Is practicing medicine a right or a privilege?
Most physicians treat it as a privilege. They appreciate being given the responsibility of earning a patient’s trust and caring for them.
In reality, once a physician has passed the requirements to practice medicine, it is a qualified right. If the physician conforms to established norms, they are allowed to continue practice.
The vast majority of physicians conform to established norms. It doesn’t mean we are all saints. Some physician are bigots, racists, misogynists, etc. Yet, almost all treat their patients with competence, dignity, and respect.
And not all patients are loveable or even likeable. We take care of murderers, drug addicts, philanderers, child molesters, and just plain mean people. Not because we like doing it. We don’t. We do it because that’s what our profession demands.
Which brings me to the case of Cleveland Clinic resident, Lara Kollab. She engaged in anti-semitic invective on Twitter.
“May Allah take back (end the lives) of the Jews so we stop being forced to go to those unclean ones,” she wrote in one of the tweets, as documented by Canary Mission, an anti-hate watchdog that exposes anti-Semitism online. She once wrote that “Allah will kill the Jews” and “Allah will take the Jews who exiled us from our country.”
But the uncovered tweet that cost her her job was:
“Hahha ewww… I’ll purposely give all the [Jews] the wrong meds”
The Cleveland Clinic took action:
“When we learned of the social media post, we took immediate action, conducted an internal review and placed her on administrative leave. Her departure was related to those posts and she has not worked at Cleveland Clinic since September,” the clinic said in a statement to Fox News.
Apparently, there were other comments on social media which she since deleted.
It’s unclear whether Ms. Kollab had a bona fide medical license or just a training certificate, valid for use solely at the residency program sponsoring her.
While I do not believe people should be punished for mere thoughts (meaning thoughts that do not turn into action), when a doctor makes comments that suggests she will intentionally abuse the trust placed in her, that has crossed a line. Whether it is idle banter, intentional mischief that does not cause damages, intent to commit malpractice, or intent to commit murder, that has no place in our profession. It is unprofessional, dangerous, or both.
The burden should be on Dr. Kollab to prove she is worthy of a patient’s trust. This will be a high bar for her. One likely not addressed by a weekend course in sensitivity training.
What do you think?
ABOUT THE AUTHOR
Jeffrey Segal, MD, JD
Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.
Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.
If you have a medico-legal question, write to Medical Justice at infonews@medicaljustice.com.com.
Absolutely fire her and yank her license. What patient, Jewish or not, would feel comfortable being treated by someone who has made comments like that. Who will trust her? I understand we all flippantly say things, but that’s like joking about a bomb on an airplane these days–its just NOT something you do. When we are in the public eye and have people’s lives/health in our care, we must be held to a higher standard. We all make choices. When you choose to behave in such a fashion, you choose the consequences also.
Canary Mission is itself a hate website which tries to damage and when possible, destroy the careers and reputation of people in academia critical and opposed to Israeli human rights abuses and war crimes against Palestinians and other Arabs.
I urge readers to educate themselves about the smear campaigns this website has initiated against critics of the Israeli government and its human rights record.
Dr Lara Kottab’s comments are troubling but no evidence of any crimes committed by her exist at this time. Her comments were probably rooted in her anger at Israeli atrocities against Palestinians. It is probably the anger in her talking, not the doctor.
I think you will find yourself in the minority here buddy. Her statements stand on their own merit. It doesn’t matter what a website has said or done nor do ones religion or political beliefs.
This is great sentiment until you realize that she was very serious in her belief. The reality is the “Palestinians “ are taught to kill the Jews not to coexist in peace. They have walked away from multiple peace agreements only wanting to destroy the state of Israel. The land they claim for their state is Jordan There were no Palestainians living there before 1948. The other Arab leaders refused to take them in as refugees as they want to keep the political process to destroy Israel. Read your bible. The Jews have inhabited the land way before Mohammed created the Muslim religion which he started as an off shoot of Judaism. Mecca and Medina were Jewish cities. Now to show their tolerance there are no Jews in Arab countries.
You are 100% correct with everything you say. It is a shame how few Jews understand this.
Mecca and Medina were never Jewish. Israel is occupying the Palestinians, not the other way around.
