Jefferson’s top emergency medicine doctor was under anesthesia when he was supposed to be supervising a hospital unit

Theodore Christopher, the top physician in Jefferson’s department of emergency medicine, was recently disciplined after he walked away from his shift to undergo a diagnostic procedure under anesthesia in another part of the hospital, according to three sources with knowledge of the incident.

During a daytime shift in late October, Christopher was supposed to be supervising a first-year resident, or intern, who was four months into her training as an emergency medicine doctor after completing medical school, according to the sources and an Oct. 30, 2023, shift schedule obtained by The Inquirer.

Christopher’s disappearance from the emergency department, located within Jefferson’s flagship hospital in Center City, raised alarms among staff because he failed to notify the on-call physician and left subordinates scrambling to find another shift supervisor. The lapse could have jeopardized patient care if another doctor hadn’t summoned backup, the sources said.

The sources asked to remain anonymous for fear of losing their jobs or suffering retaliation. They said the incident was particularly troubling because Christopher is the boss.

Patients did not experience any lapse in medical care, with multiple emergency medicine doctors on-site to provide treatment and oversee the intern’s work, Jefferson Health said in a statement.

“This matter was investigated internally, and appropriate remedial action was taken,” spokesperson Deana Gamble said. “Our commitment to maintaining the highest standards of patient care and professional conduct remains unwavering.”

She said Christopher had an emergency gastrointestinal issue that required an immediate diagnostic procedure, performed under anesthesia. Christopher, however, was disciplined because he failed to “follow Jefferson’s internal protocol regarding leaving work,” Gamble said.

Gamble did not address why he did not call backup, but said Christopher checked on “the well-being of the handful of patients under his care” and confirmed they were stable prior to seeking medical care. He then entrusted “the patients to the capable hands of our dedicated staff,” she said.

Christopher declined an interview request from The Inquirer for this story.

Christopher apologized to fellow emergency medicine doctors a month and a half after the incident during a Dec. 19 staff meeting, held virtually. According to sources in attendance, he said he made a mistake when he did not contact the on-call emergency medicine doctor before leaving for his procedure.

Christopher oversees a staff of about 60 emergency doctors who work at Jefferson’s main hospital on 10th Street, Jefferson Methodist Hospital in South Philadelphia, and cover shifts at Jefferson’s urgent care centers. About half of them attended Christopher’s December meeting.

He told them that he didn’t feel well and consulted with a gastrointestinal specialist who recommended a procedure on Oct. 30 — the day he was supposed to be attending to patients during a scheduled shift. He said as department chair, he would find it unacceptable if anyone on his staff made such an error.

Christopher said he reported himself to Jefferson’s administrative leadership. He also thanked two doctors on his staff for keeping him honest and holding him accountable. He disclosed that Jefferson’s leadership had placed him on leave as a result of his error, sources said.

The incident was not the first time that doctors on his staff have criticized Christopher’s leadership.

He had a history of being unavailable as department chair and during scheduled shifts at times, according to court records, an internal Jefferson report, and eight former and current emergency medicine doctors who spoke with The Inquirer. The eight doctors either currently work for Christopher or used to as doctors or former residents and asked to remain anonymous for job protection.

In 2020, Jefferson leaders opened an investigation into staff complaints about gender discrimination and management issues, internal Jefferson records and e-mails show. The resulting investigative report did not fault Christopher but recommended departmental improvements.

On Oct. 30, Christopher was scheduled to work a 7 a.m.-to-3 p.m. shift in the emergency department’s patient observation unit, known as the clinical decision unit (CDU), according to a shift calendar. The unit is for patients who require medical observation or are awaiting diagnostic tests to rule out heart attacks, strokes, or other serious medical conditions.

At about 10:30 a.m. that day, Christopher was undergoing the gastrointestinal procedure, a hospital GI schedule reviewed by The Inquirer shows.

Duties that he failed to fulfill during the eight-hour shift included supervising a new resident as she learned how to care for patients in the CDU.

During the daytime, the hospital assigns one attending physician to specifically oversee the observation unit. That physician often supervises a first-year resident. The unit is also staffed by either a nurse practitioner or a physician assistant.

Emergency doctors working on the first floor admit roughly 15 to 30 patients a day to the CDU, which is based on the third floor.

A nurse practitioner, also capable of providing a high level of care to patients, worked a 7 a.m.-to-7 p.m. shift in the CDU that day, according to the Oct. 30 shift schedule.

However, nurse practitioners are not authorized to supervise medical residents.

Jefferson’s residency program for emergency medicine doctors is governed by the Accreditation Council for Graduate Medical Education (ACGME), a national nonprofit that monitors residency programs. Its rules require Jefferson’s emergency medicine doctors to be “physically present” and provide “direct supervision” to first-year residents.

