Tennessee Doctors Revolt
Reporter: Maxine Magtoto
The Medical Executive Committee members at Tennessee’s Erlanger Health System (7 hospitals), were concerned about issues of patient safety. They took a unanimous vote of no-confidence against three hospital executives, according to a June 23, 2019 report in the Chattanooga Times Free Press
In a May 9, 2019 letter to the health system’s Board of Trustee’s chair, Mike Griffin, the Committee stated that the no-confidence vote was directed at Erlanger President and CEO Kevin Spiegel, COO Robert Brooks, and Vice President of Operations Tanner Goodrich.
Further, the physician’s Committee stated: “despite over 3 years of complaints and concerns by patients and physicians, hospital management has been ineffective in addressing these issues.” They said they had “no confidence in the structure of the current Executive Leadership to ensure quality and safety of patient care.”
The hospital’s Medical Executive Committee, comprised of department chiefs and other key medical staff took this gutsy step raising concerns about operational issues leading to adverse patient outcomes. The chief issues were understaffing and policies causing overcrowding in both the ER and operating rooms.
Adverse Patient Outcomes
According to the letter of no-confidence, patient overcrowding at the campus’ emergency department “has resulted in prolonged boarding of patients and difficulty in appropriate staffing, which has unfortunately contributed to adverse patient outcomes.”
The report from the Times Free Press did not include a PDF of the letter. In addition, the story did not clarify whether failure to provide “appropriate staffing” applied to doctors, nurses, and/or other personnel.
Erlanger Board Chair Disappointed Public Learned About Doctors Concerns About Patient Safety
Even though Erlanger is a public health system, the Erlander Board Chair Mike Griffin was disappointed that the public was made aware of the doctors’ concerns. He said in a statement “It is disappointing that someone involved in Erlanger’s processes would have shared otherwise privileged documents.” Apparently, Board Chair Griffin prefers that the public is kept unaware of problems at this health system’s hospitals.
Erlander’s Medical Executive Committee Points To Lack Of Senior Management Accountability
The Medical Executive Committee’s statement reflects their belief that hospital management was ineffectual in correcting problems. The physicians pointed to the “lack of accountability in senior management who are either unable or unwilling to effect necessary changes to ensure patient safety.”
At Erlanger, the physician leaders made a powerful statement.
Erlanger Health System Fails The Community
This situation is particularly acute because Erlanger is the 10th largest public health care system in the country. Erlanger constitutes Chattanooga’s only public hospital, children’s hospital, and level-one trauma center.
The toll for patients can be devastating. In times of medical emergency, needed treatment must be provided swiftly. Yet, the hospital’s inefficiency forces patients to bear their pain among others clumped along the Erlanger’s ER hallways.
Erlanger’s Executive Board Offers Non-Specific Promises
Meanwhile, Erlanger’s Executive Board has attempted to reassure the public that action will be taken. According to the Times Free Press article, the Board acknowledges that patient safety has been a prevailing issue for the past 4 years. However, while the Board of Trustees assured the public that the issues will be addressed soon, the Board failed to identify the specific issues that will be addressed.
Kevin Spiegel Provides A Vague Explanation For The Health Systems Failure, Referring To “Healthy Disagreements”
Erlanger President and CEO Kevin Spiegel asserted that staff concerns are a priority, stating:
“…my team and I are working very closely with medical staff leadership and all Erlanger physicians. We are committed and focused on addressing concerns promptly and effectively.”
Mr. Spiegel did not identify the changes that will be made nor did he admit to any system inadequacies needing improvement.
In an interview, Mr. Spiegel may have trivialized the seriousness of the situation, stating that “healthy disagreements” between physicians and hospital managers are commonplace in national hospitals. In summary, the CEO chose not to respond directly to the claims made by the Medical Executive Committee.
(The Glassdoor ratings by 55 Erlanger employees provided a 32% approval for CEO Kevin Spiegel. Also, another group of Erlanger physicians sent a letter of support for the CEO.)
Erlanger Health System Treats Patients From 50 Counties
The Erlanger system has 838 acute-care beds in 7 hospitals and treats patients from 50 counties. Erlanger is governed by an appointed 11-member Board of Trustees. The bylaws for the Board state that “ultimate authority for the operation of the Health System lies with the Board.” However, trustees delegate patient care to the Medical Executive Committee, the group that provided the vote of no-confidence.
State Sen. Todd Gardenhire, chair of a state government delegation that appoints four of Erlanger’s trustees underlined the significance of the no-confidence vote: “When the doctors at the hospital do not have confidence in the leadership of the hospital, that’s a major, major blow to the management and operations of that hospital.”
Patient Safety Issues May Have Led Erlanger To Withhold Key Data So CMS Cannot Rate The Quality Of Care At Erlanger Hospitals
CMS provides a 1 to 5 Star rating for over 4,500 hospitals in the U.S. 5 Stars is best. Almost all hospitals in the U.S. are rated by CMS. However, this academic health system refused to be rated for its quality of care. A review of the Hospital Compare website revealed that Erlanger management took the extremely unusual step of withholding from CMS the data used by CMS for hospital ratings. Erlanger must have had compelling reasons to withhold the data since financial penalties are imposed by CMS when this data is withheld.
Withholding the data meant that none of the Erlanger hospitals could be rated by CMS on the Hospital Compare website. By withholding this data, another major hospital rating service, the Leapfrog Group, was unable to provide safety grades of A through F for the Erlanger hospitals.
In effect, Erlanger management took its hospitals off the rating grid.
There was one exception, the Erlanger East Hospital received a B grade for safety from Leapfrog. The other Erlanger hospitals did not receive a hospital safety grade.
Erlanger Vice President Of Patient Safety & Quality Resigns
“I can no longer in good faith and good conscience remain in my role,” said Pam Gordon in a July 1 letter obtained by the Times Free Press. “This has caused me health issues and many sleepless nights. The vote of no-confidence from the Medical Executive Committee was directed at President and CEO Kevin Spiegel, COO Robert Brooks, and Vice President of Operations Tanner Goodrich. The vote of no-confidence had not named Ms. Gordon.
(Hospital Watchdog staff also contributed to this story.)