It seems odd to me to hear someone claim that the Palestinians don’t want to coexist in peace, when the Palestinians are asking to be allowed to return to their homes and villages to live in peace, while Israel and its supports are the ones saying there has to be separation and maintenance of a Jewish majority state (in this land where non-Jewish families were the majority).
Well said, SAS. While her comments years ago were abhorrent, I, an American Jewish physician, find our support for the actual killing of Palestinian men, women and children to be even more abhorrent. I hope some good comes of this. I hope more people come to realize that Israel’s making and keeping Palestinian families refugees from their home and killing so many of them is completely inconsistent with any of our moral values.
Perhaps you’d be good enough to detail for us the “actual killing of Palestinian men, women and children” to which you refer. Do you mean the deaths that resulted from firing missiles back at the sites from which Palestinians fired them on Israel? In case you’ve forgotten, those would be the homes of people the Palestinians don’t like, so they launched rockets from their homes, knowing the Israelis had the technology to target missiles back to the sites whence the first missiles came. Who is culpable in that setting, Steven?
Or perhaps you mean the deaths that result when Palestinians are brought to Israeli hospitals after trying to injure Israelis, but who got injured themselves in return, but too seriously to be saved despite the full court press that they get in the Israeli ER? Those? Are those the ones you mean, Steven?
When someone tells you that they hate you and will and have intentionally abused you, do you want to wait for them to kill you or worse: kill someone you love, before you take action to stop them? What are you, some kind of forgiving machine? No swords, just plowshares? Do you think the nazis were OK as well, just poorly understood? Where do you draw the line?
I was referring to Israel’s killing of Palestinian men, women and children. Human lives. People who are refugees from their homes because we Jews expelled them from their homes and villages and made and keep them refugees from those homes. I think we are culpable for that and, as Americans, culpable for supporting/enabling the killing. I look forward to the day when there is peace and justice for we Jews AND for our Palestinian brothers and sisters. If we aren’t for peace, security and justice for EVERYONE, what are we?
Survivors, Steve.
Thank you for your support, Dr Feldman !
You are clearly a self hating Jew with no idea of the reality on the ground. You need to go visit Auschwitz and walk into the gas chamber and stick you head in the ovens. I think you perspective will be different after.
I am Jewish and have visited Auschwitz (as well as Ramallah, Hebron and Palestinian refugee camps). My Jewish morality and the lesson of the Holocaust color my perspectives of how we should react to the posts Lara Kollab made years ago as she watched fellow Palestinians be killed by Israel. Jewish morality and the Holocaust tell me that no one should be mistreated, not even Palestinian families. What Kollab posted (years ago) is unconscionable, but she didn’t kill anyone (as far as I can tell). The support of physicians for actual killing seems much more heinous to me. If physicians on this discussion who support Israel’s killing of non-Jewish Palestinian men, women and children deserve to keep their medical licenses, I think Lara Kollab deserves to keep hers, too.
If this were 1938 you would have been an officer in the Jew for Hitler club.
The Palestinian situation is completely irrelevant to a debate over the fate of a physician who threatens to use her practice of medicine to harm.
Becky is 100% correct.
SAS,
Your first sentence attacked an entity/person(s) – that is Canary Mission; and hence avoided to debate the real ISSUE**. This is a textbook example of Ad Hominem. More disturbing, I feel like I am reading a press release by a PR firm or an attorney. Last part is just a mere guess and I could be wrong. I just question why a medico-legal article & debate forum suddenly turned political (by only one person…namely SAS)
** ISSUE here is how to deal with a doctor who posts hate on social media
Canary Mission’s own website is full of personal attacks against Israel’s critics. Visit it if you do not believe me.
Looked up Canary Mission website and various social networking postings. You are incorrect. They expose practices of anti-Israel activists and pro-Hamaz. I do not see personal attacks against anyone who says the truth. They call out lies. And this is what I will do now. I call you out for spreading lies on this medico-legal forum. Name one example of a personal attack against an honest person from their website. ONE.
I actually wasn’t aware of Canary Missions until I was alerted to by you. I now follow them on social media. I kinda like them.
