HomeMy WebLinkAbout20090341.tiffTo get right to the point, this is a cry for help. This is a plea to start a process
of informing the County Commissioners and the public about Banner and how
their presence in Greeley has negatively affected healthcare here.
The hospital in Greeley, North Colorado Medical Center, is owned by Weld
County. There is a board of trustees and a board of directors (NCMC, Inc)
that oversee the operations at the hospital. These groups have hired a
company, Banner, to manage the hospital for them. (I do not khow the county
goes about appointing members to the trustee board or the NCMC Inc. board.)
Banner is a multibillion dollar not -for-profit company based in Arizona.
It is a rapidly growing sentiment within the medical community that Banner is
doing a poor job as manager. This is actually the second acute crisis
involving Banner and their contract at NCMC since their arrival in Greeley.
The first occurred during a process of renewing their contract about eight
years ago and it was discovered that there were many conflicts of interest
between members of Banner and members of the NCMC, Inc. board whose
job it was to negotiate and act on the contract. At that time an opportunity
was missed to start fresh with a new manager or an in-house CEO or a
partnership with someone such as Poudre Valley. Instead, there were a few
changes to the membership of the NCMC board and it was business as usual.
This second crisis is upon us now as Greeley faces an increasing exodus of
healthcare workers.
There has been a steady and ever increasing number of very qualified and
capable physicians leave Greeley over the past years. To put it bluntly, Banner
has run off multiple physician groups and individual providers under the guise
of contract disputes and changing hospital services. There has been almost no
comment publically but when asked privately, most physicians involved
would say they were forced to leave by Banner either by being threatened
with replacement or by actually being replaced, or they have tired of the fight
with administration and are moving to a more pleasant work environment.
For the most part the ones that express some degree of satisfaction are in some
way financially bound to Banner as contracted doctors or employees outright.
The nurses and other hospital staff won't answer questions about Banner
either. They also fear losing their jobs. They too are being removed from
NCMC for questioning the new world order or for taking sides with the
physicians. No one, not doctors, not nurses, nor staff, is talking publically for
fear of retaliation but everyone is talking about this privately at home, at work,
and in every break room.
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This community needs to be asking questions of the NCMC Inc. board of
directors and the Greeley community leaders about their decision to retain
Banner as the manger of NCMC. Banner, despite the beautiful color adds and
the shiny new building addition and glowing public relations blitz, is killing
the medical community in Greeley. Perhaps no one hears there is anything
wrong because Banner only gives certain doctors, certain staff and personnel
and certain patients satisfaction surveys. Perhaps those who receive surveys
are afraid to answer honestly fearing repercussions. Perhaps it is because
most physicians refuse to comment when contacted by the media. Or, perhaps
the media who attend NCMC Inc. meetings are shut out from the executive
sessions where all the discussions of such matters take place. But, the
atmosphere inside the halls of NCMC is toxic. This sounds alarming and it
may make you wonder how things can be so bad without the community
knowing about. How can it be true without affecting patient care and patient
outcomes? The painful answer is that it does affect patient care and a great
deal of effort goes into spinning the information to keep the truth from being
heard. The fact that the patients don't experience more of the negative effects
is a tribute to the very hard work and devotion to the health care professionals
who remain at NCMC, the doctors, nurses, techs, etc... who struggle on doing
their dead best to rise above it while working in such a hostile environment.
It would be too easy to simply review an isolated year or two of Banner's
tenure and possibly conclude that fault might lie with a doctor group or two.
But, to fully understand, one must go back many years. From nearly the time
Banner arrived in Greeley there has been a steady deterioration of the
relationship between the physicians and the hospital administration. It is a
manifestation of Banner and the NCMC administration bullying the medical
staff and fostering an atmosphere of fear, fear that the member of the medical
staff will be sanctioned as being "disruptive" (the kiss of death for a doctor
these days trying to become a member of a hospital, clinic, or insurance
carriers medical staff) or that they will be replaced by doctors under contract
to Banner or more recently, simply replaced by doctors that are hired outright
as Banner employees. It is also easy to ignore the complaints of a few doctors
and chalk up their disputes with administration as the greed and selfishness of
spoiled, rich doctors who don't want to take more call or provide extra
service. But the list of physicians leaving this community in the past five to
ten years is staggering including the heart surgeon, the burn surgeon, the
radiology group (10-15 doctors), the anesthesia group twice (10-15 doctors),
the Greeley Medical Clinic specialists (general surgeons, ENT, plastic
surgeon, orthopedic surgeons, hospitalists), the gastroenterologists, the
intensive care physicians, the general surgeons, the orthopedic surgeons, and
the trauma surgeons, to list a few. When the list includes so many physicians
representing so many specialties one must pause to consider why.
