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,

{Redacted}

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. 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.

  2. 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?

  3. Concerned says:

    Just a reminder to all Summa Physicians:
    Your contract deadline is coming soon.
    Do you think you will get a fair negotiation under the current leadership?
    Something to think about.

    • Proud SHMG FP says:

      Yup, we are getting a fair contract, One that has had some give-and-take. Because concerns that we have are properly addressed face-to-face, not through blogs, not through the Akron Beacon Journal. Contracts with mutual trust and respect. With no raising of our voices, with no threats of a walk out. SEA stated they were upset that their chairman lost 30% of their stipend, what’s funny is they don’t say 30% of how much. My understanding, is in the past the stipend was close to $500,000, I apologize if my numbers are incorrect. Now you take 30% off of that, and it appears that the chairman is now being paid fair market value. I also disagree with SEA’s response that they have always gotten along with all previous CEOs. Once again, my understanding was even with the prior CEO Tom Strauss, their former chairwoman sent a letter with 80 other doctors, mainly from Unity, asking him to step down. Doesn’t seem like they really got along with the past CEO either. And since we are talking about Unity, What a great group that won’t take Medicaid patients, speaking mainly of their association with NNA, the neurology group. They’ll see you in the hospital, because the reimbursement is better,but they won’t follow you up after you’ve had your stroke if you are poor. I understand why they do this, because it’s about business and finance, and staying profitable. But when someone else makes decisions to try to stay afloat, that’s inappropriate then. I must admit, I’m upset, and sad for both sides. I’m still hoping that there’s someway out of this mess. I truly believe in service to our community.The question I have is if SEA was given the right to rejoin Summa by agreeing to USACS’s current contract in place now,would they accept? I think that’s a fair and valid question, and would truly show if they are committed to this community. Trust me, I understand the loss of autonomy and the fact that medicine has changed, and we feel like we’ve lost control. I understand that, and grapple with it along with all my colleagues. But At the end of the day, to me, it doesn’t matter whose name is on your paycheck, are you serving and taking care of your community is what is most important. Unfortunately with this contract negotiation, there was no trust on either side. Administration felt the ER would walk out, which they threatened, and the ER group felt they would be replaced, which happened. Without trust you’re doomed to fail.

      • The rest of the story says:

        You might want to get your facts straight before you start spouting off. The emergency department physician provide more free or uncompensated care than anyone else in the Summa system Emergency medicine is the only group and the only specialty required by law to see everyone who walks in their doors. I am sure you’ve had a few patients that you have dismissed from your practice for failing to pay their bills? Or when their insurance is no longer contracted by you ?
        And there is not one core faculty position including the chairman in the emergency department that was ever stipend Ted at anywhere near $500,000. They are all less than half of that. You must be thinking Of what was given out to surgeons, medical subspecialist, etc.
        The lack of trust seems to be well substantiated.
        As outlined in the opening part of this blog it appears as though negotiations were started with the USACS Group before a face-to-face meeting with ever held with the group already staffing the emergency department. And you are right, blogs are not the place where all of us need to be thrown out in the open but neither are propaganda emails and press releases sponsored by Summa and their administration. I am sure you will be welcome to step down to the ER and Pitch in or help yourself and your patients

        • Proud SHMG FP says:

          Please accept my apologies for giving an inaccurate number. Please note I did apologize in advance if the number was incorrect. but in some ways, my number still stands correct in that approximately $250,000 or less to each of the 10 core faculty members of for teaching residents, plus the $200,000, at least, that they’re likely earning by working shifts and with profit-sharing to the senior partners, I once again will apologize in advance if these numbers are incorrect. I regard all the SEA attending’s with the highest level of respect, and their dedication to teaching and education. I was lucky to be trained by many of them during my rotation. I once again cannot reiterate enough, nothing would make me happier than seeing SEA back in business at summa. Also as part of the medical group, I have never dismissed a patient for failure to pay. And in terms of insurance contracts, I’m not aware of one that we are not currently taking. I also, unfortunately, understand the lack of trust on both sides. my understanding was the contract was submitted to sea on 11/28, there was a response on 12/16. My understanding was administration felt that they were very far apart from each other, and so a Plan B was investigated, which according to emails you guys have was on December 24th, when the initial reach out was made with US ACS, prior to the actual meeting SEA had on December 26th. In terms of my comments on unity, I do apologize for those as well, they are a great group. There’s not one physician that I wouldn’t see myself or have a family member see. Unfortunately, I don’t think they take my insurance. I have many patients currently co-managed very well by them. My only frustration, which has happened numerous times, is that the patient falls on hard times, and they’re no longer able to be seen by one of the docs that they’ve had a long term relationship with. It’s a frustration that many primary care doctors have to face, with many groups. And as for being asked to pitch in and help, I would do it in a heartbeat if asked. I am not er boarded, but would be happy to help out for lower-level acuity care. I think even our medical group urgent care docs would be willing and happy to Pitch in. However once again they’re not boarded, that was a major concern raised by SEA, and once again rightfully so. I was hoping last nights meeting was going to be more about the future of what we do, but there was very little time for this, and understandably so, as how we got to this state had to be discussed, rather than get a chance to focus on what needs done right now, a week from now, a month from now, etc.

          • PCP formerly proud to say "I am Summa" says:

            Actually, I feel the meeting did focus on what needs to be done now and in the days to come.

            This goes far beyond the ER group – although it was the latest and biggest group to be torn from Summa.

            As a former Summa resident physician, current PCP and community member – the current administration’s priorities are not focused on the community and patients. Repeatedly groups and individuals have left Summa over the past few years. Yet, instead of the problem being found in the administration, it was always an issue with the physicians – physicians who had been here for years!

            For example – a certain specialty was told they could just leave Summa/ no renewal of contract – whatever contractual issues were there – I don’t care. How Summa dealt with it was the issue. In the days following, staff members would take calls from concerned patients about needing an appointment/followup and staff was not given direction in how to tell them “we don’t have a provider at this time.” Patients were left high and dry as the system scrambled to find a physician – eventually filling a gap with locums – yet all along insurance coverage was an issue.
            What I found appalling was that patients would come to me not having a specialist to follow up with – on important medications ordered by the specialist – in a field that already had a three month wait to make new patient appointments.

            The poor communication is nothing new.

            Prior to that, another specialist group left over a year ago – yet no one thought it would be a good idea to let the PCPs know. I’d refer my patients to this specialist group, singing the praises of the specialists I had worked with in the past. How embarrassing to have patients come back to me – telling me the specialists had gone!

            Repeatedly we’ve witnessed a lack of communication, a lack of concern for our patients and a lack of concern for the providers – especially the nursing staff in the hospital! There is no value for experience – seasoned nurses who have been with the summa system for decades – are being pushed out due to frustration and burnout. They come to appointments to vent – I have never seen morale as it is today. I’m afraid the damage done to Summa will leave scars.

            Summa used to be about community. I hope we – those invested in the community – can stick together to repair the damage. I don’t want to walk away from Summa – my family, friends and neighbors need us to fix the problem.

          • The ABJ in a recent editorial, aptly described Malone’s management style as “aloof.” That is a charitable description. He communicates mainly by email or by press releases from his spokesperson. No interviews with the newspapers or on-camera with television newsreports.
            As a veteran practitioner with Summa, I can tell you that Al Gilbert sat in the doctors lounge for an hour or two every day just to chat with the doctors and keep abreast of what was going on. When I was considering opening my practice in Akron, I had a one on one meeting with Al Gilbert to encourage me. Now, Summa spends $thousands to pay for “focus groups” to try to do these same things.

          • The rest of the story says:

            If you understood how medical education funding worked you would realize that summa receives far more in medical education funding from governmental agencies that it pays out to any stipends for any specialty. And the Amount of work core faculty put into their jobs far exceeds what they would make for the same number of hours should they work in any of the multiple emergency departments across the state who’d are in dire need of emergency physicians. I’m not sure if you actually attended the meeting or know any of the facts from any source other than the one sided propaganda perpetrated by summa but there are so many twisted layers to this pay to play and who is in bed with who ( both figuratively and actually) that is mind-boggling. It actually would make an incredible movie plot .
            And contrary to your assertation that anyone could go down and help in the emergency department, there’s a reason why there are emergency medicine training programs and board certification for emergency medicine. It is just as much especially as any other. Would you want a pathologist doing surgery on you?

          • Proud SHMG FP says:

            I understand quite a bit. I also understand tact, diplomacy and professionalism. I also have mentioned numerous times that I would love to see SEA back in action. But if this is the attitude SEA exhibits, it is no wonder SEA (Jeff Wright) lost his pissing match if he approached negotiations with a similar style such as yours. Please tell everyone why it wasn’t Jeff wright doing the presentation for the RFP 3 years ago, but Dr. Wilber instead,And who was the CEO at that time? Once again, my understanding for the reasoning was to avoid a pissing match 3 years ago, as what happened this year.