Not to distract from the Medio-legal-ethical nature of the article about Dr Kollab. It is as simple as many have said on this forum, including yourself…..discipline and suspend her.
Two wrongs don’t make right. Justifying her behavior and providing excuses (in the form of poor Palestinians being killed by the evil Israelis) does NOT apply to Hippocratic oath.
It isn’t difficult to figure out what to do about the Jew hating anti Israeli physician. Yank hospital privileges. Yank her license to practice medicine in the USA. And if she isn’t an Americal citizen, deport her. We don’t want her in our country.
One doctor threatening to harm any patient harms us as a profession. Many African Americans remain wary of the medical profession due to the Tuskegee experiments over 50 years ago. She took the Hypocratic Oath, this shows she did take it overly seriously
Pull her license. Let her flip burgers.
Your response reeks of anti semitism, denial of Israels right to exist and typical left wing media portrayal of reality. Israel does what it has to do to protect is people and boarders from Hamas and Hezbollah who have vowed to wipe her from the map and kill all Jews. The typical bullsh-t denial of Israel right to exist is a non starter. Thank God Israel is nuclearized and has one of the most advanced militaries in the world. I for one will always feel safe as Jew as long as Israel exists. This woman’s tweets are hateful and anti Semitic to the core and have absolutely no place in medicine OR in civilized society. Canary Mission merely assembles her internet presence and puts it in a plain usable format and lets it speaks for itself.
Am Israel Chi.
NJZ Richmond VA
I agree 100%. The problem is Israel has to defend itself from the hundreds of rockets reigning down on innocent people. Where are the do gooders going in and removing the Palestinian Hamas – Hezbaloh rockets threatening Israel. Why are they not going in to facilitate the Peace process? The United Nations is only blaming Israel where is the commendation of the Palestinian’s for the rocket attacks. I don’t see the United Nations going after Syria for killing its own people. I don’t see the United Nations going after Russia for taking over part of the Ukraine. Please explain why only the Jews are at fault.
Barry: The fact that other governments in the region abuse human rights and slaughter their own people without notice from the media, the UN, or other governments, and put Israel under the microscope and hold us to a higher standard is IN ITSELF anti semetic. Where is the outrange for what has transpired in syria? Human right abuses in SA and Egypt? The whole paradigm is so ridiculous it boggles my mind. Israel is the only constitutional democracy in the entire region, a support of LGBTQ rights and womens right, and a free market economy. W T F ?
People speak out at many injustices around the world; the problem we have is the people who defend only the injustices committed by Israel.
Many people are horribly outraged by what is happening in Syria. Tons of folks are outraged by the human rights abuses of Saudi Arabia, despite the fact that we Americans have supported the Saudi dictatorship (out of our addiction to oil).
Just because injustices are happening in other areas doesn’t make it right to make and keep Palestinian families refugees from their homes.
Lara Kollab’s comments become — not justified– but understandable when you look from her perspective, watching Jewish people justify Israel’s killing of Palestinian men, women and children who we first made refugees. Heck, I don’t see how we can blame her for voicing support for killing Jews (without, as far as I can tell, actually hurting anyone) when so many people on this list are actively supporting real violence.
As a Jew, I see absolutely nothing anti-semitic about thinking it is wrong to expel peaceful non-Jewish families from their homes, nothing anti-semitic thinking it is wrong to make and keep those families refugees from their homes. Kollab’s comments– just words as far as I can tell– were anti-semitic and have no place in medicine; support for actually killing Palestinian human beings is far worse.
We all heard that you’re a Jew. You have mentioned it few times now. I am pretty sure you’d be one of those Jews that helped Nazis round other Jews. You clearly clueless on a subject. You know nothing about Israel (judea and Samaria) and clearly you know nothing about TransJordaninas and Egyptians that call them selves Palestinians .
Ms Kottab should NOT take care of people if she even thinks to express this kind of rhetoric. She should be NO medical doctor.
I thought this discussion was about Lara Kottab threatening to kill Jews. Doesn’t that concern you? Why are you trying to change the subject. And ultimately, you excuse her because she is angry. Angry or not, if you threaten to kill patients,you have to leave practice. Ever heard of Charles Cullen or Michael Swango? Google it.
