Opinion ID: 3010958
Heading Depth: 2
Heading Rank: 1

Heading: Obstetrics and Gynecology Departmental

Text: Meetings Beginning in December 1990, the minutes of the 840 Department of Obstetrics and Gynecology1 monthly meetings began to reflect concern with Dr. Pamintuan's performance. Most of these notations indicate that she had failed to comply with hospital policy concerning response time and progress notes. For example, the minutes from the December 1990 meeting reveal that the nursing supervisor filed a report documenting Dr. Pamintuan's failure, in violation of hospital bylaws, to timely respond to a call regarding a cesarean section.2 Minutes from the December 1991 and January 1992 meetings record Dr. Pamintuan's failure to promptly enter a patient's progress notes; as a result the OB/GYN Department sent Dr. Pamintuan a memo regarding the need for timely charting. Similar concerns regarding delinquent charting were raised at the September 1992 meeting: This was a patient from the clinic admitted on 7/21/92 with acute pyelonephritis during pregnancy and stayed in the hospital for five days. Problem: no H & P, no progress notes and all orders were verbal except for admission and discharge. This chart was incomplete for two months. Only two entries were made. This chart was needed for a second admission and no documentation was present to assist with the second admission. App. at B-305. As before, Dr. Pamintuan was sent a memo about the incident. At the next meeting, the OB/GYN Department voted to send the chart to Nanticoke Memorial's Quality Assurance Committee for further investigation because the Department of OB feels that patient care was compromised in this case because of the _________________________________________________________________ 1. From 1990 through 1993, the OB/GYN Department consisted of five physicians: Drs. Cabrera (Hispanic), Rupp (Caucasian), DeJesus-Jiloca (Filipino), Tierno (Caucasian), and Pamintuan (Filipino). 2. The minutes indicate that further action on this matter was precluded because the OB nurses did not follow the Hospital Communication Policy of beeping first or calling another physician. 3 lack of information in the chart, which is a violation of the medical staff practice in this institution.3 App. at B-307. Concerns about Dr. Pamintuan's timeliness, chart deficiencies, and other complaints concerning her conduct continued to be documented at OB/GYN Department meetings throughout 1993. In January 1993, the Director of Maternal/Fetal Nursing complained about Dr. Pamintuan's response time (three hours) after being beeped; Dr. Pamintuan contended that her beeper was defective. In April 1993, the minutes reflect two complaints regarding Dr. Pamintuan. The first, from the Vice President of Nursing and Administration, accuses Dr. Pamintuan of improperly arranging to admit a patient while she was on the sanctions list for failure to keep her charts up-to-date. The second, from the Director of OR Nursing, accused Dr. Pamintuan of unnecessarily keeping the on-call team in the operating room from 1:45 am to 5:15 am. Dr. Pamintuan denied both incidents. These incidents were discussed at the May, June, July, and August 1993 meetings. Written statements were requested of all parties, including Dr. Pamintuan. In addition, the July 1993 meeting minutes reflect an additional complaint, from the chairperson of the OB/GYN Department, regarding Dr. Pamintuan's failure to answer her beeper, which required that he cover the delivery. Again, written statements of all those involved were requested. All of these incidents were forwarded to the Quality Assurance Committee for review. In addition, Dr. Rupp, the OB/GYN Department Chairperson, sent a letter to the Quality Assurance Committee reviewing the discussion concerning Dr. Pamintuan at the August OB/GYN Department meeting. In March 1994, at the request of the Quality Assurance Committee, the OB/GYN Department held a special meeting to discuss Dr. Pamintuan's handling of two cases. _________________________________________________________________ 3. With respect to this incident, Dr. Pamintuan admits that she left for vacation without completing the chart and, thus, the chart was incomplete at the time of the second admission. Dr. Pamintuan avers, however, that upon her return the chart remained incomplete because Dr. Rupp, OB/GYN Department Chairperson, had thefile sequestered in his office. 4 The standard of care in the first case was deemed appropriate. The second case involved a threatened miscarriage. Since only two physicians other than those involved in the case were present at the meeting, discussion was tabled until the April meeting. At the April meeting, [i]t was unanimous department consensus that[Dr. Pamintuan] should have performed a timely dilation and evacuation for the patient in question. Her failure to recognize and treat the apparent spontaneous miscarriage was not consistent with appropriate gynecological care. Action: A memo will be sent to the Quality Assurance Committee of the Board with this finding. App. at B-377. The report concluded: Administration has concern with the potential demonstration of inappropriate judgment [by] the above physician. Over the last 18 months there have been continued questions about her judgment and administration is concerned with safety of patients under this physician's care. App. at B-377. Besides Dr. Pamintuan's cases, other physicians' cases having complications were presented for review at the OB/GYN Department meetings. Like Dr. Pamintuan's, these cases were selected for review by the nurses. According to Dr. Pamintuan, during the time period January 1, 1992 through September 1994, there were at least twenty-four cases with complications involving OB/GYN physicians other than herself presented for Morbidity Quality Assurance Review. Of these twenty-four cases, Dr. Pamintuan contended that fifteen . . . involved morbidities that were more severe and reflected a lesser quality of care than were reflected in the two cases for which[she] was subjected to Professional Review Action by the Hospital Administration and its subordinate boards and committees. According to Dr. Pamintuan, nearly all of the morbidities resulted after care provided by the three . . . Caucasian physicians in the OB/GYN Department. The 5 minutes of the OB/GYN Department meetings, however, do not indicate that either the OB/GYN Department or Dr. Pamintuan (who was the reviewing physician in seven of the twenty-four cases) found quality of care issues in these cases. The minutes state, for the most part, that the level of care administered was appropriate, there was no problem, or the standard of care was met. According to the minutes, Dr. Pamintuan was the only OB/GYN physician whose conduct warranted review by the Quality Assurance Committee.4