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. Shameless advertising: Many of these comments have been shared on our facebook page, Medic With A Monitor. It’s managed by current and former ER employees, mostly medics and nurses. Since the start of this mess, the page has shared the inside truth about what’s REALLY happening to the staff and patients in Summa’s ERs. I invite Grunt Doc and his/her fans to take a look!

  2. Every day there is a new problem, a new safety issue, and every day it is swept under the rug. I feel less and less confident that Summa will be able to pull out of this situation intact. Such a shame to lose such a venerable institution over the greedy misdeeds of a few people.

    • Fact checker says:

      Correction. Everyday the same story gets retold, most of these stories are. “fake news”

      Facts

      1 All docs board certified in EM
      2 All patients seen by attendings
      3 Volume and EMS traffic unchanged
      4 Lwots and wait times unchanged

      • Elizabeth Combs says:

        Nice post Fact Checker. I’ll give you point number one. But speaking of “fake news”, points 2-4 are exactly that. And the most recent ABJ article uploaded tonight, isn’t the same story told. It’s more horrifying than the others if that’s possible.

      • Eyes on you says:

        Fact Checker you are delusional. Or are you Bagnoli. With FBI running around along with all the other agencies this could come crashing down. Bagnoli and his boy Terpylak spending money on private jets for little Terpylak. You guys got greedy. And don’t think bringing in your third partner Deveny will save your ass

      • Hey Fact Checker,
        I am wondering where you get your facts. Are you in the ER every day watching what goes down? No, I didn’t think so.
        Are you the one looking into the eyes of the family of a patient who was diagnosed with an acute surgical issue that required emergency surgery, who sat in the ER for 9 hours waiting for a surg eval that was never ordered?
        No, I don’t think you have any idea what is really going on in the ER’s of Summa Health.

  3. Tick tock
    1. ACGME investigation- done
    2. ACS Trauma Level reaccreditation- pending
    3. ODH investigation of care issues- pending
    4. Medicare billing fraud investigation- pending
    5. Medicaid billing fraud investigation- pending
    6. JCAHO investigation- underway

    And Summa BOD is going to hang on to this direction? At what point does the BOD own up to mistakes by its administration’s actions? When all employers avoid Summacare? When the bond ratings go down? The lawsuits will start. Any patient with an adverse outcome at Summa that starts with an ER visit will be looked upon kindly by jurors. And lawsuits will force the ACGME and all subsequent investigations into the public realm.
    Hey Summa- how’s saving that $3 million stipend going?

  4. Concerned citizen says:

    Hey BOD,
    Do you not realize the hospital is on fire? You need to fire everyone associated with this corrupt administration. Our community deserves better.

  5. Great Investment! says:

    Hey- Catholic Health Partners (Healthspan)
    How’s that $250 million dollar investment working out for you? Did you ever imagine this nightmare occurring? At what point can you step in? Or can you? Did you? All that money you paid will be paid out in fines, settlements, and increased labor costs.
    You should have waited. You could have paid a lot less!

  6. Doug Trochelman says:

    You do realize the board is the most corrupt part of Summa

    • Unfortunately, you are correct. Malone was horrible, but he was just the BOD’s pawn who was sacrificed in an attempt to save face.

    • Elizabeth Combs says:

      If not that, the dumbest. Willing to throw away the reputation of a previously well respected institution in Summit County all for ego and underhanded dealings with pillow partners. Not to mention those (anonymous) donations. Was it worth it?

    • R. Douglas Trochelman says:

      This is the REAL Doug Trochelman. I didn’t make that or any other comment on this blog.If someone feels that way about the board, at least have the guts to use your own name you spineless wonder!!

      • Distraught parent says:

        I wish I could leave my real name but I am afraid that my child would suffer the wrath from the hospital and USA CS. If you are truly on the board then maybe you should grow a spine and do what is right for these residents and get them Into an accredited residency program

  7. Distraught parent says:

    Unlike Dr. Frasier from above post, I do have a dog in the fight. My child is currently an EM resident in the program. My husband and I made incredible sacrifices making sure that our children got the best education. We help pay for a significant part of their education and I can say that medical school is not cheap. We were ecstatic when they got into Summa’s em residency. Now this?! This is going to significantly affect their career in a negative way. I am glad to see in the Akron Beacon Journal article that Dr. Bagnoli isn’t going to lose any money and will be able to staff The ED with or without residents. Why care about the residents? I don’t see that there’s anyway that the program will be reinstated. It was also very alarming that the USACS docs commented in the Akron Beacon Journal article that they will be out of there in one month. We have already been told by our child that there is little to no teaching currently going on for the residents. It is a complete waste of time. Once it is confirmed that the residency is going to be canceled then the hospital and USACS will be doing absolutely nothing with the residency and these poor residents will be continuing to waste their time in limbo waiting to be put into a residency in July. I am sure that the hospital and USACS will want to keep them and use them as cheap labor until July. Will greedy Dr. Bagnoli do the right thing and put these residents in a teaching program ASAP? Based on what we have heard about him, that answer is no since for him it is only about the money and has nothing to do with the careers of these young doctors. We are talking about 1/6 of the residency!! This is devastating. I hope that the governmental agencies investigating this disaster come down hard on all the parties involved. Dr McNamara, is there anything we can do? The hospital and the group are providing no guidance and are acting like it will all be fine.

    • Robert M. McNamara, MD, MAAEM says:

      Distraught Parent,
      Your post is the most disturbing of all and I am truly sorry you and your child/family are experiencing this. EM physicians are resilient if anything and your child will eventually come through this and find success and will have learned a valuable lesson about the business of medicine. Based on what the reporter read to me about the ACGME report supported by the quotes in the recent ABJ article I really don’t think a USACS based appeal has any chance. If SEA does come back that may change things but that is speculative on my part. I hope the residents have seen the full report, they deserve to as it is their future on the line. They can then see for themselves what the prospects are for appeal reversal keeping in mind that the ACGME, to my understanding, will not consider new information in the appeal. It would be prudent to start looking for a spot, many programs have expressed willingness to help the Summa residents. Fortunately, the standards for EM programs are high and a great education can be had elsewhere. As noted below, legal action is certainly possible but you have to weigh the costs of that in terms of your child needing to get on with their education. Some at the higher levels who had a hand in this are already paying a price in terms of job loss or loss of reputation and more is sure to come, take solace in that. I have a son finishing his EM residency this year, I am concerned about these aspects of our specialty but also realize that none other allows one to serve our fellow man as nobly as EM. Remain proud of your child and their choice.

  8. Dear Distraught Parent,
    My heart goes out to you. I have watched the residents struggling to get through these past few weeks. I just want you to know that your child is highly thought of by the ER staff. I have seen nurses and paramedics going to them for advice, or with questions because they trust your child more than the ‘so called’ attending physicians who are supposed to be teaching them.
    I see nurses and medics leaving for other jobs because they are either being forced out (threatened) by the current administration, or they simply refuse to be party to the subpar care being provided by the current group.
    While we hope and pray that the BOD and/or CHP come to their senses, we are not optimistic. Good Luck!

