The Rape of Emergency Medicine, 2017 version

Summa Health, an Ohio Hospital system, recently changed ED contracts from their 40 year group to a new one. On FOUR DAYS’ NOTICE! Four days, over the Christmas/New Year’s Holiday. That sounds distinctly unsafe, beyond the gross lack of sense, or commitment to a 40 year partner.

In case you think this is going smoothly, here’s a post to the ACEP ED Informatics Section from one of their former doctors (reproduced here with permission in its entirety):

I wanted to inform you, my colleagues, about what is going on at my home institution.   You all know me as a colleague and a fierce advocate of patient safety in EHRs. I have published on EHR patient safety for ACEP task forces and I am heading up a new ACEP task force on EHR patient safety issue reporting. It is with sadness that I have to tell you what is going in right now at my home institution.  

Summa has gone to paper.  

About 36 hours ago, our contract was taken over by US Acute Care Solutions (USACS) formerly EMP, through a scandalous process, but they literally created no plan for EHR transition.  I was the director of informatics and I, along with the rest of the physicians, was notified 4 days before New Years Eve that we were out.  We were told that when the ball dropped, our contract was over.  The physicians coming in to take over were to arrive at the facility for the first time 1 hr before their shifts and we were to sign out to doctors that had no EHR access.  No access to old records, CPOE, PACS, etc.  They went the first 30 hours without access.  Nurses were asked to do triage protocols and put the orders in under the new medical director, the only one with an account.  This morning at 30 hrs into the process some were to start training.   Now, the only information I get now is hearsay.  We strongly believe the EMP/USACS has no chance of safely staffing our 5 EDs with a total of 175k volume using part-time docs who have other full time jobs.  Our 55 docs and 20 PAs are sitting at home right now, scared for the patients that show up at the hospitals where their group spent the last 4 decades saving lives.  As a board certified clinical informaticist, I offered my services up until midnight when our contract ended but they elected to move another direction.  To the patients of Summa, I’m sorry.

Anatomy of a takeover.

As all of you are emergency physicians, I thought you’d be interested in how something like this might happen.  It is sort of a tangent to the EHR story, but I’ll include it because it is so interesting.  I’ve attached various references and additional information about the ongoing issue.  In short, the wife of Dom Bagnoli (USACS/EMP’s CEO) is the individual our hospital assigned to work out the contract renewal.  USACS/EMP has long been our chief rival in the area, so this is an obvious conflict of interest. Summa has an ethics policy that against even perceived conflicts, so two of our ED physician executive recused themselves from the process although she did not.  EMP had former Summa contracts, but had poor quality, staffing issues, and bad EMS relationships and lost their contracts or sold them to other staffing companies.  The hospital system drug its feet on negotiations until the last minute.  Contract negotiations failed when Summa (the health system) wanted SEA (Summa Emergency associates-our physician group) to fund the residency core faculty hours and wanted us to continue staffing under-performing stand-alone ERs that were built in inappropriate markets.  We found out later that they had already been talking to EMP.  

EMP is offering $100k signon bonuses, and we have heard they are paying temporary doctors up to $1000 per hour during the first 2 week transition.  I do ask you as a colleague not to take advantage of this opportunity–it may benefit you this week, but it hurts us all in the long run.  

The hospital house staff council has voted no confidence against the CEO.  The EM residency director has pulled the EM residents from the ED to keep them from having to work with non-vetted, non-EM, and non-Board certified physicians.  He does not believe that it is safe for them and they should not be subject the undue service requirements of a hospital CEO’s bad decisions.  

We are hopeful that EMP/USACS will not be able to run the residency and the department, and that negotiation will resume to restore a safe emergency care in Akron.  

Sincerely,

Jeff Nielson

Newspaper Sources:

http://www.ohio.com/news/local/resident-physicians-at-summa-health-vote-no-confidence-in-system-president-1.737494

http://www.ohio.com/lifestyle/health/fire-chiefs-concerned-about-summa-health-system-emergency-room-plans-1.737312

http://www.ohio.com/news/break-news/summa-health-bringing-in-new-doctor-group-to-staff-its-ers-starting-new-year-s-day-1.737043

http://www.ohio.com/business/emergency-in-the-er-come-jan-1-it-s-unclear-which-doctors-will-be-staffing-summa-s-emergency-rooms-1.736916

While I have no dog in this fight individually, all ED docs need to be aware that this isn’t just happening in the Bad Old Days, it happened this year.

I feel worst for the 55 former physicians and 20 PA’s of the Summa ED’s who were so disrespected by Summa, and fellow Emergency Physicians. It will make it very hard for them to trust in their new employment, wherever that may be. I hope they don’t take the money bait and help bail these new contract holders out.

For those who aren’t familiar with the title of this post, here’s a link to the original book The Rape of Emergency Medicine as a free .pdf.


Comments

  1. To all Physicians, physician extenders, nurses, techs and any other health care workers reading this, take this opportunity to tell all administrators and anyone who will listen that this MUST STOP!!! LETS MAKE THIS THE LINE IN THE SAND, lets unite TO STOP THIS DOMINO EFFECT OF LARGE CORPORATE CONGLOMERATES TAKING OVER INDEPENDENT GROUPS!!!! WE HAVE THE POWER TO CHANGE THE REPUTATION OF A HOSPITAL IN A DAY. This is the only way we can change this. EMCARE, Team Health, ED care, EMP are the death of our profession

    • Dr. Morgoth says:

      Triple bonuses for USACS executives under the sky
      Seven attaboys for yes-men Dept. chairs in their halls of stone
      Nine letters of reprimand for residents doomed to fail.
      One rule, one law for the dark System and its dark throne
      In the land of Summa, where the shadows lie.
      One CEO to rule them all, one CEO to cow them,
      One CEO to terminate them all, or in the darkness bind them
      In the land of Summa, where the shadows lie.

