I can’t be sure that anyone on the medical staff at St. Mary’s Medical Center in Long Beach, California read my 2017 post, What You Need To Know About The Flea That (Metaphorically) Killed The Medical Center CEO, but they appear to be following the same strategy in an attempt to eject a hospital CEO, Carolyn Caldwell, in whose leadership ability they have no confidence.
In that 2017 post, I recounted the story of the “no confidence” action by no more than 37 medical staff members that brought down the CEO of Ohio State University’s Wexner Medical Center, Sheldon Retchin, M.D.
I analogized the action of the few handfuls of physicians to guerrilla warfare as described in the seminal work by Robert Taber, The War of The Flea. Taber wrote about how a small band of guerrilla fighters could emerge victorious in a conflict with a larger, well organized enemy
“Analogically, the guerrilla fights the war of the flea, and his military enemy suffers the dog’s disadvantages: too much to defend; too small, ubiquitous, and agile an enemy to come to grips with.”
In the “Battle of Long Beach,” the opening salvo was fired in February this year when the Medical Executive Committee sent a letter to all members of the medical staff that they were initiating a dispute resolution process with the medical center’s administration centering around what appears to have been their learning, through the “grapevine,” that St.Mary’s was about to end very long-standing contractual relationships with the anesthesiology and radiology groups covering the facility.
In that letter dated February 6, 2019, the MEC stated their contentions that the administration had violated both Joint Commission requirements and California law pertaining to a medical staff’s rights of self-governance, (1) by refusing to discuss with medical staff leaders who will be providing contracted clinical services, (2) by initiating steps to terminate existing clinical services contracts and to award alternative contracts in retaliation for medical staff leaders’ advocacy for improved patient protection and peer review policies, and (3) by taking steps to terminate contractual arrangements with the Vice Chief of Staff so as to interfere with the medical staff’s right to select its leadership.
Although it’s unclear what, if anything, happened to the radiology group providing services at Saint Mary’s, the hospital initially granted an extension to the current anesthesia group, Long Beach Anesthesiology, which had held the contract since the 1990s. Then, in mid-May 2019, the hospital announced that it would no longer deal with Long Beach Anesthesiology and that it was awarding the contract to Somnia Anesthesiology beginning September 1, 2019.
The warm war then became hot, with the MEC calling a meeting of the full medical staff on May 21, 2019, at which there were no votes in favor of CEO Carolyn Caldwell’s leadership abilities. 58 physicians added their names to the no-confidence letter delivered to the hospital, with others, according to Chief of Staff, afraid to sign-on publicly due to fear of retaliation from the administration.
So far, CommonSpirit, the system that runs St. Mary’s, has refused to cave in to what is essentially the Medical Staff’s demand that Ms. Caldwell be terminated.
What does this mean for your organization and for you, personally?
From the organizational perspective, as in a guerrilla war, change within the organization, as well as within a domain in which the organization interacts, can occur as a result of agitation, even by a vocal minority. Just as no vote was required for a dictator like Casto to take over Cuba, no medical staff vote, no survey by Press Ganey, no long and drawn out process among “stakeholders,” is required to topple the status quo.
What you think is permanent is only temporary. How temporary is the question.
What you do, and how you do it, within your organization, and how you project it to essential third parties (e.g., hospital-based medical group to hospital) is all-important in maintaining relationships, contracts, and even existence. That’s the flea collar.
And, just the same, from the perspective of the individual, the small, the “out group,” the “flea,” a steadfast, vocal, and somewhat intransigent minority, can kill the dog. The large group can be made irrelevant. The hospital CEO can be forced out. The small organization can ingest the larger. Yes, the dog bites back. No win is guaranteed.
In the Ohio State/Dr. Retchin situation, just 3 letters signed by, at the most, 3% of the medical staff, were unable to unseat the king. Chalk up one for the flea.
Many say that the world is a tough place. Maybe it is, because it’s not just dog-eat-dog. In Dr. Retchin’s and Wexner’s world, it’s flea-kills-dog as well.
In the St. Mary’s situation, it appears as if 100% of the medical staff wants to unseat the queen, but the administration is pushing back. Perhaps it’s chalk up one for the dog.
But only time will tell. And, unlike at a state-owned academic medical center with hundreds of employed physicians, at a community hospital like St. Mary’s the huge majority of the staff have the ability to refer their patients elsewhere. Ms. Caldwell may indeed remain queen, but perhaps as the queen of a ghost ship. So, perhaps it will end up as chalk another one up for the flea.
Comment or contact me if you’d like to discuss this post.
Mark F. Weiss