{"id":13320,"date":"2022-03-28T04:47:13","date_gmt":"2022-03-28T11:47:13","guid":{"rendered":"https:\/\/worldcampaign.net\/?p=13320"},"modified":"2022-04-04T04:48:18","modified_gmt":"2022-04-04T11:48:18","slug":"doctor-fired-from-er-warns-about-effect-of-for-profit-firms-on-u-s-health-care-nbc-news","status":"publish","type":"post","link":"https:\/\/worldcampaign.net\/?p=13320","title":{"rendered":"“Doctor fired from ER warns about effect of for-profit firms on U.S. health care”, NBC News"},"content":{"rendered":"

By Gretchen Morgenson, March 28, 2022<\/span><\/p>\n

A doctor fired after criticizing care at the ER he ran said execs are focused on the financial outcome, \u201cand the outcome is \u2018Hey, we\u2019re making money.\u2019\u201d<\/em><\/p>\n

Patients seeking emergency treatment at the busy Overland Park Regional Medical Center in Kansas near Kansas City, Missouri, didn\u2019t know their safety was potentially at risk. But the medical director of the emergency department saw the danger in 2012 and for years urged his bosses to address it by adding staff members.<\/p>\n

Then he was fired<\/a>.<\/p>\n

What happened to the medical director, a former Army doctor named Ray Brovont, isn\u2019t an anomaly, some physicians say. It is a growing problem as more emergency departments are staffed by for-profit companies. A laser focus on profits in health care can imperil patients, they say, but when some doctors have questioned the practices, they have been let go. Physicians who remain employed see that speaking out can put their careers on the line.<\/p>\n

Today, an estimated 40-plus percent of the country\u2019s hospital emergency departments<\/a> are overseen by for-profit health care<\/a>staffing companies owned by private equity firms<\/a>, academic research, regulatory filings and internal documents show. Two of the largest, according to their websites and news releases, are Envision Healthcare, owned by KKR, and TeamHealth, of the Blackstone Group. EmCare, the health care staffing company that managed Brovont, is part of Envision.<\/p>\n

\"Ray<\/picture>
Dr. Ray Brovont.<\/span>NBC News<\/span><\/figcaption><\/figure>\n

Private equity firms have taken over a broad swath of health care entities in recent years. They use large amounts of debt to acquire companies, aiming to increase their profits quickly so they can resell them at gains in a few years.<\/p>\n

There\u2019s a reason private equity firms have invested in companies staffing hospital emergency departments, said Richard M. Scheffler, a professor of health economics and public policy at the University of California, Berkeley.<\/p>\n

\u201cThe money in the hospital is in the ER,\u201d he said. \u201cIt is the biggest net generator and a huge profit center for almost all hospitals.\u201d The problem, he said, is that \u201cER doctors are being told how to practice medicine\u201d by financial managers.<\/p>\n

Brovont, the fired Overland Park emergency room doctor, agreed.<\/p>\n

\u201cThese administrators who make these changes and implement these policies don\u2019t feel the downstream effects of their policy changes,\u201d he said. \u201cThey look at the outcome, and the outcome is \u2018Hey, we\u2019re making money.\u2019\u201d<\/p>\n

Three places at once\u00a0<\/strong><\/h2>\n

As a former military doctor who saw combat in Iraq, Brovont knew how to solve problems quickly. He took that approach to leading the emergency department at Overland Park.<\/p>\n

\u201cThe goal was to identify an issue before there was a bad outcome,\u201d he said.<\/p>\n

One bad outcome Brovont hoped to avoid was related to \u201ccode blues,\u201d urgent calls to help Overland Park patients whose hearts had stopped beating or who were no longer breathing. After the HCA-owned hospital doubled its capacity to 343 beds and added a separate pediatric emergency room in 2014, the facility\u2019s code blue policy became unsafe for patients, Brovont and his 18 fellow ER doctors concluded. It required an emergency department doctor to attend to code blues elsewhere in the hospital, which meant leaving the emergency room without a physician.<\/p>\n

\u201cMy physicians were being asked to be in three places at once,\u201d Brovont said.<\/p>\n

