Chapter 9: The Hearing

March 3, 1986, McKinley, Ohio

"It's too bad the cafeteria doesn't serve popcorn!" Clarissa declared as we headed to the small auditorium for Melissa Bush's expulsion hearing.

"I'm not sure Melissa being expelled is cause for celebration, nor should it be entertainment," I said.

"Seriously, Petrovich?"

"I think it's sad, really, because she was taught to hate by her church and by her parents."

"I thought you believed we're all responsible for our own actions."

"We are. But imagine if you were taught to hate from the time you were little? It's the same with Emmy's dad."

"But Emmy isn't like that!"

"Because of her dad and grandfather, or in spite of them?"

"In spite of, obviously."

"And you know what a lot of people in my church think of gays and lesbians. Why am I different?"

"Because your mom taught you to love everyone," Clarissa replied.

"Yes. Granted, I had to actually follow through on it, but it's much easier to follow what you've been taught than to overcome it."

"As my grandma would say, you're an odd duck, Petrovich."

We arrived at the hearing room, where perhaps a dozen students were already assembled. Clarissa and I took seats, and when the members of the hearing board arrived on stage, there were close to thirty students and professors seated around us.

The hearing board consisted of Doctor Warren, the Dean of the Medical School; Doctor Worth, Dean of Student Affairs; Doctor Mertens, Dean of Clinical Instruction; and two students — Arnie Johnson and Valerie Simmons, the respective President and Vice President of the Medical Student Organization. All of them, except Doctor Warren, took seats at a long table on the stage, with Doctor Warren picking up a microphone.

"Faculty and assembled students," Doctor Warren said. "We are assembled here for a disciplinary hearing for Fourth Year student Melissa Bush, who I have ordered expelled pursuant to the Student Handbook for violations of the student ethical code. Per the Handbook, she's entitled to an expulsion hearing, either with the Student Ethics Board, or a Faculty and Student Board. She has chosen the Faculty and Student Board, and will be expelled with the concurrence of all five members. Miss Bush, please take your seat."

She and a man I assumed was an attorney walked from where she had been sitting, moved to the stage, and sat down opposite the board.

"Who is your advocate, Miss Bush?" Doctor Warren asked.

"I'm Arthur Braun, partner at Volstead and Braun in Cincinnati, Ohio."

"Welcome, Mr. Braun. Doctor Worth, would you please read the charges?"

"Fourth Year student Melissa Bush, while on probation after failing her Emergency Medicine Sub-I due to mistreatment of a patient and failure to follow the training program specified by the Resident supervising her, made verbal threats against two individuals in the presence of two witnesses. In addition, she was heard by other witnesses giving approval for the death of one of those she threatened and the severe injuries sustained by the other.

"These actions are obvious violations of the ethical code to which Miss Bush agreed upon entering McKinley Medical School, and which she signed at the beginning of each succeeding year. In support of these allegations, we have statements and testimony from licensed physicians, students, and outside witnesses, all of whom will appear before us today. The penalty prescribed by the Student Handbook is expulsion, which, after reviewing the allegations, Doctor Warren has imposed, pending the outcome of this hearing."

"Thank you, Doctor Worth," Doctor Warren said. "Miss Bush, do you wish to make a statement?"

"We'd prefer to hear all testimony before Miss Bush addresses the hearing," Attorney Braun said.

"That's her right," Doctor Warren said. "The first witness is Doctor Loretta Gibbs, Resident Physician in Emergency Medicine at Moore Memorial Hospital. Doctor Gibbs, come forward to the podium, please."

Doctor Gibbs went onto the stage and stood at the podium to the side of the table where the Board and Melissa were sitting.

"Good afternoon," Doctor Gibbs said. "I've submitted a written report of the incidents which occurred at Moore Memorial Hospital, as well as copies of the written warning which was issued by Doctor Simons and the review I wrote at the end of Melissa's Sub-I, which shows she scored a total of 11 points out of twenty-five, with scores of zero for ethical behavior and for following her training plan."

