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.  


Jeff Nielson

Newspaper Sources:

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.


  1. 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:


            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??

  2. Emergency Medicine Resident’s Association has released a statement, signed by their Board:

  3. 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.


  4. 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.

  5. 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.

  6. Medic with a monitor says:
  7. 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.

  8. 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!

  9. 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.

  10. 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… 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…….

  11. 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.

  12. 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!

  13. 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.

  14. The Society for Academic Emergency Medicine has released a statement:

  15. 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.

  16. 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??

  17. 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.

  18. 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.

  19. 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!!

  20. 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.

  21. 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.

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