            And about me being happy to volunteer in the ED, I will do anything to help my community. I never said anyone can do ED, I specifically said low level acuity, I would help if asked/needed. ED is absolutely a specialty as is Family medicine. I once again am happy to help, I can absolutely manage the coughs and colds, when those patients are unable to get into their pcps so they go to the ed instead. which should never happen if pcps across our area had better access, not just the smhg docs who get our patients in, in a timely manner. I can handle the STI checks also. I too can handle the “I want a pregnancy test” chief complaint and when there is a complicated patient I can absolutely consult the FMC and IMC for an evaluation, so the patient can be sent home and follow up in the clinic the following day. also happy to help with those precipatous deliveries and help with children as this is a large part of my practice. I can also manage the hypertensive patient by calling the pcp and asking them what they would like me to do for the patient. I’m not trying to argue with you, I’m not trying to undermine the intensity of your speciality, but please don’t insult mine either . Trust me, I am the last one you want to manage an airway. But, you made it a point to tell me to go down to the ed and help out, and my point is ok, let’s take care of our community. Don’t forget it was your ED that used to have a “minor er” as part of it. Not my fault you couldn’t staff it with high quality IM/FM providers.

          • Proud SHMG FP says:

            Oh trust me, I am well aware of how the other side looks, and they got their shellacking yesterday. I am not happy with even the possibility of a conflict of interest, but I will leave it to outside sources, I.e, jacho to look into it. My understanding is that mark terpylak’s son is chief of staff of usacs and that terpylak, cliff deveny and bagnoli all have/had a debt collection company called escallate together, once again totally apologize if this is incorrect info. But to me, I want all the info exposed, both sides. Let’s see the ACH books, not just losses of the 3 underperforming hospitals. Why is showing profits so difficult? Sounds a little trump-like, are you being audited by the IRS and only when the audit is complete the other books will be shown? I’m calling for transparency on both sides if you want the medical staff to weigh in and cast votes. The medical staff should have all the info, not just bits and pieces. When 2 parties argue and are at opposite sides, my experience is the truth lies in the middle.

          • Former Summa Physician says:

            In the early 2000s when Summa Med Ed looked at the finances, the margin from the residencies ( CMS direct and indirect medical education reimbursement minus the cost of residencies) was $13 million

        • PROUD TO BE "I AM SUMMA" says:

          YOU need to get your facts straight!!!! There was NEVER an agreement in place with USACS before a face to face meeting with SEA.

      • The SEA docs are given the opportunity to join USACS and continue to serve their community and their residents. Instead they sit and home and actually PAYING their docs through January NOT to join USACS and NOT to serve their patients. How dedicated are they? How dedicated to them are they when they just walked out on them on January 1st? They could have make it a peaceful, communicative transition. And they could have stayed on as USACS. It was a disservice to the community to walk out that way and to instill fear in their residents. All USACS docs there are board-certified and EM trained and fully capable of providing excellent patient care and training experience for EM residents.

        Also, if it weren’t all about the money, why couldn’t they negotiate reasonably enough to renew their contract?

        Always two side to the story……

        • Casual observer says:

          Agree wholeheartedly. Sounds like a greedy SEA had unreasonable contract demands.

        • anonymous says:

          Join a corporate group who cares nothing about their employees or patients? Who instead care about stock markets and profits? Some people have character and dignity. BTW, they are still serving their patients at non-Summa facilities. And all of the replacement docs are not EM board certified. Thanks for your input and inaccurate information.

          • Oh, so they are double dipping then? They’re getting paid NOT to work with USACS, ditched their Summa patients and residents (that they care so much about) AND are collecting a paycheck elsewhere? That’s not what I would call character and dignity.

          • No dog in the fight says:

            From what I understand those doctors are continuing to work in emergency departments where they were already working. They are seeing patients at Western Reserve as well as Wooster Comminity I think you may be confusing “double dipping” with the balance billing Standard practice of USACS. If you aren’t familian with it you might look up what happened in Allegheny. Billing patients for what their insurance does not cover and then sending them to immediately to a collection company owned by other members of the USACS Reeks of shady and unethical And they did not walk out on anybody. They were told to leave Malone himself sent out multiple emails days before the end of the contract that there were other doctors in place for a “seamless transition”

          • So does this mean if I have SummaCare insurance, or any other for that matter, I don’t need to pay the balance? Does this mean the PCP shouldn’t even send a patient bill?

          • anonymous says:

            http://www.ohio.com/business/national-accrediting-group-confirms-receiving-complaint-of-patient-safety-concern-at-summa-1.737789

            You need a bit more well rounded education that requires more time than I really have.

          • Great article. Not sure exactly why you are posting it here for me. As it says, any anonymous person (like yourself) can file a pt safety complaint. They’ll investigate to see if anything really did happen. Let’s stay tuned before crucifying the new doctors for something that may not have even happened. Maybe the complaint was made by a angry SEA supporter like yourself.

            I don’t see you addressing anything about what SEA did. I think it’s important too keep an open mind and in general to look at what and why the SEA docs did what they did instead of just slamming a group of EM trained, board certified ED docs that are trying to take care of patients, give the residents first class training and serve the community. (And also instead of trying to insult ME. Really?)

            As I said, there’s always two sides to a story…..

        • anonymous says:

          Posted the articles to help convey facts to you. Sure there are two sides to the story. You should also stick to facts rather than speculation. Sorry you are offended and think I am insulting you.. which is kind of funny after you slammed the SEA group. SEA hasn’t left the community, they are actually still practicing within it.

          Also, the resident physicians are caught in all of this. Neither side looked out for them, and both sides have blame.

          Where are you getting that they staffed the hospitals with board certified EM docs? Read carefully. Board certified doctors, not specifically in emergency medicine. In fact they are replacing 60 physicians within a few days. As big as USACS is, it’s common sense they aren’t going to find 60 full time permanent ER doctors to staff AKRON, OH. In such a short notice with no plan in place for patients or the residency program, this is safe for patients? Some docs aren’t EM boarded (and for you to say they provide first class emergency medicine training? I believe the residents are actually training them…), all docs aren’t familiar with the hospital system/EHR, the hospitals are understaffed… Common sense that this is a set up to place patients in danger. But what do I know, you’re the ER doc.. probably working for one of these big contract groups from the sound of it. Not just supporting SEA, I’m supporting independent physician groups across the nation.

          BTW, unless you posted your name, you, too, are anonymous. Weird, eh?

        • Concerned says:

          Totally disagree! SEA docs were not given the opportunity to stay on the 1st. In fact, they were ‘removed’ from the ER at 1201. They stayed on long enough to report off to the New Docs, and it was all very cordial.
          If you were not there, you should not be trying to ‘spin’ things to fit your own preferences.

        • Elizabeth Combs says:

          I can assure you, things are NOT safe in the ED’s. Not enough physicians, wait times to see the physician at an all time high, leaving prior to being seen by a physician over 10%, some with potentially life threatening problems, length of stay is 3 times normal. USACS is in over their heads. They’re only about the money, not the patient. Get your head out of the sand or wherever else it is and see the truth. SEA has always been about the patient, families, environment and training the next generation of fine Emergency Department physicians. Don’t believe me? Look at the releases from ACEP, AAEM. Maybe you don’t recognize those organizations? Probably not…

      • LOL at the employed Doc

      • Abandoned patient says:

        I am so sad to see this happening to Summa… I have lost my trust to Summa after I had been a patient for years!

        I had to leave the ER to go to another, from not being seen.

        After my follow up appointment of course I had questions on my health, and after all of this mess; me, THE PATIENT, was punished, and terminated, for having questions and concerns about my own health.. I tried to fix this through Summa, but I guess my issue is just a drop in the bucket with all of this going on..

        Business and medicine do not mix..

        The patients best interest is to come first?

        Does anyone care about the patients and community of Akron???

        Why was I abandoned as well??

  4. Emergency Medicine Resident’s Association has released a statement, signed by their Board: https://www.emra.org/uploadedFiles/EMRA/Announcements/Open-Letter-from-EMRA.pdf

  5. justanotherfrustrateddoc says:

    Summa administration is filled with a bunch of crooks that all have multiple financial relationships and conflicts of interest. Malone-CEO, Von Gruinigen-CMO, Bagnoli (Von Gruinigen’s husband) -CEO of USACS who now gets contract for Summa’s 5 ER’s, Terpylak- head of ACO who has joint business ventures with Bagnoli.
    This ER situation is a well planned move by all of these crooks. In an ideal situation, any reasonable CEO would have liked to lock in terms of such an important contract in November leaving at least 4 weeks to allow a “seamless transition” if both parties did not agree. Even if SEA asked for unreasonable demands, it is very shortsighted of CEO to leave it to last 2 weeks of December to resolve this situation. Either he showed poor business judgement or already decided which group was going to get the contract regardless of details. Both situations are bad which should raise concerns for the Board.

    Unfortunately, the Board supports these conflicts. Chairs of various divisions are puppy dogs of these folks. SIncerely hope legal action is taken to uncover these violations of conflicts. At best, Summa and Akron coummunity deserve answers to allowances of these conflicts of interests. Unfortunately, the Akron community suffers because of these people’s greed.

    WE WANT ANSWERS!

