By Amanda Garrett
Akron Beacon Journal
AKRON, Ohio — Some local officials were gobsmacked last week when they learned from the Akron Beacon Journal that Summa Health System abruptly planned to replace its emergency room physicians on New Year’s Day.
More than a dozen fire departments and their emergency medical technicians (EMTs) partner with Summa and depend on their ER doctors for licensing, training and other things that keep operations going.
At least two people connected to those operations — Munroe Falls fire Chief Lee Chafin and recently retired Chippewa Township fire Chief Ron Browning — fired off emails to Summa on Friday laying out their concerns.
Would EMTs still have access to medications to help patients during ambulance runs? Could they still depend on Summa for monthly training? Would they even be able to provide EMS service in 2017?
Chafin said Saturday that Summa officials were able to answer some of his questions, saying neither drugs nor service would be impacted.
But New Year’s Eve, as the clock ticked toward 2017, Chafin and others remained concerned about potential emergency room delays caused by the sudden upheaval of staffing over a holiday weekend.
At midnight on Saturday, Summa’s contract with Summa Emergency Associates (SEA) — an independent physician corporation that’s separate from Summa — was to end and the emergency medicine doctors that staff all five of Summa’s ERs to wrap up work.
And a group of new emergency doctors paid by US Acute Care Solutions (USACS) of Canton was to take over as part of a new contract Summa said it began working on last week.
USACS works with hospitals across the country to provide similar groups of physician services. The company’s CEO, Dr. Dominic Bagnoli, is the husband of Dr. Vivian von Gruenigen, Summa’s chief medical officer, one of the most powerful administrative positions at the health system.
Summa officials said on Friday that von Gruenigen was not involved in the selection process and that she would not affect the relationship between Summa and USACS.
It was unclear Saturday whether USACS had enough emergency medicine physicians lined up to operate the emergency rooms.
On Friday, the group had reached out to each of the more than 60 ER doctors with SEA and offered them each $100,000 and a $75 per hour pay raise to join their company and return to the same emergency rooms they were departing.
None reportedly accepted Friday. And USACS put out an urgent plea online, saying it was looking for doctors and physician assistants to fulfill its new contract at five Summa facilities.
USACS promised to pay “premium rates” and listed Summa’s ER facilities, along with the number of visits each sees per year: Akron City (100,000), Barberton (41,000), Medina (9,000), Wadsworth (10,000) and Green (21,000).
ABRUPT CHANGE
Summa’s abrupt change in contractors — which unfolded last week — appears to be unusual.
Browning, who retired in July as chief of Chippewa Township’s Fire Department in Wayne County, said he’s been through this before with Summa and had two months’ notice to make the change.
It happened about four years ago, he said, when Summa dumped Emergency Medicine Physicians — the predecessor of USACS, which was to take over all of Summa’s ERs on Sunday — from Summa Barberton Hospital, which is Chippewa Township’s partner organization.
Summa at the time expanded its contract with SEA, the group of doctors that had run Akron City’s ER for more than 30 years, to cover Barberton.
Browning said Summa allowed two months for that transition because officials recognized how complicated it would be, Browning said.
Among other things, an emergency room physician from Summa is assigned to each fire and rescue department to serve as its medical director. EMTs obtain and distribute drugs under the medical license of their medical director.
When there’s a change in doctor staffing, fire departments must have a new medical director because, without that partnership, rescue workers would have no access to naloxone — a drug used to reverse the effect of heroin and other opiate overdoses — and other drugs used to help patients until they get to an emergency room.
There is no time to do that now. Instead of two months, Summa provided about 36 hours for the transition.
LARGER ISSUE
The SEA doctors losing their jobs have solved the immediate problem, fire chiefs said. They agreed to temporarily extend their work as medical directors for the fire departments that partner with Summa until something can be worked out with the incoming ER doctors of USACS.
But Browning said there’s a larger issue.
In his email to Summa, Browning asked officials to reconsider bringing in USACS, which was created in 2015 when Emergency Medicine Physicians joined the New York investment firm Welsh, Carson, Anderson & Stowe.
Browning, as fire chief, worked with Emergency Medicine Physicians in Barberton and said the doctors gave his department “very poor continuing education” and offered no help when they had a problem with a patient.
“I cannot speak for the current [Chippewa Township fire] chief, but I can tell you I, as a chief, would NOT allow EMP group to be our medical director again,” Browning wrote to Summa.
He said it would be better to reach out to Akron General Cleveland Clinic or University Hospitals.
It was unclear what Browning’s replacement, Chief Joyce Forrer, will do. She could not be reached Saturday.
In Munroe Falls, Chief Chafin said Summa can make whatever staffing decisions it wants in its emergency rooms.
But he said, when those decisions affect primary partners like fire departments, Summa should keep them informed “and not treat us like an afterthought.”
Chafin, like many others, said he only learned of the switch in Summa’s emergency room doctors Friday in the Beacon Journal and spent much of the day trying to answer questions about the transition.
Delays in the ER remained his biggest concern Saturday night as he waited for New Year’s 911 calls to roll in.
Summa, he said, assured fire departments they were bringing in extra staffing to help the new doctors learn Summa’s emergency room procedures Sunday.
Is it enough?
Chafin hoped it was enough.
Fire departments have limited overtime budgets and limited staff to answer calls for help.
His department “cannot afford to have squads hugging the wall waiting for beds while an organization transitions,” he told Summa in an email.
“We will watch closely over the next few days,” Chafin wrote, “and we will strongly recommend to our patients they consider transport to other facilities to expedite their care if there are delays.”
Copyright 2017 the Akron Beacon Journal