Physician whistleblower exposes human rights abuse in U.S. hospitals

PamelaWibleWhistleblower

This courageous physician blows a whistle on the human rights abuse in hospitals. Doctors forced to work 7 consecutive days. No sleep. No access to food. Doctor forced to work in ICU after having seizure. Is this the care you want in American hospitals?

Full transcript:

The hospital administration and the national hospitalist company that I worked for made this agreement that the shifts would be 24 hours. And they would be consecutive 24-hour shifts. And there were only 3 of us dong this job for 365 days a year—seven on and seven off. So seven 24s [that’s a 168-hour shift!] You know, that works if you are just taking call at night, but really what it became was you’re up at the ER at night. And you would see the poor exhausted ER doc who would come on at 7:00 am and get off at 7:00 pm while the next guy came in.

You’re exhausted too and you’re like, “They’re going home and the nurses are going home. Okay, I can do another night. Okay, I can do another night.” Then you are staying through and maybe you get done at 1:00 am and you’re like, “Should I eat? Should I shower? Or should I sleep? Well, you know if I shower then they might call me again from the ER.” So everything just gets let go and then you try to go to sleep and then you get called back again and then you see that ER doc and nurses are going off shift and the new army of people would come in and you’re still there. And then the same thing that night.

And it just got worse and worse. It got busier and busier. And the way that they do that is they hire J-1 visas [international medical doctors] and they’re locked into 3 years. So I was one of the very few people that was not a J-1 visa at this job. And they’re locked in. They can’t complain because they’ll lose their visa. So I tried to speak up eventually. And I waited a while to do that because I wanted to make relationships first and I waited. I stayed there for almost two years. And I finally brought it up and tried to have some meetings and tried to be politically correct and tried to document the conditions.

I slept in the hospital. I showered in a broom closet, a little closet in the CCU [Cardiac Care Unit]. The cafeteria closed at 1:00 pm so usually we’d miss breakfast because you’re on the wards at 7:00 am and breakfast is at 7:00. And then you’d often miss lunch because it is really hard to get off at 12:00 pm to go get something to eat. And then the cafeteria was closed because it’s a small hospital so you’d have no access to food. And then you’d think, “Well, I’m gonna go out to get a Whataburger, or whatever, (which I hate eating) and then you wouldn’t get out.” And then you’d say, “Could we have access to food?” And they’re like, “Well, you outsiders, you come in and you tell us how . . .” It was insane.

We had case management meetings in the morning with the case management team and on a transition day if I was going off my shifts and a new doctor was coming on the shifts we would all meet together. And the case managers were all fresh because they worked an 8-hour shift. They worked hard. But if they worked over 8 hours they were on overtime. So we’re doing these 24s and they’re coming on fresh. And then their boss would say, “Oh, Dr. __ is so irritable. Why is she so irritable?”

So I’m sitting there one day. I’m just exhausted going off of a 3 or 4 day stretch and my new boss . . . There were only 3 of us and everybody kept leaving. The program director left so they asked each one of us if we wanted to be program director and we, of course, anyone who had smarts said, “Uh, no way.”

So who gets to be program director? It’s the newest guy who’s like 28 and J-1 visa nice-enough guy. So he comes on and he tries to manage this program in addition to being the new family medicine grad at this hospital where we were the ICU doctors. No cardiologists. No pulmonologists. Sick, sick, sick, sick, sick patients. So he’s managing all this.

He comes on to the shift and we’re having this meeting. Or maybe he was going off the shift. I can’t remember. [She believes he had been working 8 days straight] He starts seizing. Literally seizing. You know, having a seizure. And they allowed him to work that day. In the ICU. And we are unsupervised in the ICU. It is us and only us. In fact as an internist I even got called into OB there because there’s nobody to do critical care for hemorrhages. So it was exciting, but you have got to be on your game. And I tell you what—when you have worked 36 hours you are not on top of your game and there is nobody else overlooking those cases. And, of course, the patients don’t know that you’ve worked that long. Would they fly in a plane if the pilot had been flying for 36 hours—and seizing?

UN Declaration of Human Rights: Article 5. No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. Article 24. Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay. 