Staffing issues had been a concern for Brovont since he joined the hospital in 2012. He had spoken up about them early on, according to documents in a lawsuit he filed alleging wrongful discharge, but got nowhere. The expansion of the hospital made the problem worse and brought the matter to a head.<\/p>\n

\"Ray<\/picture>
Ray Brovont served as an Army doctor in Iraq in 2005.<\/span>Courtesy Dr. Ray Brovont<\/span><\/figcaption><\/figure>\n

Staffing at the hospital was handled by EmCare, a health care staffing company owned since 2011 by the private equity firm Clayton, Dubilier & Rice. The firm exited its investment in EmCare in March 2015 after the company issued stock to the public, but EmCare directors affiliated with Clayton, Dubilier & Rice remained on EmCare\u2019s board into 2017. EmCare became Envision Healthcare and was bought by a different private equity company, KKR, in 2018.<\/p>\n

In 2015 and 2016, frustrated by the inaction on the code blue policy, Brovont took his and his colleagues\u2019 concerns to Dr. Patrick McHugh, his superior at EmCare. Federal law required Level II trauma centers like Overland Park to make a physician available 24\/7 in the emergency department to examine incoming patients, Brovont told McHugh.<\/p>\n

Hiring an additional doctor would solve the problem, but that didn\u2019t happen. McHugh acknowledged to Brovont that the decision was financially motivated, court records show, and said in an email to the physicians: \u201cProfits are in everyone\u2019s best interest.\u201d<\/p>\n

Continuing to argue for a change in the policy, Brovont sent a memo to management outlining his unit\u2019s fears; he was fired six weeks later, in January 2017. \u201cThere is a responsibility as the corporate representative to support the corporation\u2019s objectives,\u201d McHugh told him, according to court filings.<\/p>\n

In addition, Brovont was barred from working at nearby hospitals whose emergency departments EmCare oversaw. Because he was an independent contractor for EmCare and not an employee of the hospital, there was no tribunal to which he could petition against his dismissal.<\/p>\n

Brovont, who hasn\u2019t spoken out about his case until now, sued EmCare for \u201cwrongful discharge in violation of public policy\u201d in 2017. A jury awarded him $29 million, including $20 million in punitive damages, which was reduced to $26 million on appeal. That ruling was final.<\/p>\n

A spokeswoman for Envision, EmCare\u2019s parent, said in a statement that the company complies \u201cwith state laws and operates with high ethical standards that put patients\u2019 health and safety first.\u201d<\/p>\n

\u201cEnvision clinicians, like all clinicians, exercise their independent judgment to provide quality, compassionate, clinically appropriate care based on their patients\u2019 unique needs,\u201d it said. \u201cThe concern raised by Dr. Brovont was related to a hospital policy, not an Envision policy, and predates Envision\u2019s current leadership team.\u201d<\/p>\n

McHugh didn\u2019t respond to an email and a phone message seeking comment. He no longer works for EmCare. Overland Park Medical Center wasn\u2019t a party to Brovont\u2019s litigation. Clayton, Dubilier & Rice didn\u2019t respond to a request for comment.<\/p>\n

\"Overland<\/picture>
Overland Park Regional Medical Center in Overland Park, Kan.<\/span>NBC News<\/span><\/figcaption><\/figure>\n
<\/div>\n","protected":false},"excerpt":{"rendered":"

By Gretchen Morgenson, March 28, 2022 A doctor fired after criticizing care at the ER he ran said execs are focused on the financial outcome, \u201cand the outcome is \u2018Hey, we\u2019re making money.\u2019\u201d Patients seeking emergency treatment at the busy Overland Park Regional Medical Center in Kansas near Kansas City, Missouri, didn\u2019t know their safety […]<\/p>\n","protected":false},"author":1001004,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[53],"tags":[],"_links":{"self":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts\/13320"}],"collection":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/users\/1001004"}],"replies":[{"embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=13320"}],"version-history":[{"count":2,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts\/13320\/revisions"}],"predecessor-version":[{"id":13322,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts\/13320\/revisions\/13322"}],"wp:attachment":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=13320"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=13320"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=13320"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}