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Wednesday, 27 December 2006 00:00

Hospital board stands by ER decision

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Despite outcry from the medical community and general public, the hospital board of Haywood Regional Medical Center has stood by its decision to oust a long-time group of ER doctors and replace them with a corporate physician staffing company.

 

About 75 people attended a meeting of the hospital board last Thursday night (Dec. 21), seen as the last chance for the board to change its mind about the turnover. The new corporate outfit will take over emergency room operations at midnight on the night of Thursday, Dec. 28. ER doctors are not hospital employees. Instead, hospitals generally contract with a group of doctors to run the ER.

Several of the current ER doctors were invited to join the new corporate outfit, Phoenix, but only one has agreed so far. As of last Thursday, Phoenix had recruited only two new doctors for a total of three. The current ER group, Haywood Emergency Physicians, has 10 doctors who staff the ER. It is not known how many doctors the new entity will be able round up by the switch-over date.

The hospital’s move is largely attributed to a long-running power struggle between hospital CEO David Rice and some of the ER doctors rather than the quality of care or service provided by the ER doctors.

At the hospital board meeting last Thursday, four doctors spoke on behalf of the larger medical community asking the board to change their mind (see related article). The board did not budge, however. The hospital board accused Haywood Emergency Physicians of manipulating the medical community and general public — who have rallied to the ER doctors’ defense — with a misinformation campaign.

“Rumors, misinformation and outright distortion have turned what is normally an internal business matter into a public spectacle,” said Dr. Nancy Freeman, chairman of the hospital board and a family practitioner. “Haywood Emergency Physicians has publicized this dispute for its own purpose and it has threatened to damage the relationship with the hospital and medical staff.”

A county-wide meeting of doctors voted 50 to 2 last week to call on the hospital board to try mediation with the ER doctors to find a win-win solution. But Freeman said the relationship between the hospital and Haywood Emergency Physicians has been damaged beyond repair, and mediation would be futile.

“HEP has demonstrated it is not a reliable partner with the hospital going forward,” Freeman said.

Following the meeting, several physicians in the audience said it seemed like the hospital board members had their mind made up before the meeting and were not receptive to what the medical community had to say. Instead, board members and their attorney spent more than an hour giving presentations and making speeches defending and explaining their decision.

They passed out an inch-thick packet at the start of the meeting outlining “The Facts about the negotiations” between the ER doctors and the hospital. The packet presents a timeline of negotiations, faxes and letters between the two parties, a question-and-answer sheet, minutes of ER oversight committee meetings, and emails from the hospital administration accusing some ER doctors of “disruptive” and “negative” behavior dating back to early 2005.

Freeman said disseminating the packet, which contains negative information about the ER doctors, was a very difficult decision for the hospital but deemed necessary in order to set the record straight. Dr. Richard Lang, a radiologist who previously sat on the hospital board and supports hospital administration, also said the medical community and general public has not been armed with a full set of facts.

“I don’t believe they had all the information because Mr. Rice is not in the business of throwing stones,” said Lang, who sat on the hospital board until recently.

Freeman countered accusations that the hospital board was manipulated by Rice.

“It has been touted that the board was misinformed or misled,” Freeman said. “The board was not misinformed or misled on any issue. The board made this decision, not Mr. Rice. Mr. Rice works for us, not vice-versa.”

Freeman told the audience that the hospital’s decision was not a matter for public debate, and contract negotiations were a private affair. Board member Glenn White also said it was inappropriate for the ER doctors to “air their dirty laundry” in public.

The medical community feels just the opposite — that it is their business. The decision to oust the ER doctors will have negative impacts on the entire medical community, according to physicians. Some patients have already pledged to take their health care dollars elsewhere, and recruitment of new physicians will become more challenging. Members of the general public also think it is their business, judging by those who have weighed in on the issue by attending the hospital board meeting, writing letters to the editor and attending a public forum sponsored by the ED doctors earlier this week.


Impasse

The biggest message from hospital board members during Thursday night’s meeting was that they bent over backwards to try to accommodate the ER doctors during negotiations of a new contract. The current contract does not expire until May 2008. The ER doctors wanted to extend the contract until 2010, giving the group more security and therefore making it easier to recruit new doctors.

The ER doctors wanted to keep the language of their current contract and merely extend the time period. But the hospital wanted to change the language in the contract to bring it up to industry standards. The ER doctors were given 60 days to agree to new contract language or face termination. During that time, the ER doctors never made a counterproposal. They were unwilling to accept any of the new language, according to hospital board members.

Board members said they personally asked members of the ER group to make a counter offer to avoid a stalemate.

“All we asked for from the emergency department was a show of faith. Some of the guys said they were working on it and would come back to the table,” Steele said. Steele was out of town as the 60-day deadline approached. He said he eagerly called another hospital board member to find out what kind of counter-offer the ER doctors had proposed and was disappointed to learn the ER doctors had simply ignored the deadline.

“They did not come to the table with anything,” Steele said.

Board member Michael Ray also said he told members of the group to “Please make changes and come back.”

Board member Glenn White said other doctors in the community should have lobbied the ER doctors to compromise instead of merely lobbying hospital board to give in.

Freeman said the Haywood Emergency Physicians did not seem to take the hospital board seriously.

“I personally begged members of HEP to make one step forward so the board could consider extending the negotiating period as long as we saw progress,” Freeman said. “Instead we get a public spectacle.”

Lang said the ER group has done the medical community a disservice. Lang said any group of doctors has “two classy options” when negotiating a contract.

“One is to say I really love it here and I’ll accept this. The second option is to say I really can’t live with this but I’ve enjoyed working here and leave peacefully,” Lang said.

Hospital administration said the language in the new contract is industry standard. That is debatable, however. The top sticking point in the new contract gave the hospital CEO unilateral hiring and firing power over ER doctors without cause and with no recourse. West Care hospitals in Sylva and Bryson City do not have such a clause in their contracts. The American Academy of Emergency Medicine said such a clause is not industry standard, although hospital administrators are increasingly pushing for it. Even the manager of Phoenix, the corporate physician staffing outfit taking over ER operations, when asked whether such a clause is industry standard, replied, “It varies.”

Haywood Regional Medical Center is insisting on this clause with all doctors who have contractual relationships with the hospital. Hospital board member Ray said it was an issue of accountability.

“We are responsible for what goes on in our ER,” Ray said. “I took an oath for our patients and our hospital.”

ER doctors saw the clause as a loss of autonomy that would open the door for the business side of the hospital to interfere in patient care decisions that should rest solely with doctors.

The new contract language also mandated what the hospital board referred to as quality control. The ER doctors say they would have agreed to that part of the contract, but the doctors failed to mention that during negotiations and have only said that after the fact.

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