Saturday, March 27, 2021
Friday, March 05, 2021
This morning, I sent out a passel of e-mails to selected representatives and Senators in the NC General Assembly . . . begging for much-needed, post-pandemic medical reforms in North Carolina.
I am all for the NC General Assembly supporting the healthcare industry in North Carolina - but they need to do it without otherwise killing the doctors and nurses working in it. The "right to work" for doctors and nurses in North Carolina (if we are indeed doing what the Governor calls "God's work") MUST be about something other than the right to have our lives devalued, disrupted and brutally eviscerated (as mine was last year) at an MBA's whim.
Our medical labor and contract laws are 30 years behind the times. Everybody knows it. No one has FIXED it.
If you want to know why healthcare unions are getting a foothold in North Carolina, look no further than my life's story . .. as Pediatrician fired three times in 23 years for blowing the whistle on bad care. The NC Medical Board, the NC Medical and Pediatric Societies, JCAHO, Leapfrog, NCDHHS/CMS . . . ALL of the agencies and regulatory bodies charged with patient and provider safety/advocacy have been ASLEEP AT THE WHEEL as "corporate" ran over everybody (and our politicians took their money).
They all sit back and watch. And "study". And file away. And dodge. And wait for "the other guy at the other desk" to do something.
Something has to change. I can roll over and die (at 59) or I can FIGHT. I chose to FIGHT.
I was not really planning to do any more posts this weekend. But I got a "MyMindIsBlown" message from a dear friend and here we are (please remember that, in Blogger, red text will take you to links in another window).
I was informed that Central Carolina Hospital CEO, Spencer Thomas, sent out an e-mail to staff announcing that CCH had been named one of the nation's "Best Maternity Hospitals" for 2021 by Leapfrog and Newsweek.
Normally, I'd say, "Fabulous!" and "Congratulations!". But Mr. Thomas is in damage control mode and I am just OVER it.
During my tenure at CCH, I watched this man treat experienced/gifted nursing leaders that I respected-very-much HORRIBLY. He ROUTINELY made good/loyal/dedicated people feel like less than what they were. He scapegoated and gas-lighted everyone in his orbit - including me.
As a Pediatric Hospitalist, who has been working in the community/rural setting since 2008 (before the specialty was a specialty - and certainly longer than just about anyone else in the field), I myself was told that I could be "replaced by a nurse" (I actually wound up being replaced with several part-time doctors - which speaks to how BRUTAL my call schedule was). And Thomas lied to my face on more than one occasion . . . before the fateful morning on January 6th 2020 - when I walked into a neonatal mess that was, in the end, basically of HIS making - fundamentally due to the chronically short-staffed and dangerous practice environment that HIS leadership decisions created.
I cleaned it up. I reported it (just as my ApolloMD contract REQUIRED). And two days later I had a without-cause "notice" dropped on my head. So much for CMS/JCAHO standards of patient safety and reporting . . . or Duke Lifepoint "no retaliation" policies. Standing up for my staff and my babies made me "a pain in the ass". I had to be eliminated and my silence EXTORTED by merciless professional/financial strongarm tactics.
I digress. Here is a photo of the announcement).
Here is the text (because the photo is fuzzy):
CCH was recognized by Newsweek as one of the Best Maternity Hospitals of 2021! CCH was one of only 20 North Carolina Hospitals recognized on the list of 217 hospitals nationwide. Best Maternity Care Hospitals are hospitals that meet Leapfrog's tough standards for excellence in maternity care: hospitals that have low rates of C-sections, episiotomy and early elective deliveries, and follow important protocols to protect moms and babies. From Newsweek: "Though these are standards aligned with medical research and best practices, not all hospitals achieve them. Newsweek's Best Maternity Care Hospitals are an elite group of hospitals demonstrating the highest performance in the United States. Congratulations to the OB Team for this outstanding achievement!
Here's the thing. I heard about this when the announcement was made on Becker's Hospital Review. I KNEW it had to be bogus, and/so I made some inquiries (just call me a "fact-checker"):
Allow me to share the exchange:
On February 18th, I sent the following e-mail to Leapfrog (we'll keep names out of it, and I won't copy/paste text from Leapfrog):
I saw your article on Best Maternity Hospitals in the US and I've got to say, I was dumbfounded. One of the hospitals on the list was cited as deficient (by the state/CMS) in newborn care LAST YEAR. The hospital/system has driven off #4 OB's in the last two years - #5 if you count one who lost privileges - and are set to lose #2 more. They drove off #2 full-time Pediatricians - taking atrocious amounts of in-house call - and are set to lose another. This was all after a nursing meltdown - (again, hospital-caused) that saw hundreds of years of experience WALK OUT THE DOOR.
Your methodology is extremely suspect. I would like someone at your organization to give me a call.
I got a reply on February 19th. I was asked to share the name of the facility.
This was my response on February 20th:
I called your office on Friday and left a message. This is an independently published CMS report on the site survey last summer:
Again, I am the reporting physician. By my end at that facility, this hospital could not even properly feed a baby at night.
I would also like to know the time frame used to make your 2021 recommendations.
I got a response on February 22nd, referring me to the methodology used for the Newsweek article.
I was also informed that the time frame for the Newsweek piece was January 1 through December 31, 2019.
This was my response - also on February 22nd:
Good morning. Thank you for this information.
So you are basing your recommendations for 2021 on a report that is over a year old and has NOTHING to do with what is going-on on the ground at that hospital now?
All but ONE OB - and the two full-time Pediatricians responsible for your numbers ARE GONE.
I want to be clear - because I am currently engaged in conversations with CMS and the OIG regarding this matter.
I got a fairly terse response from Leapfrog on the same day (February 22nd) telling me that the hospital met the qualifications required based on the criteria identified, and I was (of course) welcome to disagree with the independent assessment.
There was no offer to reconsider the recommendation based on the corrected record. I fired off a same day (February 22nd) response:
I do (disagree). You are basically lying to the public about what is going on right now - in real time. That's the problem with numbers sometimes. Passing this on.
The email exchange was passed on to the Director of Survey Operations for the Center for Medicare/Medicaid Services (CMS) in Atlanta - and the OIG (Office of the Inspector General).
Since this e-mail exchange, I've been informed that not just two, but ALL THREE Ob-Gyn's recruited to replace the original group that Duke Lifepoint bought out/drove off (all female) have given notice (in my exchange with Leapfrog, I forgot to mention the #3 nurse midwives who had left).
And here we are on March 5th, with CCH CEO Spencer Thomas blowing the equivalent of a trombone with a bent slide.
This man is THE REASON hundreds of years of medical and nursing experience walked out the door of that hospital in less than two years.
I was PUSHED - because I dared tell them that his leadership choices were endangering my patients - and putting long-suffering nursing staff in the crosshairs.
The REAL heroes in this story are the long-time LDRP nurses who have hung on despite seeing everything we all all worked to build turned to dust by Duke Lifepoint's slashing for shareholders.
I loved that unit once-upon-a-time. Central Carolina had "the-little-LDRP-unit-that-could". We were a family. We KNEW one another's moves. We got the job done. It was truly glorious.
And Spencer Thomas destroyed that. His leadership. His choices. For his bonuses.
At some point, SOMEONE In Brentwood Tennessee needs to get their head out of their butt and SEE that the problem is NOT the doctors or nurses who left the hospital - but the "suit" they put in charge. Of course, my theory is they know it and they don't care.
PLAINLY AND SIMPLY, THIS LEAPFROG "AWARD" IS FALSE ADVERTISING.
IT IS THE EQUIVALENT OF LYING TO THE PUBLIC!
Spencer Thomas KNOWS this . . . but he'll try to sell it anyway.
The thing IS, this "award" is not "his" success to sell. Those numbers happened not because of him but IN SPITE of him. They are the numbers of the family-like team he pretty much destroyed.
The "data" is OLD. The "award-winning" data is actually MY data - and my former Pediatric Director's data. We BUSTED OUR TAILS to keep the babies well-care for and safe . . . taking serious hits to our well-being/health.
If I close my eyes, I can still smell the nose-hair-burning sewer-stench in my call room.
It's the data of an LDRP Director who stepped up to help (from another unit) after a heart-rending loss for everyone on the LDRP team - facing down a nursing meltdown NOT OF HER MAKING . . . who literally SAVED our unit . . . and who was treated like GARBAGE by Spencer Thomas.
The "data" is also largely the data of the dedicated/gifted Ob-Gyns and Nurse Midwives (all female professionals who really gave a damn about the community and their/our patients - who didn't really want to leave but were given no choice) . . . DRIVEN AWAY from Sanford and Lee County by Spencer Thomas and his money-grubbing superiors at Duke Lifepoint (in Tennessee) and Apollo Global Management (in New York City).
The citizens of North Carolina - be they patients depending on that unit or the local medical/nursing staff providing the care are NOT in the equation of the out-of-state phat cats except as pawns to LIE to for profit's sake.
If rural and community Mother-Baby units are to survive, we need CHANGE in North Carolina. We need real transparency and genuinely accountable-to-the-citizens-of-North-Carolina executive leadership in hospitals of all stripes/types.
This Leapfrog business ain't cutting it.
That's all folks. I'm taking the weekend OFF.
Update: As of 3/11, both JCAHO and CMS are aware of the Leapfrog debacle. And a Consumer Protection Complaint was filed with the NC Attorney General's office.
Update (3/18): In the "I can't make this stuff up" department, a nameless/faceless lawyer at the NCDOJ/Consumer Protection Agency opined today that Leapfrog and Newsweek are "state agencies" over whose websites the NCDOJ has no jurisdiction. I don't know WHERE that came from. The misconception was immediately corrected - with the admonition that old 2019 data was submitted to Leapfrog/Newsweek in September 2020 - AFTER I endured termination and (later) black-listing for reporting deficiencies in care that were vindicated in a June 2020 NCDHHS site survey report. CCH is deliberately and deceptively advertising a medical service environment that no longer exists in 2021 - after nursing and medical meltdowns. And this corporate sleight-of-hand is exactly the kind of thing that someone convicted of tax evasion (lying to the government for personal gain) would do. It's false advertising and a matter of consumer protection as young Mothers are being misled. At least the nameless/faceless lawyer admitted that blacklisting is a crime.
Thursday, March 04, 2021
As One Licensed NC Physician To Another Unlicensed One (Dr. Mary Johnson to Dr. Mandy Cohen/NC DHHS Secretary): PROTECT MEDICAL WHISTLEBLOWERS NOW!
Related to my last post - which went up (after much soul-searching and trepidation) on 2/28/20201, one of the biggest complaints (coming largely from folks reading on mobile phones) was that the post was "so long". They wanted something more "concise".
The post relates my own horrific pandemic experience with Central Carolina Hospital/ApolloMD and Duke Lifepoint in Sanford, North Carolina. It's my third dance as a medical whistle-blower in 23 years. And much like the first two cases (Asheboro in 1998, and ETSU/Ballad Health in 2017), it's really NOT "soundbite" material (it would have been if the NC Department of Facility Services had done its job back in February 2020).
So, I composed a (somewhat shorter) letter to NCDHHS Secretary, Dr. Mandy Cohen. You may know her as "the star" of Governor Roy Cooper's never-ending COVID-19 press conferences ("Wash your hands", "Wear your masks", "Hide from the world", "Shut down your businesses and schools", "We'll vaccinate you whenever".)
As of the date of this post, Dr. Cohen is not licensed to practice medicine in North Carolina. If you do not believe me, go to the NC Medical Board's website and look it up.
And, as North Carolina's "Chief Medical Officer", she presided over a Department that dolled out over 13 million dollars in Medicaid money to un-licensed MD's - or doctors convicted of fraud and/or sexual predation. In the private sector, she'd be out of a job for a failure of that magnitude.
Meanwhile (speaking of the private sector), even as I was professionally gutted right under her Department's stuck-up nose . . . for standing up/speaking out to protect my patients . . . I did NOT take one dime in unemployment or COVID loans. The evidence was so SOLID that I kinda hoped that, for the first time in my professional life, under scrutiny of the pandemic, the government would actually WORK to see the wrongs righted, the evil-doers punished and me restored to do what I was born to do.
I have been BEGGING for many months to meet with Dr. Cohen - to discuss the need for updating the NC Medical Practice Act to include universal medical whistle-blower protections for all doctors/nurses/staff members (contracted or employed) working under the roofs of ALL facilities in North Carolina accepting Medicare or Medicaid . . .
. . . this would be in line with CMS "conditions of participation", and JCAHO patient safety standards, and NC Medical Board position statements on the physician-patient relationship/corporate practice-of-medicine, and well, MY OATH.
It would be nice to include hospitalized babied and children/their care-givers in the equation and protection (something CMS apparently doesn't think is very important).
No, she doesn't write the laws, but high-profile Dr. Cohen could endorse the matter as a matter of public policy - and light some fires under NC legislators' collective arses. Even China is doing it.
It would be icing-on-the cake if North Carolina (particularly the Medical Board) would firmly address the issue of "medical scope creep" in Pediatrics. It is a despicable corporate practice in which highly-trained or experienced Pediatricians/Pediatric Hospitalists working in the rural or community setting are "replaced" by (largely newly-minted/far-less-experienced) nurse practitioners - "supervised" by PICU and/or NICU attendings 20-90 minutes away. NP's and mid-level providers are MUCH easier for executive (and supervisors) to intimidate and bully (not that it's currently very hard for a hospital executive to CRAP on a Pediatrician - especially a female/minority pediatrician - and face NO consequences whatsoever). It might be "cheaper", but it's inherently dangerous and a slap-in-the-face to any Mother/family that puts their trust in a hospital or system.
It would be SUPER if the American Board of Pediatrics and the American Academy of Pediatrics would do something other than invent specialties that service up their own people for disappointment and failure. But that's a story for another day.
Here's the letter to Dr. Cohen. I will close afterwards with a couple of observations:
Sunday, February 28, 2021
A North Carolina Pediatric Hospitalist Tells Her Pandemic Story to Senator Richard Burr: Thirteen Months (And Counting) In Medical Whistle-blower Hell - Courtesy Of Private Equity/For-Profit Healthcare And Cruelly-Indifferent/Morally-Bankrupt State & Federal Oversight
Author's Note: This post is long. It's detailed. And it's filled with 23 years of pure pain - the kind of pain one can only feel if they've been repeatedly professionally/personally/financially eviscerated for simply coming to work and doing their job. I cannot "sound-bite" the last year - and perhaps it IS time to write the book. If the detail and background are too much for one sitting, or time is limited, scroll about half-way down to read the letter (in blue text) to Senator Burr (who, in the wake of his impeachment vote, was first sternly reminded that President Trump moved quickly to help me get answers when NO ONE else did). I am back in the blogosphere because for the third time in 23 years, as a Pediatrician staffing a community hospital, I was fired "without cause" immediately after intervening in a neonatal ("bad baby") case, rescuing the situation/"saving" the baby, and reporting it INTERNALLY to Peer Review/hospital leadership. NO discussion. NO recourse. NO review. A total cover-up of management's failures. And EVERY SINGLE TIME I've asked the state/Federal government to enforce their own contracts/rules/standards, they've abandoned me to the corporate wolves. Corporate healthcare is the biggest SWAMP-MONSTER of all. In order to protect patients, doctors themselves MUST be protected. In the wake of the COVID19 pandemic, and with our government throwing TRILLIONS at hospitals, it's way past the time for universal/easy-to-access/timely medical whistle-blower protection for ALL (employed or contracted) doctors/nurses working at hospitals accepting Medicare/Medicaid. The people doing what Governor Roy Cooper called "God's work" in his latest re-election campaign NEED HELP NOW. We need our voices back. We need NOT TO BE "CANCELED" for doing our jobs.
(*For those unfamiliar with Blogger's format, within the body of the main post, different colored text takes you to another link or news story.)
It is a fact that, if COVID-19 had affected children with anything remotely close to the same deadly voracity that it does susceptible adults, the American medical infrastructure would have collapsed.
