March 5, 2010

All Saints surgeon: Anesthesiology services are safe, but corporate management created unnecessary strife

Dr. Dennis Anderson is a surgeon at Wheaton Franciscan All Saints. He wrote the following commentary in response to recent developments and comments regarding anesthesia services at Racine's hospital.

For background's purpose, Wheaton Franciscan All Saints ended its relationship with its long-standing anesthesiology provider in January and replaced the physicians with a hybrid of doctors and nurse anesthetists.

Here's Dr. Anderson's commentary on the change:
A lot has been said recently about the state of affairs surrounding anesthesia services at Wheaton Franciscan Healthcare. Some of the statements have been well thought out, some not so. Questions remain regarding patient safety, how the conflict came about, and who is to blame. I have been asked to weigh in from the perspective of an active Wheaton surgeon, so I offer the following as my own thoughts on the matter.

First of all, I must say that the anesthesiologists of SEAC (Southeast Wisconsin Anesthesiology Consultants) were among the best anesthesiologists I have ever worked with. Not a day goes by in which I do not regret the loss of their professional service and their personal companionship. I certainly look forward to the day when we can work together again.

Having said that, the current group of anesthesiologists and nurse anesthetists (CRNA’s) are licensed professionals, as well. They provide quality, safe service, and deserve respect. They had nothing to do with the current state of affairs. They are the innocent victims of all this. They really did not know what they were entering into when they signed up for this job. In speaking with them, none was informed of the local climate. Had I been involved in the interview process, I would have told them outright what was going on. They could have decided not to come, as it is not their fight. They could have chosen to come anyway, as it was a job, but at least they would have known what to expect. It may not have eliminated the emotional pain when harsh words are spoken, but knowing what to expect can lessen the shock.

In the past, whenever SEAC would consider hiring a new associate, they were always brought in to meet with the surgeons. Our input in the selection process was actively sought and respected. This is in stark contrast to the manner in which our new present CRNA’s were brought in. They were selected sight unseen by the administrators, with no surgeon input. The surgeons, for our part, were suddenly met with unfamiliar faces in our operating rooms, where our trusted colleagues once sat. The CRNA’s acknowledged that they did not have a chance to meet with any of the surgeons before arriving one day to start working in our OR. Thus, they were at great disadvantage, and a remarkably easy target for surgeon frustrations.

Unfortunately, as so often happens, the focus turned thereafter to personalities rather than remain properly focused on a failed process. I refer to the failed negotiations between Wheaton and the former SEAC group. Although many of the details of those negotiations are beyond even my scope, my analysis is as follows:

As this unfolded over the course of several months, there was little noise heard. When negotiations appeared to be making little ground, word started to get out. Those not directly involved in the talks, but who would be most affected by the outcome (i.e. the surgeons) began to ask questions. We got little to no information from the Wheaton negotiators. At the same time, we received constant updates from the SEAC members. Naturally, opinions began to form, but with only the information available. With no rebuttal, over time those opinions become cemented until they become virtual fact in our minds. By the time it became clear that negotiations were at an impasse, it was too late to call us in. We had already taken sides on the issue.
Had the surgeons been called in to mediate earlier in the negotiations, instead of excluded as we were, I believe that there could have been an entirely different result, and our SEAC colleagues could very well still be with us. While it was likely assumed by administration that we would naturally side with our physician friends, we may have in fact helped the hospital get some of the issues that it wanted, such as a nurse anesthetist model. In fact, as those negotiations were taking place, I was asked in a rather off-the-cuff way, if I have ever worked with nurse anesthetists. I said that I had, and that it had never been a problem. I assumed, however, that this referred to a new model to be hired by the SEAC group. Little did I know that they were destined to replace the SEAC group. It was exactly this type of slight-of-hand that so angered the surgeons. I, for one, could have easily embraced this new model had it not come about in such an unseemly way.

Now that our former anesthesiology group is gone, and permanently replaced, I can only consider them as casualties in a war that did not have to happen. Moving forward, I feel it is only fair to treat our new providers with the respect they deserve. Surgery, and anesthesia at St. Mary’s Hospital are safe and of high quality. Patients should feel comfortable coming to our institution for care. In speaking with most of the CRNA’s, now that they understand the circumstances, they are able to move beyond the hurtful words that had been tossed in their direction. We can all get back to the business of taking care of our patients, without having to worry about who should apologize to whom.

