Three top cardiologists at Detroit Medical Center have been relieved of their administrative duties for alleged code-of-conduct violations, and a fourth cardiologist has resigned for unspecified reasons, according to an email sent Monday evening by DMC executive Scott Steiner.
One of the cardiologists, Mahir Elder, M.D., medical director of the cardiac care unit at DMC Harper Hospital, said DMC's actions are retaliation against his complaints the past several years of poor quality at the for-profit hospital.
Three sources told Crain's the other three cardiologists have expressed similar complaints related to certain doctors within DMC's cardiology program and staffing and service reductions the past three years at DMC that they say have jeopardized patient care for the poor and underprivileged.
"After an extensive review of complaints received from physicians and team members, DMC has asked Dr. Mahir Elder, Dr. Amir Kaki and Dr. Tamam Mohamad to step down due to violations of our standards of conduct," Steiner, CEO of DMC Detroit Receiving, DMC Harper University and DMC Hutzel Women's hospitals, said in an email to DMC employees.
Steiner did not explain what standards of conduct he was citing. DMC would not make executives available for interviews for this story.
The dismissals come as Elder, Kaki and several other top DMC cardiologists were considering resigning this week because DMC had not acted on concerns over quality and staffing cutbacks they have raised since at least 2014, according to sources familiar with the situation who have requested anonymity.
Over the past four years, several of the doctors and former administrators have complained to DMC leadership about problems related to insufficient staffing, poor quality by certain doctors and questionable practices. They have reported problems to local DMC administrators and also to DMC's investor-owned parent company, Dallas-based Tenet Healthcare Corp.
Elder, Kaki and Mohamad have been top cardiologists at DMC for years. Elder is a two-time Crain's Health Care Hero. Mohamad is chief of cardiology and medical director of the cardiac care unit at DMC Detroit Receiving. Kaki, who was recruited from New York City six years ago, is medical director of the cardiac catheter lab at DMC Cardiovascular Center, a leading heart and vascular researcher; he practices at DMC Sinai-Grace Hospital.
"Effective immediately, they are stepping down from their administrative leadership roles in the DMC cardiovascular service line and their roles providing call coverage of our ER," Steiner said.
In addition, "DMC received Dr. Ted Schreiber's resignation from the medical staff and from his leadership positions in the cardiovascular service line during its investigation of complaints that he had violated our standards of conduct," the email said.
Schreiber, a nationally known cardiologist, resigned as president of DMC Cardiovascular Center and leader of DMC's Cardio Team One last December in a dispute with DMC and Tenet over quality issues, sources said. The same sources told Crain's that Schreiber resigned from the medical staff entirely in frustration last week and has accepted another job at a large competing health system in Southeast Michigan.
Steiner said DMC has given Safwan Badr, chair of the department of medicine, leadership responsibilities over cardiology while it seeks new cardiologist leadership. "We expect no disruption in service to patients, and we will keep you updated as we move forward," he said.
In a statement late Monday evening to Crain's, Elder said Tenet has retaliated against him and tried to intimidate him "to silence the patient safety concerns."
"My reputation as a top cardiologist speaks for itself," Elder said. "No pretextual email sent by Tenet will diminish my long accolades. Ironically, Tenet is trying an age-old tactic of trying to diminish and discredit the messenger. I was a top doctor (at DMC) for 10 years. ... Now that I refuse to stay quiet about safety concerns, they respond in highly inappropriate and unprofessional manner."
The actions against the DMC cardiologists are set against an ongoing federal investigation into DMC's payments to cardiologists, poor quality care and the improper use of employed nurse practitioners for private admitting doctors. The cardiologists named by DMC also have complained about staffing and service-line cuts.
Crain's has learned the federal investigation has broadened this year into other areas. Tenet has hired Latham and Watkins LLC, a Los Angeles-based law firm, to deal with compliance issues and complaints lodged by doctors and employees at several DMC hospitals, according to three sources familiar with the investigation. A spokesman for Latham and Watkins was unavailable for comment.
The investigation by the U.S. Department of Justice in Detroit was disclosed in February by Tenet in a federal securities filing. The company has declined interviews on the subject.
After Steiner released his statement to employees Monday evening, Crain's attempted several times to contact DMC and Tenet executives for comment about specifics of the code of conduct violations.
In his statement, Elder blasted the company.
"It is Tenet, not me, that is subject to DOJ supervision; it is Tenet, not me, that has paid hundreds of millions of dollars for misconduct, inducements, Stark violations and fraud (in a recent Georgia case); it is Tenet, not me, who blames others instead of their own failed leadership," Elder said.
"Fortunately, I will continue to see patients at DMC and if Tenet want to continue running (Cardio Team One) and cardiology as they have, I wouldn't want to be part of that type of future," said Elder, adding that he has no plans to resign from the medical staff. "I have a lot of patients who depend on me and I will not walk away from them."
Steiner said DMC is "committed to upholding the highest standards of care and operating with the utmost integrity. The culture on which we were founded is predicated upon this — and we take it very seriously."
Contacted by Crain's, Joe Mullany, former DMC CEO until early 2017 who now heads Tampa-based Bayfront Health, said he was surprised to hear DMC fired Elder, Kaki and Mohamad without specifying to them what standards of conduct they violated.
"Kaki, Elder (and Mohamad) are very good people. We always get MIDAS complaints (a system for employees or doctors to anonymously report hospital problems) and are required to investigate them. People complain about other people. It happens all the time. We looked into them, Tenet looked at them, in 2015 and 2016 and none of the behavior reports rose" to the level that required a disciplinary action.
Elder said it was "highly inappropriate and literally unprecedented for Tenet (Steiner) to issue a press release to 5,000 employees notifying them of alleged code of conduct violations from any physician let alone directors. This is nothing more than an attempt to confuse the DMC community."
Elder said DMC executives did not specify to him what the violations of the code of conduct were.
Standard of conduct violation "is actually code for 'Dr. Elder doesn't toe the company line,'" Elder said. "It's code for I cannot be bribed or blackmailed and will never give an inch as a patient advocate. I always put patient safety and quality of care first no matter where I work. ... Light always shines on darkness, they may be a multibillion dollar corporation, but you cannot buy truth and truth is on my side."
"Detroit Medical Center asks 3 cardiologists to resign leadership roles one says it is retaliating" originally appeared in Crain's Detroit Business.