For there is NO infrastructure in small communities and rural areas to cope with hoards of very sick/very young children . . . certainly not children sick enough to be in an ICU or on a ventilator. The sad truth is that most of the time, in our new-and-not-so-improved "corporatized" medical world, you can barely take good care of a "bread-and-butter" Pediatric case on a rural/community hospital's Med-Surg-Peds floor. Pediatricians still-willing-to-take-call/admit/cover community Mother-Baby units come and go through revolving doors . . . as they are generally on the bottom of any medical power pyramid, treated very poorly by hospital management and given no incentives to stay. Nursing staff ratios are chronically and stupidly unsafe (pediatrics is more labor-intensive). Experienced nurses who are comfortable caring for babies/children are falling away like butterflies caught up in a thunderstorm . . . replaced with more expensive, often newly-minted (albeit easier-for-management-to-control) "travelers". Long-standing/well-integrated teams that took decades to build have disintegrated in the face of top-down "efficiency" and corporate cost-cutting initiatives. Age-appropriate equipment and resources are thread-bare. In some places, the resulting practice environment is "third world" - especially in the middle of the night.
I know this because I have been the Pediatrician-on-duty in the middle of that night - in some of the ruralist-of-rural areas in this state for going-on 30 years. I've fought the good fight - winning most of my clinical battles against high odds. But I'm here today to tell you that we've lost the war.
Americans spend hundreds-of-billions-of-dollars on healthcare every year. A huge chunk of that money does not go to care - or even to providers (the original "managed care"/"doctors are greedy" myth that landed us where we are) . . . but to the corporate behemoth knows as "administrative costs" . . . a shape-shifting monster that is siphoning the very life out of the medical and nursing professions.
And we've let our politics KILL us. I certainly have my own opinions (it's America, and the working theory is that I can still have them) . . . opinions which I've more-than-earned . . . opinions based on my own experience (starting as a physician in public service to my own hometown back in the days of "Hillary's Village"). But in terms of "red" and "blue" sensibilities/agendas, the biggest problem we have right now is that the side that passed the Affordable Care Act (aka Obamacare) in 2010 won't admit its intrinsic god-awful flaws . . . and the side that opposed it hasn't produced anything better despite multiple opportunities to do so. Everyone's heels are dug in (as each side spews epithets at the other) - and no one will meet in the middle for the betterment of the country.
The COVID-19 pandemic laid much of what is wrong with our healthcare system bare for all to see . . . particularly as it pertains to public health surveillance, medical "intelligence" and staffing/resources/response. But no one seems to really BE seeing what's wrong, for the (often conflicting) sound bites we're being fed.
For-profit and private equity-funded healthcare is destroying medicine. Non-profit medicine is right behind them. Our hospitals were not prepared for COVID-19 because of the "business models" they've been following for the past two decades - which have slaughtered the basic "community service" side of medicine.
The United States' definition of "doing something" seems to be to print trillions in "relief" money (that we don't have) . . . and just hand it over to the grinning-like-hyenas multi-million-dollar "suits" running the multi-billion-dollar conglomerates that starved their "front lines" for profit in the first place . . . without ensuring any substantive oversight or reform.
Meanwhile, states (like North Carolina) have passed laws to make it MUCH HARDER for patients or staff-done-wrong to sue hospitals (speaking of politics and "the blame game", NC's Republican legislature may have drafted the legislation cited in the link, but the Governor who signed it into law without-batting-an-eye is a Democrat . . . proving that EVERYONE in politics loves their corporate money).
It's an emergency measure, we're told. Hospitals have to survive we're told. Well, okay. Except our standards-of-care as we move through this should not be getting lower. They should be getting higher. We should be learning from our mistakes. We definitely should be treating our "healthcare heroes" better - as opposed to laying them off - or cutting their salaries - or forcing them from their established homes/lives/dreams - while "the suits" earn their own job security by slashing for shareholders.
The ONLY way to even begin fixing anything is through administrative and medical accountability - and transparency - something that the American healthcare system quite literally spits upon. As we leverage our children's future - and throw trillions more in COVID relief in the general direction of healthcare, there should be MORE checks and balances, not less.
The general public does not understand that unless they are Federally-employed and reporting fiscal fraud, medical whistleblowers in this country remain largely unprotected (through giant cracks in disjointed laws) and are routinely buried under impossible-to-scale-alone legal mountains-of-red-tape and regulatory indifference.
EVEN the Chinese Communist Party has moved to protect its "front-lines" healthcare workforce (after letting the "early birds" die in their cages for singing their dire warnings). Not the United States.
And misery abounds.
I might actually support single-payor (i.e. government-funded/run) medicine were it not for my own experiences as a physician repeatedly wounded and left bleeding-out (three times in 23 years) by what currently passes for government oversight.
There isn't any. It's an empty show most of the time - always about money instead of care. The government has to be dragged kicking and screaming into enforcing their own rules/contracts (indeed, in my experience, they bend over backwards not to). And that's why I've come back to this blog.
This is my pandemic story . . . my "whistleblower" story, if you will . . . as conveyed to Senator Richard Burr (R-North Carolina) on 2/22/2021 . . . after two months of gut-wrenching (my guts) communications (which his office monitored) with the Center for Medicare/Medicaid Services (CMS) Atlanta Survey Operations Group (which "oversees" North Carolina).
The letter was sent just days after the NC State Auditor released a damning report stating that the NC Department of Health and Human Services (NCDHHS) had failed to properly oversee Medicaid providers . . . keeping providers with revoked licenses, and histories of fraud and even sexual misconduct in the program - and paying them millions. It's a mind-numbing display of administrative incompetence at the highest state levels.
(But HEY! Let's enroll MORE people in a broken and dysfunctional system that cannot police itself.)
In stark contrast, the NC Department of Facility Services (NCDFS, the branch of NCDHHS that polices hospitals for the Center for Medicare/Medicaid Services/CMS) failed to protect a Pediatrician with a spotless Medicaid record and CLEAN peer review file from brutal/repetitive retaliation . . . after she reported a dangerous practice environment and deficient care to her hospital leadership (all of it "owned" by her contracting company or the hospital itself) . . . while working under the umbrella of a larger for-profit hospital system that sports one of the state's most famous and trusted names - a system that boasts a "no-retaliation" policy.
That name is Duke Lifepoint. Specifically, Central Carolina Hospital in Sanford, North Carolina.
The case I was fired for reporting is public record. I am a party to that record - which exists because I filed the report - and kept reporting as my life unraveled (with the state basically treating me as an "in-house snitch"). In point of fact, what was done to me, as a reporting physician, should be IN that report (it isn't).
It started when I walked into a neonatal nightmare at shift-change on a Monday morning after returning from a post-holiday break (as a point-of-reference, I had covered both the Thanksgiving and New Year's holiday blocks). A newborn was actively seizing on the Special-Care warmer and the nursery was in chaos. I took over the clinical care from the on-call Pediatrician, got the baby stabilized and shipped out - and then reported what happened (as the straw that finally broke my back) to my CEO, and my Chiefs-of-Staff-and-Service (as my contract REQUIRED me to do).
The gist of my message was that all of the corporate slicing-and-dicing was KILLING the Mother-Baby/Pediatric service into which I had poured my time and life for two years (in fact, I had passed on other opportunities to stay/be closer to my Mom/home). It's fine (to a point) to do more with less, but you cannot do anything with NOTHING.
Because it was not the first time I had reported bad things to deaf ears in this hospital's C-Suite (on one occasion, at the request of a doctor at UNC Children's Hospital - which has recently had its own issues with doctors being afraid to report), I also contacted the Duke Quality Network (because Duke Health oversees quality assurance at the hospital).
For my trouble, I had a 3-month without-cause "notice" (that I was forced to work out) dropped on my head (by my staffing company - ApolloMD) the following Sunday night. No discussion. No review. No recourse.
The quality gurus at Duke Health did not do ANYTHING to STOP it.
