavior for which you have previously been counseled and for the reason that your continued disruptive behavior severely impacts hospital operations and staff charged with the responsibility of insuring quality patient care delivery."

Pursuant to the hospital's medical staff bylaws Dr. Huang requested a hearing on his summary suspension before a judicial review committee. In response to the request a judicial review committee of five physicians was appointed and Dr. Huang was given written notice of the charges against him, namely: (1) In July 1985 an ad hoc committee at the hospital found that Dr. Huang had exhibited inappropriate behavior toward the nursing staff and improperly examined patients in public rooms; the committee concluded that a 30-day suspension was warranted but instead placed Dr. Huang on probation; however, as indicated below, his conduct condemned in 1985 has continued. (2) On February 23, 1987, despite warnings not to do so, Dr. Huang examined a patient in the lobby of the hospital instead of a treatment room or private area. (3) Beginning on or about February 23, 1987, and continuing until his suspension, Dr. Huang repeatedly verbally abused and threatened Nurse Taylor, who reported his improper examination of a patient to the chief of staff. (4) Dr. Huang's actions indicate behavioral and attitudinal problems which commenced prior to 1985 and reappeared in 1987; these problems require that he satisfactorily complete a behavior modification program before resuming practice at the hospital. The notice of charges concluded by stating that Dr. Huang's actions "demonstrate a substantial and imminent likelihood of significant impairment to the life, health and safety of patients in this facility, prospective patients and other persons..."

At the hearing before the judicial review committee Nurse Taylor testified: On February 23, 1987, she saw a patient seated in a chair off the front lobby of the hospital; one of the legs of the patient's pants was rolled up over her knee and Dr. Huang was "bent over that knee." The same day Nurse Taylor wrote a memorandum to the chief of staff describing what she had seen. About a week later Dr. Huang telephoned Nurse Taylor at work. He was very angry, called her a troublemaker, and insisted that she retract the statements she made in the memorandum. He told her that if she did not, "something was going to happen to" her. The day after the telephone call, Dr. Huang threw open the door of Nurse Taylor's office, entered, and "started yelling." He told Nurse Taylor she had caused a lot of trouble and, pointing his finger in her face, added: "Something's going to happen to you"; he then walked out of the office and slammed the door. Nurse Taylor wrote a memorandum to the chief of staff and the hospital's president describing both the telephone call from Dr. Huang and his visit to her office.

Dr. Huang testified: He did not make the statements attributed to him in the 1985 ad hoc committee report, including the statement that he agreed he had problems in his relations with the nursing staff. He did not examine a patient in the lobby of the hospital on February 23, 1987; he merely sat and listened to the patient's complaint. After he learned Nurse Taylor had accused him of examining a patient in the lobby he telephoned her. He tried to convince her that he did not examine a patient in the lobby and requested that she withdraw her complaint that he did; she refused. During the telephone conversation Dr. Huang did not tell Nurse Taylor that something would happen to her; he said he would do his best to have her complaint removed from his file, including taking legal action. Near the end of the call Dr. Huang assured Nurse Taylor that he was not angry at her and apologized for his tone of voice. Dr. Huang went to Nurse Taylor's office because he was curious to know who she was and wanted to try again to convince her to withdraw her complaint against him. He found the door of the office ajar. When he knocked on the door it opened and entered. Nurse Taylor was very angry and accused him of entering her office without knocking. She asked him to leave and he left; he did not slam the door on his way out. Dr. Huang denied threatening Nurse Taylor or trying to scare her either during the telephone conversation or in her office.

Editor's Note: After this the case becomes complicated. The judicial review committee found that the summary suspension of Dr. Huang's medical staff privileges was not supported by evidence and, therefore, unwarranted. An appeal board consisting of the hospital's board of directors reversed this decision which was supported by the Superior Court.

The case then moved to the appeals court. The appeals court, finding hospital's technical noncompliance with its own procedural guidelines overruled the decision to suspend the doctor. Keep in mind, however, that had the hospital followed its own procedures properly the court would have upheld its decision to suspend the doctor.

Huang v. Board of Directors, St. Francis Medical Center, 220 Cal. App. 3d 1286, 1990 Cal. App.