George Campbell, the attorney for former resident Christyna Faulkner, said there is no apparent reason for this discrimination other than the institution's adherence to a fraternity-like approach to medical education.
"These unnecessary, lengthy overnight shifts, especially for people with disabilities, are no different than hazing you may have seen 20 years ago in frats and sororities," Campbell said. "It's outdated and anachronistic, and it's time for the Dartmouth community and medical community to come together to question the ethos of treatment in such a shabby manner."
During her residency, Faulkner was diagnosed with chronic insomnia, or shift work sleep disorder, a condition often diagnosed in people who work during the night. Faulkner was immediately ostracized when she sought help, and found herself facing resentment from fellow residents who were required to know about her accommodation, Campbell said.
While medical professionals said they were able to accommodate her insomnia, the residency program became an increasingly uncomfortable environment for Faulkner, forcing her to take medical leave.
Faulkner was fired after her leave and has been unable to find work despite two years of residency at DHMC, Campbell said. Dartmouth did not provide Faulkner with a reference, instead citing her performance and medical conditions as reasons to not recommend her to other programs.
"Dr. Faulkner, as a result of a qualifying condition under the Americans with Disabilities Act, has been harshly discriminated against by DHMC," Campbell said.
The issue of shifts longer than 24 hours will "flavor" the lawsuit due to the built-in prejudice in medical training, Campbell said.
In 2011, the Accreditation Council for Graduate Medical Education mandated that first-year residents can only work 16 hours at a time.
DISABILITY IN THE WORKPLACE
In a national survey of 1480 medical residents conducted by the American Medical Association in 2000, 87.6 percent reported incidents of verbal harassment in which they had been humiliated or belittled. This psychological abuse is underscored in all of the lawsuits currently filed against DHMC.
While allegations that medical residents have been subject to disability discrimination are historically rare, new legislation and regulatory guidelines have prompted an increase in such claims.
The Americans with Disabilities Act, federal legislation designed to protect the civil rights of disabled persons in the workplace and in places of public accommodation, was amended in 2008 to broaden its coverage of disabled persons to include those with mental health issues.
Nationally, few residents are terminated from residency programs, and when they are, there are usually specific, extreme circumstances, said Joseph O'Donnell, a senior advising dean at the Geisel School of Medicine.
In the past three years, two DHMC residents were terminated for allegedly failing to use a stethoscope on a physically healthy patient.
While fewer than 20 residents file lawsuits annually across the nation, experts believe that number is increasing. One possible reason is the psychological abuse and discrimination characteristic of residency programs, former resident Jeffrey Isaacs said.
Multiple DHMC residents and upper-level officials declined repeated requests for comment.
DHMC spokesperson Rick Adams said in an email that DHMC takes its responsibility to train and educate young physicians seriously and works to ensure that patients' best interests will be well-served in the future.
"As an academic medical center, we do not comment on individual academic decisions, and out of respect for the judicial process and all parties involved, we will have no comment while that process is ongoing," he said.
Prior to being hired, former resident Jennifer Connors informed DHMC that she had been diagnosed with attention deficit hyperactivity disorder and would need special accommodations, which DHMC said they would provide before her termination.
According to the court documents, the discharge was not based on medical, operational or academic justification, but rather her disability and DHMC's failure to accommodate for it. During her time as a resident, Connors said she did not receive reasonable accommodations and was stigmatized for her condition, which created a hostile working environment.
"They set her up to fail," her lawyer Norman Watts said. "This was a nightmarish experience for her when she didn't have to go through that."
Isaacs said DHMC is generally intolerant toward medical disabilities, and pointed to a time when a psychiatry resident, after learning of Isaacs' medical condition, posted a derogatory slur on Facebook referring to Asperger's as "Ass Burgers."
Isaacs said his diagnosed disability caused him greater stress than other residents, but DHMC denied him accommodations. He claimed that the medical staff circulated rumors of his unstable mental health, reporting he was on the verge of a nervous breakdown in an attempt to force him to resign.
General surgery resident David Caba Molina said that the large percentage of residents at DHMC do not feel mistreated, and that the long shifts that Isaacs experienced no longer occur.
"Overall, we are very happy," he said. "I do not see anything I do not like about my program."
Molina said that DHMC is always understanding about health issues, adding that the hospital accommodates residents' medical situations.
A CULTURE OF INTOLERANCE
A national American Medical Association survey of residents and fellows found that 25 percent had experienced nonphysical harm, 22 percent felt pressured to report inaccurate duty hours, 25 percent experienced intimidation and 50 percent said they would not feel comfortable reporting intimidation.
"Residents occupy a unique position part employee, part teacher and part student," the report said. "Consequently, they do not have the clout or organizational resources to fight against the educational system when disputes or problems occur. Residents have found their specialty choices altered and careers damaged as a result of disputes with residency program directors."
Many residents are afraid to challenge superiors for fear of harming their careers.
Former DHMC resident Thersia Knapik is suing the hospital for firing her after she criticized the ethics of a peer to his potential fellowship program.
"Dr. Knapik sued Dartmouth-Hitchcock for firing her over acting unethically and complaining about another resident's ethics," Watts said. "She'll be asking for substantial damages as a result because she had been accepted in a fellowship in Miami for plastic surgery."
Knapik's termination ended her medical career, Watts said.
Faulkner, the former resident who suffered from insomnia, created a Change.org petition directed at DHMC titled, "Stop the cover up and do the right thing."
Janet Martino, a former medical transcriptionist who worked at DHMC for 34 years, said she signed the petition because she experienced frequent mistreatment in the residency program.
"The personality problems among staff led to issues in [Dartmouth's] residency program," Martino said. "One high-up member of the staff of the residency program is difficult to get along with. The residents are still young, and the staff tore them down rather than build them up."
Isaacs noted that the majority of his complaint is against senior leadership, as they perpetuated the bullying and teasing he experienced. DHMC's small community means that disliked residents are more likely to get fired, making the medical culture less tolerant than those at other schools.
"They noticed my medical abnormalities and mocked them and were aware of them," Isaacs said. "It does seem like this mistreatment of those with medical disabilities occurs at Dartmouth."
A former resident in the general surgery program at DHMC said that the quality of residents varies greatly from year to year, leading the upper-level residents to be overworked without time to assist or mentor the younger residents.
"Favoritism definitely exists in the program," said the former resident, who wished to remain anonymous due to the sensitive nature of the case. "Once you are labeled as bad' or good,' it is very hard to overcome that label."
The former resident left general surgery because the teaching style in the medical community is mediated by hazing. The high level of discontent at DHMC is typical, but the number of lawsuits seems excessive, she said.
"It's a holdover from medicine's early development, when it was based on military hierarchy and training," she said. "In my particular case, the training style made me reluctant to call for help when I needed it."
She added that the current administration is pushing out residents that it believes does not "deserve" to be there.
"As a group, my generation of residents views training differently than in the past," she said. "I feel like older attendings are of the opinion that residency is a privilege, and trainees should work hard to deserve the best teaching, the best opportunities and the best cases."
The former resident said that resident burnout is a serious concern that DHMC has yet to fully address. Though studies have suggested methods of preventing and combating burnout, there have been few specific solutions that residency programs can implement in a clinical setting, she said.
"My medicine colleagues tell me that they laugh to themselves when they realize that surgeons still yell at their residents,'" she said. "Someday, there will be a change in how we train but it just hasn't happened yet. Maybe with my generation of surgeons, it will."
