Off the Record: When doctor-patient becomes doctor-lover

When medical boards are at their best, they focus on the types of poor judgment calls that hurt patients.

Dr. John Perry provided the Washington Medical Quality Assurance Commission plenty of those.

But boards also care about other things: when doctors don’t pay their taxes, how well doctors keep up their books, and who they date.

In February 2000, Perry, married with five children, met a woman on the Internet and later started an intimate relationship with her, according to commission records.

Normally, this would not matter to the medical board – and perhaps wouldn’t matter to most patients – but when an intimate relationship blurs into a doctor-patient relationship, medical boards become concerned. The idea is that patients should get clear-eyed, agenda-free advice from their physicians. Medical decisions should be entirely distinct from personal ones.

Here’s how that part of Perry’s story unfolded, according to commission records:

The woman Perry met had chosen to have her fallopian tubes tied, making her unable to conceive a child. But, while they were dating, they decided they wanted to have kids. So Perry preformed a tubal ligation reversal surgery on her. It worked. She got pregnant, but in November 2002 she had a miscarriage.

This led to more procedures. Perry preformed a procedure to examine her uterus in July 2003 and found that one of her fallopian tubes was not connected. After trying in vitro fertilization, Perry’s girlfriend became pregnant again, and he performed yet another surgery on her – delivering the child via Cesarean section in April 2006. By October 2006, she was pregnant again, and Perry delivered this through a C-section, too, in May 2007. The couple continued to try to have more children, but two more pregnancies ended in miscarriages. The commission wrote:

After the first miscarriage another physician performed a suction D&C procedure on Patient F which resulted in hemorrhaging. [Perry] subsequently performed at his office a second D&C on Patient F to stop the bleeding.

At every step where Perry was involved in making medical decisions for his girlfriend, he was violating widely held standards of care.

The commission summed it up this way:

Respondent’s care fell below the standard of care in regard to Patient F by his taking charge of her health care and performing numerous significant medical  procedures on her, in spite of his close personal and romantic relationship with her.

So, the tally, according to commission records, was: five patients injured in less than a two-year span and a woman whose reproductive decisions were being made with a doctor who had a significant emotional investment.

What did the commission do?

It did not do anything until March 2010. And then it put him on probation and gave him a $5,000 fine. The emphasis was on education. For example, the commission wrote:

Respondent will attend and successfully complete one of the following ethics courses within one year of the effective date of this Agreed Order. Respondent will communicate with the Commission’s staff Medical Consultant as to which course he intends to take. Any difficulty in the timing of the entry and/or completion of the course can be worked out with the Commission’s staff Medical Consultant.

He didn’t lose his license permanently. He didn’t lose his license temporarily. He could show up for work the next day and operate on anyone but family members. He just had to take some classes, and that’s the emphasis of two bills introduced this legislative session -- one in the Washington state House and one in the Senate. They would create a silent pathway for doctors to take some classes and ostensibly fix their problems out of public view. Some of you may really like this plan. California tried it for years and decided it was an abject failure.

And to understand why medical boards should generally keep their reeducation programs – not to mention true disciplinary programs – available for public scrutiny, I will write more about Perry in a future post.

Because the reeducation plan didn’t end up being enough.

Image by El Payo via Flickr