Cardiologists accuse Citizens Medical Center of discrimination
By Emily Ramshaw - THE TEXAS TRIBUNE
May 16, 2011 at 12:16 a.m.
Updated May 17, 2011 at 12:17 a.m.
The emails and memos written by administrators and doctors at Citizens Medical Center about three of their colleagues of Indian descent are, at best, derogatory. An operating room chief wrote of trying to force "the Indians off the reservation." Others wrote about their "Indian troubles," or labeled the hospital's two rival cardiology practices as "the Cowboys" and "the Indians."
At worst, they could be considered racist: "I feel a sense of disgust but am more concerned with what this means to the future of the hospital as more of our Middle-Eastern-born physicians demand leadership roles and demand influence," David P. Brown, chief executive of Citizens Medical, wrote in a 2007 memo to himself. He continued, "It will change the entire complexion of the hospital and create a level of fear among our employees."
But whether racial animus led Citizens Medical, a county-owned hospital, to close its cardiology unit to non-staff doctors - effectively revoking the privileges of Drs. Harish Chandna, Ajay Gaalla and Dakshesh Kumar Parikh to practice there - is the subject of fierce debate and a discrimination lawsuit filed by the three doctors in federal district court in the Southern District of Texas. The dispute has divided Victoria's close-knit medical community, where many longtime doctors and hospital officials say that it is not about race - the city has long been home to doctors of all ethnicities and nationalities - but a struggle over egos and influence gone awry.
The Citizens Medical battle appears to have begun over operational disagreements between Chandna, Gaalla and Parikh and hospital administrators, and a lack of trust between the three Indian-American doctors and other cardiologists at CMC. Chandna, Gaalla and Parikh have their own cardiology practice and have practiced at CMC and the neighboring DeTar Hospital for many years.
In emails, memos and court testimony, Citizens Medical administrators and doctors, who declined to be interviewed for this article, describe fractious relationships between themselves and the three cardiologists as they debated on-call schedules, compensation and leadership roles. The arguments sometimes devolved into shouting matches and name-calling - often, CMC officials suggest in the documents, incited by the three cardiologists.
"From my review of the evidence, the common denominator in the rough aspects of the operation of the hospital were the three plaintiffs," said Rex L. Easley Jr., one of the defense lawyers in the suit. The defendants directed all news media questions to him.
In emails referenced in a complaint plaintiffs filed in August, Citizens Medical doctors also accuse the three cardiologists of starting a smear campaign against the 344-bed hospital's staff heart surgeon, Dr. Yusuke Yahagi, who is of Japanese descent and who complained of harassment and threatened to leave the hospital.
"This seditious speech and subversive actions toward [Dr. Yahagi] and C.M.C. is deliberate and calculated," Dr. William T. Campbell Jr., a staff cardiologist and one of the defendants in the suit, wrote in a March 2010 email that's in the court file. He continued, "These rabble-rousing behaviors are very disruptive to general medical care and are a poor reflection on Victoria medical community as a whole."
But Chandna, Gaalla and Parikh, board-certified cardiologists who, according to the Texas Medical Board, have been licensed in Texas for 13 to 18 years, say they were raising concerns about inappropriate procedures and poor patient outcomes, not being "disruptive." In court filings, the doctors - one who was born in the United States and two who were born in India and are naturalized citizens - say they were consistently treated like second-class citizens, removed from committees and pushed out of laboratory posts arbitrarily, or overlooked in favor of "less-qualified" cardiologists CMC hired.
"It's depressing, demoralizing," Chandna said in a brief interview in his Victoria office. "We've been here for 15 years. We work 24-7. Patients like us. I don't see any other thing than that my complexion is different."
In court filings, the three cardiologists say that when they refused to refer patients to Yahagi, whose skills as a surgeon they questioned, they were put under intense pressure. They say the hospital board's chairman sent them a letter in December 2009 indicating their referral patterns could be used to determine whether to renew their hospital privileges. (Citizens Medical has since admitted that statement was made in error, and said the hospital does not take referral patterns into account in privilege reappointments.)
In February, the hospital's board of directors limited the heart program to doctors on staff, prohibiting Chandna, Gaalla and Parikh from treating patients there. The doctors promptly sued, accusing Citizens Medical of damaging them professionally and financially by prohibiting them from treating their patients there. A district judge granted them a temporary injunction, forcing Citizens Medical to allow the doctors back into the hospital in the meantime - a ruling that has since been overturned by an appellate court. The doctors are appealing that ruling to the U.S. Supreme Court, and in the meantime, Citizens Medical is allowing them to practice there.
In August, after the plaintiffs had obtained hospital records and emails in the course of their case, the doctors amended their complaint, accusing the hospital of violating their equal-protection rights and discriminating against them based on race.
The discrimination lawsuit is on hold, pending an appeals court ruling on whether Citizens Medical officials, who effectively work for the county, are entitled to "qualified immunity," which can shield government officials from liability in some cases. The doctors have continued to practice at the hospital, but they say the hospital has continued to impede their work by not notifying them when their patients arrive at the emergency room.
"Our patients were left wondering why," Gaalla wrote in a statement to The Texas Tribune. "Such actions compromise our patients' care."
Easley, the defense lawyer, classified the case as a "disagreement on how to run a hospital between some doctors and the medical staff and administration," which, he said, "escalated into an unfortunate lawsuit." But he argued that claims of racial discrimination, brought six months after the original lawsuit, are bogus, and that the documents the plaintiffs are basing their case on represent "four or five pages out of some 10,000 produced."
Brown, the hospital's chief executive, wrote the "sense of disgust" memo for his own records after a particularly contentious meeting with the cardiologists, documents show. Easley said the "Cowboys and Indians" reference was a joke made largely because the hospital's non-Indian cardiologists loved to farm and ranch and that it was not meant to be derogatory.
Easley also said the hospital has many employees of different ethnicities, including doctors of Egyptian, Pakistani, Jamaican and Thai descent - and a dozen other physicians of Indian descent not involved in the lawsuit. In Victoria, a jigsaw-puzzle-like billboard show pictures of the five doctors on Citizens Medical's cardiac care team - two of whom are black, and one who is Asian - and features the slogan "No missing pieces."
"This is a case of hospital politics that got out of control," Easley said, "and there is no culture of racism with the cardiologists at Citizens, or the hospital."
Chandna, Gaalla and Parikh say the emails and internal memos speak for themselves. Hospital administrators, including Brown, complained of their "Indian troubles" and spending "another year with the Indians." In court testimony last year, other hospital physicians testified that Brown "did not want physicians of Indian origin in leadership roles at C.M.C." In a December opinion on the defendants' request for summary judgment, Judge Janis Graham Jack of Federal District Court wrote that there was "egregious evidence" to support the racial discrimination claim.
When the hospital's chief executive "displays such overt racial animus toward plaintiffs," she wrote, "this racial animus necessarily permeates throughout the rest of the hospital, and is strong evidence of discrimination."