Before the month was out, I reported all of that to the NC Department of Facility Services/CMS - while I was still under contract/on-site. I desperately needed the Federal cavalry to ride in and enforce their own "conditions-of-participation" and patient safety standards in both Quality Assurance and Medical Governance.
"Shoot-the-messenger" is NOT how Quality Assurance is supposed to work. Not in medicine. Not in ANYTHING.
Today's date is actually significant in this saga, in that it is the one-year anniversary of the date that NCDFS/CMS officials say they got my original complaint (a full month AFTER they actually got it). Once again, we're talking about pure incompetence. While I have been out-of-a-job for 10 months, I have faithfully paid A LOT of taxes over the years. One wonders WHAT one is paying for!?!
It took NCDFS six months to even show up. Oh, they did interview me over the phone within a few days of me faxing my report in. And they accepted multiple addendums (incredibly, "losing" some of them) as my "notice" dragged on. But they otherwise sat on their hands . . . I believe, waiting for my contract to expire (so they could hide behind it).
Their stalling actually put MORE patients in harm's way - as their own report would ultimately confirm.
For in the end, NCDFS's survey report vindicated me. And when it vindicated me, having failed to intervene to stop what was going on last February, the state/CMS should have seen to my immediate restoration as part of any "plan of correction". Indeed, Duke Lifepoint should have MOVED to do it themselves - without any prompting . . . IF their high-minded "no-retaliation" policies actually meant anything.
But when it was all said and done, NCDFS left me to DIE alone on their field-of-battle - after taking a stand for "our" patients. Mandy Cohen . . . the high-profile NCDHHS Secretary and Queen-of-Governor-Roy-Cooper's-pandemic-press-conferences . . . who presided over a Department that paid out over thirteen million dollars to unlicensed-in-NC (like herself) doctors, felons or sex offenders . . . REFUSED to even talk to me about the need for medical whistle-blower protection as a matter of public policy. The whole exercise in hospital "oversight" was a sick/warped farce.
(Looking at the state's report . . . and knowing that it left out quite a bit based on what I reported . . . a discerning medical eye will note that NCDFS totally scapegoated the long-suffering nurses - and skirted around all potential malpractice/quality assurance/medical governance/administrative issues. Agency lawyers apparently didn't want those things on the record - in any fashion that amounted to taking a legal "side". It was far easier - and politically expedient in an election year - for state investigators to DUMP on the nurses - shifting blame away from medical and corporate leadership. Because, you know, it's ALWAYS easier to DUMP on the nurses.)
But here's the thing. Both CMS and JCAHO tell doctors and nurses to report "adverse patient events, medical errors, near misses, close calls, etc." (quoted from one of CMS's own quality worksheets) . . . that it's all about a "culture of patient safety" . . . that staff need not fear retribution or punitive action when they report . . . and that their jobs will be protected. While JCAHO accreditation is a "pay-to-play" game in which the hospitals paying the bill are rarely penalized, CMS has the full regulatory weight of the Federal government at its back to enforce its own rules. "No play, no pay" . . . . they can withdraw Medicaid/Medicare funding and quite literally shut a hospital/unit down. But CMS doesn't use that power to protect those who report. They stall and they turf and they dump - forcing individuals harmed by their lack of enforcement to lawyers or other agencies (in the dance of "jurisdiction").
In fact, it is apparently CMS's current position that their quality mandates DO NOT APPLY to babies and children!?! Medicare patients are protected . . . Medicaid patients not-so-much. When this excuse was ultimately tossed in my direction, I was dumbfounded. "Its all for the children" actually turns out to be a HUGE LIE in American inpatient medicine (I have all kinds of opinions about the devaluation of human life that led up to this sorry state of affairs - but it is beyond the scope of this post).
Moving on to money (which is really what it's all about), Tennessee-based Duke Lifepoint got 1.5 billion dollars in Federal pandemic relief. This past January, we learned that the CEO of their corporate "parent", Apollo Global Management (a private equity firm), propped up the world's most notorious pedophile to the tune of 158 million dollars from 2012-17.
Meanwhile, when her "notice" expired (and her time as the state-of-North-Carolina's "snitch" was over), the lowly Pediatrician done-way-beyond-dirty on Duke Lifepoint's "front lines" played the regulatory game, retreating to take care of her elderly Mother during the pandemic . . . while she waited and waited and waited (through 55 "nice" weekends) on the government TO WORK. Like so many other Americans who had to make hard choices, she put family first. She lived and navigated the pandemic "from the other (patient) side" on behalf of her Mother (as described in the letter below).
While the executive/medical leaders who made (or condoned) the decisions that gutted "the-little-LDRP-unit-that-could" kept their jobs . . . and their parent company sucked billions from the government's teat . . . the doctor languished on the sidelines when everything in her being wanted to be WORKING and HELPING. She did not apply for unemployment. She did not take out COVID loans. Dumped into a non-existent job market, she lived off savings, a gift from the Mother she was caring for (so demeaning) and the equity in her home.
When she did try to move on, she discovered she had been libeled and black-listed - in a fashion so in-your-face and egregious that Duke Lifepoint had to immediately back-track and pay a contracting company for breach-of-contract (OBTW, black-listing is illegal in North Carolina - not that the NC Attorney General cares when its done to a reporting doctor).
Make no mistake, the (mostly) boys in the C-Suite shoot-to-kill when they're angry with you.
But the state and Federal agencies charged with policing the facility and protecting the Pediatrician - so that she could protect/advocate for her tiny patients - could not be bothered. The blacklisting did not even register with the state as retaliation.
A broken heart can only take so many hits. Wounded animals eventually bite back. And "freedom is just another name for nothing left to lose". So, as of this past Wednesday afternoon at 2:41 PM, the doctor is DONE (if anyone ever asks WHAT and WHO pushed me back to the blog).
Hospital executives and many government officials NEVER EVER expect doctors to set limits or fight back when they're done wrong. They treat the doctor as patients are treated in malpractice cases . . . denying/defending/dragging the-case-out . . . and depleting already-decimated resources . . . until the doctor gives up. Doctors tend to retreat into tiny bubbles of fear and isolation - because we're terrified we'll lose what we worked all our lives to have. The bureaucrats and "suits" circle-the-wagons and double-down. Gas-lighting is a common weapon . . . the doctor is "disruptive", the doctor is "unprofessional", the "doctor" is suffering from "burn-out", and (best of all) the doctor does not "respect" administrative actions and behavior that are not themselves professional or worthy of respect.
I submit that if NCDFS had LISTENED to the Pediatrician begging for help, and come in immediately last February, this hospital's once-solid LDRP unit would not be on life support now. There is no doubt I was removed as an example to everyone else ("resistance is futile") - but it backfired over time. Duke Lifepoint bought the one multi-physician (all female) OB group in town, but in the process, ran off every doctor there (along with three midwives) . . . plus the two chronically-abused/independently-contracted full-time Pediatricians. Then, they ran off the new OB's they recruited. And all of this was after a 2019 nursing meltdown from which they have not recovered. This IS NOT an example of "normal attrition/turnover" (as executives nervously style such things to community/political big-shots). This was a clinical bloodbath.
At some point, someone somewhere in the lofty private equity towers in far-away Tennessee has to realize that the problem doesn't lie with the doctors. At some point, the ill-served community in North Carolina deserves to know what's going on. And, at some point, CMS and JCAHO need to STOP covering executive tail. One has to ask, what exactly does it take?
I played the quality assurance/patient safety game IN GOOD FAITH. I did what I was supposed to do - the way I was supposed to do it . . . reporting internally, "up-the-chain" of "command . . . then turning to the state/federal agency with clear jurisdiction (that validated my concerns) . . . then contacting elected officials - starting with the White House early last December, then Senator Burr (for continuity's sake). After many months of being treated like some THING to kick-and/or-step-over, President Trump was "on the case" in less than two weeks.
The "report" produced by CMS this past January, at the President's request, was maddening FICTION . . . filled with incorrect dates, deliberate/ineffectual deflections/attempts to "turf" (to agencies without any jurisdiction or regulatory "teeth"), glaring omissions, and well, just plain fiction. If a Federal agency can essentially lie in response to the President of the United States . . . and if the official who "supervised" the "investigation/produced the report can essentially "investigate" herself . . . what is the point of anything?
