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On Aug. 18, an article was published in the Washington City Paper titled “First, Do No Harm,” which described my providing poor medical care in an unethical manner. The information was provided by Dr. Ronald David, former chief medical officer at D.C. General Hospital, and three other (unspecified) hospital sources, according to the author, Stephanie Mencimer. Some of the information provided in the article requires further elaboration.

I was indeed the attending physician of record for a patient who underwent wrong-site surgery for a hernia repair, and the problem was indeed diagnosed by my examination just short of three weeks prior to the scheduled procedure. The details of my leaving the room, reviewing the records, and then returning to the operating room to order the patient to be put to sleep again are not true. The internal communication to the chair of the department of surgery stating that I did not re-examine the patient again in the operating-room theater on the day of surgery because I had just evaluated him less than three weeks (not over one month) previously, and remembered him well, also contained the correct sequence of events surrounding the reoperation. It is unfortunate that select information has not been communicated properly.

Full disclosure of all the events of the surgery were documented in the chart immediately. The patient was also given the full details of my error; this is also noted in the patient’s chart. There was no delay in my reporting the details of the management of the patient to the chair of the Department of Surgery, Dr. Richard Holt. The surgery took place on Feb. 3, 1999, and the document with the explanation of events given to Dr. Holt was dated Feb. 4, 1999. A copy of the explanation was given to Sharon Sellers, quality-assurance manager, on Feb. 5, 1999, by me.

Dr. David was apparently mistaken in his implication that “initially, though, the medical staff was not even planning to investigate Smalls’ wrongdoing.” Dr. Holt was responsible for the investigation of errors of that magnitude at that time (the official Sentinel Event Team had not yet been established), and that process had begun by Feb. 4, 1999, the day after the occurrence. However, there was a delay indeed on the part of the hospital as a whole in finalizing the root-cause analysis and formalizing an official wrong-site-surgery-avoidance policy. Those responsibilities fell within the realms of the chair of the Department of Surgery, the quality-assurance manager, the associate chief medical officer—Dr. William Hall—Dr. David, and ultimately the chief executive officer, John Fairman. I requested of the administrative staff mentioned above to proceed with this process in a timely manner, both in order to comply with the mandates of the Joint Commission of Accreditation of Healthcare Organizations (JCAHO), and in order to improve on this aspect of surgical care.

My concern is guarded for what Dr. David has stated as “constant rumors” of my lack of competency, because peer-review of my records may readily either substantiate or refute this concern. I learned from your article that scrutiny of the medical and surgical management of my patients by physicians outside of the District of Columbia General Hospital—specifically the District of Columbia Medical Society, which is the local arm of the American Medical Association—has indeed taken place. Wrong-site surgery is by definition a sentinel event, and therefore it is, in and of itself, a significant problem. This significant event, along with Dr. David’s concern for the alleged “constant rumors” of my lack of competence, served as the basis for Dr. David’s request for the review of the management of my patients.

What is noteworthy, however, is what Dr. David has not noted in the article: any pattern of care discovered upon review of my patients’ care by physicians outside of the District of Columbia General Hospital that demonstrated incompetence. Medical professionals are aware of the fact that errors are made, even in the hands of the most knowledgeable and thorough physicians. However, when grave errors are made in number, severe sanctions may be imposed. I feel confident that, had a pattern of substandard care been discovered by the District of Columbia Medical Society, which is a branch of the American Medical Society, Dr. David, then chief medical officer; Renee McCoy Collins, D.D.S., then chief medical officer for quality assurance; Dr. Holt, chair of the Department of Surgery; Dr. Hall, then associate chief medical officer; and Fairman, then chief executive officer, would have notified me of such and accordingly applied appropriate sanctions.

I have served as the chair of the Quality Assurance Committee of the Department of Surgery (at the request of the departmental chair, Dr. Holt) since 1994. During the monthly Department of Surgery quality-assurance meetings, all mortalities, and select cases of morbidity, are discussed in detail. The cases are discussed in a multidisciplinary manner, and recommendations for opportunities for improvement of care are documented for all of the physicians of the Department of Surgery, including me. The medical staff stands on its record for the advocacy of peer review. It is noteworthy that the elected medical leadership staff of the Public Benefit Corp. attended a training session sponsored by the JCAHO in May 1999, and formally requested of the administration, in writing, the establishment of a Sentinel Event SWAT Team, as per the recommendations of the JCAHO. We were disappointed in the delay in response on the part of the administration, as evidenced by several written follow-up requests to honor this petition. Unfortunately, the statement that I and “some of the elected leadership of the medical staff have fought to overturn disciplinary actions against poorly performing physicians and defend doctors’ shoddy work habits” is unfounded and a mischaracterization of our requests for some semblance of standardization of disciplinary actions.

The surgical services conduct weekly sectional meetings to discuss complications in patient care. If a given patient has been admitted as a result of a traumatic injury, any death or significant morbidity is again discussed at our monthly Department of Surgery multidisciplinary trauma conference. The next tier of discussion for all deaths within the Department of Surgery is at the monthly departmental quality-assurance meeting. The process for quality assurance is well-established within the Department of Surgery at D.C. General. When problems arise that involve different departments within the hospital, plans of corrective actions are delineated, implemented, and followed over a period of time. Substantial and credible documentation attests to the veracity of my statements.

The litigation of Darryl Kelley, a patient under my care who underwent a procedure to establish an artificial airway (tracheostomy) after sustaining a gunshot wound to the neck, was also cited in the article. I was dismissed without prejudice by the Superior Court of the District of Columbia from this case. I am not aware of the final outcome.

I learned from your article that the level of competence of care that I render to my patients has been under intense scrutiny by physicians both within the hospital and outside. I stand on record as being a physician of impeccable integrity, and the level of care that I render is well within the realm of acceptable medical care. Had a pattern of care that is unacceptable according to the standards of care in the Washington, D.C., metropolitan area been found, I feel confident that Dr. David, Renee McCoy Collins, D.D.S., Dr. Victor Freeman, Dr. Betty Catoe, Dr. Holt, and/or Fairman would have informed me of such and imposed the appropriate sanctions. The members of the board of directors of the Public Benefit Corp. might request of Dr. David and the three hospital sources who rendered information for the article to the Washington City Paper, in the future, to provide information that is more complete.


Medical and Dental Staff

D.C. Health & Hospitals Public Benefit Corp.