That is not to say that all issues are resolved. If it was the negotiation process that failed, then it is the process that needs serious re-examination. And Wheaton officials know that they were in charge of the negotiation process. Wheaton officials have to understand where they went wrong in this whole affair, and remain accountable so that it does not happen again. Up front, fair-minded negotiations will lead to more favorable results than the hard-lined, ultimatum-driven, corporate style they are used to. I think they know that now, but they may need reminding now and then.

Dennis Andersen, MD

33 comments:

  1. Very well said by a great MD/Surgeon...

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  2. Is this doctor on the Journal Times payroll?

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  3. Nurses aren't doctors. There is extra training for a reason.

    My advice to Racine is to not risk your life on the operating table at Wheaton.

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  4. This comment has been removed by a blog administrator.

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  5. To all those going to Milwaukee or where ever, I suggest you check with those hospitals since I'm pretty sure that they use CRNA's as well...

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  6. I hope I don't get sick here. This is turning into a circus. This is what you expect out of a union and management before a strike not our doctors and their management.

    Anyone know the closest non-Wheaton hospital with happy doctors and nurses? How how far it is from Racine?

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  7. Dr. Andersen's comments were in line with how most surgeons feel about who is administering anesthesia. They want safety for the patients, constant vigilance, someone who can and will interact with the patients and who does not overcharge. Nurse anesthetists have filled this role for a long time and there has never been any indication that they are unsafe practitioners. In fact, the opposite -- all studies show no difference in care. Nurses have long been patient advocates and the public should feel comfortable with their services

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  8. Bush's and the Johnson Family's fault.

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  9. Dr. Anderson, I think it is fair to say we understand your position. However, please understand the client has been the real pawn in this issue. It is the patient who once had medical doctors for anestesiology but now has "statically" equally safe nurses.

    I'm sorry, if I have a choice I will always pick a medical service which, for the same price of admission, has the most educated and experienced personnel. In this case I will not choose a nurse for my operating procedure.

    Remember Dr. Anderson, you could be replaced next by a nurse at the operating table. How would you feel about that? I'm sure there was a time when a MD anesthesiologist thought his job was secure too.

    This corporate model needs to be tempered with more than a little common sense. I suggest people research ahead of their surgery who is doing what. I know from personal experience that Kenosha still uses MD's for anesthesiology services. You should too.

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  10. I tend not to pay attention to people who have problems with spelling and sentence structure.

    But I will put that aside for a second to ask the previous poster why he/she thinks a medical doctor would be better at doing a nurse's work. Would you really want a doctor giving you an enema?

    Anesthesia is an appropriate function for highly educated advance practice nurses. Most anesthesiologists get bored with giving anesthesia, so they read, play computer games, talk on the phone...everything but watch the patient. Nurse anesthetists are known for their vigilance.

    As a prominent surgeon once said, there is only room for ONE DOCTOR EGO in the operating room and it is going to be him.

    Nurse anesthetists are one of the most sought after professions in the country.

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  11. Dr Anderson makes several good points concerning the situation. However, with all due respect Dr Anderson, you as a Surgeon using these CRNA's have a professional and financial interest in making sure this model works. I for one will be having any surgeries at Aurora Kenosha where the previous MD Anesthesia group has landed. I think the rest of Racine should follow. Why should we trust this administration's (that you yourself say is to blame for the current situation) decision?

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  12. RE: Dr. Andersen's reference to corporate negotiators. All negotiations with SEAC, and the new anesthesia company, were conducted by All Saints Hospital officials.

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  13. Nice try Dr but we're not stupid. Doctors are more qualified than nurses. Period, end of story. Wheaton chose cold hard cash over patients, and as the corporate model suggests, they will continue to do so.

    As the other poster suggests, you have a financial interest in making us buy this load of bull just like that other crap letter written by the Nurses Association saying everything is fine.

    All you are doing is damage control now. You might have well just written this garbage for the Journal Times.

