"Rot in hell," read a homemade sign on the closed door of what used to be a thriving dental business in Bloomington, Minnesota.
The sign and public protests at River Bluff Dental came after the public learned dentist Walter Palmer had killed a beloved protected lion named Cecil while on a guided hunt in Zimbabwe. The global outcry has essentially shut down River Bluff Dental, affecting patients and the other employees who up until a few days ago worked at an active healthcare provider.
It's a lesson other other healthcare companies have learned before: When healthcare workers go bad, the business suffers.
Disruptive behavior is not new, but the unprecedented publicity over Cecil's death is a reminder that the reputation of a physician, nurse, administrator or an executive, which is often a huge benefit to an organization, can become a liability overnight.
There's cost and risks associated with disruptive behavior that must be managed by the hospital, according to author William "Marty" Martin in the book he co-authored with Philip Hamphill, "Taming Disruptive Behavior." The book was published in 2013 by the American College of Physician Executives.
"It also unfortunately may put a little blemish on professional dentistry," he said. "You also have patients and family members who might be wondering, 'Did the person really give me enough pain medication?' They may question the quality of care they've been given or the way they've been treated."
Disruptive behaviors can range from an employee coming to work with the flu to serious criminal allegations.
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Beyond the cost of absenteeism, turnover and lawsuits, the biggest concern to healthcare organizations is damage to reputation, said Martin, who is director and associate professor of the health sector management MBA program at DePaul University in Chicago.
Often the person in question is in a position of authority and power.
"I've worked in human resources and health organizations," Martin said. "It's an unfortunate reality to interface with administrators, to hear the stories from people who view themselves as targets."
In one instance, he worked with an anesthesiology group in which an anesthesiologist was sent into therapy after making inappropriate comments to a nurse and yelling and making abrasive remarks to others. "When he got agitated -- he had a loud voice -- he would be leaning forward, it happened multiple times," Martin said.
After a six month investigation, the organization ended-up firing the doctor, he said. However, the bill for the doctor's therapy, legal expenses, and other costs came to upwards of $100,000.
The best advice is for healthcare organizations to avoid hiring these people in the first place. Martin recommends a 90-day probation period, a pre-hire psychological test to spot troublesome areas, and behavior-based interviewing that asks such questions as, "Tell me about a time you were frustrated in your last job and what did you do about it?"
Look for patterns, he said.
"Don't rely on any single factor: get a reference; the interview; a psychometric test; look at convergent validity."
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In the specific case of trophy hunting, the controversial blood sport is allowed, within limits, in parts of Africa. It is not of itself a legal reason to avoid hiring.
Whether Palmer knowingly poached a protected animal is a question for authorities. His reputation is not helped by a past federal record of killing a black bear outside of a protected zone.
"Some people in positions of power, they do believe, based on past history, they're above the law, because they've gotten a pass," Martin said. "What happens when that gets too big and egregious, they hit the boundary. … This is an issue for an organization."
In another example that has recently come to light, Pittsburgh gynecologic oncologist and surgeon Jan Seski, 68, is accused of killing a lion during an illegal hunt with a bow and arrow near Zimbabwe's protected Hwange National Park in April, according to the Daily News.
Seski directs the Center for Bloodless Medicine and Surgery at the Allegheny General Hospital in Pittsburgh.
"We have no comment at this time on this matter related to Dr. Seski," hospital spokesman Dan Laurent told the Daily News.
Here are a few more stories of bad behavior among healthcare doctors and executives.
Earlier this year, Wisconsin police charged Dr. Andrew J. Weddle, 37, with soliciting prostitution after an undercover officer placed an ad on a website commonly used for posting such ads.
Twenty-seven people responded and sent approximately 350 text messages to the officer's phone number that was listed, but Weddle, an independent emergency room physician who practiced at Aspirus Wausau Hospital, was the only person arrested, the Wausau Daily Herald reported.
In 2014, Minnesota police ran a prostitution sting, arresting more than a dozen people, including David Cress, 64, a former CEO of a Twin Cities Hospital.
This was the second time Cress had been arrested on the charge. Four years earlier, North Memorial Medical Center had let him go after he was rounded up in another prostitution sting.
In 2010, UMass Memorial Health Care CEO John O'Brien found the hospital at the center of a controversy for its use of short-skirted, high-heeled models to promote bone marrow donation.
O'Brien apologized for the hospital's practice of using professional models as lures at malls and elsewhere to recruit donor testing. In a memo to doctors and other members of the Worcester medical institution, O'Brien called the practice "an error in judgment" and discontinued the practice.
Earlier in 2015, Blue Shield of California's former Chief Technology Officer Aaron Kaufman allegedly put more than $100,000 on his corporate credit card, with much of it going towards personal trips with girlfriend actress Tara Reid, according to the Los Angeles Times.
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Kaufman was fired this past March on charges he violated travel and expense policies. However, the tipping point for the executive may have occurred at a company bowling party, where Reid posted what employees called raunchy and inappropriate photos of herself, one posed with a bowling ball.
Kaufman filed a wrongful termination suit.
In May, a nurse lost her job at Rapid City Regional Hospital in South Dakota after a video went viral of her making racist comments against Native Americans and African Americans. In the video, nurse Ryane Oliva allegedly made disparaging comments alluding to her hated of Native Americans.
Regional Health President and CEO Brent Philllips swiftly fired the employee, saying in a statement that the hospital has a "zero tolerance policy regarding racist behavior in or outside of the workplace."
Lastly, a prominent physician at South Shore Hospital in Chicago found himself in hot water this past spring after telling a racially offensive joke at the hospital's annual fundraiser, according to the Chicago Sun-Times.
Ahuja later apologized.
Twitter: @SusanMorseHFN