The gynecology staff at Greater Laurel-Beltsville Hospital has resigned en masse, charging that some surgeons at the hospital are performing operations for which they are insufficiently trained.
All but one of the Prince George's County hospital's 22 staff gynecologists announced the unprecedented action yesterday after a long dispute with the 15-month-old hospital about which physicians should be permitted to perform gynecological surgery.
"We aren't the ones who are suffering," said Dr. Charles Warfield, one of the protesting doctors. "It's the female patient who comes into the emergency room, and some general surgeon decides to whack out her ovary, and it doesn't need to be taken out."
A spokesman for the financially troubled hospital said, however, that each general surgeon who has performed a gynecological operation at the hospital has been "trained to do that type of surgery, and three of the doctors have been doing them [the operations] for years."
Dr. Nasser Rezai, who quit as head of Laurel's department of obstetrics and gynecology, said he does not question the general surgeons' competence to perform the operations but said they may lack the training and experience to properly diagnose and treat a woman's problems.
Warfield, put it more bluntly. "Technically, you can teacher a monkey to do a hysterectomy," he said, but the monkey wouldn't have the judgment to know when to perform it.
The public announcement of the mass resignations, which were effective last Friday, was a rare airing of a professional dispute usually resolved quietly by hospital staffs.
"It never should have gotten so far," said the spokesman, hospital administrator Michael Kitchen. "It's really an internal matter."
A gynecological surgeon has special training in surgery on the female reproductive system and usually operates only on the uterus, ovaries, vagina and related organs.
A general surgeon is one who does a variety of operations, including appendectomies, hernia repairs and cyst removals, but does not have a subspecialty, such as plastic surgery or chest surgery.
Dr. Rezai said at least six "purely gynecological cases," including removal of a cervical cancer and of a cyst on an ovary, have been performed at Laurel in the last 15 months.
He said about four of the general surgeons involved have sought "to do practically everything" gynecologists do in surgery.
Warfield said a major reason the general surgeons want to do the operations is because "it's a very lucrative" field.
He said a gynecologist's typical fee for a hystrectomy ranges from $1,000 to $1,200.
But Warfield said the dispute is not over money. The gynecologists who resigned can take their patients to other nearby hospitals and will not miss the small number of operations the other doctors are doing, he said.
Gynecological surgery, according to the hospital, represents about 20 percent of the operations performed at the 15-month-old Laurel hospital, which is run by the Prince George's county government.
"If we do lose 20 percent of the business, it could hurt the hospital," a Laurel spokesman said. "But I think the void will be filled by other doctors in the area. Of course, it will take time to make up."
During its first year of operation, Laurel had an operating loss estimated by the county at $1 million and was filling only one third of its beds, the lowest occupancy rate in the state.
The hospital's board of directors is scheduled to meet Sept 27 and is expected to decide then whether to continue its policy of permitting general surgeons to do gynecological surgery.
Administrator Kitchen said only seven of the 2,200 operations performed at the facility since its opening were gynecological procedures performed by general surgeons.
The one remaining staff gynecologist at Laurel is on call for emergencies while the hospital seeks new staff, the spokesman said.
Rezai indicated he and at least some of the protesters might return if the issue is resolved in their favor.
"We have resigned collectively for as long as this matter is not rectified by the board," he said.
Warfield, however, said he doesn't intend to return to the hospital.
The rules governing who may perform specialized operations on the female reproductive system vary from hospital to hospital in the Washington metropolitan area and in Maryland.
At Washington Hospital Center, for instance, general surgeons who can show that they have undergone "appropriate training" for gynecological surgery may perform such operations, a spokeswoman said. She added the decision is made by the hospital credentials committee on a doctor-by-doctor basis.
At Johns Hopkins Hospital, a renowned teaching institution in Baltimore, Dr. Gardner Smith, deputy director of the department of surgery said he "can't conceive of a general surgeon" doing a purely gynecological operation, such as a hysterectomy for cancer of the womb.
"I'm sure he would refer a patient to a gynecologist for that," said Smith, who is a general surgeon.
Smith, however, said a general surgeon might, for instance, remove a patient's ovaries during an operation for cancer of the rectum if the surgeon discovered during the operation that the ovaries had been affected.
He agreed that the general surgeon would lack diagnostic ability and judgment in gynecological matters.