The Anne Who Would Be Queen: 1997 letter to investigators

Below is best available copy of the text and scan of the response by Anne Lawrence to investigators regarding a 31 March 1997 incident which led Lawrence to resign as an anesthesiologist from Swedish Health Services in Seattle.

The State of Washington Department of Health initiated an investigation through their Health Professions Quality Assurance Commission as case number 97-05-0042MD.

Anne A. Lawrence, M.D.
[…address removed for privacy…]

[stamped] Received Aug 26 1997 Investigations

August 25, 1997

Virginia Renz, Investigator
Medical Quality Assurance Commission
1300 SE Quince Street
P.O. Box 47866
Olympia, WA 98504-7866

Re: File Number 97-05-0042MD

Dear Ms. Renz:

As you requested, I am writing to provide the Medical Commission with a statement detailing my examination of a patient without consent, and my reasons for resigning my clinical privileges at Swedish Hospital. Before I address the specifics of your request, I would like to provide you with some background information which may help to place those events in context.

I have been in private practice as an anesthesiologist in Seattle for nearly 20 years. I was certified by the American Board of Anesthesiology in 1978, at age 27 – a bit younger than most. From 1978 to 1980, I practiced at Group Health Hospital, then left to join Associated Anesthesiologists. I served as an employee and director of that professional corporation until 1994, when we merged with Physicians Anesthesia Service, my employer until April of 1997. During those 17 years, I practiced primarily at Swedish Hospital. I served terms as president of Associated Anesthesiologists, an as clinical Chief in South Surgery at Swedish. I also served on the Equipment and Quality Assurance committees in my department. My colleagues would probably tell you that I’m a meticulous clinician with a conservative practice style, and that I’m a good teacher.
[… approximately 4 lines of text removed…]

Virginia Renz, August 25, 1997 page 2

I married in December of 1987. My spouse was woman I had known for many years, but our marriage was rocky from the start. Our son, [edited] was born in October, 1988, and our daughter, [edited] in March, 1990. My spouse and I stayed together in an empty marriage, mostly for the sake of our children, until the summer of 1995.

[… approximately 3 lines of text removed…] My divorce became final in October of 1996. [… approximately 2 lines of text removed…] This was met with a mixture of reactions by my colleagues. A few of them were supportive, but I also encountered significant resistance. [… approximately 2 lines of text removed…]

My children, now seven and eight years old, [… approximately 2 lines of text removed…] They have been my single most important source of encouragement during the difficulties I have faced in the last two years.

Now, to address your specific questions: On March 31, 1997, I administered anesthesia to a patient scheduled for a hysterectomy. My patient was a 41 year old Ethiopian woman, and her attending gynecologist was Dr. Yolanda Richardson. After the patient was anesthetized, she was placed in lithotomy position. The nurse in the room noted that the woman’s pubic area has been shaved, and she commented on this. I asked Dr. Richardson whether, given the patient’s cultural background, she might have been circumcised. Dr, Richardson told me that she had not been. Following this conversation, Dr. Richardson left the room to scrub for the procedure.

To confirm the information Dr. Richardson had given me, I walked to the foot of the table and performed a brief visual examination of the patient. I placed my gloved right hand on the patient’s lower abdomen, but I did not otherwise touch her. All of this occurred in full view of the other staff personnel in the room; none of them made any comment. I returned to the head of the table and resumed my routine care of the patient. Her surgery went well, and I thought no further about the matter until April 3.

Virginia Renz, August 25, 1997 page 3

Three days after the event, the nurse and scrub technician who had been in the room with me filed an incident report. This was brought to my attention during a meeting with Kate Rogers, the head of Surgical Nursing; Dr. Lee Norman, Senior Vice President for Medical Staff Affairs at Swedish; and my Department Chair, Dr. Paul Zievers. I immediately recognized my lapse in judgment, and accepted responsibility for my conduct. I felt awful. Dr. Norman expressed concern that, given my recent gender transition, word of the incident could potentially become public. I was concerned about the effect such publicity could have on my young children, on the reputation of the hospital, on the privacy of my patient, and on me professionally.

Under the circumstances, I decided that the best course for me was to resign from the staff of Swedish. I knew that my clinical competence was not in question. But I feared that regardless of the outcome of peer review action, word of the incident and investigation would undermine my working relationships, and my ability to function professionally. Defending myself would have been emotionally arduous, and I honestly didn’t know if I could handle the stress. I knew that the peer review process was supposed to be confidential, but I believed there was still the risk of a leak to the press. The prospect of media coverage of the incident, […several words edited…] was a significant concern for me. I was also very concerned about my children, and was unwilling to risk negative publicity and its potential effect on them. I retained legal counsel, and my attorney advised me of the consequences of resignation under these circumstances, including the Data Bank report, and eventual investigation by the Medical Commission. I now sometimes ask myself whether it would have been better to have fought for my privileges, and sometimes I think so; but I’m honestly not sure.

[… approximately 2 lines of text removed…] Our work together has helped me to better understand my conduct during the incident, and the factors which contributed to it. [… approximately 2 lines of text removed…]

I regret that I allowed my professional judgement to lapse. I have accepted responsibility for my conduct, and have tried to use this incident and its aftermath as an opportunity to grow personally. I am thankful that my clinical competence was not called into question, and that the incident did not cause any harm to my patient.

Virginia Renz, August 25, 1997 page 4

I do not have specific plans for my professional future. My employment with Physicians Anesthesia Service ended automatically when I resigned my clinical privileges at Swedish Hospital. I practiced anesthesiology for over 20 years, and I feel that perhaps a change might be for the best. Among the options I am considering are residency programs in other medical specialties. Until my future becomes more clear, I plan to continue my education as a helping professional. In October I am scheduled to begin training at the Institute for the Advanced Study of Human Sexuality in San Francisco.

You have asked about a few other matters. I am licensed only in the state of Washington. Having resigned my privileges at Swedish, I do not now hold staff privileges at any health care facility. Prior to my resignation, I held privileges only at Swedish; but I have in the past held privileges at Medical Dental Hospital and St. Cabrini Hospital, during the years my corporation provided anesthesia services there. Other than the incident that gave rise to my resignation, I have never had any peer review or quality assurance actions involving my professional practice or privileges.

At your request, I am enclosing my current Curriculum Vitae, and verification of my last three years of Continuing Medical Education.

Anne A. Lawrence, M.D.

Notes on documentation

These scans are the best available copy from Washington State's Health Professions Quality Assurance Commission. Areas in white appear to be emendations made in the dossier at the request of Anne Lawrence and/or her lawyers. These are indicated by [... bracketed ellipses...] in the transcripts. Areas in gray have been edited by me to protect certain aspects of Dr. Lawrence’s privacy, and are also indicated in the transcripts below. These documents have been transcribed verbatim, including any errors in the originals. Please report any inadvertent transcription errors by contacting me.