  6. I am a > 20 year practicioner in Akron. Malone is tone deaf to the concerns of the independent medical staff, oblivious to the importance that independent practitioners carry in Summa’s book of business. He is misguided to think that creating a physician fiefdom of employed MD’s (SPI) will sustain Summa’s pre-eminence in the Akron community. He wants to create a Cleveland Clinic model of care WHEREBY ALL MDS ARE EMPLOYEES AND CAN BE GROOMED. With 70% of Summa’s MD’s being INDEPENDENT, the notion that 30% of physicians can drive an entire system is flawed. Look carefully at his responses, letters, blogs, etc. He is utterly misunderstanding OUR Summa medical family and how we built the system into a powerhouse it ONCE WAS. For instance: Before Malone, Summa and Crystal Clinic were on track to build an adjacent hospital. Summa and Western Reserve were JV partners and on and on. Now Summa is a “lone wolf” with no partners locally, and antagonistic relationships with major physician practices. Lastly: Today he dismisses the no confidence vote outright, instructs the department chairs to pen a letter strong arming them to feign loyalty. If the Board at Summa doesn’t act to remove him as CEO, then we act to issue a vote of “no-confidence” to the board of trustees (Remember the University of Akron fiasco with Scarborough?-does the board really want to be perceived as lacking leadership-these pillars of the community?). More importantly we act decisively to NOT utilize any Summa facility, laboratory, radiology facility, refer to SPI MD’s, nor admit patients there, and dissuade our patients from using Summa ED facilities. No further donations to Summa events, foundation, etc. The medical and nursing staffs at Summa wield enormous influence when we act cohesively and not cave to a derisive, autocratic CEO who leads a great organizational chart, spins a great story, but is inept to work with the skilled and dedicated physicians who make Akron their home. Yes it’s drastic and in the short term hurtful to Summa, but ultimately our patients deserve an environment whereby their doctors and nurses can practice in an unemcumbered manner. The consequences of the status quo is physician retirements, relocation, poor recruitment, poor quality resident physician attraction.

    • Look up Tammy Scarborough. The entire administration is incestuous. And Malone is a tyrant. Physicians should band together and move to get him out.

  7. Akron resident says:

    If I worked at summa still, I would start looking for other jobs. If this is any indicator of what happened with Detroit medical center while Malone was CMO, 1000 jobs cut and 300 beds closed. Summa staff, take care of yourselves and don’t get screwed by this.

  8. Medic with a monitor says:
  9. Fly on the wall says:

    Local doc “raised” in the Summa/NEOMED system here.

    I don’t want to get into a he-said, she-said argument about SEA/Malone (other than recommending the Beacon Journal for the thorough reporting). The damage has been done, and the consequences will be felt for a long time. I am also aware that there are economic realities that mean that physicians can’t practice the way we did 5, 10, 30 years ago. Like it or not, the corporate overlords from Mercy/CHP are here to stay. Either adapt, or save more and invest wisely to get your FU money quicker.

    That being said, a few posters have nailed the real core of the problem: current administration has fundamentally misunderstood Summa’s values. Many Summa docs practice here not for the money. We could get jobs with higher pay and lower stress elsewhere, but we don’t want to leave our families and community behind. We have prided ourselves on local relationships — whether it’s hospitals like Crystal Clinic and Western Reserve, educational institutions like NEOMED, or the greater Akron area. And we have expected similar relations with our administration. To that end, communication is key. Al Gilbert understood that. Tom Strauss understood that. Tom Malone doesn’t. You can’t run a hospital effectively when you’re sitting in a corporate office insulated from the real world, and firing off the occasional mass e-mail or blog post.

    During Malone’s tenure, Summa’s local relationships have been disrupted and its image weakened. Western Reserve was a messy public breakup. The Crystal Clinic was a messy breakup. The joint district of Wadsworth-Rittman sued Summa for the closure of the hospital there. The dress code announcement was an unforced error (why ridicule Walmart shoppers? They’re your client base!). A hamfisted approach to contract negotiations led to the loss of numerous highly-regarded specialty groups (GI, critical care, and of course the ER debacle). Joe Zarconi, a stalwart supporter of medical education, was booted, and his character assassinated. NEOMED students are looking elsewhere for residency.

    I don’t know the numbers behind the decisions and whether they made Summa better off — although the bond ratings have gone up. But I can tell you that communication has been woeful, and it has resulted in a loss of trust in the administration (and by proxy, the Summa brand) from physicians, staff, medical students, and the local community. And that can have longer lasting effects than a good report from Moody’s or Fitch.

    I know the ER issue is contentious. But no matter where you stand on it, it was ultimately Summa’s responsibility to 1) ensure quality care for the population, and 2) provide a quality organized education program. They didn’t. They failed their patients, and they failed their residents. That’s embarrassing. But what’s worse is that this wasn’t the first time, and probably won’t be the last. The Summa board of directors may casually dismiss the votes of no confidence of 250+ medical staff (many of whom have served the area for decades) and the resident body. But if they truly have skin in the game — and if they’re smart — they’ll listen. Which is something they haven’t done in a while.

    • justanotherfrustrateddoc says:

      fly on the wall,
      That is truly well summarized. Why don’t you submit this to ABJ and board of directors. As a fellow Summa doc, I can’t me more proud to be here and that is due to our patients, physicians, nurses, MA’s and other equally important staff/employees. While it won’t overturn any decisions, it may give a few members food for thought in the corporate hungry world.

    • Former Summa RN says:

      Great summary. Thanks for sharing with us here. Please consider sharing in an even more public forum.

  10. Eddie Gandy says:

    As a graduate of the EM residency program some 20 years ago it is saddening to read this blog. Being from SC where EM was a novel concept when I trained, I am very proud and grateful that I trained at Akron City as it was known then. I have worked with many “ER” physicians during my career and have found that those trained in your city know their stuff. So my 2 cents to this discussion is to encourage both sides to bring the temperature down, look for middle ground and don’t destroy the care in your community nor your excellent training program. P.S., i don’t miss the cold!

  11. So, after patiently waiting, more news comes out in the ABJ story.

    SEA wanted a 15 year deal! Then they countered with a 10 year deal.

    Both sides admitted they started late.

    Summa offered 4 times contract extensions to continue the negotiations.

    On Dec 29, Dr Wright had the option to sign an extension or a 5 year deal. I can understand not signing the extension at this late in the game as he became aware the CEO as a backup plan contacted several national providers. But, opting not to take a 5 year deal! Now I understand why some have been saying they walked out.

    Remove your emotions and look at this. The senior leader from SEA had a decent offer, temp contract extension, or a great offer on a 5 year deal.

    As far as wanted a 15 year deal so it is easier to recruit, that is the business of outsourcing. If it were easy to get board certified ED physicians, train them and provide career opportunities, I don’t think most hospitals would outsource.

    Plus, not opening the books. Incredibly common practice these days especially when business partners ask for stipends.

    I almost fell over after I read the ABJ article. SEA CEO swing for the fence, he struck out. There is nothing’s Ng wrong with that strategy, but he should have realized the magnitude of what was at risk. It seems as though he did and went for it because he could pull of a 2 day transition. Most would think that would be nearly impossible.

    Then others claiming care/caid fraud… you don’t even know if they have billed for any of these visits.

    This isn’t like kids growing up these days. There are no second place trophies to distribute, but there should be plenty to learn from all sides. Even those commenting on this blog.

    I myself was very frustrated after reading the latest ABJ article and felt sad for all of those misled since thy announce they were going with a new group.

  12. ancillary staff says:

    I am a current employee of Summa, having worked there for over 27 years. My department works in tandem with not only the ER but serves the rest of the hospital and the surrounding community. I have worked under the administrations of Al Gilbert, Tom Strauss and now the regime of Tom Malone. I say regime because since the day he took over, he and the administrators he’s surrounded himself with, have stripped this hospital bare at the expense of its employees and the community it serves. He had decreased staffing levels to the bare minimun, which has increased the patient load for all employees. We all work in a state continued exhaustion and fear that patient safety and our own safety are at risk. His administration has encouraged a culture of fear in all of us and a distinct lack of loyalty when it comes to all employees of this hospital. It is well known and told to us as all times that we are expendable and that they can easily replace us if we complain. We hold no value to this hospital no matter what experience we bring to the table and how hard we work. Many of us have left and gone on to better staffed, better paid and better treatment at other hospitals. The rest of us are looking to leave as well. They are happy to replace us with lower paid and inexperienced staff. Take time to think about this…..if you bring your loved one or yourself to Summa, chances are you may have a procedure done by someone who is another hospital’s reject. Our department in particular has lost so many of my fellow employees that they are forced to try and hire. We are operating at minimum staff. The problem is that now there are no applicants. The word is out and has been for some time about Summa’s treatment of its employees. The applicants we do get (and they are very few) are bottom basement and unteachable. They are actually a threat to patient safety due to their incompetance. What has happened to SEA is just business as usual for Tom Malone and his staff. The rest of us have been treated with this type of disrespect and bullying tactics for years. I have made the sad decision that even though I have a great loyalty to my fellow coworkers and to the patients that I treat who deserve great care, I need to finish out my career with a hospital system that actually values me and doesn’t remind me on a daily basis that I’m nothing more than ancillary staff and a “nonproffesional”. My schooling, accredidations, national licenses and experience mean nothing to this administration. I and my department are dismissed as unimportant. My advice to anyone…..do NOT come to this ER! And if you do, I hope and pray that you don’t hear what I heard today during a code. The new attending ER physician asking “what do we do now?” Yes folks, unfortunately that really happened…….

  13. The remaining scheduled EM resident interviews for this match year have been canceled, because who will they interview with? The individuals who interviewed for the residency know the physicians they interviewed with are no longer there. EM medical student rotations have been cancelled, including rotations for students which are necessary to graduate in June. This shows a total disregard for graduate medical education in general and for the doctors in training at the program.

