HMNMH Physicians Practice in a Hostile Work Environment

Over the past twenty years, Wall Street business has covertly taken over the medical profession while doctors have been distracted by a deluge of procedural, financial, and legal paperwork. A strategic plan was launched to extract exorbitant profit benefitting business, and is now mainstream without challenge from our profession nor the public.

Legal boardrooms were abuzz in the 1990s as a blueprint assault was made against organized medicine, redirecting a profession into a commodity. Symposiums templated this game plan for hospital administrators, while lobbyists strengthened their legal foothold. Despite recognition of this onslaught in medical journals, the anemic response from physician leadership allowed it to sweep from east to west coast. Now occurring in California, I wish to shed light on this evolution using my experience at our small community non-profit hospital.

Ten years ago, Henry Mayo Hospital went into bankruptcy. We were mismanaged, but business professionals were brought in keeping the hospital from closing. At this point, the template commenced.

Not being involved in hospital politics for 22 years, my election to the Medical Executive Committee (MEC) three years ago probably rose from whistleblowing writings in The SCV Beacon. Within months, I was falsely accused of “Code of Conduct” charges, and “Corrective Action” was taken against me. Renewal of my admitting privileges were withheld forcing me to hire lawyers to prevent the Board of Directors from removing me from the Medical Staff. Many of my colleagues faced similar problems, some of whom are no longer on staff. To my surprise, when I told my east coast friends of this problem, they said it had already happened in their hospitals.

California law allowing Medical Staff “self-governance” was interfered with and trampled upon by the Administration. I found staff meetings with Administrators verbally abusive, prompting physicians to videotape these interactions. Not surprisingly, lack of communication at our hospital amongst the Administration, Board of Directors, and MEC was sanctioned by a national oversight agency.

Medical reputations in the community were sullied by mudslinging, and we were marginalized by the undertones of spurious propaganda. There are some business people adept at this, while physicians are not. Anger by local doctors was temporized though as many have contracts with the hospital and must “keep a low profile,” especially since this Administration was notorious for financially “twisting arms” and “dangling the carrot” to silence their voices.

The use of similar tactics to influence votes skewed the Board of Directors and created dubious conflicts of interest. One member had lucrative hospital building contracts, two had hospital money in their bank, and another did secondary real estate transactions on the hospital’s behalf. Four CEO appointed physicians had profitable medical contracts with the hospital. One can see how easy a vote might be swayed. The Administration used this influence to not only ramrod changes in hospital policies and procedures, but to persecute and prosecute any physician in their way. These tactics continue today.

The only voting member elected from the Medical Staff to the 15-member Board is the Chief of Staff, and up until a year ago the Deputy Chief of Staff could vote, but this was changed by the Board at the behest of the Administration.

Has this aggressive template business takeover made any improvement in quality patient care? Not at all, as Henry Mayo Hospital still does poorly on national surveys. Then why pursue this onslaught? Profit. We have seen the salaries of all Administrators continually increase, with augmented bonuses and concomitant contribution to their retirement plans. Voila!

Humanity has been replaced by the fiscal bottom line. Physician decision-making relative to patient care is threatened, and doctor advocates have been subjected to Administrative crosshairs. At our hospital, physicians practice in a hostile working environment.

Ignorance is no excuse for not seeing this tsunami takeover of a worthy profession. If being a commodity must be the sacrifice of having excellent patient care, doctors would acquiesce. But with profit being the business motive, igniting the fire of public opinion against this clandestine assault of the medical profession must begin.

Reaching the west coast, we are now on the edge of the cliff.

Gene Uzawa Dorio, M.D. – Guest Commentary

Gene Dorio, M.D., is a local physician. His guest commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with including the Medical Executive Committee and Medical Staff of Henry Mayo Hospital, or those of The SCV Beacon.

Your Hospital Care May Be Compromised

We are fortunate in our country to have the best medical technology in the world. Unfortunately, delivery of this technology, reflected in a worldwide healthcare ranking of 37th, is a disservice to the American people and must be rectified especially when Cuba is ranked 39th.

As provisions of the Affordable Care Act are put in place, a daunting factor is the shortage of doctors who will be needed to provide this healthcare. Statistics from the Association of American Medical Colleges predicts by 2015, we will lack 62,900 physicians nationwide, and this will grow to 130,000 by 2025. This is a dilemma that cannot be quickly nor easily remedied, as it will take decades to catch up. What can be done until then?

We must harness present available resources including Nurse Practitioners (NP) and Physician Assistants (PA) to bridge the healthcare gap. Integrating NP and PA expertise is imperative, but this must be done while assuring quality patient care and not bring the American healthcare ranking even lower.

