‘We want our hospital back’

MACHIAS, Maine — Walk into any restaurant, coffee shop or gathering place in the Machias area these days and talk is the same: What is going on at Down East Community Hospital?

As with most things controversial, the answer depends on whom you ask.

On one side is an ever-growing group of physicians, nurses and community members who are criticizing hospital management for alleged heavy-handedness and a too-close relationship with the board of trustees.

On the other side are hospital leaders, who insist the problems are the work of a few disgruntled doctors disagreeing with administrative decisions and a local weekly newspaper that is irresponsibly fanning the flames.

A protest held one evening late last month across from the hospital in Machias highlighted the growing discord between the two sides and offered proof that simmering tension inside the hospital has officially bubbled over into the community.

“We want our hospital back,” said Annie Dickinson, an auxiliary board member and former fundraiser for the hospital who heads a new community group Citizens Challenging DECH, which organized last week’s event.

“There is so much mismanagement going on there.”

At the center of the controversy is a mounting trend in which several physicians at the rural health care facility have either been fired, lost privileges or left voluntarily, in many cases for reasons unexplained.

Within the past few weeks, the hospital has severed ties with Dr. James Whalen, an orthopedic surgeon with nearly 30 years of experience under his scalpel in Washington County, and Dr. Lowell Gerber, a nationally recognized cardiologist who went from hired to fired in less than nine months.

The Machias hospital employs only about 22 full-time physicians. Another 18 private-practice doctors have privileges there. It doesn’t take many to leave before a glaring hole emerges.

Several nurses and other support staff also have defected in recent years, not to mention the fact the hospital has endured a number of image-tarnishing events recently, including the high-profile death of a patient earlier this year.

Many in the Machias area are wondering whether the collective crises are starting to affect health care in Washington County.

Hospital leaders said that doctor turnover is part of the cost of doing business and health care is strong at DECH.

“I think we have a great working relationship between the board, the administration and the medical staff leadership,” Wayne Dodwell, hospital president and CEO, said in a recent interview. “There is nothing to indicate quality of care has diminished.”

Others aren’t so sure.

Dr. Steven Weisberger, who runs an internal medicine practice in Jonesport and has had privileges at DECH since 1985, said the current climate at the hospital has patients scared and turning elsewhere for care.

“Among my patient population, almost everyone says, ‘I don’t want to go to [DECH],’” Weisberger said recently. “That’s a big problem.”

Doctors in exile

In nearly 30 years, Dr. Whalen said, he never had any problems with hospital management until Dodwell arrived. Now, he said, he has been the subject of five internal investigations in the last few years. The surgeon said he doesn’t mind the scrutiny but questions its merits.

“When I started, this hospital was community-controlled. Now, it has completely lost its standing in the community,” he said. “This is not grandstanding. A hospital shouldn’t be a private fiefdom.”

Whalen believes he’s being singled out in part for cooperating with a Maine Attorney General’s Office investigation into one of his colleagues a few years back. Whalen said he was asked pointed questions and gave honest answers. But in doing so, Whalen said, he angered hospital management.

The other doctor has since left the hospital and could not be reached for comment. The details of that case are confidential. Whalen, on the other hand, has fought the hospital ever since and saw his hospital privileges officially revoked on Aug. 15.

Dr. David Rioux, chief of the hospital’s medical staff, did not want to talk specifics but explained doctor turnover at DECH in broad terms.

“Everyone is different,” he said. “As an employee, you have requirements; that is, you have to behave, you have to participate in medical staff guidelines, and you need to be a team player, just like any other business.”

Dr. Gerber, an outsider with extensive experience in cardiology, said he found out soon after he was hired that being a team player meant keeping your mouth shut.

“When I was brought in for my interview, they told me not to mingle with Dr. Whalen and others because they were troublemakers,” he said.

Gerber believes he was targeted for dismissal because he challenged the administration with new ideas. In the few months he worked for the hospital, Gerber said, hospital administrators never addressed any of his requests or needs. He asked for new equipment and staff members to improve his cardiology unit, only to be turned down.

“I became a thorn in their sides, so they found a way to get rid of me,” he said. “But it was done in such a shabby, unprofessional way.”

Gerber said he was told of his firing on a Thursday and advised not to come in the next day. He and his partner, Danielle Duval, a nurse practitioner, had built a substantial patient base that they didn’t want to abandon.

“We had to beg just to come in and get our files,” Gerber said. “After all that, they wanted us to sign an agreement saying we wouldn’t talk about our dismissal.”

Neither Gerber nor Duval signed.

