DOCTOR HOSPITAL EMERGENCY CODE

“Envision clinicians, like all clinicians, exercise their independent judgment to provide quality, compassionate, clinically appropriate care based on their patients’ unique needs,” it said. That ruling was final.Ī spokeswoman for Envision, EmCare’s parent, said in a statement that the company complies “with state laws and operates with high ethical standards that put patients’ health and safety first.” A jury awarded him $29 million, including $20 million in punitive damages, which was reduced to $26 million on appeal. Because he was an independent contractor for EmCare and not an employee of the hospital, there was no tribunal to which he could petition against his dismissal.īrovont, who hasn’t spoken out about his case until now, sued EmCare for “wrongful discharge in violation of public policy” in 2017. In addition, Brovont was barred from working at nearby hospitals whose emergency departments EmCare oversaw. “There is a responsibility as the corporate representative to support the corporation’s objectives,” McHugh told him, according to court filings. McHugh acknowledged to Brovont that the decision was financially motivated, court records show, and said in an email to the physicians: “Profits are in everyone’s best interest.”Ĭontinuing to argue for a change in the policy, Brovont sent a memo to management outlining his unit’s fears he was fired six weeks later, in January 2017. Hiring an additional doctor would solve the problem, but that didn’t happen. Federal law required Level II trauma centers like Overland Park to make a physician available 24/7 in the emergency department to examine incoming patients, Brovont told McHugh.

DOCTOR HOSPITAL EMERGENCY CODE

In 20, frustrated by the inaction on the code blue policy, Brovont took his and his colleagues’ concerns to Dr. EmCare became Envision Healthcare and was bought by a different private equity company, KKR, in 2018. The firm exited its investment in EmCare in March 2015 after the company issued stock to the public, but EmCare directors affiliated with Clayton, Dubilier & Rice remained on EmCare’s board into 2017. Staffing at the hospital was handled by EmCare, a health care staffing company owned since 2011 by the private equity firm Clayton, Dubilier & Rice. Ray Brovont served as an Army doctor in Iraq in 2005. The expansion of the hospital made the problem worse and brought the matter to a head. He had spoken up about them early on, according to documents in a lawsuit he filed alleging wrongful discharge, but got nowhere. Staffing issues had been a concern for Brovont since he joined the hospital in 2012. “My physicians were being asked to be in three places at once,” Brovont said. It required an emergency department doctor to attend to code blues elsewhere in the hospital, which meant leaving the emergency room without a physician. After the HCA-owned hospital doubled its capacity to 343 beds and added a separate pediatric emergency room in 2014, the facility’s code blue policy became unsafe for patients, Brovont and his 18 fellow ER doctors concluded. One bad outcome Brovont hoped to avoid was related to “code blues,” urgent calls to help Overland Park patients whose hearts had stopped beating or who were no longer breathing. “The goal was to identify an issue before there was a bad outcome,” he said. Scheffler, a professor of health economics and public policy at the University of California, Berkeley. There’s a reason private equity firms have invested in companies staffing hospital emergency departments, said Richard M. They use large amounts of debt to acquire companies, aiming to increase their profits quickly so they can resell them at gains in a few years. Private equity firms have taken over a broad swath of health care entities in recent years. EmCare, the health care staffing company that managed Brovont, is part of Envision. Two of the largest, according to their websites and news releases, are Envision Healthcare, owned by KKR, and TeamHealth, of the Blackstone Group.

Today, an estimated 40-plus percent of the country’s hospital emergency departments are overseen by for-profit health care staffing companies owned by private equity firms, academic research, regulatory filings and internal documents show. Physicians who remain employed see that speaking out can put their careers on the line. A laser focus on profits in health care can imperil patients, they say, but when some doctors have questioned the practices, they have been let go. It is a growing problem as more emergency departments are staffed by for-profit companies. What happened to the medical director, a former Army doctor named Ray Brovont, isn’t an anomaly, some physicians say.

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