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Sunday, December 18, 2011

Dr. Baier's Dilemma [story]

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1

The Manchester-Barnes is a teaching hospital in rural northern Kansas, but it does not focus on teaching doctors.  The M-B is one of the few hospitals in America focusing its educational efforts on teaching nurses.  It has one of the few accredited diploma nursing schools where high school graduates may start directly in nurse training and after three successful years take the state exams to become an RN.  In the first two years, the courses in traditional academic subjects (English, biology and chemistry, and others) are completed by special arrangement with a small four-year college a few miles away, where also, in night courses, one can complete the B. S. while working full time at the hospital as an R. N.  There are hopes and dreams of offering a Master's in Nursing at the Manchester-Barnes soon.

Most nursing students, whether right out of high school or older, are girls and young women.  So the nurses and doctors who make up the hospital's nurse education faculty are regularly reminded of the institution's strict ban on sexual contact between staff members and students.  Consensual or not, a sexual relation with a student at the M-B is a sure way to exit the scene. 

It was Vice President Farley ("Lee") Baier's responsibility to enforce this strict rule on nurse educators including the staff physicians involved.

2

"Dr. Baier?"  Farley's administrative assistant poked her head in the doorway one morning.  He figured someone was in the outer office with her, or she would have just said "Farley" or "Lee."  But that morning, it was instead "Dr. Baier?"

"Yes, Helen.  What's up?"

"President Anderson requests the pleasure of your company, if it's convenient."

"Ah ha," he said standing right up without even saving the report he'd just started on his laptop.  Both he and Helen understood that this special phrasing meant, "Get yourself over here right away!"  The back door to the President's office was just across the hall.  He knocked and walked straight in.

"Well, hi, Jeff," he said to the Financial VP who was standing across the desk from the President.  "Good morning, Ron," he said then, coming further in.  "Can I help?"

"Let's all sit down," Anderson said, "and be more comfortable."  All of this made the situation - whatever it was - seem serious... which indeed it turned out to be.

"Lee," said Anderson.  "Yesterday, I asked Jeff to look into an important matter that would usually have been your business."

Jeff nodded solemnly, looking only at the President.

"You see, it's about John Feikema..."

3

As Executive Vice President, Farley's duties could have been just about whatever President Anderson assigned to him.  His background was in personnel management, particularly in health-care-related organizations, so among other things at the M-B he supervised all the nurses and all the nurse education programs. 

Dr. Feikema - sometimes called "Dr. John" - was the head physician on staff in the Manchester-Barnes cardiac care division.  He actually enjoyed teaching classes and then mentoring students in the lower-level nursing care courses.  His lectures were considered interesting and not overly challenging, and he was well-known throughout the M-B.  Over the sixteen years Farley had been there, he and Dr. John had become friends.  Their wives were friends too, and the four of them socialized now and then.

There'd been a curious thing several years earlier.  Farley and the President had been meeting with a committee of doctors considering possible research projects, when a senior member of the staff expressed some vague reservations about Dr. Feikema.  Ron Anderson was a fairly new president at that time.  Neither Farley nor he had heard any concerns at all about Feikema.

But after a confusing exchange or two, another senior physician put it bluntly.  "The rumor was all over," he said, "when John first got here, that he was a ladies man, a flirt, who might have made some advances..."  There seemed to be some agreement around the table.

"Someone claimed to know that was why he'd left his practice out west," another put in.

"It was just a rumor," a third man said - in fact, all six of them were men - "and nothing ever came of it, but he was sometimes called Dr. Hands by some of the nurses.  Dr. Hands... Not that it's relevant to this meeting, but it's probably something you two might want to know.  Sorry!"

Farley had dealt with delicate questions before.  A few months after his arrival at the M-B, there'd been a question about a nurse's aide having an alcohol problem.  When he asked the Director of the Diploma School about it, he learned that his predecessor had had the custom of saying aggressively to anyone who made a formal complaint like that, "Would you be willing to testify in court about that?"

