EM Doc fired for reporting EMTALA violation

[Groove]

Saw this on Facebook

Georgia system fired physician for voicing concerns over ED policy, suit says

An emergency physician filed a lawsuit against Warner Robins, Ga.-based Houston Healthcare Nov. 19, claiming he was fired in retaliation for reporting concerns about the system's admitting practices, according to court documents obtained by Becker's.

www.beckershospitalreview.com

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[namethatsmell]

Love it. May the force be with him.

 

[thegenius]

I hope the doc wins.

I once asked if docs have ever reported an EMTALA violation. Many said don't do it because you can get fired over it. Don't we have whistleblower laws against this? And can't EMTALA violations be reported anonymously?

 

[Dr Mantis Toboggan]

Love it. May the force be with him.

Yup he should be set for life.

 

[Dr Mantis Toboggan]

I hope the doc wins.

I once asked if docs have ever reported an EMTALA violation. Many said don't do it because you can get fired over it. Don't we have whistleblower laws against this? And can't EMTALA violations be reported anonymously?

Yeah they can.

 

[bravotwozero]

I can’t believe the hospital c suite were this dumb. This has wrongful termination and retaliation written all over it.

What a bunch of complete *****s.

I sure hope he’s set for life after this.

 

[RustedFox]

We need "hospital administration reform".
Whatever that means.

 

[RustedFox]

We need "hospital administration reform".
Whatever that means.

I appreciate the likes, amigos.

This begs an important question. What would "hospital administration reform" look like?
I think it boils down to a "Who watches the Watchmen?" type question.

I mean, there have been enough whistleblower suits and cover-ups to make it clear to the American public that hospital admins are straight corrupt and evil.

Anonymous hotline? Public watchdog program? I have no idea; I'm just a guy who is sick of seeing patients go into pulmonary edema from inappropriate sepsis-bundle-set fluid boluses.

 

[Boatswain2PA]

So what should one do in that situation? Call the hospitalist for admission, document refusal, transfer elsewhere, and claim ignorance that the patient was "city call"?

This is one reason why I never check insurance status (assuming "city call" is some term for uninsured).

 

[Zebra Hunter]

So what should one do in that situation? Call the hospitalist for admission, document refusal, transfer elsewhere, and claim ignorance that the patient was "city call"?

This is one reason why I never check insurance status (assuming "city call" is some term for uninsured).

Blatant EMTALA violations like this, I would cause a gigantic stink, as well, and tell the hospitalist they can transfer the patient themselves because I refuse to assist the hospital in patient dumping.

 

[thegenius]

Yeah they can.

Yeah they can what? Sorry I asked several questions and wasn't sure which you responded to

 

[thegenius]

I appreciate the likes, amigos.

This begs an important question. What would "hospital administration reform" look like?
I think it boils down to a "Who watches the Watchmen?" type question.

I mean, there have been enough whistleblower suits and cover-ups to make it clear to the American public that hospital admins are straight corrupt and evil.

Anonymous hotline? Public watchdog program? I have no idea; I'm just a guy who is sick of seeing patients go into pulmonary edema from inappropriate sepsis-bundle-set fluid boluses.

I think one can report EMTALA violations anomymously

 

[Dr Mantis Toboggan]

Yeah they can what? Sorry I asked several questions and wasn't sure which you responded to

Sorry they can report anonymously.

 

[emergentmd]

Maybe I can go back and work some shifts in the hospital just to point out all the violations. Maybe they will fire me so I can sue them.

 

[Groove]

I'm a little suprised that Apollo went along with this... I used to work for them and although they function just like any other CMG (for the most part), the regional directors and higher ups are smart peeps. I can't imagine they did not recognize this policy as an EMTALA violation and willfully went along with it. The whistleblower was the FMD. There's no way he didn't report this to his chain of command within Apollo. Maybe they were in the middle of trying to make c-suite see the light. Man, that's a hard spot to be in as the FMD. Apollo wants to save the contract and probably telling him to keep his mouth shut while they talk to hospital admin, yet... his malpractice policy no doubt does not protect him from EMTALA violations, so he feels obligated to report it rather than willfully be complicit. I feel for the dude, but the suit is absolutely justified. I hope his career isn't over. He'll never work at an Apollo site again most likely and any other major CMG that googles his name would be reticent to hire him too I would wager for fear that he's a "loose cannon".

