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Saturday, Mar 24 2012 10:00 PM

County supervisors knew beforehand KMC residency program could be cut

BY JAMES BURGER Californian staff writer jburger@bakersfield.com

When opposition exploded last month to the decision to cut a class of student doctors from Kern Medical Center's family practice residency program, the clear target of community ire was hospital CEO Paul Hensler.

But it turns out the idea wasn't his and he didn't act alone.

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THE NEW CLASS

When the Board of Supervisors decided to take a new class of family practice residents at Kern Medical Center, the formal deadlines that usually lead to student doctors being hired had passed.

There was concern that all the top quality doctors would have been snapped up and KMC would have to accept other programs' leftovers.

That didn't happen, said Family Services Department Chair Dr. Navin Amin.

"We were wrong in our estimate," Amin said. "There were some good candidates. We did really well."

"These are people who, for whatever reason, didn't like what they got in the match," said hospital CEO Paul Hensler. "They'll all meet the standards."

Both Amin and Hensler said the competition for the KMC residency was fierce.

"We had 1,100 calls and we had 900 emails," Amin said. "It was a nightmare."

Hensler made the decision Feb. 22. But Family Practice Department Chair Dr. Navin Amin, under pressure from Hensler to cut costs, said he came up with the idea of cancelling the class.

And before acting, Hensler told all five Kern County supervisors about the idea. At least one supervisor gave Hensler the go-ahead.

The supervisors only reversed course after being deluged with community opposition.

Nearly two weeks later, a new class of six resident doctors has been hired and the hospital is exploring ways to remake the family practice residency, which has attracted many new family doctors to Bakersfield.

PRESSURE

County supervisors hired Hensler in early 2007 to reform Kern Medical Center, which was losing money and had been battered by controversy.

They credit him with saving the county "millions of dollars" and getting the hospital's revenue-over-expense statements into the black.

But the hospital remains in financial trouble and Hensler continues to search for places to save money. He's been looking at the Family Practice Department for a while.

Dr. Amin said he came to Hensler several weeks ago with the idea of cutting a class of resident doctors.

He didn't like doing it.

But, Amin said, he was worried the entire department was in jeopardy and he wanted to protect the 12 residents already in his three-year program.

He and Hensler had been battling over the Family Practice Department's finances for months. Hensler calculates Amin's department is losing $5.5 million a year. Amin bristles at Hensler's inclusion of overhead costs at Sagebrush Medical Plaza, and other expenses, as negatives on the department's bottom line.

Hensler said he has made more than 40 money-saving suggestions to Amin, all of which have been rejected.

Amin said Hensler is pushing for his doctors to see more patients, see them faster and compromise service quality.

"Dr. Amin is a very sweet, nice guy," said Supervisor Ray Watson. But "Sagebrush Clinic has been a problem for years. When Paul came in, he tried to get them to adopt newer methodologies."

Neither side was budging.

"OFF MY RADAR"

So, with a hiring deadline looming, Amin explained to Hensler that it would be unfair to accept a new class of residents if Hensler wasn't sure he'd keep the Family Practice Department.

He suggested Hensler cancel the upcoming class of residents, but sought a guarantee that current residents could finish their training.

"I thought that if I could get that much, I would do enough for my residency and my residents," he said.

"He came to me a couple weeks before (the match of hospitals and resident physicians) and said, 'If we're having these problems, should we really be taking a new class of residents?'" Hensler said. "That was totally off my radar. I hadn't even thought about it."

Hensler took it to the Board of Supervisors in early February.

"He did tell us he had a way to save $6 million," said Supervisor Mike Maggard. Maggard and Supervisor Karen Goh said they didn't comment on Hensler's idea.

"I was aware that Paul was grappling with this issue, but it wasn't appropriate for me to give him direction without being in the presence of the community and my colleagues," Goh said.

But Watson said he supported Hensler's call.

"I know he called me ahead of time and I said, 'I support your decision,'" Watson said.

BACKLASH

When the decision became public on Feb. 23, the backlash was fierce.

It is clear from emails between Hensler and the board that Hensler saw not hiring a new class of residents as a potential first step to closing the Family Practice Department.

Current and former KMC residents, patients and local family practice doctors launched a flurry of opposition at Hensler. At the next Board of Supervisors meeting, five days after the news broke, supervisors asked Hensler about the situation.

Maggard asked Hensler if ending the program would save $6 million. He expected, Maggard said, to hear the word "Yes."

Hensler said, "No."

"I distinctly remember saying to myself, 'Oops, this will be interesting,'" Maggard said.

While ending the family practice department at KMC would save about $6 million, according to Hensler's math, terminating a class of six resident physicians who make a salary of $40,637 plus benefits would save the county only a fraction of that amount.

Supervisors decided that because the issue wasn't on their agenda that day, to have a full hearing on the matter at their March 12 meeting at KMC.

REVERSAL

For most of the March 12 meeting, speakers who packed the small conference room at KMC came up one-by-one to lob appeals, critiques and direct attacks at Hensler and his decision.

Dr. Ramon Neufeld, a graduate of KMC's family practice program, said he was very unhappy with Mr. Hensler's "30-second" decision to cut the class of doctors.

"The decision appears short-sighted, unilateral, sudden, swift and fatal," he said. "This was done without any apparent due diligence or letting the community know what was going to happen."

"For someone to just decide to close the family medicine residency program and not consider us residents," said KMC resident Dr. Maryam Yazdanshenas, "It's not fair. It's not right. It's not ethical."

At the end of the meeting, supervisors delivered some chastisement to Hensler as well, then reversed his call.

"Before we make a rush to judgment, we should stop and take a deep breath and see where we really ought to go," said Supervisor Jon McQuiston.

Maggard also took a firm stance.

"If I could back the tape up and replay it, I would prefer to see us have a discussion about how we could (find a better financial model) while we sustain the program," Maggard said. "It's kind of like a huge stone has been tossed into the pool that is our community and the ripples are very, very significant."

But one supervisor didn't feel it was fair that Hensler should be taking all the heat.

"I want to accept the responsibility if I didn't understand the full picture and I didn't give you the appropriate guidance," Goh said at the meeting. "I wish now, in hindsight, things could be different."

She could see Hensler taking the heat for something not totally his responsibility.

"For me, as a member of the board, it's important to share responsibility," she told The Californian this past week. "I could see that all of the attention was focused on one person."

NEW MODEL

There may be a silver lining in all this, leaders now say. Hensler notes that the community is far more engaged now in supporting Kern Medical Center.

And there is potential for partnerships between the larger medical community and the hospital, or at least the chance to work toward the same goal.

Dr. Michelle Quiogue, president of the Kern County Chapter of the California Academy of Family Physicians, said there is resolve in the larger community to assist KMC or create a separate program to ensure good doctors are trained here and invited to stay here.

"What we want to get away from is being vulnerable to one organization's budget problems," she said.

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