Behind the doctors’ walkout

Enloe Medical Center administrators are attempting to reassure the community that the hospital is providing safe surgical services in the wake of publicity that most of its anesthesiologists quit last week after giving just two days’ notice.

The news, first reported in the Chico Enterprise-Record, sent shockwaves through the medical community. Anesthesiologists are an essential part of surgical care, and with 12 of its 16 anesthesiologists suddenly gone, the hospital faced a crisis.

It scrambled to adjust surgery schedules and prioritize the use of the remaining anesthesiologists, said Dr. Duane Menefee, the head of the hospital’s new, much-smaller anesthesiology team, in an interview Tuesday. Emergency care is completely covered, and, with some rescheduling, most elective surgeries have gone ahead.

The hospital had to be flexible, Dan Neumeister, Enloe’s CEO, said in the same interview. It is using the services of some anesthesiologists from Mercy Medical Center, in Redding, as well as “quality locum tenens"—or traveling—doctors to augment the four anesthesiologists who remain.

People can still be confident that when they come to Enloe they will obtain good care, Neumeister insisted.

Speaking of the four doctors who stayed with the hospital, Menefee said, “Some of us physicians just don’t walk out on patients. I won’t walk out on my patients. Some of my colleagues agreed with me and chose to stay.”

Contract negotiations between Enloe and the anesthesiologists, members of the group Anesthesiology Associates of Chico (AAC), had been going on for more than a year when they stalled in recent weeks, Neumeister explained. Four doctors left the hospital earlier this year.

The remaining doctors, who had been working on a month-to-month basis since July 2005, had agreed to work through May, he said.

Instead, their president, Curtis Eldenburg, announced last Wednesday that Friday, May 12, would be their last day.

It was a situation hospitals rarely have to deal with. “I have never, in years of doing this work, seen a negotiation fall apart like this,” said Dr. Bill Mazzei, an anesthesiologist and consultant with the Chicago-based firm Surgical Directions, who helped facilitate the negotiations. The doctors asked for him to be brought in last year, and the hospital liked the idea and agreed to pay half his fee.

“Usually when the parties disagree, they continue to negotiate,” he continued. “It really was a surprise when things fell apart. My best guess is that it went from being a professional process to becoming a personal issue, and the doctors felt they were not being treated fairly.”

The mass exodus made the hospital scramble, Menefee acknowledged, and it’s now busily interviewing prospective anesthesiologist hires. “We’re pretty confident that come June 1 we’ll be fine,” he said.

To hospital officials, the collapse was all about money. After both sides agreed in principle to a contract in mid-December, one that included some governance changes that Neumeister said improved efficiency, the doctors came back in January wanting a larger stipend—the money they receive for signing an exclusive contract with the hospital and agreeing to provide on-call services. (It is in addition to their incomes from service, which depends on the number and types of cases they do. Anesthesiologists at Enloe average around $350,000 annually in income.)

Instead of the $900,000 group-signing amount agreed on in December, the doctors now wanted $1.4 million, said Neumeister. Later they upped the figure to $1.7 million. Their demands, Mazzei said, were “far from realistic.”

When the hospital decided it couldn’t meet the demand, it decided not to deal with AAC any longer and instead to form a new anesthesiology team headed by Menefee.

On the other hand, Dr. Mike Pryomski, who was president of AAC from 2002 to ‘04 and one of the doctors who quit, said the monetary issues were in fact close to resolution. Interviewed Wednesday morning, he said, “It was not about money.” The sticking point was over the so-called “governance” changes, which he said was a long list of “behavioral controls and gag orders.”

He referred to the former Redding Medical Center, at which numerous unnecessary heart surgeries were performed over several years, with horrific results. “Our group saw the Redding Medical Center open-heart-surgery disaster. We vowed that we would never be put into a position of forced silence while crimes of this magnitude occurred.”

The effort to control can be petty as well, he charged. He noted caustically that Menefee had once driven by his house to check on a concern of Neumeister’s that he (Pryomski) had a Service Employees International Union sign in his yard. (The hospital is currently in contentious negotiations with the union, which represents most of its non-medical staff.) The sign was in a yard a block away. As confirmation, Pryomski played a tape of a meeting in which Menefee discussed the incident.

As for Mazzei, he lost the confidence of the anesthesiologists when they learned he’d formed a long-term relationship with the hospital, Pryomski said. They fired him as a consultant in February 2006.

Neumeister acknowledged that Mazzei continues to work for the hospital on an “as-needed” basis, consulting on operative room efficiencies with its Surgical Services Committee.

Bruce Johnson was the first anesthesiologist to quit. The president of AAC, as well as one of the most respected doctors on the Enloe staff, he left in February, taking a job in Tennessee. Three other doctors left soon after.

The conflict broke into public view at the end of April, when a retired Chico orthopedic surgeon, Doug Benson, placed a large advertisement in the Enterprise-Record calling attention to the loss of four anesthesiologists and questioning the quality of hospital management and care. He also set up a Web site where medical personnel could place a confidence or no-confidence vote on the hospital administration and make comments.

(The results are far from scientific, and such a Web site well could be a magnet for grumblers, but at the least several dozen doctors and nurses signed on to express their dislike and distrust of Neumeister and his senior staff.)

Then, when Enloe announced it was forming a new group of anesthesiologists under Menefee and had the situation well under control, another eight doctors quit.

As CN&R went to press, the hospital chief of staff, Dr. Dan Thomas, had called a meeting of the hospital’s medical staff for 6 p.m. Wednesday to discuss the anesthesia situation. Neumeister characterized it as an informational meeting with the goal of trying to prevent such a conflict from occurring again, but if Benson’s poll results are any indication, it may have turned into much more. Stay tuned.