I Forgive Her.

April 24, 2014 at 8:32 pm (compassion, defamation, doctor, lawsuit, medicine, neurosurgeon, Uncategorized, votour)


Forgiveness
by Gary M. Votour, MHCA

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Charlyn “Lyn” Votour

On October 13, 2008, my wife,  Charlyn ‘Lyn’ Votour,  took her last breath at our home in Barre,  MA.  Three years earlier,  she had been diagnosed with a rare form of bone cancer,  Chordoma, in the second vertebrae of her neck.  After several false starts,  a neurosurgeon at the Brigham and Woman’s Hospital in Boston had operated on her to remove the cancerous vertebrae, replacing it with titanium hardware designed to protect her spine and support her neck. At the beginning of the multiple surgeries this required, we optimistically had faith in the neurosurgeon’s stated belief that the surgery would go well and that Lyn would be able to recover from it.
Unfortunately for us,  that is not what happened.  During the last part of the surgeries, Lyn suffered from a pair of surgical strokes that deprived a large part of her brain of the oxygen it needed go survive. The resulting brain death left Lyn paralyzed on one side and in permanent pain. Additionally,  the complexities of the surgery itself and complications in the Intensive Care Unit (ICU) were overwhelmingly devastating. I stayed by her side in the ICU for weeks, and became her advocate out of necessity. By the time we left the hospitals six months later and returned to our home, Lyn had gained a tracheotomy, a feeding tube, a permanent catheter and an ileostomy bag.  She could barely talk and could only eat limited quantities of liquid food.
That initial faith had been misplaced.  We all tend to place great faith in doctors when we are ill. We had not realized that when that faith is misplaced, the results could become as devastating as the illness itself. We had yet to learn that even if one is drowning, when someone throws you a life preserver you should look to see whether or not it is tied to a ship or an anchor. That lesson was one we learned, but it was a hard one to accept.
For the next two years, Lyn and I worked on her recovery. Despite the pain, Lyn fought hard every day to recover a bit more of what she had lost. Her voice became stronger. She began to eat small amounts of solid food. She strengthened her good side, trying to learn to compensate for the paralysis. We remodelled our home to make it accessible for her powered wheelchair by taking a lean on our mortgage. When the COBRA period ended for her private insurance,  we worked with Medicare and Medicaid to be able to hire 5 part time caregivers, who worked with me daily to help Lyn with the tasks of eating,  bathing and therapy. Her former primary care physician, Dr. Francis Sweeney, came to see her every month (on his day off from his family practice) to help me manage her care. The local Visiting Nurse Association provided nursing care and therapy coordination.  Friends and family helped donated the financial resources needed to keep our mortgage current and our bills paid. All of these events were miraculous in themselves, and we were thankful for each and every one.
Yet the one thing absent from this extreme example of ICU level home care was any involvement by the hospitals,  and in particular from the neurosurgeon who had operated on her and been responsible for overseeing her care in the hospital ICU. Lyn’s progress plateaued after the first year, all that could be gained with the limited resources we had had been achieved.  By autumn of 2008, Lyn decided that she could not handle the increasing pain and the loss the strokes and complications had inflicted upon her. She chose to stopped eating and drinkng,  and had me discontinue the tube feed which supplied nutrients directly into her body. It took a little over two weeks until she died, with myself by her side.
Despite all that had happened, Lyn had decided that we should not sue the neurosurgeon or the hospital for malpractice or negligence. Lawyers had contacted us and offered to do so, but because Lyn had forgiven them all she did not see this as an option worth pursuing. Even after her death, I respected her choice, and decided against a proposed lawsuit for wrongful death.
I found myself alone for the first time in our 30 years together, and I had a difficult time working through my grief and loss.  It took me over a year of therapy and medication before I could begin to recover my life, and start to put the pieces back together again.  I found I had some unanswered questions, many of which dealt with the lack of follow-up from the neurosurgeon from the hospital.  I contacted the hospital and asked if I could come and see her to ask those questions as part of my journey through grief. The hospital initially said yes, but the neurosurgeon refused to meet with me.
Frustrated and angry at this refusal, on March 10, 2010, I wrote and posted here an open letter to the surgeon who operated on my wife. The letter was critical of her decision not to meet with meet with me and accused her of being uncompassionate in her response to me.  I did not disparage the neurosurgeon’s skills, as Lyn had forgiven her. I did not tell anyone that they should not see that neurosurgeon.  The letter was clearly labelled as my opinion.
Within days the neurosurgeon had an attorney send me a letter which stated she did not plan to sue me and respected my right to speak. The letter also asked me to remove the blog, and I responded by posting the letter online. I did not do anything else and considered the matter closed. At that point, I hoped that others who may be ill would learn from our experience and be more careful who they decided to put their faith in. I also hoped that other doctors would realize that showing compassion to their patients when things went wrong was not a weakness, and that admitting a mistake would not get them sued.
I decided to give meaning to my experiences as Lyn’s advocate, and continued to search for the answers I needed to find closure.  Despite the debts from Lyn’s home care,  which I still have, and my own medical disabilities I returned to school and in two years I had a Master’s degree in Heath Care Administration. I now donate my time to people who are facing illness as their personal care advocate. You can visit my website at Fierce Advocacy to learn more about what I am called to do now.
The letter stayed on-line for the next three years, accumulating page views (over 8,000) and the occasional comment. Then last spring when an attorney in Boston informed me that the neurosurgeon had filed a lawsuit against me.  Her complaint alleged defamation, and stated the blog had damaged her professional reputation. She was seeking $100,000 in damages.
I am a Christian and I believe that my primary goal in life is to follow the teachings of my savior, Jesus Christ. As much as is humanly possible, I strive to behave as He did. I searched my heart and prayed for guidance, and found I had no anger towards that doctor, and extended grace and forgiveness to her by removing the blog. I did this within days of learning about the lawsuit,  before I had been served by the plaintiff.  I replaced the blog with three words, “I forgive her” and hoped the plaintiff would see this as the gift that it was and respect what I had done.  I also informed her, through her attorney, that I did not intend to repost the blog. I also hoped that this act of forgiveness, inspired by both my wife and by my Savior, Jesus Christ, would also help me find closure, at least in part, for the grief I still struggle with daily.
I was still served with the lawsuit. Hoping that media attention would help me find assistance in defending myself against this lawsuit, I contacted the Boston Globe. They ran a front page story that included this case as an example of the struggle going on between doctors and those using online media to voice their opinions. You can read it here at the Boston Globe’s web site.
My faith that God would acknowledge and defend my actions led me to request help finding legal representation from the Digital Media Law Project, at the Berkman Center for Internet & Society at Harvard University. They found a law firm, WilmerHale, that offered to represent me pro-bono due to my limited income. I accepted their offer, and one of their excellent attorneys, Adam Hornstine, spent the last year working with me to prepare for court. We had the suit moved from State to Federal court and filed multiple motions to have the case dismissed and compel the neurosurgeon to begin dicovery so we could prepare my defense.  We were met with resistance at each move, and mutiple settlement agreements were proposed by her that, at various times: required me to admit guilt, restricted my right to speak to the press or even discuss what had happened, required complete nondisclosure of the settlement itself, remove the words “I Forgive Her” from this page and even to agree to pay her legal costs if she decided to sue me again. I consistently rejected any settlement offer that included those restrictions.
Our civil courts are a component of our legal system designed to allow two or more parties to resolve legal issues between them. It allows one to recover damages when the court decides one party broke the law in a way that caused the other harm that could be measured financially. I feel that this was a lawsuit designed not to discover whether or not defamation had actually occurred and recover damages, but to instead to intimidate me into admitting guilt that was untrue and to restrict my right to speak in the future. Throughout all of this, I maintained a position that I felt kept me on the ethical high road…  I was willing to agree not to repost the letter or write about her specifically by name in regards to her refusal to meet with me, and nothing more. I decided that the limit of my forgiveness could not extend beyond what I was willing to freely give, and my future freedom of speech beyond that was not on the table.
I have also found my voice in writing about medical ethics and spirituality. You can read what I write at my Fierce Advocacy Blog. A large part of my writing relies on my past experiences, and agreeing to wide sweeping restrictions on my freedom to speak would not allow me to continue to do so. I also felt that agreeing to a hidden, nondisclosable settlement agreement was not ethically appropriate for me. You can read my blog entry entitled “On Being Malpatient” to learn more about why I feel patient voices online should be encouraged, not discouraged.
Although we were ready to go to court and mount our defense against the charge of defamation, we made one last attempt to settle this in mediation overseen by a Magistrate provided by the court. Earlier this month,  she agreed to our final offer and the lawsuit was withdrawn. Because I believe in and advocate for complete transparency in medicine, I insisted that if I agreed to a settlement it could not include a nondisclosure clause. I am posting here the complete settlement agreement.
My heartfelt thanks go to both the Media Law Project and WilmerHale
and especially  Attorney Adam Hornstine
for handling this case with great respect for my feelings and beliefs. 

The Settlement Agreement Details

On April 4th, 2014, the plaintiff’s lawsuit against me was withdrawn. The plaintiff and I have a settlement agreement that was contingent upon the withdrawal of the lawsuit, and these are the terms.
1. I agreed to “not republish, repost or otherwise resubmit the Blog (in the complete and identical form) in any form of media, including but not limited to the internet.” Note the specific language “complete and identical form. Not reposting it comes under the category of “forgiveness”, which I had already given.
2. I agreed to not “publish, post, or submit any picture of [the plaintiff] in any form of media, including but not limited to the internet. The blog had included a picture of the plaintiff. I had no plans to post her image anywhere else.
3. I agreed to “not make any statement in any form including but not limited to the internet that:
a. mentions specifically the name of the plaintiff
b. specifically includes a hyperlink to the plaintiff’s “professional websites (such as LinkedIn or Facebook)
c. that specifically mentions “any lawsuit in which the plaintiff is a named party” (except for this Action and any other lawsuit in which she and I are named parties.)
4. The plaintiff agreed to “not make any statement in any form including but not limited to the internet that mentions specifically the name of the Gary Votour, Gary M. Votour, Charlyn Votour, Lyn Votour or Votour.”

In exchange for these obligations, the plaintiff unconditionally and irrevocably agreed that she “hereby completely, fully, and forever release, remise, discharge, idemnify and hold harmless Gary Votour.” She also agreed not to sue me with “respect to any matter covered by this agreement with the sole exception that suit may be brought to enforce this agreement in the event of a material breach”. We also both agreed that upon any alleged breach of the agreement, we would give the other party 14 days to remedy the alleged breach after being notified in writing before going back to court.

There is NO non-disclosure statement.
There is NO admission of any guilt on my part.
There are NO damages being paid to the plaintiff.

There IS forgiveness of the plaintiff for her choice in deciding to not meet with me four years ago.
I hope and pray that patients and their family members are encouraged by this case to speak up when they feel their truthful opinion needs to be heard,
and that all doctors will learn from this experience that they should show compassion to those voices, not indifference or egotism.

 

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