Palomar Health doctors and supporters marched on the sidewalks at Palomar Medical Center Monday morning protesting a contract change the hospital district announced as a cost saving move. They carried signs with slogans such as “Our docs deserve better” and “Doctors care and so do we.”
Dr. Sabiha Pasha, chief of staff at Palomar Medical Center warned that hospital doctors will be required to see more patients per day than is safe as part of a new contract that was successfully bid by a company called EMA (Emergent Medical Associates) which the Palomar Health district board accepted, replacing the existing company. The old company, Vituity, has provided emergency medical personnel for four decades, including hospitalists for eight years and intensivists for six years.
Hospitalists care for hospital patients and intensivists care for those needing critical care.
Most people don’t know that California law doesn’t allow health care providers to directly employ doctors. They must contract with private medical groups. Under the new arrangement, EMA and another company, Benchmark, will probably hire most of the doctors that worked for Vituity. Many doctors are not happy about that.
Palomar Health’s CEO Diane Hansen announced the change in a statement: “Our community and patients expect us to be good stewards of our resources. EMA’s proposal allows us to retain our staff, plus reinvest saved resources to upgrade medical care.”
The contract is effective August 1. “EMA has pledged to offer employment to the approximately 100 physicians and 45 other non-employee staff affected by this change. Based on experience, Palomar Health estimates 90-95% of affected physicians and non-employee staff will stay in their current capacities at Palomar Health,” said the announcement.
The providers were chosen by RFP (requests for proposals,) said Hansen. “EMA, a nationally respected emergency care provider, was selected through a competitive process because they are most aligned with Palomar Health’s strategic goals moving forward,” said Hansen. After the RFP process, the board voted Wednesday, June 16, to authorize Hansen and her executive team to complete negotiations with EMA and sign a binding contract, which should be completed this week.
The relationships of patients with family doctors or specialists will remain unchanged, Hansen said. “Our community and patients expect us to be good stewards of our resources. EMA’s proposal allows us to retain all our staff, plus reinvest saved resources to upgrade patient care.”
The money saved will allow Palomar Health to buy “three new CT scanners, a new MRI machine” and invest in cardiology, women’s services and orthopedics,” she said.
Dr. Pasha is skeptical, “because capital expenditures come out of a different budget. What does that have to do with physicians’ contracts?”
Dr. Pasha told The Times-Advocate that EMA approached her and other doctors with offers that made it obvious the number of doctors on duty will be reduced. It gave them five days to decide, she said.
She said, “On May 11 the contract of a group of about 110 frontline physicians was summarily terminated without cause. These are physicians who during this entire last year through the COVID-19 pandemic worked in the emergency room, the ICU and on the floors, putting their lives at risk taking care of this community.”
They worked faithfully last year, Dr. Pasha said, “I want to remind everyone that a year ago we did not understand the coronavirus, how it spreads, and how to control it. With no credible information on how to protect themselves, these physicians came to work every day doing their best. Then, when the hospital administration decided to open the federal health station for financial gain these very same physicians stepped up to the plate to staff the federal health station thereby allowing care to be provided to COVID-19 patients from far outside our health district.”
Dr. Pasha is concerned that the hospital board refused to see any members of the staff, including herself, to let them make the case for not canceling Vituity’s contract. It has refused to meet with the Medical Executive Committee, whose job, she said, “is to report quality matters to the board. The committee makes recommendations for quality care. The reason doctors don’t take orders directly from the administration is to protect them.”
She added, “Running a hospital is a three legged stool. You have the board, the administration that runs the contract; the medical staff is the body that reports directly to the board. My job as chief of staff is to bring good physicians into the hospital and make sure we collaborate with the board to make sure the physicians have what they need to practice cutting edge medicine.”
EMA, said Pasha, “runs a program where they require physicians to see more patients than you can safely see. An average of fifteen patients is ideal, and maintains compassion. This group requires twenty-five. That is comparable to ‘Hello, goodbye, I hope you feel better.’ ”
Palomar Health was not transparent in how it chose EMA, she said. “Before the district issued the RFP (request for proposals) EMA put out recruitment ads. They knew they were going to get the contract before they [Palomar] put out the RFP.”
According to Palomar Health: “By law, Palomar Health was not required to go through a public bid process. However, in an effort to be inclusive and transparent, an RFP was issued to allow Vituity the opportunity to provide a competitive proposal in hopes of being able to remain partners. Six different service providers expressed interest in the RFP. Although a tough decision, Palomar Health must continually look for ways to improve patient care and this provides the hospital system an opportunity to treat patients with the highest quality of care in the most efficient manner. To date, 90 current physicians have already met with EMA and we are hopeful they will remain with Palomar Health.”
Dr. Pasha told The Times-Advocate: “Last Thursday the board made the decision to award the contract to EMA. The nurses went to the street and we joined them and that’s where you found us.”
Dr. Pasha continued, “All three bidders came in at the same price. For an RFP for a public district you have to be clear as to why you took ‘A’ over ‘B’ over ‘C.’ We don’t know what that criteria was. They ignored us.”
According to Palomar Health: “Out of six interested organizations, the proposal submitted by EMA impressed the Board and Palomar Health executives with their established best practices to improve care efficiency through the use of advanced statistical analysis. Using their proven model, EMA will decrease patient wait times, shorten discharge times and improve diagnostic testing processes among other positive changes in the Emergency Department.
The chief of staff is elected by fellow physicians. So Dr. Pasha is not part of the group that will be employed by EMA. “I am putting myself at risk but it’s a risk worth taking at this point,” she said. “Ideally the medical staff would work with the hospital administration and insulate medical decision makers from undue influences driven by profit motives or other reasons unrelated to patient care.”
She continued, “My intent in going public is not to inflame or anger anyone—we just ran out of recourse. We want to be heard but we don’t want to make anyone angry or upset. We just didn’t know where to turn. Possibly to also make sure the public if we go with the new group that the quality will go down and risk of coming to the hospital. I don’t want to sound inflammatory. We are the gatekeeper of quality of care and safety. If I can’t get the board to change its action and then I need to warn the public and then my duty is done.”
Dr. Pasha concluded, “I request the citizens of this community to write to their elected board members and ask them to immediately suspend this process so that an external impartial agency can do a complete forensic evaluation of the situation. Your health, well-being and possibly your life depends on this.”
Hospital board Chairman Linda Greer, RN issued a statement supporting Hansen’s action. “I fully support the decision made by administration to contract with Emergent Medical Associates (EMA) and Benchmark to assume emergency medical care and other services at Palomar Medical Centers in Escondido and Poway.”
She added, “The majority of the board of directors trust this decision will improve patient experience by implementing new and improved, industry-leading practices. As a nurse in emergency medicine, I understand how important it is to work beside the best and brightest physicians, and it is our plan to continue doing just that. While we understand change is hard, I do not agree with the recent medical executive committee’s vote of no confidence in the executive team’s decision. To the contrary, I have full confidence in the leadership team in place at Palomar Health and know they make patient safety a priority in every decision and must make tough decisions to lead the district to a better future.”