What does the Canary Mission have to do with the admission “I’ll purposely give all the (Jews) the wrong meds ? Re ipsa loquitur . Our obligation as physicians is to care for patients regardless of race,religion or political beliefs. If you can’t do that or if can rationalize that statement,you don’t deserve the privilege of practicing medicine.
This “physician” doesn’t understand the concept of medicine, or healing. She deserves to have her license taken. Unfortunately when someone is filled with this much hate without reason, other than propaganda and brainwashing, there is usually no redemption or return possible.
If she showed up in my OR I would treat her fairly, well and impartially.
If showed up in her OR she would try to kill me. It doesn’t get any more stark or plain then that!
She should not be allowed to care for anyone in the US. No license, no training, no second chance. Let her practice in Gaza. She likely will be celebrated as a martyr there.
Hi Y’all
I want action when intent to harm is posted. Antisemitism should not be tolerated in this country by our profession. As always we must demand the best from ourselves and go after those with ill intent.
All the best
I agree. As a Jewish doctor I have taken care of many Muslim patients without thought of their religion. They were patients who needed my expertise as a doctor.
I agree there is no place in medicine for that kind of hatred. I have my own beliefs, but over the decades I have been practicing Internal Medicine, I have always kept politics, religion and social opinions on a neutral platform when talking with or about patients. I am here to treat an “individual”, not a stereotype. If she were under my employ I would have fired her immediately.
As in many other fields, doctors must maintain professionalism at even higher standards. Medical schools are not immune to sociopaths. Docs are obligated to remove these rotten apples; whether sociopaths, chemically impaired, or simply lacking moral turpitude (including hate). After all, practicing medicine requires full trust of patients.
A physician-patient relationship will not be viewed as proper if a potentially dangerous doctors like Dr Lara is allowed to practice again.
“Do No Harm” basic rule is not applicable when you intend to give wrong Rx!!!
Her words were troubling and hateful, especially when she threatened to give the wrong meds and intentionally harm patients. However, I am interested in what the program knew about her. Was she someone that was developing a mental health disorder? Was this normal behavior for her? Had others heard her say these things in the past? Was this a sudden change in her personality? What were her interview process and recommendations and references like? As Jeff said above, we have to hold ourselves to a higher standard and we don’t always like the people we treat. Does she need psychiatric care? And what does this say about the process and the people that selected her as a resident? Will the hospital be conducting an internal review about their methods to select potential residents in the future? Face it, we have a really screwed up educational system that doesn’t emphasize the necessary skills to make it through residency and beyond. Perhaps this doctor would have been sorted out earlier or maybe identified as a person who needed mental health attention long before this episode if others were paying closer attention.
I think this article helps puts her comments into perspective: https://heavy.com/news/2019/01/lara-kollab/. Surely it’s horribly wrong to make statements suggesting you would mistreat other people. It should be clear that it is also horribly wrong to support the actual killing of Palestinian men, women and children. At least that’s the perspective I have based on my Jewish upbringing.
Hey Steven, should Israelis not kill those people who suicide bomb school buses? Should we Jews lie down and die under attack?
You feel free to do so. I on the other hand will side with those who fight back. We are not the aggressors. Other than worldwide antisemitic sympathies which have colored the popular narrative of the Israeli-Arab conflict for over 100 years, there is virtually no accurate evidence to support your viewpoint.
Thanks, Ari. I share your commitment to security for Jewish families. However, my Jewish values teach me to have an equal commitment for peace and security for non-Jewish families. All the killing should stop. It is wrong to kill Israelis and just as wrong, perhaps even more wrong, for Israel to kill so, so many more Palestinians, especially since we made and keep those families refugees from their homes and villages.
You clearly believe that “we are not the aggressors.” I was taught that, too, and used to believe it. But we came to a land full of non-Jewish families and created a state for ourselves by expelling the majority population from their homes. That sure does look to me like we are the aggressors. I’m sure it did to Lara Kollab, too.
Hopefully you can see how your support for violence against Palestinian families could make a good person like Lara Kollab see the world the way she did.
If I am not for myself, who will be for me?
If I am not for others, what am I?
And if not now, when?