The director had commented, "Needless to say, there were fewer and fewer complaints of any kind."

But Farley had had a private conversation about the rumor with Nurse Molen herself, who had since graduated from the diploma program and was on staff.  She'd been very straightforward.  "I was afraid I might be developing a problem myself," she said.  "So I worked with a counselor, and I put it all behind me.  There's no problem now," she concluded.

That turned out to be true ever since, apparently, based on her evaluations, and on recommendations from co-workers, and Farley believed her.  After reminding Nurse Molen of the seriousness of such a problem, he thanked her for her frankness and sent her on her way.  He wrote a detailed report of the conversation for her confidential file, in case he should ever need it...

The point is, unlike his predecessor, Farley did want to know about real or rumored weaknesses or character flaws in his staff.  Maybe his blood pressure would go up for the time he was looking into a complaint or confronting someone about it, but he thought it was his duty and possibly an important one.

4

That later morning, President Anderson went on: "A part-time evening diploma student went to Jeff yesterday to say that after class one night, Dr. Feikema had had sex with her, and I asked him to get with our attorney downtown and deal with this."

"Ron thought it would be best for you, Lee - as a friend - not to be in charge," Jeff said.

Farley remained silent.  He didn't know what to think.

"I have your copy of Jeff's report here," Morrison went on.  "I'd like you to tell me this afternoon what your recommendation would be... Any questions?"

"Did you talk with John?" Farley asked Reese.  It turned out the attorney yesterday afternoon had interviewed the student and then Dr. Feikema in turn, and they had this morning signed statements confirming the summary of what they had said.

"Let me know if you want to see their statements," Reese said.  "They are summarized in my report."

Anderson said, "They both say that there was in fact sexual contact."  It turned out to be three times.  "He says it was consensual, and Jeff..."

"I believed him, and the attorney did," Reese put in.  "Not her."

"But really, in our policy, it doesn't matter..."

5

"Hey, John, come in.  Thanks for coming."  Farley was in the outer office, following up quietly on the senior docs' report of the womanizer rumors.  Farley had searched through Feikema's confidential personnel file since that meeting, trying unsuccessfully to sense any hint of reason for concern.  There was no smell of potential scandal he could detect, only evidence of Dr. John's enthusiasm, efficiency, careful management of department budgets.  His recommendations from the Oregon hospital where he'd worked previously were not particularly effusive, but they were all positive and not overly cautious, as far as he could tell.

When they were seated at the conference table, Farley turned away from chit-chat.   "I wanted to share with you a comment I heard about you the other day.  I don't know of any reason for concern - it was presented as an unconfirmed rumor - but I thought you'd want to know."

"Well," John hesitated, surprised.  "Thanks for filling me in, Lee ...I guess."

Farley summarized the conversation from the meeting three days earlier, pleasantly surprised when John did not press for any details aimed at finding out who had reported the rumor.  Which would have been a bad sign.  "I'm... Well, this kind of thing is disgusting, isn't it?" he said instead.  "But frankly, I'm not too surprised." 

When Farley waited to let him go on, the older man added: "When I was first starting here a dozen years ago, a few of the physicians in the department hadn't wanted the M-B to go outside and hire a division head."  And he elaborated for a sentence or two on professional jealousy.  He was upset, but well under control, not defensive.  "Is there anything you want me to do?" he asked finally.

"No," Farley said, "but I have to make sure you understand that as a teaching hospital, we have even more obligation than usual to make sure there is never anything sexual between staff and students..."

"Of course!" Dr. John inserted.

"...Whether consensual or not, whether just something creating the appearance of any sexual attraction or anything..."

"Right," John said.

"...Even suggestive or seductive comments or gestures..."

"It's a good policy," John said, "and as far as I know, we look squeaky clean on this, don't you think?  What can I do to make sure my reputation isn't questioned again?"

