When dealing with harassment and toxic work environments, fears of shame and retaliation often make it difficult for victims to speak up. Bystanders may be afraid to go against the status quo. But, there is power in using our voice and speaking up against these acts. This week’s guest did just that.

Episode 66 of the Hope4Med podcast features April Nitkin, a palliative care nurse practitioner who spoke up for concerns of fraud, sexual harassment, and toxic work environments. She shares the powerful story of her experience with harassment and a toxic culture in her workplace. Despite her organization’s leaders attempts to silence her, she won her federal court case and continues to speak up against hostile work environments in healthcare and advocate for safety in the workplace.

Transcript:

[00:00:00] Dr. JB: Welcome to Hope4Med.

[00:00:03] Hi everyone. It’s me, Dr. JB, and welcome back to the Hope4Med podcast. Today, we have a special guest, her name is April Nitkin. She is a nurse practitioner for palliative care who spoke up for concerns of fraud, sexual harassment, and toxic work environments. Despite Main Line Health’s top leader’s attempt to silence her, she won– again, she won her federal court case and continues to speak out for speaking up for safety, as well as speaking up against hostile work environments in healthcare. Welcome to the show.

[00:00:45] NP Nitkin: Oh, thank you so much for having me, Dr. JB.

[00:00:48] Dr. JB: Your, your bio is absolutely amazing and I’m very excited to learn more about you learn more about your experiences. So let’s go ahead and get started. Let’s start from the beginning. Can you please share with my listener your origin story?

[00:01:03] NP Nitkin: Sure, sure. So I got into healthcare– I, I joke that I was always in healthcare even before I was formally in healthcare– but I entered into healthcare as a behavioral health counselor on a dual diagnosis unit. So I went to school and I really wanted to make a difference in the addiction population, so I went to school to be a behavioral and addictions counselor, because of my own family reasons, I thought that that was really an important place to make a difference, to be an agent of change. And a short while after I was working in the field, or actually right before I was in the field formally, my brother passed away from, from suspected suicide. And he had, he was an alcoholic and had mental health issues and it, it became really hard to feel that I was an agent of change in that field, that I was truly making a difference.

[00:02:10] I worked with some amazing nurses on the floor where I was a counselor and was looking at what they were doing and with patients who were doing detox and rehab, and I thought, well, I think that that might be the right field for me. And I went back to school and I went to a second degree program, the fastest in the country, to the Drexel ACE program in Philadelphia. So 11 months to BSN and there I was, a nurse, which was wonderful and I thought that I was going to be a psych nurse when I started that process. Well, I really liked the medical part, the medicine, med-surg, head and neck cancer, urology, ICU type work.

[00:03:04] I went to, into med-surg nursing at first and really had a wonderful experience with some of the patients on a floor at Pennsylvania hospital and I saw a lot of head and neck cancer patients with, with new trachs. I also saw a lot of hospice patients on that floor and was really drawn towards those patients. And at the time, I wasn’t really sure what kind of nurse practitioner I wanted to be, but I knew I wanted to be a nurse practitioner, a little bit of me thought maybe I’ll be a psych nurse practitioner and a little bit of me thought, oh, well, well maybe I’ll be a palliative care nurse practitioner. Long and short, I went into my first nurse practitioner role was as a head and neck cancer nurse practitioner at University of Pennsylvania after receiving my adult health nurse practitioner degree from University of Pennsylvania and was there, and really was drawn back into that world of palliative care very quickly and was doing a lot of palliative care type work. And we all know in medicine, in healthcare, you’re always doing a little bit of psych with seeing patients. So, here I was, I went back into palliative care.

[00:04:31] I was fairly early in my career. I was back at Penn with palliative care after being at Penn for head and neck cancer and starting a family, and I really was in a place where commuting from the suburbs to the city was very, very hard on me after my first child. So I made a change to stay within palliative care, but went to a hospital close by my home and went to Main Line Health, and that is, is where a good part of the story takes place. I am now back at Penn medicine and I’m doing palliative care and hospice within Penn medicine. And I also get to, to manage nurse practitioners and be their advocate and be their partner. But for four year period, I was, I was at Main Line Health.

[00:05:30] Dr. JB: All right. Well, let us continue, so then what happened at Main Line Health?

[00:05:35] NP Nitkin: Yeah. So, when I started, I started January of 2016, so I have to think in the way back machine, right? So January of 2016, I started with Main Line Health and the physician lead, who was also the medical director of the hospital where I was, I was at Bryn Mawr Hospital primarily, he was a very involved physician lead and things started off a little bit different than what I was used to as far as dynamics of team. And at first I, I really thought, well, this is different, but it’s, it’s doesn’t mean that it’s wrong.

