UMC faces criticism from within medical field

By Marshall Allen

Wednesday, Dec. 23, 2009 | 2 a.m.

The ranks of public critics of University Medical Center now include two surgeons who teach at the University of Nevada School of Medicine and are steering patients — and millions of dollars in revenue — away from the public hospital.

The surgeons say problems at the scandal-plagued county hospital start at the top, with a CEO who is detached from the day-to-day operations and unresponsive to physicians’ complaints.

Primary among their concerns, they say, are inefficiently managed operating rooms, leading to long waits for patients and delayed surgeries, and the administration’s inability to correct the problems.

The doctors say the hospital is losing a significant amount of revenue because they and their peers are avoiding UMC and redirecting their insured patients elsewhere.

Last fiscal year UMC lost about $70 million, and this year it’s expected to be worse. Hospital officials have blamed the mounting losses on the economy and uninsured patients.

But Dr. Joseph Thornton, an associate professor of surgery at the School of Medicine, offered records to the Sun showing his practice was bringing about $9 million in annual charges to UMC. He and his partner began diverting patients in recent months to other facilities.

The reason, Thornton said: “There’s no leadership over there. It’s gone from bad to worse.”

Dr. Nick Spirtos said Kathy Silver, UMC’s CEO, didn’t consult physicians before closing outpatient cancer services in 2008. Spirtos, who also teaches at the School of Medicine, was featured on CBS’ “60 Minutes” for caring for the nonpaying cancer patients who were rejected by UMC, which is supported by public funding to care for the uninsured.

Spirtos said he works in almost every local hospital and none has a CEO who is less engaged or responsive to physicians than Silver.

“Anyone who wants to speak up is labeled as an outlier or a complainer,” Spirtos said. “If you want to make any constructive criticism, you are immediately an outcast.”

Both doctors said they were not speaking on behalf of the School of Medicine.

Silver said Spirtos is an “interesting character,” who is bitter because he was passed over for a contract for obstetric-gynecological services at UMC. Now he’s angry and complaining to Clark County commissioners, she said.

“He’s just out there doing so much malice that it’s hard to contain him,” she said.

For her part, Silver characterized Spirtos as disruptive.

Answered Spirtos: “Was I a disruptive physician when I took all her cancer patients?”

Spirtos said although he sought the OB-GYN contract, he is going public with his complaints because every other attempt to bring about change has fallen on deaf ears.

Silver said Thornton is a good doctor who has developed an angry personality.

“I don’t know what she is talking about,” said Thornton, who added that he does not know Silver.

Thornton said his ire was triggered when he and his partner could not get the operating time they needed for patients. He blamed it on mismanagement.

The problem erupted in June when he and his partner found their patients had not been prepared for their procedures at the hospital.

Thornton said when he raised his voice in anger, the operating-room manager called security and three guards showed up with handcuffs. Thornton, who is 64 and not an intimidating presence, was shocked and insulted.

“I can’t believe this,” Thornton said he told the UMC staff. “Because you’re (screwing) up you’re going to throw me in handcuffs and take me out of the hospital!”

Thornton went to the waiting room and told his patients to report immediately to a nearby surgical center and Sunrise Hospital & Medical Center, where he would perform their procedures. Since then, he’s transferred the bulk of his cases to other facilities.

Steve Sisolak, who as a county commissioner is on the UMC board, said he had not heard of the doctors complaints, but it’s a big problem if they’re taking paying patients away from the hospital.

“If in fact they are doing that, it’s going to greatly alter the payer mix, which is already not good at UMC,” Sisolak said.

Silver said she thinks the operating-room manager overreacted when she called security, and the woman was later dismissed. She blamed the delays on preoperative paperwork not having been properly completed by the physicians’ staffs.

Brian Brannman, UMC’s chief operating officer, said during the hospital’s recent construction there was some difficulty registering patients, but “we’re making a lot of headway in that area.”

After the Sun contacted UMC on Tuesday, Thornton called the Sun, saying he received a phone call from the School of Medicine’s surgery department chairman, who was apparently concerned Thornton’s public complaint would hurt UMC’s reputation.

Thornton said Silver promised to hire a consultant and UMC appeared to be addressing the problems. He said he still performs some procedures at UMC.

Spirtos did not back down in his criticism of Silver or his beliefs about the mismanagement of UMC. The turnover time between cases in the operating room is often more than an hour, he said, leaving him wasting time. Materials are wasted in the operating room and not carefully tallied to contain spending as is the case at other hospitals, he said.

“All of these things have gone unaddressed because you essentially have a CEO who, if she was a head football coach, never comes down on the football field,” Spirtos said.

Spirtos criticized Silver’s response to the most recent scandals at UMC — the leak of private patient information that is being investigated by the FBI, and a case where a woman with abdominal pain was ignored in the emergency room and later miscarried. Other doctors would come forward and complain, he said, but they are intimidated and afraid of losing business at UMC.

“There will be considerable criticism for anyone who goes public,” Spirtos said. “But someone needs to say that a change needs to be made.”