This post is up because I did not get a response from Senator Burr, and I simply did not have it in me to silently endure a 56th "nice" weekend of CMS doing NOTHING. So it's time to move on to other representatives and venues - starting with this blog post. I think this letter, in 2021, stands in stunning juxtaposition to my idealistic and heart-breakingly naive musings as a fourth-year medical student back in 1990 (See "Why Pediatrics").
Once upon a time, I believed.
30 years later, I am living, breathing, walking talking EVIDENCE of why Pediatric residents-in-training are not comfortable reporting bad things. Without a fundamental CHANGE in medical culture AFTER residency (i.e "the real world"), training programs are setting up these newbies for heartbreak and failure.
As I emerge from the other side of this pandemic and this experience, I am sick and tired of the chronic/vicious/arrogant administrative devaluation, disrespect and abuse - by way overpaid MBA's who would soil themselves if they walked into even one of the neonatal/Pediatric messes I've cleaned up over the years. I am tired of repeatedly sacrificing my TIME to organizations that don't appreciate its worth (being "on" for days-on-end is NOT easy). I am tired of my practice environment being a medical minefield that I slog through with no weapons to defend myself, and no one to carry me off the field if my legs get blown out from under me. I am tired of the abuse (all sides) and the repetitive moral injury - day in and day out - having NOWHERE to go when things go wrong - because NOTHING WORKS as it should. I am tired of HIPAA and hospital peer/medical board review being used as tools to frighten/silence physicians and stonewall injured patients - as opposed to actually improving care. I am tired of watching my nurses SUFFER, bang their heads against walls and give up. I am tired of watching MBA's (who plan no further than the next quarterly report) wallow gleefully in the piles of money they either make off short-changing clinicians and patients - or suck from public coffers. And I am tired of politicians telling me they "care" when, over the past decade, they've done everything they could to MURDER my profession.
I don't take comments on the blog. I cannot police them in real time. But . . .
If you're a community hospital in NC/VA/SC/TN that is run by people with actual souls, and you need an experienced/technically-gifted Pediatric Hospitalist who has NEVER EVER WANTED any drama, and who has always/only wanted a safe environment in which to work (where disciplines actually talk to one another and work collaboratively to improve care) . . . with people who actually appreciated the time/effort . . . please use the contact form to drop me an e-mail. I need a job.
If you're a lawyer interested in helping now that I've GIVEN UP ANY HOPE of the United States government doing anything about anything, DITTO (for the record, Ronald Reagan was right about government). I've done the heavy-lifting/leg-work and it's a rock-solid whistle-blower/retaliation case - very well documented along the way, and with an established public record backing me up. It would have to be contingency. I am a Pediatrician. I wasn't "rich" to start with.
If you're a REAL journalist who can get past an agenda or politics and wants to tell a story that might actually help change the world for the better . . . and maybe SAVE some children's lives along the way . . . I am available for an interview that doesn't put a hatchet in my back (as I have too many scars there already).
If you're one of my state or Federal representatives (of either party) - or a patient/physician/nursing advocacy organization, as I told Senator Burr, I am well and truly DONE . . . and more-than- READY to TESTIFY to any committee, institution or government agency . . . any time and anywhere . . . about my pandemic story (and/or previous experiences with the state/Federal "oversight" of healthcare). I would like to finally see some real hope and change for my profession - you know, the one that takes the Oath.
The problems in modern American doctoring are universal and they transcend political affiliation/identity. It is TIME to talk about ALL of the amoral/unethical corporate contract tactics that are used to "own" and silence and bully American doctors . . . the "right-to-work" notions that make doctors pawns on corporate chessboards without considering their special duties and responsibilities . . . the "without-cause" notices and "administrative actions" (that afford no vetting or due process of executive action) . . . the (unethical) no-compete clauses . . . the forced/binding out-of-state arbitrations (that keep the ugliest messes out of the public eye) . . . the gag clauses (a kind of perverse reverse extortion that spits in the face of public safety/policy . . . and often defies obligations to licensing boards) . . . the horrific failures of hospital peer review (both in terms of protecting doctors from bad faith action and policing our own bad apples) . . . the wholesale lack of executive codes-of-conduct . . . the need to permanently expand and nationally standardize/streamline licensure/credentialing in a fashion that both effectively tracks doctors and enables them to quickly MOVE to where the needs are (or where they can resume their lives once disrupted) . . . the the abusive/overly burdensome and expensive RACKET that "maintenance-of-certification" programs have become (which DO NOTHING to enhance care) . . . and the tendency of "corporate" to "cancel" the careers and lives of doctors who dare question any or all of the above.
NONE of it appears to have been discussed in Washington or Raleigh - much less seen its way into COVID-relief bills stuffed with pork.
Finally, if you are a doctor or nurse who has been hurt in the same way I have, I want to hear from you. If you are a patient harmed by the kinds of things I've described here, I want to hear from you. In confidence if you need it. NONE of us are alone. We've just been made to think we are.
When I became a doctor, I did NOT sign away my voice. Part of the job in Pediatrics is patient advocacy - I recognized this even as a medical student. The time has come to ROAR. In the wake of a pandemic and when it comes to protecting our own, the Federal government needs to EXPLAIN why it's medical "oversight" is worse than that of the Communist regime that STILL can't tell us how COVID-19 originated (as if I am stupid and do not know).
As far as COVID-19 and children are concerned, and only in the broadest medical sense we actually got "lucky" ("collateral damage" notwithstanding). For years, I've told my friends that the world will not end suddenly in fire or ice . . . but stealthly and slowly/painfully - with a very nasty/unseen "bug". Next time (and I am certain there WILL be a next time) it's unlikely our young will be spared. And, as things are going, we will have no way to even begin to deal with it. Those of us who run towards the Mother-Baby/Pediatric disasters will be long-gone.
Here's the letter to Senator Burr:
The Honorable Senator Richard Burr
2000 West First Street
Winston-Salem, NC 27104
P: (800) 685-8916
P: (336) 631-5125
Last weekend, I was furious with you - as a Republican, your constituent, and a supporter of President Trump. I actually owe a huge debt of gratitude to the President – who took quick/decisive action last December . . . to help me in my then-nearly-year-long dealings with the Center for Medicare/Medicaid Services (CMS). The issue-at-hand was CMS’s atrocious handling of a complaint I filed against Central Carolina Hospital and Duke Lifepoint (as a medical whistle-blower) on January 29,2020. My experience with the hospital, it’s corporate parent and CMS reflects everything that is WRONG with corporate medicine in North Carolina and America.
Originally, I was prepared to give you a piece of my mind – no matter how it might affect your office’s handling of my complaint from now on (it shouldn’t, and I expect it not to). But what's done is done. And the North Carolina GOP spoke for me. We’re grown-ups and Americans. We can disagree (vehemently) and move on without calling one another names, or smashing one another’s windows, or burning down each other’s houses, or “canceling” each other’s lives.
Well, unless the life is that of an American doctor crucified (not for the first time) for daring to talk back to “corporate”. CMS deliberately and methodically ignored what was done to me for doing my duty . . . according to my contract, according to my hospital privileges, according to my medical board, according to CMS and JCAHO, and according to public policy (i.e. protecting the public and serving its good). CMS and JCAHO tell doctors and nurses to report bad things. They tell us that patient safety is their primary concern. They tell us WE will be safe when we report that patients aren’t safe. I am writing today, Senator, to tell you that IT IS A LIE.
