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There is now an all out war between the medical staff and the administration and Board of Community Memorial Hospital in Ventura, California. The California Medical Association and the American Medical Association have strongly backed the medical staff against the administration and the Board. The hospital now has added a third layer of attorneys. They have local attorneys, LA attorneys and have now hired an Eastern legal firm known for its high fees and strong hospital advocacy to the detriment of physicians. This firm knows that the longer they can string this out without any compromise the larger their fees will be. This is a major waste of community funds. The Board doesn't care since the confiscated over $200,000 of the Medical Staff funds and are using this against the medical staff. The medical staff has voted "no confidence" in the Board leadership after they refused to back down from their loyalty oath demand. This comes after the medical staff voted to sue the hospital. The Eastern firm does not believe they can do this since they are an arm of the hospital. The medical staff believes as does the JCAHO that the two are separate but interrelated and that neither may draft unilateral rules. The hospital wants to ban any physician for assault, making false or misleading criticisms of the hospital, board or administration. The board also wants non-compete clauses in the by-laws. These physicians should stop doing non-paid hospital functions such as working with the utilization review committee, which is only for hospital money and not for quality of care. They must continue to do their job in assuring quality of the staff but should start admitting as many patients as possible to other hospitals. Another tact is to keep patients in the hospital longer times. This costs the hospital money which is the only thing they know. The new handpicked medical staff "leaders" are those which have contracts with the hospital and are beholden to the hospital for their income. When this is over, they will be or should be ignored for any referrals from the rest of the medical staff that remains.
Following my writing of the above, the CMA has come out with the following stories.
Medical Staffs Under Assault
A Message from CMA President
Ron Bangasser, MD
Due to the extraordinary events unfolding in Southern California, we are sending
this OMSS Advocate Newsletter to every medical staff in the state.
As you read this newsletter, please understand that this is only another example of efforts being employed by hospital administrations across the country to take away medical staffs’ right to self-governance.
Amending Medical Staff Bylaws - Be Very Cautious
As discussed elsewhere in this newsletter, there is at least one hospital
administration obsessively controlling its medical staff to the detriment of
medical staff’s right of self-governance and its ability to assure quality of
care and patient safety on an organizational level.
Legal Counsel for the Medical Staff: Consistent or Conflicting
Interests?
By Greg Abrams, J.D., CMA Legal Counsel
From time to time, chiefs of staff and other medical staff officers in
California call CMA to ask whether the hospital’s legal counsel should handle
legal questions and other legal issues which the medical staff faces. Often,
hospital administration gives the medical staff a number of reasons why it
should use the hospital’s attorney instead of hiring its own counsel. Some of
these include the hospital administration’s willingness to pay the legal fees
for the attorney, the medical staff’s or chief of staff’s personal
familiarity with the hospital’s attorney, and the seductive argument that the
medical staff is not really "separate" from the hospital itself, and
therefore should not have a separate attorney. This latter argument strikes at
the heart of the medical staff’s legal status in California as
"self-governing." For a number of reasons the medical staff should
obtain independent legal counsel in order to assure that its own legal interests
are fully and zealously represented. This is the same thing I have been
preaching for the past 10 years.
PLEASE READ FULL STORIES AT http://www.calphys.org/html/advocate_0703.htm
The LA Times had a large article on a battle between the medical staff and the administration at Tenet Queen of Angels-Hollywood Presbyterian Medical Center. The battle is over the the hospital doing external peer review of physicians after the Department of Health had stated that some physicians involved in complications had not gone through peer review. The medical staff was bypassed in the decision on the outside review and stated that Tenet was attempting to mend its tarnished national image. The medical staff has had three former medical staff presidents resign, the medical staff has formally voted no confidence in the Board and a doctor has sued the hospital to be kept on the staff. The medical leadership quit and the staff began to move patients to other hospitals. The outside investigators found inferior care, unnecessary procedures and overly aggressive therapy. The Board then notified Medical Board of California about two of their physicians who had not gone through any local peer review. I must say this was not the politic way to do things but the Board did get qualified physicians to review the cases and only acted when the hospital medical staff wouldn't. Top
CalPERS, the largest purchaser of medical care outside of the US Government, has agreed on premium increases of an average of 18.4% for 2004 in PPOs and over 27% for HMOs. This is slightly smaller than last year. The board may consider decreasing these costs by increasing co-pays for hospitals and physicians. They also may increase out of pocket for drugs.
