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Poor Performance Records Are Easily Outdistanced

Three months after her Duke privileges were terminated, she was hired at a practice in Danville, Va., and given privileges at Danville Regional Medical Center. Lenworth A. Beaver, the doctor who hired her, said he didn't know about her troubles at Duke at the time. She quit after five months, he said, because "our practice wasn't making enough to pay her what she wanted."

Johnson, a wife and mother of two girls, landed a job with Los Alamos Women's Health Services -- a New Mexico medical group -- and received privileges at Los Alamos Medical Center, records show. Although the hospital was ignorant of her past, an official said, the medical group was not.

Monia Thomas sued Pamela Johnson and Duke University Medical Center after her intestine was nicked during a tubal ligation. (Karen Tam For The Washington Post)

SUNDAY: Doctors with substance abuse problems are allowed to keep practicing, often despite relapses, and medical boards rarely revoke licenses.
Physicians Practice Despite Abuse
Some Doctors Sent to Rehab

MONDAY: A physician in Maryland or Virginia is twice as likely to be punished as a doctor in the District, where the medical board's record of serious disciplinary action has been among the lowest in the country.
D.C. Board Rarely Punishes Doctors
Despite Deaths, D.C. License Upheld
Graphic: Medical Discipline

TUESDAY: Doctors who are disciplined often restart their careers by moving to a another state, despite a federal system meant to prevent physicians from hiding troubled pasts.
Track Record of Lies, Job Dismissals
Red Flags About Md. Man Ignored
Multiple Licenses to Conceal History

The Movements of Pamela L. Johnson

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The Medical Community: Arthur Caplan, PhD, of the University of Pennsylvania discussed bioethics.

Many state medical boards allow you to search for your doctors' standing and medical compliance history.

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Before it hired her, it knew of at least one surgical complication involving Johnson and that she had been asked to leave Duke, according to a handwritten note by one of the group's partners filed in court records.

Hours After Joy, Tragedy

By the time Gwyn Vives arrived at Los Alamos Medical Center to give birth in December 2001, Johnson had had her New Mexico license for five weeks. Vives was admitted to the hospital by Johnson. Her labor was induced, and with the help of a midwife, she gave birth just before noon. With her husband at her side, Vives was "holding baby, bonding well," according to a hospital report.

But shortly after, things went wrong.

According to a lawsuit filed by Ted Vives, his wife suffered a vaginal tear and other lacerations during the delivery that caused profuse bleeding. While Johnson was repairing the vaginal tear, Vives's pulse rate soared. She was given several medications to stop the bleeding. Johnson left the delivery room about 1 p.m. to assist with another procedure, turning the repair over to the midwife.

The lawsuit alleged that Johnson's "negligence and recklessness" contributed to Vives's death, saying that after partially repairing the vaginal tear, Johnson ignored Vives's "bleeding, tachycardia, cervical lacerations, repeated alarms and signs of shock, abandoning her patient." Johnson failed to call an anesthesiologist or prepare for a blood transfusion, the lawsuit alleged.

Johnson returned to the delivery room about 1:45 p.m. after being paged and tried to repair the lacerations, then ordered that Vives be moved to an operating room. In the operating room, Vives's heart failed, and doctors could not resuscitate her. She was pronounced dead at 3:06 p.m.

The autopsy said that Vives died from excess blood loss due to an amniotic fluid embolism, "a rare complication of childbirth" that is "unpredictable and unpreventable." Cervical lacerations can make a patient more susceptible to such an embolism, the autopsy said.

A former hospital official familiar with the case said that "there were some amniotic cells found in the lung capillaries" but did not know what caused her to bleed to death.

"The bleeding had been going on, and it wasn't treated appropriately," said the former official, who spoke on condition of anonymity for fear of retribution.

"Obviously, [Johnson] didn't know she had an embolism. The transfusion wasn't done. If it had been done and she had died, no one would have said anything," the official said. "They would have said that [Johnson] gave it her best effort. But there wasn't that best effort, and that concerned the executive committee" at the hospital.

The lacerations occurred during the delivery, for which Johnson was not present. Johnson said at the time that Vives's death was due to the embolism, according to court documents.

"They were looking for a scapegoat," Johnson said in an interview.

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