Staffing Contract Disputes Causing Uproar in San Diego

Palomar Health, a public healthcare district with two hospitals in North San Diego County, is under fire — from both its own staff and North County residents — after its board privately negotiated new contracts with two physician staffing companies.

A spokesperson for Palomar Health confirmed that their CEO, Diane Hansen, signed three contracts with Emergent Medical Associates (EMA) and Benchmark Hospitalists & Intensivists (a branch of EMA) to staff their emergency departments and other in-house positions.

The decision was made to “improve quality, to improve our patient experience and patient satisfaction, and, quite honestly, to improve affordability,” Hansen told NBC San Diego. But, according to Sabiha Pasha, MD, chief of staff at Palomar Medical Center Escondido, the new contracts would hurt patients, not help them.

“They brought a staffing model that would require each physician to see 25 patients a day in a 12-hour shift,” she told San Diego’s KPBS. “So you do the math on that …, and then you have to do all your documentation. How do you take care of sick people like that?”

Pasha, who was on the subcommittee in charge of reviewing the staffing companies’ bids, said that although certain financial information was redacted from the committee’s materials, she saw no benefits in the contracts that were relevant to performance and quality. Ultimately, the committee recommended that they not switch providers. And on June 23, doctors from Palomar Health issued a vote of no confidence against the system’s administration.

In a letter sent to each of the district’s elected directors at the end of June, an attorney representing the newly formed “Citizens to Save Palomar Health” accused Palomar Health of violating California’s Brown Act, which mandates that decisions made by publicly elected officials be done in open sessions.

Kenneth Lounsbery, an attorney whose firm, Lounsbery Ferguson Altona & Peak in Escondido, is representing the citizens’ group, concluded that Brown Act violations had indeed occurred after he learned about the district’s secret approval process.

“The news came to us from a member of the board who was on the minority vote on awarding the new contract to EMA,” Lounsbery told MedPage Today. “If what this board member describes is true, he and perhaps two others were left out of the conversation and decisions would appear to have been made prior to and outside of the public meeting court requirement.”

According to California law, Palomar Health’s leadership has 30 days to respond to the group’s letter, with either plans to amend their alleged violations or a denial of the accusations.

“We’ve heard stone-cold silence,” Lounsbery said of Palomar Health’s administration. At the end of the 30-day period, if still no response has been issued, he expects to move forward with a lawsuit.

A Palomar Health spokesperson told MedPage Today via email that they are waiting to issue a comment until they “have better information to share.”

The new deals replace Palomar Health’s longstanding contract with Vituity Healthcare & Medical Staffing Services, a company that the district used to staff their emergency departments for over 40 years.

“We were surprised and saddened to learn of the decision to end their contract with us, given our extensive record of quality care for the community and the deep ties Vituity physicians have with the local community and Palomar Health staff,” a Vituity Healthcare spokesperson wrote in an email. “Our focus at this time is on ensuring quality and continuity of care for patients, as well as support for Vituity physicians and advanced care providers who are being displaced as a result of Palomar Health’s decision.”

The transition to EMA and Benchmark Hospitalists & Intensivists will go into effect on August 1. The change will reportedly only affect doctors with exclusive contracts at the hospital; the job safety of family doctors and specialists will not be compromised.

“It’s obvious that there are some doctors who’d like to save their jobs — but our job isn’t just to preserve jobs,” Lounsbery told MedPage Today. “It’s to make sure that those who are providing the work are still in place to give the best possible healthcare.”