For three years or more, Paul O. Rohart, MD, has lived in a strange world of lawsuits and exile from the job he loved for more than seven years.
It is a cautionary tale, but it is unclear who should take caution. Is it the Florida emergency physician who found himself in an Orwellian state where, as he says, trying to find out what happened to a patient who unexpectedly died resulted in his dismissal from a job he loved? Is it the patient who died of a massive overdose of Dilantin administered, according to Dr. Rohart's lawsuit, by a nurse who somehow misread his medication order?
Is it the class of emergency physicians who work for contract management firms that demand the right to fire at will, often without even giving a reason? Or is it an ailing medical system that forces uninsured patients into fast-paced emergency departments for the kind of care that is best delivered in individual physicians' offices?
Dr. Rohart might say it is all of the above. His employer, Phoenix Emergency Medicine of Broward LLC and North Broward Hospital District that operated Broward General Medical Center, the Fort Lauderdale hospital at the center of the controversy, declined to comment on his firing, their standing in the suit, or anything else, citing advice of counsel.
Some things are clear, however. Dr. Rohart was fired, and he filed suit, alleging that his dismissal came because he sought to find out why the patient died. The hospital and emergency medicine management group responded with a legal pleading. This past June, the hospital district was granted summary judgment, which the doctor has appealed. The suit against Phoenix continues.
According to a Jan. 24, 2007, report in the South Florida Sun Sentinel and to Rohart's suit, the story began April 23, 2006, when 44-year-old Michelene Plass came to the emergency department at Broward General Medical Center seeking a medication refill for a drug she took for anxiety. Dr. Rohart was her physician.
Dr. Rohart remembers her as pleasant and that he wrote a limited refill of her prescription. Later, she returned to the emergency department, saying she had had a seizure in the bathroom. He remembers that he ran her through some tests, and she seemed fine.
“The recommendation was to give her Dilantin to prevent another seizure,” he said. He told her of the plan to give her Dilantin with the recommendation that she see a neurologist soon. He went off shift, telling his relieving emergency physician about her.
“I came back the next morning, and a friend came up to me and said that my patient had died,” Dr. Rohart said.
He could not believe she was dead, he said. “I went to try to find the nurse, and they said she didn't work there anymore. We never saw her again.”
When he started to look for documentation of the woman's condition in the hospital record, he was reported to his employer and to hospital superiors.
“I was dragged into the director's office and yelled at. I was told, ‘Your patient died of natural causes. What's wrong with you?’ They basically told me, ‘Stop investigating or you will be fired.’”
Shaken, Dr. Rohart continued to try to find out why Mrs. Plass had died. “I was stonewalled,” he said.
“To make a long story short, she had had an autopsy, and it showed a massive overdose of Dilantin. The nurse had admitted to what she had done before she was fired. She had taken out 32 vials of Dilantin from the Pyxis machines, and lined them up on her desk. Then she started two IVs in both arms, and ran it in wide open,” he said.
Dr. Rohart said, “You have to give Dilantin very slowly. She put too much medication into two large-bore IV bags. She was dead in five minutes.”
In his suit, Dr. Rohart alleged that the nurse gave a dose that was six to eight times greater than he had ordered. It was, the suit noted, a lethal dose. In the news story that ran after state and local law enforcement and health agencies began to investigate the case, Sun Sentinel reporter Bob LaMendola quoted Mrs. Plass's family as saying that she was taking Klonopin, an anti-anxiety medication that can cause seizures if stopped suddenly. Without health insurance, according to the newspaper account, she had to go to the emergency department for her refill. The story and Dr. Rohart's suit noted that the correct dose would have required 3.2 vials of the drug.
“It is a huge Level I trauma center,” said Dr. Rohart. “I never knew this nurse. She was brand new. I wanted to find out what was going on. I called [the patient's] husband because I wanted to apologize. He told me that the hospital had called and cut a deal for $200,000 and [said] they would fire me and the nurse. I was part of the deal that the hospital offered up.”
He filed suit against the hospital, the management group, and two risk management groups. In the wake of that, he said, the organizations have taken steps “to retaliate and ruin my career. At some point, they tried to blame it on me.”
Dr. Rohart said he found another job, although at a tremendous financial and professional loss. He no longer works in a Level I trauma center, and when he needs a reference from his former employer, the response is that no one knows him, he said.
Suing the public, tax-supported hospital district has been frustrating for him, Dr. Rohart said, because it has sovereign immunity, one of the three factors cited by the judge in granting the district a summary judgment.
As for Phoenix, “their defense is that as an independent contractor, I have no rights whatsoever. They are not denying what they did. They just said I have no rights. That's the problem with being an emergency physician. Most people would have walked away. I'm not like that,” said Dr. Rohart.
It is unexplained why the nurse was able to obtain such a large dose of medication for a single patient without setting off some kind of warning, nor can anyone explain why no one noticed what was going on. Hospital officials told the Sun Sentinel that they had reprogrammed the drug-dispensing machines to flag large withdrawals and to stock only small amounts of Dilantin and similar medications. If nurses want larger quantities, they have to go to the hospital pharmacy themselves, the article said. Hospital officials also told the Sun Sentinel that they had retrained nurses in calculating dosages.
Dr. Rohart's suit alleges that:
▪ He was wrongfully terminated by Phoenix Emergency Medicine of Broward LLC in violation of public policy that requires hospitals to prevent medical accidents and injuries, and that as part of this it must provide an adequate risk management program that includes the investigation and reporting of accidents. In particular, the suit notes, Florida law requires reporting of medical accidents within 15 days of their occurrence.
▪ He was wrongfully terminated because state law forbids retaliations against an employee who reports an entity's unlawful actions.
▪ Even though Phoenix claimed Dr. Rohart was an independent contractor, his work conditions were more like those of an employee, and in retaliating against him, the group violated laws against retaliatory discrimination.
▪ The suit also charged North Broward Hospital District with “tortuous interference” in a business relationship between Dr. Rohart and the contract management group “by demanding that [he] be terminated…to cover up the suspicious death of…Michelene Plass; in retaliation for refusing to end his investigation of the suspicious death of Michelene Plass; [and] as part of a civil conspiracy by PEMB [Phoenix Emergency Medicine of Broward LLB] and the North Broward Hospital District to avoid further liability for the suspicious death of Michelene Plass.”
In granting the hospital district's request for summary judgment, the state judge held that the claim of interfering with the contract between Dr. Rohart and the management group was invalid because the hospital district itself was the source of the business relationship referred to in the contract. He also ruled that Dr. Rohart and his attorney had presented no evidence to show that the hospital district's actions had gone beyond its right to protect its own business interests and, finally, that as a state agency, the district has sovereign immunity.
A notice of appeal has been filed.