  9. For the parents: says:

    Distraught Parent-
    Your child and his or her fellow residents need an attorney to represent them. The entire country wants to help them. If they work hard they will be able to make up for this lost six months.
    An attorney can make sure that they leave with their funding. An attorney can represent their interests in a class action settlement.
    The residents are the victims in all of this. Fault is irrelevant. Summa promised them a quality ER education. They are not getting that. They have damages.
    Your kid will come out all right. He or she will have to work hard to make this time up but it can be done. ER is not just about trying to get the patient out of the ER. It is trying to take care of the patient.
    As for spineless wonder, how much did you make last year Dr. Trochelman? It is public record. You are a good physician. You have chosen a losing side that put self-interest above medical education. If you think that the courts will not make a connection between an anonymous donation, the CMO, and the beginning of negotiations in November with a contract that ultimately went to the CMO’s spouse, you are wrong. At the very least you are backing an administration that is inept, and had no sense of responsibility to medical education or the community. What do you think Dr. Tan your residency director would have done? He would have stood up for what is right. You know me Dr. Trochelman. I am one of many physicians you still work with. We have lost respect for you. We were working towards making something great for the entire community. We did our residency together. I am looking to leave my life long commitment to Summa.
    Why not put the administrative offices in Cincinnati? It would have been about as conducive to running medical affairs.
    Your BOD allowed an administration to negotiate in a way to save the system some dollars. Of course USACS would take on the contract. According to them it is because they were needed. Well, watch what is unfolding before your eyes. The entire community is distancing itself from Summa. The BOD will be forced to clean up this mess. And you were doing so poorly under Strauss and Zarconi? For kicks talk to people in Detroit who saw how inept Malone was. Clean up this mess. Get rid of everyone involved. Bring in SEA or another group who can bring the ER residency back. Do you really trust the current ER docs with your patients? Your patients don’t.
    Distraught parent- help your kid get an experienced legal firm to represent them. Summa will stiff them. Many are leaving Summa. Its patients, doctors, nurses, and residents in specialties other than ER.
    Population health. Funny. That was just this decade’s phrase to justify administration’s actions.
    The system’s financial health is dependent on the quality of people working at Summa, and that is dependent on how well Summa treats its people.
    So Dr. Trochelman, next week agree with your administration how everyone has this wrong. The rest of us are watching the demise of something we all used to be proud of.

    • Enough is enough says:

      To the conspiracy theorists who think there was a conflict of interest and this was a “hatched plan” to get rid of SEA, wake up and stop reading fake news. SEA’s contract was written 3 years ago set to expire 1/1/17. If SUMMA would have wanted to get rid of SEA they could have and would have planned 1 year in advance to hire USACS at their will and bring in faculty from around the country.

      Summa’s fault lies with negotiating late and not having a contingency plan when talks broke down, I repeat, they had no contingency plan. This was not a conspiracy or a conflict of interest. It was poor planning on Summa’s behalf, giving SEA the credit that they would negotiate in good faith and be looking for a contract similar to the one they currently had.

      Tough decisions have to be made in health care these days, but communication and transparency are key. I wonder if these would have been present, if the decision would have been more palatable.

      Summa has over 9,000 employees, should they negotiate with 45 docs who threaten to walk out? How would the ER nurses have felt if Summa gave in to the demands of SEA and then had to lay off 50% of the nurses because of the increased costs to Summa. It’s funny to me the nurses stand by SEA, but where was SEA to advocate for all the other ER nurses, secretaries, and staff that was laid off over the years. It’s only a news story when a doc loses their job, I guess.

      To the residents, take this as a learning lesson, maybe next time you won’t bite the hand that feeds you. You take care of level 1 trauma, see drug seekers, Stemis, strokes, brains, etc. But a 5’2″, 100 pound woman (btw who is really sweet,) named Cindy Kelly, intimidates you. She asked you to go back to work, and her texts, cell phone calls, and emails were not being responded to. But Shar’s were, eventhough he no longer worked for Summa. Did you send his emails to acgme? The grass is not always greener my friends. You guys rotate at shock trauma, I’m sure the rats in the call rooms and their attendings are much nicer and less hostile, so good luck, maybe some can match there. I truly do feel your were innocent carnage, but you could have manned up a little more. I guess this it what happens as a whole, when we make residency less like boot camp, and more like everyone gets an effort award. Can anyone imagine Sheldon Traeger saying “I’m working in a hostile environment.”

      We cannot start the precedent of docs walking out after their demands are not met, we have to think of 9,000 employees not 45. The hospital has to remain open and take care of patients. There will be no end to docs walking off, or threatening to do so. For example, what’s to stop all our employed surgeons, at the same time giving 90 days notice and walking off, unless the hospital sets a position that we will not negotiate under these conditions and you are free to leave. Once again, the problem was Summa started too late in negotiations. To all the employees spouting off and proud of their disruption and having fake news abj on speed dial, what do you want to happen. Do you want to be like the ER residents right now, looking for a job?? Are you proud that you think the bond ratings will drop, screw the expansion deal, and make it easier for a take over? If that’s the plan, great, I’m sure I will wear my new mercy or CCf logo well. I for one would like Summa to remain independent. To me it is really funny, that those in an effort to bring “Summa back like it was” are the ones truly destroying the organization, as there are more useful, productive ways of helping this organization rather than on blogs or abj.

      • Hey enough is enough you must be part of the current administration or on “the board”. It is well known what transpired. The “fix” was in for USAC’s because of Bagnoli’s wife. Wake up!!! You, enough is enough are part of the problem.

      • Eyes on you says:

        Slow clap to “enough is enough”. Your argument is BS. Everyone knew USACS was going to take over back In September. Malone didn’t have balls to make change with appropriate transition so he took the coward way out and slow played negotiations and made it appear as emergency transition. And don’t you ever bring Sheldon Traeger into this!! He would be appalled at what Summa did and how his cowardly partners have rolled over. You don’t know him. He was always for what was best for the patients and he would have seen through this. If you knew him you would have known that. On a side note Doug Trochelman is a good guy. Lay off him. The board needs to resign. This is far past allowing hubris to make decisions. Changes need to be made to save the health care system. Than includes removing Puppet Cindy Kelley, Turncoat Custodio, Gibson, Vongruenigen, the cowardly board, and of course USACS. This ER group is full of baby graduates who are missing STEMI’s, lettin appys rot. And committing fraud Left and right. It would be better for USACS to transition out to avoid many lawsuits when I point out all their mistakes to my patients and gladly testify against them In malpractice cases. And im not the only one. Bagnoli you and Terpylak are greedy greasy individuals. I can’t wait for you to get yours. You kinda look like Jimmy Dimora. Would be great if you went where he is.

      • Easier to let the truth speak says:

        Dear Enough is Enough – you have some information, but even the words that YOU are saying are not all factual and true. Yours too is a theory that you have without the facts which are known to some. So I’m not going to sit and argue with you here, I’ll let the truth be the truth and you are entitled to your own opinions.

        The one thing I would ask though is do you REALLY think that the ACGME came in and shut the program down because of the residents being “whiny”? You seemed to be pointing a finger there at the people that got the raw end of this deal! If so, you give little respect to the job the ACGME does and seem to be looking past a whole lot of other things and pointing at the residents. Also for the record, the words in the ACGME report are just that… the words in the ACGME report. If you have an issue with those words, I believe your frustration is with the auditors, not the residents.

        I wish you a great day.

      • Distraught parent says:

        Enough is enough – you clearly are on the Board of Directors or work for USACS based on your negative attitude toward residents. If you were ever a resident, then you would know that you were not in a dominant position. These residents feel so unsettled because their future is no longer clear. Let’s not forget how hard these residents have worked prior to getting to this point. Your dismissive attitude is identical to the attitude my child reports is given to them by the new attendings. They are only there in name and not in the true role of an educator. They make it clear that they feel put out having to be there and don’t want to help the residents with even complicated patients which is very dangerous. They couldn’t give a crap about these residents and they make that very clear to them every day. I am sure the the venture-capital company that controls USACS is calling the shots here and only looking at the bottom line – which is the $. The residents are just cheap labor to accomplish this.
        Enough is enough – you will be eating your words as the facts continue to surface. Look at the ACGME document, it reeks of fraud at multiple levels. What they concluded is exactly what the hospital and the new group has denied from the beginning and they would not have put this in there unless it was true. Just wait till we read the Ohio department of health and the joint commission documents. The depth of corruption will be overwhelming.

