A Boston judge ruled Nov. 3 that Brigham & Women’s Hospital had violated the First Amendment rights of a couple who led an aggressive national campaign to stop power morcellation, a surgical procedure routinely used by gynecologists.
Earlier this week, Brigham provided care to Amy Reed, who needed urgent surgery for a cancer recurrence. However, her husband, Hooman Noorchashm, had to submit to being searched and accompanied by a security guard.
Both Reed and Noorchashm are physicians. She is an anesthesiologist who was formerly employed at Beth Israel Deaconess Medical Center, and he is a cardiothoracic surgeon who had practiced at Brigham.
The decision to subject the couple to enhanced security procedures was made by Ron Walls, executive vice president and chief operating officer at Brigham.
On Nov. 2, after Reed and Noorchashm were searched at the entrance to Brigham, and Noorchashm was put under surveillance, their attorney went to court seeking a restraining order against Brigham for engaging in a “retaliatory action” that was brought on by the couple’s public criticism of Brigham leadership in the controversy over power morcellation.
The motion, filed in the Superior Court Department of Suffolk County that day, states that Reed and Noorchashm were subjected to a “humiliating and distressing physical search” at the Harvard-affiliated hospital.
On Nov. 3, at 4 p.m., Superior Court Judge Elizabeth Fahey ordered Brigham to lift all security requirements.
“Allowed as a Temporary Restraining Order, finding that both plaintiffs will suffer irreparable harm,” Judge Fahey wrote.
After the ruling, Brigham attorneys notified the couple’s attorney Tom Greene that they will not contest the injunction.
“Brigham had filed affidavits of some security personnel to try to make the point that Hooman posed a security threat,” Greene said to The Cancer Letter. “The judge basically didn’t buy it. Brigham wanted the security restrictions to remain in place, I argued they shouldn’t, and she agreed, and she lifted them.
“There was no justification to have these restrictions in place. Hooman and his wife had visited Dana-Farber and Brigham probably more than a dozen times in the past two years, and they were never required to check in or be shadowed by security personnel, so why now?”
Over the past two years, the couple’s advocacy led to FDA restrictions on the use of power morcellators and largely ended insurance coverage of the procedure. The Government Accountability Office and the Federal Bureau of Investigation are looking into claims of corporate negligence in reporting adverse events.
“My wife and I, today, were subjected to a useless search immediately prior to her going into the operating room,” Noorchashm wrote in a Nov. 2 email to Walls, executive vice president and chief operating officer at Brigham. “And I will tell you that it was all posturing your leadership had designed to intimidate, because anyone with half a wit would immediately see who my wife and I are.
“That you subjected my wife and I to a security check on a day like this is unbecoming of your MD and of your Harvard professorship.”
The documents, including the complaint, Brigham‘s opposition, Fahey’s ruling, and Walls‘s letter to Noorchashm are posted here.
A mother of six, Reed, 42, is battling a third recurrence of leiomyosarcoma, an aggressive uterine cancer, which has spread to the upper section of her right lung. Reed, an assistant professor of anesthesia and critical care medicine at the Hospital of the University of Pennsylvania, had undergone surgery and radiation for the past two recurrences, both on her spine.
The metastases can be traced to an Oct. 17, 2013 hysterectomy—performed with a power morcellator at Brigham—that disseminated Reed’s undiagnosed sarcoma (The Cancer Letter, July 4, 2014).
“Dr. Reed’s doctors, both at the University of Pennsylvania and the Brigham & Women’s Hospital believed that it was imperative that the uLMS [lung] tumor be removed from Dr. Reed as soon as possible,” the complaint states. “The thoracic surgeons at HUP expressed reservations about performing the operation due to its proximity to major vessels.
“BWH’s thoracic surgery division is world-renowned and is capable of resecting Dr. Reed’s tumor in a routine fashion. Dr. Reed is expected to stay at BWH for a total of four to five days following the surgery.”