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  14. The old SEAC anesthesiologists are now working with nurse anesthetists in Kenosha, just like the new anesthesia group in Racine has anesthesiologists and nurse anesthetists working together. The choice is not between an MD and a nurse, but is instead an MD alone versus an MD and a nurse anesthetist working together. The old SEAC group has shown by their present practice choice that working with nurse anesthetists is better. Medical providers understand that having an MD anesthesiologist AND a nurse anesthetist both taking care of every patient is the safest and most efficient way to practice anesthesia. The negative comments about nurse anesthetists are serving some petty, personal, and ulterior motives. Please stop intentionally misinforming the public.

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  15. Interesting responses. I had a different take on Dr. Anderson's commentary than many of the above comments.

    It seems like Dr. Anderson is saying, essentially, the anesthesiology deal is done. The new providers are qualified, competent professionals who surgical patients can feel safe with. If they weren't safe, as a surgeon, he wouldn't perform the procedures.

    That said, Wheaton still needs to address how it got to this point. They cut ties with long-standing doctors in the community and replaced them with out-of-towners with a cold efficiency that reflects corporate bureacracy with little local concern. This speaks to the concerns of the doctors threatening to leave. They want more local control over Racine's hospital because they care about health care in Racine.

    I thought Dr. Anderson's letter was fairly rough on Wheaton, particularly the last paragraph. But the commenters who point out Dr. Anderson and the other surgeons at All Saints have a vested interest in muting public concerns over the new anesthesiology providers.

    Like I said in the first sentence, the response in the comments has been interesting.

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  16. Dr. Andersen is clever. He is a little rough on Wheaton but not too much....just enough though to make his letter not sound like hack job (like the nurse one not too long ago).

    He's got money on the line....a lot of money. The nurses had jobs on the line. Both responded and with that much self interest involved - neither can be trusted.

    What you can trust is that 50 doctors are willing to leave, and it for a reason. Replacing doctors with nurses does not improve the quality of care. You can try to spin that all day and night, but the fact remains. Profits won and we lost.

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  17. I worked as a circulating nurse in surgery for 15 years. I became friends with many of the Dr's. and Anestheisia staff (at that time we had a mix of Docs, nurse anesthetists and anesthesia techs)...as someone working on the inside I was often asked who should I have do my shoulder surgery, or who should I have for having my gallbladder removed. I was also asked for advise about who to request for my anesthesia. Did you know you can pick your anesthesiologist, just like you choose who your doctor will be?
    Anyway the entire staff had their favorites, but we all knew who was best for each procedure that was done. When it came to anesthesia, I myself always requested one of the nurse anesthetists, whether it was for myself or a loved one. They were far superior both in care and experience over several of the docs. But only an insider might know this! Know that you are as safe with a nurse anesthetist as you are with a doctor. In cases of extreme emergencies it was a collaborative effort with a nurse anesthetist working with a MD Anesthetist. It works.
    Just for clarification I have been retired for only a few years. The
    CRNA's that I worked with were let go several years ago when their contract was not renewed by the Anesthesia group...and certainly not for reasons of incompetance. It was a sad day in the Operating Room when they left.

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  18. All same day procedures are done with the nurses for the last year.Even Froedtert uses them. But what are the cost of these nurse as compaired to doctors. Is the hospital charging the doctors rates?

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  19. Once again, the patient and Racine citizens pay for this quibble gone public. This sounds to me like the the situation boiled over, insiders responded truthfully, and once it was out there for the paying consumer to see, everyone financially dependent on All Saint's realized they may have fatally slit their own throat.

    I agree that this statement by this doctor was damage control. The trouble is, the cat is already out of the bag. We all already knew that many things are wrong with quality of services at All Saints. Records are missing, the staff is not happy. Ask anyone who has been a patient. This is a monopoly that needs to be broken up for the safety of all of Racine residents.

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  20. The "paying consumer" and previous bloggers should stop picking on Wheaton and on Dr Anderson. The public records show the top administrators and doctors at Aurora and other large groups are paid more than the top doctors and administrators at Wheaton and the doctors who left now make more than they did at All Saints. People should be grateful that top quality doctor's like Dr Anderson who could make more at Aurora or elsewhere still choose to practice at All Saints and serve the community.