"Well, be real careful about what you say and do," Farley said, "keeping this ugly rumor in mind."  He wrapped up the conversation at that point, after all of about ten minutes, by explaining he now needed to say he would send Feikema a confidential memo simply summarizing their conversation that morning.  John showed no concern.

6
Farley had asked Helen to get the two statements Jeff Reese had offered him.  Not that he didn't already know what was in them after Reese's careful and thorough report, but on principle...  They had been as described in the report.

The details in both statements were the same.  There had been three sexual encounters, all of them in cars, all of them after the night class.  The first had been in the parking lot in his car, the second in her car parked on a few blocks away, another again in his car.  The student had gotten in willingly, and the sex act had been oral sex.  The student claimed that all three times John had physically forced her to do it.  It hadn't been a trade for a good grade in class, both agreed.

"Thanks for small favors, " Farley thought.

There was no doubt about what had to be done.  Farley wrote up a formal recommendation to President Anderson, with a copy to VP Reese.  He would take it across without waiting; Helen could take the copy in a sealed envelope to Jeff's secretary.
7

"Dr. Baier?" Helen looked in.  "Your appointment is here," swinging the door open as Farley crossed from his desk to greet the young man coming in.  He introduced himself, and the two men shook hands.  He gave his name and said his girlfriend - naming her - was a full-time student in the diploma program.  He said she'd said something to him that the man in charge should know.

By now they were seated at the conference table.  "She said one of your instructors - someone she calls 'Dr. John' - had made her feel uncomfortable, and it's all over among the students that he is dangerous.  'Don't be alone with him,' the more advanced students tell the newer ones."

This was several years after Farley had heard the first rumor.

"Dr. Feikema is a respected veteran staff member of our cardiac staff," Farley said, "but this is a real concern to me.  I appreciate your bringing it to my attention."  Then he went on: "What did he do to your girlfriend?"

"She didn't want me to come, by the way, and she wasn't really upset... Just feeling a little 'oogy,' you know what I mean?"  Farley nodded.  "She told me he said she should always wear tight sweaters, like the pink one she had on that day.  And he had a kind of grin on his face.

"Was there anyone else around?"

"Oh, yes.  It was before class, but most of the other students were already sitting there.  Two or three of them told her after class that he'd said things to them too, at one time or another."  Farley nodded again, making another note.  "And earlier in the semester, one of the other girls made a really good class presentation... and he hugged her!  Right there in front of the class.  She told my girlfriend it creeped her out."

After a moment, he went on:  "Another student, she said, worked in Dr. John's office briefly, and she said he often touched her... like on the shoulder, or patting her head when passing by her chair at the table.  Once he was telling her something and came up behind her and began to massage her shoulders.  All that made her uncomfortable."

"What did she do?" was Farley's question.

"I don't know," the young man said.

Farley was concerned, but a little frustrated too.  He said he needed to talk with the "girlfriend" herself.  "Oh no," the young man said.  "She didn't want me to come, and she wouldn't come herself."

Farley told him it wasn't unusual for a student, or a nurse either for that matter, to be concerned about retaliation.  But he would not let that happen.  "We can work it out so that Dr. Feikema doesn't get any sense who came forward... And the others too.  If there are others who have been made to feel uncomfortable, I need to hear the details myself, from them, or I won't be able to warn him convincingly.  See?"

The "boyfriend" hadn't thought of that.  He said he'd try to get one or more of them to come in.  "That would help a lot, " Farley said, "but I'll be thinking about what I can do in the meantime.  The sooner, the better, okay?"

8

"You're sure we have to let him go, Lee?"  President Anderson asked that afternoon, pointing out that Feikema was in his sixties and had been at the hospital for almost twenty years.  Farley's recommendation was on the desk in front of him.

"He was warned," Farley said quietly.  "Twice.  If our policy means anything, we don't have much choice."  And then added: "...I'm sorry to say."