Hillel
Myself, I think Dr Kollab should be suspended and disciplined. But her career should not be destroyed. The doctor has the potential to do some good if she repents.
If her posts were made a long time back, she deleted them, did not harm anyone and apologized for them, then perhaps this whole thing should be let gone of. Like I said, it was the anger over Israeli war crimes talking, probably not her.
The only perspective is whether she ‘imagines’ herself harm other people. Once she expressed this kind of thoughts – action should be taken to prevent her from acting on it.
Reminds me of a night as an intern in the ER. I was alternating patients with the other resident on call, a black woman. The next patient would be mine. She was grabbing a catnap. A “SHPOS” (as a doctor’s website i expect you all will know what this means) came in with a big facial laceration from a beer bottle in a bar fight. He was shirtless and had a big tattoo across his chest that said, “I Hate N-word.” I knew what i had to do. I woke up my colleague, explained the situation to her, and she took care of him with all the dignity and gentleness in the world. She did a perfect job. If anything she was slower with the injection and more careful. Rising above it as a physician was a sign of her strength. The joy in this story was imagining this a-hole’s fear of her taking care of him, and while you could rightly criticize me for imposing it upon him, i am still glad i did it. Of course no physician would do anything but the best they could. It would be a very rare and sick doctor who would do otherwise and such a person should lose their license.
And BTW i know this is a reverse analogy…in the case at hand the doctor was a racist and in this case the patient was the racist…i so love this story i wanted to pass it on.
The female wasp looks for the appropriate live caterpillar to Inject her single egg, while the caterpillar is still alive. Eventually, the egg hatches and consumes the Caterpillar from the inside out.
This is the metaphor for Palestinians, who themselves have been injected with the hate virus. Actually, Jew hate is the most persistent cultural virus in history, and it renews itself with each new generation.
This medical graduate is the standard representative of the hate virus. My understanding is that she graduated from a medical college with a very intensive Jewish founding. This in itself is highly ironic.
She was granted the PRICELESS opportunity to become a physician from the very people she hates. The ironies of hate are always piled high with unanswered and unanswerable questions.
Michael M. Rosenblatt, DPM
I think using insects as a metaphor for other human beings is a terrible thing to do. In this case, it is the pot calling the kettle black. If anything has injected Jew hate into Lara Kollab, it is her watching Israel kill her fellow Palestinians and her watching us support that killing.
It is obviously poetic license. And it is apt and true. Regarding your second comment, the two sides are at war. War (unfortunately) can and will result in accidental deaths from “friendly” fire and directed deaths of enemy combatants.
Characterizing them as murder does not necessarily mean they are murder. It is just the opinion of the political Left which does not believe Israel itself has a right to exist.
Michael M. Rosenblatt, DPM
This resident graduated from Touro Osteopathic College from the news reports, which is a Jewish affiliated medical school. Clearly she kept Palestinian hatred for Jews cloaked for a long time. Clearly also she was indoctrinated with hatred which even her medical school education did not erase. She let her true feelings out in social media, and she expressed a desire to harm Jewish patients. She has no place in medicine.
Her comments on social media were her postings not postings from Canary Mission. I have never bought into the propaganda of Israel mistreating Palestinians. Israel brought in food, and medical supplies into Gaza along with building materials for schools and hospitals. Israel received, tunnels and rockets in return. The Palestinians build their rocket launchers into schools and hospitals to use children as human shields. This conflict remains in place decade after decade due to external terrorist funding. This is done to avoid the possibility that the Arab in the street will realize that Israel is actually willing to engage and live peacefully side by side with its neighbors. Those who profess that Israel is the aggressor in the Palestinian terror campaign are willfully blind and ignorant. The hate that is indoctrinated into Palestinian children is now the cause for this young lady to be expelled from her residency program. She needs to be deprogrammed. Spend some time listening to Brigitte Gabriel a Lebanese Arab Christian and one begins to understand the true workings of the intifada from the inside. Israeli doctors treat Muslims and Palestinians in Israeli hospitals and save their lives. This is an almost daily occurrence.
That is the true spirit of Israel and the Hippocratic oath.
Brigitte Gabriel ? The Lebanese immigrant who claims Arabs have no souls and who real name is changed from Hanan Kahwaji ? The Middle Eastern newcomer who openly supported the Trump administration’s travel ban on entire nationalities claiming immigration of Semites was a bad idea ?
I wonder who is being ”anti Semitic” now ?
Another example of Ad Hominem. I am not familiar with Bridgette but I ended up visiting her website. We can challenge facts and issues she presents. But why would we attack her character and background and try to discredit her just because she is a right-leaning immigrant? What does name-changing have anything to do with issues she debates?
Again, Ad Hominem is a weapon of a weak person.
Forget all the political discussion and just look at this situation as simple as a doctor who is publicly declaring that she would consider harming a patient. It goes against every thing physicians are taught and the very oath we take when we receive our MD degree. This is shameful and she should not be allowed to treat or touch or be involved with any patient care in any way, shape or form. As a physician, this is horrible. There are routine situations where doctors try their best to treat patients who are criminals, have different beliefs or may actually hate the physician based on theirs. Yet, appropriate care is provided because we, as physicians, have the obligation. By professing these thoughts, no matter where or the context, she has completely disavowed the very essence of being a physician and has violated the very trust a patient should have seeing a doctor as well as the tenets of being a doctor. Do no harm!!
This story helps deflect attention away from the real issue – US official and corporate support for Israeli war crimes and murder and land theft against the Palestinian people which often extends into the medical field. Israel has attacked medical professionals in the territories it illegally occupies and besieges and the siege of Gaza is itself a public health catastrophe.
I am curious to know where the outrage was three years ago when the US Air Forces bombed and destroyed a hospital in Afghanistan run by Doctors without Borders, killing some forty medical professionals and patients. Or when Tarek Loubani, a Lebanese Canadian doctor was shot by Israeli occupational forces, or the killing of Razan al Najjar in Gaza.
Or the mass murder by Israeli American physician Baruch Goldstein in 1994 of over a dozen worshippers in Hebron.
You make great points, SAS. You can even see in the comments on this list the kind of support for Israel’s killing of Palestinians that would make someone like Lara Kollab think the way she did. What’s worse? Her horrible words (that she wrote years ago), her contrition, and no apparent actual harm committed against any patient, or the actual support for Israel’s killing of men, women and children after first making and keeping those families refugees from their homes we see coming from people on this page? By the way, I got to visit the West Bank and Hebron and saw the stones that people put on Goldstein’s grave, commemorating him.
I know with great certainty that everyone on this list is a good person who wants to do good for others. I look forward to the day when the misperceptions end, when Palestinian families are allowed to return to their homes, and when there is peace, justice and security for everyone, Jewish and non-Jewish alike.
Hopefully this post on Lara Kollab will make more people consider their own biases, just as she has.
Thank you, Dr Feldman !
SAS and Feldman: this is a Medical Justice blog with medico-legal-ethical issues to discuss. Stop injecting (and deflecting) into it your political views.
Marcel, I appreciate your thoughtful comment. I think we are discussing important medico-legal-ethical issues here. If Lara should not be permitted to practice medicine because of “words”, wouldn’t that mean physicians who support actual killing should be sanctioned at least as much? If people can’t trust Lara to give them good care because she made statements in the past, doesn’t it make sense that people wouldn’t be able to trust doctors who are supporters of actual violence against Christian and Muslim Palestinian families? The fact that we countenance people who right here in this discussion supporting Israel’s killing of Palestinian men, women and children, I think we could give Lara Kollab a bit of slack, especially since– unlike supporters of Israel’s violence– Lara has apologized for her past words.
My point exactly, Dr Feldman. Dr Kottab has apologised for her comments, removed them on Twitter and expressed her sympathy for anyone offended by them.
By contrast, people openly supportive of US and Israeli war crimes seldom face flak for supporting the twin horrors of war and occupation.
