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Some doctors at Akron's Summa Health System say the medical staff is unhappy with its leadership, has been so for a while, and won't be able to recover unless the CEO, Thomas Malone, is replaced.

(The Plain Dealer)

CLEVELAND, Ohio -- Doctors at Akron's Summa Health System are divided over the hospital's decision to terminate the contract of its emergency physicians on New Year's Eve.

Summa Health CEO Thomas Malone

After a week of turmoil, about 250 Summa physicians on Thursday evening gave their President and CEO, Dr. Thomas Malone, a vote of "no confidence" at an unscheduled medical staff meeting, according to doctors who attended. More than 200 staffers later signed a letter to the health system's board of directors seeking Malone's resignation.

Summa's board responded on Thursday with a statement saying "the Board supported the need to bring in the new emergency medicine provider. We will do whatever is necessary to ensure quality patient care and solidification of a strong environment during this important transition."

The Summa board met on Wednesday night to discuss the issue, according to the health system, but has no plans to meet again in the near future.

Dr. Hitesh Makkar, who attended Thursday's staff meeting, was until that day part of a group of 11 pulmonary and critical care doctors who contracted with Summa to provide care at Akron City Hospital. Summa declined to renew the group's contract Thursday, Makkar said.

Makkar described the staff meeting as "packed" with doctors who are not happy with Summa's leadership, most who are not directly affected by the change in the health system's emergency departments.

"The overall sense of distrust and lack of relationship between leadership and staff physicians is the main reason that you saw all these people show up," he said, citing leadership's lack of respect for staffers and their opinions. "This has been brewing for a while."

Not all of Summa's roughly 1,100 physicians supported the no-confidence vote, however. Several spoke out against it on social media and in news reports Friday.

Dr. Rodney Ison, CEO of the 30-physician Community Health Care group, said most doctors at Summa don't want to have anything to do with the situation and just want to see their patients.

Ison, who attended most of the Thursday emergency meeting but left before the vote because of what he called the "unprofessional" nature of the conversation, said the meeting reflects a division among the staff over whether the hospital should be run by a board or by the physicians.

"Our hospital is there to serve the community, not individual doctors, and that's why it has a board. Nobody seemed to want to acknowledge that we all have conflicts of interest," Ison said, referring to the doctors in attendance who were or still are negotiating contracts with the health system.

"Instead of being professional, it was this emotional riot type thing. I've never seen anything like this at a medical staff meeting anywhere."

"Abrupt" decision sparks turmoil

At midnight on December 31st, Summa declined to renew its roughly 40-year relationship with emergency room doctors from Summa Emergency Associates (SEA), an independent physician group that's separate from the health system. The roughly 60 doctors were replaced by a group of emergency physicians paid by Canton-based US Acute Care Solutions (USACS).

Summa said the move came after contract negotiations with SEA broke down due to demands "that were unreasonable, inconsistent with national standards and would cause concerns from a compliance perspective." The affected staff worked at Summa emergency departments at Akron City Hospital and Summa facilities in Barberton, Green, Medina and Wadsworth.

Summa did not immediately reply to questions about the nature of SEA's demands, or which national standards were in question.

Doctors and other staffers with SEA said this week that they were not prepared for the decision, which came with less than two days' notice via memo from Malone. They also expressed concern about a potential conflict of interest in the decision to hire USACS, as that company's CEO, Dr. Dominic Bagnoli, is married to Summa Chief Medical Officer Dr. Vivian von Gruenigen.

Summa maintains the relationship played no role in the health system's decision to terminate SEA's contract or to hire USACS.

Also on Friday and in separate statements, the heads of two national emergency medicine physician groups expressed concern about how the rapid transition from SEA to USACS in Summa's emergency departments will affect resident doctors who are training there.

The American College of Emergency Physicians (ACEP), the national specialty society representing emergency medicine doctors, and the Emergency Medicine Residents' Association (EMRA) both expressed deep concern about the stability training for 30 residents working at Summa. Residents are trained by emergency room doctors and the department's medical director.

"Hospitals and health systems change staffing contracts routinely, but what is not routine at Summa Health is the abruptness of the change," said Dr. Becky Parker, ACEP president. Normally, a three-to-six-month transition period allows for personnel, schedule and other necessary adjustments, the statement said.

EMRA president Alicia Kurtz and board members echoed ACEP's fears about the resident doctors. In an open letter, Kurtz also noted the residency's program director was dismissed "without working on a transition plan as required..."

Summa did not reply to the groups' concerns Friday.

Can it be fixed?

The doctors who signed on Thursday's letter hope the hospital board will replace Summa's leadership. Makkar said he doesn't see any healing of relationships without this step.

"People don't come to Akron to practice because it's the mecca of medicine or for the weather. They come and they stay because they like culture and the hospital and the people. If this doesn't change we won't be able to keep our staff," he said.

SEA members discussing the situation on Facebook still seem somewhat optimistic, though, and some hope that the attention to their situation may help re-open contract negotiations, they say.

Ison said he hopes to never see a repeat of the behavior at the recent staff meeting, when he said those who tried to provide contrary views were shouted down, and the CEO was called a "liar" by staffers.

"We all need to develop better communication skills, and to have programs that allow us to communicate in a more constructive fashion, and our medical staff leadership has to take some responsibility for making that happen."