OPINION: What the Presbyterian verdict didn’t say: Doctors try to speak up

The recent $40 million malpractice judgment against Presbyterian Hospital in Albuquerque made headlines. But this and other large settlements in recent years point to something deeper than any one case.

In my work coaching physicians across the country — and particularly here in New Mexico — I’ve heard a troubling pattern. Doctors describe being reprimanded or censured after raising safety concerns about nurses, certified nurse anesthetists (CRNAs) or other clinical staff. These are not wild accusations. These are physicians trying to prevent harm.

One told me, “I reported a serious issue with a provider and was told to ‘watch my tone.’”

Another said, “I was advised not to follow up after I filed a concern. It would just stir things up.”

This isn’t burnout. It’s moral injury — the distress that comes when someone is forced to act against their values. When physicians feel they cannot speak out about unsafe practices for fear of being labeled disruptive, something is deeply wrong.

Presbyterian is not the only system where this occurs. But it is a large and highly visible one, and multiple recent cases have raised questions not only about individual outcomes, but about whether physicians are truly supported when they try to lead on safety.

Let’s look at the current structure.

In New Mexico, CRNAs can now earn $250,000 or more annually. Nurse practitioners often earn $130,000 or more. Many are outstanding providers. But they are rarely subject to the same level of oversight and liability physicians face.

When something goes wrong, it is usually the doctor who is named.

The doctor who carries the risk.

The doctor who is expected to supervise — but without being given the authority to act decisively when care is unsafe.

We call this team-based care. But in many institutions, the power structure has shifted so far into midlevel management that physician voices are not just diminished — they are actively discouraged.

This is not about physician dominance.

It’s about the right to protect patients — and the need to protect those who try.

When physicians raise concerns, they need more than a vague human resources process or a quiet word of warning. They need a clear, structured and protected channel to speak openly and be taken seriously. Otherwise, we send the message: say nothing, or pay the price.

The $40 million judgment, and others like it, are not just about one missed diagnosis or one family’s suffering. They are about a system where risk is borne by physicians, but power is often elsewhere.

We owe it to our doctors — and our patients — to change that.