I approached your office as well because I did not want to be lost in the shuffle of a new Presidential administration, whose notions of “reform” will no doubt be a continuation of the abysmal failures intrinsic to the Affordable Care Act . . . a train-wreck piece of legislation akin to a government takeover of medicine without the actual takeover . . . a medico-legal minefield that planted doctors, nurses and mid-levels staffing American hospitals into the extra-special-kind-of-hell where the majority of us now labor. For after Obamacare’s passage, “corporate” (hospitals and insurance companies alike) circled the wagons to preserve the status quo – like profiteering-vultures-guarding-carrion. Medical providers saw their most basic rights erode as legislators “bought” by well-funded healthcare lobbyists moved to protect corporate interests for purported economic gain. Mega-mergers and monopolies became all the rage (and I believe will get worse post-pandemic). Executive salaries went into the stratosphere on the backs of doctors and nurses – and at the expense of patients (who have seen their access to legal redress erode away – even as medical oversight and peer review fail them at almost every juncture). Rural and community hospitals were absorbed, killed or just died as care consolidated and “centralized”. Mother-baby and Pediatric care suffered most of all.
Misery abounds in medicine now. People of all walks of life within this broken system are HURTING. No one in Washington is owning up – or stepping up to fix it.
I know I would have been lost appealing to a new White House administration. For I have already written President Biden. I’ve gotten two non-specific form letters.
As a graduate of Bowman Gray and Brenner’s Pediatric residency program, trained by the late/great Jimmy Simon, I once had a dream of helping build strong interconnected networks of rural/community Pediatric care (supported by the large centers) . . . i.e talking the Pediatric care “out there” – to the children/families that needed it where they lived. Anyone can work in the big city centers (that look like shiny resorts) with the state-of-the-art support. But providing good care in “the sticks” is a different story and unique challenge. I’ve started community Pediatric programs from scratch . . . or rescued rural services after complete meltdowns (for the record, always caused by bad management/abuse of existing staff) . . . and held them together with limited resources/practically zero support . . . and taken the monster call . . . all for the love of the work. But the dream is dead. Corporate medicine has killed it.
There are days I want to throttle the academics in the lofty towers at the American Academy and Board of Pediatrics (the Board is actually based in Chapel Hill). Several years ago, they turned what I did for a living into another sub-specialty. I would actually be able to grandfather-in and sit for that (additional) Board exam if CCH/Duke Lifepoint had not worked their dark magic upon my life last year (after working almost exclusively as a Pediatric Hospitalist since 2008 – longer than just about anyone else in the field – but I haven’t worked in ten months – and I don’t have the cases to sit for the exam now). The Academy and Board have done absolutely NOTHING to protect Pediatric Hospitalists from abuse or devaluation in a corporate environment in which we ALWAYS place/rank last. The care of babies and children don’t make money for hospitals (it is more of a community service) – never mind that research shows their Mothers make most-if-not-all of the decisions about where to seek care – and a happy Mama is a repeat customer. Several weeks ago, I saw an ad (posted by Atrium Health) for a Pediatric Hospitalist – only to discover that they wanted a nurse. Devaluing my training and experience (as an “old school” Board-certified Pediatrician) to make a fast buck is not caring about the welfare of babies. That’s about pure greed. And I ask you, WHY would ANYONE spend three additional years after a residency doing a Pediatric Hospitalist fellowship – if Eugene Woods equates that doctor to a nurse?
Speaking of Atrium (and Baptist for that matter), allow me to opine that we don’t really need a sixth medical school in North Carolina (at least four states don’t even have one). We need North Carolina to treat the doctors we already have – and are producing in a factory-like fashion – with decency, humanity and respect. Doctors are NOT “a dime a dozen” or interchangeable “light bulbs”.
Moreover, medical labor laws and contracts need to reflect our duties, our burdens and our Oath – as well as current corporate realities (like the surge of doctors working under independent contracts – and the rise of private-equity-funded-healthcare). But they’ve not changed in over 30 years. In terms of advocacy, the Medical Boards and Societies have sat on their arses and let good doctors be slaughtered for the economic benefit of hospitals. If you want to know why medical/nursing unions are getting a footing in North Carolina, look no further than North Carolina’s not-benign-at-all neglect.
As I have alluded in the e-mails that have flown back and forth between myself and the Director of the CMS Atlanta Survey Operations Group (in “charge” of North Carolina) over the last two months (with your Ms. Hatfield monitoring), this is actually the third time I’ve been fired for medical whistle-blowing. It’s always “without cause” (a contractual sleight-of-hand which is perhaps corporate medicine’s dirtiest little secret). As a physician, you train for literally decades to be who you are. You have to privilege for months to get a hospital job (your life is picked apart and placed under a microscope). But everything you’ve worked for can be destroyed in a day – with just an e-mail or a phone call from an angry/vindictive executive (who has NO medical training). No discussion. No review by your peers. No recourse. One’s hospital privileges mean nothing and afford no practical protection.
The ONLY people in medicine and nursing with job security these days are “the suits”. I have learned the very hard way that it does not matter how hard I work, or how many shifts I take, or how much I cover/help colleagues, or how many little lives I save, it is NEVER enough to feed the corporate profit-monster. Apart from the love of the work (which has been my only reason for doing it) there is NOTHING in it for me except the same (or shrinking) paycheck (no raises, no bonuses, no advancement, and certainly no respect or protection).
Every single time it’s happened, I intervened in a neonatal case (saving a life or stabilizing a dicey situation) that should not have happened in the first place. Each time I reported what happened internally, through appropriate channels. Each time I was fired within days to a-couple-of-weeks of making the report (because what I reported reflected badly on management – and it’s apparently “unprofessional” now to challenge bad management). All three times I turned to the state and/or Federal government for help. All three times (including the one I am writing to you about now), the government has failed to enforce its own contracts/standards of care. Each time, I’ve struggled for months-to-years to regain my professional and fiscal footing.
In 1998, I was forced out of the Pediatric practice I started in my hometown of Asheboro – immediately after I completed concurrent public health service obligations (loan repayment for service) to the National Health Service Corps and NC Office of Rural Health. I took Randolph Hospital to Court and successfully litigated (it took three years) to a paltry settlement in my favor. It was no victory because I soon discovered that hospital executives had lied during discovery about the “confidentiality” of their non-profit books and salaries - in order to minimize the damages paid out to me (for an absorbed-by-the-hospital/lost practice). NO ONE in state or Federal government did anything to hold them accountable. It is a FACT now that if anyone had listened to me back in the day (about incompetent senior management) the hospital might not have gone bankrupt last year. Randolph’s books were so horrid that none of the big NC names would bail them out – not even Cone Health (managed for a good portion of that time by Atrium Health) – which had been “cooperatively” perched over Randolph’s door like a vulture for years.
In 2017, angry executives of Ballad Health saw me ousted from a Pediatric Hospitalist program I had started for ETSU two years earlier in Abingdon Virginia. Prior to filing the peer review/EMTALA complaint that got me fired, I had challenged being (quite literally) treated like a slave by the university – working double-time to cover UTTERLY STUPID staffing deficits – but not being paid at all (i.e. “fair market value”) for two months of overtime (a civil rights complaint has been sitting at the Department of Justice for many months). As I am certain you know, Ballad is a state-supported medical monopoly that came into being (as a merger of Mountain States Health Alliance and Wellmont Health) via cooperative agreements (COPA’s) with the states of Tennessee and Virginia . . . bypassing the FTC and anti-trust laws. The states were basically bribed with a host of flowery Ballad-funded promises to approve the deal. This situation is referenced in my current complaint to the Office of the Inspector General regarding the Central Carolina/Duke Lifepoint debacle – as it references prior interactions with the Center for Medicare/Medicaid Services (CMS).
Before ApolloMD/Central Carolina dropped their despicable “notice” on my head last January (just two days after reporting patient safety and quality-of-care concerns to hospital leadership – and the Director of the Duke Quality Network), I had spent two years covering #13, 24-hour shifts-per-month, in-house. While on-call, I “lived” in call room that reeked of raw sewage (from leaking pipes in the walls) . . . leaving the hospital only for brief Starbucks or meal/shopping runs . . . because I was afraid to be off the unit when I was on-call. Staffing, training and resources were so depleted that I was terrified that a baby or child was going to die on my watch . . . that something would happen that I could not prevent or stop. Pediatric practice conditions on my ground had deteriorated to near third-world conditions - due to fundamentally cheap/short-sighted decisions made by senior management. And (my God) . . . the poor nurses were just battered to a collective pulp.
