One Physician's Response to a CEO and UVA Health Board Member - In Defense of our Patients and Profession

Response to Opinion Piece in the Charlottesville Daily Progress: https://dailyprogress.com/opinion/column/bill-crutchfield-uva-healths-leadership-shouldnt-just-stay-they-should-be-commended/article_e83a39b0-6ee3-11ef-95e8-17b6f7b98e77.html

Reynolds Hutchins Nisha Mehta, MD MedPage Today American Society of Anesthesiologists? Glenn Youngkin Mark Warner University of Virginia UVA - School of Medicine

The opinion piece written by Bill Crutchfield, titled, “First Do No Harm,” highlights not only a gross misunderstanding of the origins of the phrase, “Primum non nocere,” but also casts the brave UVA Health physicians who have come forward to bring up germane concerns about the care and outcomes of their patients, in a negative light, referring to them as a, “cabal,” or a group that conspires in secret. Perhaps the “cabal,” is not your physicians, nurses, advanced practice providers, respiratory therapists, perfusionists, and other clinical staff who are committed to your health and safety, but the board who meet behind closed doors to make decisions that impact us all. The lack of transparency on the part of hospitals and health care systems has been cited as one of the seminal problems with American health care (1).

As a former University of Virginia faculty senator and cardiothoracic and critical care anesthesiologist, I know many in this “cabal,” well. I have worked with them, side by side, whether at two in the afternoon, or two in the morning, while they work hard in our operating rooms, ICUs, Emergency Rooms and wards saving lives – your lives, and spend yet another day, evening or weekend away from their own families. I have and I have seen them cry with families as we realize there is nothing more, we can do, or high five each other as we save a patient from the brink of death in the TCVICU. I have seen them treat their patients as if they were their own mothers, fathers, brothers, sisters, and children, never sacrificing safety while providing state-of-the-art care. I have seen them stand up, when it would be easier to stay silent, and speak up against suboptimal care and questionable billing practices.

As physicians, our responsibility is not merely to take care of our individual patients when they come to us for help at the hospital. But, more broadly, we have a responsibility to our community, our profession, and our own code of medical ethics to defend the vulnerable. This immense responsibility is predicated on trust. By painting our brave physicians, many of whom worked long hours at decreased pay during the SARS-CoV-2 pandemic, as a “cabal,” who are “doing harm,” to UVA Health by defending the vulnerable, the opinion piece exposes the health system’s need to control the narrative and the absolute lack of tolerance toward any negative revelations. The focus, rather, should be on encouraging our physicians to come forward so that problems can be solved. The very fact that our physicians had to remain confidential reflects not on our physicians, but on the health system that employs them. The editorial claims that UVA Health is better today than it has ever been. That may indeed be true, with respect to the expansion of services offered. However, it does not obviate the critical importance of highlighting problems, especially when it involves human life.

In the military, I worked day in and day out in some of the most dangerous environments on earth. However, considered a highly reliable organization (HRO), our military, unlike the UVA Health Board, took safety and process improvement seriously. Junior and senior leaders were encouraged to speak up and “see something, say something,” became more than just a slogan on a poster. Why should our patients merit any less?

Virginians will remember the history of UVA Health’s leadership suing patients and employees more than 36,000 times for over $106 million over a six-year period, taking the roof over their heads, regardless of the circumstances. Even when Kaiser Health News published their findings, UVA Health’s administration defended their practice. Thanks to the hard work of outsiders, this practice has since ended, but it is fascinating that the opinion piece makes the perverse claim that by coming forward with concerns that affect their patient’s physical or financial well-being, our physicians are causing harm, when, historically, it was UVA Health who took advantage our patients at their most vulnerable time to sue them into financial oblivion (2).

Mr. Crutchfield goes on to suggest that the A ratings in safety issued to UVA Health (by the Leapfrog Group) make any patient safety concerns by faculty physicians a lie. First, per the 2024 Leapfrog Safety Ratings, the University of Virginia Medical Center scores a B, while our neighboring health system, Augusta Health, scores an A (3). Second, research has shown that these voluntary Leapfrog safety scores are skewed toward positive self-reporting and have a poor correlation with outcomes (4).

Leaving UVA Health was not an easy decision for me or my family. We left our home in the Midwest and a position at a top twenty-five heart center to come to UVA Health on the promise of my department chair that UVA was invested in growing a patient-centered heart and vascular institute. However, with the loss of key surgeons and cardiologists and poor hiring practices, UVA Health firmly established its lack of commitment to quality cardiovascular medicine. Clinical excellence is critical and to be able to perform at that level, physicians must be able to trust that the health system is committed to recruiting high caliber physicians to join the team. When good, hard-working physicians, who always place their patients first, leave any health system, it is imperative that the health system try to understand the issues. Principled physicians, like my friends and colleagues of Crutchfield’s “cabal,” have become a commodity to health system boards and CEOs. The health system profits from our expertise, hard work, empathy, and sacrifices. When we speak up on behalf of those who are at the mercy of the health system, we are maligned and misrepresented, bullied and cancelled. UVA leaders may even reach out to other health systems, making it difficult for us to work elsewhere in the region. As a veteran of the United States Navy, our values - honor, courage, and commitment - are not merely words. They represent an ethos that shape our character and keep us grounded. Honor. Courage. Commitment. These are the words that embody my 128 colleauges. Not “cabal.”

By silencing concerns, character assassinating great physicians and surgeons and questioning their integrity, the UVA Health Board and other “friends,” of UVA Health are directly impacting the ability to hire, recruit, and grow Virginia’s not for profit health system. Commend UVA Health’s leaders? No, I do not think so. As employees of a not-for-profit state health system, these leaders work for us, the citizens of Virginia and the employees of UVA Health whose everyday charge is to deliver world class care to our community. For the sake of my neighbors, friends, former patients, and colleagues, I hope the businesspeople of UVA Health will strive to do better. Primum non nocere (do no harm), does not come from the Hippocratic Oath, as suggested by Mr. Crutchfield’s opinion piece. If he got this wrong, what else has he gotten wrong?

A revolution in American Healthcare is at our doorstep and long overdue. The time has come for the UVA Health Boards of the world to realize that the physicians, nurses, allied health professionals and researchers that are the foot soldiers in the fight for better, more economical, and empathetic care for American patients will no longer sit on the sidelines. We are not your commodity to buy and sell and we shall not be dismissed.

"In America our idealism is not unusual, nor does it differ much from that of the medical faculty of other countries; if we excel in anything, it is in our capacity for translating idealism into action (5)." -?Charles H. Mayo, MD

References

1.????? The Price We Pay - What Broke American Health Care and How To Fix It by Marty Makary, MD. Bloomsbury Publishing. ISBN-10: 1635574110, ISBN-13: 978-1635574111?

2.????? Smith, J. (2023, January 15).?Title of article.?The New York Times, p.?A1.?

3.????? (https://www.hospitalsafetygrade.org/search?findBy=zip&zip_code=22932&radius=50&city=&state_prov=&hospital=)

4.????? Med Care. 2017 Jun;55(6):606-614 Dissecting Leapfrog.

5. International Medical Progress.?Collect. Papers Mayo Clin. & Mayo Found.,?23:1020-1024, 1931

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