Gerber alleged that he is the victim of a phenomenon known as sham peer review, which basically allows a hospital staff to remove a combative physician without cause. Sham peer review is not an official term in medical circles, but Randall Manning with the state Board of Licensure of Medicine said he has heard it before. Still, he said, it’s nearly impossible to prove because peer review is wholly confidential, even when it enters the legal arena.

Asked about sham peer review, Dodwell and Rioux appeared puzzled.

“I had never heard the term until recently,” Rioux said.

Dodwell said peer review is a confidential process but stressed that any action is not taken lightly.

“Most of the time, there are corrective action measures put in place that are accepted,” Dodwell said. “In a couple of cases, a physician will say, ‘I don’t accept the outcome’ but that’s very, very rare. However, in those instances, I say, ‘You can choose to exhibit bad behavior or you can choose to work in our organization, but you can’t do both.’”

Whalen responded by taking the matter to Washington County Superior Court.

“I was at the end of my rope. … I had no other options with the hospital,” he said.

At a recent hearing, a judge approved a temporary restraining order that overturned the hospital’s decision to strip Whalen’s privileges. A final decision will be issued in the coming weeks, but Whalen called the initial ruling “landmark.”

“It basically said that the hospital was so poorly run that a court had to intervene,” he said.

Gerber, Whalen not alone

Aside from the two exiled doctors, a number of physicians, nurses and other support staff who have left the Machias hospital declined to speak on the record. Most agreed there is a sharp divide inside the hospital walls.

Two physicians in particular, who say they too were forced out at DECH, are now employed at different Maine hospitals and declined to speak because they wanted to protect their current jobs.

Not everyone is staying silent, though.

Dr. John Gaddis, an obstetrician and gynecologist who has been on hospital staff since 1983, predicted he’ll be the next physician to be forced out. Gaddis said his relationship with administrators and other doctors has been good in the past but has deteriorated since Dodwell took over.

He didn’t blame Dodwell solely but alleged that the CEO’s power has adversely affected the board of trustees.

“In general, the trustees used to be representative of the community,” he said. “They were people who were vested in the community and working for its betterment. I can’t say that’s true now. There are so many conflicts of interest.”

Gaddis declined to extrapolate on those conflicts on advice of legal counsel. Others have said that too many of the board of directors have integral roles within the hospital. In other words, the checks and balances that a board is supposed to provide no longer exist.

Dr. Weisberger, who has had hospital privileges since 1985, said his relationship with the hospital also has soured in recent years, although he still practices at DECH, more out of necessity than anything else.

“But, they consider me the enemy … because I question the things that are going on. And anyone that challenges is gone,” he said.

Weisberger agreed that Dodwell is part of the problem, but he also referenced a couple of “kingpins” on the board of trustees who he claims have been altering the by-laws to force people out. He said the administration is more interested in business than health care.

Rioux and Walter Plaut, the board’s chairman, took exception to the notion that board members have become “yes men” to Dodwell.

“I’m not someone who’s afraid to look an administrator in the face and tell them they are wrong,” Rioux said. “They are saying that we’re yes men because we work together with the administration, but I don’t think our relationship has to be adversarial.”

“I get real testy when people start demeaning the quality of the board members. We’re not yes men,” Plaut added.

Whatever the reasons, staff members are leaving DECH at an alarming rate. Gaddis estimated that as many as 100 staff members have departed since 2002. Weisberger added that when he visits Maine Coast Memorial Hospital in Ellsworth, he recognizes about half of the nursing staff because they used to work at DECH.

Vanessa Sylvester with the Maine State Nurses Association said she didn’t want to weigh in on hospital politics but did confirm that many of the approximately 150 nurses and technical employees at DECH who are represented by the nurses union are concerned as well.

“We urge the board of directors to really start listening to the community regarding services,” she said.

Community in crisis?

Down East Community Hospital was in serious financial trouble in the years leading up to 2002, when it turned to an outside agency for help.

Quorum Health Services, a national organization that provides administrative services to hundreds of health care facilities, took over the hospital’s management and tabbed Dodwell to lead.

The new CEO brought a business-minded approach that helped rescue the hospital from the brink of bankruptcy. Since Dodwell’s tenure began, the hospital has invested millions of dollars in infrastructure to improve the facility and is now running in the black, according to its latest annual report.

“One-third of Maine hospitals lost money last year. This hospital made money,” he said. “So our business model works very well, but more importantly, all of our quality scores have been very good as well.”

Dodwell referred to recent data from the Maine Health Management Coalition that showed DECH ranked above the average for Maine hospitals in core measures such as heart failure, pneumonia and surgery care-infection prevention.

