How much is a damaged reputation worth?

Terminated after four troubled months, this doctor went to court and won $30 million. There are lessons to be learned from his struggles.

By Berkeley Rice
Senior Editor

When internist Bruce Skinner was hired by Trident Health System in Charleston, SC, it seemed like a good opportunity: running his own satellite clinic, with a decent salary. But once he started, Skinner had a painful awakening. After just four troubled months at the clinic—during which he filed numerous complaints about conditions there—he was terminated. He later sued Trident for breach of contract and defamation, and a jury recently awarded him $30 million, including $10 million in punitive damages.

Because of the resulting damage to his career, however, Skinner may have won a Pyrrhic victory. The following account of what happened to him—based largely on court documents—illustrates the potential risks doctors face when they become employees of health systems or other institutions. It also suggests ways they can protect themselves.

Before joining Trident, Skinner had worked at a private clinic that provided medical services to military personnel and their dependents at the Charleston Naval Base. When that clinic closed due to cutbacks at the base, he obtained a computer printout with the names and addresses of about 1,300 of his patients, planning to use the list if he joined another group or started his own practice in the area.

In the fall of 1997, Skinner applied for the job with Trident, a hospital-based network with several satellite clinics northwest of Charleston. Trident offered him a three-year contract at a salary of $110,000 plus bonus. At its request, Skinner gave Trident his only copy of his former patient list, so his new employer could notify his patients about his new position with the system.

Trident asked Skinner to start by filling in temporarily for a retiring doctor whose primary care practice it had recently bought in the town of St. Stephen. After three months there, Skinner was told, he would take over a new and larger Trident clinic scheduled to open in a nearby town. He agreed, without getting the signed contract.

The doctor complains about conditions

Skinner was shocked at conditions at the St. Stephen clinic. He said that office charts and files were disorganized; the ventilation system didn't work properly; exam room faucets leaked; the cabinets were moldy; the sewer line backed up; and the toilets didn't flush properly. He complained repeatedly to Cheryl Aloway, Trident's regional practice manager. She relayed his comments to her superiors, who promised repairs would be made, but nothing happened.

When Trident vice president Ian Watson visited the clinic, Skinner told him he was considering contacting OSHA about conditions there. According to Skinner, Watson told him that that would be a mistake, and that by doing so, he could jeopardize not only the clinic's future, but his own future with Trident as well.

Skinner also became concerned about the clinic's licensed practical nurse. In complaints to Aloway, he accused the nurse of unprofessional and potentially dangerous conduct, such as prescribing medication by phone without his approval.

Aloway allegedly relayed Skinner's concerns to Trident but told him not to worry, warning him that if the nurse were fired, she wouldn't be replaced. After Skinner threatened to file a formal complaint with the state nursing board, Trident finally did so itself, and suspended her. The nursing board eventually investigated the nurse and took disciplinary action. Trident then dismissed her; as promised, they didn't replace her.

Skinner was also troubled by the clinic's billing practices. Because Trident hadn't completed his enrollment for federal reimbursement programs, the clinic was submitting bills for his Medicare patients under another Trident physician's name. Skinner repeatedly complained to Aloway and her supervisor about the "false" billing, but nothing changed. "Don't worry," he recalls Aloway telling him, "we do this all the time."

Skinner did worry, though, and called the state office that administers federal health care programs. When he recounted the clinic's habit of billing Medicare for his services under another doctor's name, he was told that unless he was a locum tenens, that would be considered fraud; and by knowingly participating in such a practice, he could be held personally liable. He reported his concerns about the billing to Aloway again and to her supervisor, but again he was told "not to worry about it," according to court documents.

Skinner claimed that Aloway often pressured him to increase office billings. For example, she questioned his habit of consulting with patients by telephone instead of having them come in for a billable office visit. He says she also encouraged him to revise his billing in ways he considered illegal upcoding. (Skinner later filed a false-claims suit against Trident on behalf of the federal government. Trident eventually settled the case—without admitting liability—for $5,000, of which Skinner's share as "whistle blower" came to $1,300.)

The clinic cans Skinner; he files a lawsuit

Toward the end of April 1998, Aloway told Skinner that Trident had decided to close the St. Stephen clinic immediately, and to terminate his employment, giving him 60 additional days of salary and benefits. Michael Massey, Trident's vice president for physician services, later claimed in his deposition that Skinner had been let go in part because he didn't have privileges at Trident's hospital. But in fact he had been hired in response to an ad that specifically described the position as "outpatient only."

After his termination, Skinner repeatedly asked Trident to return his former patient list. Trident claimed it was missing. The loss of that list, Skinner contended, made him less marketable to potential employers and limited his ability to open his own practice in the area.