 

[NYEMMED]

I'm a little suprised that Apollo went along with this... I used to work for them and although they function just like any other CMG (for the most part), the regional directors and higher ups are smart peeps. I can't imagine they did not recognize this policy as an EMTALA violation and willfully went along with it. The whistleblower was the FMD. There's no way he didn't report this to his chain of command within Apollo. Maybe they were in the middle of trying to make c-suite see the light. Man, that's a hard spot to be in as the FMD. Apollo wants to save the contract and probably telling him to keep his mouth shut while they talk to hospital admin, yet... his malpractice policy no doubt does not protect him from EMTALA violations, so he feels obligated to report it rather than willfully be complicit. I feel for the dude, but the suit is absolutely justified. I hope his career isn't over. He'll never work at an Apollo site again most likely and any other major CMG that googles his name would be reticent to hire him too I would wager for fear that he's a "loose cannon".

Yea hopefully he takes the hospital system and Apollo for double digit millions

 

[NYEMMED]

I appreciate the likes, amigos.

This begs an important question. What would "hospital administration reform" look like?
I think it boils down to a "Who watches the Watchmen?" type question.

I mean, there have been enough whistleblower suits and cover-ups to make it clear to the American public that hospital admins are straight corrupt and evil.

Anonymous hotline? Public watchdog program? I have no idea; I'm just a guy who is sick of seeing patients go into pulmonary edema from inappropriate sepsis-bundle-set fluid boluses.

We could start by going back to having medically trained individuals run hospitals.

Stop with the MBAs with no medical knowledge

 

[southerndoc]

I will briefly comment on this from my own personal opinion because I believe ApolloMD is a good company to work for and doesn't function like the other CMG's. Many of you know that I am an ApolloMD doc who is an associate medical director at a large site. I do not have any affiliation with this site. I have been a happy ApolloMD doc for over 13 years now, and I have been treated very well without corporate involvement in patient care. Nearly everything is left to the specific sites to run their shop instead of operating like other CMG's that enforce from above.

He is likely an independent contractor, and as such, has limited recourse. His litigation may go nowhere.

I do not know the details of his removal from the schedule, so I cannot comment on what occurred regarding contract, employment status, etc.; nor am I in a position to officially do so. ApolloMD has typically migrated docs to other sites if issues arise. They generally do not terminate your contract unless there are really serious issues (such as patient care). They realize that docs have families to feed and generally do not part ways with you. They will go out of their way to get you working at another site if need occurs. Corporate docs at ApolloMD still work clinical shifts. Litigation obviously prevents a doc from being migrated to another site.

From what I've read, the hospital was transferring unassigned patients and not necessarily uninsured. Yes, more of them are probably uninsured, but the intention was never to transfer uninsured patients but instead those without an established relationship with PCP's that admit at the facility. This probably came about by the PCP's complaining that they were admitting too many unassigned patients and couldn't fulfill their office obligations.

As someone who is well versed in EMTALA including serving in an expert witness and consulting roles, EMTALA requires specific patient investigations (i.e., they can't cite an EMTALA violation over a policy; CMS can only investigate violations after the fact and only for specific patients). I'm not sure if what the doc reported is even an EMTALA violation nor can I understand why he reported it without anonymity unless he was looking for some sort of kickback (CMS does not offer this with EMTALA violations like it does with recovered money from inappropriate CMS payments). I've been surprised at EMTALA investigations in the past. I can derail the thread with some recent investigations, but we can take that discussion offline.

So while I certainly understand the "stick it to the corporate man" mentality that seems to occur, I feel that there is more to this story than what is being discussed and I plan to reserve my judgement until all information is available.

 

[thegenius]

From what I've read, the hospital was transferring unassigned patients and not necessarily uninsured. Yes, more of them are probably uninsured, but the intention was never to transfer uninsured patients but instead those without an established relationship with PCP's that admit at the facility. This probably came about by the PCP's complaining that they were admitting too many unassigned patients and couldn't fulfill their office obligations.

Even then, whether insured or not, transferring patients with an EMC who can be stabilized at the original hospital is a violation. Unless the patient requests transfer. And I know you know that.


Interesting thought. I get Kaiser patients all the time at my non-kaiser hospital, and I transfer patients with an EMC routinely to Kaiser without asking the patient. Kaiser always accepts. Obviously if they are critically ill I don't transfer them, but I transfer stable pts who need to be admitted all the time. I guess these are not EMTALA violations because I have an accepting physician on the other end.

 

[southerndoc]

Even then, whether insured or not, transferring patients with an EMC who can be stabilized at the original hospital is a violation. Unless the patient requests transfer. And I know you know that.


