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Can we get cultures on that?

June 2009 -- A recent article in the Colorado Springs Gazette highlighted the continuing problem of physician abuse of nurses in some care settings. John Ensslin's June 26 piece was "Nurse sues Memorial, claims surgeon threw human tissue at her." The story reports that in mid-2008, Bryan Mahan, the chairman of cardiac and thoracic surgery at Memorial Hospital, allegedly threw and hit operating room nurse Sonja Morris with a 4-by-6-inch piece of bloody tissue (the pericardium), and committed other physical assaults on her. Morris says she complained to the hospital with no result, then filed a gender discrimination claim with the U.S. Equal Employment Opportunity Commission. Morris says hospital administrators soon transferred her from the heart surgery team to the main operating room, which is considered less prestigious. She finally filed suit in federal court against the hospital--but not Mahan--on the grounds that she was demoted for complaining about the abuse. Commentary from local nurses posted on the Gazette's web site in response to the story suggests that physician abuse of nurses has been tolerated at the hospital, and that one reason for such tolerance is money. Since physicians are viewed as vital revenue generators, there is a strong incentive to ignore or excuse their misconduct. Of course, patients could not survive surgeries without nurses, and physician abuse of nurses is a major threat to that survival as well, since it is difficult for abused nurses to perform their work as effectively. In addition to economics, the historic power imbalance between the two professions, and between the two genders, would seem to play a role in the cycle of abuse and impunity as well. The Gazette might have provided more context and detail, but we thank the paper and the nurses who responded for drawing attention to these important issues.

The report says the OR incident allegedly took place in August 2008. It notes that Morris's court complaint says that Mahan threw a protective layer of heart tissue during an open-heart surgery (a pericardiectomy), hitting her in the leg, and notes that she was unable to clean the area until later because the operation was underway. Morris's complaint says that Mahan

made a joke about it to the other surgeons, saying, 'Oh sh**, I hit her. Can we get cultures on that?' Morris said she felt humiliated as the other surgeons chuckled.

Morris also claims that on previous occasions, Mahan came up behind her and hit her on the head, though it is not clear why he would have done that. Morris says she asked Mahan to stop. The Gazette story says the hospital declined to comment, and Mahan could not be reached. Morris apparently still works at Memorial, where she has been a nurse since 2000, according to the court complaint.

The article does not explain that claim, but the complaint itself shows that the case is actually against the City of Colorado Springs (a government entity), which runs the Memorial Health System. The First Amendment claim alleges a violation of Morris's right to petition the government for a redress of grievances. The complaint also seeks damages for gender-based harassment under Title VII. The complaint says that except for Morris, all members of the heart transplant team during the mid-2008 tissue-throwing incident were male.

Comments posted on the Gazette web site within a few days of the June 26 report provide further context that the article itself does not. Laura Evans, a Colorado Springs nurse, says she herself resigned from Memorial because of "this type of behavior. ... Verbal abuse of nurses and other staff by physicians was a daily occurrence at Memorial, and it was considered 'normal' behavior." Evans also suggests that Morris may have been put at risk for a blood-borne illness--which the article itself did not specifically note--and that legal action should be considered against Mahan. Nurse Mary Willock notes that the Joint Commission on the Accreditation of Healthcare Organizations, apparently responding to an incident involving a pattern of verbal abuse from a heart surgeon at a different hospital, recently issued "a safety alert requiring hospitals to adopt a zero-tolerance toward workplace bullying," including conducting training and setting up mechanisms to report violations. (See JCAHO zero-tolerance policy.) Willock also observes:

Unfortunately, the underlying theme in all of this is money. We all know heart surgeries benefit the hospital coffers and, therefore, admonishing the surgeon would be counterproductive. Placing the nurse in another less lucrative position would be an easy fix.

Both nurses salute Morris for standing up for herself. Willock notes that "[m]any nurses do not and continue to be abused."

That strikes us as a key point, whatever the merits of any particular claim of abuse. Patterns of abuse like that alleged here remain a distressingly common feature of nurse-physician relations, and they can only end when those on the receiving end protest. Of course, it would not hurt if other physicians declined to "chuckle" at the abuse as well. And that might require that "we get cultures" within the hospital to change.

If you wish to share your views about the importance of zero tolerance of abuse toward nurses with the leaders of Memorial Hospital, please write to Memorial Hospital CEO Larry McEvoy and CNO Linda Goodwin by clicking here.

What is the culture at your institution? Is abuse tolerated? Please post your stories on our discussion board. Thank you!

See John Ensslin's article "Nurse sues Memorial, claims surgeon threw human tissue at her," which ran on June 26, 2009 in the Colorado Springs Gazette.

See our FAQ: What is physician disruptive behavior and why does it exist?


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