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  21. Dr. Anderson stated that he was asked to "weigh in" as an active Wheaton surgeon. I would like to know who asked him to do that. If you follow the strings, you usually find the puppeteer.

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  22. Thank you Mr Buser (Annon 1:20pm) for your thoughts!

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  23. I don't think this letter was written for the public. The real audience are the nurses that felt alienated from the doctors speaking out. Now that the dust has settled, they have to smooth things over for the sake of their own jobs. This was an olive branch.

    Amazingly, if you look back at the letter, the Dr is saying he endorsed nurses all along. The big issue in his mind is that Wheaton didn't do more communicating. In other words, he isn't upset that nurses are replacing doctors - he's upset Wheaton didn't involve him more in the negotiations to make it happen.

    What a jerk. He just threw all of his former anesthesiologist colleagues under the bus. That's real brave now that they are all gone. Oh yeah, he always supported the nurse model.....right. I'd support it after the fact too if my salary depended on their performance. What a hero. I hope they replace this jerkoff with a nurse surgeon and see if he changes his tune.

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  24. Gee, brown eyes, would you possibly one of the Wheatons that is responding to comments? Why are you so harsh? Have you never made a typo? Seriously Jen?

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  25. Doctor Anderson thNks for your well scripted prewritten by corporate answer. It's all a bunch of hog wash! Just like Mary Oimet states that margaret malnory is wanted all over Wisconsin and basically we have to suck it up and deal with her. The reason Margaret is wanted is because she is evil, and hateful and if someone finds her on the street they might just spit on her! Nice try Mary O. for taking up for your BFF!

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  26. This guy needs to continue to perform surgery at All Saints. He has to say the new "model" of anesthesia is safe.

    It is quite well known that this is a dysfunctional group of docs and nurses and many are planning to leave. There is no difference in charge between the old and the new anesthesia group. Profits go to florida. These are just employees. No motivation to stay or invest in our community. If a nurse is better doing anesthesia than a doctor then why do they not have nurse "anesthetists" in other countries? Maybe they make better surgeons too by skipping University Education and Med School and Residency instead just going to Gateway!! We want nurse surgeons at Racine! And administrators without MBAs from real Universities. Online MBA is better than one from Harvard or Northwestern Business School. "Statistically" there is no difference. Obama will fix it for us. Nobody will want to go to Medical School and nurses and techs can take over health care in this country.

    Personally I think they need to clean house at All Saints. Get rid of all the administrators. Bring in new blood. Change the culture completely to make it consumer friendly and not profit centered. Give the doctors the freedom to practice medicine without breathing down their neck and telling them what to do. And bring back the old Anesthesia group. At least the good ones from that group. Like Zimmerman, Martinez, Weiderberg, Ringwalt and the Indian ladies.

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  27. Interesting the timing of Dr. Anderson's comments. Could it be that Wheaton's market share is hurting because of all this bad publicity? All the comments made about the Anethesia given at Wheaton in Racine is true, just ask Ken Buser, he knows its true. Dr. Anderson is just trying to put on a good spin for the Wheaton Corporation. Nice try but we are not fooled.

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  28. I AGREE BRING BACK THE OLD GROUP. THE NEW ONES ARE DOING SOME INAPPROPRIATE THINGS. THEY CANNOT BE TRUSTED. THEY ARE ALL STILL AT THE MARRIOT ON ALL SAINTS MONEY. THAT IS PROBABLY ONE OF THE REASONS WE MIGHT NOT GET OUR RAISE THIS YEAR BECAUSE WE ARE HOUSING CRNA'S AND MD'S AT THE MARRIOT AND GETTING THEM PLUSH RENTAL CARS! THIS IS A BUNCH OF B.S. THEN UNFORTUNATELY FOR THE PATIENTS THEY ARE AWARE ABOUT HOW MUCH THESE PEOPLE HAVE NO CLUE!

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  29. Get rid of Margaret "Midge" Malnory the Evil Witch! To hell with her and Mary Oimet! We are not meeting with you so it can backfire on us! Mary you should be ashamed of yourself but oh yes you and Midge meet outside of work and hang out!

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  30. It is now week 4 since the Wheaton Meltdown and guess what, the employees of Materials Management, and Birth Center are told just deal with it. I wonder if Management would let thier Employees act the way these 2 Managers behave. Could employees make racial remarks about Doctors from Pakistan and get away with it? Could employees treat other employees or customers like crap and get away with it? Can the employees tell the manager to just quit if they don't like it here? Can the employees come in every day with the same lousy attitude these 2 managers get away with? The answer is No they can't. Do you see a pattern here, Managers are allowed to do anything they want, while Employees are expected to follow the Golden Rules, Mission, Vision, and Values. WHAT A JOKE!!! Wheaton this is how, and why UNIONS get started. The Employees of your organization are TOTALLY FRUSTRATED with your inaction. Employees stick up for your rights, WE HAVE HAD ENOUGH.

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  31. What standards or requirements does Wheaton have for persons seeking a managerial position? It is difficult for employees to take a manager, or supervisor seriously when they clearly have no understanding of the words they are reading in the daily reflection, or how to pronounce certain departments in the hospital.

    I think most of us know the difference between integration, and interrogation, two very different subjects. Yet the daily reflection on integration is often given as a reflection on interrogation. Don't even get me started on Stewardship, and Stewardesship!

    Most people who have cancer would go to Oncology for treatment. Not so if you work in Materials Management, you go to on-ah-cology.

    These are just a few of the flubs occurring on a daily basis, not an occasional slip of the tongue. One wonders if these people running this department hold even a basic high school diploma.

    These people manage using fear, and intimidation. Perhaps they are insecure, knowing they are in over their heads, and not qualified to do the job with which, they've been charged.

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  32. We agree with Dustin Block who wrote that this has been an interesting discussion, and we would like to weigh in and add some perspective to a few of the comments on anesthesiology services.

    We appreciate Dr. Anderson’s feedback about having more involvement in the decision-making on matters such as this one. While several physicians were involved, it is now clear that we could have done a better job with communication about the issues at various points in the process. As we move forward in our discussions with physicians, including Dr. Anderson, regarding a new leadership model for physicians in Racine, we will work to ensure that communication is improved in matters such as this. We agree completely with Dr. Anderson’s assertion that this anesthesia team model is safe and are pleased that he felt compelled to share his thoughts with the Racine Post on the topic. For the record, he acted completely independently in the submission with no participation from All Saints.

    Some comments suggested that implementing this new model was a way for All Saints to save money. We would like to clarify that this model actually costs more because we have expanded to 24/7 in house coverage, added anesthesiologist consults for the pre-operative process through discharge, and now provide new pain management options for laboring mothers. We also have more anesthesia staff than before, consisting of both anesthesiologists (physicians) and Certified Registered Nurse Anesthetists (CRNAs). We strongly believe in the value of the team model approach to care and the additional benefits for our patients. Patients do not pay extra for using this team model. We repeat as we have said in the past that the nurse anesthetist is under the direct supervision of an anesthesiologist who moves between cases but is always involved at critical points in every case. All Saints’ ratio of anesthesiologists to CRNAs is one-to-two, which exceeds the one-to-four ratio considered to be safe.

    For those who are interested in the specific details, here are a few facts regarding the timeline of recent events for anesthesiology services:
     In August 2009, when it became clear that the needs of All Saints had grown beyond SEAC’s immediate capacity, All Saints engaged Anesthetix to complete an assessment. SEAC was aware of the assessment and the results were shared with SEAC.
     On 10/28/09 SEAC served notice to terminate their contract with All Saints within a short 30-day timeframe. All Saints subsequently asked for and received a contract extension through 12/31/09.
     All Saints and Anesthetix immediately began formal discussions regarding a contract, which was then signed with a start date of 1/11/10. Before the contract was finalized, All Saints met with eight members of SEAC to invite them to continue to work at the hospital by joining the new group. Two subsequently joined and six made the decision to leave the hospital.

    We value the opinions of community members and we appreciate respectful, candid dialogue. If there are other questions or concerns, please let us know at www.mywheaton.org/sharewithus.

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  33. Ken Buser you should be ashamed of the comments made above by Wheaton. The bottom line is you know for a fact that Anesthesia at Wheaton is NOT AS SAFE as it used to be. Start by telling the truth to your customers.

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