Hushed No More

In September 1983, the chairman of the Department of Ophthalmology at Emory University School of Medicine in Atlanta, Dwight Cavanagh, MD, performed a corneal transplant on the wrong eye of a patient (Sargus Houston), eventually leaving him blind from undetected glaucoma. By then, area ophthalmologists such as Tom Harbin, MD, had already begun to see hints of grave problems at the academic center, but it was not until years later, when Dr. Harbin began conducting research for a book on the subject, that he learned the full story. Waking up Blind: Lawsuits Over Eye Surgery chronicles events from 1976 to 1997 and draws on court documents, official transcripts, letters, and interviews as well as Dr. Harbin’s own observations. The account describes unnecessary surgeries, altered records, fraudulent billing practices, concealment, and intimidation. It also highlights individual efforts— particularly those of David Campbell, MD, and Allen Gammon, MD—to have the department’s problems addressed officially and the ramifications of those efforts.

MOTIVATION
Recently, Dr. Harbin spoke to Cataract & Refractive Surgery Today about his motivation for writing the book, an effort that took him 11 years. “This is a story that needed to be told,” he said. “There are lessons there for patients, doctors, and leaders. I also wanted to set the story straight about what happened to David Campbell and Allen Gammon. Their reputations were trashed around the country, and that’s always bothered me that they were unfairly tarnished for standing up and doing the right thing.”

The lessons Dr. Harbin hopes his book drives home are many. Patients who have questions about what their physician is telling them, regardless of his or her reputation, should seek a second opinion. Members of an organization—academic, medical, or otherwise—should recognize the high cost of remaining silent about wrongdoing. “That cost is well shown in this book in terms of damage to patients but also the ultimate damage to and huge expense to the organization,” said Dr. Harbin. Leaders need to investigate problems rather than minimize them. “If you see something bad, you can’t look the other way and say he’s a high producer,” he stated. “If credible people … are bringing you stories of bad behavior, that has to be evaluated in an effective manner.”

Referring specifically to the events that Waking up Blind details, Dr. Harbin noted that silence can stymie efforts to assess potential problems. “Most of the faculty were in the middle and weren’t saying much,” he noted. “That allows a leader to say, ‘I asked some guys in the department, and they said there weren’t any problems.’”

PROPER INVESTIGATIONS
Anyone who has been in a position of authority knows that it can be difficult to sort out which problems are significant. According to Dr. Harbin, leaders need “a good sniffer.” He continued, “People come to you with things that sound terrible, and you may find out it’s jealousy or a turf issue. You can’t ignore things, but you have to be a good student of humanity. You have to set up a process where every complaint gets its due. You also have to model the behavior of not allowing funny stuff on your watch.”

Waking up Blind details departmental and committee meetings and a university ethics investigation, which resulted in Dr. Cavanagh’s exoneration and a reprimand of Dr. Campbell that has not been lifted. Subsequently, under the pressure of a ruling by the American Academy of Ophthalmology’s ethics committee, numerous lawsuits for malpractice, and an investigation by Georgia’s Composite State Board of Medical Examiners, Dr. Cavanagh resigned. Asked how investigations of serious allegations such as those in this case should proceed, Dr. Harbin responded, “You have to get objective people, third parties, with no vested interest in the outcome. If you were the dean, and the faculty produced a report as they did at Emory saying that the chairman is billing wrongly and operating on eyes that don’t have a disease, you have to read between the lines. That would call for an outside review. Not every question deserves one, but some do.”

IMPACT
Asked what impact the events recounted in Waking up Blind have had on the university and on ophthalmology in the United States, Dr. Harbin’s response was, essentially, not much. The main reason, he said, is that the matter was kept quiet.

“The only thing that people knew was that there was a bunch of lawsuits,” he said. “The details of six of them were never revealed, because they were settled. The Sargus Houston [case] dragged on for several years, and then the details were made public. … I don’t know that these events changed Emory as much as time, new leaders, and new attitudes in the whole world. The Joint Commission [on Accreditation of Healthcare Organizations] would now come in with a sentinel event evaluation if there were a wrong site surgery. There was no National Practitioner Database, so Dwight Cavanagh didn’t have to report his seven lawsuits when he moved to Texas.”

Dr. Cavanagh is currently the Dr. W. Thomas Maxwell chair in ophthalmology at UT Southwestern Medical Center in Dallas.

CONCLUSION
Since the publication of Waking up Blind in December 2009, Dr. Harbin stated that he has received “tons of e-mails from people around the country thanking me for writing this book.” People’s reactions have been highly positive, he said. “I’m sure there are people, perhaps those who don’t look so good in the book, who are not happy that I did this, but they haven’t written to me,” he said.

“My hope was to strengthen medicine by having us confront problems,” he asserted. “If we do a hush-hush on everything, then at some point, somebody from an external agency or the government is going to come in and try to clean things up, and it’s not going to be pretty for doctors.”

Dr. Harbin continues to practice ophthalmology with a specialty in glaucoma, and he is a clinical professor emeritus at Emory University. While waiting to hear from potential agents about Waking up Blind, he wrote a second book, What Every Doctor Should Know … but Was Never Taught in Medical School. Published this year, the book discusses the business aspects of medicine and was inspired by his experiences while earning an MBA. According to Dr. Harbin, “a significant deficiency in medical training is the lack of any instruction in the practical aspects of running a practice or an academic lab. Not surprisingly, young doctors flounder as they evaluate practice opportunities and enter the real world.” He said that his second book addresses these problems and that it was written to decrease the struggles of young doctors—and those who have been practicing for years—in this area.

Perhaps not surprisingly, Dr. Harbin is currently working on a third book that he said will focus on “practical ethics for ophthalmology.” Asked for his closing thoughts, he said, “You may not know the ‘what’ of ethics, but after reading [Waking up Blind], you’ll know why ethics are important and why you should speak up.”

Editor’s note: David Campbell, MD, Dwight Cavanagh, MD, and Allen Gammon, MD, did not respond to an invitation to comment on how the events described in Waking up Blind did or did not affect the landscape of ophthalmology, academics, and medicine.

Tom Harbin, MD, may be reached at tomharbin@comcast.net. The Web sites for his first and second books, respectively, are http://www.wakingupblind.com and http://www.tomharbin.com.