        • Enough is enough says:

          Actually I’m not working with usacs or the board. I’m Neomed trained, summa residency trained, probably just a few years older than your son or daughter, and I believe zarconi to be my mentor, and was almost in tears a few years ago when zarconi ran into my father and me, and he told my dad, how much he loved me. What pride I took in hearing that! My point is this, why wish for the FBI, dea, atf, odh, acgme, bpa, gmo, pms, or any other abbreviation to weigh in. You seem so excited for the ODh to investigate, great, let’s just shut down summa. Is that what you want? Keep complaining, and they’ll be no appeals process, I’m fine with that. I am well sought after.I don’t have to move. I’ll find another job in the area. Will your child? Who’s team are you on anyway? Where is the criticism for his/her CEO of his/her residency, just using those words make me sick? Excellent, let OdH investigate and shut down the entire hospital, i’m fine with that. So then you can bring SEA back to A hospital that no longer exists. I’m board-certified in hot demand, no skin off my back, I can always find another job. I work for a organization for 25% less of what my fair market value is worth, and I do it because it’s the right thing to do. I could take my talents to South Beach but I don’t. I like who I work with. I like who I work for. And most importantly I like who I serve, my community and our patients. That’s worth more to me than money. Too bad your child’s bosses don’t feel the same way. I take care of my community and my patients, Whether They have the ability to pay or not. I don’t look for stipends because patients can’t pay. I serve multi millionaires in this community and I serve the homeless, and they get equal treatment and equal respect. There’s no point arguing with you anymore. I learned long ago not to try to reason with unreasonable people. However, I can have my mom or dad talk to you on social media, as I realize that this is how we deal with situations in 2017. Pathetic.

          It is really funny that Jeff Wright has sent numerous emails to his senior partners, talking about how not to discuss anything in public, yet the people that are related to these employees/residents continue to weigh in. Excellent. Also interesting that Jeff says that none of his employees want to you work for USACS, yet i’m not sure he’s going to release his pawns from their contract and that is why USACS is willing to pay for any legal expenses when Jeff tries to sue any employee that leave his company.

          Truthfully, I would like to see S EAback. but, I don’t see any reason why there should be any adjustment to the previous contract. No more money. No less money. No more time. No less time. Instead of going to the Akron Beacon Journal, they should make a phone call to the board, to summa, and essentially say that they’re willing to except the terms of usacs current contract or their previous contract. They don’t deserve any more money,more time,Less money or less time.they should be happy with the status quo. What I would like to see happen, is essentially give them USAcs’ current contract, With the current stipends in place, but instead of three years, expand to five years so sea feals more comfortable with a longer contract, and basically tell Jeff deal or no deal. And then we can truly see where his and his groups’ character lies. If they care more about money or their community. So you accuse me of being on the board, which I’m not, but if I was on the board, this is what I would do !!!!

          • Elizabeth Combs says:

            And where the hell did you go to school? Your grammar and punctuation are pathetic. You want them to “except” the terms. Did you mean “accept”? You dumb bastard.

          • Enough is enough says:

            I’m not even sure why I bother to dignify your statement with a response, but due to your poor reading comprehension I went to NEOMED, and in my post offer evidence of why I could not possibly be a bastard. I would be happy to mail you a Webster’s dictionary if you are still struggling with this definition. I apologize for poor grammar and punctuation as I voice dictate. I promise my blog posts are much more coherent than the Dragon ED notes I received by SEA. While you continue to insult and degrade those working behind the scenes to help restore Summa, my colleagues and I will be meeting with the board next week. So keep up the good, hard work of mouthing off. You make those of us not even directly affected, not really care anymore about the situation. However, I don’t answer to you. I answer to my community and patients and will always advocate for them. Sorry I’m tired and ended my last sentence in an object of a preposition. But frankly my dear, I don’t give a damn!

          • Oh, Dany…

          • afraid to speak out? says:

            Enough is enough please provide your real name so your community and patients can be supportive of you. We want a doctor that believes in their ideas.

          • Pot calling the kettle black? says:

            And your name is? Maybe they don’t want to have to hire an attorney to file cease and desist orders as many physicians had to due to others sending threatening e-mails. I would bet money SEA will likely come back, but I think others have missed the point of what was trying to be said. Due to everyone’s disparaging comments over the last several weeks, when SEA does come back, it won’t matter. Everyone’s mouth has done enough damage, and SEA will be seeing 10 patients a day, but I’m sure with improved wait times. If you think 100% of those patients who have left the summa system will come back, you are a fool. A 50% return would be generous. Congratulations everyone! A united approach, diplomacy, and refraining from defamation would have helped Summa and SEA. Expect future summa layoffs due to decreased volume in ed visits and admits!!!!

  10. R. Douglas Trochelman says:

    My objection was to the anonymous blogger using my name to try and make their point.

    • Elizabeth Combs says:

      Enough is enough, if you’re that sought after, don’t let the door hit you in the ass.

  11. The most real Mother F@#$&r you're ever gonna meet. says:

    “How would the ER nurses have felt if Summa gave in to the demands of SEA and then had to lay off 50% of the nurses because of the increased costs to Summa.”

    Probably the same as the other thousands of people that have been laid off the past 5 years while the administration doesn’t cut their salaries one cent. Probably the same after summa decides to build a bigger front door while freezing hiring. Probably the same as spending god knows how much on new colors, badges and other bullshit while there has been one cost of living raise in 5 years. Make no mistake, I’m not a full in #seastrong guy. But the above quote pissed. Me. Off. It’s obvious Summa cares about money above all else. Want proof? Look at the average employees benefits statement on their paystub. The employees have been supporting the abortion that is summacare for years. Want to fix the problem? We don’t need a new administration, we need administrators who will admit they make mistakes. Maybe they can quit trying to earn a rich lavish lifestyle off the backs of hard working and vastly under appreciated staff. We need to start working together, not bitching in the news or on the internet together. Summa AND SEA need to be a little less greedy, a little less petty and start walking the talk. I’ve maintained that this problem isn’t one sided from the beginning. The residents are stuck in this situation, and I do feel terrible for them. But, Summa AND SEA were less than honorable with the handling of the residents in this situation. Administration from both sides, fix this. NOW.

  12. Reflecting on a Debacle says:

    The biggest losers are always the weakest among us. The current 1st and 2nd year residents, and those preparing to enter this year’s match, will not have the Summa emergency medicine residency as a choice. Also, medical students may not come to get educated. Thus, this community will likely those many great physicians.

    If that isn’t shameful enough, a group of emergency physicians and advanced practice providers based in an Ohio city 20 miles south of Akron, many of whom were trained and live in this area, are being castigated for stepping in to the void created by Summa and SEA’s incompetence. Here’s a news flash: If they hadn’t agreed to staff the ED’s, there may have been NO doctors in the ED on New Years Eve. Further, let’s remember that the USACS emergency physicians and advanced practice providers have also devoted their lives to medicine. Do you really think that they’re despicable people who lurked in the shadows waiting to stab the residents and prior group in the back? Lastly, it’s astonishing that there are people on this blog that are gleefully looking for those providers, that have stepped in to a very difficult situation, to be investigated for fraud and abuse.

