The Reality Of Pediatrics In Asheboro: Hiding Failure Behind The Gowns Of Those With Cancer

I've been pondering this post for a while. It was born of several conversations with my Mother. The flames were fueled by the N&R's front page story Wednesday (hat tip to Joe) bemoaning North Carolina's failures in child-well-being . . . as well as recent musings by Cone on primary-care (as usual, not really musings, but a hit and run link) . . . and JR's foot-in-mouth commentary on "muckraking bloggers".

Since Daddy died, my sainted Mother has immersed herself in good works. Mom . . . a Deacon at First Baptist Church (FBC) who often visits sick church members at the hospital . . . recently related “serving the line”, and then sitting through what amounted to a hospital-PR dinner at the church she has attended most of her adult life.

This time it was a glowing video presentation made by yet another new & fairly clueless representative of the same hospital whose "visionary" leaders threw her daughter out on the street nine years ago . . . after her daughter defied the edicts of the hospital's senior executives (still employed and exceptionally well-paid) in order to save a newborn baby’s life.

The baby is now a beautiful young lady. She and her parents happen to attend the same church. Her Mother is also a Deacon.

When it all went down, and as I loaded up Daddy's truck ("Big Red", once Granddaddy's truck) with the contents of my office, Mama told me that she had never been prouder of me . . . and that I reminded her of her Father.

Higher praise could not be visited upon a human being than being compared to Cecil Waters.

I am only one of a number of people we know who've been royally screwed over the years by this particular executive regime (which seems to have big problems with women of opinion and independent initiative). Nurses, in particular, are especially susceptible. I know several who work there now, and keep their mouths shut because they've got kids and they need the local job. Otherwise, they'd drive to Greensboro.

Particularly since her retirement, Mama is a bit of a agitator herself . . . a woman of the old Southern tradition who has the rare ability to graciously tell you to, "Go to Hell!" in such a fashion as to make you want to go directly there . . . as opposed to her much less refined daughter who will chase you there and back (it's those pesky Johnson genes).

So, to her immense credit, at this dinner/presentation in her own church, where the subject matter offended her every sensibility deeply and to to core, Mama watched and listened quietly.
Being a good Baptist Deacon, she held her tongue. Mama has shared with me before that several hospital volunteers attend First Baptist, and they seem to be fairly clueless about the hospital's history . . . and regularly gush about all of the hospital's new projects . . . especially as it pertains to cancer services. Every time they do it within her earshot, it's like a knife in her sternum. But everything is just "wonderful" in their world.

After this presentation, several of these folks fawned over the hospital’s rep almost like groupies . . . oblivious to the history in the room.

Mama mused aloud (to her daughter now practicing eight hundred miles from home because she was black-balled for miles locally after she was fired) that, “One of these days, I’m going to say something to them.”

When she does, she certainly has my blessing. The sad thing is that if we had a DA and/or local newspaper that was worth a damn, Mama wouldn’t have to say anything at all.

The post at Cone's Word Up prompted me to go ahead and get this post up. The big topic lately is the worsening shortage of primary-care doctors in this country . . . which includes family practitioners, as well as the specialties which lately don't have the "prestige" of specialties: internal medicine (i.e. adult medicine), pediatrics, AND Ob-Gyn. Please note that I include Ob-Gyn because many women (including me) use and consider these specialists as their primary-care provider. Some insurance companies see it that way. Some don't.

As a primary care physician, I have a few personal observations to make regarding Cone's post.

These days, I drive all the way to Hickory at least once or twice a year to see my Ob-Gyn (and last year I had my hysterectomy in Hickory because I wanted no one else to do the surgery).

One of the biggest factors in my doctor's decision to leave Asheboro (a huge loss to the community) was the way Randolph Hospital treated me (apart from being good friends and close colleagues, I was Ped to her children). Of course, there was also the small matter of the way her ex-partner behaved prior to her departure . . . behavior that I (and other female professionals) complained about long before he went too far and suffered the consequences of that behavior . . . behavior that the hospital did NOTHING about until it had no choice. Of course, as someone who was essentially been told to "shut up or else", I was long gone before any of the really bad stuff that vindicated my complaints went down.

I'd also like to note that excepting the year my case was settled with Randolph Hospital (and everyone knows how I feel about the lies and deceptions behind that settlement), as a Pediatrician I've NEVER made anything close to "the average" primary-care-provider salary (@$162,000/year) quoted in the WSJ article that Edward cites.

Despite the smooth moves that Eblin and "the team" termed "generosity", financially I was all but DESTROYED. You don't get the years of practice-building and litigation back. And I have yet to recover.

