Ordinarily, the names of hospital CEOs grace the society pages of their local newspapers—not the police blotter. Seldom are these community titans the subject of investigations by state attorneys general into questionable workplace conduct.
So, it was off-putting if not curious to see this past week a spate of unusual behaviors from a handful of hospital executives and former executives, all of whom allegedly appeared to have exercised poor judgment—or worse.
Obviously, the seriousness of these incidents varies greatly. Using skid row transients to rip off the government is a far more egregious lapse than is a questionable personal relationship with a subordinate. And, we have to presume the innocence for those executives who've been charged but not convicted. However, at face value, these incidents reflect bad judgments by people who should have known better.
Why do normally responsible people in positions of high visibility and responsibility engage in career- and institution-threatening misadventures? There is no one reason. Often, however, leaders who fall spectacularly from positions of power don't work in a culture of accountability. They didn't have someone close at hand who felt comfortable forcibly pointing out the flawed behavior and the consequences to their careers and the institutions they lead.
You see this all the time with Congress, the most unaccountable organization on earth. Under the usual formula, the Congressman acquires power and enjoys perks that include kowtows, back slaps, and ring kissing from lobbyists, hacks, colleagues, and even the media—all of whom want something. So, the pol cuts himself off from reality and surrounds himself with courtiers who laugh at his witless jokes, and nod reverently when he says something ludicrous. Before long, his better judgment is gone, and he files a bill to outlaw feather dusters, or to designate the Saguaro Cactus as the state tree of Vermont.
The public expects buffoonery from politicians but not from healthcare professionals. Doctors, nurses, technicians, hospital executives are all generally held to higher standards in the communities they serve. And the vast majorities of these professionals deserve and protect that higher status with exemplary personal and professional conduct. That's why headlines about executives gone wild garner so much attention.
So, what prompted these leaders to act recklessly? Does it reflect flaws in the culture of accountability in their hospitals? Do some healthcare CEOs and other top executives surround themselves with people who tell them only what they want to hear? In the investigation of Beth Israel Deaconess CEO Paul Levy, for example, the Massachusetts attorney general suggested that board members were too deferential to his considerable talents to pursue questions about his personal relationship with a subordinate.
Once again, we come to the teachable moment. These executives gone wild provide an excellent comparison to examine senior executive accountability at your hospital. Can your subordinates raise concerns about questionable behavior from their bosses including you—without fear of retaliation?
A top-to-bottom culture of transparency and personal and professional accountability should be fostered, encouraged, and led by example from the top. It's a great way to stay out of the headlines.
The nation's hospitals reported 8,600 payroll additions in August, the largest single month of job growth for the sector in 2010, which so far has seen erratic employment growth, preliminary data released today by the Bureau of Labor Statistics show.
The hospital sector shed 1,400 jobs in July, added 5,700 jobs in June, and shed 1,400 jobs in May, after creating 7,800 jobs in the first four months of the year.
BLS data from July and August is considered preliminary and may be considerably revised in the coming months.
Hospitals have reported 27,400 payroll additions in the first eight months of 2010, compared with 6,700 payroll additions in the first eight months of 2009, according to BLS data and revised preliminary data.
Hospitals last reported sustained payroll reductions in 2000, when 2,200 jobs were lost between January and April, BLS data show.
Overall, the economy lost 54,000 jobs in August, as the nation's jobless rate rose slightly to 9.6%. The decline in payroll employment reflected the loss of 114,000 temporary jobs from the U.S. Census Bureau, while private sector payrolls increased by 67,000, BLS preliminary data show.
Job growth in the healthcare sector continues to be powered by ambulatory services, which accounted for 16,900 payroll additions in August, and 99,400 payroll additions in the first eight months of 2010. Nursing and residential care facilities reported 2,700 payroll additions, and physicians' offices reported 5,300 payroll additions, BLS preliminary data show.
The healthcare sector—everything from hospitals, to chiropractors' offices, blood and organ donor banks, to walk-in clinics—employed 13.7 million people in August, and has been one of the few areas of job growth during the recession and sputtering recovery, creating 28,200 new jobs in August, and 158,500 jobs in the first eight months of 2010. Healthcare created 215,300 jobs in 2009, and 692,200 jobs since the recession began in December 2007, BLS data and preliminary data show.
In the larger economy, 14.9 million people were unemployed in the United States in June, and 6.2 million of them were long-term unemployed who'd been without a job for at least 27 weeks, BLS reports.
A domestic dispute may have been the motive behind a Friday morning shooting at Baton Rouge General Medical Center Mid City hospital that left two visitors wounded, one with life-threatening injuries, and police searching for the gunman.
The incident occurred at around 12:35 a.m. on Friday morning. The East Baton Rouge Police Department was searching Friday for the alleged attacker, identified as Darrell Garner, 36, who is wanted on two counts of attempted first?degree murder.
"We are deeply saddened that domestic situations have spilled over into a community hospital setting," said Bill Holman, president/CEO of BRGMC. "Hospitals should be a place for healing and wellness."
When East Baton Rouge police officers arrived at the hospital, they placed it in lockdown for four hours, and searched the entire campus. No employees or patients were injured during the shooting, and normal shift operations have since resumed.
"We thank the East Baton Rouge Police Department for their very fast and strong response to the situation and for dedicating so many officers to the response," Holman said. "We also thank our employees for responding appropriately in this emergency to ensure the safety of patients, and for their actions to provide care for those involved. It is our hope that the police will quickly apprehend the individual responsible for this and we thank the community for the outpouring of support."
The Massachusetts Attorney General's Office has chastised the executive leadership and the board of directors at Beth Israel Deaconess Medical Center in Boston for years of inaction before addressing CEO Paul Levy's inappropriate personal relationship with an employee.
Investigators determined that while no laws had been broken, the reputation of the prestigious Harvard-affiliated teaching hospital had suffered a blow.
The 11-page report issued Wednesday by the AG's Non-Profit Organizations/Public Charities Division was requested by the BIDMC board, and focused on whether charitable funds were used inappropriately as a result of Levy's indiscretions, and whether the board acted appropriately in its handing of the matter.
In May, Levy was fined $50,000 and publicly reprimanded by the board after the anonymous complaint was made public.
Investigators found that no misuse of charitable funds related to the matter, and said the employee—a former chief of staff at Beth Israel Needham who was not named in the report—was qualified for the jobs she held, and received compensation that was consistent with the position and her experience.
However, investigators said Levy's personal relationship with the employee, who left in November 2009, created the perception among other employees that her employment, her qualifications for the jobs created for her, and her six-figure compensation package were influenced favorably by that relationship.
Levy hired the employee when he joined BIDMC in 2002 and their relationship continued throughout her tenure, despite warnings dating back to 2003 from some board members and executives that the relationship was raising concerns. No action was taken, however, before the employee resigned in November, 2009. Investigators said BIDMC leadership waited too long to act.
"Had (Levy) been called on his failure to act, or had his failure to act been reported to the entire board, this acknowledged 'lapse of judgment' might never have occurred. For senior managers who reported to Levy, demanding a response was likely difficult. For board members, it was their job," Assistant Attorney General Jed M. Nosal concluded in the report.
Nosal said that respect for Levy and his accomplishments may have created a level of deference from the board that colored their better judgment. "Oversight of management is a primary duty and responsibility of a governing body and this unfortunate and preventable situation should serve as a stark reminder to all boards of the importance of diligent and independent management oversight," Nosal said.
The AG's report is sure to reignite debate over whether Levy—who until the complaint was made public, was an outspoken proponent of hospital transparency—should remain on the job. Hours after the AG's report was made public, the Massachusetts director of the National Organization for Women and the executive vice president of the Service Employees International Union 1199—which represents some BIDMC workers—said in a joint statement that they were "shocked by the facts in the report that demonstrate a clear pattern of governance failures by both the CEO and the board chairs."
"Many CEOs and board chairs in the private sector have been rightfully fired for much less. Taxpayers have a right to expect at least equal standards for public charities and for the executives of hospitals that receive millions in subsidies, and which is a key institution of the public trust," said SEIU's Veronica Turner, and NOW's Christina Knowles.
The two women said they would hold "emergency meetings on Thursday to determine what next steps we should take to ensure accountability for the many troubling facts and disturbing questions raised by this report."
The SEIU has been in conflict with BIDMC since before the Levy complaint and has been actively attempting to unionize in Boston teaching hospitals.
LifePoint Hospitals, Inc. has purchased Sumner Regional Health Systems in Nashville for $145 million and will change the name to HighPoint Health System.
The Brentwood, TN-based private hospital chain has committed $60 million in capital investments in the system's four hospitals over the next decade and will provide charity care to residents in surrounding areas and inmates of Sumner County, LifePoint said in a media release.
"Sumner Regional Health Systems is an excellent addition to LifePoint's family of hospitals. The employees and medical staff share LifePoint's mission of making communities healthier," LifePoint CEO/President William F. Carpenter III says. "We look forward to working with them to enhance the scope of services available and to find new and even better ways to provide quality healthcare close to home for the residents of these communities."
