Monday, July 18, 2022

Taking Back Medicine

I am currently trying to decide how this blog moves forward - and if continuing to publish here is the best way to move forward.  The content and subject matter is just too detailed/complicated for many folks to follow.   A few long-standing posts (detailing my adventures with corporate medicine as a medical whistleblower abandoned by the Federal government) have been archived for now.  Others remain.

For instance, I like to remember how idealistic I once was.  

Last year, I lent a lot of support to my local County Commissioners' plan to "save" my (bankrupt) hometown hospital (Randolph Hospital in Asheboro, N.C.) . . . never mind every-underhanded/dirty thing that their executives did to destroy me . . . a long time ago . . . in the days of "Hillary's Village" . . . immediately after completing a stint in state/Federal service (the National Health Service Corps) . . . all for answering a terrified charge nurse's call, rescuing another physician in WAY over his head, and saving a newborn's life.  

It was about shutting me up.  

The Cone-owned MD who screwed up was promoted to Chief-of-Staff.  That's how it works.

The greedy SOBs running that place dared called me a liar.  They made it a headline in my own hometown.  They ultimately had to RUN from that miscalculation.  

Those same execs, who made out like bandits for years - eventually drove the hospital into the ground.

More than anyone, anywhere, I had the right to want to see Randolph's doors padlocked shut. My reasoning in not giving in to that visceral feeling was that the people of Asheboro deserved a hospital - even if the hospital itself did not deserve to be rescued. 

The jury is still out on that "rescue".  I don't like everything I've been hearing (through the community grapevine).  But it's a work in progress.  There were not any other options.

Younger doctors are starting to wake up to the dangers of corporate/private equity medicine in larger numbers (they're late to the party - as nurses showed up first).  

The young guns are slowly arising from their progressive/idealistic/heavily indoctrinated/largely ignorant slumber because many of them are now being brutalized after they graduate - and/or their practice environments in the real world are being turned to hell-on-earth . . . while "the suits" make billions.  

In all reality, they really have no future if nothing is done.

In terms of being brutalized, been there done that.  Four times since 1998.  Each time "let go" (the nice term) "without cause" (meaning not vetted by my medical peers - but because some-angry-someone in "corporate" wanted it so).  All blogged about right here on Housecalls.  Randolph was first.  Then Vidant.  Then Ballad Health. Then Duke Lifpoint (during the pandemic).  

They're all medical horror stories (at least from a doctor's point-of-view) . . . stories that most folks have trouble believing when provided with the details . . . and most doctors have only endured once (just call me the Energizer bunny).  

Three were medical whistle-blower situations - in which I literally intervened to save a newborn's life after someone else's blunder.  The fourth I have never been able to process as anything put pure corporate evil - the vicious brutality and cruelty of which almost killed me.  

I still walk with a limp.

My heart was stomped to pieces in each case.  Years of hard work were negated.  Belief systems shattered (let's just say that after Vidant, I'm no longer "woke").  Dreams destroyed.  It's amazing I did not put a bullet in my brain. How many times can you give your all and be crucified for it?  

Everybody thinks doctors are so powerful.  But if we're employed or (worse) contracted, we're NOTHING and no one in the great scheme of things.  And everything's a damned $cheme now.

I laugh when executives talk about burn-out now.  They have NO IDEA what "on-call" in some of these places actually means.  And all their talk/"concern" means NOTHING.

For example (from years ago), I've stood ALONE in a room, "bagging" a dying baby whose scalp was nearly ripped off with a vacuum extractor way too aggressively applied (the baby's Mother was a G1 immigrant who spoke no English) - by a doctor who was late to a party.  Blood everywhere - on the walls and the floors - a trauma code in the nursery.  Nurses scattered everywhere but there - trying to put out the fires/staunch the Mother's bleeding (from her injuries).  Praying to God that He would help me save the very-much-wanted newborn who didn't have a say in the crap care that was "delivered" (He did - the baby survived with minimal sequelae).  

If I survived THAT (I quit that job and reported the OB to the Medical Board - the matter is public record), you can't kill me.  