Ten years ago a disgruntled doctor group or two leaving town may not have
meant much in the big picture but as the number of doctors has increased and
the number of different specialties as widened it poses a real risk to patient
care. There are days, randomly throughout the calendar, that there are no
doctors of certain specialties on call at NCMC to take of patients with certain
problems. There may be no neurologist or intensive care doctor or GI doctor.
On those days patients requiring those services are transported to other
hospitals. Some days the ICU doctor is actually in Arizona watching the
Greeley patients on a TV monitor. On many of those days coverage is
provided by temporary travelling doctors. They may or may not be able to
provide the same care as the full time doctors.
The explanations behind this are obviously very complicated and too deep for
a single essay but in simple terms Banner has a preconceived notion as how
they want to run the hospital. It begins with absolute control over physician
behavior and medical practice. It ends by replacing any physician or group
that refuses to say yes to Banner's demands. It is facilitated by a very few
physicians who use the discord to manipulate Banner in effort to make gains
for themselves. They become the validation for Banner's bad behavior. In
some instances Banner simply states that they prefer to have a certain
specialty under contract and if those doctors refuse they are replaced. They
have used "exclusive" contracts the eliminate physicians that don't play along
with them. When the mood of the medical staff reaches some critical level of
discontent that reaches the ears of the Banner corporate office in Arizona, the
CEO flies in and cleans house in the administration office with new promises
of a fresh start. There have been at least five administrators in Greeley since
Banner arrived about ten years ago. Unfortunately they have become
progressively less likely to work with the medical staff and the situation
deteriorates further.
The NCMC Inc. board needs to explain to the community why it continues to
allow Banner to run off doctors and physician groups year after year. It
should be asked why it is so difficult to recruit and retain physicians to this
community and what can be done to change that. Perhaps Greeley patients
are not worse off because just a short trip down highway 34 Medical Center of
the Rockies and Poudre Valley hospital are reaping the benefits of this. Their
administration jokes at how easy it is to recruit physicians to their facilities
and they thank Banner for it. As patients we should be asking why our
doctors are asking us to have our care, our appointments and our surgeries in
Loveland and Ft. Collins and not in Greeley. Truth be told it is not because
that is the only place and time they can fit us in. They are re-establishing their
practices away from NCMC and Banner. They love working in an
environment where the administration welcomes them supports them and
helps them prosper. They enjoy some sense of security in their practice where
the administration does not threaten to replace them or cancel their contract
every two years.
How many more doctors leaving will be the critical number? How many
patients forced to drive to other communities for care will trigger interest.
How many transfers out (or refusal of transfers from outlying towns into
Greeley) will get people demanding answers and action? I doubt there will be
any significant change while Banner remains, maybe not while the NCMC
board remains unchanged. In these desperate economic times it may not be
possible for our hospital to weather this storm. Patients will probably be
forced to have their care down the highway simply because there will not be
the physicians and nurses remaining to care for them in Greeley. Maybe
patient already accept that. Driving to Loveland is still faster than driving
across town in Denver. Perhaps the downturn will force Banner to move on.
It has abandoned many hospitals in the past when they become too much of a
burden or have played out, usually in small rural communities which lack
other healthcare options (the Dakotas, New Mexico and others). Or maybe
the community will take an interest.
The NCMC Inc. board knows something is amiss but may be misguided as to
the reasons. The trustees should also know. The trustees are accountable for
keeping the county commissioners informed and if they are not that should be
corrected. The commissioners and the media need be informed and then pass
that on to the public so that the proper pressure can be applied to effect
change. Perhaps we can get answers from the hospital, the directors and the
county as why our doctors are going away. To start someone needs to be
asking the right people the right questions.
Hello