Fired--December 2019
OSF-SFMC, Peoria
(Photo by John Carroll)
On December 18, 2001, when I was working a Prompt Care shift at OSF-Saint Francis Medical Center in Peoria, George Hevesy, Director of the Emergency Department, came to Prompt Care and told me that Keith Steffen, OSF’s Administrator, wanted to talk with me.
I knew that was it for me at OSF.
I got my stuff and walked with George down the hall and past the physician who was coming in to replace me in Prompt Care.
As we headed to Steffen’s office, we also passed Sister Canisia, the Catholic Administrator of the hospital, who was busy putting up Christmas decorations in the main lobby. As we walked past her, George said “hello” to her, but she did not respond.
We went into Keith’s office. Another administrator and OSF-SFMC counsel, Doug Marshall, were already there.
Keith was seated to my left and we talked over Keith’s large bible which was placed on a small table in front of me. Keith told me I was fired and then strangely asked me if I had turned in my keys to the front door of the hospital. I told him there were no keys to the front door of the massive 650-bed hospital. He then asked me if I had any questions and I told him “no”. Steffen told me that I needed to leave the hospital.
It didn’t take long. I left his office and walked back to Prompt Care to get my stethoscope and briefcase. A nurse hugged me and I was gone.
I had worked at OSF during four different decades and it was the only place that I ever really wanted to work. I had been an orderly in the 70s, a resident physician in the 80s, and an attending physician after that. (I still remember my patients from 1971, on 8B the neurology floor, and which rooms they were in.) I loved working for the Sisters and believed in their Mission Philosophy.
When I was out on the sidewalk on the side of the hospital, I ran into a pediatric heart surgeon who had operated on numerous Haitian Hearts patients. I told him what had just happened. He kindly invited me out to eat for lunch and I took him up on his offer.
Before being terminated from OSF, I had heard through the grapevine that Keith Steffen wanted to stop Haitian kids from being operated at OSF. So a main goal of mine, even when I was being fired, was to preserve Haitian Hearts and not allow Steffen or OSF to destroy the program. Being fired was one thing, but neglecting the lives of Haitian kids with heart problems was quite another.
As I look back on that day, which happened 18 years ago this month, I don’t think I realized the importance of the life-changing event that had just happened. I guess I was in some sort of “disbelieving state” However, it was indeed real and I would never work at OSF again.
As the years went by, being fired from the only hospital I ever worked at was a blow to my identity because I loved being a physician at OSF. Being a doctor and working in my home town at OSF was such an honor for me.
I have been on a long sabbatical. However, I have learned much during the past 18 years which I wouldn’t have learned if my life at OSF would have continued unbroken.
——–
Next: My letter to Keith Steffen in 2001 explaining my concerns regarding boarding patients in the Emergency Room.
John A. Carroll, MD
www.haitianhearts.org
2 thoughts on “Fired”
Kyle Ramsey
says:
December 10, 2019 at 8:57 am Edit
Dr Carroll, I have followed your posts for some time and have enjoy every one of them. You are spot-on with this post today, as you so often are. In retrospect, though we lose the ties, the bonds and the feeling of “home” we learn so much from what follows such events. The lessons are often invaluable in shaping us. Your story is particularly poignant for me at this time and is a good reminder to embrace change. Thank you.
Replysays:
Thank you, Kyle.
Reply
EP Spearheads Arizona Anti-Retaliation Law
BY GINA SHAW
Emergency physicians and other health care professionals in Arizona had official, legal protection against retaliatory actions by their employers as of Sept. 1, even if they are employed by third-party contract management groups (CMGs) rather than the hospital itself. The groundbreaking legislation, signed March 23 by Republican Gov. Doug Ducey, was introduced by emergency physician Amish Shah, MD, a Democratic member of the Arizona House of Representatives.
Dr. Shah’s decision to introduce the bill started with the experience of a former colleague and friend at a hospital where Dr. Shah previously worked. “He was at the nurses’ station and saw a patient safety issue: A nonmedical person was assigned to watch the telemetry monitors. He reported this properly up the chain at the hospital,” Dr. Shah recalled. “The hospital turned around very shortly afterward and terminated him. But they didn’t terminate him directly. Like many emergency physicians, he was employed by a CMG. The hospital contacted the CMG, and they terminated him.”
Shortly after the physician was terminated, a patient at the hospital died under similar circumstances to those about which the EP had complained: An untrained staff member failed to recognize asystole on the telemetry monitors. “Had they investigated the actual problem instead of retaliating against me, I believe that person would be alive today,” Dr. Shah said his colleague told him.
Arizona already has a 2003 law that prevents hospitals from retaliating against employees who voice concerns about issues such as staffing, policies, or patient safety, but Dr. Shah said it didn’t take into account this new way of doing business and what’s going on in the medical marketplace today.
