Conflicts? Let’s get hospital’s governance right

The front-page Nov. 14 Bangor Daily News article, “EMMC board axes cardiologist – Bangor physician resigns in protest,” reports an action by Eastern Maine Medical Center which is regrettable and a disservice to this community.

A hospital board of trustees provides important guidance to an institution like EMMC. It is essential to have board members who bring a broad perspective to their discussion since this is where the ultimate decision-making responsibility for our largest health care institution lies. EMMC has lost two valuable board members with the “axing” of Dr. Theodore Silver, and the protest resignation of Dr. Thomas Palmer.

The experience they brought from their years of board involvement and medical staff leadership will not be replaced. The situation is further compounded by the hospital’s indication that the currently elected vice president of the medical staff will not be allowed to take his seat on the board, because of an alleged conflict of interest.

Both Drs. Silver and Palmer are pillars of EMMC’s medical staff. Both have been able to bring different perspectives to the board, sometimes differing from that of the administration. Perhaps this is the conflict.

The alleged conflict of interest is that the cardiologist is part of a group that provides some diagnostic studies in their office. The hospital offers the same studies. Insofar as the hospital may wish to have all the business, there is a conflict.

The reality is that the practice of medicine in this community and this nation involves many studies and procedures being performed in physician offices. Primary-care doctors provide blood and urine tests. Some practices provide X-ray studies, physical therapy or limited procedures. Offering such office-based services often allows them to be provided to patients more conveniently and usually at a lower cost. Even though I am a physician who does not perform laboratory tests or procedures in my office, I can understand the appropriateness and necessity of these services.

These same medical practices, including cardiology, have succeeded in attracting excellent talent to our Bangor hospitals. These doctors provide extensive in-hospital services, and take care of all patients. There is always a physician available, day or night, weekend or holiday, insured or uninsured. What they may earn on their office studies helps them support these efforts. In a time of a physician shortage, most particularly in medical specialties, their success in recruiting and maintaining highly trained professionals has served our area well.

Cardiologists provide the expertise, which is the underpinning of the extensive heart program at EMMC. Their dedication allows the hospital to succeed in its mission to this community. Fiscally these services contribute tremendously to the cash flow of the institution.

The EMMC medical staff, upon hearing the concerns of administration regarding this alleged conflict of interest, and realizing such action was highly unusual, proceeded to retain an attorney to provide an independent opinion. Rather than await the results of this review, the EMMC administration convinced the board to proceed with their “axing” of Dr. Silver.

What else can we consider a conflict of interest? Together EMMC and Eastern Maine Healthcare represent one of the largest business organizations in eastern Maine. They bring business to many other entities, such as banks, legal firms and various service industries. Should community leaders from these firms be prohibited from having board seats? Should we imply they would be unwilling to stand up to a hospital administration that brings business and dollars to their firms and thus to their pockets? I believe the board members who volunteer their time and good faith efforts might find such allegations highly offensive. Is this really much different from the action that has been taken by EMMC and its board?

The current bylaws of EMMC’s board include provisions for dealing with conflicts of interest when they arise. This has been and should be adequate. This situation does not require a “purge” of board members. Such tactics are more expected of a cutthroat corporate business, not of a hospital essentially owned by its community, intended to be run for the benefit of the community.

Good governance of a hospital such as EMMC requires community, local business and physician input to get it right. Our patients and our community expect us to get it right.

A poor hospital/medical staff relationship is detrimental to this community. Many of us who have come here to practice medicine have put roots down and intend to stay. Recruiting new professionals to succeed us is a challenge given the current national shortage of physicians. With innumerable positions open elsewhere, almost all more lucrative than our area of Maine, an unhealthy hospital/medical staff relationship is an unnecessary impediment to this recruitment process, and ultimately to the care our community expects.

Where is the real conflict of interest? It is in the interest of this community to have effective hospital governance, as well as a collaborative relationship between its physicians and its largest hospital. EMMC and its board’s actions have put themselves in conflict with this interest.

Daniel E. Cassidy, M.D. has been a gastroenterologist in Bangor since 1981.