The letter firing Dr. David Lemonick from West Penn Hospital won't say why he was terminated. The letter gives no reason, but simply reads, "terminated without cause."
Ask hospital spokesman Tom Chakurda why Lemonick was canned, and he says it was the doctor's "inability to work effectively and professionally with his colleagues and support staff."
Talk to David Lemonick, however, and he'll say he was fired for blowing the whistle on what he calls serious lapses in patient care. It was only after he complained about these problems, he contends, that officials decided to cut him loose.
In a lawsuit filed this spring, Lemonick claims his complaints about lapses in patient-safety care were ignored, and that the hospital focused not on the alleged problems, but on him.
Lemonick, who began working at West Penn Hospital in February 2000, was fired last November. In May he sued the hospital, charging that he was fired because he blew the whistle on what he believed were unsafe conditions and practices. Lemonick claims to have warned hospital officials that patients' lives were jeopardized by foul-ups: serious delays in sending blood work to the lab and, in one case, a test result being given to a medical student who misread it. His attorney, Stephen Pincus of Stember Feinstein and Krakoff, says Lemonick is demanding his job back, along with damages and lost wages.
According to the lawsuit, "Over a number of months in 2003, Dr. Lemonick observed certain medical and administrative practices, policies and procedures by agents of the Defendants relating to the manner and quality of medical care" that Lemonick believed were "improper and in violation of applicable laws, rules, regulations, and Defendants' internal policies and standards of accepted medical care."
West Penn denies those claims.
"Our position and response remains as it was in May," Chakurda says. "We are aware of Dr. Lemonick's accusations and reviewed them when they were initially raised. As a result of that process, as well as an external review of our emergency department's practices and procedures, we find his suit to be groundless and will defend ourselves vigorously."
West Penn has not yet answered the lawsuit's specific allegations in court. It has, however, objected to the lawsuit being filed under the Whistleblower Act, which grants legal protection to those who speak out about wrongdoing by their employers. Pincus says the objections will be argued in court later this month.
Lemonick is not the only doctor to feel singled out as a so-called "disruptive physician." In a four-day 2003 series, the Pittsburgh Post-Gazette's Steve Twedt examined the trend of hospitals terminating doctors who raised questions about patient safety. Twedt profiled several doctors across the country who claimed to be fired for complaining about hospital policies. That piece mentioned a 1998 survey -- which appeared in the American Journal of Emergency Medicine -- which found that among 448 emergency-room physicians nationwide, 23 percent claimed either to have lost a job or been threatened with termination after raising quality-of-care concerns. Lemonick contends he's the latest victim of the trend.
Dr. Lawrence Huntoon, editor-in-chief of the Journal of the Association of American Physicians and Surgeons -- a publication of the Association of American Physicians and Surgeons, an advocacy group for doctors -- says doctors are fired for speaking up more often than people think.
Although he says he has no first-hand knowledge of Lemonick's case, in hospitals where such terminations take place, he says, "This practice should be a great concern to the public. How can they be comfortable there, knowing that a doctor is afraid to come forward with problems because he or she is afraid of losing their job?
"In most of these cases, we're not talking about the complaints centering around a dirty bathroom or a few crumbs on the floor, but serious lapses in patient care," Huntoon adds.
Lemonick received his M.D. from the New York Medical College in 1981, is board-certified in emergency medicine as well as thoracic surgery, and has published several scholarly papers. Until his firing at West Penn, Lemonick's medical career had been all but free of controversy or citations by state oversight boards. Pincus says that prior to his termination, Lemonick's only written admonition came on Oct. 13, 2004, for throwing away a defective chair and for allegedly speaking inappropriately to a resident. That notice came weeks after the incident. It also came two weeks after Lemonick wrote a letter to the hospital's safety officer, complaining of delays in sending blood work to the lab.
Pincus, Lemonick's attorney, says Lemonick received no further correspondence from the hospital about his behavior or his complaints, despite two written promises, viewed by CP, that his complaints would be investigated.
According to a letter dated Nov. 4, 2004, from Jerry Fedele, president and CEO of the West Penn Allegheny Health System, Lemonick's claims were being reviewed and the doctor would hear further from his supervisor. Pincus said Lemonick heard nothing, however, until Nov. 24, when he was terminated.
"We believe there was nothing to warrant removal of Dr. Lemonick from his job," Pincus says. "He was fired after he started making complaints to the patient-safety officer. The timing seems a little fishy."
Unable to find work in the area after he was fired, Lemonick was hired as an emergency-room doctor at Highland Hospital, in Connellsville. He has since been promoted to director of the hospital's emergency department.
West Penn "treated my complaints and concerns about safety as nothing more than a nuisance," says Lemonick. "I was a pain in their butt, and they decided to deal with me."
One of the most serious charges lodged in the lawsuit is Lemonick's assertion that blood work he ordered on potentially seriously ill cardiac patients was badly delayed. According to the lawsuit, one patient, the spouse of a West Penn physician, was showing signs of a heart attack. Lemonick ordered blood work to be done, but the blood wasn't drawn for nearly two hours. In the meantime, the patient went into cardiac arrest, Lemonick says.
When the test results were came back, Lemonick says, they showed high potassium levels that indicated a massive heart attack. If those levels had been detected earlier, the heart attack could have been avoided, he adds.
Lemonick claims such delays were not isolated. In a letter to the nursing supervisor dated July 21, 2002, Lemonick describes an "ugly" incident involving a pulmonary-embolism patient who waited between 90 minutes and two hours to have critical blood work. The patient lived, but Lemonick claims his complaint was never dealt with.
In another instance cited in his lawsuit, a patient suffered what Lemonick called a "huge heart attack" when the EKG was handed over to a medical student who Lemonick says was not qualified to read the results.
"Dr. Lemonick alerted the nurse manager to this serious lapse in care, but the nurse manager acted as if nothing untoward had occurred," the lawsuit contends. "Instead of addressing and correcting this problem, Dr. Thomas Campbell, head of the Emergency Medical Department, admonished Dr. Lemonick for allegedly speaking to the nurse manager in an inappropriate manner."
Lemonick admits to raising his voice at times; he had become frustrated with the lack of attention paid to his complaints, he says, and what he called a growing hostility from other staff and his supervisors.
"A woman having a heart attack wasn't diagnosed because her test was given to a medical student," he explains. "I admit it: I was pissed and I was seeing red at that point. ...
"This lady had a dramatic heart attack because of a delay in receiving test results and I was told [by Campbell] not to speak harshly. ... I asked serious questions about patient care, and do you want to know what the answer was?
"The answer was: you're fired."