On April 24, Dr. John Egar was released from his job at PeaceHealth’s Peace Harbor Medical Center in Florence. Egar was fired without cause but was told that, unofficially, his outspoken opinions on access to and costs of healthcare were the reason. Egar, a well-respected and popular doctor among his patients, plans to stay in the area and may try to join a new primary care facility that has recently opened in Florence. He does not, at present, plan to appeal his termination.
Earlier this year, Egar had penned three letters to the editor of the local newspaper, The Siuslaw News. The letters challenged the high costs of healthcare in the United States and encouraged readers to seek transparency in pricing from their insurance providers.
“My last annual report was a good one,” said Dr. Egar. “I had no reason to expect this.” Egar returned to work on April 24 after a week’s vacation “and I noticed on my calendar that there was a meeting scheduled for that morning.” He had also been scheduled for new patients and expected to have a regular day. However, he was given a letter of termination by the supervising medical director Dr. Ron Shearer and Cindy Crossley, the human resources director.
“When I asked the reason,” Egar said they replied “‘We can’t tell you not to write letters to the editor, but it was the wrong forum.’” Egar feels, as do many of his former patients and colleagues, that this statement reveals he was fired for writing letters to the editor that challenged hospital policy.
Egar claims that he wrote the letters representing himself, not the hospital organization. “They reflected things I’m concerned about in general,” he said. “And back in March when I wrote them, I never heard anything from PeaceHealth. In fact, there was a dearth of response from local readers overall.” He didn’t feel that his letters had received broad readership, and he certainly didn’t expect that the hospital was planning any sort of punishment or retribution.
Michael Huntington, a local activist and spokesperson for Health Care for All Oregon, feels that, especially since “the administrator said there were no patient care issues, there is probably more in the background. Egar didn’t agree with some of their policies on ‘production,’ meaning how much income were you bringing into the organization.”
Egar has strong opinions about healthcare policy overall and the hospital’s transparency on costs and services, in particular. “It’s certainly a cold shower,” said Huntington, “for anyone who feels that hospital policy protects providers from retaliation if they speak out, if they go through proper channels but get no relief.”
Community Support for Doctor
While PeaceHealth was within its rights to let Egar go because he was an at-will employee, many patients and community members feel the action was unjust, and it exemplifies an inattention to continuity of care by hospital management.
“Clinic patients are waiting a long time to get an appointment with a primary care doctor,” said Egar. There are often restrictions and hassles if they don’t have a primary care provider; they can’t get drugs refilled or prescriptions written.” And sometimes, the wait to get a provider can be as long as nine months. In recent months, the number of primary care internal medical physicians at Peace Harbor has dwindled from eight to two, which is exacerbating access problems.
“You hear about people who are appalled at the situation with the VA, patients waiting 14 days,” said Egar. “That’d be a dream for people in Florence.”
Some community members, such as Ron Hoagland, a former patient of Egar’s, are concerned that the decision to fire him did not come from the local level, but was a corporate decision made by an out-of-state entity that prioritizes profit and does not know or even understand the needs of the local community.
“It feels like this hospital is no longer in control of itself,” said Hoagland. “Orders are coming from far away. I know it’s the wave of the future, but it’s still shocking. He’s a good doctor. The whole thing feels very irresponsible and corporate.”
Huntington, with Healthcare for All Oregon, took part in a large demonstration shortly after Egar’s firing, and emphasized that his termination is emblematic of something bigger. “The point that HCAO would want to make,” said Huntington, “is that this is directly related to incentives,” which is something that Egar spoke out against in one of his letters to the editor. The focus is not on providing good care, but on giving doctors incentives to seek expensive tests and treatments to maximize profit. “The whole incentive system is against the idea of quality care,” he said. “It’s a system based on having enough sick people to keep it running,” instead of creating healthy people. “It’d be like funding your fire department based on whether or not it had enough fires to keep it open.”
Hospital officials declined to respond to queries from The Lund Report about Egar’s dismissal or comment on its policy of allowing employees to speak freely, and about continuity of care concerns for the underserved population of Florence.