"Clear it with the lawyer," said the President.  "Assuming he doesn't tell us to hold on, set it up with the three of us... Feikema, not the attorney."

9


"John," Farley had begun following up on the 'boyfriend's' complaint, speaking in a confidential tone.  "You'll remember that a couple of years ago I brought to your attention some rumors that had apparently circulated around the M-B about you."  Dr. John nodded.  "You asked me," Farley continued, "if there was anything in particular you could do."


"Yes?" John asked.


"Well, I've heard second-hand some details of behavior that made some of your students or colleagues feel uncomfortable."


"Lee!  I don't fool around with other women.  You know my wife.  You know my children!"


Farley raised a finger, "No, wait.  Nobody's making any allegations.  I'm just warning you that certain gestures and comments may make some women feel uncomfortable.  I want to tell you what I've heard.  Okay?  So you can do your best to avoid repeats..."

"Yes," Dr. Feikema smiled ruefully, "yes, of course.  Go ahead."

"Well, once you apparently hugged a student who had made a good presentation in class..."  Farley mentioned each incident the 'boyfriend' had told him about.  That young man had called a day or so after their one meeting to say he couldn't convince anyone to come in and talk with Farley directly.  So Farley and John discussed each of the three incidents a moment or two without much detail.  John was again not defensive, but he was frustrated:

"But none of that means anything!" he said finally.  "That's the way I am.  I'm demonstrative.  I tell people they look nice, when they do.  I pat people's shoulders, in a show of friendship.  I hug people in congratulating them... to say 'Good job!'" he added.

"People are very sensitive about these things," Farley advised, "these days... Will you restrain yourself, keep all this in mind?  It might get serious."

"You know, Lee?  I appreciate your telling me this stuff.  Yes, I'll try not to do those things... or other things like them."

A moment later at the door, Feikema looked back at Farley.  His face was a little flushed:  "I'll just have to keep my hands in my pockets," he said.

"Couldn't hurt."

10

"Good luck, John," Farley said, shaking his friend's hand.  "We'll be in touch by phone in January."  John turned silently and walked away, without making eye contact with the President's assistant in the outer office.

That was how the meeting among Ron Anderson, Farley, and John Feikema had ended.  Farley had known it had to be done, so it hadn't been terribly stressful for him... But it had been sufficiently horrible.

The three of them had taken seats in the President's conversation area, John on the couch, Ron in his big leather wing chair, and Farley on a wooden chair he'd brought over from in front of the desk.  This was the President's show, and he began right away.  "It's a bad situation, John," he said, Feikema nodding and looking down at his hands.  "We're in a pickle," Ron went on, then waited.

"I'm sorry," John said softly without looking up.  He took a deep breath.

Farley thought maybe he should say something, but President Morrison continued.  "We at the M-B are entrusted by the families and sometimes the spouses of our nursing students with their daughters and wives.  We have to keep them safe, or seeming and feeling safe, and part of that obligation is our strictly enforced policy prohibiting sexual contact with any student."

"You even told me once you agreed with the policy," Farley did finally speak.  John nodded.

Then he looked up at the President:  "Do you want me to resign?" he said, his voice a little hoarse.

The President still made no eye contact with Farley, gazing for a few seconds into Dr. John's eyes.  "It breaks my heart to say it, John, but you have to go.  Resigning is the best way for you."

"My mother," John glanced at Farley and then back to Ron: "In Arizona.  She's very sick, could die anytime."  He again glanced to Farley: "I could take an emergency leave and go to be with her."

"Oh!" said Farley.  The President seemed to respond positively, so he said, "That would be plausible, but..."

John went on again.  "I could retire after the New Year."

"We would continue to pay your salary until the end of June," the President said.  That was what he and Farley had decided that morning in talking with the hospital's lawyer.

