A dispute between a California hospital and some of its doctors illustrates the rancor that can develop when acute-care facilities compete with their own doctors.
A group of unnamed doctors claiming to represent the medical staff at 222-bed Community Memorial Hospital of San Buenaventura, in Ventura, Calif., filed a civil lawsuit in April against the hospital, alleging that they are being punished for competing with the hospital. Last week at its annual meeting in Chicago, the American Medical Association joined the California Medical Association in considering offering financial and legal assistance to the California doctors in their escalating and bitter legal battle.
The unknown number of doctors who filed the civil lawsuit in April in Ventura County Superior Court charged the hospital with breach of fiduciary duty and unfair business practices. Demanding that the hospital rescind a code of conduct and conflict-of-interest policy, the doctors' complaint said the medical staff is responsible for assuring patient quality of care and that hospital interference has damaged care and prevented the medical staff from performing its oversight duty.
The hospital countered that the doctors do not represent the entire 400-physician medical staff but only a handful of physicians who have exploited their positions on hospital committees to gain inside information to help them compete against the hospital in specialty medical services, such as outpatient surgery centers.
The hospital claims the medical staff has no standing to sue because it is not an independent organization outside of the hospital.
The facility has denied the physicians' allegations about diminished quality of care. The battle is indicative of skirmishes to come as physicians, who have seen their reimbursements decline and medical malpractice insurance and other costs increase, seek ways to increase income that frequently put them in competition with the hospitals on whose medical staffs they serve.
The hospital's code of conduct and conflict-of-interest policy require physicians to declare any competing interests and forbid those physicians who have such interests from holding staff leadership positions that would give them access to confidential hospital plans, said Michael Bakst, Community Memorial's executive director.
"The board said with all the competition, we need to protect ourselves," Bakst said. He said some of the dissenting physicians exploited the hospital board's actions and riled up physicians, further polarizing the community hospital from its primary referral sources.
"Now they've made a lot of noise and got the California Medical Association and the AMA involved to bring out the big guns, all because we've outcompeted with them in the marketplace and they didn't like that."
Bakst said the conflict has been painful and divisive.
Daniel Mulholland, a healthcare attorney with the firm Horty, Springer & Mattern who represents the hospital, said the case has percolated beyond the Los Angeles area to national recognition.
"This is not about economic credentialing," Mulholland said. "The physicians purporting to represent the medical staff don't want to have to disclose anything about their financial interests in competing facilities. They want the medical staff to have control and reduce the hospital board to a rubber stamp."
Charles Bond, a Berkeley, Calif., attorney with the firm BondCurtis who represents the doctors, said the conflict-of-interest issue is a red herring.
"This suit is about ongoing violations of the principles of medical staff governance," Bond said. "What used to be a relationship of cooperation is now one of co-opting."