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Discipline over verbally abusive behavior upheld

The Court of Appeals of Iowa upheld a decision by the state’s board of medicine to discipline a doctor who had been terminated from a university hospital system as the result of his abusive and demeaning behavior towards his colleagues and students (Al-Jurf v. Iowa Board of Medicine). The case was decided July 24.

In 2003, the provost of the University of Iowa filed an ethics complaint against Adel Al-Jurf, an oncologist employed by the university’s hospital system, accusing Al-Jurf of “personal vilification” and verbal abuse of other hospital employees.

A investigatory panel sustained many of the accusations, finding that the doctor was so combative and demeaning in his behavior that the hostile environment he created for colleagues and students was likely to undermine patient care, and he was fired in January 2005.

When Al-Jurf applied for reinstatement of his license in 2009, the Iowa medical board filed discipline charges based on the same events that had led to his firing.

A seeming mix-up in the charging documents—the citations to the statutes and rules under which Al-Jurf was charged were cited to the 2009 versions, which was improper because the conduct being disciplined occurred in 2003—resulted in the dropping of some charges. But the board proceeded with the case by altering the language of one charge to “unethical conduct.” An administrative law judge allowed the change because of the similarity of that phrase to its counterpart in the older rule, which had used the term “unprofessional conduct.”

The board’s final decision, reached in January 2011, reprimanded Al-Jurf, required him to complete a clinical practice program before he could be reinstated, and placed him on a prospective three-year probation if he was able to regain his license.

Although in making its decision the board noted that the doctor did not appear to intend his actions to be malicious and that he “clearly lacks insight and understanding of how his behavior appears to others,” a press release issued shortly after the decision neglected to mention this and other mitigating statements included in the decision.

Al-Jurf appealed the ruling, arguing against, among other things, the decision of the board to continue with his discipline proceeding despite citing the older version of the law and the unvarnished publication of his discipline in the press release. The case eventually reached the state’s Court of Appeals.

Judge Mary Tabor, writing for that court, noted that changing the language of the charge from “unprofessional” to “unethical” “did not substantially change the allega- tions leveled against Al-Jurf, who was well aware of the inappropriate interactions alleged to endanger his medical license,” and did not unfairly prejudice his defense.

The court agreed with the board’s assessment of Al-Jurf; Judge Tabor noted that he had created a “hostile educational environment” and that “his actions in threatening, demeaning, bullying, and interfering with the abilities of others to do their work failed to uphold dignity and honor in the medical profession.”

Similarly, the doctor failed in his challenge to the board’s decision to issue a press release detailing his discipline. “While the release could have done a more thorough job of reflecting the final outcome of the board’s deliberations,” Tabor wrote in dismissing Al-Jurf’s claims, “nothing in the notice was inaccurate.”