Interesting thought. I get Kaiser patients all the time at my non-kaiser hospital, and I transfer patients with an EMC routinely to Kaiser without asking the patient. Kaiser always accepts. Obviously if they are critically ill I don't transfer them, but I transfer stable pts who need to be admitted all the time. I guess these are not EMTALA violations because I have an accepting physician on the other end.

Nope, can still be an EMTALA violation unless the patient requests transfer to an in-network facility.

Just because a patient needs to be admitted doesn't mean they have an emergency medical condition that has not been stabilized. Again, it's all patient centered investigations and a policy can't be found to be at fault. If you transfer someone with unstable angina and you have a cardiac cath lab available, then yes, it's an EMTALA violation unless the patient requests the transfer.

This particular facility may have stopped having a "city call" or whatever they call it for unassigned patients. In that case, they would not have an admitting physician on call and would not have been obligated to admit the patient regardless of their stability unless a specialist service usually admits the patient (cardiology was on call and patient had chest pain, etc.).

 

[thegenius]

How can you transfer a patient who is stable without an accepting physician at the other end? They can't just bundle them up, put them in an ambulance, and send them to the other ER.

 

[Dr Mantis Toboggan]

How can you transfer a patient who is stable without an accepting physician at the other end? They can't just bundle them up, put them in an ambulance, and send them to the other ER.

If only…

(I kid, I kid)

 

[southerndoc]

How can you transfer a patient who is stable without an accepting physician at the other end? They can't just bundle them up, put them in an ambulance, and send them to the other ER.

You can't, and I don't think the claim was that they were just putting them in an ambulance and sending them elsewhere without an accepting physician.

 

[EctopicFetus]

Agreed there is more to the story. Interesting side bit is the fmd is an FP doc. Just another example of why we are replaceable. Everyone thinks they can do what we do.
the details will be interesting.

@southerndoc serious question about Apollo. They were the rising star like a decade ago and now seem like an afterthought for the most part. I imagine they are smaller than envision team USACS app and maybe even Schumacher. I know they have lost bunches of contracts. What’s the scoop on the fall from grace. I know your site is good but obviously something is amiss.

 

[southerndoc]

We've gained more contracts than lost. Some of the contracts we lost were hospitals acquired by HCA. HCA traditionally partners with another CMG that bundles their hospitalist operation. We have pulled from some sites that were not profitable or for other reasons.

 

[EctopicFetus]

We've gained more contracts than lost. Some of the contracts we lost were hospitals acquired by HCA. HCA traditionally partners with another CMG that bundles their hospitalist operation. We have pulled from some sites that were not profitable or for other reasons.

Are you guys bigger now than ever before? Doesnt feel that way but I have no data.

 

[Groove]

ApolloMD is just like any other CMG IMO. There are good peeps in the company to be sure but corporate interests supersede all. Otherwise, it would never be a successful company. All the usual metric compliance shenanigans. The usual up charging APC visits to be billed under physician NPI and mandating signature of APC charts for visits where the doc never saw the patient. In their defense, Team, Schumacher and all the rest do the same. I now work for Team and actually I'm not forced to sign an APCs charts at one of their sites but am at the rest. The usual mystifying fuzzy math when explaining physician compensation. An incredible talent for selecting leadership that could hypnotize the pit docs and quell almost any vocalized concern from the front lines, clinical, corporate specific or otherwise. (Important for any successful CMG as corralling a group of docs is probably very much like herding cats. Docs typically expect SDG treatment and payment transparency which is totally unrealistic when working for a corporation like ApolloMD but they had a really clever way of making you FEEL like it was transparent). Leadership had uncanny emotional IQ. Some of the senior admin were very likable guys and gals. I never really liked the RVU centric compensation model. It's fine if you have plenty of patients to see and are fast, but terrible during a COVID pandemic or when volume is low or there are multiple inefficiencies within your hospital that lead to consistent issues with flow. (Most hospital systems). I also did not like that during COVID, the physician pay was used to compensate APCs so that they could be kept on the schedule. (In that particular case, I believe it was a site specific decision made by the FMD and not from Apollo Corporate). However, it hurts to see $8-10K taken out of your paycheck every month to pay the APCs when you don't have volume to justify their shifts.

I never had a bad interaction with Apollo and would probably work for them again if it was in an area that I were interested or at a really good site but I tend to prefer the compensation models of TH and Schumacher, etc.. (75% base, ~25% productivity incentive). With the latter compensation models, you tend to sleep better at night and are not at the mercy of crazy swings in compensation from month to month.

