The term disruptive physician is likely one that a layman hasn't heard of. Yet, it is one that is fairly well known within the health care field. It is used by regulators including state medical boards, JCAHO, the Joint Commission for Accreditation of Health Care Organizations, as well as medical associations including the American Medical Association. Each has a policy for reporting a "disruptive physician" through the medical peer review process. The term disruptive physician is vague and ill defined. In fact, it can almost be summed up by the way Supreme Court Justice Potter Stewart defined obscenity and pornography.
It's hard to define but I know it when I see it
A lot has been written about the traits that characterize a disruptive physician.
A physician's behavior may be defined as disruptive when it ceases to be normative: A disruptive physician can be the surgeon who berates colleagues, residents, and nurses for not performing to his or her standards, and yet constantly violates protocol, arrives early or late for procedures, and disappears at the most inopportune moments. The internist who never uses drugs on the hospital formulary but refuses to serve on the pharmacy committee may be considered disruptive. The pediatrician, a favorite of patients' families, who never completes paperwork but lets it be known that the blame for a child not getting the care that the family believes is needed lies with the administration, nursing staff, and managed care providers who conspire together to prevent the doctor from practicing good medicine may also be considered disruptive. Such behavior takes its toll. Such disruptive physician behavior can undermine the morale of individual staff members, weaken the effectiveness of the medical team in delivering care to patients, spark lawsuits, make it difficult to hire and retain a good staff, and negatively affect the reputation of the institution as well as that of the entire profession. Results of a new survey show that when physicians exhibit disruptive behavior as this, it fuels the nationwide nursing shortage by affecting on-the-job satisfaction and morale for nurses: “The disruptive physician attempts to manipulate supervisors, staff, and patients.…”
The disruptive physician attempts to manipulate supervisors, staff, and patients, often passive-aggressively defying their orders and requests or requiring endless repetition of the same that results in only grudging follow-through. Such physicians will have often “acted out” in some hostile manner. They exhibit verbal hostility, throwing of charts or instruments, hitting desks or computers, or slamming doors. Vague threats against staff, colleagues, and supervisors can also be attributed to such individuals, although these are usually in the form of threats of legal action or administrative action, and not physical harm. Although the physician's ability to handle the day-to-day job requirements appears satisfactory, he or she often shows poor judgment at work by ignoring established policy or performing tasks at the mere fringes of acceptability. Although the physician is often cordial to coworkers and others, he or she is also volatile and appears overly sensitive, and may even go through periods when he or she does not talk to coworkers because they are irritating.
There's also been plenty written about its effects on the work environment.
The New York Times on Tuesday examined how some physicians' negative behavior "contributes to medical mistakes, preventable complications and even death," in addition to "low morale, stress and high turnover" among hospital staff.
According to a survey of health care professionals at not-for-profit 102 hospitals from 2004 to 2007 conducted by Alan Rosenstein of VHA, 67% of respondents thought there was a connection between disruptive behavior and medical mistakes, and 18% said they knew of an error that occurred because of an "obnoxious" physician, the Times reports. One-third of the nurses in the study knew of a nurse who had left a hospital because of the behavior of a physician. In addition, a survey by the Institute for Safe Medication Practices found that 40% of hospital workers reported having been so intimidated by a physician that they did not share concerns about prescription orders and, as a result, 7% said they had contributed to a medication mistake.
The stigma from being labeled a "disruptive physician" can end careers and ironically enough, the charge of disruptive physician has been abused as a means of retaliation. In fact, I have run across several cases in which the charge of disruptive physician was used during the process of sham peer review as a means of retaliation by a corrupt process. (more on that later in the piece)
I say it's ironic because Dr. Anna Chacko, the subject of my ongoing expose series, is the textbook definition of a disruptive physician. It's ironic because there is a plethora of examples of hospital administrations abusing the term disruptive physician to go after a physician that is innocent. All the while, Dr. Anna Chacko has spent the better part of her near three decade career in medicine being nothing but disruptive and never had anyone formally charge her with this term. This is all very logical when you consider that Dr. Anna Chacko is a Psychopath. After all what is a psychopath in the workplace if not disruptive.