You WON'T.

Not-so-fast forward a decade or so, to another small-town hospital, run by private equity:  Last month, I filed an administrative claim against NCDHHS/CMS (the Center for Medicare/Medicaid Services) under the Federal Tort Claims Act (FTCA) with regards to the so-called "investigation" they conducted at Central Carolina Hospital in Sanford, N.C. (owned by Duke Lifepoint - in turn, owned by Apollo Global Management) in June 2020 (revisited in April 2021).

That "investigation" was based (at least in part) on a complaint I filed in January 2020 - after a morning when I was pushed WAY too far (as a Pediatrician who took an Oath) - and I realized that if something didn't change really damned fast, a child would likely die on my "watch".

Apart from the basic morality and ethics of it all, I was required by contract to report. 

Nevertheless, I was fired 2 days after sending the original (internal) complaint - to the then-CEO of CCH, the Chiefs-of-Staff-and-Service, and the Duke Quality Network.

The case/"investigation" is public record (see link below) - a record that vindicates me.  So let's actually talk about it.  

I walked into an AM shift change to find an actively-seizing baby who had been placed to breast after an inadequate resuscitation AND despite declining Apgars.  A Pediatrician was not immediately called in (in stark contrast to my Pediatric Director, I would have been in-house and readily available - not almost 30 minutes away).  

About an hour later (give or take) it was noted that the baby was seizing.

Translation, the baby was not remotely properly stabilized.

Never mind basic NRP.  According to CMS policy (which the people at their desks in Raleigh and Atlanta are supposed to KNOW - not be spoon-fed) it's also an EMTALA violation.

When I arrived in the nursery, approximately two hours after delivery, the nursing staff was in meltdown (they had been understaffed the night before), they still did not have a line on the baby, no one had done a blood sugar (?my Pediatric Director was there?), and UNC had not yet been contacted for transport.

I took over the child's clinical care, got the (umbilical) line, gave the meds and got the baby out - stable and alive.

In the aftermath, it was NOT something that I could just let go/pretend did not happen.

Let's put it another way, if this were YOUR child or grandchild, would you expect me to report - or remain silent?

It was, for all practical purposes a JCAHO "sentinel event" - a "near miss" - and all of the other "nice" terms the regulators use for screwing up.  It's also the kind of thing that puts medical/nursing licenses (and supposedly accreditation/Medicare & Medicaid participation) on the line if you do not self-report.

I had to talk to someone.  But there was no de-briefing of the staff after we got the baby out.  I tried to go up the hospital's chain-of-command. My Pediatric and LDRP Directors were dodging me (it was not the first complaint about our clinical response that I'd lodged over the prior six months).  So, I went directly to the CEO.  The guy who was making all the god-awful/cheap decisions that put me in the crap situations.  The CEO who had told me that his damned door was always open.  

The guy who pretty clearly lied to my face.

Then, ON THE ADVICE OF ANOTHER DOCTOR, I went to the Chief-of-Staff and Chief-of-Service.

I had previously spent two years living/sleeping for half-the-month-every-month in a call room that reeked of the smell of human waste (from sewer pipes backed up with black goo) - holding CCH's Pediatric service together with spit, bailing wire and sheer force-of-will.  Resources and staffing were progressively decimated by administrative edicts - and the cracks-in-care/safety were putting my patients (who are babies) in harm's way.  I had not gotten an apartment in Sanford because I was afraid to leave the unit at night. 

But despite that dedicated service (and cleaning up this particular god-awful mess - after so many messes before that), the CCH CEO/DLP/ApolloMD decided that I did not deserve any consideration.  There was no discussion of what I reported.  No recourse pertaining to their action against me.  I was fired over the phone on a Sunday night (at the CEO's request).  And forced to work out a "without-cause" notice.  

It's just NOT what CMS and JCAHO tell the world is supposed to happen when a doctor or nurse files a report.  "Leading the way to Zero" (patient harm) and all that jazz.

When I finally called the state/Feds - and filed a report - I did not hide behind "anonymous".  I signed my name.

