What risks does Dr. Lemont encounter if he decides to ignore the situation with Dr. Jenner and do nothing?

The Jenner Situation: What follows is a case vignette regarding management challenges at a large academic medical center on the East Coast. While based on extensive interviews, the scenarios and individuals described are composites, and are not reflective of actual individuals living or dead. Dr. Bill Lemont leaned back in his desk chair and rubbed his forehead. His first week as chief medical officer had been a whirlwind of introductions and meetings as he tried to familiarize himself with key hospital personnel and policy as quickly as possible. His door opened and Dr. Mark Sones, the chairman of the Department of Medicine who was overseeing Dr. Lemont's orientation-entered the office for their 2:30 meeting. Dr. Sones sat down in front of Dr. Lemont's desk and opened a blue manila folder. I'd like to discuss a rather delicate situation, Dr. Sones said. To begin with, are you familiar with Dr. Jenner?" www Dr. Lemont knew Dr. Jenner by reputation - he was one of the hospital's most famous doctors. In fact, he was currently on the cover of the hospital's biannual glossy publication for staff and donors under a banner headline that read "The New Frontier of Specialized Medicine." Jenner was a world-renowned orthopedist whose patient list included a healthy dose of A-list athletes. He was also something of a local high-society fixture: a patron of the arts and a regular on the charity events circuit. In addition, his practice was one of the hospital's most lucrative. "I know that he's a walking profit center, Dr. Lemont said There's no doubt about it. Jenner's the real deal he's worked with Dr. James Andrews in Birmingham; he's got a thriving, high-margin practice here; and he's the team doctor for the local ball club. Patients get a really big kick out of that; I mean, his patients love him." "How much?" "See for yourself," Dr. Sones said, tossing the manila folder onto Dr. Lemont's desk. That's a list of charitable donations to the hospital just from Jenner's patients. We're talking millions of dollars every year. "So what's the problem? Dr. Lemont asked warily. He had a good idea where this was going. The problem, Dr. Sones said, settling back in his chair, is that we've had a lot of complaints from staff about his behavior. Other docs, too. He's always been difficult to work with, but recently the number of complaints has been increasing. Increasing quite rapidly, as a matter off act." "What are we talking here?" Dr. Lemont asked. Inappropriate contact? Boundary issues?" "No, nothing like that. But he has one hell of a temper, and he's not shy about letting it loose." Dr. Sones looked over his notes. Here's an example: He had a complication during a rotator cuff surgery and afterward just went to town on one of his surgical assistants. 'This guy has permanent nerve damage and it's your fault,' that sort of thing. He's had his share of run- ins with anesthesiologists, too. Given his nurses hell whenever he's having a bad day-that much has been going on forever." "What about his residents?" "They know the score. They come here, suffer his wrath for a few years, and walk away with their pick of appointments. Every year we get more applicants. Really talented kids, but none of them get through the program without enduring their share of public beratings. Do you think we can talk to him about it? Dr. Lemont wondered. Maybe get him to tone it down a bit?" "Sure," Dr. Sones said. He might even do that. For a week. A month, max. And then it's back to normal. Docs like this? They don't really change. They don't have to. "Dr. Lemont grimaced. Do you think," he asked, "that these outbursts have ever resulted in a patient being harmed?" Not yet, Dr. Sones admitted. But do you really want the first time to happen on your watch? Dr. Lemont didn't answer. Look," Dr. Sones said, your predecessor wouldn't touch this with a ten-foot pole. Not that I blamed him; that's basically been the status quo for some time now. But coming in here as a fresh face, you have the chance to shake things up a bit. Personally, I think it's all or nothing-tell him he needs to move on and you send a real message. Keep him on board and you send a very different message. But 'working him through it,' at this point, is a pipe dream." "How difficult do you think it would be," Dr. Lemont asked, to get Dr. Jenner to move on? Difficult, Dr. Sones said. "He may be a jerk to most of the staff, but there are one or two board members who think the world of him, and he absolutely turns on the charm for them. My guess is he would fight this, and they would back him." a Dr. Lemont leaned back and folded his hands. Jenner might well be irreplaceable in terms of both financial capital and intellectual capital. But his behavior was inexcusable in any workplace setting, much less a hospital. Either way, Jenner was a doctor whom everyone paid attention to. Lemont knew that the manner in which he handled the Jenner situation would be highly scrutinized inside the hospital walls and perhaps within members of the medical community at large