Medical Economics In Asheville And Asheboro: Hospital Administrators Manipulating/Crushing Doctors Is Just "Business"

Note to Housecalls Readers: I've reset the publish date on this post to 6/29 (as opposed to Sunday, June 27) as I want it to sit front and center on the blog's home page while I take a short break. It's gotten some traffic - probably because I'm way-beyond-done withholding names to protect the guilty. I've also played with it a little bit today and added some links. I'm working on several projects, including getting Randolph Hospital CEO, Bob Morrison to cough up some public information I asked for seven months ago (like so many CEO's these days, Bob has a CHRONIC PROBLEM with providing "honest services" and giving ordinary citizens information that he has no right to withhold. But it's a perfect demonstration of how twelve years of this young professional's life got sucked away- in small increments - by a bunch of self-important small-town bullies running my hometown hospital.)

Edward Martin, who writes for Business NC is one of those rare journalists who looks beyond who-is-who and the easy sound bite.

He actually interviewed me way back in 2006 . . . less than a year after I had entered the GSO blogosphere (at the behest of another bunch of journalists - who turned out to be blowing nothing but hot air) . . . about what happened to me in Asheboro . . . for an article he did on the arguments for and against malpractice tort reform.

My argument has always been that the medical profession will not get tort reform until it demonstrates to a skeptical/hostile public that it can do a much better job at policing its own. And in North Carolina, home to some of the nation's best medical centers, it just ain't happening.

Our Medical Board, run by lawyers, is a toothless joke. Really toothless. No, I mean really, really toothless. And our Medical & Pediatric Societies, too busy chasing reimbursements as the be-all-and-end-all of the profession's survival do not "do" individual advocacy. Stories like mine - which do not exactly showcase the inherent nobility of medicine - make the leadership very uncomfortable.

No one wants to admit that Marcus Welby is dead.

The sad fact is that for well-over-a-decade I've screamed for help until my vocal cords were raw in a professional vacuum encased by an almost impenetrable White Wall of silence that makes anything going on at the Greensboro Police Department look like a garden party.

Ed Martin's work is, of course, is offered in stark comparison to that of my own hometown newspaper, The Courier Tribune . . . whose publisher, David Renfro (married to Bonnie Renfro over at the Randolph County Economic Development Corporation) did everything he could to bury my story-of-woe.

We can't have anyone saying anything bad (albeit true) about one of Asheboro's biggest employers.

When Renfro ultimately could not totally bury the story (because Dr. Mary would not just tuck her tail, roll over, "get over it" and "go away"), he headlined it in a way to humiliate Dr. Mary and promote Randolph CEO/Bob Morrison's WARPED viewpoint . . . Bob's viewpoint being that the Bowman-Gray-trained, Board-certified Pediatrician with professional & personal ties all over the Piedmont - a woman who stood up to him/his left-hand man (Steve Eblin) in order to save the life of an infant whose care had been BOTCHED by a Family Practitioner (a Cone-owned physician that Randolph Hospital had falsely-marketed as something he was not) deserve to be fired . . . destroyed . . . slandered and libeled and drummed out of town.

And in all honesty, all of that was very easy to do . . . to a young physician-barely-free-of-two-and-a-half-years-of-indentured-servitude-to-both-the-state-and-Federal-governments . . . a young physician employed by Randolph Hospital's "controlled affiliate" . . . a young physician living in a mill-town and a "right-to-work" state . . . a young physician who simply could not be allowed to establish her own private practice (as her agreements with the state & Federal governments were supposed to allow her to do) and compete with either the hospital's "controlled affiliate" or the well-established family-practices in Asheboro . . . populated with well-named & well-connected physicians who (prior to letting her get kicked to the curb) had never thought twice about calling in the Pediatrician to clean up their messes . . . so they could get back to the office and make money.

Pushed into every ugly corner by people who were just using her to their own profitable/selfish ends, Dr. Johnson, on back-up call 24/7 for everyone, wasn't ever supposed to be human . . to show her frustration/exasperation or get testy or be just plain exhausted. No. She was supposed to just absorb every sling and arrow . . . demurely smile and say, "Please, Sir, may I have some MORE?".

