Doctors denounce EMMC leadership

loading...

BANGOR – A group of 31 doctors who are upset with the administration of Eastern Maine Medical Center met Tuesday night to draft a petition aimed at getting hospital trustees to change how the institution operates.

Some of them are calling for the resignation of Eastern Maine Healthcare CEO Norman Ledwin, while others said they want to consider the matter further, said Dr. Richard Smith, an anesthesiologist and former president of the medical staff. The doctors, who Smith said represent every medical specialty and general practice in the city, plan to meet again in two weeks.

The group agreed that the administration is not addressing the increased workload of physicians or adequately helping with physician recruitment, said Smith.

In interviews conducted prior to the evening meeting, doctors complained the hospital’s administration is more focused on generating revenues and attracting patients from afar than in supporting existing critical-care services.

“One of the goals is to alter this administration in an irrevocable way so a new agenda can evolve,” Smith said earlier Tuesday.

Smith and other doctors interviewed describe deep staffing and related problems at EMMC that they said endanger patient care. Although doctors say they have presented their concerns to hospital executives over many months, they complain the warnings have gone unheeded. The issue of shortages of physicians in various specialty fields was discussed at a Sept. 12 Medical Staff Executive Committee meeting, a copy of meeting minutes show.

The shortage problems have gotten so bad that many surgeries once undertaken immediately for such injuries as broken hips or arms are delayed for hours and more often days, because they aren’t deemed an immediate emergency, some surgeons have told the NEWS.

At other times, there aren’t enough people available to conduct emergency surgeries, although major problems have so far been averted, doctors say.

“It’s a disaster waiting to happen,” said Smith. “They keep cutting what they call cost out of the system, but they are cutting the guts out of it.”

The administration would have no comment on the doctors’ criticisms, said Jerry Whalen, a spokesman for the hospital. Irving Kagan, chairman of the EMH Board of Trustees, did not return a phone call.

Whalen said it was inappropriate for the administration to discuss patient safety issues through the Bangor Daily News. Asked if patient safety at the hospital is a public concern, he refused comment.

He said the administration would not be able to discuss even the numbers of specialists serving the hospital on Tuesday. But, he added, a survey by the Joint Commission on Accreditation of Healthcare Organizations recently gave the hospital a glowing review, finding it “superior,” an elite ranking. He said the administration would not comment on whether the survey results mean the doctors’ criticisms are misguided.

Doctors critical of EMMC say officials present the hospital as a referral center for a larger and larger area, but they want to sweep problems under the carpet. One said the problems have to be addressed or the hospital needs to stop saying it can take all patients.

For instance, Smith said that even though the hospital announced it would take patients from New York City after the Sept. 11 terrorist attacks, it wasn’t clear it could handle them. On Sept. 13, he explained, “I closed the operating room because we had so many people in the recovery room.” Smith said, “We’re in the media for accepting [terrorist victims] and here I am two days later closing the whole thing down.”

Whalen responded that elective surgeries were delayed to conserve blood because of the national tragedy

Ledwin would not comment on the criticisms of his leadership either, Whalen said. Ledwin, who was paid $454,302 in 1999, has been CEO of Eastern Maine Healthcare for eight years.

Observers say Ledwin, more than any other EMMC leader, has dramatically expanded the Eastern Maine Healthcare complex. Under his guidance, EMH has added seven hospitals along with a variety of other non-profit and for-profit entities to its network.

EMH is the dominant health care provider in the region. Recently, Ledwin publicly proposed doing more business with Canada and in Kennebec County.

The doctors say the immediate goal should be to shore up problems at the home campus. Upset surgeons spoke individually only on condition of anonymity, claiming the administration is vengeful. One surgeon said he feared: “retribution – I think it’s clear the administration would not hesitate.”

The surgeon said the administration’s policies on nursing have been detrimental to care. For instance, on the orthopedic floor, experienced nurses left after unpopular changes were made to their work environment, the surgeon said.

“We’ve really seen a serious loss of nursing care on the floor,” the surgeon said.

Another surgeon said the number of general surgeons has dropped from 19 to eight in the last 10 years. Although pay is already low compared to other areas in the country, the draw has always been the lifestyle and working hours. Now some of those benefits have evaporated as the frequency of shifts, especially at night, has increased.

“We have a shrinking number of surgeons and an increasing number of patients,” the surgeon said.

Anesthesiologists say they’ve been hit particularly hard by administrators’ alleged focus on building new business, but not supporting existing programs.

Dr. David Kliewer resigned as chief of Anesthesia Service on June 8 after more than three years in the position, citing his inability to get the administration to do anything significant to plug the drain of anesthesiologists from the area.

Kliewer is affiliated with Spectrum Medical Group, an independent practice that employs most anesthesiologists in Bangor. He explained that there is certainly a growing national shortage that affects Bangor. But local difficulties are acute, with Spectrum dropping from 23 anesthesiologists to fewer than 10 in two years. He said that represents an erosion of medical capability.

In a July 9 resignation letter, he wrote that Spectrum “now finds itself nonviable given the flat income levels and growing workload. We can offer neither lifestyle nor income to recruit or retain staff.”

In September, a letter by the Spectrum group to EMMC medical staff said meetings with the administration had been unproductive.

“EMMC has put forward a potential recruitment fund to be accessible to all anesthesiology groups, but in its current configuration, we do not believe this model offers real opportunity to deal with the long-term issues that must be addressed,” it said.

Tuesday, Smith said no one has access to an alleged $1 million recruitment fund the hospital says it has established.

Given the turn of events at EMMC, St. Joseph Hospital took an action it usually avoids, CEO Sister Mary Norberta said Tuesday. The smaller Bangor hospital has negotiated terms with five Spectrum anesthesiologists to work just for that institution. The arrangement took effect Oct. 1.

“I was afraid that we would lose anesthesia coverage and we can’t afford to do that,” she said.

Since then, St. Joseph’s surgery volume is up because many doctors don’t want to put their patients through delays now experienced at EMMC, she said. Still, she remains a proponent of completely independent medical groups that serve both hospitals.

“I didn’t want to see the group split,” she said.

Norberta, who has been at odds with Ledwin over numerous issues since his arrival in 1993, said she believes he’s clearly dedicated to his job of building EMH’s services. But she said he also adheres to the notion that it’s his way or no way.

One surgeon said anesthesiologist problems are just a tip of the iceberg in specialty shortages afflicting EMMC. The shortages include gastroenterologists, urologists, and vascular surgeons. More should be done to address these problems and the public should be aware of what failure to act could mean, the surgeon said.

“I have seen a very significant deterioration in things from my perspective,” the surgeon said. “A lot of it has to do with the direction of the hospital.”

“We are all shocked we are in this position,” the surgeon added.