[00:06:23] At first and there was a lot of sharing of personal information. There was a lot of asking for personal information. There were some off color comments that were made but it certainly progressed. And a lot of the time, as time progressed, there was a lot of talk about how the rest of the team at that time was all female. How females could use their power against men by withholding sex. His wife was a nurse practitioner on the team, first, a nurse, and then she received her degree, she was a nurse practitioner on the team at a different campus and he would talk about her. He would talk about wanting sex from her in team settings. He would talk about some traumas from his past. He would ask people about their, their own traumas, sometimes forcing people to disclose things that you could tell they were not comfortable disclosing. There was a lot of finding ways for people to show their loyalty.

[00:07:34] It was a lot of discussing other people, other leaders within the organization in a really negative way, almost in a way that built a case so that you couldn’t have a relationship with them. You couldn’t go to them. You wouldn’t trust them, building fear around certain things, making people into villains by painting a picture. And a lot of discussion about sex, about his prostatitis from having sex with lots of loose women, to about wanting sex from his wife, and a lot of comments about women’s bodies. And it was, it was just so ingrained in what would happen, that it became commonplace. And a lot of times our team meetings that were supposed to be IDTs, you discuss patient patients, patient care, they were really about past traumas, about trying to elicit personal information from us or giving very personal information about him or his desires or his, the things he’s working on or hoping for that are sexually-based.

[00:08:52] And then it– and it didn’t happen all at once. It was very slow, a slow buildup. We would talk a lot about his previous role as a cardiothoracic surgeon within the same health system, so Main Line Health has several hospitals, there’s Lankenau, there’s Bryn Mawr hospital where I mostly was in the beginning, there’s Riddle hospital, there’s Paoli hospital, and there’s other campuses, but those are the hospitals. And he was a cardiothoracic surgeon at Lankenau hospital long before I had gone to Main Line Health, and he was addicted to Vicodin and was very open about it with our team about his addiction to Vicodin and would talk about how he did surgery high on drugs. And he was a cardiothoracic surgeon who I believe was the head of the department, something, something like that, but very suspiciously made the transition to palliative care within the same health system and no longer did surgery and was, was strangely protected by them, which I guess I didn’t realize that till later. But there was a lot of like war storytelling where he got to kind of maybe brag a little bit about how bad off he was and how far that was from where he was today.

[00:10:29] Then in the summer of 2018, I was in my office– so I would be the first one in and typically and he would be usually the next person in. I like to be an early, so I could leave early, I’m also a mom of two young kids, so I felt it really important to get home in time for dinner with them. So he would, he would come in, that was not strange, he would close the door because he was often talking badly about leaders, and you don’t want everyone to hear that.

[00:11:08] But this particular morning in the summer of 2018, he came in and he really looked terrible. And my first thought was, oh, no, he relapsed. That was the very first thing I thought. And there were times where I felt uncomfortable that he was taking care of patients, but I wanted to know what was going on. I said, oh gosh, are you, are you okay? And I didn’t say you look terrible, but, but I think it was implied. And he made– he sat down, closed the door, sat down, and he was slouched over. He’s very big man, he was probably 6’7″, kind of slumped over, and he said that he was up all night really struggling with his addiction to pornography and masturbation and that he has a sex addiction.

[00:12:02] And then his body language really changed. And I think everyone’s knows, or at least every female knows, that feeling you get where you think, oh no, I’m in danger. And I had that feeling and I thought, oh my goodness, I need to get out of here. And it was very quiet and you think through things in your head very quickly. His body language changed to a way that was without referring to that this was specifically about me. It felt very much that he was talking about something sexual directed towards me and I got up and I went to, there was a bathroom in between the two offices. So my office in the offices next door and. Yeah. After a couple of moments of silence, who knows maybe it was, it was two seconds of silence. Maybe it was two hours that felt like a long time. But after some silence, I, I got up and I went into the bathroom and I locked the doors. And I didn’t know, I didn’t have a plan, what I would do next. I felt very panicked. I thought there’s no one down here and the door is closed and I got to come out of this bathroom eventually. And I believed I was about to be raped by this man. And I splash some water on my face. And then I started hearing some people come into the offices and I was, I was relieved. I’m not alone. People are here. And when I came out, he was halfway down the hall on the phone. Like nothing had happened.

[00:13:50] Didn’t look that way. He looked before he looked perfectly fine, comes in to have this meeting. I was visibly different with him with everyone. I was very pulled back. I didn’t know who I could talk to about that. And I think I went through my day justifying how I must have misinterpreted, how it must be. Maybe I’m too sensitive because I have a addictions background because of my background with my brother ma maybe I’m hormonal with just having babies. And so I did, I stuffed it a bit well, more than a bit.

[00:14:43] And then things went on, they continued to get worse. And the following week from that event, we were all sitting in the offices and going through the patient list or about to go into the patient list and who was going to see who, when he was talking about some very personal things. And he said, I’m feeling really self-destructive. This is just a week later. I think I might relapse and I, I was very quiet during. And he had said, I, I thought I might relapse. I’m feeling really self-destructive. And I think the most self-destructive thing I could do is have an affair on my wife. And I think if I had an affair on my wife– who again was a part of this this team, the nurse practitioner but at a different campus– then I think you all would have nothing to do with me. And he asked if we would be loyal to him if he cheated on his wife. And he went, he made us go through and say, each person, he wanted to hear their loyalties.

