Summa Health System’s new emergency room physician group doesn’t have enough teaching experience or academic credentials to meet national requirements to train doctors.
Hospital insiders say these and other violations, including reports of a hostile work environment for students, are among the reasons Summa recently lost its accreditation for its emergency medicine residency program.
The loss of accreditation, effective July 1, came after Summa abruptly switched ER staffing groups on New Year’s Day from Summa Emergency Associates (SEA) to Canton-based US Acute Care Solutions (USACS).
Officials with USACS say they will appeal the accrediting agency’s decision.
The report from the Accreditation Council on Graduate Medical Education (ACGME) is not available to the public. Summa officials have shared the report and list of violations on a limited basis with some employees, but insisted, for example, that ER residents put their cellphones in a basket so no one could document the violations.
Several sources inside Summa shared some details from the report. They asked not to be identified for fear of retribution or harming efforts for the health system to move forward.
Among the violations cited by the sources:
• USACS’s Dr. Scott Felten, interim program director for Summa’s emergency medicine residency, does not have the proper qualifications.
• USACS core faculty for the ER residents do not meet the 3-to-1 faculty-to-student ratio requirement and faculty members do not meet publication or academic research requirements.
• Dr. Cynthia Kelley, Summa’s vice president for medical education in charge of the residents, intimidated residents.
• Summa administrators created a hostile work environment for residents.
Summa spokesman Mike Bernstein declined this week to answer specific questions about the violations or confirm whether they were in the ACGME report.
Instead, he issued this statement: “We were disappointed by ACGME’s decision last week, and are in the process of appealing that decision. USACS faculty meet or exceed all necessary requirements for an ACGME-accredited emergency medicine program. In fact, Dr. Felten has more than four years of experience as a core faculty member in ACGME-accredited emergency medicine residency programs. We have full faith and confidence in our emergency department team from USACS — a partnership in emergency medicine staffing that is here to stay — and will continue working with them to ensure our residents continue to receive excellent training. As always, we will advocate for the best interests of our residents, patients, and physicians through appropriate channels.”
USACS spokesman Marty Richmond said his firm disputes the violation involving Felten, whose experience exceeds ACGME requirements by more than a year.
USACS CEO Dr. Dominic Bagnoli said this week that Felten, who trained at Akron General, agreed to come to Summa for 18 months. Felten’s wife is an ER doctor in Tulsa and they are considering moving back to the area, Bagnoli said.
“A lot of stuff in the [ACGME] report was not accurate,” said Bagnoli, who has read the report but declined to discuss it in detail.
Bagnoli said USACS often has 90 days to prepare for staffing a department with a new contract; in Akron, it had a couple of days.
Bagnoli said USACS had adequate core faculty for 30 residents before ACGME visited, but he acknowledged it doesn’t yet have the same academic credentials as SEA.
It would take three to six months to recruit and hire faculty with the same credentials, and Bagnoli said he needed physician teachers immediately.
Jeff Wright, who leads SEA, said his 10 core faculty members had 60 publications in the last five years.
“USACS core faculty cannot hold a candle to the core faculty we had. Nationally, they don’t have the requirements nor the respect our people had,” said Wright, who noted that the SEA ER Program Director Dr. Shar Jwayyed, won the ACGME’s top educator award last year.
An ER resident said this week the residents’ lives are in limbo while Summa tries to appeal the decision “to save face.”
The resident, who asked not to be named for fear of retribution, said residents have not met all of the USACS faculty, even though the teaching staff is supposed to be hands-on.
Richmond disputed that, saying faculty are on site and it’s possible all residents haven’t met staff since they are on rotations.
The resident wants Summa to either cut residents loose or to bring back SEA faculty.
“It’s such a travesty,” the resident said. “It’s not just sour grapes. It’s not that we miss our old attendings. They’ve destroyed one of the greatest and oldest ER residencies in the country and put the blame on everyone but themselves.”
Bagnoli, however, said both Summa and USACS are dedicated to medical education.
“There is an easy solution,” he said. “Some of SEA’s core faculty could decide they want to save Summa’s residency program. If we could get four or five of those doctors to come back and work for us and submit an appeal saying half the staff was back, we’d go to probationary status.”
Bagnoli said if USACS and SEA faculty could sit in a room with a mediator, he believes they could make it happen.
SEA’s Wright said that won’t happen.
“My guys don’t want to work for them,” he said.
USACS isn’t willing to step aside, even on the off chance that Summa’s board of directors would try to bring back SEA to maintain Summa’s residency, Bagnoli said.
“We have a binding contract,” he said.
Of the 170 hospitals USACS staffs, Bagnoli said 160 don’t have residencies.
“If we win the appeal, we’ll work like hell to make Summa one of the best residencies in country,” Bagnoli said. “If we lose, the ED can be run without residents.”
Dr. Robert McNamara, a Temple University emergency medicine chairman who has served on ACGME accreditation teams, said it could be difficult to get the decision reversed, although it could help if SEA returned.
“That would be a fairly radical move and maybe (ACGME) would be willing to put a probationary status on it.” said McNamara, former president of American Academy of Emergency Medicine.
ACGME surveyors base their decision on many interviews at the hospital and reviewing qualifications on the day of the visit, he said. “Anything that has happened since doesn’t pertain.”
Some physician leaders said this week the Summa board of directors may be considering bringing back SEA, though Summa and USACS insist their contract stands.
However, McNamara said Summa must address all violations, including leadership issues.
“Whatever the hidden report shows, when you appeal something, you address every single reason to say why we should not be terminated,” he said.
Betty Lin-Fisher can be reached at 330-996-3724 or email@example.com. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ and see all her stories at www.ohio.com/betty.