    • Prospective resident says:

      As a prospective resident that interviewed at Summa 1.5 months ago I cannot believe this has happened. I loved the core faculty and program director there. I was going to rank them highly but now they won’t be. The GME department needs to COMMUNICATE with its applicants and let them know what is going on daily if they are going to get any halfway decent residents this year.

  14. Retired Summa RN says:

    Great Summaries to FLY ON THE WALL & ANCILLARY STAFF.!!
    I worked at Summa for the most of the years that Tom Strauss was the CEO. I still remember his “Talks with Tom” and his open and candidness with hospital employees – I remember his philosophy “If you aren’t working directly with the patients, you’d better be working to assist someone who is!” This “‘Servant Leadership” is still on the Summa website, but it sure isn’t what has happened under the new administration according to the many staff I still stay in contact with. First, they move the executive offices as far away from the City or St. Thomas that they can to the “Gorge” location! “Hi in the hallways” is gone. Now, there’s an arcane dress code, a drug testing regimen that won’t hire smokers – unless of course, you’re the CEO! Wonder if they drug tested him as rigorously as a housekeeper? Wonder too if he got a flu shot, since employees were fired if they hadn’t gotten their flu shot by the arbitrary deadline! It reminds me of the worst draconian rules and regulations from the 60s, when we nurses had to stand at attention before our shift to make sure our dress was perfect!
    I see so many parallels between Dr. Malone and Scarborough that it’s scary! Maybe it will take a significant drop in major contributors to force the Board to recognize, as they did with Scarborough, that you can’t railroad people into your way of thinking/ruling! Most of the dedicated, hard-working staff are gone, and the others are just doing their job and staying out of harm’s way….sure doesn’t sound like Summa I knew!

    Congratulations to St. Vincent Charity and Mercy in Canton – you made a great choice and am glad that Tom Strauss will once again be working diligently to improve patient care…too bad they wouldn’t let that happen at Summa!

  15. I have spent over 22 years working in the ER at ACH. I loved coming to work, even spending down time there, but the past few years have been a terrible drain on all of us, physically and mentally.
    I watch my friends who daily handle the absolute worst possible traumas, supporting patients and families as they lose their wives, husbands, and worst of all children, without batting an eye. Yet now I see these same nurses crying in the hallways, or ducking into an empty patient room to try and collect themselves before going in to care for another patient.
    I see them afraid to come into work, because they do not know the physicians. They put in orders for the doctors, or modify the orders that are placed, because they know the orders are wrong. They run the codes, because the doctors are looking to them for the orders, and they leave everyday worried that one of those errors slipped past them and they will run the chance of losing their license because of it. They are afraid…and they should be.

  16. The Society for Academic Emergency Medicine has released a statement: http://saem.org/home/misc/saem-responds-to-summa-s-replacement-of-emergency-physicians

  17. Nice replies but…The problem is administration (hospital, insurance, mega ed groups and CMS) are turming medicine into a business. We have two choices continue as we have which has gotten us here or band together unionize and fight back.

  18. Abandoned patient ? says:

    I am so sad to see this happening to Summa… I have lost my trust to Summa after I had been a patient for years!

    I had to leave the ER to go to another, from not being seen.

    After my follow up appointment of course I had questions on my health, and after all of this mess; me, THE PATIENT, was punished, and terminated, for having questions and concerns about my own health.. I tried to fix this through Summa, but I guess my issue is just a drop in the bucket with all of this going on..

    Business and medicine do not mix..

    The patients best interest is to come first?

    Does anyone care about the patients and community of Akron???

    Why was I abandoned as well??

  19. Summit county resident says:

    On December 29, Dr. Thomas Malone walked away from contract negotiations with the ED group that had provided exceptional care to the patients of Summa for nearly 40 years. He then hastily awarded a 3 year contract to USACS whose CEO, Dr. Dominic Bagnoli, claimed to be ready to staff Summa’s 5 EDs. He made this claim despite being able to fully staff only a fraction of the EDs USACS is already contracted to staff. According to the USACS website, they staff 160 sites. Also according to the USACS website, they have ED physician openings in 123 of those 160 sites. This reveals that a mere 37 of their 160 sites are fully staffed. Said another way, USACS is currently fully staffing only 23% of the sites it is contracted to staff.

    Clearly USACS is not prepared to fully staff Summa’s EDs. Since the takeover, physicians have been working longer that safe lengths of shifts, spending less time with patients, working multiple shifts in a day, sometimes in different EDs within the system, and having some physicians work everyday since the takeover without a day off.

    On January 15, the Board of Summa Health sent a letter to employees and physicians saying the Board will be….

    “Hiring an executive coach who will report directly to the board….”
    “Revising their contract renewal process in accordance with best in class standards….”
    “Providing direct Board oversight for all physician contracts…..”

    Clearly the Board recognizes that Dr.Thomas Malone does not provide good leadership, does not have effective contract renewal processes and does not posses the ability to provide contracts for physicians without the direct oversight of the Board. While the letter from the Board shows a desire to avoid the same horrendous leadership and contract negotiation mistakes in the future, it says nothing about how the Board intends to protect the public from the issues arising from the ED contract being given to a company that does not currently have enough physicians to safely and adequately staff the EDs.

  20. Concerned says:

    USACS is shipping in doctors from all over the US, Some as far away as Las Vegas, in order to try and keep a minimum number of physicians and Nurse Practioners in Summa ER’s. Are these doctors credentialed to work in Ohio?

    The ER Nurses and Residents are the real Heroes here, keeping the ER’s functioning and providing care for patients. If not for them, these ER’s would have been shut down. Every single day there are issues, mistakes which are being caught by the nurses, residents, and pharmacists. How much longer is this going to continue? Are you going to wait until someone dies from Malones incompetence?!

    • You have to be licensed in Ohio…before all this went down. The “Vegas docs” are folks who have spent time in Ohio either for residency or work…not random people who are shipped in. No state gives out emergency credentials…it’s possible these docs want to help…can’t force someone to do that!

      • Concerned says:

        Sorry Sean, but you were not there. You have not been listening to the physician comments about how much hey hate it here and can’t wait until they can go home. Of course, everyone wants to go home eventually, but sadly, Malone is making sure that there will not be a home for the Summa staff to return to.

  21. Concerned says:

    So Malones’ solution to all of his problems is to pay out more money to hire a ‘coach’ to help his administrators…why does a person with multiple degrees who is running a multi-million dollar company need to be ‘coached’? Unbelievable!!

  22. States don’t provide credentials, only a license. A practitioner must be credentialed by the hospital before they can practice there. In general, the hospital will do primary verification of these credentials, ie document the person hasn’t lost their license in another state, doesn’t have 100 malpractice cases they’ve paid out on, really are board certified, etc. This primary verification is time consuming and takes weeks to do, but it is the safest thing to do. In extraordinary cases, emergency credentialing may be granted, but in my opinion, losing a pissing contest with a long standing group of physicians is not grounds for granting emergency credentialing. Now instead of primary verification of the doctor’s credentials, you are relying on secondary or tertiary verification. That is, you are taking the word of some outside party that this practitioner is really who they say they are. Probably works out most of the time, but it is a short and slippery slope until you find your hospital as the lead story on Dateline NBC or 20/20. The standard tried and true credentialing process is the gold standard for a reason.

  23. Concerned says:

    It is really frustrating to the staff that issues with the new docs continue, and nothing is being done. Doctors have been putting in orders which would kill patients, medication errors which are reported, but nothing happens.

    If the nurses followed these orders, patients would already be dead. Thank God for nurses who know what they are doing, but it’s only a matter of time before something gets passed them.

  24. USACS Doc says:

    For those who say the current docs are ordering inappropriate things and practicing bad medicine, you are insulting your own specialty…all of the docs working are board certified…I know because I am one of them. Perhaps the current nurses aren’t used to new ways of doing things, but don’t insult your colleagues who trained with you and took the same exams as you as being “dangerous”. We are all one in the grand scheme of medicine!

    • Eyes on you says:

      USACS Doc,
      You sir or madam are not the same as SEA. You guys closed a residency down in Tulsa when Scott Fenten took over that program. And with ACGME comes in on Tuesday I suspect the program is in danger. That doesn’t matter to you guys though. And you’re likely an employed ER Doc. Being told what to do and where to go. So let’s talk about orders being put in incorrectly. At least you admit there are errors. The nice part of it is that all these errors are being documented. Patients info and how you are screwing up. That’s gotta suck have so many people looking over your shoulder. Ask Tom Malone about that with his coach. They should have had one with him in Detroit and maybe he wouldn’t have put his foot in his mouth up there. And some advice….big brother and big sister are watching you. So cut down on the fraud……

      • Elizabeth Combs says:

        Does anyone find it interesting that Mark Terpylak’s son is Chief of Staff at USACS?

        • Who’s his son? I don’t see that…

          • Elizabeth Combs says:

            To concerned. His son is Andrei and is chief of staff at USACS. So 2 senior management positions are affiliated with them. Kind of makes you want to scratch your chin and say hhmmmm. Wonder when that negotiation actually started….

