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Physician Confronts Hospital In Modesto California – Corporate Medicine and The Risk of “At Will” Physician Em

Posted Jul 08 2010 3:06pm

This is an interesting case and ruffled feathers along with the facts from what I read here seem to be mixed in.  The hospital fired the doctor who works for a physician’s group; however, doctors in California are covered under the whistle blower statutes.  He wants to be able to come back and practice at the hospital once image again. 

I hear stories from doctors as to what happens at hospitals and like anywhere else there are personality conflicts but when it comes to caring for a patient and life saving therapies and surgical procedures, that has to be set aside.  Since being fired he has his own practice open and sits on a few advisory panels so his accreditation doesn’t seem to be at risk with others trusting his judgment.  

Two incidents the story recalled was with a nurse who refused to use a defibrillator to resuscitate a kidney dialysis patient and the nurse said the patient should have been given medication first, again none of us there who are reading this can judge here and the patient records and conditions at the time are the key. 

Another patient was not admitted when the bowel had been perforated during surgery and appeared to be in septic shock and the hospital would not send the patient to intensive care.  The information is all confidential until decisions are made.  The hospitalists do have a work group sometimes called “the consultants” that they need to contact in many issues before making decisions and we are seeing more and more of this occurring today, sometimes when not urgent or when a patient is not in the state of life threatening illness or injury there is time and other times there is not.

Utilization managers once the patient has been discharged will play the role of a Monday morning quarterback afterwards and evaluate all the decisions made by the doctors to see where cost items were out of line or if they felt other decisions should have been made and this can get sticky at times.  It’s always easier after the fact to look back which can be helpful to learn from, but today with the big emphasis on “cost” this can be in jeopardy of growing out of balance too.  Sometimes doctors are told in staff meetings that they “are not meeting their quotas”, so you ask what is this?

Quotas are the base dollar amounts needed by hospitals to meet their bills and if admissions are down, there’s not much that can be done and pressure to admit marginal cases should not be pushed and again it comes back to the doctor.  If doctors are pushed into admitting more patients, it’s a double edge sword as later when utilization gets a hold of the records, they can be disciplined or fired for admitting patients who didn’t need to be there.

At any rate this will be an interesting case to follow and see the outcome.  It doesn’t sound like he needs the money but is rather trying to address his part in bringing around an awareness with hospital management and doctors working there.  We have this big issue with control over doctors at the City of Hope here in California for another example.  It would seem that a full on whistle blower suit would have been initiated if it were money, but can’t say for sure.  BD 

Dr. Mark Fahlen isn't afraid to criticize what he calls "corporate medicine" and the pressures exerted on doctors working for large health care systems.

According to Fahlen, his complaints about nursing practices at Modesto's Memorial Medical Center got him in trouble with hospital administrators.

He is seeking reinstatement to the hospital's medical staff and won a battle last month when a judicial review panel reversed a decision to deny his hospital privileges.

He is now waiting to hear if he can continue treating patients at Memorial, an affiliate of Sacramento-based Sutter Health. 

"I feel very happy that the (review committee) was strong enough to stand up to Memorial and stand up to corporate medicine and make the right decision," said Fahlen, a kidney specialist in Modesto for seven years.

Nurses at Memorial had their own complaints about Fahlen. And it appears hospital officials believed he was too confrontational with staff and that his conduct interfered with patient care.

Fahlen said that instead of addressing his concerns about nursing practices and patient care, he was fired in May 2008 from the Gould Medical Group, a large physicians group closely aligned with Memorial.

"I have spent $200,000 in legal fees since this started," he said. "I think the public has a right to know what the risks of corporate medicine are and the risks to doctors who are at-will employees.

Fahlen, who started his own practice after leaving Gould, is known for more than being a loose cannon. He is serving a second year as director of the Department of Medicine at Doctors Medical Center and serves on Stanislaus County's Community Health Center board, an advisory panel for the county's federally qualified health clinics.

He said Gould fired him three months after he was given a raise from $212,000 to $274,000 a year. A Gould spokesman declined comment about Fahlen because it's a personnel issue.

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