Before I go on, here's a quick recap for all first time readers. Dr. Anna Chacko is currently the head of radiology at the Pittsburgh VA. I began tracking her case after sources within the hospital reached out to me. They did this because in their estimation Dr. Chacko has been nothing short of a terror since arriving there in October of 2008. The hospital attempted to remove Dr. Chacko this past March and April, however Congressman Brad Miller reached out to the head of the VA himself, General Eric Shinseki, and the hospital's decision was overridden. Since beginning my investigation, I have spoke to prior colleagues from coast to coast and found that her current behavior is part of a pattern of behavior that causes terror and destruction everywhere Dr. Chacko happens to land. Prior to her stint at the Pittsburgh VA, Dr. Chacko spent fourteen months at St. James Hospital in Butte, Mt. Prior to that she spent about a year at Boston University Medical Center. Prior to that, she spent about six years as head of radiology in Lahey Clinic in Burlington, Ma., a suburb of Boston. Prior to that she spent time in various VA Hospitals as part of her military career. Here are some of the most egregious examples of Dr. Chacko's pattern of behavior as a "disruptive physician".
Upon arriving at St. James Hospital, Dr. Chacko wasted no time in attacking her colleague there Kristi George. George was the radiology manager at St. James. George was actually on vacation the first week of Dr. Chacko's employment. Dr. Chacko made comments about Ms. George's looks, her competency, and she systematically lied in order to impugn George's character and standing in the hospital. Dr. Chacko would often make snide and inappropriate comments about George to George's best friend at the hospital, Jeri Doyle. Doyle was not only Ms. George's best friend, but Ms. George was her boss.
Eventually, multiple witnesses heard Dr. Chacko promise Ms. Doyle that if she helped her (Dr. Chacko) get rid of Ms. George that Ms. Doyle would take over her position. Ms. Doyle is currently serving as radiology manager. Ms. George and Ms. Doyle now don't speak and are, let's just say, no longer friends. Meanwhile, Ms. George was eventually fired right after Dr. Chacko left St. James. Her firing, and everything that preceded it, was the subject of a civil claim between Ms. George, St. James Hospital, Dr. Chacko, and other parties, that was recently settled and is now under seal.
While at Lahey Clinic, Dr. Chacko would often bring in members of the radiology department into her office. Then, Dr. Chacko would ask one radiologist why another radiologist hates them. Then, Dr. Chacko would bring in the other radiologist and reverse the process. These questions were often based on wild misrepresentations or outright lies. No one in fact hated anyone else. Instead, Dr. Chacko would make this up in order to split the department.
In another case, Dr. Chacko bought several hundred thousand dollars worth of radiology equipment. The equipment was delivered and the salesperson was finalizing the deal when Dr. Chacko demanded to cancel the deal and take the equipment back. The salesperson was so livid that she could be heard screaming through the hospital, "you had no problem with our equipment when we paid for you to go to India (Dr. Chacko's place of birth)"
In one infamous incident,Dr. Chacko lit into a resident at a staff meeting calling her lazy, careless, stupid, etc. The staff, sat in horror, too amazed to speak up. They looked at each other in shock at the vitriol, and just as they were about to say enough, lets move on, she stopped and discussed another issue. But she swung that issue around to residents and then began the attack a new. The rest of the staff were too shocked to say anything and they looked around like “are we hearing this correctly, this is too much”. Everyone was whispering and about to say move on when she stopped and started on another item. The item was again artificially swung to residents in general and then on to the resident again. The staff again listened and were about to speak up and the cycle repeated itself 6 or 7 times, each time a shorter echo but no less personally violent. Each of the staff said the same thing: shameful. And they later felt shame and said later that they should have spoken up. From fear they held back a few seconds, she knew when to change the subject, and knew she could do it all conference long.
(I confirmed this incident with the subject of the attack, now a doctor in a hospital in Illinois, but lost contact with her before getting permission to use her name.)
Finally, when Dr. Chacko was removed from Lahey Clinic, she was removed forcefully by security. She could be heard screaming through the hospital, "kiss my big Indian ass "as she was dragged out.
