The medical staff at Eastern Maine Medical Center will consider a bylaw change tonight that would make it possible to discipline or dismiss doctors who make statements that “undermine an individual’s trust in a practitioner or the hospital.”
The proposal’s broad language strikes some as a crackdown on free speech that is not reconcilable with the First Amendment or the professional responsibilities of doctors.
“It’s really a gag order. It’s close to what we objected to in the health plans [HMOs] saying you couldn’t criticize the plans,” said Gordon Smith, executive director of the Maine Medical Association. “I don’t think physicians should be under a gag order on issues they think are important.”
Smith said this proposed provision for Maine’s second-largest hospital is different from any he’s seen.
Dr. James Raczek, president of EMMC’s medical staff, said the proposal was based on a model from the Federation of State Medical Boards. Raczek and Dr. Irwin Gross learned of the model while attending a conference, he said. The proposed changes to EMMC’s bylaws would establish 18 standards for determining unacceptable behavior, Raczek said.
“The things that are in this particular appendix, if they were put in the public light, [the public] would say they made sense,” Raczek said.
At the same time, he said the issue of the proposed rules is not something he believes should be considered publicly. Rather, the discussion should be within the medical staff committees and staff as a whole, he said.
Doctors contacted by the Bangor Daily News said they had little trouble with most of the provisions that would prevent things like profane or disrespectful language, demeaning or intimidating behavior or outbursts of rage or violent behavior. But they said they would consider the restrictions on free speech carefully.
EMMC officials have been asking doctors and nurses to be quiet about various issues affecting the hospital after dozens of representatives of both groups stepped forward to describe publicly problems they say endanger care and that they contend are being swept under the carpet by administrators.
After doctors complained publicly about problems they said weren’t being dealt with, trustees gave CEO Norman Ledwin a vote of confidence without inviting the doctors to present their concerns directly. Shortly thereafter, a joint conference committee of trustees and doctors was assembled for the first time at EMMC in more than two decades to investigate.
Eight months later, the committee is still working away, said EMMC trustee chairman John Woodcock on Monday. He said the meetings involve sensitive issues, and he “[doesn’t] think it’s appropriate to air them in the paper yet.”
He also declined to discuss the freedom of speech questions related to the proposed bylaw change, saying that would be appropriate only if they are approved and submitted to trustees for a final vote.
The issue of what should be discussed publicly has been the subject of at least two memorandums from EMMC officials. The latest, in early January, came after an overwhelming vote by the medical staff to support a nine-point doctors’ petition complaining about staffing and other issues was reported in the NEWS.
Raczek sent the memorandum to medical staff suggesting details of the meeting should not have been discussed publicly.
“While the EMMC Medical Staff Bylaws do not specifically state that Medical Staff meetings are confidential, I believe giving the press specific information of how an individual voted at a Medical Staff meeting is a ‘Breach of Trust Among Colleagues,'” Raczek wrote in the memorandum, which was obtained by the NEWS in January.
Smith said that while legally protected information and some other forms of sensitive information should be kept confidential by medical staffs, doctors shouldn’t be under broad gag orders. More restrictive rules are best suited to working committees, he said. He said every medical staff views the issues a little differently.
Smith said the public grants nonprofit hospitals their tax status and the public has an interest in their functioning. And just as the public has an interest in trustee actions at those institutions, it also may be interested in the actions of the medical staff and other groups, he said.
Correction: Clarification A front-page story in Tuesday's paper concerning proposed changes in Eastern Maine Medical Center staff bylaws carried a headline that was misleading. The bylaw changes must first be voted on by the medical staff. The EMMC trustees then must approve the changes, but the new bylaws govern medical staff only, and do not become part of the administration's operating rules.