    • Elizabeth Combs says:

      To Summa Physicians,

      If you’re conflicted about how to vote in regards to last night’s meeting, please take a few minutes and walk down to the Emergency Department. Talk to an RN for 3 minutes. This situation is dangerous, heart wrenching for these dedicated nurses that only have the best interest of the patient in mind. Patients are walking out without being seen by an MD after waiting 5-6 hours with potentially life threatening conditions. That didn’t happen prior to 1-1-17. It’s happening several times per hour. Over 10% leaving prior to being seen by a physician. These docs are in over their heads. Please vote your heart and not with the crap you’re being fed by Dr. Malone and his cronies. We plead of you! Vote to reinstate that doctors that deserve to be there and have for the past 4 decades.

  2. Let’s just be clear that one of the needs working identified the STEMI and the doc did absolutely nothing. #worldclasscare

  3. Very sad situation to start the year. “”Prayers and blessings to those affected””

    The business of medicine unfortunately continues to grow as even academic center try to fit in (ie UC is opening up many FEDs). For example, about 15 yrs ago, my newer graduates form a group and won a contract at hospital from a group of older graduates who then won another contract from the first graduates of the program. Eventually, all groups were assimilated by a different larger group.

    Walmart started as mom-pop store then grew and expanded by swallowing other mom-pops then comes stocks, globalization etc. EMP started by a emergency medicine residency trained physician from akron general (Dr Bagnoli) then grew in walmart fashion, SEA is is an incredible 60+ physicians group and could be looking for contract in akron-canton and beyond. The nearby independent lake health group lost contract to EMCare who then lost contract to USACS in a span of 3-4 yrs. It would not surprise me if the hospital heads in similiar fashion of constant changing group.

    Scientist say earth will be destroyed billions of yrs from now when our expanding sun engulfs it as a red star, but religion predicts quicker demise of man against man.

  4. Former Wadsworth-Rittman Hospital employee says:

    Summa executives screwing over their employees for money? Where have I seen that before?

    • Jerry Goodheart says:

      send all c orespondence concerning this entire outrage to pres.elect Donald Trump and see what happens!

  5. Thank you Malone and Bagnoli says:

    Dear Mr. Malone and Mr. Bagnoli,

    Thank you for taking the time to not only read the comments from the concerned Summa staff, residents and patients, but providing your email address. I will be sure to hand out that email address to everyone who has something to say about your unwise and selfish business deal. I hope you find it personally rewarding to hear the opinions and concerns from the physicians, nurses, medics and other hospital staff whose hard work and solid ethical practices have been the only reason the Summa empire has been successful for the past 40 years. Now you may sit back and watch it crumble beneath you. For those of you who may have missed it, his contact information is as follows:

    malonet@summahealth.org
    officeofceo@summahealth.org

  6. Local ED doc says:

    I read through this article with lots of interest. I live in the area and work for another hospital/group outside of these two. I know several docs from both groups. They are all hard working, good clinicians and proud to call all of them my friends. Sounds like the contract negotiations went down to the wire, and both groups were caught off guard for this transition.

    I find it hard to believe that the wife of the CEO for USACS was in charge of the negotiations. That would be wrong. But I’ve also been in many many contract negotiations, and for them to go down to the last minute, someone was not budging in them.

    So question for the SEA docs here on this discussion: what was your side of the contract terms, and what was the hospital offering? Having that information would be very helpful for the rest of us to see where the negotiations were.

  7. Concerned Specialist TM says:

    Probably will be in court and jail

  8. Local Fire/Medic says:

    For Dr Malone and Dr Bagnoli to state these claims by, Fire Depts, ED staff as well as the media are false, regarding the safety issues says more than anything….The old saying goes “if it looks like a rat, smells like a rat, then it must be a rat”. These two wreak! It’s coming from all ends. The only person I’ve seen supporting this whole issue is Chief Natko from Akron fire. Who claims they transport X number of patients to citys ER…Hmmm yet andAMR handles roughly 75% of Akron Fire transports with their code 2 system…Another pinnacle of health care standards.

  9. Just another doc says:

    I saw what USACS did to the residency program at Allegheny General Hospital. They are all about money and don’t care about resident education since there is no money in it! I feel sorry for for the residents at the well established and respected Summa program!

    • AGH residency grad says:

      If they did something to the residency program there, it’s not clear what. Where I now work, we have several graduates from there who are as well-trained as the folks I graduated with in the pre-USACS days.

  10. How many perforated colons during routine colonoscopies have happened in the endoscopy unit at Summa since Malone came on board and scrambled the GI docs, compared to before? Just asking.

    • OMG. This is precisely why I don’t want to get a screening colonoscopy!!! As a former medical transcriptionist, I cannot tell you how many times I worked on reports where a routine colonoscopy doesn’t go as planned….

  11. Tom Strauss says:

    Whoops, my bad.

  12. (probably not really) Dominic Bagnoli says:

    Ladies and gentlemen, in the end, I don’t care. Two months from now this will be but a speck of dirt in the rear view mirror and USACS will be that much more improved and influential. I have nothing more to say here.

    • This commenter used a different email address and a different IP than the first Bagnoli replies, so I suspect this not to be Dr. Bagnoli. (Beware the Internet).

  13. Former Summa Resident says:

    Dom:

    As a prior goatee persone myself this troubles me to say but what are you doing? You are paying $1000 an hour to staff the emergency department, don’t say you’re not the third-party contractors you used left a nice little paper trail, how can you not get at least one of them to come and support you on this thread? ”

    I don’t understand how you are the CEO of this company. Besides the shitty actions you took in a hostile takeover of the contract you were completely unprepared and have completely lost the narrative surrounding this controversy. All you do is deny deny deny and call others liars, although everyone else is giving the same narrative. I assume if you are so confident in your preparation and your ability to serve the community of Akron that you will agree to publicly publish the Physician coverage hours, waiting to be seen time, left without being seen numbers, patients per hour seen per provider, Longest shift worked by a single provider, and adverse outcomes that were reported for the months of December vs January.

  14. Dominic Bagnoli says:

    To the attention of Dr. Malone, other professionals, and the community,
    I have taken the time to read through these comments just like my partner Dr. Malone has done. I am appalled by the comments and misinformation that is being fed to both my fellow health care professionals and the community as a whole. The health care system as a whole in this country is a hot topic and there are continuous adjustments that need to happen in order to continue to provide care for the most people possible.
    With this being said, my goal is for USACS to provide the greater Akron area with superior care. I understand for many that this transition has been hard. USACS, Dr. Malone, and the Summa Board are working hand in hand to make sure that this transition is as seamless as possible. The USACS group has reached out to many if not all SEA physicians asking them to work for us and to continue to serve the community that they claim they love so much. As a good faith measure I want to answer concerns directly and openly just as my colleague Dr. Malone has offered.
    You can reach me at dbagnoli@usacs.com
    You can reach my wife at vongruev@summahealth.org
    If you have any questions about the GME and/or the residency program you can direct your concerns to Cynthia Kelley at kelleyc@summahealth.org

    I do not have the time to answer the many great questions that were presented in this post. However, I wanted to take the time to let everyone both professionally and personally know that I am here with my team to make this transition seamless.

    Thank you.
    Dominic Bagnoli
    CEO
    US Acute Care Solutions

    • A concerned local doc. says:

      There is a lot of “he said” “she said” going on here. I did some research. I looked up all the names of past/present SEA docs (internet is great). Then I went to Summa’s own website (http://www.summahealth.org/foundation). I looked who has donated to the intuition out of their own or their company’s pockets.
      SEA docs have donated between $1,150,000 to $3,450,000. Yes well over one million dollars and maybe over three million dollars.
      1) Vivian E. von Gruenigen, MD, and Dominic J. Bagnoli, MD together have given $25,000 to $99,999.
      2) Thomas Malone is listed as giving at or above $1,000 annually. I would imagine that adds up to about $3,000 total by now since he has been there about 3 years. Maybe more, but not even $25,000.
      3) Cynthia Kelly has given none that I can tell.
      4) There is no indication that EMP or USACS has given anything.
      Now I realize that there may be other sources of giving. But I still find this telling. Who really cares about their institution and the community. And who cares about their pockets?

      • Understand the data says:

        I can tell you this much – SEA contributes to things like special educational training to the residents to get them prepared and ready for their board exams. They do this with things that fall directly in line with a focus on resident education but fall completely outside anything the ACGME requires a program to do. They do this because they run a good program and care about training good physicians. I am sure this voluntary contribution to resident education gets reported in an open and transparent way (and hence recorded and publicly available) There are probably many areas this is true, but I have heard many residents talk about how SEA contributes to their education out of their own pocket in ways they are not required to do.

        On the other hand, I’m personally not impressed with the lack of professionalism of someone like Dr. Von Greunigen by not removing herself voluntarily from the selection committee with the unquestionable complexities in the possible conflict of interest. This is why your recuse yourself. This isn’t to suggest that this directly means she’s pushing money improperly under the table, but in the court of public opinion my vote goes to those that I know contribute voluntarily, openly and generously to the benefit of the residents in order to further the overall well-being of emergency medicine, than to someone who knowingly sits on a committee that chooses her husbands company.

    • Current resident says:

      Hence why the current doctors working in the emergency department even admit that they are only part-time. What are the residents and patients supposed to think buy hiring part-time positions when you have perfectly capable than able-bodied board-certified attendings ready to go. Poor form

    • Concerned says:

      Partner? Hmm

    • Malone and Bagnoli are fools says:

      Let’s all pitch in and buy them a thesaurus. I’d die happy if I didn’t hear these two pompous assholes say seemless one more time.

    • MedPeds resident watching the trainwreck from afar says:

      I am a resident physician, not in your city thankfully. From where I sit, you are like every other healthcare administrator – you are about the bottom line. You have participated in replacing a seasoned staff of ER physicians – good or bad – with something far inferior. You mistakenly believed they would stay and work for you. You believe the same thing every other hospital administration believes – that YOU are essential and we are expendable. Hospitals have begun treating us like shift workers while exploiting our knowledge, ability, license and most importantly, our patients. You see, at the end of the day, they are OUR patients, not yours. The only absolutely essential part of a hospital is the doctor-patient relationship and a hospital without is is a useless, expensive building. We can accomplish more with our brains and a band-aid than you can with a fine building full of ancillary staff and expensive equipment – if devoid of that relationship. Business and Medicine do not mix – change is coming.

  15. Local Fire/Medic says:

    They keep using the word “seemless” you bit off more than you could chew so you scrambled to ask SEA employees to stay on with the lure of high hourly rates and bonuses. However none of them chose to do so. Why do you think that is. 65+ well educated, intelligent individuals chose not to sign in with this new group. I wonder why that is? Maybe they didn’t want they’re good name tarnished with your fly by the seat of your pants politics and terrible reputation associated with your group… Moron

  16. Local Fire/Medic says:

    Malone and Bagnol continue to state that this is a seemless transition. Those are the only remarks they’ve made publicly. Yet they both have the time to browse this whole comment sections and still have yet to answer any questions with factual answers. Bur your encouraged to contact them directly…Uh huh so they can spin the web if lies and catch you in it. If they are so confident in there transition spit out some facts. Because we all know someone who is currently associated with summa emergency rooms, they keep us in the loop and they def have no reason to lie.