Dr. Shah, who had been elected to his District 24 seat representing central Phoenix and south Scottsdale in November 2018, heard more about this issue at the American Academy of Emergency Medicine’s 2019 Advocacy Day, where he was an invited speaker. “After hearing from Dr. Wanda [Espinoza-]Cruz from Florida, who was terminated after reporting to her hospital administration that inadequate physician staffing had contributed to long waiting times and a poor outcome for one of her patients, I realized that my friend’s experience wasn’t just a one-off issue,” he said.
So Dr. Shah decided to introduce a bill.
Uphill Battle
Working with experts on his staff, he crafted AZ HB2622, which stated that neither health care institutions nor CMGs can retaliate against any health care professional and that retaliatory actions include not only termination but also any adverse action, including taking physicians off the work schedule. (The law requires health care professionals to act in good faith by reporting the issue of concern to their administration first using proper channels, giving them an opportunity to respond.)
To pass the bill, Dr. Shah faced an uphill battle: He was a freshman Democrat in a state legislature controlled by Republicans with a Republican governor. He had to get buy-in from the opposing party and business interests such as hospital groups. “You have to go through what’s called a stakeholder process to have any real chance of passing the bill, meaning that you invite people affected by the bill to the table, including people who are likely to be your opponents, and you have to hear them out,” Dr. Shah said.
One of those stakeholders was a lobbyist who represented all the major hospital groups in Arizona. “We sat down with her, and said, ‘This is what we’re considering,’ and she said, ‘OK, this is actually in line with our values, and we’re not going to oppose it; however, we do have concerns about some of the language,’ and asked for a few changes with regard to hospital liability,” he said. “We did not object to those changes, and we were pleasantly surprised.”
Getting the hospital groups on board was a big win, but campaigning for support in the legislature still took intensive work. “Because of the sensitive nature of the story, we had my friend who went through this meet-behind-the-scenes with lawmakers instead of giving public testimony,” Dr. Shah said. “He spoke with the House and Senate leadership and some of the majority party staff, and I think that was key to the fact that the bill passed with solid bipartisan support.” He also partnered with the Arizona Medical Association.
The COVID-19 pandemic postponed the Arizona legislature’s work on anything that wasn’t critical or COVID-related, so passage was delayed until this past March. “This is a very big deal,” Dr. Shah said. “It’s one of AAEM’s big priorities, and when I speak to emergency physicians locally and nationally, people are very enthusiastic.”
During the course of the pandemic, another retaliatory firing of an emergency physician underscored the need for such protections. Ming Lin, MD, was fired from his position at St. Joseph Medical Center in Bellingham, WA, in March 2020 after advocating for better respiratory protections, quicker lab turnarounds, and more restrictions for visitors. (EMN. 2020;42[5]:1; https://bit.ly/3f8RXfX.) Dr. Lin, who had worked at the hospital for 17 years, is now suing PeaceHealth, which operates PeaceHealth St. Joseph Medical Center, and TeamHealth, the contract management group under which he was contracted to work.
Inspiring Achievement
“This is a critical problem in emergency medicine,” said Robert McNamara, MD, an AAEM past president and a professor and the chair of emergency medicine at the Lewis Katz School of Medicine at Temple University in Philadelphia. (AAEM has called for an investigation of Dr. Lin’s situation by the state Attorney General and the State Board of Medicine. [AAEM Position Statement. March 28, 2020; https://bit.ly/3aFn6Fr].) He noted that HR 6910, federal legislation to guarantee due process to emergency physicians—also introduced by an EP, Rep. Raul Ruiz, MD (D-CA)—is making its way through Congress.
“AAEM is putting its weight behind the national bill, but there’s no reason for people not to try to do the same thing at their state level,” Dr. McNamara said. “I’m not aware of other states that have put forward legislation like this yet, but when we see success in one state, folks in other states often do the same thing.”
Dr. Shah’s achievement should be inspiring to other emergency physicians, Dr. McNamara said. “There has been a sense of fatalism that this is all a big machine, and we can’t stop anything, but the newer generation of emergency physicians is really getting stuff done. They see the corporate takeovers, the punitive contracts, and less ability to be in a physician-owned group, and they’re stepping up and getting more active—running for office, getting involved with state medical societies, and being more involved in their states. It’s very encouraging.”
Dr. Shah, who also serves on the board of the Arizona College of Emergency Physicians, has drafted a resolution to bring to national ACEP this month calling for the Arizona bill to serve as model legislation for other states. “Corporate entities have a lot of power, and many EPs feel like the odds are stacked against them,” he said. “We in emergency medicine have the highest rates of burnout. So to get a win like this, enacting policy that supports the physician doing the right thing, feels very good for many of us.”
Ms. Shaw is a freelance writer with more than 20 years of experience writing about health and medicine. She is also the author of Having Children After Cancer, the only guide for cancer survivors hoping to build their families after a cancer diagnosis. You can find her work at www.writergina.com. Follow her on Twitter @writergina.
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