    Clearly, the situation is a screw up. Summa and SEA both abdicated their responsibility to their constituents. Dr. Wright allowed (and continues to allow) pride to determine the fates of all those for who he’s responsible, that is, SEA’s providers. Summa selected a leader who through arrogance thought he could force a contract on SEA. Why the SEA leadership didn’t take the contract extension that would have avoided this circumstance is beyond my understanding. The Akron City emergency medicine faculty are also culpable in this situation. If I had devoted my career to residency education, I would not let pride destroy the residency that I helped to build and sustain. Yet have they created a separate group to lease its services to Summa? If they have, I haven’t heard anyone mention it on this blog.

    The people to blame for this debacle are the Summa Board that selected the leadership team that failed our community and the SEA leadership that allowed its greed and arrogance to enable USACS to capitalize on the situation.

  13. USACS our hero says:

    Yes, thank god for USACS! Summa’s ERs might have gone without doctors! What if USACS, TeamHealth and others weren’t there? Maybe Malone would have been more serious about the negotiations? That’s why Summa is serious with the anesthesia group. There is no viable alternative. In that case both sides can negotiate in good faith.
    ER and hospitalists are the only specialties where large contract management groups exist. The only specialties where patient care receipts often go to investors rather than the physicians who generated the patient billing.
    When the venture capital firm bought a percentage of USACS they were buying the hope of continued expansion of USACS. Summa is just one piece that shows the venture cap firm that USACS continues to grow its volume. The only revenue is from patient billing care receipts. It’s a free market economy, but is this really how we want our healthcare to go?

  14. USACS is our Heros?! In what Universe? I never heard of a ‘hero’ that left an ER uncovered so they could drive to the nearest fast food joint to get a bite to eat?

    My God People!!! How long are you going to allow these leeches to suck the life blood from the venerable institution that was once Summa?

    Maybe they should change the name to USUCS….

  15. Retired Hospital Administrator says:

    As a retired hospital administrator from California, I am at a loss for what happened here. I know nothing about SEA, USACS, or Summa, but I know good and bad business AND THIS WAS BAD BUSINESS. According to the CEO, he had no issues with the original group citing their clinical and academic excellence and stated it was purely a business decision. I can’t tell you the number of times over the years that both medical and non-medical personnel came to me to renegotiate and tried to hit a home run. I can’t think of one time in over 25 years where I wasn’t able to come to an agreement (one of us walked away potentially unhappy but we were still able to reach an agreement) with the other party (unless I didn’t want to and was looking for an out). How could such an important negotiation be left to chance like it was? I understand a previous comment where someone mentioned that these doctors represented a small part of the entire organization (I believe it was 90 out of 4000—-Please don’t respond with hateful responses if I am wrong on the exact number) but remember that the ED is the gateway to the institution in most cases. Enough is enough stated that this decision was in the best interest of Summa to move in a new direction and that those who wanted to keep the old way were contributing to the death of the institution.
    I will be totally honest with you. I would NEVER have allowed this deal to go through since the CEO of the new group is married to Summa’s CMO and has some ties to another administrator and that administrator’s son. I would not need to waste the hospital’s time and money getting a law firm to rubberstamp the legitimacy of the deal. Even if this deal was completely above board from start to finish (and I doubt it was), there is no way that you could convince the public that it was. Heck, you can’t convince me that it was. By doing this you have destroyed the credibility of the institution. Unless Summa’s BOD believe that the Akron consumers all recently fell off of a turnip truck, I can’t see how they could have thought going through with this was a good idea.
    Right now it looks like the EM residency is going away and now you will have multiple other governmental agencies sniffing around—-and that is never good. From looking at the anger in the comments on this blog, it looks like the medical staff is being pulled apart. With the CEO on the outs, I am hoping/praying that there is someone aggressively keeping the peace and trying to bring the medical staff (actually–all employees) together or you can kiss this place goodbye. Even though I worked on the west coast, I have interacted with CCF administrators over the years and I have no doubt that they are getting ready to swoop in and take advantage of the situation since it looks like they are the competitor in town.
    I would really love to know how the meetings with the CEO and SEA went but guessing short of a lawsuit with the creation of public documents, that won’t happen. To me it seems doubtful that this group was looking to lose the contract and subsequently become unemployed and destroy 40 years of work so I have to believe that the fault lies with the CEO. The CEO controls these negotiations and I am betting he walked away. Looking at a comment by Dominic Bagnoli MD from USACS, he felt that if he could sit in a room with the original group with a negotiator that he could work things out. That is a smart idea and he sounds more like a businessman than a physician. Too bad the hospital CEO didn’t think about this because this whole situation could have been avoided.
    In the short term, the hospital needs to get rid of anyone with close ties to the new ED group or there will never be any trust in the institution and conspiracy theories will continue to circulate. The other option would be to get rid of USACS and have the hospital hire another group OR make all the ED physicians hospital employees. Having a BOD with such close ties to the CEO of the new group will never fly and I don’t see how anyone could think this is a good thing and will help the hospital move in a positive direction. Sounds like the only thing this will do is create a corrupt admin (if it isn’t already and then it will become more corrupt). Used to love watching the Dukes of Hazzard when I was younger and Boss Hog was funny (on the TV show) but if you turn this institution into the same situation with a Boss Hog (and not an unbiased CEO and BOD) there will be nothing funny about it. If I was still working and offered this position as CEO, I would run for the hills—definite career killer.

    • Elizabeth Combs says:

      Very well said, retired hospital administrator. To see how the negotiations took place, there’s an article in Emergency Physicians Monthly that gives play by sorrowful play. This deal was done long before SEA ever asked for anything.

      • Retired Hospital Administrator says:

        Elizabeth,
        I remember in graduate school being given case scenarios in ethics—-some of the cases were so out in left field that you just laughed at them, saying to yourself this could never happen, and move on to the next one. Here is how I would make a question for this situation:
        Question:
        You are the hospital CEO and you are looking to replace your current ED contract group with a local competitor due to a failed negotiation. You are aware that the prospective group’s CEO is married to the CMO of your hospital. Additionally, you are aware that the prospective group’s CEO is close friends with another administrator and has that administrator’s son on his payroll. Should you enter into negotiations with this prospective group?
        a. No way in hell
        b. Yes, if your goal is to destroy the hospital and go work for the competitor
        c. Yes, because the hospital’s CMO said it is all above board and she had no interactions with her husband
        d. Yes, after receiving a check written out for $50,000 to your middle name–“Cash”.
        e. Yes, after getting confirmation that all is good from a law firm that has ties to the prospective ED group.

        How any sane administrator could have allowed this and how any sane BOD could continue to support this is beyond me. I would love to have a forensic accountant go through the books of all administrators involved. There had to be some serious bribes being passed around. Run as far away as you can from this hospital before it implodes.

        • Elizabeth Combs says:

          Retired Hospital Administrator,

          I’d find your scenario very, very funny if it weren’t so true. Be glad you’re from California and you don’t have to live with the ramifications of this.

        • Dear Retired Hospital Administrator: Have you considered contacting our local newspaper with your comments?

          • Reflecting on a Debacle says:

            Dear retired hospital administrator,
            A question: In all your negotiations, did the other party ever refuse a 4 week extension to get the deal done?

  16. CCF Opportunity says:

    Cleveland Clinic- looks like you need to build a bigger Akron General! Seriously!
    You need more beds and a much bigger ER!

  17. Interesting says:

    Interesting post on Doximity which I will quote fully. From a Dr. Manish Jain:

    “Dr. Tom Malone and Valerie Gibson were a disaster for residency training at Detroit Medical Center. Dr. Malone almost single-handedly got the prestigious Ob/Gyn residency program placed on probation. The faculty physicians from Wayne State University were undercut by a quasi-private group that had the support of Dr. Malone. Only when he was let go was order restored and the program was able to go back to full accreditation. My advice to Summa is to cut and run from Valerie Gibson as well.”