Central Carolina’s LDRP unit had been “the little unit that could” for years. But I have NEVER seen a Mother-Baby service fall apart in the way that one did – in just under a year. By my “end” at CCH, this hospital could not even ensure that a baby was properly fed at night. That’s NOT just me saying it. The state of North Carolina ultimately confirmed it.
I was forced to work out the hospital’s “notice” (a first for me – as usually, when these things happen, you are paid to leave). I contacted the NC Department of Facility Services (NCDFS) – the enforcement arm of the Center for Medicare/Medicaid Services (CMS) in North Carolina – on January 29, 2020.
Alas, Federal “oversight” has been a JOKE since that day to this one. As NCDFS stalled, I was repetitively eviscerated on the field-of-battle (by ApolloMD and Central Carolina and Duke Lifepoint) . . . right under the state and Federal government’s noses . . . even as I continued to file reports IN REAL TIME . . . during a pandemic.
Meanwhile, the Federal government threw billions in pandemic relief at the healthcare system gutting me (Duke Lifepoint). And the system’s private-equity “parent company” (Apollo Global Management – not to be confused with my contracting company, ApolloMD) propped up the world’s most notorious pedophile.
When my “notice” expired, I was dumped into a non-existent job market with a sick 85-year-old Mother to take care of (the reason I stuck with Central Carolina for as long as I did – as it was close to home). For the record, Mother is a retired Special Education/K-1 public schoolteacher who served Asheboro for over 30 years. A teacher raised a Pediatrician. We BOTH have taught and cared-for the children IN FRONT OF US – red and yellow, black and white – from all walks and backgrounds and faiths. Neither of us deserved what this hospital dished out. Since this happened, I have lived off savings, a gift from my Mother and the equity in my house.
Last year, as Mama’s primary caretaker, I got to navigate the system from the patient’s point-of-view . . . getting her through two major surgeries (a shoulder replacement and kyphoplasty) and rehab – as well as my own breast-cancer scare. Of course, in retrospect, and considering Andrew Cuomo’s performance in New York (murderously dropping COVID-positive patients in nursing homes), my forced unemployment almost seems like a small blessing. I could keep Mama in her own home and attend to her needs myself . . . keeping her safe from the same government that had repeatedly failed me and was apparently killing other people’s parents.
I look back on that situation and remember all of the sons and daughters of all of the people who died trying desperately to get the media and government to HEAR THEM and CARE about their plight . . . just as so many healthcare providers flocked to social media at the beginning of the pandemic to complain about the lack of corporate preparedness and PPE’s. I remember the whistleblowers who endured retaliation if they said a word. Doctors like me. Meanwhile, Andrew Cuomo got an Emmy from the Hollywood crowd for his “optics” . . . when all I ever saw was a pale/pathetic/petulant imitation of Michael Corleone.
My transition from long-suffering doctor to care-giver occurred on the heels of (probably) catching COVID on-the-job last March (sleeping in the aforementioned fetid call room). I say “probably” because neither ApolloMD nor Central Carolina/Duke Lifepoint cared enough about me living or dying to even offer to test me. I have Hashimoto’s Disease and suffered complications of the illness (a myxedema flare). It took months to identify and then recover.
With no other choice, I waited for the state to do its job. But after NCDFS got what it wanted with its stalled site visit/survey in June (a watered-down “show” of “oversight” based on what I’d reported) . . . and even though the report vindicated me . . . I was left behind . . . my life utterly destroyed because I had done the right thing for “our” patients. CMS did NOTHING to see me restored.
I have been exceptionally grateful for Ms. Hatfield’s attentive eye . . . as a witness to events in this saga as they unfolded starting early this January . . . first when President Trump’s inquiry enabled me to expose the CMS Atlanta Survey Operations Group’s determined/methodical negligence . . . and later, when I challenged that same office’s attempt to DUMP me on another agency (the Office of the Inspector General). The agencies involved were aware that she was watching in real time.
For the last two months, Ms. Hatfield has witnessed the Director of the CMS Atlanta Survey Operations Group posture and squirm and writhe to cover-up/dodge the short-falls of an “investigation” that she supposedly “comprehensively” supervised.
The Director has thus far been allowed to “review” her own deliberately stalled/botched “investigation” – apparently hoping I will just go away. It is actually the SAME despicable game hospitals play with malpractice victims in lawsuits . . . i.e. deny and stall and deflect until the plaintiff runs out of money or gives up.
At this point in this game, I have NO CONFIDENCE in the Director’s ability to acknowledge – much less correct – the agency’s multiple failures of oversight in this case. Neither should you (as a Senator helping dole out the money that pays for it) after what Ms. Hatfield has witnessed.
First, in response to President Trump’s inquiry, the Director produced a “summary” of her “investigation” that read like pure FICTION.
When I challenged that “summary”, we very quickly discovered that (despite the alleged “comprehensive” supervision) the Director did not even have a copy of my original complaint (or indeed, at least one or two of the addendums filed later).
The Director has not explained the extended delay between the filing of my complaint and the hospital survey six months later (after I was interviewed over the phone on 2/4/2020). NCDFS had a full month to intervene and STOP what the hospital was doing before pandemic restrictions went into play – when doing so would have likely preserved my job and prevented MORE patients from being placed in harm’s way. I was still under contract and still on-site/available to interview for almost 3 months after I filed the complaint. If CMS had intervened in a timely fashion, my “notice” could have been withdrawn (with apologies and very little damage done).
The Director has yet to satisfactorily explain WHY, when CMS finally did show up, her “SSA” (the NC Department of Facility Services) could not independently follow the wealth of evidence in front of them, and cite Central Carolina for its obvious deficits in both Quality Assurance and Medical Governance (i.e. shooting the messenger – in violation of JCAHO’s patient safety standards and CMS’s own “conditions of participation” – done without conducting ANY discussion or peer review). The oversight-and-policing of these matters were and remain very much under CMS jurisdiction.
That would have laid a firm foundation (not that they did not already have one due to the deficiencies identified) for addressing my predicament and restoring my job/lost wages under a “plan of correction”. I strongly suspect NCDFS did not want such citations on the public record (in a survey report). It might give other doctors unsavory ideas pertaining to enforcement.
I mean, the PROPER response to the kind of complaint I lodged with hospital leadership is to sit down, and talk (in an interdisciplinary fashion), and work out a solution to the patient safety issues identified by the “adverse event” – so that it is less likely to happen again.
Isn’t that what we learned from the Challenger disaster and the airline industry – and from 9/11?
NOTHING prevented NCDFS from citing those deficiencies except a desire (by state officials in an election year) to “cover” for the hospital’s high profile/big money medical parent (Duke Health) . . . which supervised Quality Assurance at the hospital and whose network Director was aware of my concerns BEFORE I was given “notice”.
On top of all of this . . . and in the wake of a NCDFS/CMS survey report that vindicated me . . . as I attempted to “move on”/find work (near my Mom) . . . I endured (and reported to NCDFS as it was happening) a brazen black-listing (illegal in North Carolina) by Duke Lifepoint . . . as evidenced by the breach-of-contract on a Locums assignment at a DLP facility in Rutherfordton (arranged through a company other than ApolloMD) . . . scheduled for last September/October. All Duke Lifepoint had to do (to prove the “What, who, us?” act that they/Central Carolina had been putting on) was let me work. But Duke Lifepoint LIED to my Locums company – telling them that I could not be credentialed – when I had, in fact, re-credentialed without ANY problem DURING my “notice” period at Central Carolina (technically/ironically after I had been fired). It was then that I discovered that Central Carolina had retroactively rescinded my hospital privileges in June – right before the NCDFS survey – without my knowledge or contractual consent – based on the hospital’s agreement with ApolloMD. The Medical Staff Coordinator at CCH shrugged it off an “administrative” action (i.e. not peer-reviewed and not reportable as an adverse action to the National Practitioner’s Data Bank). Once caught in their lie, Duke Lifepoint actually had to pay my Locums company on a portion of the breach (to pay me for September – alas, October was lost to a 30-day “notice”). The black-listing was a malice-soaked corporate move which firmly solidified a Federal whistle-blower claim. But if you read the “investigation” summary produced by Atlanta last month, NONE of this registered with NCDFS as retaliation/punitive action!?!