Her words were troubling and hateful, especially when she threatened to give the wrong meds and intentionally harm patients. However, I am interested in what the program knew about her. Was she someone that was developing a mental health disorder? Was this normal behavior for her? Had others heard her say these things in the past? Was this a sudden change in her personality? What were her interview process and recommendations and references like? As Jeff said above, we have to hold ourselves to a higher standard and we don’t always like the people we treat. Does she need psychiatric care? And what does this say about the process and the people that selected her as a resident? Will the hospital be conducting an internal review about their methods to select potential residents in the future? Face it, we have a really screwed up educational system that doesn’t emphasize the necessary skills to make it through residency and beyond. Perhaps this doctor would have been sorted out earlier or maybe identified as a person who needed mental health attention long before this episode if others were paying closer attention.
There are good and bad people in all walks of life, and we as physicians must treat all humans equal. And as human physicians, we sin and have our own inherent biases, but these can NEVER affect how we treat or intend to treat our patients. If a murderer were exsanguinating in the ED after a GSW, do we let him die? No. You save a life, and leave the judgement for the courts, and eventually God. If a physician in training broadcasts their prejudice and intent to harm, repetitively, they must be removed. Nice call Cleveland Clinic.
My original point in writing was simple. The doctor-patient relationship is based on trust. The intern squandered that opportunity, even if she was just a young and foolish. Is she safe for a medical practice? I don’t know. But it should be HER burden to demonstrate. And it will be a tall burden.
My analysis does not change even if no one was supposedly harmed by her SO FAR. As an intern at the Cleveland Clinic, she was probably not in much of a position to cause harm. And even more so, how would one ever know? Eventually all doctors harm at least one patient. In this case, we would never know if the harm she caused was INTENTIONAL or if the harms she later causes will be intentional. That’s the cloud hanging over her. The Cleveland Clinic made the right call…not on their watch. In an extreme interpretation, here’s what the Cleveland Clinic was hoping to head off – the low likelihood but nonzero possibility of Michael Swango Redux. https://en.wikipedia.org/wiki/Michael_Swango
I am not sure we reach the proper analysis in trying to understand (and justify) WHY she said what she did. What if I changed the facts to say she was scared of leprechauns and would intentionally give Irish nationals the wrong medications? Then we would easily conclude what I originally intended. Whether or not one views her professed hate as rational or irrational, justified or not, the Board cannot be complacent in separating her from patients who she may intentionally harm. The Board’s threshold for action is generally far lower.
Back to the medico-legal ramifications. My educated guess is that the Ohio Board of Medicine will take no action. Why? The fired intern’s license is a limited one. It’s an institutional permit conditioned on her being employed by the Cleveland Clinic. She’s no longer employed there. So the license will soon lapse without further action on its part. Further, the fired intern is in no position to cause direct patient harm at the Cleveland Clinic.
It is settled law that a private entity can fire an employee who brings disrepute to the employer because of online speech. There are exceptions. But, the private employer has a great deal of latitude.
State and federal government have less latitude. Actively terminating a state sanctioned license over a matter of pure speech could be actionable and set up a First Amendment fight. The argument the fired intern would propel is that the state can only control speech if it has a compelling state interest and can be accomplished in no less restrictive way. Strict scrutiny. The plaintiff would argue the state has not met that burden.
The state would counter that the speech was a harbinger of potential imminent action. Or that strict scrutiny does not apply and this is more likely straight professional regulation over commercial speech, a lower threshold. Still, I doubt the Board will want to trigger a constitutional brouhaha when its solution will automatically be enforced with no further action. One thing I’m certain of. If the Board does act, there will be any number of Jewish constitutional lawyers queuing up to help the fired intern, likely gratis, defend against Board action.
Medical Justice points to a logical analysis of Cleveland Clinic’s action at firing the intern due to her online hate speech and actual threats against Jews.
Other important aspects not discussed, even if Jewish counsel seeks to get her re-hired based upon free speech statutes is that free speech is covered under GOVERNMENT aegis, not private enterprise. Even though Cleveland Clinic does receive Government funding for some of its programs, it is not specifically a Government agency, like a Veteran’s hospital, by way of example.
Another concern is specifically medical-legal. Assuming that this doctor took part in even a minority aspect of patient care and the patient had an untoward result or complication, plaintiff’s attorneys will certainly examine the comments made by her, and will quite likely implicate her if the patient is Jewish or an Israeli. This could result in a forced settlement of an action that could otherwise be relatively easily defended. We have to assume that her continued employment might serve as a “virus” against Jewish patients…or it would be so considered by plaintiff’s attorneys.
