A surgical nurse told me about a patient who returned due to complications following an operation. When re-operated upon, they found that the person was near death due to a sponge the surgeon had left in the patient the first time.
The law required that she report the incident but she didn’t.
‘Who do you think would happen?’ she asked me. ‘I would wind up paying the price. Not the doctor. He has power and prestige. It would be me that would be hurt for making a report.’ She wasn’t willing to risk her career.
I can understand her reluctance. But it isn’t only the less powerful who won’t act, as we know from the case of Dr. Kermit Gosnell, who in January was charged with eight counts of murder. At least six women who had received abortions at his clinic wound up in emergency rooms—two died as a result of complications from botched procedures performed by Gosnell—but there was only one written report from a doctor regarding the infections, punctured organs and fetal parts that remained in the women’s bodies.
In January, Gosnell was arrested and charged with eight counts of murder: one woman died while receiving an abortion and seven fetuses’ spinal cords were severed after they were born alive.
“We are very troubled that almost all of the doctors who treated these women routinely failed to report a fellow physician who was so obviously endangering his patients,” the grand jury report stated.
Not reporting wrongdoing by peers is widespread and not just amongst medical personnel. I’ve witnessed it amongst faculty (it is the student’s fault, not the teacher’s) and by members in a ministerial association (it is the congregants who are unreasonable, not the clergy). The instinct to circle the wagons and protect the colleague is strong. In law enforcement, this is known as the blue wall, where cops put up barriers to disclosure of misconduct. The military does the same with wayward soldiers, and so do most professional associations and labor unions.
The reasons not to report wrongdoing by colleagues are strong. Organizations depend upon loyalty. Colleagues need to continue to work together. So whistleblowers are perceived as traitors, betraying the mutual trust upon which the association rests.
But in the long run, the incompetent colleague is also a threat to the integrity of the organization and, in some instances the costs of not reporting incompetence is high. Gosnell is charged with murder and you wonder how many lives would have been saved if he had been reported sooner.
The American Medical Association writes “physicians have an ethical obligation to report impaired, incompetent and unethical colleagues.” Pennsylvania law goes further. It requires doctors to report abortion complications to the state health department.
The AMA, the law and ethics all point to the duty to report incompetent colleagues. Those doctors who treated Gosnell’s patients who suffered complications and didn’t report them now are threatened with legal action. The investigation shouldn’t stop there. One doctor and a medical examiner who did report Gosnell said they never heard back from state officials.
The system failed at several levels.
“We are encouraged to be whistleblowers, but whistleblowers never prosper,” said Craig Klugman, assistant director of the Center for Medical Humanities & Ethics, at the University of Texas Health Science Center. “There are a lot of personal sacrifices that often go along with it.” Physicians who reports peer misconduct often undergo great stress, including strained relations with colleagues and costly, lengthy litigation.
Peers need to be more than trade unionists. They also have a duty to protect others—the public from bullying cops, civilians from trigger-happy soldiers, students from inept teachers. and patients from incompetent physicians. “That’s been understood for centuries,” says Laurence McCullough, a historian of medical ethics at Baylor College of Medicine.
Whistleblowers pay a heavy price, but moral courage is often risky. In this instance, doctors, whose prime value is to do no harm, put countless women in harm’s way. And I wonder how many more patients have been operated upon since the surgical nurse I spoke to failed to report the surgeon who left in the sponge.