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Wednesday, 20 December 2006 00:00

Hospital board stands by ER decision

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A new set of doctors will take over emergency room operations at Haywood Regional Medical Center at midnight on the night of Dec. 28.

 

Despite calls by the medical community and general public to reconsider, the hospital board stood by its decision to oust the long-time group of ER doctors and replace them with a corporate physician staffing company. A packed house of 75 people attended a meeting of the hospital board Thursday night, seen as the last chance for the board to change its mind before the turnover.

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 countywide meeting of doctors voted 50 to 2 last week to call on the hospital board to reconsider its decision. Dr. Richard Steele, a hospital board member and a urologist, said that the vote was misleading, however. It was not done by secret ballot, but instead a show of hands. Some doctors felt if they went against the majority they would suffer from the loss of referrals by other doctors, he said.

The majority in the medical community, however, have lauded the quality of care, reputation and standing of the current ER doctors. They attribute the conflict to an ongoing power struggle between the ER doctors and hospital administration and called for mediation to find a better solution. Four doctors were selected by the medical community to present their concerns to the hospital board at Thursday night’s meeting (see the Dec. 27 paper for their remarks).

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.
The invocation that opened the meeting called on God to help the board “deliberate with openness, wisdom and thoughtfulness.” There was no deliberation about the decision, however. Instead, board members and their attorney spent more than an hour giving presentations and making speeches defending and explaining their decision.

It became clear board members had no intention of changing their minds when they passed out an inch-thick packet at the start of the meeting outlining “The Facts” of negotiations between the ER doctors and the hospital. The packet presents a timeline of negotiations, letters between the hospital’s attorney and the ER doctors’ attorney, a record of all correspondence between the two parties, a question-and-answer fact sheet, minutes of ER oversight committee meetings, emails going back to early 2005 issues the hospital administration had with “disruptive” and “negative” behavior by a couple of the ER doctors and more. (See link for “Hospital Q&A” to read a portion of the packet.)

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, also said the medical community and general public has not been armed with a full set of facts. While the ER group has pushed its version of events, hospital administration has been reluctant to partake in a public tit-for-tat.

“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 CEO David Rice. Rice has been accused of targeting the ER doctors due to a long-running power struggle with a couple of individual doctors in the group.
“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, and 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.

The doctors elected by the medical community to share their concerns with the hospital board said the current conflict is a symptom of a larger problem — the lack of communication between the hospital board and medical community. They said physicians feel excluded and walled out and asked for a more direct line of communication with the board.

Freeman addressed this concern at the end of the meeting.
“The board pledges to increase it’s communication with the medical staff — circumstances permitting,” Freeman said.

Freeman almost forgot to mention this pledge. Freeman was about to conclude the meeting for a recess when hospital board member Mark Clasby leaned over and prompted her to make the communications pledge.


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 to the group.

The ER doctors wanted to keep the language of their current contract and merely extend the time period. But the hospital felt it was important to renegotiate the language in the contract to bring it up to industry standards.
The ER doctors were given 60 days to negotiate a new contract with the hospital or face termination. During that time, the ER doctors never made a counterproposal. They insisted on keeping their current contract and were unwilling to bend even an inch, according to hospital board members.

Board members said they personally had conversations with members of the ER group to make a counter offer so they could continue negotiating.

Steele said he felt the initial contract proposed by the hospital was a little strict, and advocating loosening it, as did others on the board. For example, the first set of language proposed by the board allowed the hospital CEO to fire a doctor without cause or recourse with 14 days notice. The softer language gave 30 days notice. Steele said theydoctors never made a counter offer that indicated they were willing to compromise.

“All we asked for from the emergency department was a show of faith. Some of the guys said they were working on the numbers and would come back to the table,” Steele said. Steele was out of town when the deadline approached. He said he eagerly called another hospital board member to find out what the ER doctors proposed as a counter offer 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 urged the ER doctors to compromise instead of merely urging the hospital board to be patient.

“I encouraged them to go back to their emergency room counterparts and get them to compromise,” White said. “We got no participation from the other side.”

Freeman had a similar statement.

“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. We get misinformation fed to the press. We get questions stirred up as to whether or not Mr. Rice should stay.”

It is debatable whether all of the language proposed in the new contract is truly industry standard, however. The top sticking point in the new contract gave the hospital CEO unilateral hiring and firing power over the ER doctors for any reason and with no recourse. West Care hospitals 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 agency 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 groups of 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. The new contract also had language that mandated cooperation from ER doctors using a computer system installed by the hospital that the ER doctors say is inefficient and the medical community rather unanimously dislikes. The new contract also eliminated partial compensation by the hospital to the ER doctors for indigent patients who couldn’t pay their bills.

The new corporate staffing agency agreed to all of these terms.

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.

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