"So, you would take an immediate, emergency leave," Farley said, "and in early January - about a month from now - you would write me a letter saying you want to retire, effective at the end of June..."  He looked closely at the older man.  "But you can't come back to the M-B in the meantime, John."

"Can I be the one to tell my staff?"

So, they worked it all out.  President Anderson wound the meeting up quickly, standing and extending his hand.

11

The memo from the Personnel Office to staff the next morning read as follows:

Dr. John Feikema of the cardiac care unit and the nurse education program has taken an emergency leave of absence, effective immediately, to go to be with his aging and ailing mother who appears to be nearing death.  Any questions should be addressed to Dr. Farley Baier's office.

*

On January 16, the follow-up memo read:

Dr. John Feikema, now on family medical leave until the end of June, has announced his intention to retire at that time.  He has been with the Manchester-Barnes Hospital and Health Center since 1980.

*

The heart of Farley's last letter to Dr. Feikema, of the same date, said:

We do not expect to see you at the Hospital again, John, except to collect all your personal belongings from your office, which you are to have done by the end of the month.  Please co-ordinate your visit for that purpose through my office.  You will also need to meet with members of the Personnel Office to work out details of your retirement benefits.

It ended:  Best wishes.

12


"Lee!" Helen whispered sharply, hustling in, closing the office door firmly behind her, and crossing to him at the desk.  It was now late January.  "Mrs. Feikema is here, Lee."

"Sharon?" Farley murmured.

"She's in a bad way," Helen said.  "I tried to do my thing, calm her down, hugged her too.  Didn't change anything."

Farley was beginning to stand up.

"I know you're not supposed to, Lee," she went on, "but you really have to see her."

Farley told her to go get Sharon, John Feikema's wife.

While John was slender and a little shorter than Farley himself, Mrs. Feikema had a robust figure, an attractive face, and matched Farley's height.  She'd started to talk even before they could sit at the conference table or Helen could get the door closed behind herself.

"John won't talk to me," Sharon cried out, on the verge of tears.  "He sits there eating what I cook for him, looking down at his plate.  He doesn't respond to questions.  Then he goes back down to his office in the basement.  I'm going crazy, Lee!"

"You know, Sharon..." Farley started to say.

"I've come to you.  You've got to help me.  What's happened?  What - is - going - on?!"

"You mean - " Farley started again.

"I mean, I know he went to Tucson to see his dying mother, who is not dead yet by the way.  And I know he's not coming in to work and nobody calls him at home anymore.  But, Lee, he won't tell me!  What's happened?"

Farley knew the hospital attorney would have a stroke if he ever heard about it, but he was going to tell her.  "Sharon," he said...

"John had oral sex with a non-traditional nursing student, three times, in the Fall semester.  She complained, apparently planning to get some money from suing the hospital.  John admitted it happened, saying she'd been the aggressor, which apparently is true."  He paused.  Sharon's eyes were closed.  Maybe she wasn't surprised?

"The complaint was six weeks ago or so," he added and paused again.

"John knew he would get fired for this, Sharon.  So he did the right thing: he resigned.  His regular salary will continue through June, and then he'll be on retirement."

Sharon opened her eyes and looked for something in Farley's face, but did not speak herself.

"Are you going to be all right, Sharon?"

She stood up, taking a deep breath and kind of squaring her shoulders.

"I think you need to get some help, Sharon," Farley said as he slowly stood too, trying to keep his voice steady and calm.  "I could call up to Counseling.  They'd talk with you if I asked..."

She shook her head.  "No.  No, thank you.  If I need you, I'll let you know..." turning to go.  She hadn't even set her purse down, clasping it to her chest.  She opened the office door herself and went on through.

She didn't call back.

When Helen came in after Sharon had left, Farley said to her:  "No one can know she was here, you know."

"Right," Helen murmured.  "Are you okay, Lee?  I feel so bad for her!"

"I do too," he said.  "And as for me, well, I'll feel better soon..."


***

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