As a member of the Medical Executive Committee (MEC) and Chairman of the Department of Medicine at our small community hospital, Henry Mayo, I have studied these details and would like to convey to you my findings. Our hospital is not presently considering PAs for staff membership; therefore I will restrict this discussion to NPs.

A Nurse Practitioner is a registered nurse (RN) who has completed graduate-level education 1-2 years beyond their degree, with some even specializing in fields like pediatrics. Typically, they provide primary care in an outpatient setting like a clinic or medical office under the supervision of a doctor. For years, qualified RNs have moved forward attaining an advanced degree as a NP allowing better and complete care to our patients. So what is the problem?

Hospital Administrators now want NPs to take care of inpatients, but obviously, these patients are much sicker than those who are outpatient. NPs rarely get training in a hospital setting, and prior to their post-graduate degree, RNs are taught to follow and implement physician orders, not to develop nor manage a medical care plan.

I trained in a hospital starting my first year in medical school, and this continued through surgical and medicine programs for the ensuing 10 years. My recognition and ability to treat acutely ill inpatients allows strategy development from the initial history and physical resulting in a treatment plan, and then management of that patient during their hospital stay. NPs are fully capable of this intellectually, but it must be rigorously taught in a hospital setting to assure quality and perfection. They do not have these initial qualifications, but should they be restricted from a hospital inpatient setting? I do not believe so, as long as adequate training and oversight is maintained.

The State of California regulates the “scope of practice” for NPs as legislation is not at the federal level. Some of these rules though sit in a “gray zone” and hence there is tugging by special interest for doctors from the California Medical Association, nurses from the Board of Registered Nursing, and Administrators from the California Hospital Association.

In order to allow NPs to provide patient care in a hospital, by State law, a Committee on Interdisciplinary Practice (CIDP) must be established. Henry Mayo did this, but the hospital Administration asserted control over this committee by recently having the Board of Directors change a Hospital wide Policy removing it from the auspices of doctors. Consequently, the physician chairperson was replaced by an Administrator, and this has been surreptitiously done at other hospitals as well.

With the CIDP no longer a physician committee, I must be careful not to divulge confidential information. Suffice it to say, problems faced by other similarly changed outside hospital committees are: oversight credentialing and proctoring of NPs is not by the Medical Staff but instead by the Administration CIDP; there is no physician committee peer review of NPs; and NPs are hospital employees.

This last problem is fearfully disturbing as NPs might be financially coerced into discharging patients too early at the behest of the Administration. No doubt this will especially effect our elder senior patients.

Wherever you live, your local hospital may now be implementing programs using personnel not scrutinized by physicians. The healthcare rendered to you or your loved one might therefore be substandard and lead to undesirable complications. As Americans, this should be where we start tugging our special interest.

The doctor shortage will have a profound effect on every community attempting to receive adequate medical care. Using existing resources like NPs will bridge the healthcare gap, but this must be done wisely and carefully to assure patient care is not compromised.

California and other state legislators must be made aware of this problem and strictly define the rules between outpatient and inpatient care, as there is clearly a difference in acuity and intensity of illness. Ultimately, any legislation concerning acutely ill patients cared for by NPs must lean toward scrutiny by well-trained medical doctors, and not hospital Administrators.

Should we see this happen, you might expect our worldwide healthcare ranking to improve.

Gene Uzawa Dorio, M.D.

Gene Dorio, M.D., is a local physician. His guest commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with including the Medical Executive Committee and Medical Staff of Henry Mayo Hospital, or those of The SCV Beacon.

 

Elections Aren't Over Yet: HMNMH!

Nationally, we made it through another election. Closer to home though, a different election is evolving which will have a profound effect on healthcare in our community. The physician Medical Staff of Henry Mayo Newhall Memorial Hospital (HMNMH) will have their annual election of the Medical Executive Committee (MEC) on Wednesday, December 5th. Those elected to serve will help guide and shape the health and well-being of the Santa Clarita Valley.

On the MEC endorsed slate are:

Dr. Cecilia Hann – Deputy Chief of Staff

Dr. David Krieger – Secretary

Dr. Mark Sender – Treasurer

Dr. Maria Sandra Umali – At-Large Representative

Dr. Felix Barte – At-Large Representative

The HMNMH Administration intends on challenging this slate by bringing nominations “from the floor” of those hand-picked doctors who fit their needs. The MEC has allowed me to report through The SCV Beacon the details of this election, with those nominated “from the floor”, and the final results.

Below you will find a letter sent to the Medical Staff concerning the importance of this election. Fortunately, the drama and length of this campaign is much shorter than what we saw nationally.

Physician Medical Staff: Sitting for three-and-one-half hours in the Santa Clarita City Council chambers brought a small break in the controversial hospital Master Plan debate three years ago. Many in the crowd got up to stretch while others hurried to the bathroom. Of course, I took several swigs of Gatorade knowing we were far from concluding this marathon.