Not hiring her is a form of control of legal exposure. In fact, it is even an obvious decision.
When I was a surgical resident at a VA hospital during the Vietnam War, we had one particular anesthesiologist who was strongly against the War and made no secret of his opinions. Every chance he got, he lambasted the then president and our Government’s actions during that war.
During my tenure there (I was also one of his students) he was never disciplined or fired. I assume this because he never stopped his comments. He was an excellent teacher and closely monitored me. He obviously never remotely indicated any vitriol against our Veterans and treated them with excellence, love and respect. That was never an issue.
In the case of this new medical licensee, that IS the issue.
Michael M. Rosenblatt, DPM
As a brief note, it is possible to STRONGLY REFUTE charges of “war crimes and illegal occupation” by the Jews of Israel, both by their Government and by previous wars and various treaties.
Several comments have been made here with allegations of such improper activities by Israel. I have refrained from commenting on these because they are off-topic. However, it is difficult to leave them “un-refuted.”
I would refer readers interested in these comments to Professor Alan Dershowitz, a registered Democrat. He has refuted each of these allegations as befits a legal scholar well versed on the history and law concerning Israel and its various “neighbors.” He has several books on the subject and a strong Internet presence.
Under no circumstances can Professor Dershowitz be viewed as “far right” or reactionary. Those inflammatory comments are not supported by fact or historical representation.
Michael M. Rosenblatt, DPM
We’ve strayed off-topic into politics. Let’s get back to the issue. She was not fired for holding an unpopular political belief. Nor was she fired for hate speech. She was fired for threatening violence. That crosses a distinct line.
This discussion is not about her freedom of expression; indeed she was never told to stop saying anything. Firing her was removing an imminent threat to their patients.
I think only through free speech can people exchange thoughts,ideas and concerns. You can entirely disagree with someone’s comments while affording her the right to say whatever you might think is stupid, horrible or amoral. However, I think the physician was unwise to think that people would not respond to the possibility that she might actually give patients wrong medications on purpose. If she would have said I do not like treating Jewish patients, I could more easily chalk that up to thinking that may not fit my thinking. However, intentionally giving patients the wrong medications can result in morbidity and death which raises issues of criminality that I will leave to the law dogs.
Self-righteousness can be a problematic issue upon which to act, so I would keep in mind that according to religious folk a young man who grew up around the Israel area taught his followers to hate the sin, but love the sinner. So be circumspect about this distinction.
Ms. Kollab is free to say what she wants. No one is censoring her speech. The Cleveland Clinic removed her from any opportunity, however remote, to make good on threats to the Clinic’s patients. As a private “citizen”, the Clinic is well within its rights to decide the type of decorum it demands of its employees.
Whether the State can disgorge Ms. Kollab of a property right, her license (even if merely an institutional permit), the threshold will be higher and possibly will rise to a free speech matter. But some speech can be censored by the state if it passes strict scrutiny. The government must have a compelling interest and it must be accomplished in the least restrictive way possible, a tall order. But the state would choose a different path. They would argue, if it came down to it, that Ms. Kollab threatened patients in the abstract and that is unprofessional behavior. Disciplining physicians for unprofessional behavior is done all the time by Boards of Medicine.
Just her statement that she feels people of a certain religion deserve to die would make one want to examine her patients’ charts carefully to make sure her patients are all getting competent and caring treatment. However, her statement that she feels it’s appropriate to give harmful treatment intentionally clearly makes her a public menace were she to have a medical license, which can be a license to kill in the wrong hands. Not only should she not hold a medical license, but her patients’ charts should be reviewed to make sure she hasn’t acted on her feelings and intentionally harmed patients. If there is evidence she’s intentionally harmed patients (for example, by not using appropriate antibiotics, or giving a NOAC to a patient with a GI bleed), then she should be arrested and charged with battery, with a hate crime enhancement.
This is America. We accept all religions and all ethnicities. This person should be disciplined in such a way as to deter others from similar behavior.
The fact that she is a physician in training makes it worse.
Other than packing a pedometer and a sleep tracker, it also features a coronary heart rate monitor.