Originally published on May 4, 2019

While bullying and harassment in medicine — often motivated by "ego or jealousy or pride" — typically go to colleges or HR departments first, taking one's peers to court is a rare last resort, according to a Toronto health lawyer.

But physicians or residents in junior positions, who are often the target, are rarely able to see a lengthy court battle with their peers or institutions to the end, Valerie Wise says.

Part of why, she says, is because it could limit their career options. But losing the battle could also saddle them with part of the other side's legal expenses, on top of their own.

"It's definitely north of a million dollars," Wise told White Coat, Black Art's Dr. Brian Goldman. "So most people are looking at losing their homes."

In recent years, numerous journals and health authorities have sounded the alarm over harassment and bullying that can erupt when the power imbalance between medical students, junior physicians and their superiors turns ugly.

"Sometimes, when you have a new program starting, or a young doctor coming in with new ideas, it can be perceived as threatening by some of the other doctors who have been there doing things the way they want them done for a long period of time," Wise said.

Valerie Wise is a Toronto-based health lawyer who has worked on both sides of disputes involving allegations of doctor bullying. (Sujata Berry/CBC)

According to an April 2018 survey by Resident Doctors of Canada (pdf link), 77 per cent — of the 833 residents who responded — experienced some form of "harassment or intimidation" in the preceding 12 months.

Seventy-seven per cent of residents cited patients as the most common source of harassment. Other sources included a staff physician or program director (60 per cent), an allied health professional (55 per cent) and fellow residents (55 per cent).

Harassment took the form of verbal abuse, "work as punishment" and loss of working privileges, among others.

Landmark workplace harassment suit

Most harassed doctors choose not to take any action because those who do risk paying a heavy price.

In a rare move, Halifax cardiologist Dr. Gabrielle Horne fought back — and won.

Horne's decade-long legal battle with Nova Scotia's Capital District Health Authority began in 2002 with a workplace dispute when she claimed that she was pressured to add the head of her cardiology clinic to her research team.

She refused. Soon afterward, the doctors who she said pressured her then alleged her "of having done things that harmed patients" — allegations she describes as "ridiculous."

Her privileges at the Queen Elizabeth II Health Sciences Centre were then changed, limiting her ability to continue her research.

What it felt like was that basically there was a massive corporation, which was the hospital, that was prepared to use millions and millions of dollars to crush me. - Dr. Gabrielle Horne

Horne filed a complaint against the physician who she alleged had bullied her with the College of Physicians and Surgeons of Nova Scotia, but she said it was dismissed after the college found his actions "did not constitute conduct unbecoming a doctor."

She felt she had no choice but to take legal action, in order to save her reputation.

When Horne's privileges were restored in 2006, she sued the health authority for loss of reputation and career.

"What it felt like was that basically there was a massive corporation, which was the hospital, that was prepared to use millions and millions of dollars to crush me," she said.

Gabrielle Horne lost 4 years of research while waiting for her clinical privileges to be restored. 'They just destroyed my reputation in the most public way, and I had to file a lawsuit to try and clear my name,' she said. (Anjuli Patil/CBC)

Regardless of the outcome, the public nature of litigation alone could scuttle a physician's reputation, Wise noted.

As the lawsuit dragged on, Horne contemplated giving up the legal battle — and her career.

"I called up my lawyer and said I was through. I was leaving the practice of medicine because nothing was worth this."

Her lawyer, Michael Wright, talked her out of it, saying he'd let her know when the case was hopeless.

In 2016, she won the lawsuit and was awarded $1.4 million in damages against Capital Health for administrative bad faith.

A doctor who testified on Horne's behalf at the proceedings said that the situation boiled down to "a classic case of workplace bullying."

An appeal decision in 2018 reduced the amount to $800,000, but Horne's lawyer said it's still the highest award in the country for loss of reputation.

The reduction meant it wouldn't cover Horne's total expenses incurred over the years-long legal battle, which she told Dr. Goldman amounted to $1.3 million.

"The amount of money that they were made to pay is not enough to make a large health authority feel pain," she said.

'Nobody's been held accountable'

Horne said that while she was satisfied with the verdict that concluded Capital Health acted in bad faith, she's less optimistic that the decision sent any strong messages about workplace harassment in the medical profession.

"The Health Authority has yet to acknowledge any wrongdoing whatsoever, even after the Court of Appeal decision. Nobody's been held accountable," she said.

In a statement to White Coat, Black Art, the Nova Scotia Health Authority's VP of research and innovation Dr. Gail Tomblin Murphy said the department is "committed to a safe and harassment-free work environment."

Its respectful workplace policy, which began in the fall of 2017, "provides teams with direction on how to proceed if they feel they have been a target of bullying behaviour or harassment."

Dr. Horne's lawsuit victory was said to be the highest award in the country in a case that found a health authority acted in bad faith leading to a loss of reputation.

Wise calls Horne's case a significant one in her line of work.

"Personally, I think the lesson is that if you can be brave, sometimes, at the end of it, you will be vindicated — but it's a long haul," she said.

She stressed the need for physician leaders and administrators to develop their interpersonal skills to better detect and manage potential conflicts between team members early on.

In December 2017, the Canadian Medical Association released a new Charter of Shared Values, intended to be a guide "to promote trust and respect within the profession and for each other."

One of the charter's pillars, named for Reciprocity, declares: "As a physician ... I will be kind with my physician colleagues, and expect them to respond similarly; I will share and exchange my knowledge and experience with them; and I will be generous with them in spirit and in time."

Written by Jonathan Ore. Produced by Sujata Berry.