Friday, August 11, 2006

Triumph or Tragedy?

I have been following the story of Dr. George Hsu over the past year, and like a Hollywood movie, it is finally approaching the climactic ending, though I still don't know if it's going to be one of triumph or tragedy. Here's the timeline version:

March 2004 - Dr. Hsu, a small town family physician in Elgin, North Dakota, has his license revoked by the State Board of Medical Examiners based on an anonymous complaint. He is accused of inappropriate care in 10 cases.

November 2004 - Rather than accept a hearing judge's less punitive recommendation to monitor Hsu's practice, the medical board revokes his license instead. At the urging of his patients, who are local farmers and ranchers, Dr. Hsu files an appeal.
Rolf Sletten, the board's executive director, said monitoring would have been too intense to be practical in Hsu's case. He said the board said it believed the breeches in Hsu's medical care were too serious and that, coupled with Hsu's attitude and prior history of being disciplined by the board for untimely charting of patients' medical records, revoking his license was the best course of action.
Hsu said he also is frustrated because the 11-member medical board voted without comment, and he has never heard its explanation for taking the most serious disciplinary step it can take against him.

Sletten said Hsu's attitude worked against him.

He said that when Hsu addressed the board, he complained about the investigation and review process and only talked about being monitored when "nudged by his attorney.
Sletten said he can't remember when a district court has overturned the board's decision to revoke a medical license.

January 7, 2005 - Medical Board denies a rehearing.

January 29, 2005 - The townspeople of Elgin organize fundraisers to help out the financially-strapped Dr. Hsu.
Klein said people are finding it difficult to replace Hsu.

"It's about trust and that's something you can't get in a pill," she said.

Hsu said he's deeply moved by the response from the community.

He said his practice was characterized by carrying one of the nation's top patient loads, even while his personal income was in the bottom 10 percent of family physicians.

"I have not been able to save a lot of money and the legal costs have drained my personal resources," Hsu said.

February 2005 - Hsu files an appeal in state court. The national media pick up his story.

Hsu's supporters write Letters to the Editor in the local newspaper criticizing the Medical Board's decision. [1] [2]

March 22, 2005 - Dr. Hsu writes his own Letter to the Editor, entitled Price of defensive medicine is steep.

March 2, 2006 - One year later, it's over. Elgin Doctor Back in Business
The state's medical watchdog panel was wrong to revoke the medical license of an Elgin doctor accused of improper patient treatment, a district judge has ruled.

South Central District Judge Sonna Anderson's order said George Hsu should have his medical license reinstated if he agrees to additional monitoring prescribed by the state Board of Medical Examiners, which licenses and disciplines doctors.

"The record does not support a determination that the departure from the standard of care is so serious as to justify the revocation of Dr. Hsu's license," Anderson's order said.
Hsu said he has been working as an auto mechanic and has started a highway striping business with his son.

He said he has not had a haircut in the nearly two years since the board first barred him from practicing medicine.

"It was a protest, I suppose," he said. "I'll probably get my hair cut now."
March 21, 2006 - Then again, maybe not. Elgin doctor's case still up in the air.

April 4, 2006 - Board revokes license again:
George Hsu was ready to get a haircut and scrub his successful highway striping business in western North Dakota to return to work as a rural doctor.

But Hsu, 62, of Elgin, learned that the state's medical watchdog panel would rather have him painting highway lines in a pony tail than seeing patients.

April 25, 2006 - Judge orders board to reinstate doctor's license
In a sternly worded order received by attorneys Monday, a judge says the medical license of George Hsu, a doctor in Elgin for some 20 years, should be reinstated if he agrees to additional monitoring.

It is the second time South Central District Judge Sonna Anderson has ordered the state's medical watchdog panel to reinstate Hsu, who was accused by the state Board of Medical Examiners of improper patient treatment.

Anderson said her first order, issued in February, may not have been "crystal clear to the board."

"The (board's) order revoking Dr. Hsu's license was reversed," Anderson wrote. "If it was not explicitly clear in the earlier order, let it be clear now."

She used bold letters in part of the order to emphasize her point.

Doug Bahr, an attorney for the medical board, said Anderson's earlier order "at least in the board's opinion, was unclear.

"She has made it clear," Bahr said Monday. "People won't be guessing."
April 28, 2006 - Board to appeal to State Supreme Court

Mar 3, 2006 - The Bismarck Tribune writes an editorial questioning whether an taxpayer-funded appeal is justified.

April 20, 2006 - Dr. Hsu writes another Letter to the Editor: Disregarding Truth and the Law
In 2002, Sletten informed me that a "confidential panel" was not satisfied with my response to a complaint involving three cases, and unless I agreed to some form of discipline, my license would be revoked. I did not understand what it was that I had done wrong, and I asked if I could meet with the board face to face. "If after that, they can look me in the eye and tell me that I was wrong, I'll comply with any discipline they feel is appropriate." But that was "not possible."

I asked what my options were. Sletten told me, "You can fight this and go before an administrative law judge, but it doesn't matter what he decides, because we'll do what we want anyway."

I did not believe this was possible, but the facts speak for themselves. The board's case against me was weak, but the three complaints increased to six, then seven, and finally to 10, even though not a single one originated from a patient or family member.

May 2006 - More Letters to the Editor in support of Dr. Hsu [1] [2][3]

July 6, 2006 - Board ordered to pay court costs, attorneys fees of doctor
The state's medical watchdog panel must pay attorneys' fees and court costs for an Elgin doctor it accused of improper patient treatment, a district judge has ruled.

South Central District Judge Sonna Anderson awarded George Hsu $26,602 in an order dated June 30.
"It's no surprise," Rolf Sletten, the board's executive secretary, said of Anderson's most recent order. "It was clear that's what she was going to do - there is no news in that. In truth, the cost issue will be decided by the Supreme Court."

Hsu said Wednesday that he expects the medical board to appeal the award of attorneys' fees and court costs to the state's high court.

"I think it will just give them another black eye," he said.
Court documents show that the board has spent $39,400 in attorneys' fees, court costs and its investigation of Hsu.

Totally fictional yet based on real life movie adaptation version: Psychologically scarred Vietnam and Gulf War vet becomes a maverick, sometimes arrogant, old-fashioned doctor with a heart of gold. When he gets cited for a minor infraction, his bad attitude ticks off the crotchety, iron-fisted Medical Board Executive Secretary who vows to show the rogue doctor who's boss and put him out of business. He misleads the Medical Board with selective evidence and they have no choice but to revoke the small town doctor's license. The once untrusting but now loyal townspeople come to the doctor's aid and despite the overwhelming odds, they win their appeal. But Mr. Executive Secretary refuses to accept defeat and takes the case all the way to the Supreme Court where........a decision will be made. Triumph? Or tragedy?

We must wait for the final chapter.