And/so, Dr. Mary Johnson, the very first physician recruited to Asheboro under Bob's campaign to populate Asheboro with doctors that Randolph Hospital more-or-less "owned", was also the first of a mass exodus of young professionals who became disenchanted with "the team's" heavy-handed, suck-up-to-the-"right-people"-ways.

But Dr. Johnson's exit wasn't because she decided or wanted to go.

It did not matter that this particular Pediatrician was raised in the town, and, after a year of soul-searching, had come home with the intent to stay (nobly thinking that maybe she could prevent what had happened to her at Randolph from happening to other children). No. Dr. Mary Johnson had committed the unpardonable sin of stepping outside of the mill town box - of not knowing her place . . . and she was a threat to Bob Morrison's status quo.

And if anyone, including Dr. Jim Kinlaw - the man who laid the bait to bring me home, tells you otherwise, THEY ARE LYING TO YOUR FACE (something this hospital is very good at).

Indeed, if he's asked, good "Christian" Jim is gonna smile and side-step and try to throw you off the fecund stench-of-it-all by telling you that Mary is "a little whacky" (never mind what his partners said). But don't EVER kid yourselves about what really happened here. What Jim Kinlaw (a "most-favored" doctor who served on Randolph Hospital's Board-of-Directors) sat back and allowed to be done to one of his young colleagues had NOTHING to do with "normal turnover", and everything to do with preserving his own white-bread "market share".

You see, in the fair mill-town of Asheboro, one does not challenge Bob Morrison - or his hand-picked buddies on Randolph Hospital's Board of Directors & Corporate Membership (fine, upstanding people like Bill Redding and J.B. Davis and Keith Crisco and Mike Miller and Jim Kinlaw - I've left out more than a few but you get the drift). NOBODY talks back to these people - not even young professionals who know their stuff. And if you do, you are toast.

Ergo, it's the reason that these days I tell young medical professionals checking the place out to "Run, Forrest! Run!!!" from any job offer in Asheboro.

From that standpoint, Google is a wonderful thing. These newbies don't have to look very far to know that Steven Eblin thinks, "Good Pediatricians are a dime-a-dozen" . . . or that Asheboro has certainly treated them that way.

[I know it's been twelve years, but I've always wanted to look Eblin in the eye and ask him, "How's that dime-a-dozen theory working out for you, you OILY, CLUELESS, ARROGANT ASSHOLE?".]

Before we continue, let's be clear on one thing. It was NEVER about the money for me. It was about the principle of being crap-canned by a bunch of greedy morons (after working my butt off for nearly three years in order to build something we all could be proud of) . . . all because I didn't play the "right people" games and roll over/go back-to-sleep/let a baby die . . . and was not inclined to let the guy who screwed-up off the hook.

It was about about the catch in my Mother's voice when I first called her to tell her I had been fired . . . and (later) the pain in my Daddy's eyes upon reading in his hometown newspaper that the liars running the local hospital had added insult to injury by calling his daughter a liar.

It was about EVERY regulatory body and state/Federal agency that was charged to care NOT CARING one bit about what had been done to me . . . and DOING NOTHING to fix it.

It was about watching my friends & colleagues leave town one-by-one as their hopes for something very special in a Mayberryish setting died . . . about seeing so much promise rot on the vine because NO ONE had the guts or the moral fortitude to stand up to Bob Morrison and Steven Eblin.

You see, back then (1998) was not now. Incredibly naive and stupid (to believe that "the system" would protect and vindicate me), I played by all the "collegial" rules you were supposed to play by. I quietly filed the complaints with peer review and the Medical Board and JCAHO and DHHS (i.e. keeping the medical ugly behind "the veil") and relied upon the system to check & balance itself. I kept my mouth shut in public venues . . . and let my (as it turns out, negligent/useless) lawyer do the talking to the press. And I turned to the Courts.

But the sad fact is that even when I technically "won" (but not really), I lost. And that was mostly because the local press was asleep at the wheel.

You see, my "vindication" in civil Court did not grab the hometown headlines that being called a liar (ironically, by liars) had. The (as it turned out fraudulent) settlement in my favor was "reported" as a second-page short-take - as throwaway news. Indeed, many of my parents' friends would not have known about my legal "victory" against the hospital had my parents not told them. And God knows most of my patients' parents never got the low-down. Thanks to the Courier deftly covering Bob's tracks, from their viewpoint, Dr. Johnson had disappeared from the landscape - and abandoned them. The practice/hospital executives (wanting to keep "the business") most certainly had not told them the truth . . .

