Delaware physician whistle-blower wins free-speech appeal

Judges agree that state administrators acted "recklessly" when they decided not to renew the doctor's contract after he voiced concerns about patient care.

By Amy Lynn Sorrel — Posted Feb. 27, 2006

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The U.S. Court of Appeals for the 3rd Circuit in January upheld a $1 million judgment in favor of a Delaware physician who lost his job at a state hospital after he spoke out on patient care and safety issues.

The court found that the Delaware Dept. of Health and Social Services violated the First Amendment rights of David T. Springer, MD, when the agency did not renew his contract at the Delaware Psychiatric Center after he complained of staffing problems and administrative interference with patients' medical treatment.

Doctors and attorneys say the case is a successful template for doctors who, within proper channels, use the First Amendment right to free speech to speak out about patient care problems. They also say that the federal ruling can be referred to as precedent in future whistle-blower cases on this issue.

Some argue that the decision gives weight to growing concerns that hospitals abuse peer review systems to retaliate against doctors who are whistle-blowers or economic competitors. The ruling could have implications for private facilities, they say.

Others, however, argue that Dr. Springer's case does not extend to peer review, and that the ruling has only narrow applications to public hospitals.

Regardless, "the courts have said this is a matter of the utmost public concern when a physician speaks out about the health and safety of patients," said Thomas S. Neuberger, Dr. Springer's attorney.

Court documents show that in a series of memoranda from October 1999 to March 2000, Dr. Springer, a psychiatrist and president of medical staff at the Delaware Psychiatric Center, had complained about patient abuse, overcrowding and personnel shortages. He criticized the administration for hiring unqualified staff members and for discharging patients early.

"The situation has deteriorated to the point that physicians are being asked to practice medicine at below their minimum ethical standards on a routine basis," Dr. Springer wrote, with the support of other medical staff members.

He communicated his concerns up the chain of command to the hospital board; Greg Sylvester, secretary of the Dept. of Health and Human Services; and then-Gov. Tom Carper. He subsequently learned in May 2000, that after nine consecutive years of service, his contract would not be renewed by Renata J. Henry, director of the Division of Alcoholism, Drug Abuse and Mental Health in Delaware's Dept. of Health and Social Services.

In a lawsuit filed in October 2000 in the U.S. District Court in Wilmington, Dr. Springer alleged that he was the only doctor whose contract was not renewed, and that the nonrenewal was retaliation by the agency for voicing his concerns.

The state argued that Dr. Springer was "disruptive" in making false statements against the hospital and that as a state agency, it could not be sued for liability. Henry argued that Dr. Springer would have been let go anyway because he did not bid for his contract as required by a new state law.

In April 2004, the district court jury found that Dr. Springer's complaints were a motivating factor in the decision not to renew his contract and that the state was liable because it had violated his free speech rights.

The 3rd Circuit Court of Appeals upheld the jury's findings that Henry "acted at least recklessly ... if not intentionally ... with respect to Dr. Springer's constitutionally protected rights." Henry "singled out Dr. Springer for intentional disparate treatment," the opinion stated.

The court went on to say that the manner in which Dr. Springer communicated his concerns to higher officials, "was not inappropriate."

According to attorney Neuberger, "For other physicians, the court has said this is a road map when faced with this dilemma, and if you do it appropriately, like Dr. Springer did, the federal courts will protect you." He added that the court had taken unusual action when it attached Dr. Springer's memos to its ruling.

Even though Dr. Springer was not peer reviewed because he was a public contract employee, the ruling could have applications to private doctors and hospitals, because the federal court's ruling can be referred to as precedent in future whistle-blower cases that deal with reporting patient safety issues, Neuberger said.

The American Assn. of Physicians and Surgeons filed a friend-of-the-court brief in support of Dr. Springer. The group stated that hospitals and their administrators must be held legally accountable for wrongful actions to ensure that physicians speak out for patient care without fear of retaliation.

"Now [doctors] can point to a successful decision from the second highest court in the land" that admonishes hospitals for making decisions based on their own administrative interests, said Jane Orient, MD, executive director of the AAPS.

But other lawyers say that although the court's findings were fair and reasonable in the case of Dr. Springer, the ruling exclusively governs public institutions, and the court did not intend to focus on more global issues such as peer review.

"The hospital as a private organization has appropriate regulations and bylaws for professional conduct and can deal with it in a different way" because bringing forward concerns can be disruptive to the work environment, said Mark Kadzielski, a health lawyer in Los Angeles who represents medical staffs in peer review cases.

That does not mean doctors should not speak up, he explained, but there are channels that should be utilized.

"One could argue that's exactly what Dr. Springer did," Kadzielski said. "The people responsible in this case were the [state]. In a private hospital you would write to the chief of medical staff or the CEO."

The Medical Society of Delaware and the Delaware Healthcare Assn. did not take a position in the lawsuit and had no comment.

Delaware Dept. of Health and Social Services spokesman Jay Lynch also declined to comment on the case. "We are consulting with the AG's office and deciding whether to appeal," he said.

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Case at a glance

David T. Springer, MD, v. Renata J. Henry, director of the Division of Alcoholism, Drug Abuse and Mental Health of the Delaware Dept. of Health and Social Services

Venue: U.S. Court of Appeals for the 3rd Circuit
At issue: Whether a public hospital wrongfully terminated a doctor for speaking out about the inadequate quality of patient care at the facility. The court ruled that the doctor had a First Amendment right to speak out and that the hospital had unfairly retaliated against him for doing so.
Potential impact: Doctors and attorneys say the decision provides a road map for doctors to use when reporting patient care problems. Some argue that the ruling could apply to private settings in which hospitals abuse internal systems to get rid of doctors who are whistle-blowers. Others argue that the ruling has narrow applications to public institutions and that private hospitals have their own appropriate avenues for speaking out about patient care.

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