Pamela Wible

Pamela Wible, M.D. is dedicated to ending the human rights abuse of medical students and doctors so patients can receive the health care they deserve.  Dr. Wible takes on the medical culture of bullying, hazing, and abuse that claims the lives of so many doctors in her book, Physician Suicide Letters—Answered

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27 comments on “Physician whistleblower exposes human rights abuse in U.S. hospitals
  1. melissa mason says:

    total insanity. way to call it out Pam

  2. Anonymous md says:

    Insanity! Where is the oversight?! Bell Commission limits the number of patient contact hours for resident physicians but who is protecting these physicians and their patients??!

  3. U Watson MD says:

    No MD should ever agree to work under these conditions – this is where hammering out the conditions of your contract come in . All the visa MDs must warn as many as they can by posting info for graduating residents/fellows in their previous training facilities and as many others as they can reach . These hospitals and mega groups will be forced to change this torture. Young docs DONT DO THIS – go to work at a great Urgent Care and go home after 8-12 hrs and have a life you can love and doesn’t kill you prematurely.

  4. LK Patch says:

    I have been a Hospitalist for 11 years. The corporations who took over large hospital chains and think they own doctors are heartless. I am not on a VISA, but I have suffered years of abuse and took it because I was “a team player”. My last job went through 3 long spells where 2 of us were covering a 24/7 service inhouse. That means doing 24 on and 24 off for months on end. The last spell lasted 7 months. I would go into the Administrators office several times a month to say “You HAVE to get us help, something is going to happen if you do not.” He would give me that blank look and let me know that recruitment and Locum Tenans were too expensive. Obviously, 2 Hospitalists was cheaper than the 4 to 5 actually needed to have a decent life style.

    Then something happened. My husband got Glioblastome multiforme. I was at work when he went through the CT scanner, and I left with him an hour later after asking a local internist to cover my patients. I told them I was not going to leave his side until he died. They had to give me a FMLA leave. 23 days later my husband died and 3 weeks after that I returned to work after his wake. Everybody at the hospital, including the administrator, was so nice to me. I told them they were too late. They took too much from me, and I missed the most important event in my life because of them, and I was NEVER going to give them that much of myself EVER again. They found people to cover when they had to, and they could just keep it up. I went to 30 hour weeks and refused to relent. I have a new job now, but the same boundaries that I defend. If you want me take me on my terms. So glad I am that I am close to retirment. I will miss Medicine as it is what I love to do after more than 3 decades, but the good old days are gone for most of us and the business of Medicine has destroyed the Profession of Medicine. It will mean organization and a lot of battles to take it back. The practice of abusing foreign doctors with Visa’s is taking off in my area as well. They are being treated as near slaves. The hospitals treating them that way are well known for their charities. Go figure.

    • Pamela Wible MD says:

      Sick. We can stop this by refusing to be abused. And refusing to allow our colleagues to be abused. Life is short. I am so sorry for the way your were mistreated.

      • Linda Shaw, MSN, ARNP, FNP-BC says:

        After having similar experiences with expectations that are not humanly possible for the past 25 years, I have finally comprised my quick list thoughts on the subject:

        -THERE ARE NO VICTIMS ONLY VOLUNTEERS!
        Of course there are some true victims out there, but this is for people like us who volunteer to torture ourselves in jobs that no human should subject themselves to.
        After watching “other” professions “get home” after 12-13 hour shifts and being on my 17th hour straight at the local hospital (I was a pulm/critical care ARNP) ; I also had the aha moment of “why am I doing this to myself?” GOOD for those other professions or anyone else who actually has boundaries in their work/family balance. I didn’t for 25 years.

        -WORKAHOLISM WAS MY EXCUSE TO BE “ENTITLED” ON MY DAYS OFF

        It took a lot of soul searching to realize that I “volunteered” to be abused by 90 hour work weeks and never seeing my family for a REASON. I used it as an escape……… and a socially admired escape. Who doesn’t love a workaholic???
        What I would do then, on my days off, is mutter my “martyr anthem” of “I worked 90 hours this week, I just want to crash, don’t bother me about the house/dinner/etc. etc.”
        My poor family were the ones who suffered from my addiction to “be the best, be the hardest working, be everything to everyone -outside the home of course.”
        The answer to this problem I had….. I had to grow up, start taking personal responsibility for the work choices I made and start taking better care of my health and family. It’s not easy giving up the personal satisfaction of working my “ass off” and having the admiration of everyone accept those that matter……….