In spite of all this, DECH has faced community criticism before. Two years ago, a group of concerned area residents circulated a petition calling for the resignation of Dodwell and members of the board of trustees. At the time, a representative for the Maine State Nurses Association union said employee disruption and dissatisfaction at DECH was worse than at any other state hospital.

Fast-forward to today, and the problems appear to persist. Even with Whalen and Gerber, Down East Community Hospital hasn’t had the most positive image in the last year.

The case of Reid Emery, a patient who left the hospital on a snowy evening against doctors’ wishes and was found dead in a snowbank the next day, was particularly high-profile.

An investigation into the 61-year-old Eastport man’s death found that the hospital erred in its policies, and DECH was required to implement a plan of correction to address deficiencies.

Earlier this year, a former employee was reprimanded for potentially exposing one patient to another patient’s blood through a transfusion. An investigation found that the employee also administered outdated medication, failed to monitor a sedated patient and drew teardrops on a patient’s face with a marker.

Last December, the hospital was charged with overbilling Medicare for certain services between 2005 and 2007 and was forced to pay back more than $100,000 in outstanding claims.

Most recent are the situations involving Whalen and Gerber, who are challenging their dismissals in court.

In a lengthy interview last week, Dodwell, a charming, even-keeled leader, downplayed public relations problems. He even passed off the recent concerns as isolated incidents that have been intensified by one-sided coverage in the Machias Valley News Observer, a local weekly newspaper.

Karen Hinson, the paper’s editor, said the paper’s coverage would be more balanced if the hospital leaders were not so evasive and combative. Hinson in particular recalled a recent exchange between her and Dodwell.

The paper had begun writing stories about doctor defections as well as editorials that criticized the hospital. Hinson said hospital brass requested a sit-down interview and basically told her not to print anything negative.

“I brought a copy of the First Amendment. I don’t think they liked that too much,” she said in a recent interview. “Since that meeting, they have stopped advertising in our paper.”

Hinson said the hospital also pulled all copies of the Machias Valley News Observer out of its facility.

Dodwell explained that the decision to pull the newspaper from the hospital was made with patients in mind.

“We don’t want our patients to be unduly concerned or frightened about something we don’t believe is real,” he said.

You say you want a resolution

Balanced or not, the newspaper has brought the hospital’s internal rumblings to the public sphere. If the recent protest is any indication, it’s likely to continue.

More than 100 people picketed outside the hospital late last month, contrasted by a smaller group of hospital supporters on the other side of the road, both a literal and symbolic divide.

Protesters held signs that read “Current mood: frustrated,” “Patient care matters,” and “Put community back in Down East Community Hospital.”

On the other side, doctors and nurses held signs that said, “The great ones are still here.”

Sandra Prescott, a community member, wondered why the two sides weren’t trying to come together.

“It’s important for the community to seek answers, and so far we aren’t getting any,” she said.

However, as Dodwell stood with a group of the hospital’s supporters at the protest he was asked point blank by a protester to address the other side and perhaps extend an olive branch.

Dodwell politely declined.

Most who protested against the hospital shared a common concern: that the “community” has been removed from Down East Community Hospital.

No one is certain how the issues will be resolved.

Dr. Gaddis said he’s not happy that the community has begun protesting, but he’s glad people are paying attention.

“The best way to resolve this would be for the trustees to wake up and work with the community,” he said.

Board chairman Plaut said the trustees are in uncharted territory.

“We’ve never been in this position before,” he said. “Especially now that it has gotten personal. We’re talking about doing something to address these issues, but they have become visceral and emotional. Everyone has an agenda.”

Dodwell, too, lamented that the issue has spilled over into the community.

“That’s the real shame in all of this; there are individuals out there that have their own personal agendas, that want to frighten and scare our community into not coming to a high-quality organization,” he said.

Weisberger and others contend that patients already are seeking care elsewhere. He said resolution could come only with the removal of Dodwell and Quorum’s management.

Whalen, on the other hand, was a little more optimistic but said any resolution “has to favor the community. My solution would be six months of counseling. Bring in a mediator and work this out. The hospital is redeemable.”

If nothing else, the community is paying attention to the hospital issue in a way it hasn’t to date.

Katherine Cassidy and David Burns, who are competing for the House District 32 seat that includes Machias, have brought the matter up in recent forums.

Cassidy, in particular, has called for a public meeting to address the problems directly.

“A meeting, shaped as a ‘community conversation,’ would be an opportunity for [people] to hear directly from the hospital’s administration and trustees, to ease their concerns,” she said.

As yet, a date and time for the public forum has not been set or even agreed to by hospital administrators.