Bias In The Western Medical Profession Pt. II

Here's a story from Mayo Clinic Horror stories.
http://www.mayoinfo.com/horror/social_service.htm I have copied it here for you to read.

Mayo Clinic is thought to be one of the best places to get medical are in the USA. There are other big famous hospitals all over the world who have these kinds of horror stories, but for some reason the western doctors are never talking about those. And furthermore, they are not even talking about their own botcheries.

The Mayo Clinic had always loomed larger than life in my growing up years in Rochester. Vague memories of when my twin brother and I got into too much aspirin as a child and of "going through the clinic" as a 4th grader over worries about academics, melds with stark memories of my wife's treatment for brain cancer and her physician's offer of a home visit the night she died. More recently I remember an acute appendicitis and the excellent surgeon who saved my life and made it possible for me to graduate in time to replace the oncology social worker at Mayo in 1989.

Throughout, I have had the deepest respect for the integrity and competence of this Clinic, these marvelous people, who had twice saved my life, and made it possible for my wife to enjoy her last days with her young family, pain free. Changing careers from industrial technology and teaching to practical nursing and homemaking for my family, and later to medical social work made it possible for me to give back some of what I had learned, as a result of these life affirming events.

It is time for me to try to find some way to respond again after the life changing events that Social Service supervisors started and Mayo administrators have (apparently) finished, after my termination for whistle-blowing in 1991. It has taken me five years to come to this point of understanding. I share my story with you, both to assist me in coming to terms with it, and to attempt, one more time, to influence the systems and attitudes that allowed this situation to progress unchecked for over 10 years.

Starting work in oncology at Methodist Hospital a month before I graduated, I was eager to start off on the right foot and live up to the standard that "the needs of the patient come first". So, despite the lack of an orientation period or mentoring from oncology social workers, I sought out knowledge and wisdom from the oncology team of physicians, nurses, chaplains, aides and therapists who welcomed me and taught me what I needed to know. The work was quickly satisfying and rewarding and I would be in that position today, had I received any effective support from my Social Service supervisor Martha Holtan.

Despite obvious success in integrating into the oncology team, where I spent over 95% of my time, I could do nothing right in the eyes of my supervisor, even though she never actually observed my work with patients or even visited my work area at Methodist! One to four hours of supervision a month at the Clinic, quickly became a 'therapy' session in which my supervisor 'diagnosed' my shortcomings and demanded that I come up to her personal (but elusive) standards, "or else". Social Service colleagues tried to help me understand her methods but were relieved that they were "off the hook", for they too had been her "project" at one time or another. I responded by trying harder and acting on her "suggestions" only to be faulted again and again in a continuing treadmill of unattainable expectations. When I was threatened with termination the first time, joint sessions with the Section Head Vickie Moore, seemed to make matters worse and I looked forward to the day when my supervisor would begin to focus her hazing methods on a new supervisee.

I received the required social work license from the State of Minnesota in the fall of 1989, and asked my section head for the required mentorship and clinical supervision from a master's level social worker. This requirement was much like that of any other professional residency or apprenticeship program. My direct supervisor Martha Holtan didn't have a master's degree and couldn't provide the required clinical supervision or mentoring. The Section Head Mike O’Brien's continual offers to circumvent the requirement by "signing off" on forms brought more tension to the supervisory relationship. I didn't find out until after I was fired in 1991, that my requests for required clinical supervision, brought unwanted attention to the fact that my direct supervisor, Martha Holtan was practicing social work at the Clinic without the license required by law. My supervisor was later cited by the State Board of Social Work. Both Section Heads and Paula Horner, another supervisor, were also cited for violation of the licensing laws in their failure to report her unlicensed practice. Every other social worker at Mayo received the required clinical supervision which I was repeatedly denied.

In the Spring of 1990, My supervisor Martha Holtan, breached patient confidentiality by requiring me to provide her with complete, detailed, personal information about one of my patients and his family, during supervision. I found out much later that this patient was a personal friend and a St. Mary's colleague of my supervisor, when she stated her intent to become actively involved with his terminal care at home. My written report to the Section Head Vicki Moore, was rejected out of hand, and my supervisor never spoke another civil word to me again. The verbal and non-verbal harassment continued until I was fired. This, despite two formal complaints, and corroborating evidence of harassment and abuse from other workers including two eye-witnesses.

My insistence on a change of supervisors, after a denigrating performance evaluation, brought more scrutiny and pressure to conform to inflated documentation standards and a continuing treadmill of unobtainable goals from my new supervisor. The pressure to resign or be terminated was unrelenting. Only the satisfaction of my work with patients, the supportive relationships of my colleagues on the oncology service, and my belief that more effort and information about my actual work with dying patients would turn the situation around, motivated me to continue. I was wrong.

My termination was planned in December of 1990 during an investigation of my complaint about my supervisor's harassment of me. Personnel intervened to delay my termination until the "proper" documentation was in place. My new supervisor Paula Horner routinely started each supervisory session with: “I have a concern”. When she could find nothing but criticism for my work, I told her that I believed I was being set-up for termination. Her silence and ruby red face told me the truth. I was suddenly terminated November 15, 1991, despite an improved performance evaluation and my direct supervisor's hesitancy to support termination.