It obviously didn’t register with the “supervisors” in Atlanta either. For if “jurisdiction” was the issue, THIS would have been the time to invite the Office of the Inspector General to the “party”.
[As an aside, and speaking to the way contract law in North Carolina is skewed to favor healthcare conglomerates, WHY should a North Carolina physician, working at a North Carolina hospital, contracted though the North Carolina “shell company” of ApolloMD (to get past the NC Medial Board), be forced to binding arbitration in Georgia? WHERE is the NC Attorney General?]
As the supervisor of an “investigation” literally BUSTED on all of these counts, the Atlanta Survey Group Director has NEVER ONCE picked up a phone to talk to me (after asking if she could – immediately after I challenged her fictional “summary” last month).
Compounding the injury already inflicted by her agency’s indifference and neglect, and after weeks of stalling, she tried to dodge her responsibility – and DUMP me on the Office of Inspector General (as we have established, something she might have done much sooner IF she did not have “jurisdiction” over what the hospital did – which she actually does). I KNOW that she did it expecting me to (1) get lost in another 6-12 months of red tape, and (2) have it tossed out in the end because I was not a Federal employee (knowing that my savings/bank account was depleted, and I was living off the equity in my house).
As Ms. Hatfield can confirm, I DID contract the OIG (despite prior life “lessons”) and was surprised to be told that they actually have jurisdiction over CMS/their investigations (oh, and they don’t like “dumps” from other agencies).
A 40-page (Word Document) complaint was filed with the Office of the Inspector General on 2/8/2021. I not only asked for an examination of the original complaint (as a matter of quality assurance), but also a through review of CMS’s handling of my complaint – from start to finish.
I am writing to you now to BEG for your help in getting this case rapidly referred to someone higher in the CMS “food-chain” . . . someone who can prioritize this case . . . someone who actually has the ability to PICK UP THE PHONE and call in someone high-in-the-food-chain at the OIG . . . to rapidly resolve this in a fair and just fashion that does not see me lose my house.
Before I was fired, I lived in constant fear that something very bad was going to happen to a baby on my watch due to circumstances largely beyond my control. I have spent the last almost ten months terrified that I will never work/do what I love again – because I spoke out to protect my patients from being placed in harm’s way by corporate greed and indifference.
No American doctor should experience this.
Senator Burr, since I first filed my complaint, I’ve sat on the sidelines waiting on government to work through two (failed) impeachments, a pandemic, your own (comparatively rapidly conducted) opened-and-shut investigation by the DOJ, a summer of hatred and violence – soaked in identity politics – where practically no one was held accountable for anything, and an election that has me thinking I now live in a banana republic.
I should be AT THE VERY FRONT OF THE LINE now. I’ve waited 13 months for the system to work as it should – when, in fact, this matter should have been addressed this time last year. As a “front-lines” Pediatrician, I should have been protected as I tried to protect patients – patients who cannot speak for themselves. Even China recognizes this now.
What would YOU have had me do if it were your daughter, granddaughter or grandchildren placed in harm’s way?
I was bemused last week to see Central Carolina make the Newsweek/Leapfrog list of 2021 “Best Maternity Hospitals”. I did some digging – to the point of e-mailing Leapfrog to question the methodology. Turns out the numbers are pre-pandemic and based on 2019. Those were actually MY numbers – and those of my long-suffering Pediatric Director – and of four of the Obstetricians who were driven off by Duke Lifepoint management – even as we all burned our candles at both ends to navigate a nursing meltdown. It takes into consideration NOTHING that happened last year. And it shows how fundamentally useless Leapfrog and JCAHO studies can be in terms of assessing and recommending safe care to the public.
As I have said before, the hard work is already done. Whatever it may not have done with regards to assigning deficiencies in Quality Assurance and Medical Governance at Central Carolina Hospital last June (as demonstrated by how I was “handled” after submitting an internal complaint to hospital leadership), NCDFS/CMS identified and declared deficiencies in newborn patient care based on the complaint I filed (after months of treating me like an “in-house snitch”) – citing the very case I was immediately fired for reporting.
Duke Lifepoint, in turn, black-listed me (once again, supposedly illegal in North Carolina) and breached a signed contract (as documented by a partial pay-out to the Locums company that arranged it) . . . IMMEDIATELY after I filed a complaint with their “Ethics and Compliance” Department – detailing how I was treated after filing the internal complaint that started this mess. That treatment makes a LIE of the “no retaliation” policy spouted by their CEO.
The case is not complicated (as a NC Medical Board attorney opined, when I spoke to her this past week). The case is simple. I reported something embarrassing and potentially legally damaging to the hospital. ApolloMD, Central Carolina and Duke Lifepoint did what they did to shut me up. They were and are COMPLETELY in the wrong.
It should now be a simple matter for the Federal government to restore the doctor who stepped up – and who has gone above/beyond – to protect “our” patients. That “accounting” could happen in ONE afternoon – with both CMS and the OIG exercising their combined regulatory powers to hold ApolloMD and Central Carolina/Duke Lifepoint responsible for their greed – and attempts to extort silence at the cost of my career and life.
I don’t have months – or even weeks – to see this happen. I need help RIGHT NOW.
After absorbing three strikes to my soul as a medical whistle-blower in 23 years, I am quite prepared to make some NOISE to finally get some REAL HOPE and REAL CHANGE. As my Mother opined during this past (55th) weekend since filing my report with NCDFS/CMS (sitting and waiting on government officials with safe/protected/9-5 jobs who-do-not-seem-to-care TO ACT) . . . there is JUST NO SENSE in me having to rebuild my life every few years because an overpaid hospital executive (or group of executives) would rather (as demonstrated by their actions) risk letting a newborn baby DIE than do what is necessary to see that he/she is properly cared for. These executives would rather let a Mother/family endure the loss and feel that pain . . . in the name of a fast buck or bigger profit margin for their shareholders. They casually accept the calculated risks to providers and patients, and gamble with our lives, that they will “win” on any given godawful night – when resources on their decimated/under-staffed grounds depend on people like me pulling a victory from sheer determination and thin air. Their way is to enrich themselves on the misery they impose on "the front lines" and on the backs of the people doing what NC Governor Roy Cooper calls "God's Work". THAT is what I have been fighting for a good portion of my career.
This not just about me. It started as a stand made for both my nurses and my patients – living in a community where I commuted to work. Those who remain at Central Carolina are good people. The patients they serve are good people. They deserve far better than what Duke Lifepoint has dished out. They deserve new senior management and a firm capital commitment to their OB unit and hospital – whether I ever work there again or not.
In the wake of the COVID-19 pandemic . . . and in the face of multi-billion-dollar equity firms controlling healthcare (in a fashion that very few doctors/lawyers/patients can fight alone) . . . and with the Federal government printing more money-that-we-don’t-have to prop up their operations . . . medical whistle-blower protection needs to be UNIVERSAL – meaning available to any employee or contractor working at a hospital/facility billing under Medicare or Medicaid. It needs to be easy to access and timely in its assessments – not allowing providers to languish in hellish limbo as I have.
I am ready to testify to Congress – any time – any committee – anywhere. Just put me where I need to be to do it. Get this Brenner’s alumna past Nancy and Chuck's damnable fence - before you retire and join another healthcare board (like the new-and-scary Atrium-Baptist mega-monopoly). Let your legacy be about protecting children and the people who take care of them.
Thank you for your attention to this matter. Once again, I am literally BEGGING for a convergence of senior CMS and OIG officials upon my case this week.
I should NOT have to BEG.
Mary H. Johnson, M.D., FAAP
(Address redacted for publication - see contact form on sidebar)
And that's it, folks. I will update the story as it evolves. But today, I am free in a way I've not been for a VERY LONG TIME.
3/3/2021 Update. Letter to NCDHHS Secretary, Mandy Cohen. Published on Facebook with a link to this post: