3/22/2007

A little more Clinic stuff...

I hate to beat a dead horse over this story, but it has generated a great deal of interest (and it's not the coal plant!). So I offer just a couple more thoughts.

First, for anyone who would argue that the Tribune did not purposely try to sensationalize this, I ask why was the story about Dr. Garver's leaving not contained on the back of the Sports page in the Business section? Accountants change firms, lawyers go out on their own, and engineers do both. Sometimes the former firm even sends a letter out to the clients informing them of that fact. Ever seen one of those stories on the front page?

Me either.

Second, I noticed a number of hits on the piece yesterday from the Benefis Healthcare IP address. So, to you Benefis readers, maybe you could chime in: Has Benefis or any company owned or controlled by Benefis ever asked a physician or other professional to sign a non-compete agreement?

Third, as aptly noted in a comment, the girl who received the letter from the Great Falls Clinic couldn't read it. So, assuming the Tribune's story was accurate, the girl's family already knew that Dr. Garver was leaving the Clinic, and had made arrangements to continue care with him. Then the family received a letter that their poor daughter could not read. Yet she was "pretty traumatized" by it? How? Who told her about it and what it said? Did the person who told her about the letter and its contents not first tell her not to worry because she could still see Dr. Garver? Why is this a front page news story? And, probably most importantly, just how did the Tribune get their hands on this 'story?' (Maybe someone from that Benefis IP address could help us out with this last question...)

Fourth, physicians are not slaves because they work in healthcare. Where do we get the idea that we are entitled to healthcare, on terms set by us, and that we should only have to pay for it what we want to pay for it, if at all? Why do we think we have some "right" to choose our physicians? What if our chosen physician says I will only see you if you pay me "x" dollars. Does he or she not have the "right" to make that decision?

Finally, I understand why the Great Falls Clinic has to stay officially silent in the face of this sort of criticism. You see, Dr. Garver can talk all he wants (even through his lawyer) but the Clinic has certain confidentiality concerns.

The owners and employees of the Clinic do, however, have First Amendment rights. I know many of these people, and the ones I know are contributing members of our society. I cannot for the life of me understand why these individuals stand by quietly while the Tribune contrives an attack on them and their ethics.

Why don't the doctors, the nurses, the staff, call the Tribune when something like this is run on the front page? When the Tribune quotes a Benefis official as implying that the Clinic refuses to do charity care, why is the Tribune not overrun by telephone calls and letters from the Clinic's owners and employees? If Benefis and the Tribune have decided to launch a PR war against the Clinic, wouldn't you expect the owners and employees of the Clinic to at least speak up in their own defense, let alone fight back?

Please do.

13 comments:

WolfPack said...

"The owners and employees of the Clinic do, however, still have First Amendment rights."

GeeGuy- Can the Tribune or any other citizen truly infringe on this constitutional right? If so, aren’t you attempting to infringe on the Tribune’s First Amendment Rights? Losing a little perspective perhaps?

GeeGuy said...

Absolutely not. I am not losing any perspective.

First, I am not sure how you can read what I wrote to imply that the Tribune is infringing on anyone's First Amendment freedoms. You would agree, though, would you not that for various reasons, other than the force of law, one might not have the 'freedom' to speak one's mind, right? In other words, if your business were sued you might well have the absolute freedom to speak your mind, but for various and sundry reasons you might choose not to because that speech has consequences. And you could certainly limit your employees' rights to speak their mind by contract.

Likewise, the Clinic probably cannot officially take a position on this whole matter, despite the fact that its owners and employees have the right to speak up.

As far as my attempting to infringe on the Tribune's rights of speech, I am not sure where I suggested that the Tribune should not be allowed to print all the garbage they want. But, if they choose to print garbage, they cannot really expect not to face criticism, can they? So are you reading my criticism to imply that the Tribune should be somehow prevented from printing what they want to print?

GeeGuy said...

One retraction. In re-reading it, Wolfpack, by saying the owners "still" have rights, I am implying that the Clinic doesn't or lost its rights somehow. Fair point.

I have changed the post to note your correction.

WolfPack said...

I was only really making note of the tone of your post. If I was standing in front of you I might have responded with "Why are you yelling?”. It's not like the Tribune was taking a crack at lawyers.
The Clinics letter and non-compete clause certainly are the best business moves whether done by the Clinic or Benefis. They are not though in the best interest of patients. I don’t condone the Tribune’s exaggeration of the facts, but if the truthful parts are a little embarrassing for the Clinic, so what. They can always change their business practices and not enforce a provision of the contract or take the high road and let patients know candidly what’s going on with their doctor. I have some personal experience with a doctor leaving and not being fully notified by Benefis. I thought they were “asses” and I have no lower standard for the Clinic. I have no problem with medical professionals making big dollars; I just don’t like it when patient consideration is back seated while they fight amongst themselves over quarters.
Can any Clinic doctor say he/she is proud about a purposely vague lawyerly letter sent out in their name? A letter crafted with the intent to keep/trick patients. Why not it was legal, good business and who likes a traitor turncoat physician/partner anyway?

GeeGuy said...

I am "yelling" because we only have one newspaper in this town, and I don't like misleading press.

Have you seen the letter? If not, how can you say it was a "purposely vague lawyerly letter...crafted with the intent to keep/trick patients?"

If so, would you email me a copy of it?

WolfPack said...

You got me. I was relying on the Tribune’s accounting of it. Do you really think that the Clinic’s letter said that Dr. Garver was staying in town and that his patients had the option of moving with him or continuing with another Clinic doctor? If not I would call that vague. I acknowledge the Clinic has no legal obligation to fully inform patients about a doctor who is about to become a competitor but that doesn’t mean they can’t or shouldn’t. I have employees leave for other employers and customers that do business at my competitors. I will and have given current good employees an honest reference to a prospective new employer (yes, I too spend money on recruitment and it hurts to lose good people). I also don’t run down my competitors to fluff myself up. Legally, I don’t have to provide a reference that makes it easier for someone to leave me but it is the right thing to do. When I lose someone good I evaluate my compensation package instead of attempting to sabotage their prospective success. There is also nothing legally stopping me from talking about my competitions weaknesses but I think it’s in poor taste to do so.

Yes, we need a second print media. If you start it, I will be your paperboy as long as it’s an afternoon paper or a weekly rag distributed at bars and restaurants. Will you pay mileage?

a-fire-fly said...

I am curious why this doctor leaving is causing so much controversy. I have recieved several of these letters over the years, stating that a doctor is leaving the Clinic.
I have never before seen such a fuss.
I received this letter. It states that the Dr is leaving the Clinic. It states that the Clinic still has a excellent Pediatric Department, aquaints you with members of that dept who will be available for new patients, and thanks you for choosing the Clinic.

Anonymous said...

wolfpack;

I am a Clinic physician. I have seen the letter that was sent to Dr. Garver's patients. I am not in the least bit embarrassed by the letter. I can say without reservation that I am proud of the way Dr. Garver's departure has been handled by the Clinic.

It is fair to say that there is always more to the story when a physician leaves his practice. I do not feel it is appropriate to comment specifically about Dr. Garver. But in general, when a physician leaves the Clinic we have a moral and legal obligation to notify his patients. We have no obligation to "candidly" comment on the reasons behind his departure. In fact, I would go so far as to say we should not comment on confidential reasons for a departure, as the truth would very often make the departing physician look bad.

About 10% of physicians will change practice in any given year (A.M.G.A data). Physicians with the Clinic, as well as independent physicians in Great Falls, change practice less than the national average. Often this move is secondary to compensation issues.

(As an aside, most of the physicians who have left the Clinic, yet stayed in town, make more money on their own then they did as partners. The reasons for this are beyond the scope of today's post, yet dovetail nicely with recent threads voicing baseless concerns about financial incentives for self-referral, etc.).

Others leave for geographical reasons, family obligations, etc. In each case, a letter is sent to every patient in the Clinic database who is linked to that physician. Occasionally we will announce why a partner is leaving (academic appointment, retirement, etc.). Yet most of the time it is simply a letter announcing the departure, in order that the patient may arrange for continuity of care with the departing physician, or within the Clinic if they so chose.

The individual physician may choose to send a letter to his patients announcing his new practice location, or more likely will take out an ad in the Tribune. The Clinic will even provide a departing physician with the names and addresses of his practice panel at no cost (and with no hassle). For example, when Dr. Mungas left the Clinic, he both mailed a letter and took out an ad.

I still fail to see the relevance of this article. I don't want to belabor the point, but this was sensational journalism on par with a tabloid. It is not front-page news. It doesn't even warrant a mention in the business section in my opinion. So a doctor is moving. It happens every month. I don't remember a similar outcry when Dr. Garrity left independent pediatric practice to join the Clinic.

Although I have no independent knowledge of Ms. Cates motivations, I can guess that she or the Tribune was contacted either by Cherish Aldridge’s father, or more likely by Dr. Garver's attorney. I am not familiar with Ms. Cates, so I can’t comment on her body of work, other than to say this article was poorly researched, full of errors of logic, and designed solely to cause harm to the Clinic’s reputation. Yet as poor a reporter Ms. Cates may be, where was her editor in all this?

Does anybody realize the harm articles like this can cause a community? Recall that second to Malstrom, healthcare (Benefis plus the Clinic) is Great Fall’s largest employer. Recall that the Tribune is widely read across north central Montana. Every time one of these articles appears, it drives patients to Kalispell, Missoula, and Billings for their care. We can have all the economic development experts in the world at the Chamber of Commerce or BID, and they won’t have a fraction of the (positive) influence that articles like this have (in the negative). Again, what were Ms. Cates and her editor thinking? Bad news is better than no news?

I too wonder how Clinic physicians and staff suffer silently with the slanderous P.R. war being raged by Benefis via the Tribune. I usually take a deep breath, and reaffirm my belief that it is below us, as professionals entrusted with the health and well-being of individuals in this community, to lash out. We have a history of taking the high road, and I think that it has served us well to date. Recall when the Tribune printed letters from the E.R. and anesthesia groups accusing Clinic physicians of cherry-picking? Well, it was a struggle for me to stay silent. Yet over the ensuing weeks, I had countless patients tell me that they were proud of the Clinic for acting professionally, and staying above the fray.

Remember, a hospital doesn’t take care of patients, doctors and nurses do. You see, Clinic physicians take care of all comers, regardless of ability to pay. We take call, so that Benefis can run an E.R., and field a level IV trauma center. Geeguy, you are right, when a patient can not pay their E.R. doctor, or their anesthesiologist, it goes without saying that as their surgeon I don’t get paid either. I simply feel privileged to provide emergency care to members of this great community.

I suspect that the majority of people in town don't realize how good healthcare is here. I trained at major institutions on both coasts. There is very little that can be done at an academic medical center that we can't do here. In my opinion, we have incredible physicians, support-staff, and facilities in Great Falls. I am proud to be a member of this health-care team. I only wish the Tribune would take similar pride, and foster a positive take on healthcare issues in Great Falls.

WolfPack said...

Rooster,

I never said that the patient letter should include why a physician is leaving. As a patient I think it would be helpful and proper for the letter to outline my options. The options should include following the departing doctor with instructions on how to do so. The only reason not to do this is protection of Clinic revenue streams.

I also don't understand why this letter was sent to children personally. Some of whom are not patients of Dr. Garver. My kids (6, 8 and 10) received one and have never seen him, same is true for my neighbor’s kids. The letter confused my wife (she tossed it before I could read it) and it worried her that our kids were in the Clinic system linked to the wrong physician. Some of the reason for the splash of this story might be the sloppy way it was mailed out to half the town’s children. If everyone is talking about it, doesn’t it become fodder for the newspaper? As you stated there is sometimes more than fiscal issues involved when a physician leaves, so the overly wide dissemination of this letter could be wrongly or rightly interpreted as a message in itself about Dr. Garver. This is especially true when the letter tries to peel off Dr. Garvers patients before he has even left the clinic. My family may be unique but we pick our physicians not the practices where they work. Because of this, continuity of service for us means telling us how to maintain contact with our doctor. At this point I’ll give a nod to Dr. Hinz of the Clinic for being an excellent pediatrician for my kids. If he ever leaves I hope our Clinic letter is addressed to us parents (they don’t have any problem getting the bill in my name) and lets us know how to continue the physician/patient relationship for my children with Dr. Hinz if we so choose. It’s not legally required to help us out but it would be a nice way of saying ” Thank You” from the GF Clinic for all the money my family has spent there.

Off topic but you brought it up. Why again don’t Clinic anesthesiologists share in indigent ER care by accepting call duties? I appreciate that you do, but not all from the Clinic is gold and not all from Benefis is pyrite. I’ll quit posting about this medical stuff because all I know is what I read and my limited experience as a patient which clearly doesn’t qualify me as any kind of expert.

Geeguy- Sorry for high jacking your blog. I do really want the paperboy job though, where can I send my resume boss!

Anonymous said...

I will respond to Wolfpack's question for Rooster because it is clear the lack of and biased reporting by the Tribune has affected him: "Why again don’t Clinic anesthesiologists share in indigent ER care by accepting call duties?" First off, ER care is not indigent care. ER care is well paid business, just ask the ER physicians. But to the point, Clinic anesthesiologists have since the merger been prevented from working at Benefis. Benefis had an exclusive contract with the current anesthesiologists that excluded Clinic anesthesiologists. Furthermore, Benefis paid these anesthesiologists to take all call and to exclude Clinic anesthesiologists from working at Benefis. In other words, the anesthesiologists collected payment from services to patients and Benefis paid them as well. Now, after all the years of payments and bribes to the current anesthesiologists, Benefis and they cannot agree on new contract terms because the anesthesiologists decided to try and get even more money for this scheme, but Benefis found their blackmail price too high. Instead of Benefis paying its anesthesiologists more money like they want, Benefis and the anesthesiologists worked up this scheme that the anesthesiologists could work less for the same money instead of the same work for more money by getting Clinic anesthesiologists to take call without pay from Benefis. Neat idea because they knew they could get the boneheads at the Tribune to help because everyone knows they won't investigate the truth. So what do they do, they tell the Tribune that Clinic anesthesiologists won't take call and the Tribune of course believes the crap fed to them. If Benefis would contract with the Clinic anesthesiologists and pay them like Benefis pays the other anesthesiologists, I am sure they would do the job and probably would be willing to take over completly for the current anesthesiologists. The bottom line is, why should Clinic anesthesiologists take call for free when the current anesthesiologists are paid to do it? Why didn't the Tribune bother to ask how much the current anesthesiologists are paid by Benefis? I'm sure there is even more to the story, but unitl the Tribune employs investigative reporters it will have to be reported on blogs.

Anonymous said...
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Anonymous said...

I've been fighting the Deaconess-Columbus merger since 1996, and more recently, the attempts by Benefis to maintain its illegal monopoly and deregulate itself from price controls at the same time, which it finally managed to do with the help of Mr. Laslovich from Anaconda(!) in the Legislature. I e-mailed Laslovich, and told him if he was getting any payment from "Benefis" for this, he would surely burn in hell, or worse, be exposed in the Tribune.
I, too, have been very disappointed with the Tribune's coverage of the hospital(s)-Clinic dispute and continuing battle for monopoly control over our lives, as well as our bank accounts. Health care is truly the scandal of the century. Why aren't these people subject to normal business rules of fair pricing (i.e., non-discrimination, having to show real costs as the basis for pricing, etc.?) And how can the Clinic enforce a contract against its own doctors that they can't practice in the same community for a period of time after leaving the Clinic?
The fact is, we no longer have a workable legal system or a workable healthcare system. Both doctors and lawyers are actually taught to "maximize revenues" and use their monopoly power and status as "agents of the court" to screw the public even unto (and beyond) death.
No wonder people are flocking to alternative medicine and quack clinics in Mexico in droves. At least they charge reasonable rates, and don't have the legal power to confiscate the patients' estates after the treatment fails.
Paul Stephens, Montana Green Bulletin greateco@3rivers.net

GeeGuy said...

"lawyers are actually taught to "maximize revenues" and use their monopoly power and status as "agents of the court" to screw the public even unto (and beyond) death."

No offense, Paul, but they must have started offering that class after I graduated from law school.