[00:15:52] And one of the people in the room was like, I don’t think it’s about this. I think it’s about other things. And you’re processing these things and a lot of emotions about this, which that’s what we do in palliative care, where like always trying to palliate everyone. And I thought to myself, is that what that was? Like, what he’s talking about, the self-destructive thing, is that what that was last week? Is that where this came from? And I was too afraid to ask and I didn’t want to bring it up because I thought maybe if I just ignored it, maybe it all would go away. But it felt like maybe a test or I don’t even really know, I keep trying to assign things that I’ll never know, intention behind things I’ll really never know the answer.

[00:16:45] But then it was very obvious that the relationship had forever been changed. I was, I did not ever allow myself to be alone with him. I stopped coming in early because I did not want to be there without anyone else. I didn’t have lunch with him, certainly not alone, which that was a big thing that the team would meet for lunch. But if he was ever in a place where the rest of the team wasn’t there or if there was a risk that they would leave early and I would still just be with him, I didn’t want to be there. So, I really pulled away. And I really shut down and I really didn’t talk to the rest of the team very much for self-preservation. And after a few weeks, and mind you, I went from full-time and then I cut my hours to part-time to try to avoid him because he really wasn’t there. He wasn’t there on Fridays, and he wasn’t there most Thursdays, so I thought, oh, maybe I can just avoid this guy because I thought it was, it was personal to me. So just avoiding him that would solve the problem. So then a couple of weeks–

[00:18:02] Oh, then I went from full-time to part-time to per diem because per diems get to go to other campuses. So, I’m working like almost full-time hours as a per diem, trying to get out of there, but they kept hanging on to me at this campus. But after a few weeks of me really like staying away from this guy and very obviously uncomfortable, he met with me and he said, we have to have a conversation. And I thought he was going to bring up what happened. And I was like, well, I can’t avoid it. Here it is. And he said your team feels that you don’t share enough personal information. Your team feels that they’re sharing their, their most sacred information with you and you’re not sharing it back. And your team feels that you don’t trust women. And that my behavior of not sharing personal information is affecting team morale. And then he brought each member of the team in to tell me, or try to coach them into telling me, how my not sharing personal information is making us a weaker team. One person who he brought in was very concerned that my husband, he worked at Main Line Health at the time as a risk manager or safety specialist is the nicer term we use, right, as a safety specialist.

[00:19:56] And she had felt very concerned that I was sharing some of the things that were being said about different leaders, about people’s personal life, sharing with my husband. And my response was, I don’t think that the workplace is necessarily the place that we should be concerned that someone’s telling their spouse what someone’s saying, and that didn’t go over so well. And there really was a culture of, this was like group therapy, was IDT, and tears flying and lots of things that was commonplace. And it was, it was not okay to question him. And he had made that very, very clear several times, not just with me, but with other people and had alienated people from the team who didn’t agree with him or questioned him and spoke really poorly of people.

[00:21:04] So he, he really gave the example, if you don’t want to be ostracized, you fall in line, you do what I say, and this is how we do it. And the one nurse practitioner who had spoken about how she was concerned that I was talking to my husband, she was really the only person who said anything like that.

[00:21:30] But she was definitely a favorite of his and had been over his house multiple times, had really been very enmeshed in each other’s lives. He had also talked about her dating life and IDT and gave her advice and made her cry once because he called her out on what she was doing with her dating life during our team meetings.

[00:21:53] So it was, it was very dysfunctional. It was a very intense cult-like atmosphere, but I tried to just figure out a way to make it work. And I don’t think I really realized the magnitude of the dysfunction until a very eye-opening moment, where in February of– actually I have the exact date because I have to keep notes ‘cause it was so long ago– it was February 27th, 2019, or no, I’m sorry. No, that’s right. So February 27th, 2019 we were in an, I was per diem at this time, but I was very much at that campus more than any other campus. I was in the offices and before we ran the list, all of us were together.

[00:22:54] There were four nurse practitioners, myself, and this doctor and the doctor had said, what I need you to do is I need all of you to look at a patient’s insurance. He was very frustrated, and had mentioned before that he was frustrated that the nurse practitioners were not getting reimbursement for the Blue Cross patients for their bills. So there that day you have five nurse practitioners, one physician, and who knows how many patient bills were just not being collected because they, we couldn’t have nurse practitioners get reimbursed for the Blue Cross patients. So he said, I want you to look at the insurance and for the Blue Cross patients, I want you to send me the note, which is fine.

