"Hospitals should own up to their bad decisions," says the attorney for a neurosurgeon who's filed suit against a New York state hospital. "They should not just dig in further." And when an experienced physician questions a hospital's clinical policies, hospital administrators shouldn't attempt to punish him.

The surgeon, James Holsapple, MD, claims that he lost several positions after he challenged a policy at Upstate University Hospital in Syracuse, N.Y., that let unqualified assistant surgeons perform surgery on their own.

He'd first raised concerns in 2007 as a new member of the hospital's medical executive committee and a surgical quality officer. A newly proposed policy allowed a single spine surgeon to oversee 2 or more assistant surgeons' procedures taking place simultaneously. Arguing that the assistants weren't qualified to perform cases on their own, he advised the committee to drop the policy, but was overruled.

Dr. Holsapple also notes in his lawsuit that the hospital had ranked near the bottom in a national assessment of spine surgery outcomes, and that he'd warned administrators that full physician payment for these supervised surgeries might expose the hospital to Medicare fraud claims.

After the policy was implemented, an assistant-driven surgery resulted in post-op complications and a patient's difficult recovery. When Dr. Holsapple again urged hospital leaders to retract the policy, the meeting ended in heated conflict.

The New York State Department of Health later received an anonymous complaint about the policy and investigated the hospital. In May 2010, it issued a 60-page report on a broad range of code violations, including "mulitiple lapses of service regarding performance of a surgical procedure by a surgeon not credentialed to perform the procedure."

Dr. Holsapple argues that his disputes with hospital leaders over the policy cost him his positions as residency coordinator and departmental quality officer, and claims that pediatric cases were steered away from him. An attorney for Upstate Medical University, which runs the hospital, denies these claims and points out that the hospital has submitted a plan to correct the deficiencies in the state's report. It has also abandoned the practice of assigning a neurosurgeon to supervise multiple surgeries.

While Dr. Holsapple had originally filed his lawsuit in federal court, given the protection federal authorities extend to whistleblowers, the case was denied status (due to the hospital's state ownership) and he re-filed it in state court.

Leigh Page