Cone alluded to the wait locals have in seeing a physician. I've got news for him. In every Pediatric practice where I have worked . . . everywhere . . . sick children are seen the same day . . . it most certainly does NOT take seven weeks. Not-so-sick kids might have to wait a day or two, speciality evaluations generally take longer, and obviously well-checks should be scheduled in advance . . . but acutely-ill children are worked in. Fielding the phone calls (not reimbursed) and triaging these children (either through the office or to the ED if they're really, really sick) is stressful and labor-intensive. This places a tremendous day-to-day burden on Pediatricians . . . who are already the lowest on the totem pole in terms of respect and reimbursement.

A classic example of the dismissive way in which Pediatricians are treated is being routinely paged to C-Sections that are less-than-emergent at all times of the day. If a Ped covers call at a hospital, our office schedules are constantly at the mercy of the Obstetricians and the hospital's OR. In most smaller hospitals, if a section is called, for whatever reason, the Ped has to be there. If you're the only person in an office, and you get the call, the patients in the office are screwed. And that's fine if it's a true emergency. But lots of times these days it's not. C-sections have increased from a little over 10% of all deliveries to approaching 40% in many hospitals during my fourteen years as a Pediatric attending (thank you so much John Edwards). I've been called to sections called "failure to progress" which really translated to "the OB can't fail to make dinner at the country-club". In these situations, if you object or ask for a delay to finish your office work, you almost invariable lose the argument . . . because the hospital is ALWAYS going to side with the OB (and berate your character and lack of dedication in the process). Neonatal nurse-practitioners on duty 24/7 are a still a luxury that most smaller & rural hospitals do not have a budget for. When the Ped is called (at all hours of the day or night), we're often treated dismissively . . . as if our time is not as valuable as the other doctors, and we're only there to dry-off the baby. On any number of occasions, I've been called in the middle-of-the-night literally hours before the "emergency" section took place . . . arriving to an empty room that was not even set up. You sit there bleary-eyed, and you wait, and you want to cry because someone was just beyond inconsiderate.

But then there are the genuine emergencies that rock everyone's world . . . and the Ped is the only one in the room who can clean up the mess. Suddenly everyone is singing our praises and promising they'll do better . . . work with us more. But it doesn't last long.

Alas, in Asheboro, although popular with the nursing staff, I didn't get much praise from the powers-that-be. First, my partner and I were "arrogant and cliquish" females. And ultimately, I got fired after cleaning up the mess that a man made . . . and refusing to cover-up how that mess got made.

I've had to do a lot of that on the road. It's always a cluster-screw, and I'm always the one who pays. More on that in a future post.

And here's my comment for Joe (on the N&R's article): The way that people who take care of (and serve as advocates for) children are treated in this country says a great deal about how society really regards children.

Therefore, the study does not surprise me at all.

Speaking of society, there are several people in the GSO blogosphere who have been quite nasty to me as I've fought tooth & nail to bring what Randolph Hospital did to me to the general public's attention. I'm supposed to "get over it" and "get a life". I've been called a "whack-job" (Fec) and a liar (Ed) . . . told I have no "integrity" (Roch). JR made a New-Year's resolution to tune "the trolls" out. And according to Dr. Sue, the diagnosis is "malignant narcissism".

On this point, Sue is fundamentally clueless. And yes (Billy) sometimes I'd dearly love to "slap some of these people to next Friday". The arrogance and cruelty of people who've NO IDEA what it's like to practice medicine in today's corporate environment . . . and who've demonstrated no empathy whatsoever for the professional rape I endured while in public service (as they clammer for the same government that turned its back on me to provide free "universal care" to the whole world) is absolutely infuriating.

Actually, this adventure in blogging has NEVER been just about meMeME (Sue). One of my driving forces in this arena is to keep the bright-eyed, bushy-tailed, idealistic newbies from making the same mistakes (and trusting the same people/institutions) I did . . . and from getting hurt like I did.

If I keep one young doctor from walking down my path, it’s very much worth it.

The "young-uns" are STILL not getting taught much of anything about the business & legal side of medicine while they're in training. They are not hearing or studying the horror stories. They get no preparation. They are lambs to slaughter.

This is because, by-en-large, the medical establishment does not want them to know that they are fresh meat.

As I commented at Kevin's yesterday, where the AMA (and the AMSA, its medical student branch) is concerned, "the voice of the physicians" splintered and sold its soul years ago. And the Horcruxes are now hidden everywhere.

We were sold out by the older, pre-managed-care, pre-physicians-as-employees generation that included Ed Cone's father.