    Betty Lin Fisher, if you’re reading this, you have a lead for your next story. I’m sure your colleagues from the Detroit Free Press would be happy to compare notes on Dr. Malone.

    Summa BOD, I hope you take medical education into account when choosing a new CEO. Your last pick has been a FAILURE: a 2-star Medicare rating, sanctions of Summacare and now this. Whatever was spent on consultants cleaning up after Malone should be invested into a leadership team that won’t run the hospital further into the ground.

    • Elizabeth Combs says:

      Funeral arrangements are being made for Summa Health. They will be announced Friday, February 24th when the BOD appoints T. Clifford Deveny as the new CEO. Obituary will include the business dealings between Dominic Bagnoli and T. Clifford Deveny. In lieu of flowers, please send donations to University Hospital or Cleveland Clinic Foundation. May Summa Health rest in peace.

  18. Enough Crying Medic says:

    By now I would have thought most of the shenanigans would have died down. However, I see many still concerned over USACS taking a job that was left open and doing what they could with little to no help from the auxiliary staff. USACS did not “take over” Summa’s ER. Contract negotiations failed. Someone has to step in and treat patients no matter how understaffed you are. They came in and got it done. Now for all those bleeding hearts crying for SEA, hear this. The SEA group as a majority was not the golden group everyone says they are. They had lazy, uncaring physicians as well. In many cases they treated the PA’s and NP’s poorly and never used them to their potential; sources say they simply used APP’s as scribes and never let them have any autonomy. Additionally, they grossly underpaid their APP’s when compared to other ED’s in the area. The also didn’t call them Advanced Practitioners either, they termed them Extenders. Now if you’ve made it this far I used the term Auxiliary as a blanket term for RNs, Medic’s, Etc; I bet you didn’t like that I called you Auxiliary Staff, did you? So now that some APP’s are working for USACS they are: 1. Paid up to and in some cases more than other competing EDs in the area 2. Treated better, given autonomy and the physicians actually get off their asses and see the patients unlike many from SEA. 3. USACS had nothing to do with the residency. That was all Summa’s fault. The ED can be run fine without residents. Trust me. Listen, we all complain about the Residents, it’s all a big joke, ‘oh the resident did it’. So now everyone is so worried about them being gone? Really? I would rather have an NP in those rooms who has years of experience versus a resident who has only read treating patients in a book.
    If you’re still here I have more. As for our “Robin Hood” Medic with a Monitor (but without a Job) I have some comments for you. How did this affect you? Did it affect you directly? Did Dr. Bagnoli personally come and give you a wedgie? No, you just have nothing else to do (especially now) except harass and intimidate a well-run ER group that has stepped in to treat patients. When do you let it go? When you lose your job? Oh wait…. too late for that. If I was your significant other I would be furious that your actions, not another’s, led to your resignation. For your benefit and piece of mind I have no affiliation with USACS or SUMMA. However, I do have information and what I do know is that USACS is run very well. They have done a good job at SUMMA and outlying EDs and are continuing to get better. They treat their employees great and they communicate with them, imagine that. SEA was so mismanaged and communication was almost an afterthought. SEA looked after the Docs and that’s it. They didn’t care about the so-called Extenders. USACS does care and it shows. So things are not always what they seem with all the propaganda flying around. Medic really loves to stir the pot doesn’t he? I admit the Medic does have a Good Hart…… : -).

    • "RobinHoodMedic" says:
    • Real ER Nurse Saving Lives says:

      Enough Crying Medic- Wow! You are a real asshole! You have no idea what the hell is going on inside Akron City’s ER. Yes we had our issues with SEA docs. But we knew who we could count on and knew that the pts were going to get good care. These docs now have very little idea how to care for pts. When you have docs that can’t run a code or read an ekg, you have big problems. We also see new docs everyday from this group. We are unable to develop a rapport with these docs I order to run like a well oiled machine. There is no way to develop trust. This group is very lazy and does not want to listen to any concerns regarding pts conditions. None of them practice with urgency within an emergency room. My God it call an emergency room for a reason. None of them are willing to come into rooms when asked by the nurse to do so. We had our problems with the SEAbdocs but they were willing to come into rooms and listen to what was being told to them regarding care for pts. So until you have step foot into our ER and have seen first had how is whole shit show is playing out and effecting out pts and our community, you need to keep your mouth shut. The nurses, medics, hopitalists, ICU, trauma, and ER residents are the ones keeping our pts alive.

  19. Dr. John Smith says:

    USACS loves their PAs and NPs! Because they offer the biggest profit margins on billing for the corporation! Let me tell you a little about how they work.

    USACS was created by Bagnoli when he partnered with Wall Street Investors and a few big groups (EPPH, MEP, TBEM, and others). Many members of these groups woke up one morning to find that their groups had effectively been sold to Bagnoli by their CEOs. The huge beneficiaries where those few individuals at the very top of their groups. They were paid big, big money for their stakes. Most working docs awoke to decreased pay and increased uncompensated work outside of clinical shifts. The way the company works is by decreasing physician pay, with million$ in profits going to the top few guys and the Wallstreet investors. Effectively the physicians become assembly-line, fast-food like employees to enrich the corporation. The less they are paid, the more the corporation profits big.

    They are sold on getting “ownership” with a tiny portion of “stock” that could be worth something someday. The overall plan is to package the entire operation up and sell it, in full, to Wallstreet in a few years after going fully public. This is what they tell you to convince you to sign up!

    This will generate multi-millions for the select few REAL owners, and perhaps a little return for those average workers with a tiny percentage of their “stock”. The real joke is that it won’t amount to much when compared to lost compensation over even a few years for the average USACS doc.

    New residency grads don’t even know what they are missing, and are the most easily duped. Over the years this will be considered the new “normal”, as EM Physicians go to work for these “McMedical” groups.

    Who can really blame the doctors for not working that hard, or punching out when the day is over, and not staying after for free. The harder they work, the more corporate profits roll-in, and the richer the top few guys get. The whole “ownership” thing is just a savvy marketing campaign, as are the flashy parties, logos, core-value sayings….

    The SEA guys realized this, most likely, and were smart not the help USACS destroy their livelihood. They should have negotiated better, but the deal with USACS and SUMMA was likely finalized with a wink and a handshake months before December 2016. They didn’t stand a chance. Most of us don’t anymore….

    • Sounds like Dr John Smith is a little worried about his profession. Maybe physicians in general are overpaid. Well not maybe, that’s a fact when NPs and PAs are just as qualified and can do your job for half the pay and just as well. This guy is getting salty about people finally realizing how overpaid and overstaffed the medical community is with physicians. Surgeons deserve high dollar pay. No one else can do that job. Physicians on the other hand, well, looks like NPs and PAs may be taking over. You should be worried or sad.

      • If NP’s are really as qualified as physicians, then how do you explain that their training is shorter and less intense, and that they MUST work under the supervision of a physician? When NP’s have to make the final difficult decisions and assume the liability, then we can talk.

        • Disgusted is a FOOL says:

          Since when do NPs and PAs have to work under your supervision? In Ohio NPs can prescribe meds without Dr orders or signature. NPs and PAs do make final decisions, assume liability hence why they are offered medical malpractice insurance at the facilities they work at. NPs training is shorter? Please explain how their years and years of experience in the ICU is so beneath all your years reading a book? In my experience it’s the ICU nurses teaching the Docs and residents how to manage their patients. Disgusted is grossly uninformed. Get your facts straight.

