Health

Wednesday, Apr 10 2013 09:59 PM

Former medical director alleges groups prioritized profits over care

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    By Casey Christie / The Californian

    Bakersfield Family Medical Center at 4580 California Avenue.

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  2. 2 of 2

    By Casey Christie / The Californian

    Bakersfield Family Medical Center at 4580 California Avenue.

    click to expand click to collapse
BY RACHEL COOK Californian staff writer rcook@bakersfield.com

The ousted medical director of local medical groups is suing his former employer claiming he was wrongfully fired because he raised concerns that administrators and employees who were not doctors overruled medical decisions because they were more concerned about costs then patient care.

An amended complaint filed in San Luis Obispo County Superior Court last month alleges that Dr. John S. McGee was fired from his job as medical director for Bakersfield Family Medical Center and Coastal Communities Physician Network medical groups "in retaliation for recommending and approving appropriate and necessary medical care, his insistence on properly performing his statutory duties as medical director, and his refusal to participate in an unlawful scheme to compromise patient care for corporate profits."

In addition to the two medical groups, the lawsuit lists Heritage Provider Network Inc., Bakersfield Family Medical Group Inc., and Bakersfield Family Physicians Medical Center Inc.

Bakersfield Family Medical Center and Coastal Communities Physician Network are affiliated medical groups of Heritage Provider Network. They work as intermediarys between managed care plans, including Aetna and Anthem Blue Cross, the lawsuit says.

The lawsuit alleges that during McGee's less than two-year tenure, management and non-physician staff denied, changed and delayed care in contradiction with McGee's and other doctors' orders.

"Defendants' CEO, (Robert) O'Keefe, repeatedly and regularly challenged the medical decisions made by Dr. McGee and his staff, and directly confronted and debated treatment with the companies' hospitalists, the member's treating providers, and even the patients themselves directly, based exclusively on financial considerations," the complaint says.

O'Keefe died on Oct. 28, 2012. Registered nurse Carol L. Sorrell is the current chief operating officer for Bakersfield Family Medical Center/Heritage Physician Network and Coastal Communities Physician Network.

A statement from Heritage Provider Network Wednesday said the company does not comment on pending litigation, but touted its work.

"Heritage Provider Network is focused on providing quality, affordable, accessible healthcare to all its members throughout communities in California and has been nationally recognized for doing so," the statement said.

McGee had more than two decades of experience in internal medicine and a history of working in managed health care when he was hired in November 2010, according to the suit. He worked first in Bakersfield overseeing out-patient authorization for Bakersfield Family Medical Center (BFMC) and Coastal Communities Physician Network (CCPN), but his office moved to San Luis Obispo in May 2011 to oversee in- and out-patient services for CCPN plan enrollees as well, the suit says.

The lawsuit alleges that McGee increased CCPN's profitability and that he was so successful that his contract was changed in November 2011 to increase his salary and other benefits.

"Despite Dr. McGee's highly successful performance as medical director, defendants continuously threatened and pressured Dr. McGee and his staff to disregard patient safety in order to further increase profits," the lawsuit said.

The case lays out what it says are numerous examples of profits trumping patient care and hostile practices to achieve those ends. It alleges that O'Keefe pressured McGee and other employees to increase the denial rate for out-patient service requests to 6 percent from a historic level of 2 to 3 percent "without consideration of the nature of services requested and utilized or their medical necessity."

The suit claims that in April 2012, McGee and his staff met with an administrator for the CCPN office in San Luis Obispo to discuss their fears that changes made by non-physician employees and management to medical services were "compromising patient care" and increasing the risk of disease and death.

The complaint outlines specific cases that were brought up, including an instance in which the vice president of in-patient services cancelled a request made by a doctor and ordered by McGee to transfer a patient "whose particularly dangerous medical condition required immediate transfer," and another case where McGee's order to transfer a patient for surgery was changed to send the person to a different facility that could not provide the needed care "resulting in days delay before transfer to the facility ordered by Dr. McGee."

The suit also cites an ongoing issue of pediatric in-patient treatment, saying that management/non-doctor employees "routinely" delayed or denied transferring child patients to Santa Barbara Cottage Hospital and would instead try to s end them to "contracted facilities in Madera or Los Angeles."

"(Management and non-physician employees) would additionally delay requests for air-ambulance transport to such more-distant facilities (even in life-threatening, emergent cases) while they attempted to modify the transfer and save money)," the suit says.

In "rare cases" when use of an air-ambulance or transfer to Cottage Hospital was approved, McGee and his staff "were criticized and berated" for using expensive services. The suit says similar issues occurred with acute stroke patients.

McGee was then called to a meeting with administrators in April where he was criticized, the suit says. It says the next morning, O'Keefe instructed him to fire his "most-experienced nurse case manager" who took part in the previous meeting, a move McGee and his staff took as retaliation for "concerns about the quality of patient care, to drive a wedge between Dr. McGee and his staff, and to unambiguously convey the threat of termination for anyone else who continued to advocate for patients at the expense of company profits or questioned administration's acts."

On June 27, 2012, McGee was given written notice that he was fired effective immediately.

The lawsuit alleges that McGee's reputation was damaged and he suffered "grief, humiliation, and anxiety," as well as "aggravation of his asthma and episodes of chest pain." It also alleges his contract was breached because he was terminated without cause without the required 90 days' notice or severance pay.

The lawsuit also claims the providers violate California law that prohibits an employer from retaliating against an employee for making complaints about unsafe patient care.Don Ernst, the San Luis Obispo attorney representing McGee, said he believes the case will show that the providers were putting artifical limits on patient care.

"Dr. McGee went to bat with for those patients and was terminated for it," Ernst said.

Ernst said McGee's concerns have been reported to the California Department of Managed Health Care and the California Labor and Workforce Development Agency.

Rodger Butler, a spokesperson for the Department of Managed Health Care, said complaint information is confidential so he could not confirm if a complaint had been received or spurred an investigation.

John Metz, executive director for health care advocacy group JustHealth, said nothing in the lawsuit surprised him.

While Metz said he couldn't weigh in on the merit of the claims, he said the conduct of making decisions based on the financial interest of providers and corporate personnel is something his group sees on a regular basis.

"We've been seeing this for decades," Metz said.

A case management conference in the case is scheduled for May 20.

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