With no notice and the directive to "leave your cases on your desk and leave the building," I notified the oncology service the next morning (a Friday) of my departure and met with my replacements to consult on current patients who needed immediate discharge planning. This led to an angry call from my Section Head Mike O’Brien objecting to my presence in the hospital. Apparently the ethical requirement for case consultation and timely transfer to a new social worker had eluded him completely.

The following Monday I received a call from Douglas Parks from Personnel informing me that I was no longer welcome on Mayo property. I told him that I would be on Station 54 at Methodist hospital all day with my father who was recuperating from prostate cancer surgery. Doug Parks replied:

"Mike O'Brien has told me that he has notified security that you were not to be on Mayo property. Security is prepared to physically remove you if you show up anywhere on Mayo property including the hospital."

To avoid causing any disturbance that would impact my father's recovery I decided to avoid Methodist Hospital entirely that day even though the rest of our family was at work or unable to be there for him.

Dad died suddenly that evening, alone, and I never got to see him alive again.

The impact of these events on my personal life and my family has been severe. The stress of the conflict at work was a significant factor in the breakup of our marriage and supportive relationships in the neighborhood. My father's death came a month after my uncle's death, two weeks before my aunt's death and in the middle of my divorce proceedings and custody study.

My efforts to obtain work were frustrated by negative phone calls by social service colleagues to prospective employers, which had the effect of casting me as a trouble maker. Several successful interviews resulted in no offer and no explanation after a final interview was suddenly canceled. It appears that I have been effectively blacklisted. The financial drain of 3 & 1/2 years of unemployment has left me bankrupt and with out a home after depleting everything I had saved for my family. After a series of temporary short term jobs, I remain out of work and dependent on my family. I never thought that anything or any one could persuade me to leave my home town and my family. It looks as if I was wrong.

The personal cost to me while severe, come at a greater cost to the Mayo tradition of honesty, trustworthiness, and strict attention to the highest standard of professional conduct. These Mayo traditions have been severely compromised by Social Service leaders who had personal career concerns (promotion, retirement, or retention) which prevented them from addressing their obligations to patient care and ethical practice.

I have tried to address these issues in the belief that the truth would certainly be heard by someone. Two internal complaint committees had to deal with obvious lies by social work supervisors. (For instance, one would think that it would be easy, even for a committee, to determine definitively, the effective date of a state licensing law). Even when the lies were defined and documented, the committees failed to respond. The head of Personnel at the time Tony Enquist, threatened "serious consequences" if I continued to pursue the matter which he described as "sensitive" to the chief administrative officer John Herrell.

Jill Beed in the legal department made several half hearted attempts to buy silence with money after I sued, but would not address the issues of harassment, reprisals, breech of patient confidentiality, and cover-up.

The National Association of Social Workers (NASW) decided over a 5 year period, that it was I who "probably" was at fault, despite the State of Minnesota's statements to four supervisors that they had violated licensing laws. NASW made their own complaint to the State Board about my involvement in the complaint process, violating their own rules! This resulted in a State Board hearing and a five minute deliberation, finding no problems with my practice, but not before a two year investigation by the Attorney General's office had taken its toll. My former section head Mike O'Brien, even went so far as to file a state board complaint falsely accusing me of denigrating my supervisor's reputation when I reported her illegal unlicensed practice!

My lawsuit against the Clinic was doomed from the beginning by Mayo's high priced outside counsel Dorsey and Whitney of Minneapolis, where Walter Mondale is a partner. Interestingly enough, Tom Tinkem couldn't keep a straight face when I mentioned the lack of notes and documentation from Doug Parks about my father's death. This makes me wonder what damaging documents have been withheld or destroyed to ensure the lawsuit would be dismissed for "lack of evidence". The various courts involved, including the Minnesota Supreme Court, could not agree on the reason for dismissal but they all agreed that this case should not be heard in open court with witnesses and facts present.

It was the State of Minnesota Board of Social Work who found that my supervisor Martha Holtan, was in violation of licensing laws by practicing without the required license. The Board also found that Vickie Moore, Mike O'Brien, and Paula Horner had violated their duty to report her unlicensed practice. Apparently professional ethics and licensing laws are of no concern to Mayo, as those issues have been covered up and have not been addressed at Mayo to this day. The social workers involved are either enjoying a Mayo paid retirement or have retained their supervisory and administrative positions of influence over subordinates serving patients.

The other issue that has not been addressed is the cover-up. Certainly, if the needs of the patient come first, as the public statement of professional responsibility suggest, it would be necessary to address the issues of patient confidentiality, of harassment and reprisal, violations of State licensing laws and professional ethics and the cover-up of responsibility for these "mistakes". Just the fact that this process resulted in 7 & 1/2 years of legal work involving untold numbers of people and non-productive hours, tells me that something is desperately wrong with internal oversight. The amount of money spent on outside lawyers in this case, tells me there was significant responsibility avoided by Mayo.

It continues to amaze me how, otherwise intelligent people, can avoid sitting down with all the relevant facts on the table to discuss their mistakes and problems and how to avoid them in the future. In 11 years we have yet to do just that.

Well, that's my story, my understanding to date. I've finished with every process that I can think of. I wanted to clear up any partial information or misunderstandings that the adversarial and largely non-productive legal process has engendered over the years. I remain committed to working with the dying and bereaved, where truth telling and integrity seem to be effective for all concerned. Maybe you will have an opportunity to influence the attitudes and systems at Mayo one day. I hope that reprisals are a thing of the past, when you do.