SOS in the ER

The Latest from Marquette, MI by Brian Cabell

The Doctor: “Morally, I can’t work at this hospital anymore.”

UPHS Administration: “We are committed to safe staffing.”

WE’VE ALL HEARD the stories from UPHS-Marquette over the years—unhappy doctors unwilling to stay long-term with the hospital, overworked and exhausted nurses ready to leave their profession, overlong delays in the Emergency Department, misdiagnoses of illnesses, inefficiencies throughout the hospital, a lack of transparency, a priority on profit over patient care…the list goes on and on.

And we’ve wondered, are these just the chronic complaints you get about any institution that serves the public? Is this just isolated, anecdotal griping? Is it exaggerated? After all, every hospital in America gets criticized from time to time; no institution is perfect.

However.

We’re now hearing from voices within the hospital. Specifically, five doctors either with direct or indirect involvement in the Emergency Department. These are authoritative, in-the-know voices. For obvious reasons, they prefer that their names not be publicized; they fear retaliation…For clarity purposes, we’ll refer to them as Dr.#1, Dr.#2, Dr.#3, Dr.#4, and Dr.#5.

“Several doctors are planning to leave the Emergency Department in the near future,” says Dr.#1, who’s closely associated with the ED. “We are good people trying to provide good care for our patients, but the system is not designed to support that.”

“They’re already understaffed in the Emergency Department,” says Dr.#2, a local doctor who’s familiar with the workings and the personnel in the ED. “The physicians and techs are overworked. The hospital has offered no solution. In fact, they’re going in the other direction.”

Going in the other direction, as in cutting the number of hours daily that doctors will be assigned to the Emergency Department. Originally, the administration ordered a reduction of eight hours a day (starting May 1st), but after pleading from ED doctors, that was reduced to four hours. Still too much, the doctors say.

Waiting room times at the ED reportedly reached an all-time high last year, and boarding times (the time before an ED patient can be sent upstairs as an inpatient) have quadrupled in the last decade.

“I’m worried about someone dying in the waiting room or on a bed because we can’t get to them,” says Dr.#3, an ED doctor. “I don’t want to lose my license. But more important, it just feels horrible when you know someone needs care, and you can’t do anything about it.”

So, why has the problem in the Emergency Department become so acute? The doctors point to several specific failings--attributed to poor decisions, budgetary cutbacks, and a hospital administration that either can’t or won’t respond to the urgent concerns of its employees:

1. DOCTOR TURNOVER throughout the hospital…Doctors come and doctors leave. They don’t want to stay, our sources tell us, in large part because of the profit-first attitude and the dismissiveness of the administration. Locum doctors (temporary fill-ins) are brought in to replace them.

   “They’re bringing in replacements, many of them younger and inexperienced, and with no ties to the community,” says Dr.#2, the local doctor. “It’s a loss for the community.”

   “We won’t be able to provide proper radiation therapy treatment for cancer patients over the next several months because we don’t have enough oncology doctors and techs,” says Dr.#4 who works with the Emergency Department.

   “The problem is a loss of talent,” says Dr.#5, an ED physician. “We can’t send our Emergency patients most of the time to a vascular surgeon or a GI doctor, or urology, or opthamology, or facial surgery, because there are no doctors available.”

2. NURSING STAFF TURNOVER…It’s especially serious in the Emergency Department where the long-term, experienced nurses have left, leaving behind a less experienced staff with little institutional knowledge. Nurse-to-patient ratios are skewed, to the detriment of the patients. Efficiency has suffered.

   “We don’t have a triage nurse most of the time,” says Dr.#5, “so patients have to wait, sometimes for hours.”

3. EMERGENCY DEPARTMENT REGISTRATION…It’s been contracted out to an agency that is slow and inefficient.

4. ELDERLY CARE IN THE ED…Many of the older folks who arrive at the Emergency Department need to be taken upstairs for inpatient care, but hospital policy keeps them downstairs in the ED because the hospital would not be reimbursed for that care.

   “We can’t send them upstairs for therapy, so they get stuck in the ER,” says Dr.#3, the ED doctor. “They fill the beds down here, they’re not getting the proper care, and it disrupts the flow in the Emergency Department.”

5. PEDIATRIC CARE IN THE ED…Few kids who arrive in the ED can be sent upstairs for inpatient care because the hospital has very few pediatric nurses.

   “There are no nurses to take care of them,” Dr.#3 continues, “so they’re trapped in the ER or they’re sent to another hospital and they’re incurring huge bills.”

6. STROKE SERVICE…Patients with strokes in the ED are serviced by a telemedicine agency, one that is affiliated with LifePoint--a less efficient group than the one the ED previously worked with.

7. 24 HOUR-A-DAY HOUR DIALYSIS…The hospital used to have it. No longer. It’s either contracted out to an understaffed group, or dialysis patients are simply transferred to Green Bay. Again, huge transport bills for the patients.

