Doctors departing NCH? Care concerns at the Naples-area hospitals grow
Here are some things to know about NCH Healthcare System’s admissions policy. Liz Freeman, email@example.com; 239-263-4778
Half a dozen specialized radiologists at the NCH Healthcare System have left or given notice, which could create gaps in services for patients and affect the quality of care, according to a former fundraiser for the nonprofit hospital system.
The resignations are further evidence of a management crisis, said Robert Stucker, immediate past chairman of the fundraising committee for the NCH Center for Philanthropy.
“These departures and numerous other very disturbing physician staffing and morale issues at NCH indicate that there is a serious management problem at the hospital,” Stucker said in an email. “This needs to be addressed immediately by the board of trustees and the Naples community before the quality of our hospital healthcare is degraded even further.”
Stucker is among a growing list of critics of a policy change in which NCH-employed hospitalists are handling more admissions. Independent primary-care and concierge physicians say the change takes away their rights to direct the medical care of their patients while they are hospitalized.
Collier residents who are patients of independent physicians have been vocal in their opposition to NCH’s admissions change, which began as a pilot project last summer in select hospital units.
In addition, the Collier County Medical Society said 95 percent of doctors who have responded to a recent survey do not agree with the admissions change.
And 96 percent said they do not have confidence in the NCH management team’s leadership in the future. The survey, begun in early December, received 200 responses in two weeks and still is active.
One departing radiologist was recruited to start NCH stroke program
The departing radiologists specialize in minimally invasive procedures to diagnose and treat diseases throughout the body.
One of them is Dr. Mazen AbuAwad, who performs aneurysm stenting and coil placement as a lifesaving intervention in stroke care. He was recruited by NCH several years ago to start its comprehensive stroke program.
AbuAwad is the only neurointerventional radiologist in Collier County who performs the minimally invasive stroke intervention, a crucial service for the community’s elderly population at high risk of having a stroke, said Dr. William Ford, a radiologist who resigned last year from NCH.
Physicians Regional Healthcare System confirmed AbuAwad has applied for privileges with the intent to build a comprehensive stroke program, said Marti Van Veen, a spokeswoman for Physicians Regional.
Some of the interventional radiologists who gave notice to NCH came to Collier from Ohio-based Radisphere, a national radiology group that NCH contracted with several years ago for off-site interpretations of scans, Ford said.
The hospital system declined to say whether it has received 90-day notices from any interventional radiologists.
“NCH has a fully staffed and functional radiology department treating record numbers of patients,” spokeswoman Debbie Curry said in a statement.
NCH continues to have a contractual relationship with Radisphere, and any suggestion otherwise is not true, according to a follow-up statement.
It might be true that NCH currently has a fully staffed radiology department; many of the departing radiologists are completing their 90-day notices, Stucker said.
Once their 90 days are up, NCH faces paying for expensive and temporary relationships with interventional radiologists, and the quality of care offered might suffer, Stucker said.
Dr. Cesar De Leon, president of the medical society, said what’s happening in the radiology department also happened in 2011. The radiologists were forced to go elsewhere because they did not fall in line with administration directives to change their structure.
“It saddens the Collier County Medical Society to learn of the recent internal implosion of the radiology department at NCH,” De Leon said in a statement. “In particular the leader of the NCH Code Save a Brain stroke program, Dr. Mazen AbuAwad, was not retained by NCH to provide his lifesaving work for the community of Collier County. Dr. AbuAwad was universally considered irreplaceable by the medical staff of NCH who have seen his world class abilities firsthand.”
The resignations from the radiologists should be enough to force the board of trustees “to recognize the true liability the current leadership is to our community,” De Leon said.
Dr. Raymond Montecalvo, a longtime radiologist in Naples and now medical director of a national radiology group, Virtual Radiologic Corp., said there are not enough radiologists nationally.
Hospitals are deciding between contracting with national groups for off-site interpretations or employing radiologists, along with having interventional radiologists on site for the minimally invasive procedures, Montecalvo said. The catch for radiologists becoming salaried employees is they lose control over their billing, he said.
Montecalvo said he heard that NCH could not come to compensation terms with the interventional radiologists. Their departure means NCH is losing about 80 percent of its on-site radiologists, Montecalvo said.
“A critical piece of the clinical infrastructure is crippled,” Montecalvo said.
‘It is very toxic. Patients are getting a disservice.’
Ford said NCH’s management style with physicians is to expect them to fall in line with all directives.
“They have taken the doctor out of the equation, and nobody can advocate for the patient anymore,” Ford said. “It is very threatening. It is very toxic. Patients are getting a disservice.”
The most visible discord between NCH leaders and its medical staff is over the policy change for employed hospitalists to handle more admissions, over the objections of independent primary-care and concierge physicians.
In October the medical staff unanimously showed no support for the admissions change. The Collier County Medical Society began a campaign to inform its physician members and their patients how it will alter the patient-physician relationship.
The Florida Medical Association and other professional medical organizations have sent letters against the admissions change; and the Collier County Commission and Naples City Council asked NCH to put the hospitalist project on pause and listen to residents’ concerns.
Many residents have said they will boycott NCH. A group of physicians and residents has hired attorneys who have indicated they will take legal action if NCH does not rescind the policy.
Physicians Regional gets more applications
In recent months, physicians with privileges at NCH have been applying for privileges at Physicians Regional, Ford said.
“It is off the charts,” he said.
Physicians Regional, with two hospital locations and a combined 201 beds, confirmed an uptick in applications.
“We continue to receive applications from area physicians to join our medical staff,” spokeswoman Van Veen said. “To date we have received more than 100 applications over the past few months.”
The Collier County Medical Society is continuing its campaign against the admissions change and will likely buy more air time for commercials about it, said April Donahue, the executive director.