Reed’s lung metastasis was removed Nov. 2 at Brigham under the care of Scott James Swanson and Suzanne George. Swanson is co-director of Minimally Invasive Thoracic Surgery at Brigham and chief surgical officer at Dana-Farber Cancer Institute. George is an assistant professor of medicine at Harvard Medical School and clinical director of the Center for Sarcoma and Bone Oncology at Dana-Farber.
According to Noorchashm, Swanson and George had no prior knowledge of Walls’s decision.
“In the many times I have cared for Amy, with you at her side, I have never felt threatened or unsafe or have required any unusual security procedures,” George wrote to Noorchashm when informed of the security measures. “I cannot speak for BWH policies, but only from my personal experience and interactions with Amy as a patient and you as her family.”
Brigham initially intended to appeal Judge Fahey‘s decision, a Brigham spokesperson said to The Cancer Letter.
“Dr. Noorchashm and his wife left the hospital before we had the opportunity to do so,” the spokesperson said. “We believed that the appellate court would have allowed the hospital to continue with the security measures we had put in place.”
The security measures were intended to “adequately address the fears and anxieties of hospital faculty who felt targeted by Dr. Noorchashm, [and balance that] with the desire to treat Dr. Noorchashm with professionalism and discretion,” the spokesperson said. “When members of the hospital’s security team perceive a threat, it is not unprecedented for the hospital to implement security measures in order to ensure the safety of faculty, staff, patients and visitors.”
It is unclear whether Reed and Noorchashm will be subjected to similar security measures in the future.
“The hospital does not have a statement to share regarding this,” the spokesperson said.
Searched at the Door, Followed by Guard
Four days before Reed’s surgery, on Oct. 29, Brigham COO Walls sent a letter to Noorchashm, describing security measures that would apply to him:
“In light of concerns created by your on-going communications with BWH staff, your presence will be subject to the following standards and expectations:
- “Upon arrival at the hospital, you will present to the information desk at 75 Francis St. and identify yourself.
- “A plain-clothed Security officer will escort you to a discreet location where you will be subject to a security screening.
- “A plain-clothed Security officer will escort you at all times while you are on BWH property, with the exception of when you are in your wife’s inpatient room, or in conference with members of the care team, at which time the officer will remain outside the door.”
Brigham’s policy on patient rights states that patients have a right to a “prompt response to all reasonable requests and a right to personal dignity and to a reasonable extent, privacy,” the complaint states.
Brigham has violated both of these patient rights with regard to its treatment of Reed, the complaint states.
“BWH has refused reasonable requests from Dr. Reed and her husband Dr. Noorchashm to lift the arbitrary security requirements the institution has imposed, despite the fact that no such restrictions were required on any of Drs. Reed or Noorchashm’s previous visit to the hospital,” the couple’s complaint stated.
Earlier this year, in an unrelated incident, Michael Davidson, a Brigham cardiovascular physician, was shot and killed by Stephen Pasceri, who apparently believed that a post-operative drug Davidson had prescribed caused his mother’s death.
Brigham‘s attorneys did not refer to the incident during the Nov. 3 hearing, a Brigham spokesperson said.
“Counsel for the hospital explained to the court that the BWH community had been recently traumatized by violence in the workplace, and as a result the hospital is very sensitive to providing a safe facility for patients, visitors and staff,” the spokesperson said to The Cancer Letter.
Noorchashm, a cardiac surgeon at Thomas Jefferson University Hospital, requested that Brigham revoke the security requirements, because he has no intention of harming anyone. Noorchashm said that nothing he has ever said or written in any way constitutes a violent threat.
“I assure you that I pose no physical danger to anyone at BWH—most on the cardiothoracic service are my friends and esteemed colleagues,” Noorchashm wrote to Walls Oct. 31. “We are there at a very difficult time, by choice, for help from the physicians and surgeons we trust.
“I assure you that the strain and duress this BWH corporate imposition is causing on your patient, Dr. Amy J. Reed, and our entire family is unwarranted and unnecessary. And if you choose to persist, it will likely cause extreme psychological duress for my wife and other members of the extended family.”
