Monday, July 16, 2018

What Profit Is There To Be Found In One Pediatrician's Two Decades Of Wandering - And A Hospital's Downfall?

This post has been updated.  Scroll to end.

I've not blogged in a very long time.  But it does seems to be TIME to pick the pen back up - at least once.  It's time doctors were really heard - and their experiences in the trenches of medicine assessed by those who make policy.

Twenty years ago, executives running my hometown hospital (Randolph Hospital in Asheboro, North Carolina) fired me just two weeks after I answered the call of a terrified charge nurse and intervened in a "bad-baby" case being managed by a Cone-Healthcare-employed Family Practitioner.  After I stabilized the baby and shipped her to North Carolina Baptist/Brenner Children's Hospital, the doctor I "rescued" trashed me to the baby's parents - falsely alleging that I had somehow caused her harm - when, in fact, by ALL accounts, I saved her life (the Randolph nursing staff - as well as former colleagues/teachers at NCBH - quickly set them straight on who really was responsible for their medical nightmare . . . and it wasn't Mary Johnson).

As an aside, to this day, I get a Christmas postcard from the baby's grateful parents - featuring a just picture of the family - but on any number of bleak mid-winters, it's been what kept me going.  A few months ago, I ran into the Mother/daughter at Church and found out that the now-very-accomplished-young lady is studying to be a nurse.  And I went home and cried.  Really bawled.  She will make such a huge difference with her life - as I have tried to do with mine.  And it was all WORTH IT.  I would do it all again.

Moving on . . .

Now, I don't mind rescuing situations/people.  But the professional libel I simply could not abide.  The next morning, I reported what had happened to hospital Peer Review.  Medical Peer Review is a quality-of-care/internal safety activity supposedly protected by law.  The problem is that those who serve on such committees are protected - but those who blow the whistle on bad care are not - no matter what the "safety managers" say.

I've been schooled on that more than once over the years since - very recently (last year) enduring a near-exact replay of what happened in Asheboro - courtesy of publicly-supported systems that should know better - but whose executives know that the government rarely does anything unless (1) there's a money-trail defrauding the Feds, or (2) a patient dies.  Unfortunately, in the great scheme of things, money is more important than death.  My most recent experience is another story for another time and place.  The bottom line is that in medicine, whistle-blowers (protecting patients instead of reporting fiscal irregularities) are thrown under the bus - and backed over.  "Reform" didn't fix it.

In Asheboro, I had just completed concurrent two-year service obligations to Asheboro/Randolph County, through the National Health Service Corps and the NC Office of Rural Health.  In other words, the state and Federal governments had paid off my medical schools loans to recruit me back home - and KEEP ME THERE.

But Randolph Hospital executives basically spat in the governments' faces . . .  as they stole the practice I had started/built-from-scratch out from under me . . . and LIED to everyone (including their Board of Directors - who lapped it up) about what they had done - and WHY.

Asheboro was . . . and still is . . . my home.  I sued the practice I worked for (Randolph Medical Associates - a wholly-owned affiliate of Randolph Hospital).  In the meantime, I made my living as a Locum Tenens physician - traveling all over this state and several others - contracting out my services to staff offices, practices, clinics and hospitals.

I also provided feedback on Randolph's operation (requested by the Federal government I had served) DIRECTLY to then-US Department of Health and Human Services Secretary, Donna Shalala (that would be the Clinton administration - aka:  "Hillary's Village").  Of course, the Federal government, while finding merit in my complaint, did not lift much of a finger to help me - or enforce their own agreements.  Randolph Hospital finally paid my malpractice "tail" . . . over nine months after asking for my Congressman's (Howard Coble) help.  But that was about it.

The government had false teeth.

It was a swamp.

In retaliation for filing suit and singing my song-of-woe to the Feds, the hospital dropped a SLAPP (Strategic Lawsuit Against Public Participation - actually now illegal or at least legally-curtailed in a number of states) on my head - in an attempt to empty my bank account (paying interminably sluggish/less-than-brilliant local lawyers) and get me to drop the lawsuit.  The headline in my own hometown newspaper (lapped up the hospital's press releases as "gospel") was that I was a "liar".  My parents got to read that.

It's something one NEVER gets over.

But it did not work.  In fact, that stunt only fueled the fire.  It was about honor.  I fought tooth-and-nail to a trial date - and then, settlement.  Randolph's hospital executives, namely Robert Morrison (the old CEO) and his VP of Corporate Planning and Development (Steven Eblin - who ultimately became CEO), had to tuck-tail and RUN.