[00:23:58] An incident two billing, totally fine. Send me the note and I will co-sign. Well, the thing you have to do with that billing is you have to see the patient, attest to that, I saw the patient, I agree with such and such, And that’s how you do that billing. The problem was, as I said, he wasn’t there most Thursdays and every Friday. And he was asking for those bills to be sent to him on those days as well. And it was very clear he was asking us to commit fraud. And one of the nurse practitioners in the room who was very pregnant at the time, and maybe that was symbolic to me in some way, but the nurse practitioner in the room who was pregnant, she voiced her concern about this and, and named it, called it fraud, said she wasn’t going to risk her license. And he spent 45 minutes lecturing, shaming, using ridiculous examples. He spent this time telling her how she was wrong and he was right and said things like “have you ever gone 70 and a 65? Oh, well, that’s worse than what I’m doing” and got very defensive with her. And I think that was the beginning of the “aha!” moment where I thought I’m not the only one that feels this way.

[00:25:38] We’re just too scared to talk to each other, to say, Hey, like something’s really wrong here. And the next day, I wished I had said more in that meeting. I think my only statement was something about it being penny-wise, pound foolish, there could be fines. One of the nurse practitioners in the office, she, her husband was a federal agent who she texted actually during that meeting to find out how basically, how this man could best commit fraud.

[00:26:13] And she gave him some pointers. So through those text messages, she gave him some pointers on how to best commit fraud. Don’t drop too many bills in the same day, on weekends, or things like that. So they, the final word was, this is what you’re going to do. And he also was seeing hospice patients and dropping bills to Medicare. So not only Blue Cross fraud, but Medicare fraud for hospice, which is, anyone who works in medicine knows you don’t mess with Medicare. Right? But it was a much bigger problem here. It was a bigger problem than me being uncomfortable. Then be thinking this guy was a creep to me. It started to become clear that this was a predator and he had created this culture that was not only toxic, but it was really dangerous.

[00:27:03] What was going on for people’s psychological safety, for the patients, for the type of care that we all were doing, palliating others. I was concerned to say the very, very least. The next day I saw this nurse. And she was actually in the hospital to do something different. She wasn’t working that day for the team. She was there for something different and I saw her and she said, this is a toxic atmosphere. Basically, I’m not going to take this anymore. I’m not going to let him bully me into losing my license. And I made a decision right then and there. And I, in some ways I’m a little embarrassed that it took me having to see someone else, someone else’s pain, but I think it was a wake-up call. And I talked to a lot of about what to do next, including someone I would consider would have considered a friend at the time who was the VPMA of two campuses. And he encouraged me to go to HR and a very specific person at HR who was over. I believe the director of the group that, that this doctor was in and that person was Eric Mendez.

[00:28:30] And I started very quickly trying to connect with HR. And I say, trying to connect because I made phone calls and more phone calls and left messages and could not get anyone to speak to me, which is wild to think that here I am feeling unsafe with this information, what am I going to do? I need some guidance who better to talk to me than HR. I can’t even get a meeting with them. I can’t even tell them what’s going on. I had a meeting with, I couldn’t get a meeting with Eric Mendez at first. And so they gave me a meeting with another HR rep, which I think was my HR rep or my HR manager. And I had him a meeting on the books. She canceled, got another meeting on the books. That meeting was canceled, and I was at this point desperate. So, I left a voicemail saying I need to speak to Eric Mendez. I need to re a physician’s unethical and illegal behavior. Well, that got people’s attention. So I did end up getting a meeting with Eric Mendez and I met in one of the corporate offices.

[00:29:57] And I had to write out a letter to make sure that I could get through saying all these things. I reported a cult-like, toxic work environment. I talked about how I feared for my safety and reporting him for these things, because mainly him, but also the retaliation of the people who he had groomed so well to be oh so loyal.

[00:30:28] And I used the term “they would lay down in front of a bus for him” and he took diligent notes. Eric Mendez did. And I told him about the sexual harassment. It was so much that I told him it was just page after page after page of notes. And I told him about the fraud. I gave him specific medical record numbers at the time.

[00:30:54] I told him about how to look for the fraud because of the billing patterns and things like that. And I told him at that meeting that I wanted to remain anonymous if I could. And he was concerned by that. But I was concerned about what this could potentially mean for my safety. And my husband, he was a safety specialist within the health system, this health system that was preaching “speak up for safety,” so that was their motto, speak up for safety. And he really, he has always been a wonderful advocate and partner and he feels guilty because he said, this is going to be okay. This is what they stand for. They stand for speak up for safety. They will keep you safe. If you do the right thing, the right thing will happen if it’s in the ear of leadership.

[00:31:51] He knew the then CMO, now COO, Barbara Wadsworth, who we both had a lot of respect for. And that was, that was her battle cry, speak up for safety, a culture of safety. And, and the reason why that is so important is they, very truly their actions speak to something very different.

[00:32:15] They wanted me quiet and I spent a few more meetings, met again with Eric Mendez April 1st. So I think that was the second week, April 1st. And he really tried to urge me to not remain anonymous. He said to really look into these behavior issues, and that’s what he called them. Behavior issues, not sexual harassment. I’m not using the words that I used, which was predatory behavior.

