Seven Physicians Lose Hospital Privileges in
Paperwork Jam

Clinical Competence Was Not an Issue

Nick Mulcahy

March 24, 2020

Seven Florida oncologists lost their medical privileges at a local hospital, then lost a subsequent lawsuit to have themselves reinstated, and last month paid the hospital nearly $1.5 million to compensate for the defendant's legal costs.

The only consolation was that, in an unusual twist, the group ultimately got respect and compassion from a United States district court judge who presided over the case.

The story begins with the oncologists, who all had privileges at Parrish Medical Center in Titusville, Florida, a public hospital on the state's Atlantic central coast, a region best known for its NASA facility and space mission launches.

Parrish is the only hospital in the immediate area; the nearest alternative is 30-plus miles away, and thus Parrish's cancer center is convenient for local patients and physicians.

The group of seven oncologists had established their roots in the area as members of the Space Coast Cancer Center, an independent clinical practice. But in 2015, Health First, a regional health system, bought the practice and the oncologists became employees for that entity, which also owns hospitals, a multispecialty medical group, outpatient services such as home and hospice care, and health insurance plans. 

In 2017, the seven physicians began the process of getting their medical privileges reappointed at Parrish. In the United States, such privileges mean, among other things, that a doctor can have access to their patients in all areas of a healthcare facility. Physicians typically seek privileges at facilities near their practice, as locale often dictates where a patient is treated and/or hospitalized.

Hospitals are responsible for conducting the related credentialing process and granting or denying privileges.

Each of the seven oncologists — Germaine Blaine, MD, Cynthia Bryant, MD, Juan Castro, MD, Ashish Dalal, MD, Firas Muwalla, MD, Brendan Prendergast, MD and Richard Sprawls, MD — had previously successfully applied for medical privileges at Parrish and had been reappointed each time their terms expired.

Meanwhile, Parrish was in the midst renewing accreditation of its oncology program from the influential American College of Surgeons Commission on Cancer, which required patient outcomes data as one of its measures of quality.

What followed was a prolonged bureaucratic dance whereby the seven physicians were all recommended for renewal by internal committees at Parrish, but needed to provide patient outcomes data (per the Commission on Cancer's needs) to finalize the process. That data ultimately had to come from their employer, Health First, which jammed up the flow of paperwork and, in effect, refused to turn over much of the data.

Without the data, Parrish chose not to re-up the group's medical privileges.

The oncologists then filed their lawsuit, arguing that the decision did not follow contract bylaws and their due process rights had been denied.

"Health First is a monopoly," said Craig Deligdish, MD, director of Parrish Center Cancer, in comments to Medscape Medical News.

He believes that Health First, in refusing to fully release the paperwork/data, was hoping to block the Commission on Cancer's accreditation of its competitor Parrish and thereby weakening its reputation and viability, with the end result being more patient visits and procedures at regional Health First facilities.

However, speaking about the lawsuit to Florida Today, Sean Snaith, director of the Institute for Economic Forecasting at University of Central Florida, Orlando, said it's possible that Health First had no "nefarious" intentions by refusing to release the data to Parrish Medical Center. Businesses are often reluctant to disclose competitive information, he said.

Health First has experience in this legal realm.

In 2016, a collection of independent physicians, including Deligdish, scored a financial settlement with the health system, which was accused of anticompetitive actions that allegedly hurt physicians' ability to practice medicine, as reported by Medscape Medical News.

Health First did not respond to Medscape Medical News' request for comment.

Respect From the Bench

At the lawsuit hearing last year, Roy Dalton Jr, US District Court judge, ruled in favor of Parrish but had no harsh words for the oncologists.  

Instead, Dalton said that Health First, while not a named party in the lawsuit, was ultimately responsible for all of the troubles that the physicians encountered, including loss of privileges at Parrish.

"…at bottom, this dispute revolves around the thinly veiled effort of Health First to flex its muscle in the long running, heavily litigated, 'scorched earth' turf war for Brevard County's healthcare business," Dalton wrote in his judgement of the suit.

Next, Dalton offered the seven oncologists some respect: "The plaintiff physicians here, all eminently qualified in the field of oncology, have been employed as foot soldiers in the intractable hostilities."

Dalton then suggested Health First management experienced no pain from these actions, but that others have.

"Whether Health First has any concern for the reputation of their employee physicians, or the unfettered delivery of healthcare services to Brevard County citizens, or simply regards this as unfortunate but necessary collateral damage, is unclear. No sacrifice is too great when it's not yours," he wrote.

In a February staff memo obtained by Medscape Medical News, Parrish CEO George Mikitarian, MD said that the case was over, the reputations of the seven oncologists were not tarnished, and $1.495 million was paid to the hospital.

"We are pleased to report that in the case of Germaine Blaine, et. al. v. PMC [Parrish], the seven Plaintiff physicians agreed to, and have all signed, a Settlement Agreement," he wrote.

"The Physicians were given a letter which states that their non-renewal of privileges by the Board was not based on their 'clinical competence or professional conduct, nor based upon conduct which affected or could have adversely affected the health or welfare of a patient or patients,' " he added.

One of the seven plaintiffs, Health First oncologist Muwalla, put a positive spin on the outcome.

"We remain steadfast in our commitment to our patients and serving the Titusville area," he said in a statement. "And even as Parrish Medical Center's refusal to allow us to serve our patients at the hospital continues, our mission remains clear: Beat cancer."

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