To make a long story very short, let's just say that the NC Department of Health and Human Services (which basically set me up as an in-house "snitch" for months) took its sweet time about showing up (hiding behind the pandemic as it bore down), actually "LOST" reports I sent in (they were replaced), and left out A LOT in its site survey (although they did identify the case that pushed me to report as a deficiency in care - if not the EMTALA violation it actually was). 

By the end of that "notice", CCH could not even properly feed a newborn.  It says so - right there in the state's report!

I was not even interviewed in person - with the record in front of me - during the government's "investigation".  

And NCDHHS/CMS's failure to take decisive "immediate jeopardy" type action placed other babies in harm's way.

Later on, when challenged, CMS investigators in Atlanta just kept shoveling over my dead body - to cover-up what Mandy Cohen's NCDHHS team had neglected to even properly examine . . . most notably the EMTALA violation . . . along with the glaring deficiencies in medical oversight & governance, quality assurance/patient safety reporting protocols and medical peer review (there wasn't any).

They appeared determined to dodge the small matter of retaliation against their reporting physician - who had done what she was supposed to do.

In corporate medicine, an executive can decide to "kill" a doctor, and you are just dead.  No one in Washington or Raleigh has done anything to protect physicians from this kind of thing - particularly not when Obamacare was passed and the corporate raiding of healthcare subsequently went on steroids.

One of those "investigators" in Atlanta essentially told me IN WRITING that Pediatric patients/newborns did not matter - because they were not Medicare patients!?!

And I'm sorry.  That's just (insert expletive referring to bovine excrement).

Here's the kicker/very sore spot:  NCDHHS/CMS actually identifying the EMTALA violation would have afforded me protection as a whistleblower under Federal law.  

To add insult to injury, those same CMS "investigators" methodically/seemingly determinedly IGNORED repetitive acts of retaliation (by Duke Lifepoint) that took place right under their noses . . . acts that amounted to witness intimidation and interfering with a Federal investigation.

Blacklisting their reporting MD (illegal in North Carolina) was cool with CMS. No referral to the NC Attorney General. And vindictive/frivolous/retaliatory complaints to the Medical Board (filed by an angry CEO trying to cover his tracks - without ANY justification/due process action by his Medical Executive Committee or BOD to back it up) - filed while CMS investigators were IN "HIS" HOUSE (!?!) - were just fine with the purveyors of patient safety at NCDHHS and CMS.  No referral to the USDOJ.

[To their credit, the NC Medical Board did not play - perhaps because anticipating what the CEO might try (going after a doctor's privileges or licensure is a common tactic to discredit medical whistleblowers), I had self-reported what happened (to the Medical Board, and NC Medical/Pediatric Societies, and Academy/Board of Pediatrics) - and did not pull ANY punches when I did.]

Other doctors and nurses at CCH were scared for their jobs/livelihoods/licenses - and were leaving in droves.  CMS KNEW THIS - they HAD IT IN WRITING.  They even had a copy of a formal/internal CCH report identifying a culture of retribution on that LDRP unit (for reporting bad things) as a problem - long before I even took the job!?!

But ALL of the vicious retaliation was LOST on these people.  These state/Federal employees did not care.  With their publicly-funded 9-5 jobs intact, rarely leaving the comfort/protection of their offices while doctors and nurses did the "hero" bit, they kept shuffling paper from desk-to-desk as my life BURNED - because I did the right thing by my patient.

They told me (no job/savings depleting) to hire lawyers (to fight their battles - against billion-dollar companies - lounging behind liability shields) . . . but gave me NOTHING to take to the lawyer.

Please tell me, if the doctor (or nurse) doing the right thing is not protected by the state/Federal governments, WHO PROTECTS THE PATIENT?

It for sure AIN'T the "Duke Quality Network".  Or Alan Levine/Scott Niswonger before that.  Or David Herman before that (he was a REAL piece of work - just ask the folks in Belhaven).  Or Bob Morrison/Steve Eblin before that.

