"To MHS Hospital Board and Medical Executive Committee Members,
Thank you for providing a forum for us to safely and anonymously voice our concerns. In an effort to ensure these issues reach the appropriate audience, a copy of this letter is to be provided to MHS Hospital Board and MEC Members.
We do not believe the Emergency Department contract management group, Emergent Medical Associates (EMA) has delivered on their promises as laid out in the original RFP presentation.
EMA promised, “Boots on the ground“ and that Dr. Lee Weiss would be on-site, “two weeks of every month“ to, “maintain a strong on-site presence through clinical and administrative shifts.“ During the past two years of the pandemic (April 2020-April 2022) Dr. Weiss worked 18 shifts in total, he was not present on the island at all for approximately 6-9 months during the onset of Covid, he is not a regular presence in the department, and does not participate in any of the monthly committee meetings.
EMA has moved zero physicians to the Hawaiian Islands, full-time, to administratively lead, support, and manage the awarded MHS ED contract. Despite 40+ years of staffing the emergency department, zero emergency medicine physicians were involved in the search and selection committee to choose the ED contract management group.
EMA promised to, “Seek an Associate Director from the current group and all would be welcome to apply.” We have not had a democratically elected leader at any juncture during EMA‘s tenure.
EMA promised to improve the quality of patient care delivered, then proceeded to hire a physician who had lost privileges at numerous hospitals throughout the state (including a prior termination at MMMC) and two advanced practice providers (APPs) who were dangerously under qualified to treat patients. We transitioned from a department where all ED patients were assessed, bedside, by a board certified Emergency Medicine physician, to a model that allowed for unsupervised, independent evaluation, treatment, and disposition, by NPs & PAs, while fraudulently billing at full physician rates.
EMA promised to transition to, “fair billing“ and, “ethical billing.” They projected an average patient charge of $900/visit ($1100 less than the previous ED management group averaging $2000/visit). Over the past two years the average patient charge has, instead, increased to $2221/visit under EMA’s management.
EMA promised to, “improve patient experience, one patient at a time“ and to implement an, “in-house tablet based patient satisfaction survey program.“ It is widely known amongst all staff that the vast majority of patient satisfaction data is fraudulent.
EMA promised to be held accountable for their, “citizenship.” We are concerned about the impropriety of collecting a staffing fee to run the MHS Covid-19 Clinic while mandating these same providers, simultaneously, evaluate, manage, and bill patients on EMA’s behalf within in the emergency department.
EMA attempted to fire a physician for wearing an N95 mask at the onset of the Covid-19 pandemic. The message to all other physicians in the department is very clear: protection of the contract and profit supersedes all else, including patient care, physician health and well-being.
We are concerned about the amount of money EMA is funneling out of state and into mainland bank accounts. In light of this we find it disingenuous that EMA is simultaneously asking the hospital, state and taxpayers to subsidize their contract. We are even more concerned that the unanimous decision made by the five local MHS Hospital Board members to audit and investigate EMA‘s finances was squelched by EMA friend and confidant, Michael Rembis, and his attorney.
We are concerned that three physicians have recently quit, two have taken leaves of absence, one has tragically died by suicide, and an additional six ED physicians and healthcare providers are actively seeking employment elsewhere. As EMA now depends on locum tenen physicians, doctor’s who are not invested in our community, they attempt to compartmentalize and diminish these losses. They assume little to no responsibility for this wave of unrest.
Finally, we are concerned this discontent extends far beyond the emergency department. Physicians, surgeons and healthcare providers in multiple other departments wish to speak publicly about how decisions made by the current CEO have negatively affected patient care, physician wellness, retention, and hospital morale.
Dr. Robert McNamara, former president of the American Academy of Emergency Medicine (AAEM) states, “There are many problems within the field of Emergency Medicine that have little to do with the practice of medicine, and are largely centered around the business of medicine. The physician practice management industry is at the core of these problems. The issues threaten the integrity of the specialty, the career satisfaction and longevity of its practitioners, and, ultimately, the quality of care delivered to emergency patients.“ Dr. McNamara has graciously made himself available to speak on our behalf, in person, to the MHS Medical Board and the Medical Executive Committee on Maui.
We believe an immediate RFP to replace this off-island, California-based, contract management group is the only way to stabilize the department and to improve patient care, physician wellness, and physician retention. We advocate for the formation of a democratically organized, local, physician-owned, practice management environment, as endorsed by AAEM physician groups (AAEM-PG). In our professional assessment, this is the only option and solution for MHS and Maui County emergency medical care at this critical hour."
After this was received, Dr. David Williams was fired, although he was ratified as the Vice Chair of the Emergency Department. I wonder if the Chair of the ED on the Medical Executive Committee is still Dr. David Williams though because he can be fired from his job, but he is credentialed with the Medical Staff as an ED physician and that designation doesn't go away even if your employment goes away. For example, my fellow surgeons voted me as Co-Vice Chief of Surgery three years ago for a two year term, but I wasn't employed by anyone, so I was still part of the medical staff leadership team with that title. I wonder? Did they just fire their Vice Chair of Emergency Medicine who can likely keep his title for two years, unless they change the bylaws, because technically he can still practice medicine in Maui without an issue and he is still the EMS Medical Director, State of Hawaii, DOH, Maui County? Just some Thursday morning musings.