Since Dr. Chacko began working at the Pittsburgh VA, her behavior is similar. There are several doctors at the VA that are legal resident aliens. Dr. Chacko is known to threaten to go to immigration and report them if they cross her. Dr. Chacko disallows the radiologists to have any personal conversations. Often, doctors hide in utility closets just to converse. In a bit of tragic irony, one source tells me that the chief tech and the administrative officer at the Pittsburgh VA were best friends for years. Then, the chief tech began siding with Dr. Chacko. Meanwhile, the administrative officer filed several formal complaints against Dr. Chacko. The two, the tech and the administrative officer, are now no longer on speaking terms and this source believes that the chief tech is now Dr. Chacko's spy trying to find information about the radiology department.
Finally, my source also tells me that Dr. Chacko has been filing a series of complaints against members of the department for a series of dubious problems.
In each case, Dr. Chacko's behavior goes to divide the hospital and the department she's supposed to lead. Friends are often put in a position to attack other friends. More than one source has complained of Post Traumatic Stress Disorder after having to deal with Dr. Chacko. More than one has hired an attorney to deal with complaints leveled at them by Dr. Chacko. Sources describe climates of fear, distrust and extreme stress when they've worked with her. I have only scratched the surface on a thirty year career in which there are systematic examples of Dr. Chacko being a "disruptive physician".
She has worked in numerous states in numerous hospitals. Yet, she's never faced any formal discipline for being a disruptive physician. I earlier said this is ironic. That's because it's common place for the accusation of a disruptive physician to be used simply as a tool of retaliation. As I said, I have run across several cases in which this has happened. In one case, Dr. John Bagnato began investigating the major hospital in his hometown, Phoebe Putney. Dr. Bagnato found what he believed to be a systematic practice of overcharging and over billing of many of the indigent patients that Phoebe Putney. His investigation became a crusade and is now the subject of the documentary, Do No Harm. Dr. Bagnato told me that about a year he attempted to reinstate formal privileges at Phoebe Putney. Prior to that, he would only be at the hospital an average of once monthly. During this process, the hospital opened up a peer review investigation in which Dr. Bagnato was charged with, among other things, being a disruptive physician. As of the last time we spoke, those charges were still pending.
In another case, Dr. Stephen Taylor of Huntsville Vascular Surgery Inc. got into a financial dispute with the rest of his team. This dispute eventually lead one of his former partners to bring up a formal complaint that Dr. Taylor was a "disruptive physician". Dr. Taylor told me that he was making $750,000 yearly prior to the incident and once the charge wound up on his record he was only able to make between $50 and $75,000.
In another case that is frankly to complicated to recount here, Dr. Shirley Pigott was charged with being a "disruptive physician" because she didn't send a patient their test results in the required 15 days. (the test results were sent about a month after that time had expired)
When I started working on this series, the question I wanted most answered is how Dr. Chacko has gotten away with perverting the medical system for so long. After all, having a Psychopath run wild runs counter to everything we stand for. The answer to this question is extremely complicated and will need to be the subject of more than one blog post.
It's clear that the perversion of the term "disruptive physician" is central in answering that question. It is both tragic and shameful that Dr. Chacko has had a career that has taken her from Texas, to Boston, to Butte, Mt. and now Pittsburgh (as well as many places in between) and never has she been brought up formally on charges of being a disruptive physician. Given that it is common place for innocent doctors to be the subject of false "disruptive physician" charges, that is nothing short but an indictment of the corruption of the medical system at large.
It is, however, a situation that can be corrected. Both JCAHO, the Pennsylvania Medical Board, along with dozens of other regulators and medical associations need to be notified immediately of the overwhelming evidence that Dr. Chacko is a disruptive physician. The purpose of the creation of this term was to prevent exactly the environment that Dr. Chacko's behavior creates in each and every place she winds up working. Never has a case so obviously exposed the weaknesses and flaws of bad policy like that of the case of Dr. Anna Chacko and the term "disruptive physician".
Here's the definitive dossier on Dr. Chacko.