For the record, I did not agree to total silence.  NEVER.  EVER.  It's a little tidbit just about everyone overlooked.

Fiscally and emotionally gutted in the wake of three years of what can only be described as HELL . . . and knowing I could not come home/practice in professional/economic safety as long as "the evil twins" ruled Randolph's roost, I stayed "on-the-road" . . . coming home between weeks-to-months working far from the one place I wanted to be.

I lived the Johnny Cash song.  In terms of real-world experience, my CV (medical resume) is like nothing you've ever seen.  It was a lonely life.  But I saw wonders - and different ways - and MORE very bad things.  The "House of God" (especially lately) has NOTHING to do with God.  But I know I made a difference.  And I made many friends along the way - friends I would not give up for anything.

Most of them are nurses - not doctors.

I found out not-too-long afterwards that Randolph executives had lied repeatedly on-the-Court-record during discovery (about the "confidentiality of their non-profit books - and what was in them) . . . shorting me of literally hundreds-of-thousands of dollars in compensation for very real losses at settlement.  One cannot make an "informed" decision in settlement negotiations if the other side is flat-out lying.  And the Court should not, in ANY way, condone the lying.  As far as I was concerned, it was perjury - and FRAUD (something my lawyer, whose swimming pool I paid for, should have caught), and I went after them - begging local,state and Federal law enforcement agencies for a proper investigation and prosecution.

The local newspapers, Asheboro's Courier Tribune and Greensboro's News & Record, bought and sold by both Randolph and Cone's advertising dollars BURIED the story.

Donald Trump did not have to tell me about "fake news" - or Russians.  I lived Pravda right here in my own hometown.  No news was permitted that might upset certain most-favored apple-carts.

NO ONE would MOVE.  I went at it FOR YEARS - going so far as to develop this blog and spend almost eight years in the Greensboro North Carolina "Blogosphere" (also known as "Blogsboro") being viciously excoriated by the progressive likes of Edward-Cone-of-the-Moses-Cone-Healthcare-Cones.  Before it was all over, I was even cyber-stalked.

But this was before the #MeToo and #TimesUp movements made crimes against women not cool.

To be clear, Edward Cone, scion of the Cone family, champion of the journalistically-oppressed, defended the cyber-stalker.  He was apparently pursing a seat on the Cone Foundation Board of Directors - and it was seemingly his mission to "get rid of" Mary Johnson - to shut her down/up. The same DA's office that refused to investigate Randolph Hospital executives for their lies and subterfuge (essentially defrauding the National Health Service Corps of its investment in my recruitment and retention), "prosecuted" the case I brought against the cyber-stalker.  The whole exercise was a wholesale JOKE.  I never had a chance - the charges against the cyber-stalker (who made it clear he knew where I lived) were dropped.

In terms of getting a fair shake - or any HELP - from Edward's GANG of socio-political do-gooders in the oh-so-progressive Greensboro ether, my "sin" was being of a conservative social/political mindset - failing to worship at the altars of the likes of Bill and Hillary Clinton, John Edwards, Mike Sleazely, Beverly Perdue, Roy Cooper and Barack Hussein Obama.

One of my more recent bosses along the way (an academic who has made his own bones sucking on the "non-profit"/public dole for a very long time) told me that he was "basically a socialist".


On this very blog, I warned anyone who would listen that Obamacare was a glorified Ponzi -scheme (everybody seems to forget that Michelle Obama was an overpaid patient-dumping hospital executive when fortune-and-the-Democratic-Party plucked her husband from political obscurity to head a national ticket).  To this day, I simply cannot understand how anyone with even the tiniest of brains could not see that the ACA was politically-motivated disaster that would bankrupt practices (particularly Pediatric ones) and hospitals - and that it was DOOMED to fail.

Yet every MBA in healthcare drooled over what would become the ultimate house-of-cards.

With regards to what passed for "oversight" of my own situation, I ultimately filed a complaint asking that District Attorney, Garland Yates, be removed from office for failing to do his job (in North Carolina, the Attorney General cannot/will not touch an investigation without the invitation/request of the DA with jurisdiction).  The local and not-so-local legal systems, of course, moved to squash that.

And I finally stopped clicking my heels/gave up on home.

Edward Cone got his board seat.  I don't have enough pejoratives for that man and his brand of "citizen journalism".

Meanwhile, the town was declared "dead" by Forbes magazine - as the ruling cabals faltered, and businesses/banks closed (or were eaten).  It was an All-American trend magnified by Asheboro's in-bred/mill-town corporate sensibilities.