  17. The SEA doctors are some of the kindest people inside and outside of the workplace. Not to mention they are WELL qualified and took excellent care of patients. They did the right thing in my opinion 98% of the time, even if patients didn’t not like it. The way medicine should be.
    I worked with EMP docs at another facility. SEA took over this contract. Needless to say, I felt bad for the doctors no longer working there, but I can tell you one thing after working with SEA… it was the right choice. To say narcotics were over prescribed, the copious, unnecessary amount of tests ran by EMP is an understatement.
    I appreciate what SEA taught me.
    The nurses and residents left behind are who will truly suffer beyond recovery.

  18. As an ED RN caught in the middle of all this I want to thank IMS, ICU docs, Neuro, and all of the other specialists who are coming down to the ED the moment ED nurses call, staying with the patients, and getting them out of the ED as quickly as possible. Thanks to all the local EMS providers who have wisely chosen to bring their patients elsewhere because they are concerned about Summa EDs current ability to cafe for them properly. I have never been so afraid that patients are going to suffer due to excessive wait times and or medical incompetence in my near 20 year career. We greatly appreciate your help and support during this unseemly transition. Thanks Jeff for getting this conversation going.

    • Local ED doc says:

      Wow, really? SEA are the only good docs in existence, and all other docs are really bad docs? I know both groups, trained with ones who work in both groups, many trained in the same place. They are all board certified ED docs. These new docs are working in a very difficult situation. New EMR, new facility, new nurses, new protocols. I’ve been through several EMR changes, staffing changes, and it is always increased wait times, increased LWOT, concern about bad outcomes. Bad outcomes happen with perfect care sometimes. And these docs only had a few days notice? Add hostile nursing staff, I can’t imagine working there as a doctor under those circumstances. All of a sudden, these other docs medically incompetent? Really? I can understand that you are mad at losing close colleagues, but things will get better. And I agree with the other poster, the ones that I know from SEA are very kind and nice people. The ones I know from USACS docs are very kind and nice also. Many are local, lived there for a long time. Have family there also. You should try to get to know them. I’m sure they have doctors coming in from other places to help in the transition, but many are local doctors.

      Also, I’ve asked around to many of my fellow ED docs at Aultman, Mercy, Cleveland Clinic, and anyone who has been in contact with USACS has not been offered $1000 per hour. Not even close. Anyone who believes that is crazy. I could work 2 months at 200 hours each month and take the rest of the year off.

      • Summa ER nurse says:

        I am a nurse that currently works in the emergency department affected. I can tell you that my colleagues have been very professional during this transition. This isn’t personal, this isn’t a witch hunt we have legitimate concerns about patient safety. These doctors have not treated patients according to current standards of care. We have 4 pages of examples just from the last two days. 83 yo F CP SOB only order was a lumbar X-ray, female in her 20’s lactic acid 7.8 MD wanted to discharge her. The list goes on and on. We will not stand down or brush over these concerns.

        • Former Summa RN says:

          It’s amazing how the claws come out. With regards to USACS , having worked with many of the doctors when they were EMP, I truly enjoyed working with them. When they lost the contract to SEA previously, I appreciated how they kept it clean and stayed classy all the way until the end. It was a very different transition compared to what I am witnessing now. USAC doctors are what would make me entertain returning to work in a Summa facility. With regards to compiling a list to show standards of care being violated, please at least take off your blinders. I saw numerous things sent out of City ER when SEA was onboard that showed up in competitor hospitals that were also flagrant violations of standards of care per your standards. Wait times in a Level 1 ER? Imagine that, not uncommon whatsoever. ER has always been a team type of atmosphere, if things are being missed by the doctors, where are the nurses who are supposed to approach them with their concerns? Instead of making lists, perhaps communicating your concerns with your attending is more productive. I have never been made to feel uncomfortable approaching any of the USAC doctors with concerns. It was a bidding process, SEA lost. With regards to improper relationships, do you honestly think for one minute either Summa or USACS attorneys would not have flagged it? What I do see is a company that expected to win, and lost. So rather than walk away gracefully and wait for the next bid, they create discord, feed distrust, and attempt to drag down the ER in the process. Trust me, I have no love for Summa admin, but what’s done, is done. If you don’t like it, move on, find a new job. We are ER nurses, doctors, medics….WE thrive on change. You either embrace it and love it, or fight it and hate it. Life’s too short to hate. Welcome USACS, you have my faith in returning to a Summa ER.

        • ER Patient says:

          I just returned from one of the ER departments that was involved and now has new physicians. Other than a little bit of a longer wait time which can be expected in any type of change like this I left feeling better than I have from past visits which had the SEA physicians. Now every experience is different but I never felt that way with the SEA docs. As an example a couple months ago I fell down a flight of stairs and knocked myself out, just for a minute, so I went to the ER due to concerns from family members. I was there and was given a Tylenol and sent home. No tests were performed and I only saw the physician for a total of 3 minutes (my sister had timed it). Tonight it was a complete 180 in bedside manner. The DR sat with me and I was able to explain issues that were going on other than what I was there for and gave me advice for that as well. I left feeling better on all fronts. Something I was never able to say with the SEA group.

          • How many Percocet did you get? Is that why you feel better?

          • ER Patient says:

            None actually but see its people like you that would turn people away that are in need of true care. The point I was trying to get across had nothing to do with meds given out but the fact that someone falls down and was unconscious was only given a Tylenol and told to go home. Way to miss the point.

          • Doc Vader says:

            But did you die?

          • ER Patient says:

            Not only is your response/question asinine for bringing something like that up but also very unprofessional considering your name has “doctor” in it. You have no idea of what medical issues someone may have where a fall could be fatal if not thoroughly examined.

          • Doc Vader says:

            But DID YOU DIE?! No? Ok then. 10/10 for the doctor.

          • ER Patient says:

            If dying is the only thing doctors are worried about there would be a lot more problems with our healthcare system than what this article is even about. Yes I’m alive , but it was no thanks to the doctor that I saw that night. After a long conversation with my PCP she suggested a different hospital to go to that’s not in the same system, she even works at the hospital I was first seen at. Once at a different hospital they did a more thorough exam and tests and concluded that I had a concussion and that there were certain things I needed to watch out for due to medications I was on so there wasn’t an adverse reaction. That doctor deserves the 10/10 in my eyes. But if just making sure someone isn’t going to die is all it takes to work in an ER then there shouldn’t be any problems with staffing the hospitals that you’re saying will be affected. I certainly hope you can understand everything because it seems to me that you’re just being a child and a internet troll but it’s fun for me to reply so maybe someone that does read this they will be more informed.

          • Watch the video to understand the comment, it's a joke. says:
        • I’m a reporter. Please contact me if you’d be willing to comment for a story I’m writing. 404 245 1733

    • Night admitting crazy doc says:

      Please page me when you need help, don’t hesitate. I will support you as much as I can when I am on at night. As you know I am quite busy but I will do my best to answer your call. Thank you so much for helping me do my job on the night I am on at Akron city hospital. We cannot do our work smoothly without your hard work, I am very grateful.

  19. eric olsen says:

    Mr. Malone

    You will not be able to outrun this. It just stinks to high heaven.

    I was a resident at Summa in the ED in the early 2000s. Many of my attending physicians are now your former ED staff. They are and always were hard working and a credit to the profession. They helped to turn hundreds of young interns into well educated and prepared physicians that have since gone on to serve in EDs throughout the country. While these docs can end up anywhere in the country, most settle in the Ohio area. As a result, the entire state of Ohio has benefited from the hours of work that the physicians at SEA have dedicated to the profession. I have boasted that I felt my training was top notch and I have encouraged interested med students to take a good look at the Summa program when looking into EM residencies. Sad to say that there is really no program left to brag on.

    You can’t tell me that you have the best interest of the 30+ emergency medicine resident physicians that are currently training there(and many more resident docs in training that work with the ED in ortho, internal med etc) in mind when you pulled the rug out from under them. Hardly, you instead threaten them and tell them that if they do not return to work you will try to hurt their career? You think that they should put their careers in jeopardy by working side by side with replacement doctors that do not know the system and have been working an unsafe number of hours? I have worked with 3 different EHRs and I would certainly not be comfortable jumping into a new job with no training on the system and limited access to old charts. How do you put so much faith in physicians that you have never met? Physicians that have no record that you have reviewed? Physicians that have not been through hospital credentialing? And you want your residents to go to work and put their names on a chart with these people? You have put your self interest before the interest of the people that you sir are supposed to serve. Plain and simple.

    If there was such a gross contract dispute then share the details with an impartial news outlet. Show us that you made a sound business decision. One worth putting the lives and careers of so many in jeopardy. I have no doubt that you will hide behind a corporate curtain and claim that “it is not Summa policy to ….blah, blah, blah”

    I hope that the truth does finally come out and that you get what is coming to you. You certainly deserve it.

  20. Connected indirectly says:

    I am sure facts will come out and I agree they are wanted. I see the posts of administration offering their email addresses, but I know of emails sent to these individuals asking for facts and the responses were not accurate. The fact that Dr. Malone states as a fact above that the Residents are behind the administrations decision is just, well… absolutely undeniably and completely false (see house staff council letter stating no confidence). Therefore, he is also just continuing to spread lies as truth. But it isn’t my intent to get into a he-said she-said, just to open the eyes to the reviewers about things we already know and don’t need more facts for.

    There seems to be so much desire for information about the contract negotiations, and it is true this would help some people knowing where this broke down. But let’s be very clear on the things that I think we DO know. SEA is good. Simple as that. They are just good physicians with good hearts and focused on patient care. They continuously stepped up and volunteered for their residents and their patients. They created an amazing residency system at Summa. I bet I can find 50 prior Summa Residents that would sing praises about this program for every 1 that might speak negatively (and I’d argue I could challenge you to even find that one). I’ve witnessed this first hand. These doctors are respected and loved. SEA is loved. So what do you think is going to happen when you rip them out in a 4 day period? There will be chaos, and no matter who’s side of the contract this broke down on there is one person in charge of such a drastic change – the buck stops at Dr. Malone. Even if (and I am not saying this is true to be clear) SEA had some crazy requests in their negotiations, it was because, quite frankly… they were that good. I don’t think they had crazy requests, but we will find out eventually. But again, when you build such an amazing system and you bring the best of the best to the table, you get to ask for more. That’s just the way it works. So let’s say that Summa wasn’t sure they could continue to pay for this good system and demands they felt were unrealistic… I’m pretty sure it was Summa’s responsibility to ensure they were at the table early enough with enough of a plan to either work through the issues leaving enough time for the discussions, or to have a plan in place where a smooth transition would occur. That, my friends is a focus on patient safety and good administration. Caring that the system you have isn’t ripped out in 4 days with no transition plan. Honestly, anyone that goes to paper based documentation during a time like this DID NOT HAVE A TRANSITION PLAN. I also would assert that even if they feel they did their job, they did it poorly, I can tell you that. Again, there is one person who is accountable for that – Dr. Malone. That’s where it stops.

    So I ask you Dr. Malone, what exactly is your responsibility in this? I kind of believe you have all of it. I don’t really personally care about what happened or why the contract failed. I know you ripped out your ED in a way-too-quick fashion, I know there is no transition plan or at least a poor one, and I BELIEVE you are under-staffed and scrambling to find workers. It is clear that there is an upheaval in the community of emergency patient care which is further impacting outside agencies and other departments as well. These I think are things that don’t need facts – we know them, and ultimately the responsibility for the cause of this is Dr. Malone’s. He’s the CEO. Why is all this frustration making us lose sight of that? Doesn’t matter why the contract failed – nobody can say ripping an ED staff out in such a short time was a good idea. And it’s Dr. Malone’s responsibility.