          • Elizabeth Combs says:

            Can we all have a moment of silence tomorrow when Summa BOD announces Deveny as new CEO. He’s in bed with Bagnoli, Terplyak, etc. Guess they didn’t learn anything. Just more of the same. Downfall of Summa.

          • Reflecting on a Debacle says:

            With the BOD choosing him, I expect that the change to USACS is final.

          • Elizabeth Combs says:

            So let me get this straight. Valerie Gibson still has her job, Cynthia Kelley still has her job, new interim (yeah, right) CEO has business dealings with Dominic Bagnoli that destroyed an Emergency Department with excellent medical staff to be replaced with sub par physicians. And they parade Cliff through the department today that has been decimated, no residency program when it was nationally known, patient care so dangerous a nurse actually risked her job to do an interview with channel 5 news in hopes something would change. Kudos to her for standing up for the patients. Level 1 trauma accreditation likely revoked. What more do they want to happen? The only resolution is to bring SEA back, swallow their prides and admit their errors. Census is down, bond ratings will suffer. The downward spiral continues.

          • Elizabeth Combs says:

            The news just reported that Summa is back “on par” with wait times. Average door to doc times are 15 minutes. Jerome, can you prove that?

          • "RobinHoodMedic" says:

            They meant to say 5 hours

  20. I hope that Mr. Deveny takes a step back from this and looks at the big picture, rather than the pap that theBOD and Summa administration has been feeding him.

    This Administration has been purposely skewing the numbers to make it look like there has not been any changes in the number of patients in ER. That is Bull. I am told that Ambulance crews are coming in complaining that they were going to AGMC, but they were so busy they had to go on ‘bypass’ telling them they had to go elsewhere.

    The ER Staff are worried. USACS does not have enough physicians to cover the shifts, in fact, Dr. D. Custodio is working shifts in the ER to help cover for missing doctors. I am told the news reporters at the press conference yesterday wanted to interview him, but he refused, citing his need to be working in the ER seeing patients. I mean come on, when was the last time you saw a VP and CMO in scrubs getting his hands dirty seeing patients?

    People are fleeing Summa like rats from the Titanic This alone should be a wake-up call for the BOD, but they have their heads buried in the sand so they cannot see what is going on.

    Just 18 months ago, Suma ACH was easily seeing 300 patients a day, and while occasionally people were waiting in the waiting room, it was never this bad. Today there are ten patients waiting by 10 am, and the numbers continue to climb throughout the day. It is not uncommon for there to be 20-30 patients waiting, and even in the middle of the night when the census is the lowest, they have people waiting in the waiting room.
    There is no reason for this other than the inexperience of the USACS doctors, and their inability to perform their duties in the manner in which the Summa Health Staff and patients have come to expect and deserve.

    Mark my words, this BOD will rue the day they chose to follow Valerie Gibson and Tom Malone down this slippery slope of ethics violations.

    • So how can board members be “fired”? I don’t know how many people are on the board, but they are not doing what is best for Summa. Does anyone have an answer?

  21. Promised Too Much says:

    USACS was counting on at least half of the SEA docs to cross over, even saying they would pay for the noncompete defense. Has not happened. Even for outrageous signon bonuses. USACS has been able to lure NPs to Summa because of outrageous per hour. Even from AGMC. Probably not long before AGMC ER docs begin to jump ship. Why not? $100,000 bonus and more per hour? A new ER? And USACS will pay for noncompete defense?
    Yes, this little escapade by Malone with his willing administration has cost Summa significantly and is beginning to cost other health systems their providers. And who will pay for the additional providers to replace the residents after they are gone?
    Perhaps one benefit of all this will be an improved respect for the work that ERs do. Docs, nurses, and staff. What do primary care doctors do when their patients call them with anything other than the most routine problems? You better go to the ER. There is a comfort level when an ER doc knows the pcp and tells him/her why the patient can go home or why they need admitted. Does not happen now. And once the residents leave there will be no familiarity.
    So good luck Deveny. Perhaps at lunch you and Bagnoli can talk about how this whole situation is unfair. You need to clean house.

    • Elizabeth Combs says:

      You are correct. The census is way down and that doesn’t take into account the number of patients that leave without being seen. That’s because they’re tired of waiting 3, 4, or 5 hours in the waiting room. USACS cannot keep up with even a decreased volume. What are they going to do July 1st when there are no more residents? The residents are doing the bulk of the work now. The situation is so unsafe there. The medical staff doesn’t trust these physicians. Nurses are fed up and are looking for work elsewhere. They don’t want to work in the unsafe conditions. When is the BOD going to wake up? I don’t think Deveny is going to be the answer to so many people’s prayers.

  22. Indeed, the ER staff has been steadily losing nurses and medics for the past two years, but this situation has ignited that spark into a full-fledged two-alarm fire. The majority of the nurses working night shift have been working in ER for a year or less. Many are new grads, who have no clue what they are doing.

    This summer/fall they expect to lose an additional 15 + nurses alone. While many are graduating and moving on to different jobs, others are just fed up with the unsafe conditions that they are being forced to work under.

    Now Admin has decided to cut the nursing staff in the ER (because of the low census). What kind of effect will this have? Instead of four nurses in a district, there will be three. That is three nurses for sixteen patients.

    Any or all of those patients could be critically ill ICU/CCU/Trauma patients requiring 1:1 care. When it is time for lunch breaks, there are only two nurses for those sixteen patients, unless the nurses have managed to take their lunch break early or forgo having a break at all. (Have you ever worked a 12-16 hour shift on your feet and running the entire time without a break?) And God help them if there is a Cardiac Arrest, Trauma Team, Stroke Team, or Stemi Team. Each of those teams pulls three additional nurses from the ER, leaving only one nurse with 16 patients! Let’s think about that for a minute. ONE NURSE…how in the hell do they believe that one nurse, sixteen patients, and a handful of new doctors who have no idea what they are doing, equals a good patient outcome for those patients presenting to Summa ER’s?

    • Elizabeth Combs says:

      Concerned – so scary if they are cutting staff. The nurses are catching so many life threatening orders and stopping them. Thin out the nurses and who knows what will happen. I’ve heard from so many people that they will not go back to any of the Summa ERs with what is going on. I agree. I certainly won’t and neither will my extended family. The doc to door times of 10-15 minutes are laughable. That may be correct after they’ve spent 3-4 hours in the waiting room. When a patient waits 4 hours for a single pain pill for a headache and a patient with difficulty breathing by an ACLS squad waits 3 hours for the first order to be put in, it’s a recipe for disaster. The board of directors is being fed false facts. LWOTs are 5-10-%. That’s after a very low census. Something has to give! these doctors can’t handle the patient load and don’t think they even want to. Get. Rid. Of. Them. Summa can come back stronger than ever if they wake up and correct the damage done.

  23. Just Facts says:

    Hiring Deveny means denial and digging in. There have been problems and poor support of that ER for years. The BOD has no incentive to change course. Perhaps trauma accreditation and the verified loss of the ER residency will shake them. Perhaps a poor match in ALL specialties will affect them. Perhaps transfers of residents in other specialties to other programs will wake them up. So far they have only dug in.
    Know any large companies giving up Summacare? Heh heh

  24. Dr. John Smith says:

    Ahhh… The “Door-to-Doc Time”. That’s an easy one to lower. Just put a Doc, PA, or NP in triage and have them see the patients as the triage nurse does. They click on the patient in the computer, and maybe enter some orders, or not. The “Door-to-Doc Time” is zero minutes for those patients. Do that all day and you start averaging a bunch of zero minutes into your mix. Then the average wait time numbers go down…. Way down. Every decent ER director knows that one. After that you can send them to the waiting room for 4 hours and their “Door-to-Doctor” time is “0” minutes.