Several years ago, Bob Morrison turned the helm over to Steve Eblin, as Randolph Hospital snuggled up to Cone Health - angling for a buyout/takeover - and going so far as to enter into a management agreement with Cone (who is, in turn, managed by Atrium . . . formerly Carolinas Medical Center in Charlotte).  The Courier Tribune gifted Bob with a soap-box on their editorial page - where he could showcase his true-deep-blue-Kool-Aid-slurping colors.

The notion of a proposed merger of the Atrium system with UNC churned my stomach.  Fortunately, that collapsed under its own weight.

To this day, I really do believe that I was the first employed/regional doctor sacrificed on the merger altar - because I preferred to refer my more complicated patients to NC Baptist Hospital/Brenners instead of Cone (following a natural referral pattern) - and because what I did on that fateful night in 1998 made Cone "look bad".

In 2017, it was announced that Cone would take over/absorb Randolph. Steve Eblin had finally landed the big fish - and a phat retirement - as Bob Morrison did before him - both of them having bled the hospital coffers dry while the dying mill town kings and their newspapers drooled.

But this year, at the end of May the deal fell through.  Cone DUMPED Randoph like a really bad date.  Someone exercising "due diligence" had finally taken a "forensic" look at the books (the look I BEGGED FOR twenty years ago) and said, "Not NO, but HELL NO!"

And then, twenty years of sucking-up having left him a pool of his own saliva, Steve Eblin resigned.  In terms of healthcare management, he is a corporate dinosaur - and a poster child for what one should NOT do if you don't want to run a hospital aground.  It's simply NOT necessary for hospital executives ANYWHERE to HURT good physicians (particularly primary-care physicians - in shortage EVERYWHERE) in order to get the upper hand - or make their bonus.  It just isn't.  From what I hear now, I was just the first physician in a long line of doctors that Steve and his "team" screwed-over in his rabid quest for market domination.  The managers of medicine have crushed an entire generation of physicians - now walking away/retiring early in droves.  It's a corporate wave that needs to CRASH against its own rubble and never rise again.

For me . . . my heart permanently broken and sutured-over a half-dozen ways/times because of what this man did to me a lifetime ago . . . Eblin's resignation felt like Christmas morning in the Tardis with my favorite Doctor (that would be Twelve).

There is a lot of talk about what should happen next - and who should take over - IF someone can afford to risk taking over (I would think it could only happen after bankruptcy is declared).  The big vultures are circling.  I know what the locals - as well as local MD's (many of them jumping ship to other near-by hospitals/systems) would like to see.

So once again I picked up my pen - to write my "representatives" in North Carolina State government . . . as well as a Governor who, as Attorney General, let a good doctor swing.

NONE of them cared before - and I fear it's all and only going to be about covering tail now.

Here's the body of the letter (sent on 6/29/2018):

After literally decades of inept leadership - with senior executives never having an original thought and following every bad medical fad . . . treating good doctors as pawns on a chessboard of greed . . . and chasing a "take-over" by Cone Hospital at the expense of every other sensible cooperative relationship they might have forged . . . only to be dumped in the end . . . Randolph Hospital is at the brink of fiscal ruin.

As a former public servant . . . cast out of my own hometown twenty years ago for the sin of standing up to those same inept executives . . . because I answered a terrified charge nurse's call in the middle of the night . . . in order to "rescue" a floundering "Cone-owned" doctor and save a desperately-ill newborn's life . . . forced to sue . . . then swindled of fair restitution at settlement . . . and reminding all of you that I spent YEARS begging for a forensic audit of the place . . .I have more-than-earned the right to express this OPINION to each of you.

After the well-intended but nevertheless dire mistakes made by NC leaders over the past two decades with regards to mental health care, North Carolina is in dire need of inpatient Adult and Pediatric psychiatric services.  

The state should take over Randolph and turn the bulk of the hospital into a centrally-located state-of-the-art psychiatric facility.  Basic Emergency Department, LDRP, and medical/surgical services could be contracted out to larger facilities (oh, I dunno, like Baptist), with anything remotely complicated being transferred out.

Get rid of the "leaders" that sucked the lifeblood out of hospital coffers and drove it into the ground (it CANNOT all be blamed on Obamacare), and start over.

It could be a big step towards solving a LOT of problems.

One can only hope for the change that Asheboro/Randolph County never got.

I hope the time is now.  To everything there is a season.

And perhaps there was a reason, after all.

2018 Post-election UPDATE:  

Apart from some scathing commentary on several stories/letters published in the Courier Tribune - as well as "fun" on my (private/closed to search engines) Facebook page, I did not "go to war" against Former Randolph Hospital CEO, Bob Morrison, in his failed candidacy for Randolph County Commissioner.

