Are you justified in firing a disruptive physician if he is shown to be a direct threat to patient safety? A lawsuit involving a surgeon who'd get so angry in the OR that he'd freeze up suggests so.

A Mississippi hospital fired a surgeon who frequently lashed out at staff and patients. Sometimes his anger got so intense that he "froze up" in surgery, according to court documents. The surgeon filed a lawsuit against his dismissal, but the courts upheld the hospital's action, noting that his inability to move during surgery was a threat to patient safety.

From the time he became an employee at Baptist Memorial Hospital North Mississippi in Oxford, Miss., C. Jake Lambert Jr., MD, a cardiothoracic surgeon, was prone to angry outbursts against staff and patients, court documents show. After the hospital had received numerous staff complaints about him, including freezing up in surgery, he was referred for evaluation to Edward M. Anderson, PhD, a psychologist at Pine Grove Recovery Center in Hattiesburg, Miss.

Dr. Anderson's report said Dr. Lambert should be monitored for 5 years and start intensive treatment to address his disruptive behavior. The report cited 3 known instances of the surgeon freezing up in the OR and included this damning indictment: "It is our impression that Dr. Lambert is currently unfit to practice medicine with reasonable skill and safety."

Based on the report's finding that Dr. Lambert was unfit to practice medicine, the hospital suspended his staff privileges, noting that his actions were "detrimental to patient safety." Dr. Lambert was told his suspension would be reported to the National Practitioner Data Bank, but he didn't exercise his rights to a hearing and his attorney actually waived those rights, court documents show. Under Dr. Lambert's employment contract, the suspension gave the hospital authority to terminate him, which it then did.

Dr. Lambert filed suit against the hospital for firing him, but lost in a summary judgment and an appeal of that judgment. His first claim was breach of contract, asserting that Baptist had a duty to independently investigate Dr. Anderson's findings and to give the surgeon the opportunity to seek a second opinion. But the appeals court said the hospital did not need to investigate further because it had already dealt with numerous staff reports on Dr. Lambert, including his freezing up in the OR, before Dr. Anderson took up the case. Furthermore, the court noted Dr. Lambert never stated that the complaints against him were unsubstantiated.

Dr. Lambert's lawsuit then contended that he was defamed when the hospital reported his suspension, along with the observation that he was unable to practice medicine safely, to the National Practitioner Data Bank. The suit claimed this was a false allegation because Dr. Anderson's report suggested the surgeon could continue working if he met monitoring and treatment recommendations. The appeals court, however, countered: "Dr. Lambert argues that Dr. Anderson's report was inconsistent, but he fails to prove the falsehood of the statement at issue" - that he was unfit to practice medicine.

Dr. Lambert also claimed intentional infliction of emotional distress by the hospital when it reported him to the data bank. But the appeals court said the surgeon failed to prove Baptist's action was "wanton and willful and evoked outrage or revulsion," as the law requires. An attorney for the hospital did not respond, and attorneys for Dr. Lambert were not listed in the appeals court ruling.

Leigh Page