[00:32:49] But the behavior issues could only really be looked into if I gave permission not to be anonymous. And I said, I, I really need to talk to my husband about this. He also, I forgot to tell you, he knew this doctor for 20 years. And the reason why that’s noteworthy is they had a relationship very obviously. And he had said– in hindsight, I would have done more to protect the integrity of who was looking into this had I known that that relationship had such history– but I had met with Eric Mendez again and he had asked me if there were any people that he would be able to talk to. And I gave him some names and he wrote them down and then he told me I probably won’t speak to them, was a little bit of a test to see if you would give me any names, which I also found strange and felt very reminiscent of someone else’s behavior and very reminiscent of this testing loyalties or honesty, or I don’t know.

[00:34:09] But that same day, April 1^st, I spoke to my husband. We agreed you can’t just dip your toe in something like this. If you’re going to do it, you have to let people investigate the way they need to investigate. So I wrote to him, first I tried to call him Eric Mendez and couldn’t get ahold of him. So, I left him a voicemail and just to make sure he got it, I emailed him. And I said, you do what you have to do. Don’t worry about me being confidential or however I put it, but I don’t want this looming over my life anymore. You do what you have to do. Don’t worry about the confidentiality piece. So that was April 1st. And he had told me that he wanted to act very quickly. Which I understood, but I was also nervous because I was set to work with this doctor alone several days coming up on the next couple of weeks. So I thought, Ooh, could we maybe push this a little bit? If you’re going to confront him about this, could it be after I have to work with them?

[00:35:29] And he said, no, I want to, I want to do this quickly, or I don’t want to do it at all. So, I mean, of course I want to do it quickly then, so don’t wait for anything. You don’t have to wait for any special date. I put that in the email and he said that he would keep me updated as to what was going on. And hear anything. I didn’t hear anything still didn’t hear anything. And I wrote, and I reached out to him and I want to look at this just to get my dates. Right. But there was 16 days, I have all this because of discovery, of course for the case, but 16 days without him doing anything. So, he either wanted to act quickly or not at all. And then he has me waiting with this incredibly stressful situation, which he knows every time I met with him, I told him about the stress of, of going through something like this. I had never reported anyone to HR before. But also every interaction felt like, do you know that I reported you?

[00:36:39] And it, it just was, it was very surreal the whole thing. But after 16 days of, of really no contact between them I got a tech, I was at Bryn Mawr hospital and this doctor wrote me a text message on my phone. So we communicated a lot through text and it said, don’t get scared, but I need to talk to you this morning. Can you come to my office at 9:45?

[00:37:10] And I think all the blood drained out of my body. And I thought he definitely knows what is he going to do to me? What is this? Is this going to be an ambush? And I grab my purse. And I, I went into the stairwell, and I called my husband and I said, I got to go. This is what happened. And he said, don’t leave. It’s not what you think. And I said, no, no, no, this is what he wrote to me. Don’t be scared. Don’t be why would someone, right. Don’t be scared if there’s nothing to be scared of, it’s and with everything that was happening, I just, I said, I got to go. I got to go right now. And my husband said, it’s, it’s re I promise it’s not what you’re thinking. And I said, well, how do you know? And he said, you’re about to win the Daisy award. And he’s trying to get you down there because every one’s going to surprise you with the Daisy award. So that surprise was ruined, but I did, I won the Daisy award which is, is a nursing ward for excellence and compassionate care. And it was a very tainted day because this was all brewing.

[00:38:24] But during that time that I, from before I knew what the, that I was getting the Daisy award, I wrote to Eric Mendez, this is what he wrote to me. I’m really scared what’s going on? Did you talk to him? You told me you were going to talk to him or you are going to tell me before you talk to him. Or when you talk to him and I didn’t hear anything back until later that evening where he was, he, I wrote back to him and I said that I won the Daisy award. No, there wasn’t a confrontation from him. And he wrote, oh, that’s so wonderful. Can you give me more medical record numbers? For us to look into, and he said that he was trying to get ahold of this doctor and that he was unable to firm up a time, but he, he was likely going to speak to him the next day.

[00:39:27] So now I know after discovery that he didn’t write to him to set up a time, hadn’t spoken to him, hadn’t really made any effort until I wrote that email saying that I had received this text message and I was scared what’s happening. Maybe he forgot, who knows? It was very present in my life. Maybe it wasn’t very important in his.

[00:39:51] He did have that meeting. He told me that he was going to have a meeting the next day. And he did follow up with me after the meeting. He met with me and I believe it was the next week after he had met on a Friday while I was at work at Bryn Mawr. And I had already heard that this doctor was seen by several people looking very distraught. He had been crying, he was shaking and that he was in meetings and then had to leave. So, I was already armed with that information a little bit. When I met with Eric Mendez and Eric Mendez told me that he had met with this doctor and had expressed at first the concerns about the billing and he had told me, that, oh, well, somebody must have gotten it wrong.

