For four decades, they were the doctors who cared for patients who came through the emergency room doors at Akron City Hospital.
On New Year’s Day, that abruptly changed at City Hospital and Summa Health’s four other emergency departments.
After contract negotiations broke down in the final days of 2016, Summa chose to contract with a national group based in Canton.
Both Summa and their longtime ER doctors say they never expected their negotiations to go sour.
But they did, and with it comes backlash, including a no-confidence vote by hundreds of doctors against Summa leadership, allegations of a culture of fear and a community worried about the future of its largest employer.
In separate interviews, leaders of both Summa and Summa Emergency Associates (SEA) laid out their sides of why they could ultimately not reach a contract.
But both accuse the other of putting their own interests first instead of what is best for patients.
Late start
Negotiations for the contract, which expired Jan. 1, started with a phone call in early November by Valerie Gibson, chief operating officer of Summa and president of Summa Health System (the hospitals).
During a meeting with the Beacon Journal on Friday afternoon requested by Summa after repeated requests for information about the negotiations, Gibson acknowledged that the negotiations started late.
“We are going to own that. We had no intention of not renewing the contract with SEA,” she said. “We were not in any way, shape or form looking to go with a new vendor.”
In a separate telephone interview, Dr. Jeff Wright, who leads the independent physician corporation that’s separate from Summa, agreed it was late but said, “I thought if people devoted the time and energy to get it done, we’d get it done.”
Summa provided its first written contract Nov. 28. Gibson said it takes time to craft the offer.
Summa’s initial offer was for a three-year contract with a two-year extension.
Wright’s group was given two weeks to respond. Summa said SEA came back with a 15-year agreement with no opportunity for cancellation, as well as a requirement for Summa to pay the group a stipend beyond what SEA bills insurers and patients. Wright said he initially asked to either not staff underperforming emergency rooms — Barberton, Medina and Wadsworth — that were losing money or set up different payment structures.
Wright said he wanted a 15-year deal because he was having trouble recruiting and retaining doctors when he only had three-year contracts.
Gibson said when it became apparent upon seeing that first counteroffer that “we were far apart,” she offered a 60-day contract extension.
It was the first of four extensions Summa officials said they offered SEA. Wright refused all four, Gibson said, including ones in the final days before the contract ended.
Wright said he initially turned down the extensions because he thought there was time to get the contracts done.
The last extension he refused, he said, was after it became apparent that Summa had contacted a competitor and could possibly replace SEA.
Wright said he didn’t want his doctors to be used to staff the ERs while Summa prepared a transition plan for their replacements.
The first and only face-to-face meeting that Summa had with SEA was between Dr. Thomas Malone, Summa’s president and CEO, and Wright on Monday, Dec. 26. Malone had taken over negotiations because Gibson was on vacation over the holiday.
Wright believes he and Malone should have met more in person and sooner. Ben Sutton, Summa senior vice president for strategy and performance management, said plenty of negotiations happen by phone and email.
Throughout negotiations, Wright said, his colleagues wondered if Summa truly wanted to renew the contract. Dr. Vivian von Gruenigen, chief medical officer, is married to Dr. Dominic Bagnoli, CEO of the Canton-based US Acute Care Solutions (USACS), a competitor of SEA. After talks broke down with SEA, Summa entered a contract with USACS on Dec. 29.
Wright’s group and others have questioned what they say is an apparent conflict of interest.
Gibson said as soon Summa opted Dec. 29 to contract with USACS, the hospital sought outside counsel to make sure they were following protocol. Von Gruenigen was removed from the process.
“Let me be clear: Her involvement was pretty much on the periphery,” Gibson said.
Wright said von Gruenigen should never have been involved.
Sutton said that Malone reached out to USACS and two other ER groups when talks were “getting down to the wire.”
“Our intent was never to send out an RFP [request for proposals]. We negotiated until the very last minute we could,” Sutton said.
Another large sticking point between the two sides surrounds the inspection of financial books. Summa officials said they are required to get a third-party, fair-market assessment, which includes looking at SEA’s finances related to Summa’s ERs, for the health system to pay a stipend beyond what the doctors charge patients and insurers for services.