  25. Concerned says:

    So, to recap:
    Mark Terpylak is a Summa Executive.
    Mark Terpylak’s son is the Chief of Staff at USACS.
    Vivian Von-Gruenigen is Summa’s CMO.
    Vivian Von-Gruenigen’s husband Bagnolli is the CEO of USACS
    The Law firm hired to ‘clear’ Summa of conflict of interest concerns is the same firm used to represent Escallate last year.
    Escallate was founded by Bagnoli.
    USACS Physicians were told Dec. 24 that they were going to be coming to Akron to take over.
    Multiple requests by SEA to speak with Bagnolli were declined.
    On Dec. 31, at 2300hrs, two USACS docs showed up in ER to take over the work of the five SEA docs, and 4+ residents who were there.
    SEA docs gave report to the USACS docs on all of the patients they were seeing.
    SEA docs stayed in the ER until 0045 to make sure their patients were being cared for. Then and only then, they left.
    At 0300, one of the two USACS docs left, (having to go to sleep so he could come back in and work dayshift) leaving an ER with 37 patients in the hands of one lone doctor, who has no computer access, no training on the electronic medical record system, and no training on local EMS protocols.
    All documentation had to be switched over to paper charting, since the physician could only give written orders on patients.

    Then USACS gives control of the Summa Health ACH ER to a doctor who has only been out of school for four years.
    Unbelievable…

    • Other facts says:

      SEA was given a contract 11/28, they didn’t respond till 12/16. The 2 parties were sooooo far apart. Summa offered a 3 year contract. SEA asked for a 15 year contract and threatened to walk. Can anyone one please tell me where in America, a physician can get a 15 year contract? Who gets a 15 year contract in any field?? When 2 parties are sooo far apart in negotiations, you have to have a plan b. Let’s say I’m selling a house, it’s listed for $1,500,000 I get an offer for $300,000 and the prospective buyer tells me I better take it or he will walk.Do I have the real estate agent pull the yard sign and stop looking for other buyers while the negotiating is going on, or do I continue to have my home listed? Same situation. So would SEA be willing to honor and take the same contract usacs signed? I doubt it. So there is noooo conflict of interest. It doesn’t matter who is related to who, when the contracts between the 2 companies are so far apart, summa got a better deal with usacs. Plain and simple. Let’s say I’m hiring someone for a new position in my company,one candidate who I want to keep and promote wants 100k, but my cousin who is equally qualified, is willing to do the same job, but will take 50k. Guess who gets the job. The one who is cheaper. It’s dollars and cents (sense too), not conflicts of interest

      • But why then did admin lie to everyone and tell them that they did not meet with or plan for USACS to come in on new years eve. Why has admin continued to lie to staff, and media about the situation?

        • Other facts says:

          I don’t think anyone lied. I think summa expected a contract with Sea and was shocked and surprised with the counter offer that was delayed and unreasonable and had to then start looking elsewhere. Contract was sent November 28, an unreasonable 15 year (no cut)counter offer was given back to summa on December 16. my understanding is the first time summa had any contact with USACS wasn’t until December 24. Once again, if anybody knows of a contract anywhere in the United States, please let me know where I can get a 15 year contract and be guaranteed a job, regardless of performance or metrics and can never be fired for that 15 years. Thanks.

          • Other facts says:

            Malone has resigned, whether by choice or force, who knows. All I know is expect the same results as the Browns, whenever you change leadership so frequently

  26. Labor Negotiator says:

    Anyone with any background in contract or labor negotiation can see what happened here from a thousand miles away. Any contract that expires over the holidays and doesn’t have a provision forcing a decision 3-6 months prior to expiration is incredibly slanted toward labor (SEA in this case) Whomever approved this contract at SUMMA, likely the prior administration, bears the blame for this oversight. This contract allowed and enabled this scene to unfold where the contracted party (SEA) could just sit back and let this get down to the wire, which is exactly where they would want it, because it gives them more LEVERAGE. I’ve seen no evidence that they were pushing hard prior late November to get this contract done, and why would they? They knew they wanted changes, (longer contract and more money) so the later the timeline got, the more to their advantage. They slow played getting the contract returned mid December asking for a 45 Million dollar deal, 3 Million per year over 15 years. BAM! Take that Summa, or we’re walking out on New Years Eve and you’re screwed! Not a bad strategy if you are in a position that you can’t be replaced, which is clearly what the leadership of SEA thought. The SEA leadership mistake was two fold. One, underestimating the ability to be replaced. Secondly, reportedly had compromise offers from Summa along the way and instead of taking a good deal, they believed they had the upper hand and the hospital would fold. Reminds me of the classic labor union technique where they stick to ridiculous demands in the face of the a company’s offer and promise to close the plant if it can’t be resolved. They stick to their guns, plant closes and the workers are screwed. Great job union bosses, you sure showed them. The rest of this is just sour grapes. Make a big stink, throw out conspiracy theories, etc. Seen it too many times to count. Hope SEA big wigs enjoy whatever pity they are receiving, because that’s about all they’re going to get out of their failed negotiation strategy.

    • Eyes on you says:

      That’s all fine and dandy except everyone knew USACS was getting this contract months earlier. Tons of chatter. That’s why SEA walked away in manner they did. No extension would have mattered. This deal was done in October. I have tons of photos of Terpylak and Bagnoli chumming around with Vivian. It’s ok you’re giving the deal to your boy…I would also. Just don’t lie and try and lay blame elsewhere. That’s the shitty part. The lying. And Malone wanting to destroy SEA In the process. What’s to become of ship jumpers like Custodio who stabbed his group in the back. Welp he may need put his resume out

  27. Elizabeth Combs says:

    Ding dong the witch is dead….. He’s resigned! Hallelujah! Now get SEA back!

  28. Fly on the wall says:

    If you were against Malone, it’s premature to celebrate his retirement. As long as the rest of his appointments and administrative team are in place, things will probably stay the same. The rest of the wood rot needs to be removed.

    Lydia Cook needs to go.

    Tammy Scarborough (wife of Scott, the guy who scammed the U of A out of 100s of thousands while he was dean there) needs to go.

    And Valerie Gibson (Malone’s right hand woman, who by all accounts is worse than he is) DEFINITELY needs to go.

    Cindy Kelly is on notice.

    Now is the time when medical staff has a real opportunity to make changes. The search for a new CEO will take about 60 days, and the sooner med staff unilaterally recommends someone, the better.

    I, for one, think Joe Zarconi would be a good man for the job. He is highly regarded, both among Summa and NEOMED faculty, I think he has a good understanding of the economic realities in which we live nowadays, he is one with true “skin in the game,” and he won’t ever leave residents hanging the way the current administration has.

  29. Concerned says:

    The ER is being turned into a battleground by the administration. USAC Physicians are ordering archaic treatment modalities which have not been researched in years, and when nursing staff stop and ask questions, they are being told to “stop being so picky”.
    I am sorry but nurses are trained to work with a questioning attitude at all times, to make sure that our patients remain safe.
    If you are going to refuse to allow the nurses to ask questions, then you might as well hire a bunch of people off the street to care for your patients, if you have any left by that point.

  30. http://www.ohio.com/news/summa-health-loses-accreditation-for-emergency-medicine-residency-program-1.746245

    ACGME came down hard. The EM residency lost its accreditation and will likely close July 1. The institution is on probation, which means no new programs or residency slots. Pretty much every other training program will be affected by this rolling calamity.

    This should be turned into a Harvard Business Review case study of how NOT to manage a hospital. The residents lost, the hospital lost, and the patients lost. Only winners here are the corporate interests and their lackeys. One can only hope that the proper heads start rolling ASAP.

  31. IM service says:

    Way to go Summa, SEA, USACS
    40 years of EM residency down the tubes.

    Malone, Gibson- you would allow a contract that manages over 180,000 patients a year to go to the last minute? Really? It should have been taken care of in July just because of this eventuality. It smacks of wanting to make the change to USACS all along. And you believed USACS that they could manage a residency? You saved $3 million by going with USACS. Now you lose the CMS funding that goes with those 30 residents, about $4.5 million. And USACS has to hire many PAs to replace the residents, another $2.5 million. And a healthy premium will be required to get PAs as well as physicians to work there. And this does not begin to account for costs associated with patients choosing to go elsewhere. Or fraudulent billing. And when is your Level 1 Trauma reaccreditation? March, 2017? You will lose that too.
    Cynthia Kelly, DIO- you are in way over your head. You threatened to fire residents? You can never do that. Anyone with ANY GME experience knows that. You are the equivalent of USACS to SEA since you took over for Joe Zarconi. And now you will watch residents from ALL programs transfer out. Great job. How will you add this to your CV?
    SEA- Did you really think that you had the residents interest at heart? 15 years, really? If you do, start allowing your docs to go back to work.
    USACS- did you really think you could take over this contract and continue the residency? How many articles have your core faculty published? And it’s the best you got? Let this be a lesson to any academic institution considering USACS. They have a great track record of losing an EM residency and jeopardizing all of the other programs. Also, are your attendings seeing every patient that’s admitted? My patients tell me no.
    Von Gruenigen- you eliminated the conflict of interest? Really? Were there any anonymous donations to the Foundation in 2016? For how much? The higher the money amount of a potential conflict the greater the need to make it clean. How much revenue to your husbands company was involved? Over $40 million annually? You got caught.
    Custodio- you turncoat. You turned your back on your friends. Also, the residency was lost on your watch as chair. Good going. You honestly thought the residency would continue? Guess what- you along with Gibson, von Gruenigen and the rest will soon be looking for jobs.
    What will happen next? Residents from Surgery, Internal Medicine, and Orthopedics will begin transferring to other residencies. As that happens faculty will start leaving. So Summa, how’s that population care model going? Final step will be a sale of Summa. It will take the buyer 10 years to begin to fix this.
    Way to go for all involved! Was Cleveland Clinic behind this? They are the only beneficiaries of this fiasco.

