An orthopedic surgeon was removed from a Florida hospital's call list because of concerns that he was too slow and inefficient. Insisting he was just being conscientious, he refused remedial help and sued the hospital. After 13 years of litigation, a federal appeals court recently rejected his lawsuit.

In 1996, physicians at Orlando Regional Healthcare System, now Orlando Health, told Raymond Pierson, MD, he took too long on surgeries, scheduled cases at inappropriate times, labeled routine cases as urgent and waited too long to dictate operative notes. The hospital removed him from its call list and reported him to the National Practitioner Data Bank, but it never took away his privileges during many years of internal investigations in addition to the litigation.

While physician-investigators for the hospital said Dr. Pierson's surgery times were longer than those of other surgeons, they conceded they were "not excessive, and no harm to his patients has been demonstrated." However, they alleged Dr. Pierson scheduled surgery in the late evening and early morning, which "put an undue burden on hospital resources," and he sometimes delayed dictating operative notes by 25 to 30 days, which was "unacceptable regardless of his busy schedule."

Dr. Pierson, who filed his lawsuit in 1996, says his cases took longer because he was very conscientious. He maintains his patients were discharged 4 days before similar patients treated by other surgeons in the hospital, and many nationally renowned peers supported his practice style. He disagrees with the alleged length of dictation delays but admits he sometimes took longer than others because he provided written files along with dictation.

He charges that physicians who reviewed him for the hospital were biased competitors and performed "sham peer review" that shouldn't have been afforded federal protections. His lawsuit names 18 physicians who helped review him and lists 21 different charges, including breach of contract, antitrust, civil conspiracy and defamation.

The courts threw out all of his claims before they ever came to a jury trial. In a statement, Orlando Health said it was pleased with the appeals decision. "We have always treated team members and physicians - whether they are employed or independent - with respect and in a professional manner," the statement said. "Our expectation is that physicians and team members mirror that behavior and act accordingly."

Dr. Pierson has moved to California and now works for Sutter Health, but he insists his fight is not over. He plans to request a rehearing of the case, and if that fails he will petition the U.S. Supreme Court. "I'm not going to go away yet," he says. "There is too much at stake here, not just for me, but for all physicians who still want to meet high standards of care."

Leigh Page