. . . and Asheboro's newspaper was the LAST place on the planet where they would find the truth of what really happened to their child's doctor . . . a doctor brought home with . . . and then eviscerated courtesy of . . . their tax dollars.

And/so, to this day, although she maintains a home in Asheboro, Dr. Mary makes her living on the road. It's a much harder living than the one she envisioned. And very, very lonely. And it's also VERY STUPID in terms of the bigger picture . . . because she could be doing the same thing she's doing on the road in her hometown . . . were it not for a bunch of bullies encased in Teflon that would be the envy of Ronald Reagan (may God rest his soul).

Yet Dr. Mary's classmates-still-in-Asheboro cannot understand why she's not tripping over herself to get to that high-school reunion.

Alas, the big dawgs in Asheboro can NEVER, EVER admit that they screwed up. They cannot make amends unless they are dragged to it kicking and screaming (I will be working on that later this year). It's just not done. A friend of mine, a young professional also raised in Asheboro, and who also came home only to be treated very badly, likens these men and the shows they put on (we've both heard the, "we're partners" thing before) to the "dance band on the Titanic".

But that's the way the Bill Reddings and Keith Criscos and J.B. Davises and and Mike Millers and Bob Morrisons work. They sit on the Boards and crush people's lives (using someone else's money if the can) as they collect their phat paychecks, and live VERY well, and laugh at their inside jokes about "Crazy Mary" at their carefully-staged/scripted healthcare forums. And we-the-ordinary-people, paying for a bad party, are supposed to be grateful for the crumbs they throw, and clap when they give themselves awards.

The problem IS that Dr. Mary isn't crazy at all . . . never was. She was just true to herself, her Oath and THEIR MISSION.

I've digressed. Let's get back to Ed Martin - who probably is my favorite journalist ever . . . because he does not cower or run from the ugly-of-medicine . . . because he openly challenges the notion that it takes a hundred years to change anything of import in the profession.

Here's the excerpt from Martin's 2006 article, entitled "Athwart Torts" (referencing a story yet to be told by the Courier Tribune or the Greensboro News & Record). During the interviews, conducted by phone, Martin could not have been more gracious or understanding of my predicament . . . willing to get beyond the soundbite and hear explanations . . . never putting me down or on the defensive:

Many (malpractice/personal injury) lawyers paint it in a word: scary. They scoff at opponents' claims that competition in the marketplace and government regulators protect the public. Asheboro pediatrician Mary Johnson offers an example.

The setting is Randolph Hospital in 1998. She answers a page from a nurse, but by the time she reaches the newborn unit, a baby is blue from the chest down and in shock - dying. "I've been cleaning up messes like this right and left," she thinks. As she struggles to clear bile and other wastes from the child's lungs, she decides to file a complaint, alleging incompetence and lack of training of the attending physician, with the hospital's peer-review committee. Such panels, which operate out of the public eye, are supposed to be the first line of defense against bad doctors. The baby, rushed to a larger hospital in Winston-Salem, survives. Johnson, who says she had been told by administrators not to complain about other doctors, finds herself the center of controversy. "Two weeks later, I'm out of a job fired."

Complaints to the N.C. Medical Board, the state agency that licenses and disciplines doctors, fell on deaf ears, she says. No fan of lawyers she also filed complaints with the State Bar alleging misconduct of hospital lawyers during the dispute - she nevertheless says peer review is, in her words, a joke. "There's little or no protection for doctors who blow the whistle." A hospital spokeswoman, citing confidentiality rules, declined to comment.

Bob and Steve always draped themselves in privacy and confidentiality. It's very convenient to use something that's supposed to protect patients to shield themselves.

Anyway, Ed Martin had a new story out in the April 2010 edition of NC Business Week - this time writing about the ouster of the CEO of Mission Memorial in Asheville, North Carolina.

