On April 26, 2010 Dr. Vajinder Toor was murdered in front of his pregnant wife and young child. This tragedy sprung from an unresolved conflict between a resident/intern doctor in training at the Kingsbrook Jewish Medical Center in New York City and his direct supervisor and the management of the hospital.
The victim, Dr. Vajinder Toor, was a postdoctoral fellow at the Yale School of Medicine who was working with the infectious-disease section of Yale-New Haven Hospital. Dr. Toor worked at Kingsbrook Jewish Medical Center in Brooklyn before joining Yale. Dr. Vajinder Toor had been the Chief Resident of the Department of Medicine and supervisor of the residents/interns in the program there.
The accused, Dr. Lishan Wang, was working to gain his qualifications to get a medical degree here in the USA. Dr. Lishan Wang was a doctor from the People's Republic of China and studied medicine at Beijing and was living most recently in Georgia. Dr. Wang had completed the first two portions of his residency. Dr. Wang needed to take several qualifying exams and the rest of his training before he would be eligible to apply for a US medical degree. A dedicated doctor Dr. Lishan Wang felt it was his obligation to bring to the attention of the hospital management problems involving patient health and safety.
While remembering that Dr. Toor's family is bereaved of their cherished loved one, the US justice system must uphold the human rights of both the accused and the victim of this terrible crime. The Superior Court in New Haven CT will be facing these challenges as this case proceeds. We do not condone a violent act or want to give the appearance that it would somehow validate issues and thus achieve support for grievances is not justified. But perhaps we need to focus on a discussion that leads to a more enlightened pathway. Transformative justice leaves the system changed for the better. Let us hope by facing the truths of this case that we can address the critical issues of our medical care system and prevent further harm to patients or resident/interns. We must look unflinchingly at the entrenched problems within our medical care system. We must advocate for protections for medical professionals who voice concerns for patient safety and human rights considerations. We need medical professionals within the system to point out failures and areas for improvement and to protect the human rights of vulnerable patients. Medical Professionals are the defenders of the human rights of patients.
This tragedy highlights the frustrations of resident/intern doctors working in US hospitals to address issues of their employment and training. Hospitals in the USA routinely recruit doctors from foreign countries to come here and then use them to provide hospital care while they are in training. This system can be beneficial to all concerned - patients get economical care from resident/intern doctors, hospital saves money (less staffing costs) and the foreign doctor gets training in the USA he/she otherwise could not afford. In a perfect world all would benefit. But this is not a perfect world. Hospital administrators get greedy and want to cut staff costs so they over schedule these doctors for long exhausting shifts. They also provide inadequate support staffing of nurses and other experienced medical personnel to provide supportive help to the resident/intern. This directly affects the quality of medical care given to patients and puts tired exhausted resident/interns responsible for life and death decisions when they are sleep deprived. These resident/interns are still in the learning phase of their training, the stress of long hours, lack of sleep and lack of time to relax and decompress has a negative impact on everyone's ability to make decisions. This leads to medical errors and can lead to injury, disability and even death of patients, especially in a critical care environment. Resident/interns are placed in a busy inner city hospital environment to handle the emergency and critical medical needs of the gang members, domestic violence victims, and the homeless. They are responsible for medical care in a managed care system that often fails to provide adequate funding for these populations and in a system where no insurance often means no care. Hospitals use the resident/intern doctors for tasks not usually expected to be doctor tasks because it is cheaper per hour than to pay an experienced RN to do them. Once here in the USA it is difficult for these foreign resident/interns to return back to their home countries. The cost of air fare is very expensive especially if they have a family that they brought with them. Essentially they are entrapped by the hospital with little chance to improve their working conditions. If they complain about the long hours, lack of support help or inappropriate duties they have their employers support for their green card status revoked and then they risk being deported back to their country of origin by the US Immigration Service. Foreign resident/interns do not understand how the American medical system works. In China the system of medicine is nationalized - the hospitals run by the government itself. All citizens in China get basic health care, there is not a tiered system of those who have insurance and uninsured as there is here in the U.S.A. Many foreign resident doctors naively believe that the management would correct the inequities of the employment conditions and quality of patient care. These resident doctors obey the authority of the hospital management and find it difficult to stand up to management in patient care issues or even for their own human rights.
This deeper issue about the patient safety concerns voiced by Dr. Lishan Wang and the terms of Dr. Lishan Wang's employment were never resolved adequately. Dr. Lishan Wang filed an EEOC complaint on July 28, 2009 in US District Court, Eastern District of New York. On April 13, 2010 a Federal judge postponed the conference call on status of federal discrimination case until May 6, 2010.
Dr. Lishan Wang, 44, is now charged in the killing of his former colleague, Dr. Vajinder Toor, outside Dr. Toor's residence on April 26, 2010. Dr. Wang is also accused of firing at Dr. Toor's wife, but she was not wounded. Dr. Wang was being held in $2 million bail and the case was being held at the New Haven Superior Court in CT.
The tragedy of this case is that there are inadequate safeguards to permit a doctor to bring patient safety concerns forward and to address inequities in employment and to safeguard the human rights and civil rights of all concerned. Now the violent act of a homicide and the prosecution proceedings will mask the underlying problem that existed at that hospital. Homicide is not justified. Dr. Lishan Wang will stand trial for his actions. But had Dr. Wang's human rights and civil rights been protected would there have been a different outcome?
Our heartfelt condolences go out to Dr. Toor's family and to Dr. Wang's wife and three children. We can hope that all who have control over this case look to find a way to have transformative justice with consideration of the human rights of all involved.
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The prestigious Institute of Medicine (IOM) in December 2008 released its landmark report, Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, the most comprehensive study of resident work hours conducted to date. The study reviews the robust evidence base linking fatigue with decreased performance in both research laboratory and clinical settings and makes a number of important recommendations for changes in the current system of training physicians. These include new limits on resident physician work hours and work load, increased supervision, training in structured hand-overs and quality improvement systems, more rigorous oversight and the identification of expanded funding sources necessary to successfully implement the recommended reforms. Additional information on Resident Duty Hours: Enhancing Sleep, Supervision, and Safety can be found at http://www.iom.edu/residenthours. Copies of the report are available from the National Academies Press; tel. 202-334-3313 b or 1-800-624-6242 or on the Internet at http://www.nap.edu. In addition, a podcast of the public briefing held to release this report is available at http://national-academies.org/podcast.