  32. For the Summa BOD says:

    For the Summa BOD-
    You are being sold a bill of worthless goods by Malone, Gibson, and Kelly. You will spend nearly $100,000 on the ACGME appeal. No matter what you are being told, the accreditation withdrawal for ER will hold. You simply cannot fix those things in 30 days. To appeal by trying to show how they are wrong will not fly. Do yourselves a favor and read the bios of the EM core faculty. Then go to any other EM residency and read their bios. See the difference? They have no publications. And once being chief resident means nothing. And your current PD? What has he done? What national presentations? Spending this money on a high priced consulting firm is wasting that money. The ACGME will not bend for this. As to institutional probation there is a simple way to reverse it. Fix the problems identified.
    You are on a one way course. SEA is being blamed. What is done is done. Start repairing. Get rid of the current administration. Residents in other programs will start leaving. Why would they want to take a chance on being in a program that loses accreditation like EM has.
    You will lose Summacare contracts over this. Summa’s sale value has gone down dramatically. It will continue to go down.
    You can right this ship. Get rid of the current administration that has alienated all of the physicians. Hire back SEA. If you don’t do this you will see more loss. Residencies that can’t fill. Lesser quality residents. Attending staff that leaves. Decreased volumes. Lost summacare contracts. And finally Medicare/Medicaid fraud. Does the BOD really believe every ED patient has been seen by an USACS attending? They haven’t. Patients get upset. They will contact the OIG. And jcaho.
    So, as a BOD stay as entrenched as you want. You maintain this path and a fire sale will occur. You have a fiduciary duty above and beyond the administration. You have a duty to Akron, and your patients. Fix this. Don’t believe your administration. See where Malone got you?

    • No dog in the fight says:

      It sounds as if the Board of Directors has totally ignored their fiduciary responsibility to the hospital system as well as to the Akron community. I would think that there would be definite grounds for a lawsuit from the city of Akron against every member if he Board of Directors for violating that responsibility. Their actions or lack there of and lack of due diligence and selecting a new group has led to the loss of much-needed medical education programs not only for the city of Akron but for the country as a whole. They’re obviously not enough emergency physicians available or the staffing issues that we hear about A about USACS Would not be ongoing. And knowing that the board and administration allowed substandard faculty to destroy a program which had been placing high-quality emergency physicians in the community for decades. They should be ashamed. How can that even be seen as something which enhances “population health”. If members of the board do not take their position seriously and think of it as more than something to put on their resume then they shouldn’t be members of the board. I am sure that whoever purchases Summa in the inevitable fire sale will make some drastic changes

      • No dog in the fight says:

        And on another note I am sure all of these things will be totally tanking the bond ratings for summa.… Translation skyrocketing interest rates which will cost them millions

  33. Still scratching my head says:

    Dr. Bagnoli stated he did not start talking to Summa until last week of December and got a call on 12/31/16 at 5 pm to take over. Unless Drs. Bagnoli and VonGruenigan can prove that they never discussed the ED coverage issue in their life as husband and wife, this is the non-profit equivalent of insider trading in the for profit business world.

  34. Still scratching my head says:

    An additional concern is possible misrepresentation of Dr. Felten’s background. I thought the ABJ misunderstood what they were told. However USACS also states “Most recently, Dr. Felten served as residency director for USACS. In this role, he worked with the residents and residency programs at all nine USACS graduate medical education facilities.” First of all only hospitals (or teaching health centers) not USACS can sponsor residencies. Second, you cannot be a program director for 9 different residencies. The way the quote is worded, it appears that it is a USACS administrative title not an ACGME one. I am going to let others decide whether this an intentional spin on the truth or not. At the minimum I would like clarification. The ACGME may have picked this up.

  35. Still scratching my head says:

    Sources:
    https://www.usacs.com/summa-residency-advisory

    Read the stringent requirements for an accredited EM program. The core faculty requirements are not being met.

    https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/110_emergency_medicine_2016.pdf

  36. Bemused onlooker says:

    It’s amateur hour at Summa.

    First, it’s clear that they didn’t prepare for the possibility of the ER program losing its accreditation. No contingency plan was in place, and now they’re scrambling around like chickens with their heads cut off. Official statements are being sent by administration petulantly blaming SEA for their own shortcomings. Money is being thrown out the window on mercenaries hoping it can cover up the systemic marginaliation of medical education. Not even Kellyanne Conway could polish this turd.

    The ACGME sent a message to the Board of Directors: heads need to roll. You don’t need a consultant for that. You just need to demote or fire everyone in the Malone administration: CEO, COO, CMO, VP of Med Ed. They are collectively demonstrating the Peter principle of having risen to the level of their own incompetence. Good lord, for the amount of money the hospital is throwing at locums or useless consultants, they could hire some real talent into the C-suite.

  37. AngryEDDoc says:

    Wake up everyone. This whole thing was planned from the beginning. Malone wanted to get rid of SEA and their demand for a 15-year contact was the ticket to do this. He drags his feet and avoids the whole situation and leaves SEA hanging. What type of a competent CEO would let such an important hospital contract go to the deadline without aggressive negotiation? (Obviously Malone–with another motive). Rather than express his intent from the beginning and have to go through a complicated process of getting proposals from multiple groups, Malone waits and declares a last minute emergency giving him the ability to go directly to his buddy Dominic’s group (USACS). This is the dream situation—SEA makes a tactical business mistake and now Summa and USACS can capitalize on it. I love how Dominic from USACS has tried to portray himself and USACS as the savior for the ED mess at Summa and emphasized how his wife, Vivian (CMO at Summa), played no role in the decision-making–blah, blah, blah. I would encourage everyone to go to EP Monthly and read this article (http://epmonthly.com/article/deal-breakers-summa-story/). Here is a direct quote from Dominic about his wife’s “lack” of involvement: “The only interaction I had with her around this contract was on the 24th, where she said: Tom’s going to call you. I hung up that phone call and started to say, “can you believe…” and then she goes, “I’m not talking to you about it.”
    Read between the lines on this—his wife (Summa CMO) and Malone (Summa CEO) laid the foundation for this deal and did it without an email chain (Wow–isn’t it amazing that the Summa independent analysis couldn’t find an email/paper trail and therefore concluded there was no foul play here! I guess no one has heard of conversation and the lack of a paper trail?!) and then his wife walked away from the deal. Yes, she won’t talk to him “about it” because she knows everything about “it”—I mean she knows nothing about “it” (the independent investigation proved that!).
    I am angry for the ED residents who are the ones getting screwed here. I am mad at SEA for what they did and mad at USACS for their role in making this whole thing happen. Look at the “faculty” that they brought in. Except for the simulation director who was part of the original SEA group, you won’t find any of the other faculty if you do a pubmed/medline search. Just because you are a practicing ED physician doesn’t mean that you can be a meaningful member of an EM residency program. If you go to any national EM meeting (i.e. ACEP Scientific Assembly), you won’t find the new USACS “faculty” (I have to put the term in parentheses since it is laughable to even call them that) attending educational sessions or participating in residency/educational meetings—-go to the USACS Circus tent in the exhibitor’s hall and you will find them there–socializing and trying to recruit residents into their cult.
    I applaud the ACGME for what they did, but only wish they could pull the residents out quickly since these guys are just wasting 6 months until the inevitable happens and the residency is terminated. Congratulations Summa on your lack of foresight to see or consider what was going to happen and your ability to throw the residents under the bus without batting an eye. Congratulations Summa on your decision to waste more time/money appealing the ACGME decision. Congratulations also to USACS on your acquisition of another site and the destruction you caused (USACS=The new Team Health—the business of emergency medicine without concern for the individual doc).

    • Amen. Anyone who believes that Bagnoli somehow got enough docs licensed and credentialed to staff 5 EDs in 7 hours is nuts. It doesn’t pass the sniff test. I think the more likely scenario is that this was planned including all of Summa’s delays in coming to negotiations. The “extension” was just to give more time for the transition, not a good-faith effort to actually negotiate.

      I’m proud of the 65 docs (well almost all the 65 docs) for sticking to their guns and for having saved up enough money that they could afford to stick to their guns.

      I’m also disappointed, but not surprised, by how weak the ACEP statement was.

      I’m also disappointed but not surprised, that Bagnoli didn’t do the ethical thing, which, when Malone came to him with this supposed “sudden need” to say “I can’t do that. It’s not ethical with my wife being the CMO. It’s not good patient care. And it will ruin my reputation.”

      Now we can all see what kind of a business he is running. It’s nice to have it out in the open for anyone that thought CMGs weren’t “that bad.” No we all know. They really are “that bad.” It’s not too late to roll them back, but we’ve got to quit going to work for them.

      • Edward Cornett, DO says:

        Ole, Dom will bring in his so called “Firefighters” to “save the day”. Yea, right!! That is how he sold it. Foul, foul… his wife should have never been involved in any part of any negotiation. Yes, it is the EMP way or the highway… Seen if with my own eyes.

