A California court has ruled that Kaiser Permanente has to pay $11.4 million--$7.5 million of which came in punitive damages--to radiologist Michael Martinucci, MD, who was fired from the provider for trying to make improvements at one of its diagnostic imaging facilities.

"When you see people constantly disregarding good quality patient care, you get to a level where it's just no longer acceptable," Martinucci said, according to the American Medical News. "I could have let the retribution go, but then you say to yourself, that's not what I got into medicine for."

When Martinucci joined Southern California Permanente Medical Group in 2003, he said that the radiology department was deficient in standard protocols for ultrasound, CT and gastrointestinal screenings. In 2004, with approval from Kaiser administrators, he worked to revise, implement and supervise new procedures and standards, as well as conduct clinics to train the radiologic technologists.

Martinucci's efforts were met with resistance from the technologists, who failed to follow the new protocols. In June 2005, Martinucci wrote up several technologists for unsatisfactory performance, the court documents showed.

In the face of staffing shortages, Kaiser asked Martinucci to screen mammograms and other images for which he was not trained. The doctor declined to perform the tasks until he completed the necessary continuing education requirements. Later, complaints arose that Martinucci made racial comments and sexually harassed a male technologist.

Kaiser sent Martinucci a letter in February 2006 demanding that he resign or be fired, leading to his resignation. He later sued Kaiser for defamation, retaliation and breach of contract.

In December 2008, a Los Angeles County jury rejected the allegations of sexual harassment and racial comments and found that Kaiser failed to use reasonable care in its investigation of the complaints. Jurors also concluded that Martinucci's advocacy efforts were a "motivating factor" in Kaiser's decision to terminate him.

Martinucci's work "was welcomed and implemented...There simply was no connection between those efforts embraced...and his separation from the medical group," said Kaiser spokesman Jim Anderson.

Kaiser is appealing the verdicts. However, Martinucci said he hopes his case sends a message other physicians will hear: "It's important for doctors to stand up for patients and proper care and to know, if they have to fight back, they can fight back successfully."