8. COMPUTER SYSTEM…ED doctors have to work with three different systems, and the systems don’t talk to each other. Totally inefficient, requiring extra work for the doctors.

9. UNRESPONSIVE HOSPITAL ADMINISTRATION…There are meetings, discussions, and exchanges of emails, but little or no progress is made in addressing the doctors’ concerns.

   “The administration is taking its dictates from the corporate office,” says Dr.#1. “There’s nothing we can do about it. The hospital is designed for maximum profit, there’s nothing to ensure safety.”

   “If you try to talk to them and suggest something,” says Dr.#5, “it’s like trying to buy a used car. They say, ‘Oh, I’ll have to talk to Tennessee (the corporate headquarters) about that.’”

   “The CEO (Gar Atchison) is not approachable. He’s condescending,” says Dr.#4. “If he would just hang out with us and see what we’re facing, even for a short time, he’d begin to understand. But he won’t.”

The doctors’ comments clearly are damning. No holds barred. It’s no wonder that we hear that several of the physicians are planning to leave the hospital.

UPHS ADMINISTRATION RESPONSE: Administrators, both in Marquette and in Tennessee, have heard the criticisms but they push back on most of them. They have a hospital to run, they say, in a difficult and uncertain environment…All hospitals nationwide, they contend, are facing these same challenges—including a shortage of clinical workers and providers, a shift in demand for healthcare services, and rising costs.

“We are committed to safe staffing and dynamically review staffing on each of our units—at a minimum of three times a day—to align with national standards and support our delivery of the best patient care possible…” the hospital explains. “…We regularly analyze our ED provider coverage and staffing models, which fall well within industry benchmarks…”

“Currently, our provider and staffing turnover rates in the Emergency Department are consistent within industry standards. We continuously evaluate the specialty services we provide to ensure our care is reflective of what our community needs—when they need it.”

UPHS insists it’s using the best, most efficient services, including telemedicine, in treating its Emergency Department patients.

“Another common industry practice is to contract with vendor partners for specific clinical and support functions,” the hospital continues, “and these partners (dialysis, registration) are not immune to the workforce challenges and other industry pressures we are all facing right now…”

Bottom line from UPHS and their corporate parent Duke LifePoint—they’re doing their best under difficult circumstances, they meet industry standards, and their patients are being well taken care of.

So, how can the hospital administration and the doctors have such radically different views of how the hospital operates? If this were just a single disillusioned doctor complaining about his/her employer, we could dismiss it. But this is five (and we’re assured there are many more), and the five, frankly, don’t seem like bomb-throwers or whiners. They strike us as articulate, highly-skilled, conscientious caregivers who seem truly shocked by what has happened to their hospital.

“I’ve worked in ER’s and ICU’s in other hospitals,” Dr.#5 says, “and nothing comes close to this.”

“I love living here and I want to stay,” says Dr.#4, “but I want to be proud of the hospital where I’m working. And I’m not.”

“I’m committed to this community,” says Dr.#1, “but morally, I can’t work at this hospital anymore.”

Yikes.

But maybe, just maybe, since we’re past the Covid crisis and these criticisms are being voiced, there’s now hope for improvement?

“During Covid, it was tough for all of us,” Dr.#1 explains, “but it felt like we were all working together. These last two years, though, it’s just fallen apart.”

“Lately, it (the hospital’s downward trend) has been picking up steam,” says Dr.#3, “and now it’s roaring like a freight train.”

Solution?

“There’s an inherent problem with for-profit hospitals,” says Dr.#1. “It’s time for somebody else to take over.”

There have been repeated rumors over the last few years that other hospital groups—The University of Michigan, Bellin, and Marshfield—have shown interest in buying UPHS, but nothing’s come of it so far. Would they provide distinct improvement? Hard to say. Further, as many will recall, Marquette General, which was the nonprofit predecessor to UPHS, had its own set of problems.

And nonprofit hospitals which comprise 57% of the hospitals nationwide (compared to 24% for-profit, and 19% government-owned), are now struggling with many of the same challenges as the for-profit institutions.

One other possible, and unsatisfying solution here, and it’s a distinct possibility: UPHS, tired of dealing with the turnover and criticism within the Emergency Department, simply hands it over to an outside business—a Contract Management Group—and let that group deal with all the problems. That would probably not be the best way to rebuild the public’s trust in our hospital.

Ultimately, there is this one simple, indisputable fact: for-profit hospitals are designed to make money for their investors. That’s their priority. They wouldn’t exist unless they were making money. Of course, that doesn’t preclude providing good care for their patients, and many for-profit hospitals are doing just that.

There’s no simple answer here. All we can say with absolute certainty is that good people—skilled caregivers that this community desperately needs—are fed up with the institution where they serve. And they’re reluctantly leaving that institution--and us.

We’re poorer for it.

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