Please go to this link to comment on this article:
https://politicsonmaui.com/maui-er-doctor-firing-the-strange-case-of-dr-david-williams/
Maui ER Doctor Firing: The Strange Case of Dr. David Williams
Posted By Deborah Caulfield Rybak
August 30, 2022
Dr. David Williams, one of Maui Memorial Hospital’s most senior emergency room doctors, was abruptly fired last month. The exact reason remains unclear; the hospital will not discuss personnel issues. However, based on documents obtained by Politics on Maui, it seems to have little to do with his professional skills and more about hospital politics.
Williams’ termination followed an angry letter he sent to 50 members of hospital management about the actions of hospital chief of staff, Dr. Vijak Ayasanonda. After Williams was elected as vice chair of the emergency department by his peers, Ayasanonda sent a series of texts searching for complaints that could besmirch Williams’ otherwise clean personnel file. It was an unsuccessful effort. Williams’ election was subsequently ratified by the hospital’s Medical Executive Committee (MEC).
Days later, he was fired.
ER management company complaints
This latest series of events comes on the heels of publicized unrest among members of the hospital’s emergency department. The turmoil briefly boiled over into the media with a front-page story by the Honolulu Star-Advertiser’s Sophie Cocke in early August. It reported numerous mismanagement allegations leveled against Emergent Medical Associates (EMA) in an anonymous letter sent to the hospital’s Board of Directors and the MEC.
EMA is the Southern California-based group contracted to run the emergency department in 2018, shortly after the hospital was sold by the state to a Kaiser Permanente subsidiary. The anonymous letter claimed that EMA had failed to meet a number of contractual promises and that morale in the emergency department was low. Five ER physicians had departed, either permanently or on leaves of absence, with others currently looking to depart. EMA split hairs challenging many of the letter’s assertions, but the loss of physicians, for whatever reason, is real.
The story provoked a short editorial by the Star-Advertiser which read, in part, “Patients deserve better than a hospital plagued by strife between staff and management.”
Similar complaints were raised in an online petition launched in July by local trauma surgeon Dr. Stephanie Yan. In it, Yan calls for the EMA contract with the hospital to be terminated, and hospital Chief Executive Officer Mike Rembis to be replaced. She also discussed Williams, calling for “the resignation of the actors involved in falsifying career-damaging accusations regarding Dr. David Williams.”
EMA officials have denied any involvement in the Williams matter, even though Chief of Staff Ayasanonda also wears a second administerial hat–he’s employed by EMA as Co-Associate Director of the emergency department. The company said in a statement that the texts “did not involve EMA,” as Ayasanonda’s actions came from his capacity as chief of staff.
However, Maui Memorial Hospital spokesperson Tracy Dallarda also denied that Ayasanonda acted in any hospital administration role in regard to Williams. “Our physicians are part of the autonomous medical staff of Maui Health, meaning they self-govern,” she said in an email.
I reached out to Ayasanonda for comment on his texts and received no reply. I also contacted hospital Vice Chief of Staff Dr. Cordia Wan and Dr. Aaron Altura, respectively the vice chair and secretary of the Medical Executive Committee—the “self-governing” hospital organization. Wan is out of town; Altura did not respond.
Williams referred all questions to his Honolulu attorney, who declined to comment.
Retribution fears; confidentiality agreement
As I researched this story, many health professionals from the hospital and within Maui’s medical community spoke emotionally of the ongoing heavy-handedness by hospital management. They also praised Williams, whose career in the hospital’s emergency department spans almost a decade. But no one would speak on the record, fearing retribution.
Petition-writer Yan—who said she isn’t directly employed by the hospital–was the exception. “David is an excellent clinician,” she said in an interview. “He’s very safe and a proponent for patient care and an advocate for staff as well as physician wellness. That’s why I think he was very popular.”
The reluctance to speak publicly is not unfounded. On August 26, an email sent “on behalf of hospital chief of staff Vijak Ayasanonda” reminded staff of confidentiality rules—not just in relation to patients, but to hospital business. Attached to the email was a rather onerous confidentiality agreement. In addition to standard patient confidentiality language, it also contained an additional admonition: “No practitioner shall disclose information that by policy is not available to the public and/or that is acquired in the course of his/her work/placement with Maui Health.”
The consequences for doing so are severe. The agreement concludes, “I understand that any violation of these health care and business ethics constitutes grounds for disciplinary action, up to and including discharge (termination).” Other penalties are monetary: “equitable and injunctive relief” and “damages.”
Outspoken advocate
Williams has been an outspoken advocate for physicians, health personnel, and patients. In the pandemic’s chaotic early days, he argued with hospital administration about its series of confusing mask-wearing rules. At one point management prohibited mask use at all. When Williams insisted on wearing an N95 mask at work, he was yanked from the emergency room and later sent to work on Lanai. EMA says it was asked by hospital administration to “temporarily remove” him.
At that time, the American Academy of Emergency Medicine (AAEM), a national organization that advocates for “democratic physician groups,” wrote a letter in support of Williams.
“I sent [Williams] an email with attachments [regarding hospital bylaws about termination] that he shared with hospital administration,” AAEM co-founder Robert McNamara said in an interview.
Three months later, Williams was returned to work in the hospital ER.
People familiar with his situation said Williams continued to advocate on behalf of emergency room physicians. Among other issues, he insisted that the department hold a democratic election, per hospital bylaws, to vote for the chair and vice chair of the department. His election concerns were heard.
First “democratic” election
On June 3, Williams wrote in his letter, the emergency department held “our first free, fair and democratic election.” Williams was elected Vice Chair. As bylaws dictate, the vote would then be ratified by the Medical Executive Committee, which includes representatives from all hospital departments. The ratification is usually an administrative, rubber-stamp procedure.
However, at the MEC’s June 14th meeting, Ayasanonda raised vague concerns about Williams. In his letter, Williams said Ayasanonda “alluded to ‘reports,’ data and evidence of unprofessional behavior.”
As a result, the MEC postponed the ratification vote and, instead, formed an ad hoc committee (from which Ayasanonda recused himself) to investigate Williams.
Williams wrote that Ayasanonda’s actions laid the “groundwork for a tactical and intentional smear campaign, targeting a respected colleague, member of the MHS medical staff and delegitimizing the fair departmental election.”
“Williams has a total clean file”
Although Ayasanonda had recused himself, he wasn’t absent from the process. Days later, he sent out the first in a series of text messages to emergency department charge nurses seeking information on Williams. Williams included screenshots of the texts in his letter.
In one, Ayasanonda wrote, “I need your help. Williams has a total clean file…he has the chance to become the chair of er if he stays clean for 2022. If any of you and everyone else can help and please document complaints and uors [unusual occurrence reports]. If not, I worry [about] the relationship with docs and nurses moving forward.”
In another, he wrote, ‘If I have nothing by November, Williams is considered a member in good standing and can run for chair. He got enough docs to vote him in as vice chair through December already.”
Emergency room nurse supervisor/manager Julius Montehermoso subsequently wrote to a colleague, “Can you please send me the issue with Williams ASAP? I’ll pay you the time to work on it.”
And contrary to hospital statements that the matter was a “self-governing” physician matter, Ayasanonda wrote in one text, “I’m sitting with admin now.”
“Malicious and hostile” allegations
Williams was furious and wrote in his July 15th letter, “The insinuations of impropriety directed at me were and are baseless, malicious, and hostile. I believe [they] were made to derail the ratification of my fair election to Vice Chair.”
The reports Ayasanonda ultimately provided to the MEC ad hoc committee apparently didn’t reach any kind of threshold for denying Williams the elected position. The MEC subsequently ratified the emergency department’s election results.
However, following that ratification, Williams was fired. His demands for an investigation into the matter remain unanswered.
Too many stressors?
In the midst of a physician shortage on Maui, there now is one less skilled, local ER physician on duty at our hospital.
The AAEM’s McNamara is concerned by the current situation. “You can’t just fire David Williams,” he said. “This has to be done with good reason. There needs to be a chance for Dr. Williams to address those reasons in front of his peers on the medical staff. It shouldn’t just be the administration or this outside company who can cut him off.”
With the current “confidentiality agreement” mentality at the hospital, it’s doubtful that the community will learn whether Ayasanonda’s actions and Williams’ termination has been investigated or not. The standard hospital response these days: because of Covid, times are tough. Doctors and nurses are hard to find.
Still, social media comment threads fill up regularly with new complaints and allegations about conditions at Maui Memorial. As one commenter on Maui Now recently put it, “I don’t know anyone who works as a nurse or doctor that is currently happy with management. It is truly a hostile workplace.”
I heard the same sentiment voiced by dozens of hospital workers I interviewed. Said one, “We have never felt so helpless, or hopeless.”