Walls replied to Noorchashm, saying that his decision is consistent with his mandate to protect Brigham.
“You must understand that nothing relieves me of the responsibility I have to ensure the safety and security of the patients, family members, visitors and staff who enter our doors every day,” Walls wrote. “This requires me to use my best judgment and, after a careful review of your prior communications with hospital staff, I stand by the decision with respect to your upcoming visit.”
On Nov. 2, Brigham security staff searched Reed’s belongings immediately prior to her surgery. Noorchashm was subjected to a physical search, and a member of Brigham’s security team accompanied him at all times—except when he and Reed were in private care meetings with physicians.
Since Reed’s initial morcellation surgery in late 2013, Noorchashm has widely and publicly criticized Brigham’s leadership for ignoring and “stonewalling” the couple’s attempts to address the harm that power morcellators pose to public health. Noorchashm has sent multiple acrimonious emails berating top physicians at the institution for their “corruption,” “atrocious complacency” and “failure” to prevent harm to his wife (The Cancer Letter, July 4, 2014).
“Dr. Walls’ letter explicitly contains a threat against Dr. Noorchashm in retaliation for his exercise of his constitutional [First Amendment] rights,” the complaint stated.
Brigham argued in court filings that Noorchashm‘s emails represent “a credible threat to the safety of BWH employees,” citing multiple complaints from hospital staff members who are concerned about their security. The filings include several colorful emails from Noorchashm to Brigham leadership:
“I have all the time in the world to mince words with you,” Noorchashm had written in a March 15 email to hospital president Elizabeth Nabel and Robert Barbieri, the head of obstetrics and gynecology at Brigham. “But I assure you that the longer you wait to take full responsibility, to apologize, to make good on your failure, the harder you will fall in full public view. I will make sure of this.”
The hospital filed affidavits from Greg Foley, a retired state trooper, Robert Chicarello, director of security at Brigham, and John Pierro, senior vice president of facilities and operations at Brigham:
- “I believe that Dr. Noorchashm‘s presence at the Brigham and Women‘s Hospital presents a definite safety risk to Brigham and Women‘s Hospital physicians and staff as well as to members of the general public,” Foley wrote.
- “In my professional opinion, and in consultation with members of law enforcement and others, the email messages are of a kind and nature that I perceive as exceptionally hostile and which demonstrate a will and desire to disrupt the safety, security and peaceful access of hospital staff, patients and visitors,” Chicarello wrote.
- “The risks of harm to BWH employees, patients and staff has been assessed and would be considered heightened, should these security safeguards not be allowed to remain in place,” Pierro wrote.
Brigham officials declined to provide examples of Noorchashm’s communications that in their judgment could be construed as physical threats. “The hospital does not intend to respond,” a spokesperson said Nov. 2 to The Cancer Letter.
Brigham officials are bullying Noorchashm and Reed, said Richard Kaitz, a Boston real estate lawyer whose wife, Erica, died in December 2013 from leiomyosarcoma upstaged by power morcellation at Brigham (The Cancer Letter, Nov. 21, 2014).
“I am completely outraged. This is nothing other than pure, unadulterated harassment,” Kaitz said to The Cancer Letter. “Hooman worked at Brigham for almost a year after Amy’s morcellation. They know Hooman; they know he’s not a threat. He’s the furthest thing from a physical threat to walk this earth!
“I’m absolutely and completely appalled. To do this to a guy when his family is down and undergoing serious medical issues requiring lifesaving treatment at Brigham—it is the height of arrogance, aggression, and bullying.”
Kaitz filed a lawsuit against Brigham earlier this year, alleging that Brigham physicians knew of the risks of the device and are responsible “for the wrongful death of Erica Kaitz, and the conscious pain and suffering she experienced prior to her death, due to Dr. [Jon] Einarsson and BWH’s medical malpractice and their failure to obtain informed consent.”
