Doctors: Offer to work for less was rejected

September 02, 2002|by BOB MAGINNIS

Just about everything you've heard why Washington County Hospital's trauma center closed is wrong, according to Dr. Frank Collins, assistant director of the facility for six years. Collins said the general trauma surgeons didn't want more money, but less, as part of a compromise the hospital administration rejected.

James Hamill, the hospital's CEO, said that particular compromise was not made as a formal proposal, but didn't disagree with Collins' assessment that the two groups aren't close to a resolution of their dispute.

The local trauma center closed June 1 when the hospital announced it could no longer find enough doctors willing to cover all the shifts for the following month. At a meeting last week in Annapolis, hospital and state officials worked out a compromise, but doctors didn't attend the meeting and so far haven't agreed to any deal.

Collins said that he and other doctors couldn't be there because many colleagues are on vacation, leaving them short-handed. On the day of the meeting, Collins said he saw 20 patients in the hospital, 20 in his office and did several surgeries, some of which had been scheduled months ahead.


As for the compromise, Collins said it was developed by the general trauma surgeons to help the area's three neurosurgeons, who've been hurt by falling insurance and Medicare reimbursements, even as their malpractice insurance costs went up.

The demands of a Level II trauma center, which requires on-call doctors to be there 24 hours a day, combined with their private practice duties, made for work weeks of 80 to 100 hours, Collins said. The proposal to help included the following:

  • Drop the trauma center designation to Level III, which wouldn't require doctors to be in the hospital constantly when they were on call.

  • Pay the general trauma surgeons less, and

  • Give the savings to the neurosurgeons for taking trauma call, so they could afford to pay a part-time doctor to cover some weekends.

"You've got neurosurgeons who have been forced to expand their coverage areas to other hospitals, because in order to make your overhead, you've got to double and triple what you do," Collins said.

Collins said Dr. Abdul Waheed, the hospital's chief of medical staff, took the proposal to Hamill, but Hamill rejected it because, Waheed told them, he didn't want to set a precedent by paying for surgeons to be "on call" when previously the doctors had provided that service at no cost.

"We want less money and we've been saying that since June 1. Mr. Hamill said no and shut it down," Collins said.

A summary of Dr. Collins' remarks was hand-delivered to Dr. Waheed's office, with a request for comment, but he did not respond.

Dr. Michael Radley, one of the neurosurgeons, confirmed much of what Collins said but did say that "we've always gone out to other hospitals."

Like Collins, Radley said that the issue is not money.

"We need help, personnel-wise. That's what the issue is," Radley said.

Hamill said that the idea Collins spoke of was never part of a formal proposal, but was "a suggestion that someone made in the hallway." Hamill said that the proposals the hospital considered were written by doctors' attorneys, then submitted by the chief of staff.

What the hospital did to help out neurosurgeons while negotiations continued was to pay for a physicians' assistant for their practice, Hamill said.

Although what the hospital paid to the general surgeons in the trauma program was increased from $65 to $100 an hour, Hamill said that additional reimbursement for the neurosurgeons "is not something we traditionally do."

Hamill did confirm, as noted by Collins, that the hospital had sent out contracts with what amounted to fill-in-the-blanks sections so that the doctors could decide themselves how to divide the pool of $1.5 million the hospital made available for additional compensation.

The dispute is not simple, because the doctors I've spoken to and hospital administrators each have very different views of it. From the doctors' perspective, the hospital refuses to work with them, while the hospital says it's willing to talk, but says doctors won't meet them halfway.

My feeling is that if a physician loved and respected by both sides, like the late John Marsh (for whom the hospital's cancer center is named) were involved, he might be able to help both sides find common ground. Barring such a person stepping forward, an outside mediator will be needed.

Something everyone can do without is the comments of people like Maryland State Police Superintendent David Mitchell, who issued a statement accusing the doctors of walking out on the people of Western Maryland and forgetting their Hippocratic oath.

Dr. Radley said Mitchell wouldn't take his call, but said an aide in Mitchell's office told him the letter was written to get the process moving. Instead, it prompted anger and hurt, Radley said. In my mind, it's a predictable outcome when those who don't know what they're talking about behave as if they do.

Bob Maginnis is editorial page editor of The Herald-Mail newspapers.

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