Doctor Gibbs then provided a summary of the incident with the patient with Kaposi's sarcoma, and Melissa's comments afterward, as well as her behavior when she was reprimanded for the incident. Following that, Doctor Gibbs described things I hadn't seen, including a pair of heated arguments over what Melissa felt was mistreatment, and her continued poor attitude towards both doctors and fellow medical students.

"Are there any questions from the Board for Doctor Gibbs?" Doctor Warren asked.

There were none, so Doctor Warren asked if Melissa's attorney wanted to question Doctor Gibbs. He acknowledged that he did.

"Doctor Gibbs, did Miss Bush react in front of the patient you described with Kaposi's sarcoma?"

"No. It was in the hallway outside the treatment room."

"So the patient was unaware of her reaction?"

"Yes."

"And other than expressing shock, did Melissa say anything else in the hallway?"

"No. As I said, we went to the lounge."

"And there, did you give her a chance to explain herself?"

"Her reaction was quite obvious, and witnessed by two other medical students."

"Yes, I'm sure you believe that. Did you, without asking for an explanation, threaten, and say to Miss Bush, and I quote, 'Do not ever think that way in this hospital, or I will have you bounced from the program so hard that you would never practice medicine'?"

"I did make the point that her thinking was out of line for a physician."

"But you didn't give her a chance to speak, so you don't know for sure what she was thinking, do you?"

"It was obvious from her reaction."

"So you say. I'll ask you again, do you know, for a fact, what Miss Bush was thinking at the time? Or did you assume?"

"I was confident in my assessment of the situation, and it was confirmed later by statements she made to other students."

"Did you witness those statements?"

"No. They were reported by those students."

"Thank you, Doctor Gibbs. I have no more questions, Doctor Warren."

"Uh-oh," Clarissa whispered.

"Yeah, this could be bad," I agreed in a whisper.

"I actually have a question," Arnie Johnson said.

"Objection!" Attorney Braun stated firmly.

"Our procedures aren't like a court of law, Counselor," Doctor Warren said. "Mr. Johnson may pose his question."

"Thank you, Doctor Warren," Arnie said. "Doctor Gibbs, in your expert, professional opinion, did Melissa Bush's attitude negatively affect her treatment of patients?"

"It did."

"And does the source of her bad attitude matter, according to the grading system?"

"No, it doesn't."

"And finally, how many incidents did you document where she failed to follow instructions or failed to perform her duties in a satisfactory manner?"

"Nine."

"That's all, Doctor Warren," Arnie said.

"Nice recovery," Clarissa observed quietly.

I nodded, "They didn't ask those questions originally because they felt it was a slam dunk."

"Our next witness is Doctor Andrea Simons," Doctor Warren said.

Doctor Simons replaced Doctor Gibbs at the podium and described her interactions with Melissa Bush, including describing two meetings when Melissa had received written warnings about her behavior, as well as confirming that she'd reviewed all of Doctor Gibbs' assessments. There were several questions from the board, all of which I felt were designed to deflect questions from Melissa's attorney.

"Doctor Simons," Attorney Braun asked, "did you personally observe any of the alleged behavior by Miss Bush?"

"On two occasions."

"Would two such incidents normally result in written reprimands?"

"No. But I was asked to observe after Doctor Gibbs identified the problem."

"I understand that. Did Miss Bush tell you that Doctor Gibbs had threatened to fail her?"

"Yes."

"And what did you do?"

"Stated that given all the evidence, including personal observation, such a warning was well within Doctor Gibbs' purview as a Resident in a teaching hospital."

"Is that true when the Resident is acting by presumption, rather than by facts?"

"I trust Doctor Gibbs' judgment; she's demonstrated her skills and abilities in the Emergency Department as an Intern and a Resident."

"But those skills are quite different from those of a teacher or mentor, are they not?"