        -WHAT YOU PERMIT YOU PROMOTE

        I was the highest paid ARNP in the hospitals that I rounded in….. I had negotiated with the doc I worked with and made sure he knew how much he could rely on me. Some of the other ARNP’s were making LESS than an RN. But guess what? If WE allow others to get away with things………they WILL. It’s not their fault, it’s ours. And going along with that is, don’t expect the bucks for just having a license or degree- be worth what you’re asking :).

        -EXPECTATIONS, WITHOUT NEGOTIATION AND AGREEMENT FIRST, ARE JUST PREMEDITATED RESENTMENTS

        This was another long overdue lesson I learned. Expecting others to “have common sense” and know that I am overworked or overwhelmed, or haven’t taken a day off in months is my stupidity. ASSUMING others “should know” things is childish. I had to, again, grow up and start asking for exactly what I wanted and get an agreement with others before I set up expectations in my head. This went for my husband too. How many times I sat next to him and thought…. “why isn’t he rubbing my feet? I worked like a dog this week. He KNOWS I love my feet rubbed.” Guess what? He isn’t just sitting there wondering and anticipated my wants :). If I ask though, I just might get it.

        -THE VICTIM TRIANGLE

        I rode this triangle until I had a saddle imprint on my backside! LOL. I was “victimized” by an unfair and unrelenting health care system. I persecuted others for their dictatorial torture of myself and my colleagues by badmouthing the system, getting mad, throwing a tantrum now and again. Then I rescued the whole system by telling myself “well, you can’t change it, you’re just one person, nobody is actually gonna have guts to band together and commit to bucking the system….etc. etc.” Why did I do that? Rescue the whole system I was a “victim of?” ……. So I could stay in that victim role and be “not good enough” , the martyr, you name it. It isn’t much different from the battered wife who gets mad, calls the cops, then doesn’t press charges so she can stay in the relationship. Sick, I know, but I remember that I did similar behavior when it came to my work.

        -BOUNDARIES ARE MORE THAN A CLICHE’

        I had the passive aggressive/victim boundaries……. after taking “crap” time and time again, drawing a line in the sand and drawing another one when the 1st one was crossed………I would BLOW. “I’m not taking this anymore.” The irony is, if I had set calm and solid boundaries from the start I wouldn’t have had to lose my cool. Other people start off with “don’t screw with me boundaries.” Those were the people I would just write off as “not team players, or premadonnas.”
        The healthy “adult” boundary looks like this: ” I appreciate that you need to cover 150 patient rounds today. I am willing to provide care to 30 of them. I will also keep my eyes open for anyone interested in joining the team to help out with the overflow. Thanks and have a great day today!” NO looking at how they are reacting or even engaging in a response. It’s MY boundary, not a point of negotiation. When I did this the 1st time, the eyes looking back at me bulged, but they could see I wasn’t pleading like a little kid, exploding like an angry teen………. I was calm and I meant what I said. It worked.

        I hope someone can relate to this and I applaud the whiste-blower in this video!!

        Linda

  5. Nick says:

    Also the government needs to get the hell out of our doctors office and allow our doctors to HAVE TIME to be with each patient, not over work them ect… yeah i know that exists and its BS, they need to protect doctors prescribing pain medicines and the like from prosecution. Its not the doctors fault if someone ODs its the persons fault no 2 ways about it. Then maybe people can get treatment, freaking america is all about blaming someone else and not taking responsability, if we would be responsible for ourselves, most drugs could be legalized but no everyone wants to pass the buck. Drugs dont make you steal or kill ect…. the person does that the same with guns the same with anything else.

    • A. Lautin MD says:

      The endorphinergic system is a few millimeters away from every other CNS system. And encephalin centers are not localized to just one area. It is interlinked, interfaced with the other basal forebrain systems. We understand very little, and often we’ve can do very little. Yet write an rx for opiate and an imaginary line is crossed. A saber rattles on a DEA officers belt; the machinery of the Leviathan is triggered. It is too ridiculous for me to go on. I will stop:bExcept to note that what is driving this is big money, control, control and punishment, punish, punish, punish. Health care providers suffer, as does the patient (and we will one day all be patients) as does the population.