As I stood in the aisle speaking with friends, one of the council members came off the dais confronting me and taking aim at my comments (several octaves above their usual tone) claiming I took “kickbacks” from the Transitional Care Unit (TCU), and ending it with I “had no right to be there and give my opinion.” Even during the break, the voice was so loud, Channel 20 re-started their filming trying to capture this verbal assault.

Taken aback, but not backing down, I told this City Councilperson it was my right to voice an opinion, and countered I never received a “kickback”. Fortunately, there were many other vocal community leaders shouting the Councilperson back up to the dais.

More than anything else, I was bothered this person, who I didn’t know, had this browbeating attitude. Bing…the light goes on. In order to sway their opinion, the hospital planted false information to marginalize and neutralize any physician counter-voice to their plan. Logically, with the hospital running the TCU, a “kickback” would have meant Henry Mayo was giving me money! Even with this not being true, false accusations is the way politics and business now seem to operate.

Many times I have alluded to hospital Administration’s attempt to takeover the Medical Staff despite California law assuring our self-governance. “Evidence based” are catch words now relied on by doctors and the public to maintain standards of practice, so I again present part of the hospital “game plan” they follow which might ultimately limit your freedom to give quality patient care:    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1140733/

Physicians at Henry Mayo have systematically been charged with “Code of Conduct”, “disruptive physician”, and “Corrective Action” to control our Medical Staff and eliminate any doctor who might fight against their takeover. The hospital Board of Directors have been told our Medical Staff is the worst behaved in the nation…and they believe it! Behind this is their game plan to dominate the Medical Executive Committee (MEC) and change By-Laws, ultimately personally benefitting financially the hospital Administration, and negatively affecting patient care.

I recognize this problem has stayed under your radar since I’m sure many of you are pre-occupied by the continued jumping through the hoops of red tape and paperwork in order for your practice to economically survive.

Serving the MEC for two years has allowed me to illuminate these problems while fighting to maintain self-governance and quality patient care. Election of next year’s MEC members will be at the Quarterly Staff meeting on Wednesday, December 5th. I wholeheartedly support the “slate” as these physicians will give us our best chance of enduring the relentless hospital Administration onslaught.

Undoubtedly, there will be nominations “from the floor” promoted by the hospital. Most of these doctors will have financial ties with HMNMH and can easily be arm-twisted into voting against our best interest. Please be aware of this potential threat to our medical decision-making, patients, and this community. We must prevent the “kickback” methods used by politics and business to take hold of our Medical Staff.

You have the “right to voice an opinion” through your vote.

Gene Dorio, M.D.- Guest Commentary

Gene Dorio, M.D., is a local physician. His guest commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with including the Medical Executive Committee and Medical Staff of Henry Mayo Hospital, or those of The SCV Beacon.

Hospital Horror Story: Absence of professional conduct standards at Henry Mayo

Dear Dave, How ironic and timely your commentary was in the SCVB concerning our local hospital, Henry Mayo (HMNMH). My elderly mother was a frequent patient at HM both in the ER and in-patient.  She was a widow and I am her only daughter who lives five minutes from her and three minutes from HM. Needless to say, my name is all over her records.  I will add that over the years, I have talked with more doctors and nurses at HM than I could count.

On Friday Sept 7, 2012, mom was taken by ambulance to HM; as far as I can piece together, around 2:20 p.m.  Her building managers, by protocol, gave the paramedics a sheet of paper with my contact information written on it clearly in two places. I had just spoken with mom at length the night before so not speaking with her Friday was not a concern; I would have touched base on Saturday.

I didn't have to. A call came to my home on Sept. 8th about 7:10 a.m. from a former care-helper whom, thank God, had kept my number (yes, somehow this nurse managed to dig up an obscure phone number). She kept saying mom was "very bad". I immediately called HM and through a circuitous route spoke with an RN whom I could barely communicate with due to a language barrier. She was mom's nurse at the time. I did get two pieces of information: she said she called me "a lot" and left messages at my home (that did NOT happen) and that mom's condition took a bad turn and she was sent to Holy Cross (....whisked out by around 6:15 a.m.) I told her I was around home all day and have a working answer machine and received no calls from her. When I asked what number she had called, she gave me mom's home number. I was stunned. I asked her to look further and within seconds she recited my home number. How in this world she so easily accessed my number at that moment is beyond any rationale.

I telephoned Holy Cross and they insisted that mom was not there. I kept insisting and repeating the information I was given and after being on hold a while, "Dr. M." came to the phone.  I expected to get mom's room number or ICU information but instead I heard "I did everything I could but I could not save her". Horrible. When I went to Holy Cross to sign papers, they were not happy with the actions, or lack of, from Henry Mayo..."we will do our own investigation". 