I've already posted thoughts on JR's latest post about "muckraking bloggers". To answer him further, on a "hyper-local" level, I can see the subtle ways in which my blog is affecting the way that Randolph Hospital markets its services. Executives who periodically seek a higher profile dive back into their holes when I answer the puff-pieces in the Courier Tribune on this blog.

And, as I noted in a previous post, certainly, over time, Randolph Hospital is finding some small measure of accountability by virtue of my blogging . . . as Pediatricians who’ve heard my story of woe do not risk their own futures . . . and take a pass on Asheboro. If I can keep a young doctor from selling his/her soul & future to the NHSC and/or NC Rural Health Service, it’s a good day (many young docs don’t understand that if they can land a good private practice gig, they’re better off paying their own loans).

In my travels, I have found that it is indeed a small medical world. You don’t screw over doctors (or nurses for that matter) without it getting around. And no matter what Randolph’s PR gurus feed the general public (via the Courier Tribune, and to a lesser degree, the N&R) . . . Asheboro has a bad rap and not just in Pediatrics.

I do sometimes feel a small twinge remorse about the effect that speaking out might have on access to children’s access care in Asheboro, but at the same time I would not wish what I have been through . . . medically, professionally or legally . . . on my worst enemy. I don't want other young doctors to go there.

I know in my bones that the biggest factor precluding the development of a strong Pediatric presence in Asheboro, North Carolina are two way-overpaid, way-over-rated hospital executives named Bob Morrison and Steve Eblin.

Let’s look at the facts. At the moment, their hospital-owned Pediatric practice (RMA) is down to two Pediatricians (from a recent max of four). Since “the team” of Morrison and Eblin drove two doctors in federal (and state) service out of town almost ten years ago (after reneging on a multitude of promises . . . and contractual agreements), a number of Pediatricians have come and gone through RMA’s doors. Yet in those years there has been no net gain in the Pediatric workforce. In fact, if you look at the number of Pediatricians with hospital privileges at Randolph, there has been a net loss of one provider.

Anyone who paints this as “normal turnover” (in what should have been a period of tremendous growth) is either lying to themselves or smoking something.

Like Thomasville and High Point, Asheboro should have a thriving and independent private Pediatric presence. It doesn't because of Bob Morrison and Steven Eblin's treatment of Pediatricians.

Part of the problem has to do with that fact that, as opposed to specialists governing specialty care nearly everywhere else in the country, in Asheboro, Family Practice rules. The FP’s continue to build and expand their thriving practices . . . in part because there is no strong private Pediatric competition (and I mean no dis-respect to Renuka Harsh or Pat Chamberlain). As I understand it, hospitalists cover call adult medical call . . . but not Peds.

RMA is “the dump” practice . . . for the poor that are not taken care of by the health-department (a whole nuther story), for the hoards of Hispanics recruited by the mills, and for the clinically-complicated. I found out the hard way that the services of doctors who staff such practices are often abused.

It's not the kind of environment (or history) that is easy to sell when you're trying to recruit new Pediatricians.

This environment is also the major reason that an FP who really-screwed-up nine years ago got off with a slap on the wrist . . . while the Pediatrician who rescued the Neonatologist-wannabe from his own mess was thrown to the wolves.

All primary-care providers in Asheboro are not created equally.

As my partner and I watched incredulously, the hospital had actually marketed this guy's abilities in Neonatology . . . when his only claim to expertise was a NALS instructor course (as opposed to the many months my partner and I had spent in our Pediatric residencies doing nothing but NICU). People were taking their babies to this guy based on a lie.

But still, as a lowly employee of the hospital's "controlled affiliate", I was supposed to just clean-up and shut up.

The other part of the over-all problem for Pediatricians in Asheboro is plainly and simply good-ole-boy mill-town politics. I did not worship at the altar of "strategic-planning" wannabe-guru Steve Eblin. Eblin (& Morrison) wanted me "to just go away" because I talked back. I did not fawn all over the plans for Randolph Hospital's total domination of the medical landscape (WHICH WAS A BAD PLAN). Ergo I was stomped (but good), and the wagons were circled.

Morrison and Eblin have treated Pediatricians like dirt during their tenure (based on my experience, there is certainly an element of sexism in the problem), and the community is suffering mightily from the consequences of their supreme arrogance and short-sightedness.

The “non-profit” mission to which they originally paid lip service was betrayed long ago. Yet they’ve still gotten the raises (courtesy of their Board of Directors) . . . to which local tax dollars contribute . . . and will have the golden parachutes when they retire.