I like the sound of that so much, let me say it again:  FAILED CANDIDACY.

As Morrison was (finally) running for public office (something I predicted long ago), in large part on his "record" as a "fiscally responsible" local healthcare visionary, the Courier (for whom he authors opinion columns) was hard-pressed to delete my comments - on First Amendment grounds.

Bob lost resoundingly - by an almost 80-20 percentage point spread.  I REALLY wish I could say I had something to do with it.  But (1) the Courier's online footprint is a joke/I doubt many people saw my comments, (2) Bob's political colors don't match Randolph County's mainstream AT ALL, and (3) he was simply beaten by a better woman.

For instance, I've not actually seen anything online in the way of a graceful concession - thanking people for their consideration and/or vote.  It's as if he was "owed" the position.

What the numbers tell me (in addition to figures in another candidate's race) is that (1) people have very long memories (in addition to my own reflections from the waiting room - please see the comment on that article, I am referencing an alcohol referendum several years back - in which the winners played dirty), and (2) people are generally not stupid.

The sorry state of Randolph Health's "health" now is a direct result of Morrison-followed-by-Steve-Eblin's leadership . . . as well as the inherent flaws in healthcare "reform" that Bob so enthusiastically supported.  For such a supposedly smart guy (and like so many hospital CEO's - who thought Obamacare would leave them swimming in Medicaid money), Morrison was too busy blindly following Pelosi's lead to see the loopholes that would ultimately sink his ship.

Well there's a third thing.  Maybe the Courier needs to get NEW advisers and columnists.  Asheboro isn't running solely on mill-town cylinders anymore.

We don't have any updates yet on who Randolph Health's savior is going to be - or, indeed, if there will be a savior.

But one can hope that, when whoever-the-savior-turns-out-to-be does their own close examination of this hospital's history, they will take steps to correct Bob's course . . . and, for the good of the community, make conciliatory/reparative overtures to those people/entities that Bob-and-the-rest-of-Asheboro's-"right-people" stepped on-or-over to get what they wanted.

Politics and politicians, among which Bob can now count himself for his run, never cease to amaze me at their brazen audacity to rewrite or ignore their own history.  These days Bob paints himself as a progressive champion of the people, yet in the early days of Randolph Medical Associates' Pediatric marketing campaigns, he and his strategic team declined to market their "non-profit" practice to the east side of town - because that "business" belonged to the Health Department (numbers equated to funding or some such rubbish).  It was about being "the premiere" practice in town.  In those early days, when the mills/mill owners were flying high and playing fast/loose on the backs of cheap labor moving in/up from Mexico, Bob would not hire translators.  We made do with whoever in our orbit happened to speak Spanish.

Bob's vision then wasn't what my Federal and state loan repayment was about.  It wasn't what I was about.  I took an Oath where identity politics has no sway.  As a community Pediatrician, I see the patient in front of me - using the resources I have.  If those resources are not enough to serve the patient well, I get them where they need to go.  But as lowly employed Pediatrician in Bob Morrison's organization, I was "a dime a dozen", and had ZERO say.  Getting rid of me was about covering up the miscalculations and sharper edges in Bob's early "vision".

Now people CAN change.  They DO evolve.  But I would submit that if Bob Morrison and Steven Eblin had done these things, I would not still be on the road - serving children everywhere but home.

What Bob's "team" did, on so many counts and in so many instances - for the sake of power and control and status and phat salaries/executive bonuses and expensive board retreats, was just wrong.  Everybody knows it was wrong.  And in the end, although it might take a long time and a lot of good people may fall by the wayside, wrong loses.

Doing right - by patients AND the people who take care of them - MATTERS.

Saturday, January 20, 2007

Why Pediatrics

About a month ago, a cousin's son, now in college, called me. He wants to go to medical school. The family, like mine years ago, is middle class . . . certainly not wealthy . . . and he is worried about how to pay for it. My long-retired debt is nothing compared to what he will likely face. He does not in any way want to burden his family. He wanted to know about "loan-repayment" for public service arrangements, and my cousin said, "Call Mary".

He's an incredibly bright kid . . . and he asked questions I did not even dream of asking when I was his age. I was brutally honest, telling him that I would not encourage anyone who was not absolutely certain about his/her calling to go into medicine right now. But if it was what he really wanted to do he should go for it. I also offered the following advice: 

You must remember that medicine eats its young - and the only one who is going to look out for you is you. Keep your eyes wide open. Get a lawyer to review any employment or partnership contract you sign out of residency. If a hospital administrator's lips are moving, he is lying. Anything that sounds too good to be true, is.