I then went to HM to retrieve some of mom's personal items they had retained and spoke with some of the staff who shall remain nameless because they were not on duty at the time of the events. They were also shaking their heads on how this could happen.  I am presently following up with a nursing supervisor (also nameless), for starters, about this incident.  She was also puzzled with acknowledging that my contact information is all over the records. 

It was very difficult, emotionally, hours after mom's death, to go to her apartment and listen to the stressful calls on her answer machine from the nurse telling me it was serious and get to the hospital asap.

The medical care that mom received is not the issue with me right now; it is the absolute absence of professional conduct standards. That negligence cost me my last in-person time with my mom as there were times in the 19 or so hours she was in their care that she was stable and coherent. The haunt that I live with most, is that while mom was laying in that hospital bed she was being told that I had been called and she must have been wondering why I didn't show up.  It isn't easy to go to sleep each night thinking of that.  Its a pretty heavy psychological weight to bear.......all put upon me by the negligence of some staff at Henry Mayo Newhall Memorial Hospital. 

I have made it known to some of HM employees; I have no plans of just going away quietly.

Betty Arenson- Valencia, CA.

Betty Arenson is a resident of Valencia. Her letters/commentaries represent her own opinions and not necessarily the views of any organization she may be affiliated with or those of the West Ranch Beacon.

Hospital Horror Stories: New ICU under quarantine after death

(Updated 9:00 PM Sept. 4, 2012) The HMNMH new ICU is under quarantine. A 19 year old patient has died of an infection and has contaminated the ICU which apparently happened on Monday, Sept.3, 2012 . Any nurses, family, or employees are being required to wear protective gowns upon entering the ICU. All of the patients in the ICU are being tested for the acinetobacter, a particularly bad bacteria, by having blood and x-rays taken. Medical personnel at HMNMH think the ventilator was infected with the bacteria. 
The State of California Public Health Department has... NOT... been notified as the administrator, at the time of the original posting, wants to keep this infection a secret by not telling the public or health authorities. This is another example how the administrator of the local hospital is managing all actions so he can put his "nothing is wrong" spin on all problems. Instead of investigating and responding he is behind close doors with his team in the spin factory headquarters.

Hospital Horror Stories: Surgical Apparatus left in Patient after Surgery!

A patient came into the Henry Mayo Newhall Memorial Hospital after a traffic accident with a fracture of the hip and was sent to surgery. The orthopedic surgeons are in a group of two. The two orthopedists see all of the orthopedic injuries at this hospital. Despite other doctors wanting to share the load the administrator refuses to let any one else see the orthopedic patients.

The doctors work 24 hours on and 24 hours off. Well all was going okay until the patient with the hip fracture was transferred to another hospital. As is the protocol for the hospital admitting the patient, an x-ray is taken of the injured area on admission. This new x-ray showed some surgical apparatus, a tube to drain the wound, was left inside of the patient with the injured hip.

The other orthopedic doctors have cried out to the Henry Mayo administration to open up the emergency room to orthopedic care for other doctors at the hospital. The administration, as in the past, has refused once again. The Henry Mayo hospital medical staff feels the two orthopedic doctors are too tired to safely operate on patients in a sleep deprived haze. The apparatus in the hip was removed at another hospital and patient did well except for having to endure another surgery!!

Hospital Horror Stories: Patient has Heart Attack while waiting for Doctor to return

A father was having some unusual feelings in his chest and his family drove him to the Henry Mayo Newhall Memorial Hospital emergency room to get checked out by a doctor. The dad is not overweight and exercises on a regular basis. He is 47 years old and has a healthy father as well.

When he arrived at the emergency room he was first checked in by the clerks in the emergency room. Then he was told to wait till a bed is available. So the family sat down in the waiting room and could see the clerks and nurses walking around and talking and sipping on drinks. After 45 minutes of waiting they called this man’s name and he was escorted back to see the Doctor. The doctor came over and briefly talked to this dad. Again he appears muscular and fit. The nurse put him on oxygen and ordered an EKG. The tests were done and the family waited for 85 minutes for the Doctor to come back. But the emergency Doctor did not come back in until a Doctor who was walking buy noticed the EKG on the scope. Immediately he was yelling for help as the father started to experience a heart attack. The cardiologist that was walking by saved this mans life. The cardiologist called over to Holy Cross Hospital and got the man a bed there. The man went there and had a cardiac procedure saving his life. Had the patient been left to the care of the Henry Mayo emergency room he may have died. The advice this patient’s family gives “is don't go to this hospital as the care is below bad. Again stay away from Henry Mayo Newhall Memorial Hospital.”