"Doctor Gibbs has received high marks from her other students, and I've personally observed her teaching. She's an excellent physician and teacher."

"Who jumps to conclusions without allowing her students to respond. Doctor Simons, has Doctor Gibbs ever missed a diagnosis?"

"Every physician has."

"And what was done in those cases?"

"The same as for any young physician — discussion with more experienced physicians about the error, how it was made, and how to correct it in the future."

"Something NOT afforded Miss Bush in this case. Thank you."

"Doctor Warren, I have a question," Doctor Mertens said. "Doctor Simons, to your knowledge, did Doctor Gibbs make attempts to work with Miss Bush before she brought the problem to your attention?"

"She did."

"By assigning her what Residents and medical students call 'scut'?" Attorney Braun asked, interrupting.

"That work needs to be done," Doctor Simons said. "And by doing it, medical students, Interns, and Residents demonstrate that they have the dedication to the profession and are willing to do the tasks necessary to provide excellent patient care."

"Including getting coffee or picking up dry cleaning?"

"Retrieving dry cleaning would violate the guidelines at Moore Memorial Hospital, but getting coffee is a typical task for junior staff in many industries. It is rare at the hospital, but yes, that does happen."

"And it's normal for a student to be assigned to 'scut' for their entire training period?"

"No. But when there is a serious question about a student's ability to treat patients, they will be asked to demonstrate their reliability and responsibility by following instructions to do those tasks without complaint."

"How, Doctor Simons," Attorney Braun asked, "is a student supposed to learn or demonstrate their skills if they are never allowed to exercise them?"

"Had Miss Bush responded the way most students do, by responsibly and reliably completing her assigned tasks in a timely fashion with a good attitude, she would have been invited to perform procedures commensurate with her training and education to that point."

"So you admit she wasn't given a chance to show her skills; thank you, Doctor."

"She was treated as any similarly situated student would be treated," Doctor Simons stated firmly.

"And how many students have been subjected to the same treatment in the past year?"

"To doing 'scut'? All of them."

"To the extent Miss Bush was assigned that work?"

"I believe she's the only one."

"Thank you, Doctor."

There were no further questions, and the next witness was Jill, the medical student who had witnessed the incident in the hallway and others. She didn't add any new information, and nobody asked her any questions. Next to take the podium was a medical student, Natalie Sparks, who had heard Melissa make the threats.

"She stated that she hoped the two young men would get GRID and die," Natalie said. "She also stated that if they were to come to the hospital, they would 'regret it'."

"What did you take that to mean?" Doctor Warren asked.

"That she would either directly harm them or withhold necessary treatment, if she could."

"And do you believe she meant it?"

"Yes. She was extremely angry because her brother had been rejected by all the colleges to which he had applied and had been turned down for enlistment in the military."

"Thank you," Doctor Warren said. "Counselor?"

"Miss Sparks," Mr. Braun said, "was Miss Bush actually in a position to control treatment for patients?"

"That would depend on the situation and what the Resident or Attending asked her to do."

"Would she have been unsupervised?"

"No."

"So the alleged threat to withhold treatment was empty?"

"I don't know, but she did make the threat."

There were no more questions, so the next witness, Jon Pence, was called. Surprisingly, he was from Faith Bible, and he testified that Melissa had celebrated Lee's death and Robby's injuries and had expressed her wish that Robby would die as well. Nobody asked him any questions, nor did they ask any of Jeremy Burke, another member of Faith Bible, who testified to the same thing.

"What's with the church people?" Clarissa asked.

"I'm going to wager it's about not being banned from Taft. I told you what Doctor Blahnik was doing, and this might well be a way to try to show they aren't the evil bastards we all know they are."

"Wow!" Clarissa gasped. "Did you just say that, Petrovich?"

"Let's just say that if I'm looking for where Satan has set up shop, I'm going to check Faith Bible first."

"Weren't you just talking about love?"