He is in the process of applying right now, and we talked about the strategy of all that. It's a game . . . and it's played very much like Survivor. He told me he was struggling with his personal statement (something that all of the schools request with an application). He wanted to stand out . . . to not appear like just another idealistic, "I wanna save the world" sap. He wondered what I wrote.

I told him that two rounds of medical school applications were a lifetime ago, and I had no idea what I had written. But he was in luck because I had saved the personal statement I had penned for my Pediatric residency application. I saved it because I'm proud of it . . . in fact, I was told it was passed out for a number of years to seniors at Bowman Gray as an example of fine writing . . . and a great statement of purpose. The statement was posted, for a while, on the original Asheboro Pediatrics website*. Of course, it came down when the website was overhauled and greatly simplified for those with short attention spans . . . not to mention little or no interest in how a good doctor's life can be derailed. (*Addendum:  That website is no more.)

Sometimes when I read the statement I want to weep.

I e-mailed my cousin's son the statement and (against my better judgment) some information links on federal loan-repayment programs (even though I'm suffering under no illusions that they've cleaned up their act). The following is the text from the web page.

Dr. Johnson authored the following “personal statement” in 1991, before she applied for her Pediatric Residency Program (at Brenner’s). While her experience in Asheboro has left her considerably more world-weary than she ever dreamed possible when she wrote this, the sentiment and hope still stand:

Three and one-half years ago, when I began medical school, the last medical specialty on my list of possibilities to consider was Pediatrics. As the daughter of a first grade teacher, catching brief, mostly after-hours glimpses of her life in the classroom, I had been witness to many of the pitfalls of that profession without experiencing any of its joys. I marveled at my mother’s tolerance and dedication, yet at the same time, it was crystal clear to me that dealing with children on a daily basis did not pay.

As I have a soft spot in my heart for the underdogs of this world, from mistreated animals to North Carolina State University basketball players, I focused my attention on Obstetrics. It was the fourth specialty on my list of fields catering to the “medically disadvantaged” - namely the mentally ill, children, the aged, and women. However, in the delivery room, the “miracle of birth” (the “procedure” for which I was so psyched-up) paled in comparison to its end result - the child - the reason for all the commotion in the first place.

Now while I am an idealist, I cannot sign on the humanist’s dotted line. The reason this world can be such a cruel place has much to do with the people in it, and life is not fair. Children, it seems to me, are the greatest social, medical and legal disadvantage in this or nearly any other society simply because they depend so totally on others to care and to speak for them. Being one of those people upon whom they can depend seems like a most worthwhile and challenging way to spend a life - my life.

The “mantle” of the M.D. degree carries with it much responsibility - not only to my patients (and their parents), but to the community as a whole. I hope to be an active voice in my little corner of the world (wherever that turns out to be), not only for children, but for any cause I believe in. Physicians are in a unique position to persuade and educate, and it is a position I intend to use. I cannot just sit back and watch the world go by. But in this role as a teacher, I shall never forget that I can learn just as much from my patients and students as they can from me. And balance is important, my professional and other responsibilities will not so engulf my private life that I neglect my family or personal interests and pursuits.

I learned a great deal last year. I discovered (to my delight) that babies in the Newborn and Special Care Nurseries were not so fragile that they would break when touched. I found that I could conceal my anger as I interviewed a parent who had almost certainly abused her little girl. I learned how to quietly absorb a father’s desperation and rage as he fought to come to terms with the fact that his son had failed a bone-marrow transplant and would die. I did my best to comfort a pair of nearly perfect parents after they delivered an anencephalic child. Meanwhile just down the hall two addicts who had just produced a perfect baby (when they’d probably have difficulty properly caring for a pet) taught me how to vent my frustration into constructive help for that baby and that family. Yet even after the most dreadful day, it was amazing how easily a child’s smile could make the world right again, if only for a little while.

Robert F. Kennedy was right twenty-four years ago when he said that the future is made by each of us working to change a small portion of events for the better. Pediatrics is about the future and the difference I can make - one child at a time.

Pediatrics does pay. It will pay. Mother’s aforementioned tolerance and dedication are not all at mysterious to me now. And although my procedure-oriented friends in Obstetrics and Surgery will no doubt reap several times the monetary reward than I, they can go tie square knots. Walking on water is not such a big deal when you can play in the pool with the kids. 

Inspired by Jerry Bledsoe, I am following this up tomorrow with a Rhino-like piece on my experience in Asheboro (only one installment as we don't want to bore those in the local blogosphere who don't care anyway).

Then I'm going to take a break for a little while.