The big bucks

This morning’s Post-Standard includes my salary in its report "How CNY hospitals pay CEOs big bucks."

This is not the first time I’ve seen my pay reported in the local newspaper. About 15 years ago a story included my pay, and I remember feeling quite embarrassed by it at the time – especially in light of some comments that friends and co-workers felt obliged to make.

I am well paid for the work I do. I appreciate the confidence that has been shown in me by the Board of Directors, and I appreciate what the Board pays me.

The chart, below, shows how my pay last year compared with that of the CEOs at other Syracuse hospitals, according to today's newspaper.

CEO pay is public information for not-for-profit organizations such as hospitals. Each non-for-profit hospital is required to file an annual form with the IRS that documents its finances and includes the highest payments it makes to employees, officers, and vendors. Anyone can get a copy of IRS Form 990 by asking the organization for it or by consulting a service such as Guidestar.

About a year ago, Paul Levy, CEO of Beth Israel Deaconess Medical Center, reported on his blog about his own $1 million annual pay, commenting:

Americans are often ambivalent about high salaries for corporate executives: They often complain about them, but, at the same, time, everybody hopes that he or she can someday earn them!

Inspirational Medicine

Last Friday NPR’s “Day to Day” radio program broadcast a segment about low morale and disaffection among primary care doctors.

A lot of doctors said they would prefer to be in another profession. Furthermore, only about five percent of the doctors-in-training are choosing primary care because of the significant medical school debt they have to repay and because they are discouraged by the daily example of unhappy older doctors.

One of the physicians interviewed on the program told how she stopped participating in health insurance plans a few years back. Another doctor who left practice complained about insurance companies that “put profits over patients.”

A third physician lamented the loss of patient contact, as well as the decline in intellectual satisfaction. The physicians said that medical practices are succumbing to the time pressure of seeing many patients with little opportunity for attention to individual situations.

I've written before about the coming shortage in primary care physicians.

Training these physicians is a source of satisfaction and pride. Each quarter a new group of family practice residents rotates through the internal medicine service at Community General Hospital. These second-year residents are from the training program St. Joseph’s Hospital Health Center, and they provide a real service to patients as they learn from Community’s attending physicians.

Last week one of the residents was honored as a local hero by the American Red Cross. One morning in August Dr. Michael Loeb (photo) came across a bad accident at the New York State Fairgrounds on his way home after night duty at Community General Hospital. The exhausted resident did not hesitate to stop his car and help the injured family.

Dr. Loeb described the situation for a local television station:

"…[T]he day of the crash was the day after one of the most brutal calls I’d ever had,” he said. “It had just been a crazy night…My first reaction was ‘I need to get over there [to the accident site],’…and my second was ‘This isn’t going to be pretty.’”

Dr. Loeb got out of his car and crossed the lanes of traffic to provide assistance. The following morning, I saw Dr. Loeb in the emergency department when one of the attending physicians told me what he had done. I thanked him and said his example was inspirational.

Dr. Loeb reminds us why people choose medical careers, despite the demands, distortions, and pressures of the medical marketplace. People choose medicine because they care about patients, and they want the knowledge and training to be of help.

Wrong-side surgery

Today’s newspaper carries a story about a wrong-side surgery at St. Joseph’s Hospital Health Center. My thoughts go first to the patient – and then to the caregivers at St. Joe’s.

The story recalls a wrong-side surgery that took place at CGH in 2004, about which I wrote last year. I learned about our medical error the morning it happened, and we conducted a root cause analysis that same day. I promptly apologized to the patient for our medical error, and I apologized to the surgeon because our safety processes did not prevent the error.

Hospitals are complex places where modern medicine allows us to do much good for patients, but modern medicine is accompanied by risk. All hospitals rely upon internal processes to reduce the risk of error, but we didn’t follow our process – we failed our patient and we failed each other – one day in 2004.

Following the root cause analysis, we took many other actions to improve our safety processes. We reached out to another hospital administrator who had experienced a wrong-side surgery; she helped us learn from that experience. We invited the Joint Commission to conduct an on-site review, we visited a local company to learn about industrial safety processes, we hired an operating room consultant to help us improve, and we made changes in our Universal Protocol. We re-trained all staff, and each member of the Medical Staff committed to following the Universal Protocol.

Because health care involves human beings, mistakes, regrettably, are possible – not just in the Operating Room, but anywhere. That’s why standardized processes help fallible individuals safeguard patients .

Today's news story reminds us that the lessons from our own wrong-side surgery must remain fresh for all of us.

This posting appeared in a different form on December 16, 2007.

SEIU's corporate campaign

Yesterday members of SEIU 1199 picketed my home. Interestingly, the picketing was not intended to influence me at Community General Hospital, where I am CEO. Instead, SEIU seeks to use me to pressure one of Community’s employees who serves on the Board of Iroquois Nursing Home. I have declined to apply the pressure.

Earlier this year SEIU conducted an organizing campaign at Iroquois. Having won its election on March 7, 2008, SEIU is negotiating its first contract – a process that is not apparently proceeding to its liking, judging by the calls and personal visits I have received from Al Davidoff, SEIU Vice President.

SEIU has made Iroquois the object of a “corporate campaign” intended to pressure, to intimidate, and to publicly embarrass the organization. As a tactic, corporate campaigns have been used by SEIU with organizations across the country, including such notables as Beth Israel Deaconess Medical Center, Sutter Health Care, and even the California Nurses Association. Anyone interested in learning more about this tactic need only search the Internet for “SEIU corporate campaign” and read the links that appear.

Corporate campaigns employ the methods of community organizing, political action, and public relations, such as letter writing, telephone calls, picketing, and publicity. SEIU corporate campaigns target elected officials, as well as candidates for office, and they involve outside organizations in an effort to bring additional pressure on the Board and management of a target organization – in this case, Iroquois Nursing Home.

Along with St. Joseph’s Hospital Health Center and Crouse Hospital, Community General Hospital shares the responsibility to appoint Board members to Iroquois. We three hospitals established Iroquois to meet a community need some 15 years ago, under the auspices of Plaza Corporation, Inc. Plaza is the sole member of Iroquois Nursing Home and Rosewood Heights Nursing Home. Plaza's two nursing homes are independent, not-for-profit corporations, separately licensed by New York State, each with its own Board of Directors.

As the three members of Plaza, Crouse, St. Joseph’s, and Community have the responsibility to appoint qualified community representatives to the boards of both Iroquois and Rosewood. Community’s appointees to Iroquois have served as Directors there from four to 15 years each.

Board members have the legal responsibility for nursing home governance. They are fiduciaries – that means, the Directors have legal responsibilities to the residents of the nursing home and to the communities served by the nursing homes.

About a year ago, the Iroquois Board elected one of the Community-appointed Directors as it chairperson. SEIU thinks that makes Community responsible for decisions made by the Iroquois Board. Mr. Davidoff has asked me to intervene with the Community employee serving as Board chairperson. The intention is to bring pressure from Community General Hospital's management upon a hospital employee who has fiduciary responsibilities at Iroquois.

I have explained to Mr. Davidoff – as I did to his predecessor, Marshal Blake – that Community sees Board membership at Iroquois as a community service, not as a puppet of Community’s administration.

Mr. Davidoff has informed me that SEIU would seek to generate unfavorable publicity for Community General Hospital, unless I make an effort to interfere with the Board of an independent, not-for-profit facility. That apparently is the price one pays for doing the right thing in the face of an SEIU corporate campaign.