Enloe acts on anesthesia

All eyes at Enloe Medical Center will be on Dr. A. Duane Menefee in the coming weeks. That’s because Menefee heads the group of anesthesiologists, called Medcorp, that the hospital’s Board of Trustees selected last week to provide anesthesia services there.

The board picked Menefee’s newly formed group over Anesthesia Associates of Chico, a larger group that had long held the anesthesia contract at Enloe. Menefee is now under considerable pressure to develop Medcorp into a full complement of anesthesiologists. He estimates the hospital needs a minimum of 13 anesthesiologists to be fully staffed; he now has three, including himself.

The board’s decision was the latest installment in an ongoing drama at Enloe that first went public in late April. That’s when contract negotiations between AAC and hospital CEO Dan Neumeister turned nasty and he asked Menefee, a member of AAC, to form a new group.

Shortly afterward, the hospital’s medical staff entered the fray, voting no confidence in Neumeister and forcing a stand-off that was resolved only when Neumeister, Board of Trustees Chairwoman Betty Dean and Vice Chairman Mark Spelts all resigned. That did not solve the anesthesia problem, however.

Bad blood remained between AAC and Menefee’s group, with the former accusing Menefee of disloyalty and Menefee accusing his former associates of abandoning their patients. Following the resignations, the hospital’s Medical Executive Committee—the physicians who head the various medical departments—tried mightily to bring the groups together.

“We had pretty avid support for AAC,” Dr. John Howard, chief-elect of the hospital’s medical staff, said in a phone interview, “but we didn’t want to blame Duane, either. We just wanted to get them back together.”

For one thing, neither group had anything close to a full complement of doctors to offer. “Either group working alone was not going to be ideal,” Howard said.

In the end, though, the rancor between the groups was too much to overcome, and the MEC gave up. Unable to decide among themselves which group to back, the doctors turned the issue over to the hospital’s Board of Trustees. “We trusted they would handle it with all due diligence and care,” Howard explained.

Such trust was new and apparently the outgrowth of improved communications between the board and the doctors since the resignations were announced.

“It was a difficult decision,” Howard said, “but by that time we felt the board was acting with integrity.”

For its part, the board invited AAC and Medcorp to submit proposals and make hour-long presentations during a Monday, July 3, meeting. The following Thursday (July 6) the board met for more than four hours to discuss the proposal, finally deciding to go with Medcorp.

“This was a very tough decision,” said Darby Makel, interim chairman of the Board of Trustees. “There were lots of personal relationships involved. But all parties involved agreed that it needed to be resolved, that the board needed to make a decision.”

Carl Leverenz, an ex-officio member of the board, said to some extent it came down to money. There was a big difference between what the two groups sought financially, “and that’s a major factor, to be honest,” he said.

Menefee’s group has a long way to go to be adequate to the need. While he’s recruiting new full-time physicians, he said, he will make use of temporary anesthesiologists, called “locum tenens.” He has a number of them lined up, enough to go through the summer “fully staffed.”

He said the board’s decision to contract with his group has removed the uncertainty that made recruitment difficult. Two doctors from Colorado have made verbal commitments to come to Enloe, and he’s working to attract two others now practicing in the Bay Area. He said he hopes to have a relatively full slate of doctors in two or three months: “This is a wonderful community and people want to live here.”

He also hopes the AAC doctors will join his group and said he planned to contact each of them personally to ask them to do so.

There reportedly have been quality problems with a couple of the locum tenens hired recently, and Howard said the hospital’s doctors would be scrutinizing anesthesia in coming weeks to be sure the locums meet hospital standards. He said he expected anesthesia to be adequate for surgeries, but a sudden influx of trauma patients could be problematical.

“We’re hoping and expecting to achieve gradually adequate coverage within a couple of months,” he said. “By six months we should have what we really want.”