    • SD says:

      I’m a primary care provider at a very busy urban clinic. I had to post a reply because I’m not sure why you think it’s the government who dictates our schedules (contrary to popular belief, the government isn’t at fault for EVERYTHING). In fact, it’s not the government who dictates the amount of time we spend with each patient. It’s the hospital or corporation who owns where we work. THEY are the ones who want the revenue from more and more appointments. THEY are the ones who set quotas of the minimum number of patients we are required to see each day and if we aren’t meeting that minimum we are expected to actively recruit for new patients to join our practice. A bit more sleep, regular healthy diet (not gulping down food on the run because I don’t get a lunch break), having the time to drink enough water in a day and go to the lavatory as often as is medically necessary would be lovely. But that being said, I love what I do.

      • Linda Shaw, MSN, ARNP, FNP-BC says:

        I agree that the hospitals and group practice leadership decide on the census of their providers, how they expect the provider to build a patient base, etc. But where I differ is the root cause. The CEO’s and COO’s are just the dog kicking the cat. Who kicked the dog?

        1. ridiculous plaintiffs in ridiculous lawsuits that drive up malpractice and the bottom line for practices/hospitals

        2. organizations with way too many chiefs and not enough indians……… higher level management is expensive and there are WAY too many top heavy organizations.

        3. Government and private regulatory bodies like CARF/OSHA/JACHO (who we actually PAY to rape us of time, resources, patient encounter time, and other B.S. like making sure we don’t have a beverage in the doc box). If we actually did every single piece of paperwork that we were supposed to do, we wouldn’t have time to see more than 2 patients a day.

        4. Reimbursements from Medicare and the almighty “advantage plans” and especially Medicaid aren’t enough to keep the lights on. This makes us have to see 50 patients in 6 hours just to get the receivables to cover staff, electric, the fleet of billers to keep appealing all the denials, another fleet of utilization reviewers to get permission to do anything a doc wants to order, and a fleet of social workers so that you don’t get sued for discharging a homeless guy without a “plan” that they won’t follow anyway because nobody had the TIME to really sit down and find out what was up in his life………….

        So, while the big bad businesses do set the rules for their employees, the government, i.e. CMS and the other “mafia protection” organizations we pay to “endorse us” (aka offer their protection for money) are the real root cause.

        Linda

  6. Wendy Corbin says:

    I’m a patient, what can I do to help. I’m not surprised by the abuse, but I don’t know enough about the system to know how I could be helpful. It’s very sad to
    read that people who love the healing profession are being so abused. Serious consequences that arise from fatigue is not being taken into account! That’s just one
    angle of the atrocities in this story!
    Sincerely,
    Wendy Corbin

    • Pamela Wible MD says:

      At this point we need more public awareness. Share this article. Speak up. Ask your doctor about working conditions. Do you really want a surgeon who hasn’t slept in 36 hours doing your brain surgery? This should be part of informed consent. Public outrage will fuel change. The doctor-bashing stories in the media do little to increase patient empathy FOR doctors. Need more patents to understand that we are ON THEIR TEAM.

  7. Gabe Komjathy MD says:

    Look,these J-1 visa candidates are usually devoted kids that for whatever reason couldn’t get into a North American medical school. In the past 30 years,I have worked beside many such physicians and for the most part they are competent docs.The “proper”national medical education authorities should make every effort to make the “5th pathway” more fair and open to them.Leaving these doctors at the mercy of the conditions in these subpar institutions is of no benefit to anyone.I’m sure the patients of these places, who are most likely to be indigent ,have no clue to what is actually occurring.This is but one dilemma stemming from the widely variable standards evident in our present dysfunctional health care system.

  8. Linda Wooddell RN, BSN says:

    I know this happens a lot to doctors, but it does happen to nurses too, and not just in hospitals. Nurses are made to work short staffed. When a nurse calls out and there is not enough nurses – guess what? Mandatory overtime. This happens a lot in nursing homes for nurses and LNA’s. I’ve had to work 16 hours straight, then have 8 hours until coming in for my next shift. This happens quite a bit.

  9. The Whole Truth MD says:

    Let me say that to properly report this information you must try to hear from all sides. I am a physician at the hospital that your whistleblower is speaking about. When you hear only her side it sounds horrible. I don’t think it can be compared to REAL human rights issues, but it does make for good headlines, I suppose.

    First, let me say that this physician was a competent, friendly and very thorough physician. The hospital hired an independent agency to fill and manage the hospitalist positions. That agency decided how many positions were needed and set the hours for each position. She was fully aware of the conditions, hours and requirements of the position before she agreed to take that position. She was under contract, but that by no means prohibited her from quitting at anytime, if she was not happy with the conditions. She was not handcuffed to the hospital doors.

    Speaking to her living conditions, she told me that she was given a stipend for a hotel and food by the agency, but she choose to keep the stipend and live in the hospital and shower in a “closet in CCU”. As far as “no food access”, the cafeteria opened at 6am and remains open M-F until 6:30pm. Sat-Sun the hours were limited, because it is a small hospital. The food is great. After hours, there are sandwiches, chips, fruit and snacks in the physician lounge fridge. If it was empty the house supervisors always had keys to the cafeteria, so she could have gained access to food at anytime. Also there is 2 major grocery stores, several fast-food places and several restaurants within walking distance of the hospital and that also deliver to the hospital. So to say there was no food, was lying.

    As far as working conditions, she is right- they worked 24 on for 7 days. We all thought that was unsafe and the independent physicians as well as the hospital-employed physicians complained about their hours to administration. Administration tried several times to discuss this with the hospitalist company, but they controlled who worked and when and for how long. To date, the administration has been able to convince the company to change the hours and work requirements and hire more hospitalists to help. To alleviate some of the sleep deprivation, the other hospital physicians offered to take calls at night and take shifts, if the physicians felt they weren’t safe to proceed. Also the ER physicians would try to batch calls to the hospitalist to give them time to sleep and would admit stable patients at night and call the hospitalist in the morning about these patients.

    As far as the physician that was “forced to work in the ICU after having a seizure”, I personally have no knowledge of this situation. I am surprised to hear of this. At our hospital, many of the physicians have worked there their whole careers, and we all like to consider ourselves family. If anyone would have known about this, any one of us would have stepped in to take a shift or two, until it was safe for him to work. I know for a fact that administration would not have let that physician work given the liability.

    I think for full disclosure, it does have to be said that this physician was fired by the hospitalist agency. I am not sure what the terms for her dismissal were, but she didn’t leave because of her horrible working conditions. Again I will say if her working conditions were “a human rights violation”, I would think she would have quit on her own accord.

    I know there are many instances where we physicians work under stressful, sleep- deprived, unhealthy and sub-optimal conditions. If we are honest, most of that is self-inflicted. We are too prideful to ask for help, too caring to walk away. We accept less than optimal conditions for numerous reasons, but no one is forced to work. To say that this situation was a human rights violation is laughable.

  10. Ne Di says:

    Here is is why, controlling salaries to stay high in expense of discriminating your fellow americans https://www.change.org/p/robert-m-wah-md-do-not-outsource-american-jobs-when-americans-qualify-for-them

  11. Absolutely insane! I just shared this on FB and twitter. I am in shock. This is a side no patient ever sees. I make sure they do now! Thanks Pamela! Angela

  12. I can remember having Psychiatry call like this. We covered an entire 800 bed hospital, ER, and 3 inpatient psychiatric units (general adult, geriatric, and adolescent). Progress notes had to be written on all Psychiatry inpatients every day. The inpatients amounted to 45-55 or so, plus new Psychiatry admissions. I was usually there non-stop from Friday evening all the way to Monday morning, when I then had my “regular” work day of outpatients and consults to see in the general hospital. I would lose track of days, and notice new nursing shifts coming and going. In between all the rounding were also emergency calls from 6 psychiatrists’ outpatients. There was no time to go home, sleep, shower, eat, etc. Sometimes, even getting restroom time was challenging as the beeper would go off in the middle of that. 🙂

    Consider that psychiatrists are supposed to be “doctors of the soul,” and bring about healing in depressed, anxious, psychotic, delirious, addicted, and sometimes belligerent patients. I remember thinking that after 3 days working the above call duties, I was more “insane” than any of our inpatients. I did not have much in the way of boundaries then. But after 3 years I realized that the pace was killing me and I moved on to another job . . . which unfortunately, was even worse. Fortunately, I did learn my lesson and changed my entire manner of working in 1999 — and have not looked back. I do give back, though, by caring for my colleagues who are still feeling stuck in such situations — and helping them see that they have options of where and how to serve others.

