By Kim Pope, RNFA
As a traveling surgical nurse first assistant (RNFA) I worked at SVMC from 8/2018 – 2/2020. I was one of the people who cared for the unfortunate mother who died after an anesthesia mishap in the operating room (OR).
The widespread bullying I experienced at SVMC is unlike anything in my 45 year career. Many good people employed there fear retaliation. For them, and for the patients, I will share my experience and explain my support for both Pandyas for the hospital Board.
I was the RNFA for a c-section of a lady whose death was investigated by the health department. The case is now public information. Anesthesia was provided by Dr. Jagpal’s employee from Comfort Care Anesthesia. Without announcing it, she left the room for an extended period with the monitor alarms inaudible. Later, she returned and reported abnormal vital signs. I initiated CPR, but the anesthetist did not display knowledge of the CPR guidelines. She asked me to stop compressions early, even when there was still no pulse. The patient died weeks later.
An emergency can arise in the OR at any time. CPR is usually a forte of anesthesia providers. Typically, the mentorship of your employer and colleagues brings confidence in these skills. I know because I was director of an open-heart surgery program for 9 years. The anesthetist’s boss should have ensured her basic competencies but she clearly did not receive support working for Dr. Jagpal.
After the patient was stabilized, Dr. Jagpal tried to coerce me into saying the anesthetist was present for the whole procedure. He was more interested in hiding the events than showing remorse or evaluating his employee. When I was the Director of Surgical Services at a large Birmingham, AL hospital, I would have immediately met with the family, debriefed my employees, and made a remediation plan. From the Cleveland Clinic and Cedars Sinai Medical Center, to SVMC, I am a fierce patient advocate wherever I go. I was not put-off from telling the truth to the administration and health department.
After that I received multiple anonymous, threatening phone calls to “keep your mouth shut,” and “you need to stop talking about OB and go back to Alabama if you know what’s good for you.” Even my 84 year old mother received such a call. After this point the lateral violence from coworkers and clinical management on ‘Dr. Jagpal’s team,’ as well as bullying from certain physicians, intensified as I continued to speak out. Finally, they cancelled my contract.
Actually, the environment was hostile enough before this patient death, and, I’ve been told, before my time at SVMC. A culture of disrespect and management through intimidation permeates SVMC. While favorites or leadership would disagree, many employees seemed to feel the hospital administration did not value the OR and its staff very highly, and I had to agree. The reporting system where we could voice problems was a dead end. Sometimes the risk manager came to the OR to cover things up better, but that’s it. SVMC doesn’t even have an independent ethics hotline available for employees to report unethical incidents, like most hospitals do. Forget about reporting anonymously. I would have used this service many times at SVMC if they had one. Employees had nowhere to be heard or get support. Our concerns did not really matter.
In an area like Porterville with few options, most people stay in this traumatizing work environment because they need to feed their families. Having captive employees reduces the incentive for the organization to improve, or demand better from their contractors, like Dr. Jagpal. In my eyes, he took full advantage of this and created unparalleled toxicity for personal reasons. Dr. Jagpal’s few surgeon friends got unconditional cooperation and preferential treatment to get their operations done, day or night. Others were blocked out, especially if they had a challenging case, critically sick patient, or tend to speak up for quality improvement. Those surgeons benefitting participated in this too – avoid tough cases, trash-talk the surgeons who go the extra mile, and indoctrinate the impressionable staff in the toxic notion that there is only one right way to be a surgeon.
The staff is so deeply morally injured, that to keep from getting targeted further, they go along with this dangerous narrative. Some even felt a false sense of authority to question the judgement and skills of surgeons who have developed their abilities through intense training and study that the staff have no true knowledge about, including me.
Here’s one example of how this warfare was perpetrated: I was harshly interrogated multiple times while operating with one orthopedic surgeon to divulge specific details of operations done by specific other surgeons. He wanted points to criticize in their department meetings. I never had anything bad to say, but others would offer some random facts to avoid scrutiny, allowing him to disparage work he didn’t understand because he was just an orthopedist. This conversation would get carried by anesthesia providers into other rooms, allowing other surgeons and staff to embellish the negative story about a surgeon who was not present.
To fuel more virulent gossip, I watched as anesthesia providers repeatedly left the OR they were assigned to in the middle of operations to spy on the blacklisted surgeons while they were working, unaware. This was despite the fact that the state forbade this practice after the OB related death I described above.
I believe the OR leadership should have educated the staff on professionalism, variations in surgical practice, and how urgent cases or emergency room consultations work, so the staff could be relieved of some of this animosity. But no one in leadership provides these system insights and reinforces job expectations. This is how leadership is responsible for promoting the emotional abuse of the staff at the hands of the unethical people around them. It’s actually quite dangerous for patients. It prevents a safe and cohesive team approach to the patient by eliminating the possibility of trust in the captain of the OR: the surgeon.
Disrespect for surgical services means disrespect for patients and the community. Any of the surgeons or cardiologists who use operating rooms could’ve taken the initiative to speak up against the negative environment.
The only physicians I saw always speak up, do the right thing, and remain singularly fixed on the patient were Dr. Gaurang Pandya and Dr. Tejal Pandya. They never once changed what they thought was right based on how others treated them, and I know they paid dearly for it. I helped while they did case after difficult case with skill, patience, composure, and good humor. It was clear that they had confidence in our hospital and our staff.
They stopped to teach the team about the anatomy or pathology we were involved with, no matter the hour. When it was better for the patient, they operated together. I knew they were caring for patients others might have turned away, or sent to another city without their families. This means they are the only ones doing certain operations for the whole community, because no one else was willing to.
This is what Sierra View needs. The good people and good facilities you have cannot be put to good use without courageous moral leadership. The same backstabbing, animosity, and gridlock I saw in the OR is happening in your board, and with that nothing can be accomplished.
It does not surprise me at all that both of the Pandyas are running to make a change. They know exactly what is at stake. The Pandyas have demonstrated compassionate, creative, longitudinal dedication to the wellbeing of the Porterville community, inside and outside the hospital. For a happy, healthy SVMC that can meet its potential I wholeheartedly support both Pandyas for the Board. They will do the right thing regardless of the personal cost. In my eyes, they already have.