Christopher’s absence, if left uncovered, would have violated its requirements. The intern was never without adequate supervision, said Gamble, the Jefferson spokesperson.

“The CDU is not isolated to the third floor,” Gamble said. “It is not a physical unit, but rather a service. It is also staffed by a nurse practitioner and other health-care providers.”

Failure by a physician to supervise a resident can put patients at risk, especially if their condition is “complicated or touch and go,” said Arthur Caplan, who created the Center for Bioethics and the Department of Medical Ethics at the University of Pennsylvania Perelman School of Medicine.

“Residents are not yet full-fledged doctors. They’re still learning,” said Caplan, now a professor at New York University. “You have to be available, and you certainly shouldn’t be unconscious, undergoing a procedure.”

Jefferson and other hospitals rely on a safety system for additional physician coverage in unforeseen situations. Jefferson’s emergency department always schedules a backup doctor to quickly step in if a doctor on shift is unable to work because of a sudden illness, car accident, or family crisis.

Christopher was required to activate the system by calling “jeopardy,” the term used to summon the on-call emergency doctor.

His failure to do so on Oct. 30 resulted in Christopher being placed on a leave in November, three sources said. He was back working in the hospital by early December, they said.

Gamble, the Jefferson spokesperson, declined to provide details about the disciplinary action, including whether the physician was placed on leave, with or without pay, and for how long.

The Pennsylvania Department of State, which licenses medical doctors, is now considering if further discipline is warranted. Under Pennsylvania law, a doctor has a duty to provide care for patients and can face discipline for failing to properly supervise staff, which can include physician trainees.

Last month, a complaint was filed against Christopher with the state, The Inquirer has learned.

The complaint started a process that can take months to resolve and may not become public. All complaints are confidential unless wrongdoing is found.

State regulators will decide if the complaint against Christopher warrants an investigation. Any findings of misconduct would then go to the Board of Medicine, which ultimately determines discipline.

Amy Gulli, a state department spokesperson, said she could not confirm nor deny that a complaint was filed.

Christopher, 68, has been honored for his physician advocacy work as a past president of the Pennsylvania Medical Society. He also has held leadership positions in national emergency medicine organizations and trained scores of young doctors in his nearly 30 years as the hospital’s chair of emergency medicine. He is an endowed professor at Sidney Kimmel Medical College.

But his leadership record at Jefferson has been controversial.

‘Most interviewees reported feeling that there is a lack of leadership, primarily by the chair, or that they do not trust leadership.’

In late 2020, Jefferson hired an outside law firm to investigate allegations of gender discrimination in the emergency medicine department under Christopher, court records show.

Investigators interviewed both female and male doctors on his staff. The majority said they lacked faith in Christopher’s leadership. Doctors interviewed blamed him for a “poor work environment and culture,” and criticized him for a failure to mend divides, an inability to make decisions, and being unavailable, according to the resulting report.

“Most interviewees reported feeling that there is a lack of leadership, primarily by the chair, or that they do not trust leadership,” the 42-page report, marked confidential, concluded. The report became public through federal court records in 2022 as an exhibit in a now-settled civil rights lawsuit. Neither the report nor the lawsuit has been written about previously by news outlets.

The investigation was spurred by female emergency medicine doctors who had complained about discrimination over the years to Karen Novielli, Jefferson’s vice provost of faculty affairs and professional development, court records show. Novielli, through a Jefferson spokesperson, declined to be interviewed for this story.

By then, at least two top female emergency medicine doctors had taken Jefferson to court. One filed a contract dispute in state court; the other brought a civil rights lawsuit in federal court. Both female doctors alleged gender discrimination by Christopher. Jefferson settled the 2007 and 2020 lawsuits for undisclosed terms and monetary awards, court records show.

A third female emergency medicine doctor had also complained about ongoing “gender equity failure” in Christopher’s department.

The third female doctor, who did not file a lawsuit, wrote a June 2020 email to Christopher, Novielli, and a key Jefferson point person on diversity and inclusion efforts. The female doctor wrote that gender bias had run rampant in the emergency medicine department. She detailed how men took credit for contributions by female physicians, who faced retribution for speaking out.

The investigation by the outside law firm found that some women believed they were paid less than male counterparts, given fewer promotions, and made to feel invisible and bullied.

However, others said they did not feel as though their careers were hindered by their gender. Some interviewees said they believed Christopher was doing his best to run a department with a lot of “turf wars” and personality clashes.

Jefferson’s spokesperson, Gamble, said in a statement e-mailed to The Inquirer: “In 2020, independent counsel was brought in to investigate concerns raised within this department. The resulting information did not substantiate the allegations.”

The review resulted in departmental changes to improve communication and involve faculty more in decision-making, she said.

“Jefferson is committed to fostering a secure and inclusive work environment that values and respects the contributions of every employee,” Gamble wrote. “We take allegations of discrimination seriously.”