    I believe that physicians are the only ones who can make any changes in this pattern, because at least some of it continues because we tolerate it. Many are fearful as the video describes. Any health care reform has got to care for the physicians who take care of the patients, or we are all sunk for sure. Blessings to you, Pamela, in bringing attention to these issues.

  13. Shannon says:

    All I can really say as a patient is, “Thank You, Thank You, Thank You”!
    If more doctors would stand together and fight for your rights and the rights of your patients, then maybe things would start to change. Nobody should be subjected to the work environment or should I say the sweat shop, that our American doctors and their patients have been made to endure.
    I am unbelievably sorry that you or anyone is made to work under these conditions, for fear of losing what income and career they do have. Please just know that there are many people who will stand behind you and are willing to stand next to you in order to begin to correct what has been deemed acceptable, because however it is spinned it is absolutely NOT ACCEPTABLE!!!

  14. Julia says:

    Physician slavery pure and simple. It’s inhuman. Everyone needs to be made aware that these things go on and demand it stop.

  15. Julie Greene says:

    Remember, Yeah I remember I was “sectioned” once by a doc who reeked of B.O. I knew his reasoning was way, way off, his sense of logic much more illogical than he claimed MINE was, and who was the patient, anyway? I knew he worked “nights on call.” I knew those docs showered there sometimes.

    Of course I knew all that. I didn’t have blinders on just cuz I was “patient.” What did they expect? I was a “regular,” and a whistleblower, too. As I often say, if folks don’t like what I write, they should have behaved (borrowed from Anne Lamott).

    Keep in mind that tired doctors make decisions that can affect the rest of your life.

  16. Pamela Wible MD says:

    From a female physician:

    Very powerful…of course-I wonder what has happened to her? And the others…
    The point about J 1 visa doctors is true here in NYC as well. We need some kind of
    oversight-but it is not clear to me what can be done about this. Are there any
    human rights organizations that are interested in America’s medical system
    abuse?

    No one would believe doctors are put under this kind of pressure and working conditions.

    At one private medical office-I was confronted-bodily, by the owner-who prevented me
    from leaving at any time to by lunch-once there-in the office-I was not allowed to leave
    the office until my 12 hour shift was over…His screaming and bodily preventing me
    from leaving to pick up so lunch was way over the top-and of course, every sentence
    ended with-you will be fired right now, if you try to leave to get lunch…

    It was really insane, and also very abusive-I was shaking, and it was in the public
    that this confrontation occurred…

    anyway, Have a great day, and thank you for your work,

  17. Pamela Wible MD says:

    Dear Pamela:

    The long shifts that medical professionals have to do in our US hospitals is dangerous, not only for the providers but also for the patients. I don’t know what the shifts are like for the doctors, but I do know that in Spain the nurses and other support staff do not work longer than an 8 hour shift. They still have a long lunch break in Spain — two hours from around 2pm to 4pm. The nursing staff work from 6am to 2pm — the first shift. Lunch has already been provided to the patients before 2pm. The second shift is from 2pm to 10pm, but things slow down in the hospital between 2pm and 4pm, so there is some quiet time when the second shift comes on duty and they have time to review what has happened during the first shift. There are no procedures or tests or operations scheduled between 2pm and 4pm, and the patients have a break so they can take a little nap. The last shift is from 10pm until 6am, dinner has already been served, and patients are not constantly awakened during the night for blood pressure checks (unless absolutely necessary). I think it is a much more intelligent way to staff a hospital. I am not sure how it works for the doctors, but they do not have appointments scheduled between 2 and 4 pm, so the whole hospital quiets down in the middle of the day, and if staff need time to catch up on paperwork, they can get some time during that two hour “slow-down” in the middle of the day.

    We really need changes in our healthcare system in this country!

    (submitted by female doc)

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