    Here is another: Ambulance comes in. It’s a very simple patient. Just needs Amoxicillin for a sore throat. You see them on the stretcher, but it takes 5-10 minutes to get them registered and on the board. The second they appear on the tracker you hit “Discharge” with a script for the Amoxicillin and canned “Sore Throat” instructions. Length of stay = 0 minutes. Average some of those in, times in the computer go way down.

    I’m sure USACS knows these, and all the other, more important tricks to make the times in the computer change.
    (How do I know?… ;-)).

    You see, that’s what emergency medicine is all about these days. Faking out the CEO/Hospital’s dashboard tracker. There are others for Length of Stay, Door to Admit, Door to Discharge times, CT Ordering, etc, and you better know them all. Every “recorded” second and click counts.

    Now, you also have some canned psychological jargon and set up scripted interactions to manipulate the patients for their satisfaction surveys. And, you hit those chosen hospital metrics for the different conditions, or change your wording in the chart when necessary, and you’ve gotten the important parts of emergency medicine covered.
    (get those blood cultures cooking!)

    That’s how the game is played. Make it important, and we will focus on it. Happy clicking….

    PS, Sad Doc-I love my NPs and PAs BTW. They rock!

  25. Summa lies says:

    Akron General has been overwhelmed. Today alone the OR had to cancel 15 elective cases because they don’t have open beds. Summa is hurting the whole community and it’s only going to get worse. Who does the board of directors answer to? This is a travesty. Seamless??

    • Elizabeth Combs says:

      That’s not surprising. When there are more than 30 in the waiting room at last evening, where do you think they’re going to go? Everything is falling on deaf ears with the BOD. It’s already hurting the bottom line. So when they have to lay off nurses, hoping General is hiring. It was NEVER like that when SEA was there.

    • This is complete BS. Everyone knows AGMC is on diversion every other couple of days. Their ER is much smaller. Plus it’s the god damn busy season people! Of course the census is high! Everyone is sick! Oh no, the waiting room has 30… blah blah blah 27 of which have a cold and don’t need to be seen. Plus last night was Monday night. Historically the busiest day for any ED. How do you people not know this? Are you just ignoring these facts? Or are you complaining just to complain? Give me a break. All the nurses and staff on here complaining about wait times and USACS docs need to suck it up. Those are your patients. Do a better job. Come together. Help the new docs out instead of dividing the whole system.

      • Why do the new docs need help??They have now had almost 60 days to adjust.

        • Elizabeth Combs says:

          Yes, Mondays are the busiest day. But Summa’s census is way down and they still can’t keep up. The nurses are doing a great job catching errors by these docs and protecting their patients. After 2 months, nothing has changed since January 1st. Other than the revolving door of doctors working there.

          • I’m pretty sure I recall a large amount of physicians, who are currently out of work, are currently credentialed at Summa, could literally start tomorrow, and they all have a great rapport with Summa nursing, staff, and the community. Hmmmmm, now who could that be??? Maybe they should end this ridiculous ‘strike’ and get back to treating patients. All this would end if this new group just had a little help instead being painted the bad guy. If you all had such a good working environment with the previous docs then I invite You to call them and ask them to come help see patients. After all it’s the patient that truly loses in all this.

          • As I understand it, the “other” physicians are working elsewhere. They are not “striking”. They were unable to get a fair contract from Malone and “Mrs. Bagnoli”. The “new group” should not have promised something they couldn’t deliver.

          • Elizabeth Combsr says:

            Wouldn’t that be amazing. SEA comes back, ER is packed to the gills, patients are given the outstanding care they used to take for granted, nurses can go back to delivering the professional care they became accustomed to giving, residents go back to receiving superb education, medical staff can breathe a sigh of relief knowing who’s hands their patients are in. We can all dream. But instead of a dream, summit county is in the midst of a nightmare and residents are suffering. And you are exactly right, it’s the patients that are loosing. Such a sad thing and so easily rectified. Come on, board of directors. Census is down 10%, 10% are leaving without being seen. Do the math. You’re all about the $$$. Going to hurt you!

          • They have moved on says:

            The SEA docs have moved on to other EDs with a better work environment with contracts that provide them a sustainable business model. They won’t work for the balance-billing, understaffing, under educating, poor paramedicine supporting, profiteering up democratic group of transients that is USACS. Everyone needs to move on. There are better places to work and be treated than Summa at this point. Cliff will get it turned around but it will take a long time.

          • I just read “The Rape of Emergency Medicine”. I understand why SEA did not want to work with or for USACS.

          • It's Time to Move On says:

            It’s been 2 months. SEA isn’t coming back. It’s time to move on.

  26. Dear Disgusted says:

    Yes, the Rape of EM explains a lot. The large contract companies tout the efficiencies in scale such as billing, malpractice insurance, etc as a good justification for the contract management groups that have many ED contracts. EM is the only specialty that has this because historically many specialties such as FM, IM worked in the ER. Hospitals hated trying to generate the ER schedule. So ER entrepreneurs were born who told hospitals they will take the schedule burden away for so many $ per hour, then turned around and paid less money to the often poorly trained ER providers. They made money 24/7/365. A great gig. Even better if you were able to take on many hospital ERs. Pretty soon they became traded companies. Shareholders made money by the revenue that came in that was supposed to go to the providers.
    Hospitalists are in a similar position now. Their problem is that they have several specialties who can be hospitalists.
    Other hospital-based specialties banded together and came out with policy statements against these large groups. Hospitals still love them. USACS may be better than some but the venture capital firm is still counting on patient care receipts to fuel its value.
    Population care may end up solving this in that hospitals ultimately want to employ all of the physicians that care for the population being managed.
    It remains to be seen if USACS can adequately continue to staff Summa facilities. It’s not adequate now. The USACS physicians who are working treat their shifts like the very rental car that Bagnoli said never gets washed. I wonder why.

    • Disgusted says:

      I guess it is time to move on. I just called my health care provider. Fortunately I am covered at Akron General.

      • Not ready to move on says:

        To disgusted, call your health care provider and see if you’re covered at Western Reserve. SEA is there so you would be in great hands. No one should go to any of the Summa ER’s unless they’re suicidal.

        • Concerned says:

          After two months of this nightmare, I think we are all ready for some quiet time on C5. Oh wait, you have to be a USACS patient now to get into C5….damn.

        • Disgusted says:

          To not ready to move on, I am covered at Western Reserve. Thank you!

          • Not ready to move on says:

            I wonder if anything would change if the nurses banded together and stood up to administration saying they don’t feel comfortable with the USACS doctors. They are probably afraid to speak out. I guess I don’t blame them.

        • At a loss says:

          Be part of the solution and had a family member go to the ED and it was nothing that has been described her. The nursing staff and the physicians seen were appropriate and they caught a heart block and admitted to ICU appropriately.

          • Move on says:

            Been to the EDs except Barberton. Census higher than last year. Waits are 30 minutes or less on average. The misinformation campaign and propaganda is just that.

          • Good one says:

            That’s hilarious! Any other lies that’ll make us laugh?

          • Move on says:

            Do you have any evidence to the contrary?

            BTW one sign of a losing cause is ad hominem attacks.

          • Not ready to move on says:

            I know for a fact census is down. And wait times under 30 minutes? Hysterical! How long have you worked for USACS? You’re delusional. Don’t get me started on the subpar care given.

          • Move on says:

            I have reality on my side: all I have to do is drive over to an emergency department and look. And you know for a fact? How is that?

            The care is subpar? How do you know?

            This entire blog is a sad affair. Misinformation, exaggeration, taking things out of context, belligerence, etc.