According to Skinner's lawsuit, Aloway made comments to other Trident employees implying that he had stolen an ECG machine, a fax machine, and other items, and had caused physical damage at the facility. Although Trident didn't investigate these allegations, they were repeated at local physician meetings, his suit alleged. (In her deposition, Aloway admitted she had given Skinner permission to take some of the items in question.)

After the clinic closed, patients who called Trident asking for Skinner were told, "We don't know where he is," or "We can't talk about it." According to Skinner, those comments raised doubts about his professional reputation and exposed him to potential claims of patient abandonment.

When Skinner contacted recruiters and sent resumes to prospective employers, Trident didn't respond to their requests for references. One recruiter told him he'd heard that Skinner had "sabotaged" the clinic at St. Stephen.

In January 2000, Skinner sued Trident and Aloway, claiming he'd been fired in retaliation for exposing conditions at the clinic. He sought compensation for lost wages and benefits for the remainder of his three-year contract, and for loss of income due to his inability to find other employment. The suit also asked for damages for slander and defamation. Initially, Skinner did much of his own legal research. But as the case developed, he retained Charleston plaintiffs' attorney Gregg Meyers to represent him.

Trident denied all of Skinner's claims in its motion to have the suit dismissed. It argued that since he never had a signed contract, he had no basis for a breach-of-contract claim. Without the contract, he was an "at-will employee" who could be discharged at any time for no reason.

Trident's lawyer insisted that Skinner had no evidence to support his claim of retaliatory discharge; that he couldn't prove his termination or any subsequent actions by Trident caused prospective employers to reject him; and that Aloway's accusations of theft—even if false—didn't qualify as slander without evidence of malice on her part. Skinner had damaged his reputation himself, Trident claimed, by filing the false claims suit, thereby branding himself as a troublemaker.

A big jury award for a damaged reputation

The judge eventually dismissed Skinner's claims of retaliatory discharge and breach of contract. But after a three-day trial last December, the jury awarded Skinner more than $30 million in damages, including $10 million for defamation, $10 million for negligent supervision, $10 million in punitive damages, and $250,000 for "conversion" of his patient list.

Trident called the verdict "outrageous," and said it would definitely file an appeal. Skinner, naturally, was pleased by the verdict. "I'm delighted that the legal system worked in my case," he says. "It's nice to get validation from your fellow citizens."

"This case was about the value of a doctor's reputation," says Skinner's lawyer Gregg Meyers. "I think the jury saw a guy they really respected, and they felt he deserved to be compensated."

That compensation, however, may not repair the damage to Skinner's career. Despite sending out hundreds of resumes since he was terminated, Skinner has been unable to find another job as a physician. He attributes his failure to his troubles with Trident. "All that notoriety didn't help," he says. "I'm tainted now. I'm labeled as a whiner and a trouble-maker."

Despite his victory in court, Skinner's finances are still precarious, and will likely remain so for some time. "Everyone thinks I've already gotten a check for $30 million, and that I'm shopping for a new house and a yacht," he says. "But I haven't seen a penny of that award yet, and if Trident appeals, it will probably be years before I do."

Even if he does, Skinner, now 52, fears that his career as a physician may be over. He works part-time reviewing medical records for a plaintiffs' law firm in Charleston, at $30 an hour. He admits he feels "woefully underemployed," but says, "I need to get on with my life."

Looking back, says Skinner, "I realize I was pretty naive and foolish when I took the job with Trident without a contract, and even after I was fired. I should have turned the case over to a good lawyer earlier instead of trying to handle it myself." He feels his case was also hampered at first by a lack of documentation. "Instead of just making my complaints orally to my supervisors," says Skinner, "I should have documented them in writing, so I'd be able to back up my allegations."

Look before you leap, and document your concerns

What can you do if you find yourself stuck in a troubling job?

Internist Bruce Skinner, the subject of the accompanying article who won a $30 million verdict against his former employer, makes this recommendation: "Just as you document your medical records on the assumption that a patient could sue you, assume that your employer could screw you," he warns. "That means you should document any complaints you have. Without documentation, you'll have a tough time getting a good lawyer to represent you, let alone winning your case."

Initially, Skinner did much of his legal research on his own, at a Charleston law library, and didn't contact a lawyer until after he had filed his suit against Trident. He now concedes that he should have consulted an attorney sooner.

How can you protect yourself from the sort of difficulties that Skinner encountered in his new job? Here's some advice from lawyers and practice management consultants:

Don't start work without a written contract. An oral agreement has little legal power.

Read a proposed contract carefully, and have your attorney check it over.

Before starting work at a new facility, inspect it yourself. If you're concerned about conditions there, make a written report to your employer detailing the problems.

If you suspect your employer of questionable billing practices, get detailed documentation to back up your concerns.

Communicate complaints within the company—in writing—before taking them elsewhere. If your employer's response is unsatisfactory, then contact your attorney or the proper government agency.

Berkeley Rice. How much is a damaged reputation worth?.

Medical Economics

Jul. 11, 2003;80:52.