"Yeah, but that doesn't mean ignoring evil when it presents itself."

"You don't think this will change anything, do you?"

"No, but it does allow them to distance themselves from the Bush family."

"Not going to work," Clarissa declared.

"I hope not."

Doctor Warren summarized what I would have called the prosecution's case by recapping the evidence and then asked if Melissa wanted to speak. Her attorney said she did, so she went to the podium.

"Doctors and fellow medical students," Melissa began, "I regret that I have to say this, but everything you have heard today was the result of bias against me by Doctor Loretta Gibbs. From the beginning, she acted abusively, and as you've heard, when I reacted with surprise to a potential diagnosis, she refused to allow me to explain myself. And it was just that — surprise, nothing more.

"A diagnosis of GRID, or what is now being called AIDS, in McKinley, Ohio, is an extreme anomaly. Prior to that patient, there had been exactly one case at Moore Memorial Hospital. One. This isn't New York City, or San Francisco, or even Columbus. That's why I reacted in surprise. I was never allowed to explain myself, and every time I tried, Doctor Gibbs refused to listen, and instead, gave me scut. The more I tried to explain, the worse it got, with her accusing me of having a bad attitude and her refusing to properly train me. When I approached Doctor Simons, Doctor Gibbs slandered me, and it was accepted as truth.

"I brought this to the attention of Doctor Mertens, who accepted the statements of Doctor Gibbs and Doctor Simons and refused to take any action on my behalf. Did I make intemperate statements about Mr. Jackson and Mr. Fields? Yes, and for that, I am sorry. I was under significant stress caused by the way Doctor Gibbs treated me, for which I was not given any help by either the Medical School or Moore Memorial Hospital. I regret saying those things and wish I could take them back. I apologize for my harsh words, and if Mr. Jackson would consent to see me, I would personally apologize to him."

"Fat chance of that happening," Clarissa observed quietly.

"Agreed," I replied.

"In conclusion," Melissa continued, "I believe that the punishment being imposed is too harsh, given the circumstances, and is fundamentally unfair. I ask that you take into account the facts presented that show I was misunderstood and then mistreated, which led to the accusations made against me here today. Thank you."

"May I speak?" Attorney Braun asked.

"You may," Doctor Warren agreed.

He moved to the podium, and Melissa sat down.

"Members of the Hearing Board, I understand your procedures are not as formal as a court of law, but even so, due process is important. First, I'll point out that Doctor Warren, who proposed the penalty of expulsion, is sitting on the Hearing Board. That appears to me to be something of a conflict of interest, as well as having the potential to exert undue influence over his colleagues and, even more so, over the student members. That concerns me greatly.

"That said, having reviewed the Student Handbook, I understand that Miss Bush agreed to this procedure and the composition of the Hearing Board when she signed the necessary pledge at the beginning of each year. That doesn't solve the problems in my mind and raises a number of legal questions which, I understand, are not allowed in this forum."

"He's threatening to sue," I whispered.

"Yep," Clarissa agreed.

"I would like to propose a possible solution, which my research shows has been used in the past. I propose that rather than expulsion, Miss Bush be suspended for the remainder of the academic year and that she receives a grade of 'incomplete', which would be made up by repeating all of her Sub-Internships for her Fourth Year, with the caveat that Doctor Gibbs does not supervise Miss Bush under any circumstances. I think we can all see why that might be a problem if it were to occur.

"Miss Bush would accept that punishment without any objections or further proceedings. I believe, were outside observers to review this case, that a convincing argument could be made for that punishment, rather than expulsion, which would result in Miss Bush being effectively barred from the practice of medicine for life."

"Nice judo move," I whispered. "He made it clear they're going to court and thinks they could win."

"Could they?" Clarissa asked.

I shrugged, "No idea, but I bet you anything the medical school would rather avoid that potential outcome. And to be honest, Doctor Gibbs should have let Melissa try to explain and truly hang herself."