Chris Van Gorder's career has taken many twists and turns, with an awful start in law enforcement leading to a brand new one in healthcare. Now he has a beat he's never walked before: Top cop of San Diego-based Scripps Health.
The board of the not-for-profit integrated delivery system named Van Gorder, 47, as interim chief executive officer and president late last month, less than six months after joining the organization as chief of healthcare operations.
The "interim" was dropped from his title just days later, although Scripps Health officials said the board may decide to search for another CEO at a later date.
"I didn't anticipate this was going to happen at this point in time, this quickly," Van Gorder said.
But that's what can happen when physicians lose confidence in management, even though Scripps Health posted a $36 million profit on revenue of $739 million last year.
Scripps Health operates five acute-care hospitals and has nearly 2,400 affiliated physicians and 7,900 employees.
Van Gorder must manage the healthcare equivalent of urban unrest. He replaced Stanley Pappelbaum, M.D., who resigned May 26 after the medical staffs at four Scripps Health hospitals gave him votes of no-confidence. Physicians at 145-bed Scripps Memorial Hospital-Encinitas also gave a vote of no-confidence in Scripps Health management but didn't name Pappelbaum directly.
Searle Turner, M.D., Scripps Health's senior vice president and Pappelbaum's closest deputy, also resigned.
The 62-year-old Pappelbaum was among San Diego's most visible healthcare figures, but observers say he created enormous rifts during his three-plus years at Scripps Health, which included 17 months as CEO and president. Much of the turmoil has been linked to Project Scripps, Pappelbaum's ambitious $250 million makeover of the system intended to make it more competitive in San Diego's bruising managed-care market.
Project Scripps included a variety of cost-cutting measures and efficiencies:
* Band physicians who practice within the Scripps system into a new independent practice association.
* Boost patient-care expenditures from 75 cents on the dollar to more than 90 cents.
* Extend patient care throughout San Diego County.
* Link all Scripps Health hospitals, clinics and offices via a computerized patient record system.
While observers said some physicians bought into Pappelbaum's vision, he alienated other doctors who felt their income and autonomy would be threatened if they didn't align with Scripps Physicians, Scripps Health's 1,200-doctor medical group.
Another gripe had to do with Scripps Health's change at the beginning of the year from capitated to per diem contracts for all types of patient care. Sources said it succeeded in both pressuring doctors to shorten lengths of stay and angering area health plans. The latter had begun encouraging physicians to refer patients outside of the Scripps Health system, although system officials said the drop was minimal and confined to physicians who practice at 417-bed Scripps Mercy Hospital in San Diego.
Employees have contended that staff turnover at all Scripps Health hospitals has been high. They've also voiced concerns about the wages being paid.
Scipps Health's hospitals also had lower-than-average scores on its recent Joint Commission surveys. All the hospitals were accredited but with recommendations for improvement.
"(Pappelbaum) was trying to do too much, and he didn't get the support of the doctors, who are generally conservative and resistant to change," said a source close to Scripps Health who asked not to be identified. "And when you (mess around) with a doctor's wallet, they're not happy."
Scripps Health's board wasted little time after Pappelbaum's departure to make sweeping changes: Much of Project Scripps was immediately put under a 60-day review by the board; $6 million a year was pledged to boost the wages for 2,400 nurses and support staff; and Brent Eastman, M.D., resigned as chairman and president of Scripps Physicians.
Eastman, who remains as Scripps Health's chief medical officer, was unavailable for comment.
Pappelbaum, who has said he will start a consulting firm after spending some time with his family, declined comment for this story.
Van Gorder, who described his management style as collaborative, is meeting with Scripps Health's various medical staffs to gain input.
"My intention is to stabilize and move the organization forward and start a rebuilding mode. It's a time of listening," he said.
Van Gorder would not speculate on whether a proposed merger of 320-physician Scripps Clinic, a separate organization, into Scripps Health announced last month would help mend relationships between area doctors and the hospital system. Scripps Clinic had broken off from Scripps Health in 1995.
Van Gorder's job transition is nearly as abrupt as his move into healthcare.
He started out as an officer for a Los Angeles-area police department in the mid-1970s, but he was badly injured in a 1978 on-duty traffic accident. After a year of hospitalization, Van Gorder was told he could only participate in light police duty, so he took a job running the safety department of Orthopaedic Hospital in Los Angeles, where he had been treated for his injuries.
Van Gorder was president and CEO of 726-bed Long Beach Memorial Medical Center before joining Scripps Health in December 1999.
Van Gorder said he believes his short tenure at Scripps Health gives him an advantage in calming a frayed hospital system.
"It gives me no preconceived ideas about Project Scripps," he said, noting that some parts of the program were flawed. "I'm being received here with the same sense of openness."