            Move on

          • They have moved on says:

            I’m sure Dom has brought the full force of his company and bankroll to stabilize the situation and will no doubt make sure it is successful given that his wife’s job and his companies reputation are in the spotlight. We won’t know until a year from now when the financial data and mortality rates come out on whether Jerome and Dr. Custodio are cooking the books on volumes and outcomes or whether the ACGME and the city councilwoman are right. The only thing for sure is that Dom has born all the downside risk here………both SEA and Summa/Malone chose not to. I think time will show that Dom is the one who made the bad short term business decision, but he was probably willing to have this deal be a loss leader for future Summa and CHP contracts. Besides if volumes are down, he can always staff it more sparsely and bill more aggressively.

            But let’s be clear who really caused this situation……the Summa board.

            The Summa board have a clear vision and are trying to ram 15-20 years worth of change into 3-5 years and they are sticking to it. Let’s be clear on what they are doing. They are choosing providers that are cheap and practice inexpensively. The are aligning themselves with providers who need to accept lower Summacare rates in order to get volumes into their practices and who order less tests, procedures, and expensive medicines. The BOD if full of businesspeople who want cheap insurance for their companies and know that Summa won’t be able to compete in higher margin fee for service business with CCF and UH so they’ve made the choice to focus on competing on cost. USACS will fit perfectly in this model and will soon displace docs in the hospitalists and post acute care as well. It will be adequate care and it will be cheap. It will be great for employers and Medicaid HMOs. It won’t be the best. That is a paradigm shift for the doctors and nurses at Summa. The term “population health” is just window dressing to make this new business model palatable to providers and the public.

            What we are witnessing now is a divorce between those docs that are OK with this new paradigm and those that are not and Summa is deciding unilaterally who is on their “population health” bus and who is not. Doctors who see lots of patients and perform a lot of treats and procedures cannot be on that bus and the board is quickly and decisively throwing these docs off the bus. Malone was just executing the plan. He and the board probably knew he had a good chance in leaving in this manner.

            At the end of the day, what we all have learned is that the Summa board is accountable to no one but themselves and they have the most power in determining the direction of Summit county’s largest employer and health care provider. Let’s hope that their bold moves benefit someone besides their own business interests.

  27. Former Employee says:

    I am a nurse and former employee (of many years ago) and community resident. This whole scenario makes me so sad about a hospital (now system) I loved during my time there. I have spent my life in health care and what has transpired here is beyond anything I have seen in 45 years in the industry. Does the Board not have a single administrator to tap without financial and business ties to the new ER group? I find their choice incredibly short-sighted and it tells the community there will be no substantive changes after Malone. It’s like watching a train wreck in slow motion. Very sad and frustrating. I feel for all those who are still working there amidst all this turmoil.

    • Not ready to move on says:

      To move on, you want people to drive by and see all the cars in the parking lots? Do you know why that is? Because they are waiting hours to be seen and even longer once treatment has started. Patients are in the ER’s for 12 hours. No wonder so many leave without being seen by any doctor.

      And to former employee, you are correct. They are all connected financially. This was purely a financial decision and let patient care fall where it may. It is a scary situation. I hope the residents of Akron and summit county catch on.

      • Move on says:

        Cars in the parking lot could mean 2 things, lots of people being seen or long waits. As I’ve actually been to 4 of the 5 EDs, it’s the former.

        The Board chose Deveny as clearly they agreed with Malone’s decision, but as the discussion was becoming about him, he needed to move on.

        if the SEA docs want to work for UH or CCF, then keep on driving. Theyve chosen to move on. I suspect they’ll fine the EDs in fine shape when they return.

        • Not ready to move on says:

          When is the last time Akron City ER saw less than 200 patients? Can’t remember? Months? It was yesterday.

  28. Scary times at Summa says:

    So glad to see this site is working again. Much has transpired. Brave nurses went to the local newspaper to let the public know what is really happening inside the walls of the ER, the failure to recognize life threatening conditions, drug dosage errors, long wait times.
    Summa’s response is to say, don’t worry, even the janitors can call a stroke team. Then Lanie meets with the nurses on the med/surg units upstairs to tell them if they loose their jobs due to low census, blame the ER nurses. All of this is their fault. They should be calling Dr. Custodio or Dr. Wellock to tell them when these doctors are putting patients in dangerous situations. Funny, that wasn’t in place before January 1st. It wasn’t necessary then.
    Hooray for these nurses. Hope more come forward.

    • Concerned says:

      I too am glad the site is working again as it has been one of the few places where staff can vent their concerns without being forced to risk their jobs and livelihood.

      To say that Summa is going through a period of change is an understatement. And the passive-aggressive way administration is trying to pit one group of staff against another is more reminiscent of something you might see in a junior high school spat rather than an Elite Hospital System, where patient care has always been the number one goal.

      Three months out and we are continuing to hear from frightened staff about the appalling care and the ‘at times’ dangerous orders the Nurses are trying to intercept before they reach any patients.

      I would ask Summa this, when the behavior of previous nursing leadership became so bad that nearly half of the nursing department (hospital wide) resigned, the hospital took a good look at those Nursing Leaders and made some tactical decisions in an attempt to stem the hemorrhage of nurses. And for a time, it worked. Staff had a Leader with whom they felt comfortable and free to discuss issues without having everything held against them. The morale improved, and things were just starting to look up, and then this.

      Not only did you ‘break off the clot’ that was stemming the hemorrhage, but you also added a new physicians group which acted like thinners, making the bleeding worse.

      Now, you have two choices. You either put a tourniquet on that wound, or you let the patient bleed to death.
      Which is it going to be Summa?

  29. Grow a Spine, Summa BOD says:

    When will you learn? Look at ER deaths in the last week. One could have been prevented. Don’t believe your administration. Certainly don’t believe Custodio. This death did nothing to instill confidence in your nurses or the paramedics.
    And whose bright idea was it to lay much of the blame for the ER accreditation loss on the very ER residents who have been so negatively affected? And how many of the current third year residents are staying on with USACS at Summa? In years past 2-4 residents always stayed on. Good luck with recruitment. Putting the blame on the ER residents only puts the institution’s probation at greater risk.
    And how did you do in this year’s match? How many foreign medical grads did you have to take after internal medicine and family medicine did not match fully?
    The BOD needs to understand that Summa is sinking. In all areas. Medical education. ER patient care. Employers will leave Summacare. Your bond ratings will suffer. You need to take action. Hiring Deveny was a mistake and signaled that you were digging in. You don’t have much more time.

    • Scary times at Summa says:

      That was not the only preventable death. Not to mention the bad outcomes. It is not getting any better. What will they do come July and the residents are gone? They’re the ones doing the work. There were only 22 out of 139 from NEOMED the matched at Summa. A lot of those are transitional. That seems pretty low. Of course none of the residents would agree to stay on with USACS. They’re much smarter than that. At least they had 2 1/2 years to train under the guidance of intelligent, committed, compassionate Emergency Medicine Physicians. SEA kept the cream of the crop from prior residency years. We all know residents whose hospitals didn’t offer them jobs had to go somewhere. That’s where USACS comes in. Someone finishes bottom of every class so I guess USACS serves some purpose.
      Having a low match for residents has repurcussions for years to come. Summa will not get over this. The BOD hasn’t responded yet. Why would you think they would now? Cowards! Just wait for the lawsuits to come piling in.

  30. Folks, thanks to all of you who commented on this blog post. At 450 comments this is the most-commented article I’ve ever posted. The passion and emotion of all of you have made this a very interesting event, and I wish all the best to SUMMA, SEA and even USACS, as wishing for them to fail helps no-one.

    And, now, it’s time to close comments here. Thanks,