Summa officials said Wright refused to open the books, or only wanted to show those of the ERs where SEA was losing money. Wright said he was willing to share all of his books, but with a nondisclosure agreement.
The hospital system and Wright’s last and final offers before the USACS decision were still far apart. Aside from the access to the books, the hospital wanted three years plus a two-year extension and SEA wanted 10 years.
Gibson said in a last-ditch effort for a deal, Malone verbally offered a five-year deal Dec. 29. Wright refused, Gibson said.
Wright said by then he was not sure Summa was interested in a deal to stick with SEA because the health system had already contracted with his competitor.
“Why would anyone go through this?” asked Dr. David Custodio, interim chair of the emergency department, referring to the 48-hour transition. “It would make no sense to us to continue to negotiate to the nth hour if we didn’t want them on board.”
A week of turmoil
In the seven days since the ER switched providers, there have been separate no-confidence votes by more than 230 Summa physicians and the emergency residency staff, both calling for the resignation of Malone and his leadership team. A Summa spokesman said the board has no meetings planned to discuss the doctors’ no-confidence votes.
Additionally, the doctors voted Thursday to request an outside investigation and the reinstatement of SEA. The doctors are also attempting to send out a survey link to all of its 1,100 physicians to anonymously vote since many doctors say they fear for their jobs if they speak out.
There have also been complaints of a patient safety issue filed with the Joint Commission, a national health accreditation group, and the Ohio Department of Health, whose spokeswoman confirmed that the agency forwarded the issue to the Centers for Medicare and Medicaid Services (CMS). Spokeswomen for all three agencies said they were aware of the issue and that there have not been site visits at this time.
Summa officials said they could not discuss the filings, but the system has 30 days after the Joint Commission received the complaint to file a response. That deadline is Jan. 24, meaning the complaint was filed before the ER staffing switch.
Summa also is facing backlash nationwide from four national organizations.
The American Academy of Emergency Medicine, the American College of Emergency Physicians, the Emergency Medicine Residents’ Association and the Council of Emergency Medicine Residency Doctors issued separate statements late last week questioning the impact of the abrupt staffing switch on patients and resident physician training.
The group of ER residency directors said it had been in touch with Accreditation Council for Graduate Medical Education, which “will be investigating the program” Summa said it notified ACGME about the staffing switch and a site visit is normal with a change. In addition, a celebrity doctor who goes by the name ZDoggMD, with 400,000 Facebook fans, spent the majority of a Facebook Live session Friday night talking about the Summa controversy.
Many doctors are worried about the future of Summa.
“Patients are at risk and the community will suffer because of poor decisions by Tom Malone and the continued cover-up attempts by those close to him,” said Dr. Joe Blanda, a longtime orthopedic surgeon and independent doctor. Blanda’s wife, Dr. Michelle Blanda, a former chairman of emergency medicine, is an SEA doctor and they are investors in Western Reserve Hospital, which is in a protracted contract dispute with Summa.
“I supported Summa until Tom Malone started his tyrannical tactics,” Blanda said.
Malone has not been made available by the hospital’s communication’s department to answer questions from the Beacon Journal, despite multiple requests.
Another Summa-employed doctor, who asked not to be named for fear of retribution, said he believes SEA was wrong in the negotiations, but that the failure to get a contract is Malone’s fault.
“This probably went down because of two egos,” the doctor said. “But the reason it went down the way it did is he [Malone] didn’t realize there would be this backlash.”
The doctor said he won’t vote on the anonymous survey, fearing it could be traced.
Doctors have said the ER issue was the last straw in a series of failures.
Dr. Hitesh Makkar, vice president of the Summa medical staff, said he and other doctors worry that future doctors will not choose to come to Akron and that Summa could become the target of an outside company.
But not all doctors are against Malone.
Dr. Thomas Mark, chair of Summa’s department of anesthesiology, said Malone and his leadership have his full support.
“Part of this is to run a successful hospital, tough decisions have to be made,” said Mark, whose anesthesiology group recently signed a one-year extension with Summa and is negotiating a multiyear contract.
Betty Lin-Fisher can be reached at 330-996-3724 or blinfisher@thebeaconjournal.com. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ.