What are the real, human costs of corporate medicine? Patients at Portsmouth Regional Hospital (PRH) are experiencing corporate medicine at its worst. These cancer patients lost their Oncologist because he had the audacity to defend their best interests.
This story begins with Dr. Paul Poulin, the former head of Oncology at PRH. He expressed concerns about record keeping and pharmaceutical procedures that could place his patients at risk. He was fired “without cause” on March 30th. Seacoastonline reports that Dr. Poulin believes this ongoing conflict with the PRH’s administrators is what led to his dismissal.
“Poulin said he wasn’t given a reason for his termination, but suspects it’s due to “conflict” with hospital administrators about “broad patient care issues.” Poulin described that conflict as being about how records and the hospital pharmacy “are kept.”
Dr. Poulin was fired abruptly and without notice to his patients on Saturday, March 30th. That day, a member of PRH’s corporate team went to Dr. Poulin’s office and politely told him that he was dismissed effective immediately. He was handed 3 months’ pay and informed that he could not practice medicine within a 10 mile radius of the Hospital. Then he was asked for his keys and told that his possessions would be mailed to him before he was escorted out of the building.
The hospital informed the doctor’s patients, in some cases just hours before a scheduled chemotherapy, that he was no longer affiliated with the hospital and to choose a new oncologist.
It is worth noting, at this moment, the first sentence in the hospital’s Mission Statement:
“Above all else, we are committed to the care and improvement of human life in the communities we serve. In recognition of this commitment, we strive to deliver high quality, safe, cost effective healthcare.”
I’m far from an expert on cancer, but I know a little bit about the relationship between cancer patients and their Oncologist. It’s a very different relationship from the one would have with say, the cashier at the grocery story. In some cases, patients are dealing with hope for remission. In other cases, patients are hoping that their lives can be prolonged beyond the statistical probabilities.
Either way, an Oncologist is more than someone who conducts tests, makes a diagnosis and recommends a treatment. They not only treat the ailment, but also the fallout that comes with digesting the realities of cancer and the effects of treatment. An Oncologist will be a very special and important source of hope, friendship and understanding. A good doctor, regardless of specialty will also be an advocate for their patients if something about hospital procedures could put their patients at risk. In fact, the PRH Mission Statement rightfully raises that expectation.
Dr. Poulin’s dismissal and the manner in which both he and his patients received the news are characteristic of the worst of corporate medicine. Medical professionals who “cause trouble” because certain practices could place their patients at risk are putting their jobs on the line. And what does this say to the patients? If your doctor defends your interests, you will lose your doctor and your questions will not be answered. Moreover, you will simply be asked to choose another doctor in a manner comparable to a shoe sales person telling you they don’t have the color you want so choose another.
The patients are not taking this lying down because losing a doctor you trust, especially when dealing with serious illnesses, is a big deal. If or when that occurs, patients will be upset and have questions.
Certainly, firing Dr. Poulin for what amounts to small scale whistle blowing is bad enough. The abrupt manner by which the corporate team fired Dr. Poulin showed little common courtesy, let alone concern about patients’ needs. There was no time to digest the news which is, to put it mildly, insensitive to the patients. Anyone who suggests that this is what a smooth transition to another doctor looks like has not been paying attention to the patients, who are anything but pleased with this news.
“A week ago Monday, prior to an appointment that morning with Dr. Poulin, we received a call at home letting us know that Dr. Poulin was no longer affiliated with Portsmouth Regional Hospital. No explanation for his departure was given. My husband was asked to arrive for his scheduled chemotherapy and to select a new oncologist. That day, rather dizzied and upset by this turn of events, we went for his chemo treatment. None of the staff were able to respond to our questions of “Why?” “What happened?”
Mrs. Cosely’s letter also says something else, which reflects the satisfaction that patients had with Dr. Poulin as an Oncologist and their displeasure with PRH:
“We have read Dr. Poulin’s account of his firing in the Portsmouth Herald. We have little reason to doubt his interpretation of what has happened. His care of my husband was beyond reproach; he was available, supportive, informative and compassionate. He demonstrated genuine concern and kindness. In your haste to shoo him out the door, you’ve displayed shortsightedness and callousness toward your “clientele.”
Perhaps York Hospital or Wentworth-Douglass will embrace Dr. Poulin and the many patients who will choose to follow him in his new oncology position.”
Other patients have utilized different methods to convey the same sentiment. Be it visiting Dr. Poulin at his home or through open letters to the editor patients are saying they want their oncologist back. Because the nature of cancer is such that treatment has to be continued, transitions to other oncologists are seen as temporary measures until Dr. Poulin is reinstated.
This is not a reflection of the quality of care Dr. Poulin’s patients can receive from another Oncologist. It is reflective of the reality that “quality care” means much more than scheduling chemo. It also means being there for patients who are as willing to be there for their doctor. It is a bond.
Corporate Health Care refers to patients as “clients” and only sees case files and dollars in a system.
As Dr. Poulin said so well:
“Poulin described PRH as “run by lawyers and MBAs,” while staff physicians, he alleged, “are treated like pawns in the system.”
By ending Poulin’s contract, PRH “gets rid of what they consider to be a trouble maker” and “serves as an example to others,” he said.”
PRH is owned by Hospital Corporate of America (HCA) which has as a similar Mission Statement and values statement. Among the values HCA and presumably the hospitals it owns say they subscribe to:
“• We recognize and affirm the unique and intrinsic worth of each individual.
• We treat all those we serve with compassion and kindness.
• We act with absolute honesty, integrity and fairness in the way we conduct our business and the way we live our lives.
• We trust our colleagues as valuable members of our healthcare team and pledge to treat one another with loyalty respect, and dignity”
Corporate medicine reflects the principles, practices and cultures that you can find on Wall Street, at Koch Industries or any corporate entity. This is the same HCA that paid a $750 million fines as part of a settlement in a case of Medicare Fraud several years ago. Engaging in Medicare Fraud has more to do with greed than concern about patient care. Perhaps things have changed since then.
When the corporation’s business is high finance, oil or manufacturing one can almost accept the premise that profits comes first. However, when the “business” is healing; the absence of human consideration is corporate culture at its worst simply because this “business” is about our well-being and our very lives. When healthcare providers are intimidated into silence and looked upon as cogs in a wheel, we are also witnessing how far the culture of intimidating employees has trickled up. First they came for low skilled labor, then they came for Unionized Employees. Now they’re coming for people who are highly skilled and specialized professionals who are entrusted to heal us.
When compliance takes precedence over the well-being and basic consideration of patients as occurred in the case of Dr. Poulin and his patients, it is corporate medicine at its worst. It also shows that greed comes above anything – and any one.
If this can happen in New Hampshire, what stops it from happening in Rick Perry’s Texas, Scott Walker’s Wisconsin or Jan Brewer’s Arizona?
Image from yourhealthdollar.org