Roy Exum: Erlanger's Power Play

Wednesday, February 14, 2018 - by Roy Exum
Roy Exum
Roy Exum

Some smart and well-respected people will meet at Erlanger Hospital tomorrow to face a problem that, if the truth be known, could seriously affect the quality of health care in our region. At stake are more areas of quality medical care than can be identified in the Yellow Pages, but what it comes down to is who should control the most critical medical component of the human effort in Chattanooga – the UT College of Medicine at Erlanger.

Should it be Erlanger’s Board of Trustees, since they allegedly finance the widely-respected program, or is it the University of Tennessee, since their Board of Trustees and quite-capable medical academicians adroitly administer it? As best I can understand, this newest wrinkle is over the federal Medicaid and Medicare dollars that infuse the Medical College each year. You tell me who actually controls those shared federal dollars, and I’ll tell you who will control the College of Medicine. It should have never come to this, but it has – thus, we must confront it right now.

Every year Erlanger proper is allocated approximately $11 million to assist in the post-graduate intern and resident programs offered budding physicians in Chattanooga. This lifeblood is immediately transferred to its good-faith education partner in Memphis and has enabled hundreds of top-shelf professionals to finish their training in Chattanooga. The result is that millions of us have benefited from this necessary and quite-right process.

Maybe that’s too simple because the actual formulary/business model is so very complex, but what is clear is that quite a power struggle has been allowed to erupt in recent months. I believe this rift is between a driven hospital management team, as laudable that may well be, versus UT Medicine’s quite-arguable need for anonymity, complete independent reasoning, and a totally unencumbered methodology that must never threaten teacher nor student alike.

In its 40-plus years as an integral part of medical achievement in our state, UT Medicine has been a cornerstone at Erlanger. But in recent years a lack of diligence, a dramatic change in critical areas within our region that include rural medicine, and a payment conundrum beyond mankind’s realm, has completely altered the landscape.

Right now everybody is a loser in this escalating shoving match and, unless decisive steps are taken quickly, what has been a great blessing since the early 1970s could quickly erode. Erlanger’s Trustees have just given Kevin Spiegel the singular authority - as unthinkable as it truly is - to sever the UT program at his whim and if such occurred it would be a true doomsday for millions of innocents who live in our region and depend on the hospital

The hospital trustees are scheduled to meet with members of the University’s board of trustees early tomorrow afternoon. Steven Schwab, the Chancellor of the UT College of Medicine, and Kevin Spiegel, the CEO of Erlanger, are the key antagonists, and Spiegel – the dynamo who has resurrected our failing region trauma center – strongly believes he should be in control over all in his domain.

Conversely, the huge majority of Erlanger’s medical staff fiercely disagree. Many are established physicians and specialists who would otherwise not be in Chattanooga if they could not teach as well as practice at our largest public hospital. Literally each can cite a myriad of challenges and problems that would occur. There is a long-held belief that a teaching hospital thrives from a fiscally strong hospital, and that the hospital benefits greatly from a strong education program. It is very true.

Spiegel’s stand is that the interns and residents in the UT program should be confined only to Erlanger, while college officials insist the best education is when those-in-training are included at Memorial, Parkridge and, most especially, rural hospitals where their presence is invaluable. Spiegel believes such interaction hinders the hospital’s competitive edge, then the question quickly becomes should educational opportunities be affected in a black-white business plan?

Worse, each surgical resident must have a certain amount of time in various disciplines – thoracic, ob-gyn, vascular, orthopedics, etc. Yet, in this case, the best thoracic practice in the South is centered at Memorial. Erlanger has no burn unit, ophthalmology venue, and other areas where top-tier procedures must be best taught. It is clearly a disadvantage for any UT resident to be limited in any scope.

It is also patiently ridiculous that ‘glass walls’ should ever prevent UT residents in various specialties from access to physicians not at Erlanger. The medical education system was never designed to be exclusive and to prohibit a candidate for thoracic surgery – for example -- from access to Rob Hedrick’s robotic brilliance is near unfathomable. When petty personal differences actually limit a medical student’s knowledge base, it is hardly a trick to find the line between life and death.

Another example: Right now I have a friend in a horrible struggle with advanced cancer. His surgeon is restricted to Memorial while his oncologist can only work at Erlanger. Who among any at tomorrow’s table of the combined trustees can condone such an unforgiveable quagmire to a man in a Stage Four condition? To acknowledge such, and condone it, is a direct dereliction of a board member's duty and those who are sworn to represent the people should resign rather than nurture a known fraud.

On a more personal note, the genius surgeon Jim Zellner had to remove a rib of mine that had gotten sick several years back. But now Dr. Zellner doesn’t go to Erlanger. As for me, Erlanger remains my hospital of choice. Ain’t that just swell – I have no choice but to go elsewhere other than our Level 1 trauma center but my point is there are hundreds of thousands who haven’t the options I do. So do we just stand accepting lesser options or do we remedy out pitfalls once and for all?

Erlanger’s medical leadership has been alarmed by what some see as a “power grab” from Spiegel for some time. Granted, Spiegel believes it is his job to seek “only the best” for the hospital, which includes driving away or slighting any competition, and his mission is to put the billion-dollar hospital operation on a full-speed-ahead course. His detractors cite fast-growing collateral damage, a bottom-line increase of just one percent, and a lack of trust for the executive team that is mounting in pressure.

The joint meeting of trustees tomorrow cannot shirk the responsibility of what will be presented and tasked.

The hospital’s Graduate Education Committee - universally regarded as the backbone of the medical staff -  had drafted a “no confidence” letter in recent weeks and insiders whisper a vindictive twist has already resulted in the hospital’s ever-changing dynamics. This is not right, not at all.

A “no confidence” letter smacks in the very public face of a fundraising appeal for the new Children’s Hospital being built on East Third Street, and the new psychiatric facility near the Erlanger campus, and so many positives to the fiscal plant.

Instead, the growing critics point to the fact there have been no upgrades or new construction for the UT College of Medicine, that new dean Bruce Shack hasn’t been approved by the UT Trustees, and that an increasing shortage of available beds underscores the need for a strong residency program more than ever before.

Tomorrow we need a dose of leadership in its purest form. It should never have come to this. It has.

* * *

One evening an old Cherokee Indian told his grandson about a battle that goes on inside people. He said, “My son, the battle is between two ‘wolves’ inside us all. One is Evil. It is anger, envy, jealousy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego. 

“The other is good. It is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion and faith.’

“The grandson thought about it for a minute and then asked his grandfather: ‘Which wolf wins?’

“The old Cherokee simply replied, ‘The one you feed.’”

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