[00:40:54] I was just talking about how frustrated I was, whatever it was. Basically, he was saying that there was no fraud that he was intending to commit. And when he finished talking about that piece he went into the behaviors and that this doctor didn’t deny and said, oh, well, she took it the wrong way.

[00:41:21] And he was crying, very distraught. Shaking. He said that we were like a family. He felt that he had let me down. And basically, he didn’t deny any of the behaviors admitted to them and felt ashamed, embarrassed that he had let me down I knew that he would admit to the behaviors he had even said, things like in meetings, he would say, oh, I, I hope if someone sends me to HR that they give them something good enough to get me fired. I don’t want to just get a slap on the wrist. I want to be fired. So I just had a feeling he wouldn’t deny it. He did make some excuses for what it was about, but I was told that he cried for several hours, was inconsolable. And I was, I was concerned about him, hearing that, you hear that about anybody you think, oh, that’s heartbreaking. But someone is not mentally well, you think of what the worst-case scenario could be. And I, I was worried and I asked if he was getting help. And I was told that he would spend a week to two weeks, or 10 days, something like that, getting the help he needed and that he would be stepping down from his director position. And when he returned, they would find a way to get him into a different part of palliative care. And really, I don’t know the exact words, but I was given the impression that he would be in the outpatient world, that I would not be working with him again. And there were a lot of emotions and it was a roller coaster.

[00:43:17] But after that meeting, I went back to work, like we do in medicine, right? Your life can be falling apart but put on a brave face and go back to work. And I went back to work. He knew it was me. He apparently was not told that it was made, but I was told that his comment immediately was that, oh gosh, I gave her the Daisy award yesterday. And he did not give me the Daisy award. Let’s be very clear. He was present and involved, but he neither nominated me nor voted on that. It’s, it’s a very nursing-based award.

[00:44:02] And I knew he knew, I knew he was upset. I didn’t know who else knew, but I knew that it was only a matter of time before he told his loyal followers. And what version they were going to hear. I think, I think it started to weigh on me. He wasn’t there. He was away doing whatever, the help he needed, whatever that meant. I saw in discovery that they gave him a lot of support, offered him a lot of support through the health system. EAP. They had him set up with a counselor. This person was checking in on him. Never once did I get offered that.

[00:44:51] I was very emotional and, in the meetings, I guess I would never say inconsolable. I cried a little bit. Maybe, maybe that’s a piece of it, but I believe it’s, it’s more about protecting an investment. And I wasn’t in their eyes worth protecting. And that was the conclusion I came to, but I wasn’t there yet. So, the next day, the day after I had that meeting, I had what I found out to be a panic attack at work– and anyone who has had a panic attack especially for the first time, it was terrifying. And I was on a floor, I was about to go into a family meeting and I was asked about this doctor and how’s he doing by someone else, by another doctor. And I thought I was okay. And then all of a sudden I started to not feel okay. Now I’ll spare you the details of everything I felt. And but it ended up, I was in the office with people all around me. I felt like I couldn’t walk. I was hyperventilating. And I needed my husband to leave work, to come pick me up.

[00:46:19] And things went on with how I felt, and I believed that there had to be something medically wrong with me because, Hey, I’m a strong person. This can’t be a reaction to stress. This can’t be a panic type behavior. I’ve been through some things in my life and none of those things broke me. And I went through every test you could think of. I had an MRI of my brain because I was having all these neurologic type issues. We thought maybe I had MS at one point. So that’s why we were getting the MRI, MRI of the brain. I wore a Holter monitor for, I think two days. I had a bajillion EKGs, I had testing to see if it was seizure activity, but I could not wrap my brain around that.

[00:47:22] The emotions and the stress of the situation, it felt like was killing me, literally killing me. I couldn’t drive. I had my, my son and daughter, I missed out on things in their lives because I couldn’t drive them places. I couldn’t show up places. I would be sitting still somewhere. And all of a sudden I would feel like I got to get out of here. And it was this fight or flight feeling. I could not just be, I was jumping out of my own skin. Slowly things got better for me. I found the help I needed. I also got to help with some medications, some Zoloft layered in as well. But we came to realize that this was from stress. This was directly related to the stress of the situation.

[00:48:18] By the time that I was able to come back to work, he was back at Bryn Mawr working. And another physician from the team came to really was acting more as the medical director, but in everyone’s opinion or vision of what was going on, he was in good standing, and they put me back to working with him. So I was on the schedule with him. And I earlier on, had decided I needed to leave this, this atmosphere for myself. This was not healthy. I, I would die if I stayed there and I felt that way. I felt, even if my physical body didn’t die, my spirit was dying there. And I was in the process of securing a different position for myself back home, back at Penn. And I knew that I would be safe there. And that’s a funny thing to say about a job at that level. You need to take safety into consideration physically safe and emotionally, mentally safe there. And I went back. I ended up talking to more people as I got closer to knowing that I would be leaving.

