Opinion ID: 3010958
Heading Depth: 2
Heading Rank: 3

Heading: Dr. Pamintuan's Contentions and Evidentiary

Text: Support
Dr. Pamintuan contends that Nanticoke Memorial used the alleged deficiencies in her performance as a pretext for its actual discriminatory motive. She alleges that the actions taken against her were more severe than the sanctions imposed on non-Filipino physicians with similar records. Regarding charting, Dr. Pamintuan contends that recordkeeping problems at Nanticoke Memorial were longstanding and involved many physicians, not just Dr. Pamintuan. As early as March 1990, Executive Committee meeting notes indicate that physicians were delinquent in their record keeping, with two (neither of them Dr. Pamintuan) on the delinquent chart list for several months. According to the minutes, these latter physicians' charting delinquencies were severe enough to jeopardize their reappointment. According to Dr. Pamintuan, during the last two weeks of her summary suspension, thirty percent of the hospital's medical staff was delinquent in completing charts. Dr. Pamintuan contends that since her termination the Nanticoke Memorial has indicated a willingness to positively respond to other physicians concerning delinquent charting. Specifically, Dr. Pamintuan points to two letters indicating that the charting delinquency problem has continued to be a hospital-wide concern since her suspension. Like the charting problem, Dr. Pamintuan contends that response time has been a long-standing concern at Nanticoke Memorial. She points to the February 12, 1990 minutes of the OB/GYN Department meeting, which record that [t]he OB nursing staff has concerns in regard to _________________________________________________________________ 8. For a more detailed discussion of the review action, see Pamintuan v. Nanticoke Mem'l Hosp., Inc., C.A. No. 96-233, 1997 WL 129338 (D. Del. Feb. 24, 1997). 9 having difficulty reaching some OB physicians by beeper and/or phone. In response, the OB/GYN Department adopted a policy whereby detailed records were to be kept regarding each physician's response time and availability, such that the Department would be able to review cases and correct any problems. Dr. Pamintuan argues with respect to clinical evaluations that Nanticoke Memorial failed to perform a valid comparative review of her performance with that of her colleagues. According to Dr. Pamintuan, the only way Nanticoke Memorial can establish that she was in fact subject to the same standard of quality review as other physicians would be by a comparative review analysis. In support of her argument, Dr. Pamintuan proffers the testimony of two physicians, Dr. Andrew Stiber9 and Dr. Thomas Dyer,10 both of whom testified at the Judicial Review Committee hearings. According to Dr. Dyer, in fairness I think that you have to review twenty-five consecutive cases of any practitioner, and also compare him to other people doing the same work. . .. If the quality assurance is questioned, the statistical consort that you could make a valid judgment on is twenty-five consecutive cases. And then of course the standard of care is what you're comparing it to, so you want to find out what another practitioner or other practitioners do with the same kind of case. I think that anecdotes are a problem. App. at B-423 to B-424. Dr. Stiber, who provided a written review of Dr. Pamintuan's performance in the four cases before the Judicial Review Committee, found Dr. Pamintuan's care in all instances to have been appropriate. He concluded by stating: Finally, after reviewing all four cases, I am very _________________________________________________________________ 9. Dr. Stiber is a clinical Associate Professor at New York University Medical Center and former Chairperson, Section 1, District II, of the American College of Obstetrics and Gynecology. 10. At the time of Dr. Pamintuan's review action, Dr. Dyer had been a practicing OG/GYN for nearly 30 years and Chairperson of the OB/GYN Committee at Milford Memorial Hospital for more than 25 years. 10 concerned that the issues here are not quality assurance, but the issues of denying a doctor the right to practice medicine. App. at B-433. To further substantiate her claim of disparate treatment, Dr. Pamintuan points to the following excerpt from the Executive Committee's January 19, 1994, meeting minutes: QUALITY ASSURANCE: A representative from the Quality Assurance Committee reported a problem with a provider that caused a focus review on the provider's care. Some timely action must be taken to move forward and protect patients. A memo is being drafted to outline steps to prevent professional review action and allow this person to practice in an unencumbered fashion. This type of intervention has worked in the past. By the next Executive Committee meeting, hopefully a volunteer program will be developed. The concerns are: (1) 30% complication rate, (2) 30-40% mortality rate post-op, and (3) 20-25% curative infection rate. The trend will be sent to the Department of Surgery. A process group with all involved will be scheduled with a consensus standard developed. The suggestion of a Pre-Op Conference could be helpful. App. at B-436. Dr. Pamintuan alleges that the aforementioned physician is Caucasian. Nanticoke Memorial, however, contends that all but the last three sentences of the excerpt refer to Dr. Pamintuan, with the last three referring to a study on thoracotomy. 11 _________________________________________________________________ 11. To further buttress her allegations of intentional discrimination, Dr. Pamintuan points to instances in the past involving alleged discrimination on the part of Nanticoke Memorial towards its employees and its patients. Her evidence ranges from the testimony of a hospital employee concerning segregation of patients in the 1950s and 1960s to an alleged study, a copy of which was not produced, prepared in 1979 reporting community concern that there were too many foreign physicians in the Emergency Room. Dr. Pamintuan contends that in response to the aforementioned survey, Nanticoke Memorial discriminatorily removed all of the Filipino physicians from its emergency room. Dr. Pamintuan also proffers the testimony of several former 11