The three-market HighPoint Health System employs more than 1,300 people and serves 11 counties in northern middle Tennessee. Hospitals include the 155-bed Sumner Regional Medical Center in Gallatin, one of the largest non-government employers in Sumner County, which provides cancer treatment, cardiac care, same day surgery, orthopedics, diagnostics, women's health, home healthcare and rehabilitation services; Riverview Regional Medical Center North and South, an 88-bed medical center with campuses in Carthage; and Trousdale Medical Center, a 25-bed critical access hospital in Hartsville. All facilities are accredited by The Joint Commission.
With the acquisitions,LifePoint now operates 52 hospitals in 17 states.
The merger of healthcare information technology providers Allscripts-Misys Healthcare Solutions, Inc. and Eclipsys Corp. has been finalized, now officially called Allscripts Healthcare Solutions, Inc.
The merger creates one of the nation's largest exclusively HIT providers, with more than 5,500 employees and combined 2009 pro forma revenues of approximately $1.2 billion. Atlanta-based Eclipsys has 2,800 employees, more than 6,000 healthcare clients, and annual revenues of $515.8 in 2008. The new Allscripts will have a client base of 180,000 physicians, 1,500 hospitals and 10,000 nursing homes, homecare agencies and other post-acute organizations—the largest network in healthcare.
"Our vision is to create a connected community of health to put the right information in the hands of all stakeholders at the right time, empowering them to deliver world-class outcomes, for both their patients and their organizations," said Allscripts CEO Glen Tullman.
"No company has a larger footprint in healthcare, crossing the entire spectrum of provider organizations from hospitals to physicians to nursing homes, home care agencies and other post-acute providers," Tullman said.
He said the new company can address the lack of connectivity that is plaguing the U.S. healthcare system, which makes it difficult for providers in hospitals, physician offices, nursing homes and other care settings to access and share patient care information.
He cited a Harvard School of Public Health survey published last month that showed that only about 12% of US hospitals had a basic electronic health record in place in 2009, and that physician practices and post-acute settings aren't doing much better.
By connecting physicians, nurses and other healthcare providers to real-time information provided by its own and third-party systems, Tullman said, Allscripts can deliver a single patient record at any time to providers across care settings.
Phil Pead, chairman of Allscripts and the former CEO of Eclipsys, said the merger creates an attractive product as the healthcare industry prepares for the $30 billion in federal funding for HIT implementation. "There is a level of excitement from both the market and from our clients that we are now positioned to make the connected community of health a reality for providers and patients," Pead said.
The new company will also offer:
A portfolio of systems for hospitals including Sunrise Acute Care, used by hospitals with more than 200 beds; the Helios line of connectivity systems; the Enterprise Performance Management system; and the Allscripts Care Management and discharge management systems.
Physician practices software of all sizes, including Electronic Health Record, ePrescribing, Practice Management and Revenue Cycle.
Post-acute care systems for skilled nursing facilities, homecare agencies and other extended care organizations for electronic patient referrals from hospitals.
A platform that uses Microsoft.NET and other technologies to integrate hospital and physician practice data.
An "open architecture" approach that simplifies connections to third-party applications across care setting, providing a single patient record.
Thomson Reuters has acquired healthcare benefits auditor and expense management consultants Healthcare Data Management, Inc., effective immediately. Financial terms were not disclosed.
King of Prussia, PA-based HDM will immediately become part of the Healthcare & Science business of Thomson Reuters, headquartered in Ann Arbor, MI. Thomson Reuters said in a media release that the acquisition will enhance its ability to remove healthcare waste, make cost and quality more transparent, and support compliance needs for payers. The acquisition is also expected to strengthen Thomson Reuters' audit and payment integrity capabilities, including medical, prescription drug, provider, eligibility, and plan design.
"Healthcare Data Management brings unmatched expertise in health benefits auditing and expense management reporting solutions," said Jon Newpol, executive vice president at the Healthcare & Science business of Thomson Reuters. "Together, we're poised to meet the increased demand for auditing and compliance due to the Sarbanes-Oxley Act, the healthcare reform law, and an overall focus on eliminating waste from the healthcare system."
Newpol said HDM's BenefitsAudit and BenefitsWatch business lines will allow Thomson Reuters to expand services for employer and government markets. "As a result, our new Audit & Compliance offering will support both retrospective and ongoing assessments of claims data," he said.
HDM was one of the first companies to build model employee health benefit plans and use data to monitor plan performance. The company also provides consultations for self-insured health benefit plans that are managed by plan administrators and pharmacy benefit managers.
Baptist Health System announced this week that 200 jobs will be eliminated at the Jackson, MS health system as part of a cost-cutting strategic overhaul that comes with a weak economy, falling admissions, and anticipated lower Medicare reimbursements.
Baptist Health Spokesman Robby Channell said the cuts and restructuring are being implemented after four month-long top-to-bottom review of BHS operations that have identified about $16 million in savings, about $13 million of which will come through renegotiating supply contracts and system efficiencies.
"We have to look at how to do things differently, spending less and doing more with less," Channell says. "Really, we're just trying to plan for the future. We hadn't sat back and looked at off of that until the last year or so."
Of the 200 jobs slated for elimination, 186 are now filled, including 50 nursing positions. However, Channell says the strategic review also identified another 136 jobs that were deemed to be necessary and would have to be filled, including 49 vacant nursing positions. Channell said BHS anticipates that many of the laid-off workers will reapply for the newly identified jobs.
Channell says that BHS employees were told when the review began that it might result in job losses. "They knew this was coming. We've been communicating with employees throughout this process," he says.
In addition, Baptist is relocating its Pediatric Outpatient Services away from the 640-bed Baptist Medical Center and to its Same Day Surgery Unit, to account for declining inpatient pediatric admissions.
Cambridge Health Alliance CEO Dennis D. Keefe says the nonprofit health system is reviewing legal options in the wake of a state labor board ruling that struck down CHA's unilateral cuts to health benefits for retired nurses at Cambridge Hospital.
Massachusetts' Commonwealth Employment Relations Board ruled that CHA violated state labor laws and failed to demonstrate sufficient financial need when it declared an impasse in negotiations and cut health benefits for retired nurses by 40%. The unilaterally imposed cuts raised retirees' share of health insurance to 50%, up from 10%.
"We continue to believe our negotiations with the Massachusetts Nurses Association, which represents the Cambridge Hospital nurses, were conducted fairly and with proper consideration," Keefe said in a media release following Friday's ruling by CERB.
Keefe says CHA imposed the cuts at a time when some private and government entities were shelving pensions and retiree health plans and abandoning former employees. "We wanted to retain a fair benefit. We feel that providing 50% of a retiree's healthcare costs is a reasonable and affordable offer to our public employees," he said.
MNA called the ruling "a complete victory" for nurses at Cambridge Hospital, saying CERB "flatly rejected the hospital's claim that it was eligible for an exception in this particular case, due to 'externally imposed' and 'economic' circumstances beyond their control."
CERB ordered CHA to post a notice to employees stating that it had violated state labor laws, and that the health system is taking corrective action that includes:
Restoring all terms of retirees health insurance benefits for all MNA members that were in effect before CHA made the cuts.
Participating in good faith collective bargaining that includes mediation, fact-finding, or arbitration.
Making whole employees for economic losses suffered from CHA's cuts.
"We are thrilled and vindicated by the board's ruling," says Betty Kaloustian, a nurse at Cambridge Hospital and chair of the nurses' local bargaining unit. "The board got it right. Our employer had an obligation to negotiate with us and they chose not to. Unfortunately, the hospital's actions have had a devastating impact on those nurses who they were trying to force to retire, not to mention the impact on all the other nurses who were seeing their benefit slashed. We are appalled at the lack of respect shown to those nurses who have given their heart and soul to this institution."
MNA Executive Director Julie Pinkham says state labor laws "couldn't be more clear on this point, and we are amazed that this public employer tried to claim otherwise."
"While this case is settled, we can only hope those who made these unlawful decisions are held accountable for the financial cost involved in creating this crisis, as well as for the impact these actions will have on the nurses' trust in the CHA administration going forward," Pinkham says.
Keefe believes CHA's record deficit in 2009 and other pressures on the public safety net hospital "were conclusive and compelling evidence of the serious economic threat under which we are operating."
In the last two years, he said, CHA has closed six health centers, all inpatient services at Somerville Hospital, inpatient pediatric services, 35 adult psychiatric beds, and ceased offering inpatient addictions services. "In doing so, we have had to reduce our work force by 450 full-time employees. That just gets us to where we are today: still confronting the forces of a deteriorating economy and a healthcare environment that is experiencing declining volumes, shrinking reimbursement, and continuing pressures from state and federal health care reform," Keefe said. "If this does not meet the definition of financial exigency, I'm not sure what would."
The CERB ruling doesn't change the financial facts for CHA, Keefe says.
"Unlike municipalities, we don't have taxing authority and cannot raise revenues to cover massively rising costs," he adds. "While we remain ready and eager to return to the bargaining table and develop a mutually agreeable labor contract, we need to be clear that the MNA's rejection of CHA's reasoned proposal threatens CHA's future."
The California Nurses Association has raised troubling accusations of ethnic discrimination against Sutter Health's California Pacific Medical Center and St. Luke's Hospital in San Francisco.
The union alleges that CPMC and St. Luke's Hospital are "engaged in systematic discrimination against the hiring of Filipino registered nurses." CNA leaders, flanked by Filipino community leaders, made the accusations during an Aug. 19 press conference.
CNA Co-president Zenei Cortez, RN, said that St. Luke's and CPMC RNs, many of them Filipino, have been outspoken in defense of their patients, and in opposition to Sutter and CPMC's plans to reduce services to the largely lower income, minority community depending on St. Luke's.
"Rather than respond to the concerns of the community, CPMC and Sutter have chosen instead to retaliate by carrying out a punitive, illegal, and immoral campaign of discrimination," Cortez said. "There can be no excuse for racial or ethnic discrimination. A hospital should be a center of therapeutic healing for patients, not a model of bigotry."
CNA on Aug. 18 filed a class-action grievance against Sutter and CPMC for contract violations in a "systematic policy of discrimination." CNA also called on Sutter Health to direct CPMC to end the discrimination. The union asked for an investigation by the San Francisco Human Rights Commission.
CPMC CEO Warren Browner, MD, called the accusations "false and designed to cover up the union's own failure to win a contract despite three years of negotiations."
"We pride ourselves on our diverse hiring policies and our longstanding commitment to promoting equal opportunity employment," Browner said. "The allegations of discrimination made by the California Nurses Association are dishonest and without merit."
The CNA made its case in the court of public opinion with written statements from former employees. Chris Hanks, a former director of Critical Care Services at CPMC, alleged that Diana Karner, the Sutter West Bay vice president of nursing told him several times, "you are not to hire any Filipinos."
CNA said CPMC hiring data supports the accusations. "A review by CNA of active employee lists provided by CPMC demonstrates that in early 2008 there was a major demographic shift among the nurses being hired at St Luke's. Before February 2008, 65% of St Luke's RNs were Filipino. After February 2008, only 10% of RNs hired were Filipino," CNA said.
Browner said the hospital's data tells a different story. "In 2007, 63% of our nurses at St. Luke's were Asian. Today that number is 66%," he said. "We do not have any way of identifying what percentage of our nurses are Filipino because we don't break down these categories by ethnicity or country of origin."
The CNA's discrimination claims are questionable, however, owing to issues that the union must have known about but failed to mention.
First, the United States reportedly has a seven-year backlog of work visa applications from foreign-trained healthcare professionals, including Filipino nurses. Assuming that CNA's hiring data from St. Luke's is accurate, it seems highly likely that any decrease in the number of Filipino nurses hired is owing more to this backlog, which is well beyond the control of any hospital, than to discrimination.
Second, a big critic of extending work visas for foreign-educated nurses—including Filipinos—is the American Nurses Association, the nation's largest professional trade association for RNs, and a one-time affiliate with CNA.
In fairness to ANA, their opposition is not based on discrimination. "We need to be dealing with our domestic healthcare workforce problem. We shouldn't be using immigration as a means to address the nursing shortage," Cheryl Peterson, ANA's director of nursing practice and policies, told HealthLeaders Media. "That being said, we do believe that nurses and other healthcare workers have the right to migrate and we benefit when they migrate and work here."
The fact is, with the ongoing economic doldrums, Peterson said, "nobody is bringing nurses in. The whole recruiting of foreign-educated nurses is bolloxed up because of the economy and also because of the availability of visas."
As jurors in the court of public opinion, here is where we stand: CNA wants us to believe that two major hospitals in one of the most liberal, ethnically diverse, and politically correct cities in the United States are engaged in "systematic discrimination" against an ethnic minority because a subset of workers from that group allegedly criticized the hospital.
CPMC wants us to believe that the accusations are a red herring designed to distract rank-and-file members from the union leadership's failure in contract talks. One side is fabricating. Who sounds more believable?
If the CNA's accusations are shown to be true, they will raise serious questions about the judgment and fitness of the executive leadership at CPMC. If the accusations are shown to be false, they will raise serious questions about the judgment and fitness of the executive leadership at CNA.