[00:49:47] I was talking to people about how they could stay safe and arming them with that information about what I went through and who I reported thing was to, and that I am now in a position where I’m working with this man again. And I thought that that was important because I did feel guilty that I was leaving, and I felt like I was leaving a predator in place. I wanted people to know who they were working with and know who they were working for. And I was kind of starting to tell people as I was securing when I would start at Penn medicine and thought I would start in like September, October, because credentialing takes forever. And I started to tell people about I will be resigning, but I’ll stay.

[00:50:49] And this was like late June, early July of 2019. I’ll stay until September. I’ll stay through September. I don’t want to leave anybody on alert for staffing, that should give you plenty of time. I knew there were a lot of maternity leaves coming up and they were going to be really hurting for staff. And truthfully, I wanted time to make sure that people knew. And that was how I felt like I was making some peace with it. My husband was still there, still working. We had talked a few times about how I need to make sure that leadership knows what I went through because at the time I thought there’s no way this happened this way with leadership with the Barbara Wadsworth’s knowing that that Eric Mendez must’ve withheld this information and that’s how we’re in this position.

[00:51:49] So I had written to Eric Mendez and I said, I would like to have a exit interview. And I would like to have an exit interview where I’m able to talk to leadership and talk about why I’m leaving. And some of the things that I think they need to be aware of. And he wrote back to me, oh, thank you. Can we push this until… and gave me some later date in July? I had told the den sitting director medical director about what happened, the whole history of everything, because I wanted him to know, I did not want to work with this doctor again. I don’t want to be at that campus when he is there. And I needed to justify why. And I also wanted him to know what was going on and, and he didn’t know, at least he told me he didn’t know what had led to him even becoming the director.

[00:52:56] So I told him, and I believe he tried to reach out to Eric Mendez, but he was on vacation. So, this was early July, like right after 4th of July I was working at these different campuses. They were sending me other places. I was making switches with people when there were opportunities to do so to not be on that Bryn Mawr campus. And I received a message that instead of going to riddle one morning that I should go to the new town square campus, which is one of the corporate offices, that’s where Eric Mendez office is. So this was, I believe the 17th of July. And I went in and I believed so naively it’s, it’s funny to even think about it right now, but I believed that he was going to apologize, which is quite the opposite of what happened.

[00:53:58] And I’ll spare you the details. I know we’re, we’re over time now, but he basically said that I had told people and I had which I was very open about. Yes. I told people, I, I told a lot of people about my reports, it’s my report, what I went through. But he had said that I broke confidentiality and that if he didn’t, that he needed to do an investigation of me. And if I had told people, then I would, I would be terminated. And it was as if my world was falling apart all over again, because I was being credentialed. That was my exit plan. I was leaving. And if I was terminated, he said he would have to report that to Penn. And I knew that that would, that would stand in the way of going back to Penn, that would, that would end my career. And he said, I asked what I could do. And he said, well, if you move up your resignation, then date to be effective immediately. I won’t tell Penn anything. And I’ll help you get your credentialing. I needed a form filled out by my collaborating physician, not doctor was my collaborating physician.

[00:55:26] And Eric Mendez had told me that if I resigned immediately, that he would take care of it. He would go to one of the other physicians. He would make sure it was taken care of. So that’s what I did. I said, okay, I’ll do it. Right there from the parking garage, I sent an email and they shut off all my access so quick. Even though they said that they wouldn’t, and I was crying in the car and I called my husband who had just been off promotion within that health system. So he was having a good day. He was in the same building, having a good day. And he couldn’t believe it. I couldn’t believe it. It was, it was wild.

[00:56:10] I can’t believe the next things that happened in like such a mind-blowing way, but the next day, very next day there was a system. So, every campus coming in for this meeting for palliative care. So every palliative care campus gets together. And Barbara Wadsworth, the chief nursing officer, decided to use this venue to make a statement. And this doctor and his wife were sitting there. Of course, I wasn’t there. I was, I was exited, but they were sitting there, all these other campuses and Barbara Wadsworth stood in front of the group and said, April Nitkin made allegations against and said the doctor’s name. An investigation was done, which concluded with April’s resignation. We support the doctor’s name and we will move on. I do not want you speaking to April and you will not speak to each other about this.

[00:57:25] I was called by two different people after that meeting and given that statement exactly the same. Anyone who didn’t know me that was in the meeting or didn’t know the situation would have thought she made this up. She was caught. She left in disgrace.

[00:57:48] Through the depositions, through discovery. I found out that Barbara Wadsworth was made aware early on. She had conversations with this doctor where he had admitted to what was going on. She felt intimidated by him. He yelled at her with his fist clenched. But she betrayed me. I expect some, some kind of identifying with who you are close with some kind of loyalty to your group or believing someone you identify with, but she was a nurse, a woman, and she betrayed, not just me. She betrayed my entire family. She betrayed my husband and she betrayed every single person in that meeting. And finding that out was very devastating. It really was. After depositions. I, my husband and I cried. I wanted to quit this process so many times, but I stayed with it because I wanted to be an example to my children.

[00:59:13] And I wanted people to feel some validation for. I felt that too, and I didn’t speak up. And there were many times my husband had to be the person helping me up, pushing me along because it was exhausting. I mean, really from 2019, I was in federal court. The end of October and first day of November of 2020. I mean, that’s, that’s a long period of time to be going through and reliving these things over and over and over again, and hearing some pretty, pretty horrible statements of why they didn’t support me, why they didn’t act to support and keep safe. The employees, the patients, because this is a predator who is with a very vulnerable patient population, too.

[01:00:17] That’s not anything to be ignored. And in federal court, Barbara Wadsworth said that she did not want to suspend him because she didn’t want it to have to be reported to the medical board. But was willing to suspend me. And in the notes, I also read that they had continuously, leadership had continuously given him reassurances of how they wouldn’t put this in his file and did things to make him feel secure and safe and cared for when I was being given the opposite as the person who reported these things. So when I think of why even speak to someone like you? Why, why get this story out there? On November 1st, a jury, a federal court jury found that Main Line Health leaders acted with malicious intent towards me. And I want to be very clear it’s because I did what they asked me. I spoke up for safety and we need to have some accountability for these leaders to actually align themselves with the words they use.

[01:01:42] And we’re at such an important time. We’re at a time where we have nurses going to jail for making mistakes. We have people feeling unsafe because of COVID or sexual harassment or physical harm at work. We have nurses week. We have the nurses march. We have all of these things. And what we have learned is if we use our voice to actually have more power than we’re given credit for and speaking up not hiding is where we find that.

[01:02:25] Coming together. I have, I have had multiple people reach out to me since the Frontline nurses article was published about my case and, and very humbling the way that that was written, it warmed my heart. But I am not someone that my story is not a strange story, that I did something about it and followed through.

[01:02:50] And wasn’t intimidated to the point where I just backed away that that’s the strange part, intimidation from leadership. It, it needs to stop and we need to start holding people accountable for having a safe workplace. We need to hold people accountable. For nurses being treated in a respectful way and not just as, as bodies that, that need to show up at the hospital and get their job done.

[01:03:33] That there’s an obligation of a health system, a multi-billion dollar health system to, to keep us safe, to keep us psychologically safe. And I, I have to tell you, it really is a David versus Goliath story with what took place in the courtroom. My lawyer, his name is David Kohler, right? So David versus Goliath in name as well. And David Kohler, he’s about our age and he would show up with his daughter’s purple backpack to the courtroom, to federal court. And you looked over on the Main Line Health side and they had, I think one day we counted eight, eight lawyers in very, very expensive suits and with the briefcase, and I thought we don’t stand a chance.

[01:04:33] We don’t stand a chance and we won and we’re, we’re going to appeal the hostile work environment claim. They didn’t feel that it was pervasive enough to move forward. But I think with what came out in court, I think we, we stand a chance and I will continue trying to urge people to have a safer work environment, not just for themselves. But for others and for their patients. So I know that I talked for a long time.

[01:05:14] Dr. JB: Okay. Well, what I can definitely say April, is that this is the quietest I’ve ever been on a podcast.

[01:05:23] NP Nitkin: And I couldn’t even fit at all.

[01:05:27] Dr. JB: I don’t think I asked you one question besides the story, and I said, continue, that’s about it. But this is such a powerful story. It’s so powerful. It’s so needed. And I am really honored that you came onto the Hope4Med podcast to share it. Because the mission of Hope4Med, the mission of this podcast is to have these conversations, right? To say the things that need to be said. And there’s so much things that need to be improved in our healthcare system.

[01:06:07] But being a place of psychological safety is so important and there’s not a lot of avenues where that’s possible. But what we’re creating here hopefully, is it’s that safe harbor. I keep saying, it’s that place that’s not affiliated with your place of employment. Even so much because I understand that different people have different comfort levels in terms of having these types of conversations. Right? So we made it so that you can be an avatar. You don’t have to, you can be anonymous, you can dress your avatar however you want to, you can name your avatar however you want to. But behind that avatar is a person who needs to share and who needs to hear that they’re not alone.

[01:06:53] NP Nitkin: And, and in my story, there were times where, I hope people heard that. I didn’t believe that I could have been affected by stress the way that I was. And we put this false narrative around ourselves that if we’re strong, we can do, we can put up with anything and it’s not about strength. Sometimes it’s strength that it takes to reach out and get the help you need and get the support you need. And I couldn’t have gone through this process, no part of it, if I was going through it alone.

[01:07:37] Dr. JB: Yeah. Who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or prerecorded. Come learn some, each one teach one. I’m done.