  21. Mark Owen says:

    In my 30 years as an ED billing consultant I have occasionally consulted their billing agents. I found the SUMMA EDPs to be excellent documenters indicative of dedicated phsicians. Not dedicated to documenting for dollars and RVU incentives, but dedicated to quality patient care. However, emergency phisicians with exclusive contracts operating under EMTALA is inconsistent with reimbursement based on the fee for service model and free markets. Recent changes in hospital quality guidelines and payment rules add downward financial pressure on EDPs. Adding incentives for all providers to take risk to maximize revenues also works against small independent EDP groups. What happened here was the confluence of greed and survival, a few in this deal saw a big payday and/or survival as “good business”. Takeaway lesson, independent groups need a new business arrangement with their hospitals. Get creative, you need a shared risk where the independent group is a true partner with the hospital. Commit part of the Group’s assets to the deal. Stop cashing out profits at the end of every year. Invest in your group’s future. Help your partner solve their problems not just your own. Invest in advocacy to fight for legislation that serves you and your facility. Good luck.

  22. Georgia Reed says:

    I cannot even imagine the upheaval being experienced by the nurses, technicians, administrators, and patients at Summa. The staggering amount of information that is kept within an EHR, and the disruption to the workflow processes of everyone trying to provide safe patient care, it’s just unbelievable that this is how they are choosing to transition! Unbelievable. I think the Ethics committee has a lot to look into.

  23. Concerned says:

    It is difficult to put into words what we are witnessing. As a witness I was present when the SEA physician walked the concerned and confused Summa resident to Dr Wright during a busy ED shift and Showed him the emailed letter from T Malone stating the SEA contract was not renewed. Dr. Wright remained composed and PROFESSIONAL.
    Why was this information not portrayed in a personal phone call to Dr Wright, professional to professional. Why was
    The email sent to the Summa residents and the SEA PAs and CNPs only on Tuesday Dec 27.? Bullying.
    Does this sound like an organization that is concerned about Residents or mid level providers. Does this sound like an organization an SEA physician would want to join?
    If this is how you treat your colleagues, how will you treat your patients?
    Why was a USAcuteCare member handing out his business card to a newly hired SEA Employee in November at ACH?
    Why did this same person state he was in meetings in November at ACH?
    Why did Dr Bagnoli call T Malone his partner? Partner in crime?
    How will T Malone from this partnership?
    Is Dr Bagnoli’s wife, a board member involved in the negotiations a partner too?

    Fully staffed with board certified physicians?
    Not fully staffed. Not all EM board certified physicians.
    If I made an appt with my PCP for a laceration, I would be sent to the ED. Why would you staff the ED with IM physicians?
    A lot of ??????????

  24. So much for QUALITY OF CARE!! wow I can’t believe what I just read here.. TERRIBLE! !

  25. Concerned says:

    Apparently there was some kind of huge staff meeting this morning with the ER staff, many of whom came in from home on their day off to ‘discuss’ the situation that is continuing to evolve in the Summa ER’s. More than half of the staff from the department showed up. Only two members from administration were there.
    The results? Nothing. Staff was told that this is the way it will be and basically they needed to ‘get over it’.
    In Summa Health’s Akron City ER, the majority of ER Nurses are either brand new grads, or people who have been hired within the past year. Couple this with new doctors who do not know the hospital policies, procedures, or protocols, and you are just asking for someone to be harmed.

  26. Concerned RN says:

    Where are the other Summa attendings?? Do they think their specialty is safe? It’s just a matter of time before Malone and Company come and replace them for a cheaper and crappier version. Why not join the residents and vote no confidence?…Stand up for something! Stand together!

    • Tom's Bonus says:

      This exactly. Everyone thinks they are safe until it is them. As someone who was close to the situation my opinion is that Tom malone is here to cut costs and put the institution up for sale. NOTHING else makes sense and the hospital employed doctors need to wake up and stand for something before there’s nothing left to save.

  27. A Medicare regulation expert says:

    There may be a bit of Medicare fraud here. It seems these new docs are not privileged at the hospital. In that case, they may not be able to order services. Likewise, it was mentioned that the medical director’s name is being used for all EHR entries. If that doctor’s name is being placed on the orders for services to get them recorded, then none of those services can be billed to Medicare under that doctor’s NPI. So not only is the hospital paying the ED docs a high salary, the hospital cannot bill for any of their services without committing Medicare fraud!

    • Wakeup Summa says:

      Insurance fraud and Medicare fraud. The nurses were being told to either a) do all the orders themselves (outside the scope of their license) or b) Issue the orders under the name of the CMO, which is illegal and unethical. It’s not fair to the nurses to put them in the position of taking care of the patient or risk their license doing things they aren’t supposed to do.

  28. As a former employee, this is just another example of Summa going downhill. So sad. At one time I was proud to be an RN at this institution

  29. Disgusted says:

    I worked for emp for five years. Huge turnover. Little concern for the employee. Have to believe that concept was also used on patient.

  30. William Drake says:

    After reading these comments , definitely avoiding Akron City Hospital until further notice!

  31. Sydney Smith says:

    Definitely poor management on the part of Summa administrators, but that has been par for the course for them since Catholic Health Partners took over. I don’t know how the board is run these days, but it used to be composed of members of the community who cared about the community and about the hospital. Whatever the financial reasons for the change in emergency room groups may have been, there’s no excuse for not taking steps to smooth the transition. A responsible board would hold the administration accountable.

  32. Family of patient
    Doctors are working unsafe hours and nurses are working dangerously understaffed. Patients are are not receiving the care they need. I have witnessed falls, meds not given at proper times, incorrect charting, dehydration and more. It is frightening.

  33. Tom's Bonus says:

    I think that’s the exact point. Tom is here to sell the place, plan and simple. In the end, he’s not from the community and he has no investment in the people of NE Ohio. He’s here so everyone blames him and forgets their is a hospital board supporting all of the decisions he is making. In the end he will move on and be a cancer to another health system and the people of our community will be left holding the bag – in short, he gives exactly zero shits.

  34. Sidelines says:

    Summa CEO Malone wanted to bring on this change. It was evident when he refused to meet face to face with an SEA representative regarding the contract until Monday, December 26th, after already meeting with the new group. Instead of meeting face to face with SEA, only indirect communication was made, despite SEA’s pleas to meet with Malone directly.

  35. RN-current says:

    t I am currently employed at SUMMA and appalled at the current situation occurring at this hospital. This decision was made based upon financials only, no regard to patient care/safety, effects on employees and effects on the institution as a whole. We hear two sides of the story but unaware of the truth. I happen to believe more of what SEA says than the current administration. We have been through many transitions since the partnership with Mercy Heath has occurred and many of these have had not so positive outcomes for patients and employees. I not only have worked with the physicians and staff in the ED, but my family members and myself have been patients in the ERs and treated well. We do not know the credentials of the current ER physicians and must assume they are competent to care for traumas, strokes, cardiac emergencies, etc. This is not an issue of being a “nice” person but it is an issue of providing quality, compassionate care to all the individuals seeking medical care in our institution. Has anyone wondered if this change was forced by Mercy Health? USACS is a contract provider to all eight Mercy Health hospitals in the state of Ohio. Coincidence? I think not. This is another tactic to make more money for the institution. With that being said, one would think the employees would reap these benefits. I don’t think my 40 cent raise reflects the amount of money the hospital is making. Has anyone addressed the fact that SUMMA is a revolving door for nurses? We are never told the turnover rate for nursing, but each week somebody is leaving. Change is inevitable but the changes that have occurred under Mr. Malone’s tenure have, for the most part, had negative effects on patient care and employee satisfaction. Mr. Malone is Mercy Health’s puppet and they control his strings 100%.

  36. Summa FP doc says:

    ATTN CINDY KELLEY

    I would like to give a special thanks to Dr. Cynthia Kelley. I guess I didn’t realize the woman I spent 4 spent years with at OUCOM would give up her ethics and morals so easily. You spent the time that is to be spent educating ER residents, demoralizing them. Probably because you couldn’t find anyone to give a lecture, not even you. Threatening them with letters of “unprofessional conduct”. Don’t you realize, you don’t have a residency anymore? Your facility to resident ratio isn’t even close to meeting standards. The “attendings” you have, had to be credentialed on an emergency basis to even set foot in the ER to work and those are the people you think should teach your residents? You don’t even know them!! Let’s not even get started on your new Residency Director. How many publications does he have?

    I guess there is a reason you have that special title and big paycheck that goes with it. They choose you because you will do what they want you to do, without question. Sit Cindy, sit……

  37. I have worked in another hospital system for years and right after this came out, I knew it was all about MONEY and nothing more. I have no respect for a hospital that would dump a well respected and long-time ER physician group so suddenly, putting needless stress and strain on their employees in the process. Any lay person can figure out that it cannot be good for patients and If I need emergency care, I will not be going to any Summa location if I can help it.

  38. Dispensable doc says:

    Probably an ill advised selfie all things considered …

    https://twitter.com/DoctorViv/status/747166554236784640

  39. Former Resident, Current Staff Member says:

    I would encourage anyone who is on staff at Summa to attend the Medical Staff Meeting at Idabelle Firestone Auditorium tomorrow evening at 545PM.

    What has happened to the ER Department in the last 2 weeks has been a travesty. I understand there are 2 sides to every story, but this entire ordeal has been beyond irregular if not chaotic and something is very awry.

    I believe that we, as a medical staff, should call for an independent investigation of the negotiations, including investigations into Dr Von Greunigan’s involvement into this drastic change as a major ethics violation. If Summa refuses, then, we should call for the resignation of Dr Malone and Dr Von Greunigan.

    Those of us who received the email from the Summa chairman to simply “move on” is unacceptable. We must stand together as a medical staff and demand accountability for this extremely irregular situation and hold those responsible for it accountable for their actions.

    • Let this be the line in the sand for the few independent groups left in this country. Be strong my Akron EM Colleagues. The residents should solicit the support of ABEM, ACEP, and AAEM and stand together against the administration. You have our support from AZ and I am sure the rest of the EM community around the country who have not sold their soul to the conglomerates.

    • Fed-up floor RN says:

      They are now threatening write-ups to anyone posting on social media about this and are attempting to cut staffing on floors to pay for these ER docs. But remember, patient safety is Summa’s #1 priority.

    • I’m a reporter covering this story. Would love to speak with you on the record. 404 245 1733

  40. Curious Mind says:

    Rumor has it that some of the Chair Persons if you will, are in support of Mr Malone’s move. However the question begs to be asked what is the logic behind their support. I would love to hear a legitimate reason as to why they would support such a dramatic shake up in such a short period of time. My guess is fear mongering. Snap the fingers and jump! I guess at this rate propel will say anything to keep their jobs, they way summa is running the show.

  41. Fed-up floor RN says:

    Attention Summa employees, now is the time to take advantage! They’re not watching right now, so go ahead, violate Summa’s recently-implemented archaic dress code. Show your “Mom” tattoo! Wear your third earrings! Tuck your pants into your boots! (because that actually only makes sense during winter). If you don’t tuck your pants, show your BARE ANKLES! SANS PANTYHOSE! Gasp! After all, what are they gonna do- spend an exorbitant amount of money on your less capable replacement?? Don’t forget to bring your hooded sweatshirt in case you feel the cold chill (plus the stench of greed) wafting from the board of executives.