Referencing all of the above, destroying good doctors' careers, decimating community Mother-Baby/Pediatrics units, snowing federal agencies and state health departments (for the COPAs/monopolies they would approve), closing/bankrupting community hospitals . . .  it's all in a day's work for many of the "suits" of medicine.  They plunder and rape their landscapes for the fastest buck.  They collect their phat checks.  They don't care who they destroy in the process.  They move on.

Doctors, nurses, patients.  We don't matter.  We're numbers on a spread-sheet . . . the "surplus population" Scrooge bemoaned before his redemption.  

According to the bean-counters of medicine, an experienced/seasoned/board-certified MD is easily replaced by the next medical student/resident Atrium spits out of its bright shiny collaboration with Baptist . . . or (better yet - because they come cheaper and are easier to control/abuse), an "advanced practice" nurse (at least that's what my former Chief-of-Staff at ApolloMD told me).

I am not the only doctor fighting back now.  Grass-roots efforts are taking form (particularly on social media) to fight off the corporate evil that has invaded medicine (and permeates its every pore) . . . largely because the Federal government (USDHHS, CMS, the FTC, etc) has long turned a blind eye.

Now, CMS apparently wants to shovel over that too.  There is ZERO accountability.  It's despicable.

It has to be a "grass-roots" effort now.  Because the American Medical Association, and American Academy of Pediatrics, and ALL of the specialty boards sold us out long ago - for their place at the big-money/political tables.  In terms of genuine advocacy for their membership, they've been useless for decades.

It's both heartening and (oddly) discouraging to know that I am no longer alone in the fight/grass.  

Because I have been at this a LONG time . . . tilting my sword at the reflections in the windows of the medical glass palaces/C-suites . . . plodding along in the ether (either here or on Facebook) . . . longer than almost EVERYBODY now tik-toking and twittering and building social media platforms/networks - acting like no one's ever thought or said what they're saying and thinking.  

Burn-out?  Moral injury?  Puhlease.  It's WAR.  And the doctors who actually give a damn about something besides money are losing.

Back in the day, when this blog started, no one (including KevinMD - today's "voice" of medicine) really cared about one lowly Pediatrician's battles on the front lines of medicine.  Better-placed colleagues looked away.  They stayed silent.  They went along to get along.  

Medicine's version of "collegiality" was the hardest pill for me to swallow after years of soul-crushing work, isolation and sacrifice.  

But NOW "the dark side" of medicine is affecting more physicians more personally . . . THEIR care, THEIR careers, THEIR lives, even THEIR loved ones.

The club is getting bigger.

In 2020, repeatedly shot as the messenger, I was once again abandoned on the field of battle - to bleed out.  

Except that I didn't.  They couldn't kill me.  I've gotten up.  Every time.  When there were no jobs, I took care of my Mama - who faced two surgeries during the pandemic.  If I couldn't do anything else, I could at least keep her out of a nursing home - where so many people were dying - because the billions in healthcare profits didn't make it to their bedsides.

I was out of work for over a year.  But my particular knack is always getting back up and going back to the work I love - to do what I was born to do.  

And I am working again - with a group of good people who really care - for a hospital that has yet to fall to merger-mania.  If they succumb, it WILL be a hard fall from grace.

I survived.  Just barely.  But still, how long did I SCREAM for help on this blog?

And what was it all for?

Even a pandemic hasn't fixed what's wrong.  No one learned ANYTHING.

Can medicine really be taken back?  Is it the heart of it too injured?  Are we just empty shells?

7/20/2022 Update:  Even if the Center for Medicaid/Medicare Services (CMS) was ASLEEP AT THEIR WHEEL, at least the U.S. Department of Labor was paying some small attention to the goings on at Central Carolina Hospital

The trouble is that doctors are considered "professional labor", and generally get ZERO protection from the government when they are done dirty.  

I actually learned this the very hard way when East Tennessee State University (ETSU) literally sold me over a state line as "medical slave labor" to Alan Levine (who has a long history of lying for money)/Ballad Health back in 2015-17. . . under terms I never/ever agreed to.  Long story short, I did 110 overtime shifts in less than a year due to insufficient physician staffing by Niswonger/the university (we were 1 1/4 doctors down) - but was not paid for 30 of them due Levine's creative/convenient "interpretation" of a contract addendum (after the fact of me working the shifts) - under the cover of two (TN/VA) COPAs (which created Ballad's regional monopoly), and right under the FTC's nose.  I was paid LESS to work overtime weekends.  The corporate "reasoning" for treating me like that was just INSANE.

NO ONE in state or Federal government "oversight" cared.  Scott Niswonger did not care (I wrote him - begging for help). The children's hospital bearing his name got all kinds of lovely funding from Ballad - Alan Levine had to be kept happy - what was the life/career of one doctor to him?   

And, as he cruelly short-changed me for my soul-sucking bedside work, Ballad CEO, Alan Levine, paid himself a bonus for working on the merger.

There is whole lot of HINKY going on with corporate medicine in central and east Tennessee - where Ballad and Lifepoint are both based.  The "boys" are all in bed together.

As for Central Carolina, the NC Attorney General's office DODGED (I had to contact Josh Stein myself) . . . completely ignoring the small matter of the "corporate practice of medicine" . . . i.e. a Georgia-based staffing company (ApolloMD) firing a whistle-blowing physician upon the demand of a Lifepoint CEO . . . without benefit of fair review or due process.  My case was sent to the NC Department of Labor.  But I've not heard one word out of anyone there.

As per usual, money is more important to the Federal government than the medicine.  Employee lunchbreaks are more important than a contracted Pediatrician (literally "living" at the hospital) being professionally crucified for reporting an EMTALA violation.  I spent MORE time in that hospital than ANY employee there - INCLUDING my own Pediatric Director - AND the Chief-of-Staff who thought I could be "replaced by a nurse".

"Duke" as Lifepoint's "medical parent" - charged with oversight - was NEVER in that building.

And the government, on its white horse, NEVER really showed up.  It was all a show.

7/22/2022 UpdateA Facebook friend brought this article (on CMS's attempts to bury pandemic safety data - most, if not all of that applying to adults) to my attention. 

It should be noted that my concerns about NCDHHS original/stalled "investigation" of Central Carolina Hospital/Duke Lifepoint wound up on Fleisher's desk.  I was blown off.

The CMS Director (in Atlanta) who "oversaw" that original state survey was basically allowed to investigate herself.

Do you think that office is going to admit they screwed up?

From the article:  "The people who were harmed during the pandemic deserve to be accounted for . . . "

Well, not all of them were patients.  And sometimes, even the patients don't know what really happened.  Do you think the parents of that seizing baby were told what really happened by anyone at CCH - while I was at the child's bedside, cleaning up the mess?

Medical Whistleblowers - of ALL ranks - employed and contracted - deserve protection from the Federal government.  The US Department of Health and Human Services and CMS have ignored the issue as a matter of policy/regulation for literally decades.  

For instance, they should be telling hospitals, "If we catch you retaliating against a doctor or nurse or ANYBODY ELSE reporting a problem, your ability to bill Medicare/Medicaid - and your JCAHO accreditation - go out the window".

Instead, they crane their necks to look the other way.

It's been a giant black hole in reform legislation since day one.  Shooting the messenger has become corporate sport.

We came forward by the thousands during the pandemic.  Instead of protection and help, we got liability shields protecting our tormentors, short-staffing and profit-mongering.  We got Lee Fleisher trying to bury the data that might back us up.

WHY isn't this getting fixed?

8/2/2022 Update

Merrick Garland's latest move is RICH given what Duke Lifepoint put me through in 2020 - when I intervened/reported on behalf of a baby who was WANTED (long before Roe fell) . . . . and the government just stood by and watched.

For EMTALA does NOT just apply to Emergency Departments.

When I reported an in-your-face EMTALA violation to NCDHHS/the Center for Medicaid/Medicare Services, the Federal government placed the burden of identification and enforcement ENTIRELY on me, as the reporting physician.

They went so far as to say that Pediatric patients/babies did not matter at all in the great scheme of EMTALA enforcement.