In a new study over half of California physicians were not accepting Medicaid patients. This was especially true for medical specialists.
In the People's Republic of Massachusetts, the Association of Health Plans issued a statement of support in a law suit to ban boutique practices in the state. These have been declared legal by Medicare and all states that have looked at the issue. The interesting part of this was the statement "the group fears more doctors will start charging patients for better care". This means the Plans don't give good care.
While this was going on the AMA passed guidelines which do not have to be followed for boutique practices. The guidelines stated that the patient has a choice of whether or not to join. When the patient does join the contract must be clear and concise. The contract should be one based on more testing but based on the best for the patient. There should be no extra fee for record transfers of those patients that do not wish to join the boutique practice.
Hospitals are finished using Residents as free labor for their institutions. As of July 1, the rules that Residents may only work a limited number of hours kicked in. This will cost the hospitals millions of dollars per year to hire additional nurses or physician assistants to do the work originally done by the Residents. This is one of the few times that making hospitals pay more makes excellent sense.
In Cincinnati not only are the hospitals fighting but so were the physicians and the insurers. The area was known for its low insurance payments compared to the rest of the country. In a breakthrough, Anthem has agree to an increase in pay to the area's OBs. The Federation of Physicians and Dentists, a union, signed up 85% of the OBs and helped guide them in their contract negotiations. The good thing from the insurer side is the five year contract leading to some stability. Top
The New Jersey hospitals are showing a 71% jump in malpractice premiums in 2003. This makes a 378% increase in the past five years.
The Florida Legislature has quit its special session without resolving the major malpractice problem of the state. This means they will again be called back into session giving them money for not doing their work the first time but on the other hand messing with their family vacation plans. The physicians are continuing to quit any high risk procedures and are looking at other places to practice. The Senate did finally pass a bill but there needs to be negotiations between the two houses. Hopefully, these can be worked out by the negotiators so the Houses may return to vote only. I doubt if that will happen and if it does the numbers are so far out of line, I would not be surprised if Gov. Bush vetoes it.
The Jacksonville, Florida surgeons who went out of business May 1 over the malpractice situation have returned to work after two months. The physicians found some malpractice plan to cover them temporarily. Three of the 20 physicians left for greener pastures. This means the OB/GYNs that also stopped doing surgery due to lack of backup will return to work.
Pennsylvania problems continue. In the most recent analysis of the problem, case western Reserve has stated that a cap will probably stabilize premiums and will stop physicians from dropping high risk procedures or leaving the state. However, the cap may be unfair to injured parties. The main jest of the article is that a new "no fault" system should be considered. Physicians would notify patients of errors and would give compensation to them via special scheduled compensation amounts, like Worker Compensation. The trial lawyers want patients to be able to opt out of the no fault system and use the physician's admission in court. Won't happen!
In Kentucky, the physicians have decided to self insure. They will set up a reciprocal
The Conning Research Corporation has come out with a report on the national malpractice crisis. The report blames the tort system with its larger payouts for the problem. Conning has a bias since they are owned by Swiss Reinsurance Co.
In a survey of patient satisfaction of California hospitals 18% had poor ratings. In the Bay Area 10 of the 50 participating hospitals had poor ratings. Half of these were Kaiser. The participants were people who spent at least one night in a medical facility between July1 and October 31, 2002. Kaiser acknowledged their poor showing and stated that they have been working to change it. They also state they have high marks for quality but these don't translate into patient satisfaction. Top
The Inspector General is doing a probe of Boston VA where seven of eleven radiologists resigned. The physicians resigned over pay, respect, and tensions with the Universities. This started almost a year ago when the administrator challenged the contract and pay of the Department chief. Since the physicians have left about 2000 exams have gone unread. The VA doctors were also doing outside work while supposedly working at the VA. Top
In Cincinnati, Ohio the not for profit hospitals are attempting to fight the for profit specialty hospitals in the correct manner. They are putting up their own specialty heart hospital in direct competition. This supply and demand effect will increase competition and should increase quality in the area.
In Dayton, Ohio the non profits are competing with the for profits with advertising campaigns. There are heart and orthopedic specialty hospitals there. In Dayton the specialty hospitals were all developed with physicians who were not allowed to participate with their own hospitals in the role of medical dare delivered.
In Wisconsin the for profit Orthopedic Hospital is gaining patients and numbers of surgical procedures. This growth has not hurt the flow of a non profit on the other side of town. A study has shown the for profit was at or below the average cost per procedure in the area. Top
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.