  38. Predictions says:

    Predictions-
    1. Summa spends over $100,000 on ACGME appeal
    2. In March Summa learns accreditation withdrawal for EM stands
    3. ACS comes in March for Level 1 Trauma accreditation. Guess what? The 75 USACS docs don’t have 16 hours trauma CME
    4. OIG investigates claims of multiple patients seen by residents but not attendings.
    5. Several residents from specialties other that EM begin transfer
    6. The match does not go well for all Summa specialties
    7. Bond ratings go down
    8. Summa administration continues to blame SEA
    9. Several lawsuits occur
    10. In June Summa BOD finally gets a spine and cleans house.
    Goodbye Gibson, Custodio, ER et al

    • Grabbing my popcorn... says:

      10 might happen earlier. There’s been too much bad press for Summa recently — every story is either about a public lawsuit involving former partners (Western Reserve, city of Wadsworth) or about the fallout from the ER debacle. They’re losing ground to Akron General, and now UH might start muscling in on the territory as well (they’re already in Ravenna, and will probably be looking into taking over Wadsworth). If I’m on the BOD, I’m watching things closely, because the narrative is spiraling out of control, and all the money spent on rebranding seems wasted now.

      Admin got overconfident, and the ACGME decision caught them with their pants down. Their immediate reaction — blaming SEA for their own shortcomings — was ill advised and poorly executed. Hearing there’s scrambling behind the scenes now, and the appeal is an obvious (and expensive, if 100K is true) hail mary.

      Match day is late March, right around the end of Malone’s tenure at Summa. Should the appeal fail — and should programs have a bad match — then this will be the last straw for many. ACGME is sending a strong message here, and an administrative shakeup may be the only thing that appeases them — which would have to be done quickly so as to not affect next year’s match as well. A new DIO would have to be in place well before July 1. And Malone leaving gives the board cover to replace his entire administrative team (COO, CMO, etc. ) under the guise of “moving forward and mending fences.” Promoting from within seems out of the question at this point.

      Place your bets, ladies and gentlemen.

      • No dog in the fight says:

        It appears the Summa administration, Malone and the Board of Directors totally underestimated the value of the ED Seems like they felt “anyone”
        Can work in the ED and didn’t realize the general public , EMS and other physicians were sophisticated enough to realizes the impact of replacing seasoned Emergency Physicians with ties to the community and to an established residency with transient hired guns
        The trickle down effect is being felt. Would love to know the actual decline and census numbers in ICU , stroke , and trauma. Not to mention upcoming losses and expenses related to bad outcomes and poor care and defending Medicare issues
        I am sure the losses make the money SEA was asking for seem like a drop in the bucket
        Wasn’t there an old song with the line ” you don’t know what you’ve got til its gone”?
        Summa is finding that out the hard way

  39. The absolutely phenomenal EM residents who have been carrying Akron City ER since the night that USACS walked in, are all on the verge of walking out. Even if they do stay, come July they will all be leaving. When (not if) that happens, the entire hospital is going to pay the price.

    Patients are already bearing the brunt of the issues with the USACS Doctors, being left in the ER for hours. And we are not talking 6, 8, or even 10 hours. We are talking about patients who are being ”forgotten’ by the doctors. Patients in the ER for more than 24 hours!

    The staff who work at Summa are afraid to bring their own relatives to the ER! Tell me what is it going to take?

    I truly believe that Summa’s BOD has now realized the magnitude of the errors made here, and are desperately looking for a face-saving way out. They can’t or won’t admit they were wrong. They really need to swallow their pride and admit that bringing back SEA is the only way they will ever be able to save this ER and possibly even Summa in its entirety.

  40. SEA is out for good. I don’t see Summa canceling USACS contract, paying their penalties, and then affirming to the world that they made a bad decision. There was a reason SEA didn’t have their contract renewed and there is a reason SummaHealth won’t agree to SEA’s terms.

    As an outside observer, it has been interesting, sad, and appalling how this has played out. It truly is an ideal case to discuss in business classes for many things that were wrong with this situation. This will make many health system CEO’s make sure their ducks are in a row before changing groups.

  41. Robert McNamara, MD, MAAEM says:

    Sad day for this residency. From what I can see in the above comments it seems highly unlikely that they will get the decision reversed. The ACGME appeals process when I used to be on the RRC EM appeals panel would only allow consideration of the information in existence at the time of the on site survey. If that is still the rule (which I assume it is) then the lack of insitutional support and the credentials of the faculty cannot be “revised”. No new faculty additions or promises of support will be considered in the appeal. If not already done, it would be nice of the administration to show the current residents the written decision of the ACGME and the exact specifics of the appeals process so that they can make a reasonable judgement as to how hard they need to look for a new spot. Have them sign a confidentiality agreement to keep it from the public eye if need be but at least give them some useful information on the matter.
    This will go down as a painful lesson in the specialty of EM, my sincere sympathies to those affected. Hopefully, it will give pause in the future to other hospital administrators and wake up the academic side of the specialty to the fact that one cannot ignore the “business side” of EM anymore as it threatens the entire specialty.

    • Bill Fraser says:

      Dr. McNamara,

      I have incredible respect for the job you have done advocating for EM and EPs.
      I will preface this question with the admission that I am the residency director at a USACS site in Columbus Ohio. Two of their core faculty at Summa were on staff in Columbus. Both are excellent educators.
      The question is does it really make sense to close the program? It seems the only losers are the junior residents. I am hoping that ACGME is making a strong statement that this kind of thing cannot be tolerated and will ultimately decide against closing the program in favor of probation. Also it seems like they are punishing the EM residency rather than administration and the Med ed dept.

      • Stating the obvious says:

        I would like to state the obvious solution:

        1) Give the contract back to SEA.
        2) Kick out USACS.
        3) Tell ACGME everything is back to the way it was.

        This way:
        1) 60 ER docs get their jobs back
        2) USACS doesn’t have to pay large sums to attract talent to Akron. If USACS walks away, they may salvage some of their reputation. At this point, their name is MUD. Maybe worse than mud.
        3) residents get their jobs back (most importantly)
        4) Community gets its stability back. Patient care can stop suffering.
        5) ER nurses stop quitting because they don’t like to work in a high risk poorly staffed environment.

        Let’s just chalk this up to lesson learned. Time for SUMMA to swallow some pride.

        • Bill Fraser says:

          I am not advocating for USACS. my only concern is for the residents who are caught in the middle here.

          The points you make are clearly on target. My guess is that Summa is not going to give the contract back to SEA so the rest doesn’t seem likely.

          I don’t wish to start an argument here. I really feel bad for the residents. I am all in for any solution that does not adversely affect the residents.

      • Patient's Family says:

        Dr. Fraser,

        I am glad to have the opportunity to ask a USACS residency director this question. Last week, I was in the Akron City ED with my elderly aunt. She was ultimately diagnosed with CHF and a non STEMI and admitted to Telemetry. We were in the ED for 8 1/2 hours and the attending did not come in the room to see my aunt or speak with us. Is it standard practice for USACS attendings to not see the patients if they are being seen by residents?

        • Bill Fraser says:

          That should never happen. It is a company policy and billing requirement that the attending sees ALL patients that are seen by a resident. There are no exceptions.

          I should point out that I do not speak on behalf of USACS and I don’t have direct knowledge of the operation in Akron.

          • Elizabeth Combs says:

            There are nurse practitioners working in the ED under their own license and do not require an attending physician to see. And the ABJ reported that Barberton’s ED is staffed only with a nurse practitioner on the night shift and can access an attending via teleconference if need be. Something needs to be done. Staffed by physicians from at least 12 different states that are obviously only there for their $100K signing bonus. No one is worried about the EM residency program. This was a coveted, highly regarded program that took years to build and was destroyed In only a month. Summa BOD is sleeping through this. Summa Health System is becoming an embarrassment to the community. Very sad when you think December 31, 2016 it was a well respected institution.

          • Bill Fraser says:

            Elizabeth,

            Excellent point. Thank you. Attendings don’t see all patients seen by an APP. But we do see all that a resident sees.

            Bill

          • Patient's Family says:

            Dr. Fraser,

            Thank you for the response. I suspect that my aunt is one of many patients that have been seen by a resident without being seen by an attending.

            This is not good for the patients and doesn’t seem to be fair to the residents. If this is the way the residents are being “taught” by the new faculty, I would argue that the junior residents will not be “losing” when they move to a program where they will have a better learning experience and environment. No question though that no matter how this shakes out, the residents have taken much of the brunt of Summa leadership’s poor decision.

          • Bill Fraser says:

            I sincerely hope that your aunt is doing well. I have absolutely no dog in this fight. My primary concern is for quality patient care and for the well being of the resident physicians. I can tell you that the physicians USACS has placed at Summa that I know are as committed as I am to the above principles.

      • Eyes on you says:

        Bill,
        There are many reasons they are closing down the residency:
        1. Threats from Cindy Kelley and Valerie Gibson to the residents if they didn’t do as told.
        2. No faculty with any real academic credentials.
        3. New residency director who already ran program into ground in Tulsa. Who didn’t even stay for GME meeting because he had OKC-Cavs tickets In Oklahoma (but cries like Nick on the Bachelor)
        4. Young men getting admitted to floor and dying hours later because inadequate CP work up.
        5. Medicare fraud with attendings not even seeing patients.
        It goes on and on.

        • Bill Fraser says:

          Please let me be clear on three things. 1) I don’t speak for or with the knowledge of USACS. 2) I have absolutely no first hand knowledge of the operations at Summa. 3) as a program director with a reputation as resident advocate I am appalled at what has happened here and what these residents are enduring.
          If all is lost in terms of the residency then we owe it to the residents to make the transition as easy as possible. That is my only concern.