  42. The American Academy of Emergency Physicians has released a statement on the USACS Summa takeover:

    http://www.aaem.org/calendar/current-news/aaem-statement-on-usacs-replacement-at-summa-health

  43. Shoutout to Rubber City Politics and their excellent summary of the issues. Well written, cogent, informative. (Why can’t I do that?)

    https://rubbercitypolitics.wordpress.com/2017/01/03/what-we-know-about-the-summa-health-shake-up-and-why-this-goes-beyond-the-er/

  44. As a physician at the competing hospital in town (and a former Akron City Hospital physician), I would like to know the specifics of what SEA was asking for that made the hospital walk away. I absolutely do not believe what the SEA doc mentioned in the original post. It was not just about the freestanding EDs and the compensation for resident teaching. When I was on staff at Akron City, I got tired of hearing the SEA docs whine about their hours and compensation. Compared to the primary care physicians (and even a lot of the surgeons), the SEA docs made a great living with senior partners making over $400K/year. When it came time for contract negotiation with them, it was always the same thing—they tried to strong arm the hospital into giving them excess compensation. In one of the previous comments, someone wrote that the group may have asked for something excessive in the contract negotiations but that they were worth it. Must have been an SEA doc that wrote the comment. Goes to show you that no one is irreplaceable. Personally, I know nothing about USACS but I can say that I am much happier dealing with the ED docs at Akron General. I get much better reports from them and I feel they take much better care of my patients. The SEA docs have no one to blame but themselves and they need to stop pointing fingers at everyone else and take a good long look in the mirror. They are the ones responsible for the destruction of the EM residency and their current residents’ futures. I am sure Summa is saying “good riddance.”. I just hope those selfish docs from SEA don’t work their way over to AGMC.

  45. Elizabeth Combs says:

    If anyone on this site attended the medical staff meeting at Isabelle Firestone tonight, there are many people waiting to hear the outcome. SEA strong!

  46. Concerned says:

    The Beacon Journal wrote an article about another group being fired from Summa ACH:
    http://www.ohio.com/business/another-doctor-group-out-at-summa-no-confidence-vote-in-leadership-possible-sources-say-1.738278

    I was not at tonight’s meeting, where Summa notified the medical staff (physicians only) that they were replacing the ICU/Respiratory Group at ACH as well. (See link above)

    I am told that following the meeting, “sources state Medical staff just voted—-99% vote of NO CONFIDENCE in CEO Tom Malone.”

    When 99% of your physicians vote against you, you better start listening.

  47. Let’s think about this…it’s not in either Summa or USACS’s best interest to do this last minute. Summa gets bad publicity and USACS has to fill a crap load of shifts (making their other hospitals’ docs work more). If this was truly pre-planned as mentioned here, summa would have gone through normal rfp process to protect themselves and USACS would have better prepared. It does nobody any good to pull this off last minute unless SEA was asking for something crazy. If it wasn’t USACS, it would have been Team Health or EM Care. USACS is physician owned and provides great care to many parts of Ohio and beyond. Let’s not throw anyone under the bus on this without thinking it through…if you were CEO of the hospital, would you pull something like this over the holidays last minute knowing the repercussions? Not unless SEA made it impossible to negotiate further. I know many USACS docs, and they are just as good as any one of us just like I know the SEA docs are also good. Both parties aren’t dumb…there’s a reason it happened when it did and how it did…maybe folks don’t like what they hear, but maybe SEA did this to themselves

    • Take another look Sean says:

      SEA most certainly did not do this to themselves. Malone and Bagnoli were both blinded by their egos and made poor decisions for themselves and the institutions they are supposed to lead. Malone reached out to Bagnoli a full two days before his first and only meeting to negotiate with SEA at which time I can only assume Bagnoli falsely represented his institution as being equipped and ready to cover a system of this size. After that, Malone had no intention of renewing with SEA. The one meeting 2 days later was just a farce with no real effort on his part to come to an agreement. No Sean, SEA did not do this to themselves. Malone and Bagnoli did this to everyone: The patients, the hospital staff, the residents, the Akron community, the are EMS and the many families in the community that SEA provides a job to.

    • Sean, C’mon. SEA did not do this to themselves. SEA and most of its Doctors have had a great relationship with Summa and the community for years. Malone had the power to continue the negotiating process if he so chose to. However someones pocket had to be lined so he pulled the trigger with no thought of consequence or backlash. Bagnoli was completely overwhelmed and unprepared. As inside sources claim they still are. Malone and Bagnoli expected 60% of SEA employees to jump ship to this new group, with higher hourly rates(for the first month only) and sign on bonuses. Word is Bagnoli claims .they have 70 some people in the process of getting credentialed. HA. What a load. Clawing at the bit to get people the last 4 days ago, now all of a sudden 70 some people are lining up to take these positions. Right, cause the unemployment line is over saturated with Physicians, PA’s and NP’s.

  48. ACEP’s President has released a statement today (January 6th): http://newsroom.acep.org/news_releases?item=122808

    It’s a bit of a disappointment in that is addresses only the Residency disruption and only alludes to the issues of a too-rapid contract change.

  49. The rest of the story says:

    Tom Malone, CEO of Summa, and apparently in charge of ruining Summa Health System , just sent out an email stating that he plans to stay the course and ignore concerns of his medical staff. He had the nerve to try to just dismiss the vote of no confidence against him by saying it was from a minority of the medical staff. Granted not all of the medical staff of Summa Healrh System was present but of the hundreds who were only a handful voted in his favor. And a few didn’t even have the nerve to stand up and raise their hand. They did a little sneaky ” put my hand up by the side of my head maneuver ” and if you have them walked out of the room The emergency departments are in turmoil. Patient safety is at risk. Graduate medical education is in jeopardy. Is it going to take the government to come in and take over? I’m sure that will be good for everyone

    • Elizabeth Combs says:

      As a Summa employee of more than 3 decades with many in the ED, it is with great sadness but conviction that I say I will not, nor will my family be a patient in any of Summa’s Emergency Departments. How many more paying customers are you willing to loose, Dr. Bagnoli?

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