As for their "vision" and "legacy", Morrison and Eblin have been blathering about building an outpatient facility (in part, to house their hospital-owned practice) for literally years. Plans have been widely publicized and then inexplicably fallen through without even a whimper from the local paper. Now suddenly, getting a building up fast is a highly-publicized priority . . . as another doctor (with resource$ I did not have) is building his own really-big-show just up Fayetteville street.

During Bob Morrison's tenure, the hospital has bought up a lot of surrounding land, but realistically, the ONLY "big" things Morrison has accomplished during his reign here is to build a new ER (it seems everybody's doing it) and hook his coat-tails to Cone's cancer services.

The hospital's major addition was pretty much a done-deal before he came here (although I've heard some good stories about that).

On a larger "community" front, the Asheboro 20/20 initiative of a year back (which Morrison fronted) is widely viewed as a joke.

The fact is that Morrison & Elblin have successfully hidden their failures behind these things . . . in large part because (1) they're members of every local business society & fraternity around, and (2) David Renfro over at the Courier Tribune refuses to print anything negative about this hospital unless he simply cannot ignore it.

It is my hope that if parents in Asheboro and Randolph County are inconvenienced often enough . . . or disgusted enough by their lack of local Pediatric options and the high turnover of physicians) . . . they will see through the PR and propaganda that Randolph Hospital regularly spews (someone recently called it the “cult of personality”). Then someone (or group of someones) will call these executives on their reprehensible behavior, and something will change for the better.

And of course, as I said earlier in the post, if we had state regulatory agencies or newspapers or law enforcement that were worth a damn, the community would've put this together before now, and shown these two carpet-baggers the door long ago.

As I've said in previous a previous post, people like Morrison and Eblin, who have lied before and gotten away with it (and profited from it), WILL LIE AGAIN. Doctors need to beware of this hospital's history when they consider entering into contracts & agreements. They've put too much into their training and careers to be treated the way I was.

Therefore, every hit on my blog profile is a tiny victory against Bob Morrison and Steven Eblin . . . and every single WORTHLESS pencil-pushing, butt-kissing bureaucrat that stood by and let them do it.

Hammering (get it?) JR a little more, where medical blogging is concerned, some of the best "hyper-local" medical posts I’ve ever read are from bloggers who do not post regularly . . . and who do not have big readership numbers. Dr. Scott’s recent heartbreaking post on “Just Practicing” . . . basically about giving up and leaving an area (and Pediatric practice) devastated first by Hurricane Katrina . . . then by governmentatl apathy and neglect . . . is one such example.

That was power in spades. The kind that haunts dreams. And JR, these stories are NOT making the newspapers.

I also felt Dr. Scott's pain as I read some of the comments on the post. Some people are just jerks.

As a hyper-local medical blogger. I am literally living Orac’s motto of, “A statement of fact cannot be insolent.” I’m not doing this blogging thing for “fun”. In fact, I’d rather not be doing it at all. I’d rather be quietly practicing Pediatrics in my thriving/growing ten-year-old hometown practice.

But I’m not.

My focus is what went horribly wrong for one Pediatrician in one small town in North Carolina. But my reasons for being in the blogosphere resoundingly demonstrate what is wrong with medicine and law on a much broader scale. It's a good case-study for textbooks in medical school and residency . . . something for others to learn from. Until someone plugs all the black holes I feel through during my ex-special ten-year voyage through public-service hell, I’m gonna be in people’s faces speaking facts . . . truth . . . to power.

On a larger front, corporately-sponsored, uber-medical-blogger, Kevin, says he wants "provocative" posts to feature. Well, Kevin, I don’t know of another blogger anywhere who routinely tells her own state Medical Board that they are a bunch of do-nothing, elitist snobs who can’t make a MOVE without their lawyer’s approval.

You see, Kevin, the North Carolina Medical Board failed this Pediatrician completey and utterly nine years ago, when they did not protect or defend the duties they required. Now, there is plenty of blame to go around. The Feds (NHSC) and NC Office of Rural Health both sat on their hands and let everything I’d worked for slip through their fingertips. Right and wrong did not matter. Ethics was YEARS from being anyone's concern.

I played by ALL of their rules and protocols. I did the dance of jurisdiction. NONE of it works.

I don’t care who knows it now. I don't care who it embarrasses. And an election year approaches.

The Board's legal staff has done NOTHING in nine years but try to keep what happened to me in Asheboro stuffed firmly under that rug. It grates even more now, given another experience in another nursery a little over a year ago.

Now, when the Medical Board could finally help me find some small measure of “justice” . . . when it DO SOMETHING to finally hold Morrison and Eblin accountable for their lies . . . and for their big swindle . . . the Medical Board would rather re-write the law than make a simple referral to the Attorney General’s office. It’s maddening.

Meanwhile, nobody but nobody in the mighty GSO-blogosphere-that-wants-to-be-relevant cares! The blogger-big-dawgs will not do anything to help a local doctor (one of their own) bring pressure on public officials to apply the law as it is written, and rectify a wrong literally in their own backyard.

Yet they'll STILL yammer and whine about what is wrong with primary-care medicine . . . and want to "debate" . . . all the while shutting out a local doctor who dared call them on their own dirty tactics.

They can't admit they were wrong and went too far.

Just like the guys in Asheboro.

For the Rochs and Eds of the world: One of my legal claims was about unfair trade practice on the part of a “non-profit” (supposedly held to a higher standard) . . . “tortious interference with contract”. My damages were about what my practice was worth . . . about what it was worth to RMA/Randolph Hospital to knock me down and keep me down. Lying about the "confidentiality" of your profits/losses (and the salaries of your doctors and yourselves) is material to the claim. It’s not rocket science.

Unless you're any of the lawyers involved . . . the one who lied to me about "punies" not being taxable . . . the ones who filed false answers on behalf of their clients . . . the ones (representing the hospital/Medical Board/DHHS) who would now cover it up now . . . and the ones (local and state prosecutors) who could fix it.

And it's a crime now. Not a civil claim. The Randolph County DA and/or Attorney General have the power to do something about that.

Let’s be even more "provocative". Until very recently, according to the NC Medical Board, it was just swell in North Carolina for doctors to participate in executions . . . a-okay for them to violate a physicians sworn Oath to “first do harm”.

Time and time again I’ve watched medical “collegiality” be defined as a medical community winking and nodding while an impaired and/or dangerous physician kept right on practicing. On the other hand, the definition of “collegiality” apparently does not include lending assistance to . . . or speaking up for . . . a competitor when he/she is down or being treated unfairly/in bad faith. “Collegiality” most certainly doesn’t include standing up for patients placed in harm’s way . . . or protecting medical whistle-blowers (i.e. your own) from retaliation.

Being more "provocative", I’ve watched good doctors . . . entire practices in fact . . . give up and/or get trampled by big corporate machines that do not give a rat’s tail who they hurt as long as the profit margins can be manipulated to make the suits’ production bonuses.

I’ve watched our WORTHLESS state Medical Society completely sell out to the hospital association and special interests. The big guns at NCMS KNOW what Morrison did to a doctor in Asheboro, yet they've plugged him and his Board members in their publications!?! It makes it crystal-clear that doctors are but nothing cogs in the corporate wheel.

Meanwhile, our politicians play lip service to ethics and fill their pockets on the side. “Non-profit” monster Blue Cross Blue Shield of NC gets to write its own laws about what mental illnesses is, and what it will and will not cover.

The “ordinary” guy and gal have virtually no chance and certainly no champion . . . especially not in hypocrites like John Edwards . . . Mike Easley . . . or Roy Cooper. Please note, they're all Democrats.

I certainly got the mother-of-all-lessons as I discovered that our legal system is a complete joke unless you have a whole lot of money, political connections, or you play on Duke University’s lacrosse team.

In this state, in this county, in the town of Asheboro, North Carolina, (especially if your run a "non-profit" hospital) you can just can put your hand on a Bible, flat-out lie and get away with it. It really doesn’t matter at all what you swear on.

And Bob Morrison & Steven Eblin continue to hide behind big-brother Cone Hospital, as well as the hospital gowns of those with cancer.

It's where the money is.

But let's be clear . . . their "legacy" is about more than a building.

And it is NOT something to be proud of.

*09:35 AM Update: Several edits (spelling and syntax) this morning. I had the night off and used it to write.

7/29 Update (8:50 AM): A friend of mine commented on the irony to be found in the way Morrison and Eblin have staffed their clinic over the years . . . in the "lean" periods after Pediatricians came and left through the revolving doors. They have hired Locum Tenens. Which, of course, means that they ultimately pay MUCH MORE for the physicians' services (in the way of reimbursement and mileage/car for the physician . . . and administrative fees for the Locums company - for housing and insurance and administrative fees). These "non-profit" business geniuses do this while I (still owning a home in Asheboro) make my living as a Locum Tenens everywhere else but home.

Your tax dollars and mine at work.

But they had to "win" at all cost.

Still worse, to this day, they hide behind the Board members (including several prominent physicians) and community/state leaders that shield them from accountability for their actions.