The only reason I know about the article is because the CEO of the rural hospital where I currently work had the cover of NC Business's April edition proudly displayed on a hospital bulletin board . . . since the hospital where I currently work (along with its parent company) was listed amongst North Carolina's best hospitals in several aspects of patient care.

Randolph did not make any of those lists. (Cue meow.)

The kind of stories that Ed Martin is writing DID NOT EXIST fifteen years ago . . . or even ten years ago. And they're still very rare now.

But they are getting written now. And Martin does them better than anyone else. Describing Mission Memorial, he could have been describing any mid-sized county hospital in North Carolina . . . including and especially, Randolph:

“Historically, 20 to 25 years ago, physicians were the No. 1 go-to for hospital administrators. They had a much larger say in the management.”

Then, most hospitals stood alone, governed by rubber-stamp boards of businessmen and run by CEOs hand in hand with local doctors whose portraits would hang in the hallways after they died. Hospitals rarely competed.

But, as Martin goes on to write, things change. More physicians are employed these days. And over the years, smaller hospitals have sold out to conglomerates . . . or merged into networks . . . or forged "cooperative relationships" . . . in my case, the kind of relationship that allowed Bob Morrison and Steven Eblin to sacrifice a homegrown Pediatrician who did the right thing by a patient - in order to stay in the good graces of the larger hospital (that would be the Moses Cone Healthcare System) which then "owned" the FP who did the wrong thing.

[As I've noted on Housecalls before, according to the former Director of RMA (Mike Bridges), "his" Pediatricians were supposed to refer all of their patients to Cone (instead of Brenner's) too. Never mind that requiring phyisicans to refer to one institution or another as a condition of employment is illegal.]

According to the article, Misson's CEO, Joseph Danmore, like Morrison & Eblin, was a fan of buying up practices - and/or forming hospital-owned entities (which would then compete with existing private practices - not exactly endearing the hosptial doctors to the existing private practices) . . . of keeping physicians under "control" by employing them.

There's a big upside for executives. In a "right-to-work" state, employed doctors (already second-class members of the medical staff) who prove to be "disruptive" can easily be disposed of.

The thing about that is that doctors don't school & train for (at the very least) eleven years . . . or do the indentured servitude to pay off their loans . . . only to come out and be treated like Darth Vader's drones. It ain't Star Trek and my shirt isn't red.

Danmore's tactics turned doctors off - to the point that nearby smaller hosptials aligned themselves with Mission's larger competitor - and a Trauma Surgeon resigned (Trauma Surgeons being much more important to a hospital's bottom line than Pediatricians).

It's fascinating reading, especially given that I've worked in western North Carolina and witnessed the politics first-hand. And I could continue to summarize, but I would invite you to read Martin's piece . . . since, as a journalist (and unlike the David Renfros and John Robinsons and Edward Cones of the Piedmont), he saw relevance in things going on right under his nose.

The story even includes a blog.

I wish blogs had been an option way back when - a place where my parents and colleagues and friends on the nursing staff could go (as opposed to a tone-deaf newspaper). I think the medical landscape in Asheboro (and my life) would have been very different.

As it is, I'm blogging about history (unless, of course, I sue somebody) and the winners write the textbooks. (God knows that Ed Cone-of-THE-Cones and "Mr. Citizen Journalism", John Robinson are not going to bite the hand-that's-fed the trust fund and the advertising budget.)

Make NO mistake, Bob and Steve won. Because they did not play fair and none of Asheboro's "right people" (Davis and Crisco and Redding and Kinlaw and that ilk) called them on it. Nor did all the noble folk in public office - you know, the people who keep telling us they'll stand up for "the small people". And the area's MSM journalists moved off the fouth estate for more comfortable digs long ago (it's working out for them about as well as the "dime-a-dozen" theory did for Eblin).

Destroying Mary's life in Asheboro was just "business".

The thing about that is, if you screw enough people over, doing your business is a whole lot harder because no one wants to do business with you. [It's a theory that North Carolina's current Commerce Secretary (formerly a member of Asheboro's City Council), Keith Crisco, has yet to grasp or appreciate. I'm pretty sure Keith once served on Randolph Hospital's BOD or Corporate Membership. But, of course, Bob Morrison has not been willing to provide the lists.]

Make no mistake, Randolph Hospital has a reputation. It's not a good one.