More than a year of tension between doctors and administrators at Long Beach’s St. Mary Medical Center came to a head this week, as medical staff filed a lawsuit against the hospital and its operator, Dignity Health.
The complaint, filed Tuesday, June 16, lists more than half a dozen actions the administration at St. Mary’s and Dignity Health have taken since late 2018 — when California Attorney General Xavier Becerra approved a merger between Dignity Health and Catholic Health Initiatives — that the medical staff says have violated multiple laws intended to protect the quality of patient care. Dignity Health on Wednesday, June 17, denied it did anything wrong.
The Press-Telegram reported on many of these actions as they unfolded, including the administration’s decisions to end contracts with the anesthesiologists, radiologists and, most recently, the emergency room doctors against the medical staff’s wishes.
Doctors have said they consider the move not to renew the current contract with the hospital’s emergency services provider, which ends July 1, to be especially egregious given the coronavirus pandemic does not show any signs of letting up.
Carolyn Caldwell, the hospital’s CEO, said when the announcement was made that the decision would not impact patient care.
“Our ER is delivering excellent medical care to the Long Beach community,” she wrote in an April memo to staff, “and we will continue to do so as we prepare for the July 1 transition.”
The lawsuit, though, argues that St. Mary Medical Center and Dignity Health have violated portions of the California Business and Professions Code, the Health and Safety Code, and the Code of Regulations that give hospital medical staff certain rights — including the ability to provide input into the potential termination of service provider contracts — to ensure the quality of patient care.
“SMMC believes these claims are without merit,” Caldwell said in a Wednesday statement.
Two doctors at St. Mary’s, Drs. Mauricio Heilbron and Douglas McFarland, submitted declarations in support of the lawsuit.
McFarland was the chief of staff for the hospital’s medical executive committee — a group of doctors elected by their peers to represent them in discussions with hospital management — through most of the contract turnover, and Heilbron is currently the committee’s vice chief of staff. McFarland declined to comment for this story, citing the need to consult with the medical staff’s attorneys.
But Heilbron said in a Wednesday phone interview that by ending contracts with the hospital’s longtime service providers — all of which have provided care at the St. Mary Medical Center for decades — the administration has shown its disregard for the community.
“Dignity obviously doesn’t care about Long Beach,” he said. “They don’t care about our patients. We’re meaningless to them.”
Service providers are the entities that employ the doctors who work in hospitals. State law prohibits hospitals from directly hiring doctors as one way to ensure physicians — tasked with prioritizing patient care above all else — can remain independent from financial and other considerations of hospital administrators.
By ending those contracts, the medical staff has argued, St. Mary’s has effectively laid off doctors with decades of commitment and experience in Long Beach. And in doing so, Heilbron said, they have lowered the quality of patient care available at the hospital.
Caldwell, meanwhile, has repeatedly said changes in service providers for the hospital have not and will not affect the level of care.
Throughout the dispute, the medical staff has argued that any changes to contracts would be motivated by retaliation. In February 2019, when doctors caught wind of plans to end the radiology and anesthesiology departments, members of the medical staff said they believed those organizations would be targeted because they were home to doctors who were publicly critical of Dignity Health.
Caldwell, for her part, has denied that accusation.
“Rest assured,” she wrote in a February 2019 memo, “that retaliation has not been a factor, nor will it be, in this review process.”
But the lawsuit says that St. Mary Medical Center and Dignity Health have done more to violate the law than simply end contracts without doctors’ input.
It also argues that hospital administrators have tried to chip away at the medical staff’s independence by changing the way decisions were made, including by creating at least two new panels, with hand-selected members, to replace longstanding groups that had the power to approve or deny changes to the medical staff’s bylaws, among other duties.
And the decision to end contracts has also impacted doctors’ right to self-governance, the lawsuit says. Three of the five members of the medical executive committee work for the current emergency services provider.
“Starting July 1,” Heilbron said, “60% of our elected leadership will be gone.”
While some of the current emergency room doctors have been retained by the new provider, Heilbron said, those physicians were “carefully selected.”
“None of the people that were selected,” he said, “are elected officials.”
The medical staff’s complaint asks the judge to issue an injunction requiring the hospital to keep the current emergency services group on board and to abide by the medical staff’s bylaws, among other requests.
Caldwell, meanwhile, said the hospital was completely within its rights not to renew the emergency services contract.
“After a lengthy process, a new ER group was brought in,” she said. “It’s important to note that the majority of current ER physicians have been hired by the new group.
“Please know that the SMMC Emergency Services will continue to be provided,” Caldwell added, “without interruption.”
It’s a credit to the doctors who remain at the hospital, Heilbron said, that the rampant turnover hasn’t led to any disasters for patients. But, Heilbron said, he’s worried that if the administration continues on the path it’s charted so far, the worst could be yet to come.
“We’ve managed to cope, and that’s probably their argument — ‘Well, we’re doing fine,’” he said, “but we’re not really doing fine, and it still doesn’t justify their actions.”
Citing the few resources the medical staff has in comparison to the health care giant, Heilbron said, he wasn’t sure how much of an impact the lawsuit would have.
But, Heilbron said, he and other doctors feel obligated to try to protect the level of care St. Mary’s provides.
“We’re just trying to keep the administration from decimating us,” he said. “And those of us that have been here forever aren’t going to let that happen without a fight.”
The administration, it appears, is also willing to fight.
“SMMC,” Caldwell said, “will be aggressively defending the allegations.”
A trial-setting conference has been scheduled for Sept. 25.