I worked for them for several years but was never under the impression that they were losing a lot of contracts. The ones I was privy to them losing were due to other forces and were at sites that were probably not profitable for them and another CMG was willing to take a smaller subsidy, etc.. They definitely seem to thrive in these medium sized contracts in niche areas and for what ever reason have not grown on the scale of TH or some of the other players.

Any litigation was always well handled. I think they contracted with Medical Mutual but any outside representation was always fantastic.

Lavish annual meeting/parties. One of the hotels in Atlanta was one of the nicest places I've ever stayed.

The corporate buy in program where you bought "equity" within the company and was a clever method of raising corporate capital and increasing liquidity from pit docs paychecks was hilarious and surprisingly successful.

Regarding the original article, I think any CMG is capable of "turning a blind eye" towards a potential EMTALA violation in the interests of contract stability but like most suits, I'm sure there are two sides of the story. It will be interesting to follow and see what happens.

 

[Groove]

The bad thing these days is that with any CMG, you really need to make sure you don't burn bridges and piss someone off when you exit. I've always bent over backwards to make sure no feathers were ruffled when I changed jobs. These guys can burn you and blacklist you and because they control so many job sites, can seriously affect future employment. I know one doc in the area that sued a CMG (not Apollo) for not paying him money owed when he left. (This is through another person, I don't know the details and did not know this doc personally) and was reportedly blacklisted at all of their sites. They took over a contract in town where he was working and he had to leave because they wouldn't contract with him.

I really hope this guy thought long and hard and got legal input before reporting the EMTALA violation. That kind of whistleblower suit does not go unnoticed among the CMGs and is another reason I'd expect him to find employment opportunities limited in the future.

My philosophy working for these corporate giants is very much like it was in residency. Keep your head down, don't cause waves, work hard and keep your mouth shut. Make hospital admin happy and make your FMD look good. Hide in the middle of the metric bell curve. Don't be an outlier and draw too much attention to yourself. All these things are good for job security. Sad, but true.

 

[thegenius]

The bad thing these days is that with any CMG, you really need to make sure you don't burn bridges and piss someone off when you exit. I've always bent over backwards to make sure no feathers were ruffled when I changed jobs. These guys can burn you and blacklist you and because they control so many job sites, can seriously affect future employment. I know one doc in the area that sued a CMG (not Apollo) for not paying him money owed when he left. (This is through another person, I don't know the details and did not know this doc personally) and was reportedly blacklisted at all of their sites. They took over a contract in town where he was working and he had to leave because they wouldn't contract with him.

I really hope this guy thought long and hard and got legal input before reporting the EMTALA violation. That kind of whistleblower suit does not go unnoticed among the CMGs and is another reason I'd expect him to find employment opportunities limited in the future.

My philosophy working for these corporate giants is very much like it was in residency. Keep your head down, don't cause waves, work hard and keep your mouth shut. Make hospital admin happy and make your FMD look good. Hide in the middle of the metric bell curve. Don't be an outlier and draw too much attention to yourself. All these things are good for job security. Sad, but true.

So sad I agree

 

[Kryptocoin]

The bad thing these days is that with any CMG, you really need to make sure you don't burn bridges and piss someone off when you exit. I've always bent over backwards to make sure no feathers were ruffled when I changed jobs. These guys can burn you and blacklist you and because they control so many job sites, can seriously affect future employment. I know one doc in the area that sued a CMG (not Apollo) for not paying him money owed when he left. (This is through another person, I don't know the details and did not know this doc personally) and was reportedly blacklisted at all of their sites. They took over a contract in town where he was working and he had to leave because they wouldn't contract with him.

I really hope this guy thought long and hard and got legal input before reporting the EMTALA violation. That kind of whistleblower suit does not go unnoticed among the CMGs and is another reason I'd expect him to find employment opportunities limited in the future.

My philosophy working for these corporate giants is very much like it was in residency. Keep your head down, don't cause waves, work hard and keep your mouth shut. Make hospital admin happy and make your FMD look good. Hide in the middle of the metric bell curve. Don't be an outlier and draw too much attention to yourself. All these things are good for job security. Sad, but true.

This . Unfortunately.


"They can hurt you more than you can hurt them"

 

[Arcan57]

I can’t believe the hospital c suite were this dumb. This has wrongful termination and retaliation written all over it.

What a bunch of complete *****s.

I sure hope he’s set for life after this.

Problem is the hospital doesn't employ him. So the relevant questions are does Georgia extend whistleblower protections to contract workers and if not was the doc terminated in a way that violated their contract with the CMG? I f$%#'ing hope so. Everyone involved on the admin side of this should cough up enough money that they're no longer a viable concern.