Courts Undermine Efforts to Weed Out Bad Doctors, Experts Say

Several recent court rulings overturning decisions to dismiss doctors for poor performance are undermining the profession's ability to weed out poor practitioners, health professionals say.

Several recent court rulings overturning decisions to dismiss doctors for poor performance are undermining the profession's ability to weed out poor practitioners, health professionals say.

The most recent case occurred in early December, when the Tel Aviv District Court ordered the Maccabi health maintenance organization to reinstate Dr. Shmuel Levin, a gynecologist whom Maccabi had dismissed from its Bat Yam clinic in July. Maccabi terminated Levin's contract after a professional committee found serious flaws in 16 cases he had handled. One of the most severe incidents occurred in March 1999, when Levin mistakenly removed an ovary from a woman at Assouta Medical Center in Tel Aviv, saying "he didn't know exactly what he was supposed to operate on." After that incident, Maccabi forbade him to perform any more operations.

But Judge Yehuda Zefet ordered Levin reinstated earlier this month, saying his dismissal was a severe blow to his status, dignity and income. The judge also heaped scorn on Maccabi's professional evaluation of Levin's performance, saying the "few, and not especially grave, testimonies" that Maccabi had gathered against the doctor did not justify terminating his contract. Maccabi plans to appeal this ruling.

In another case about 18 months ago, a court rescinded Maccabi's dismissal of a resident in family medicine who had been the subject of numerous complaints by patients.

Dr. Vladimir Yakirevitch also continues to perform cardiac operations at Assouta, even though the Health Ministry took the unusual step of revoking his license in 1996 following reports of severe malpractice in his role as head of cardiac surgery at Ichilov Hospital. Among other breaches, the ministry found that he had walked out in the middle of extremely delicate operations in order to attend to patients he was seeing privately. But a court restored his license and permitted him to conduct a limited number of operations at Assouta. In this case, the Health Ministry wanted to appeal, but the state prosecution refused.

Professor Shuki Shemer, Maccabi's CEO and a former Health Ministry director-general, said that such decisions by the courts severely undermine the HMOs' ability to uphold professional standards among their doctors and to oust poor practitioners. Numerous other senior health professionals, including both HMO officials and hospital directors, echo this charge.

Furthermore, such rulings merely compound the problems of a supervisory system that is already characterized by excessive delays in dealing with complaints and the frequent whitewashing of medical malpractice. In Levin's case, for instance, it was only in April 2000, a year after the botched ovary operation, that Maccabi decided to bar him from operating on its patients. And even then, it failed to report this decision to the Health Ministry, with the result that Levin continued to perform operations at the state-owned Wolfson Medical Center in Holon. Levin says he even continued operating at Assouta.

This reluctance to take action, which is partly due to pressure from the doctors' unions, is merely increased when pressure from the courts is added into the equation. In another recent case, for instance, the Leumit HMO rescinded its decision to fire Dr. Yoram Vechtel, though Vechtel will in practice not work until the charges against him are investigated further. Leumit had decided to dismiss him after a 68-year-old patient at its South Tel Aviv clinic died, and a Health Ministry investigation found that Vechtel had ignored an urgent call from the clinic's medical team to perform resuscitation on the patient. But after Vechtel sued for reinstatement in the Tel Aviv Labor Court, Leumit backed down, informing the court on November 20 that it was reversing its decision.

Similarly, the Health Ministry recently agreed to let a surgery resident resume his residency at the state-owned Sheba Medical Center in Tel Hashomer, after it had originally dismissed him due to extremely negative reviews from several senior surgeons in the department. In this case, too, the resident sued in the Tel Aviv Labor Court, and on September 30, the ministry informed the court that it had rescinded its decision.