  42. Then Be Clear says:

    2 core faculty from the Doctors program in Columbus? When I looked at the Summa EM core faculty they did not exactly light things up with pubmed articles or presentations. They may be excellent educators but the previous SEA rank and file, not core faculty were excellent educators and many had contributed to state and national venues. Your core faculty were once chief residents? Any with MEd? Multiple SEA attendings including noncore faculty did. Your core faculty could not hold a candle to SEA noncore faculty! Your core faculty caused a great residency to lose its accreditation. You have no dog in the fight? Do you really believe that? Your corporation interfered with a contract negotiation. I understand it is a business. Ever wonder why there are no large anesthesia, pathology, cardiology contract groups? As a specialty each has chosen to not prey on others. That puts them at the whim of administrators. Summa will negotiate in good faith with the anesthesiologists because there is not an anesthesia equivalent of USACS. YOUR corporation is the problem. Why was YOUR corporation able to partner with a hedge fund? Because the hedge fund sees potential value coming from the patient care receipts. Those patient care receipts should be returned to the physicians caring for them. Yes, I realize there are economies of scale with larger groups, regardless of industry. But the benefits of the economies of scale should go to the physicians, not directly or indirectly to shareholders or venture partners.
    Don’t get too comfy at Summa. ACGME nixes the EM residency. It will not get reversed. Well done USACS. Poor 2017 Match. Investigations into billing for patients not seen. OHD investigations because of reported poor care. Summa will replace the administration and repair relationships. You won’t be a part of it. Your corporation lost so much legitimacy taking over the contract. Bagnoli is portraying it as coming in on a white horse and saving the day. Ha. Good luck recruiting nationally after this. USACS should pony up at least as much as EMRA to assist residents find new residencies. After all, USACS lost the residency.

    • Bill Fraser says:

      Hello,
      Yes. I really have no dog in the fight. I have identified myself. You have not.
      I would be happy to continue this thread in a non public forum. W.fraser@icloud.com
      BTW only one of the two was core faculty.

      • Elizabeth Combs says:

        I am a big advocate of nurse practitioners. They are very well educated and play a major role in the practice of medicine. In many instances I would prefer them over the IM of FP attendings in an outpatient setting. However, in an ED setting, there are frequently times the care needed would fall out of their scope of practice. I would hate to be one of those patients at Barberton at 2am that needed more care than an NP could deliver. SEA always had attending physicians at all Summa ED’s. Guess USACS is going for the cheapest way possible and let patient care fall where it may.

        • Bill Fraser says:

          Elizabeth,

          I appreciate your concerns. I am not in any way advocating for USACS. I had no part at all in this abrupt transition. Continue to do your best for your patients. The rewards for a good outcome are beyond compare. Thank you for what you do. It matters.

        • fact checker says:

          This is wrong There are Board Certified ED physicians at Barberton 24/7

          • Bill Fraser says:

            Again. I don’t have knowledge of operations at these sites. I am not here to defend USACS. I got on this post to advocate for residents.

        • Curious Mind says:

          SEA had numerous physicians assistants as well. With no disrespect to the NPs, have a wider range of education.

  43. Robert McNamara, MD, MAAEM says:

    To Bill Fraser,
    I am not part of the ACGME or RRC EM so I really have no inside information on this matter. Certainly I agree completely with your dismay for the residents as innocent bystanders in this matter. In the past I was a site surveyor and on the RRC appeals panel and my comment was based on those experiences. If a program’s accreditation was withdrawn or probation levied we were told that new information could not be considered on appeal. It was tough to watch a program present great new things and then tell them sorry your only option is to reapply as a new program, termination upheld. So unless there was something missed or misinterpreted the appeal will be difficult. That is why I asked that the residents get to see the letter.

    I can only speculate but the ACGME had to view the wholesale replacement of faculty, the squabble over faculty salary support and the purported threats to various parties as showing lack of institituional support/concern for the program. This less than one week turnover is unprecedented to my knowledge in EM programs. Administration is being punished here, this is a major embarrassment to them but again the residents are the ones who are paying the higher price.

    I cannot comment on what “Then Be Clear” says about faculty but I do, of course, strongly agree with the points about corporations, hedge funds and the despoiling of our specialty rooted in greed. The existence of USACS/other CMGs did not occur in a vacuum, my generation decided to look the other way when EM “leaders” began to make a lot of money off other doctors and then when they sold this profit making scheme to lay entities (or partnered with them) all ethical boundaries evaporated. Many states have laws preventing lay corporations from owning physician practices. Ohio unfortunately rescinded its regulations a short while ago. The death of this residency has many roots, I hope in the future we can cut a few of those and learn to respect the value of true physician ownership and to restore some of the professionalism regarding not interfering with the professional life of a colleague for money reasons.

  44. Edward Cornett, DO says:

    EMP/USACS…. BAD-BAD choice. How is it that CEO of EM/USACS and his wife who headed the Summa negotiations was even allowed. FOUL…. EMP has a sordid past. They will recruit and pay high, then bring newbies to staff the ED. I have seen that first hand. EMP on one contract let go almost 75 years of EM experience go to bring newbies for peanuts per hour.

  45. Report any bad outcomes to Ohio Department of Health.
    https://www.odh.ohio.gov/odhprograms/dspc/complnt/complnt1.aspx

  46. Brother-in-law is attorney says:

    Legal Referral
    http://www.mann-law.net/Defense-For-Physicians.shtml
    The residents have damages. PGY1 and 2 residents have to transfer to another program. The educational program is decimated. 5 hours of conference every week? By USACS faculty? Research projects ground to a halt (how many postgrad day presentations from ER this year?). Are the third years really prepared for the Boards? Will Summa hinder transfers? Protect yourselves.

  47. Nominate Kelly says:

    I nominate Cynthia Kelly, DO, for the ACGME Parker J Palmer Courage to Lead award.
    Given to DIOs who have demonstrated excellence in overseeing residency programs at their sponsoring institutions.

    She should get this just as her predecessor Joseph Zarconi, MD did.

    Probably won’t get it though. A few things to hold it up:
    1. Institution placed on probation
    2. EM program’s accreditation withdrawn
    3. Creation of a hostile workplace for residents
    4. Allowance of a totally inadequate PD and core faculty to be put in place.

  48. Summa is now attempting to snuff out staffs ability to remain informed by blocking Ohio.com, the Akron Beacon Journals Online website. Staff who have always been able to use on-site computers to review the news during their work breaks are now blocked from seeing this one website.

    It is interesting that they can still access other news sites, like CNN, and Newsnet5.com. So why is this one site being blocked? Because it is reporting the truth about what is going on in the ER at Summa Health System., and the Powers That Be at Summa do not want people to know the Truth. Since when are company’s allowed to censor what people read?

    Complaints about USACS physicians have been continuously covered up by the current administration. The few complaints presented to management are being turned around to try and blame the nurses, the other department’s, anyone but the physician who is ultimately responsible for these patients.

    In the past, SEA doctors who were at the end of their shifts would stay until their patient’s care was complete and they had been admitted or discharged. It was uncommon for a SEA physician to turn over a patient to the oncoming physicians. Usacs Docs are out the door the moment their shift is over, leaving numerous patients waiting, sometimes for hours, before being dispositioned (dispo’d). Several times, these patients have sat waiting so long that the doc who originally saw them the day before has gone home, slept, eaten, and returned for their next shift, only to have their patient returned to them.

    USACS docs are ‘forgetting’ to put in consult orders, then getting angry because the patients are mad at them. They try and blame it on the nurses (who are protecting and caring for 5-6 other patients) for ‘not noticing’ the issue and calling it to the attention of the covering doc, but it is their responsibility to make sure their patient is correctly dispo’d.

    Summa is seeing only a fraction of the patients today as opposed to what they saw just a few months ago, yet at any given time they have 15-40 patients sitting in the waiting room waiting to be seen. For an ER who easily saw 300+ patients a day this past summer to go to seeing 180 patients a day, there should be a wait time of ‘0’. It is ridiculous.

  49. EM doctor 11 says:

    I graduated from Akron General EM program. Although not formally familiar with Summa (Akron City EM Residency) at the time, I did have the opportunity to work along side their residents as we would share rotations at Akron Children’s. I found them to be very well trained and good people. It is sad to see their legacy tarnished by recent events.

    In terms of where fault lies with this recent debacle at Summa, I don’t know details, but would probably tend to agree with SEA. I have seen the transition with hospital administrations over the years. The attitude frequently found is one of greed and with little care towards patients or those that treat them (RN’s, MDs, etc…). Greater attention has been placed on meeting ridiculous metrics and rationing resources than on supporting the medical staff to help with patient care.

    In terms of USACS, I do not know them personally. I have heard some negative information, but cannot verify first hand. I do know that they replaced my group at the Mercy contracts in Cincinnati last year (offering us a terrible pay package which only 1 of the 71 doctors took) and are understaffing them terribly (this was a decision apparently made by John Starcher, CEO). Although wait times have gone up at these prospective facilities, I hear that Starcher got a promotion (in hospital administration, obviously no poor decision goes unrewarded)!

    Hospital administration needs to understand that without physicians, their hospitals do not exist. CMGs also need to understand that they cannot expect insulted members of a previous group (in this case SEA) to help them when they take over their contract. I wish the remaining residents at Summa luck in relocating. Again, it was a great program. It is sad to see greedy hospital administrators bastardizing patients, physicians, and now training programs.