Shortly after public demonstrations opposing Egar’s termination, PeaceHealth’s Chief Administrative Officer Rick Yecny published an editorial in The Siuslaw News, indicating that the hospital has “common-sense” policies related to free speech. “Caregivers are free to communicate their opinions,” he wrote. However, “We do not permit caregivers to speak on behalf of PeaceHealth unless they are authorized to do so.”
In response, Egar maintained that he was not speaking as a PeaceHealth employee when he wrote those editorials.
With regard to the continuity of care, Peace Harbor has been funneling Egar’s patients to other providers, and a long wait is expected. Until very recently, Peace Harbor had been the Florence area’s main primary care provider. A few months ago, however, Springfield’s McKenzie medical group opened a new primary care clinic in Florence. Led by Dr. Phillip Taggart, who had formerly been with McKenzie in Eugene, McKenzie Primary Care Associates has five physicians and is now another ption for those who are able to change physicians.
Egar indicated that he would like to stay in the Florence area and, with the recent arrival of McKenzie, might approach that clinic about moving his practice to their office.
Temple can be reached at [email protected].
In response to "Recent news reports and conversations in our community [that] may have left ... the impression that PeaceHealth restricts its caregivers from expressing their opinions in public", Rick Yecny, Chief Administrative Officer of PeaceHealth in Florence, assures us that PeaceHealth caregivers are free to communicate their opinions without PeaceHealth presuming "to exercise any control over a caregiver's off-the-job personal life or right to free speech."
John Egar wrote three letters to the Siuslaw News calling into question practices prevalent in the healthcare industry without identifying that he was a primary care physician employed by PeaceHealth. Not long after the last of these letters, Egar was summarily fired "without cause". No complaints from the Egar's hundreds of patients. No charges of professional misfeasance from Egar's peers. No allegations of moral turpitude from PeaceHealth administrators. Dismissed without cause - except the suggestion by the PeaceHealth firing squad that we can't tell you not to write letters...
Florence is a small community and PeaceHealth is its predominant if not sole healthcare provider. Mr. Yecny's statement avoids the obvious question: did Dr. Egar's letters prompt his dismissal. Mr.Yecny's protestations about an atmosphere encouraging constructive criticism fosters the impression that Dr. Egar's summary firing must have been for cause; an impression that is unfair to Dr. Egar, to the community and to his hundreds of patients who are left to wonder if the letters were not the cause, was their care deficient or substandard in any way?
Peace Health's actions are symptomatic of a growing problem in healthcare reform: the business of medicine overwhelming the practice of medicine. Balancing the legitimate interests of business, physician and patient in reforming the system is not going to be achieved by silencing expression of concerns. PeaceHealth claims that it encourages constructive criticism by its care givers are belied by its summary dismissal of Dr. Egar. Left without voice are Peace Health's care receivers.
I make the below remarks having organized the
street demonstration questioning the firing of Dr. Egar with whom
I have shared past healthcare reform efforts.
"Medical McCarthyism" is the best way to describe the PeaceHealth
retaliation against physician Egar for publicly raising concerns about
healthcare reform and costs. But the sacriface goes beyond Egar.
Dr. Egar's 1000-plus patients lost their doc and all continuity
of care with no notice, through no fault of their own.
What the actions of PeaceHealth show is that "Continuity of Care" is a fantasy
-- as is the "physician-patient" relationship and "choice" of doctors. Our
only real 'choice' remains selecting our insurance provider.
PeaceHealth has determined that docs are fungible -- easily replaced -- and that
patient resulting costs, concerns or risks are simply not part of the decision
in this new era of corporate-controlled health delivery.
Importantly, instead of becoming a visible part of the discussion concerning
this retaliation, local medical professionals have 'hunkered down' -- essentially invisible. I have the email from one saying he would be"run out of town" if it were
to be shared beyond the walled-in doc community.
In short, this raises the question if major parts of medical professionalism are DOA.
I say this after asking docs outside the area -- who have an interest in general healthcare reform -- if the "profession" has self-limited its relevance. In a word, their answer was 'yes.'
With the PeaceHealth retaliation, the public interest now loses the wisdom, experience and insight of its medical professionals who would otherwise publicly comment on healthcare issues or costs. Do our policy makers care?
One remedy might be legislative: prevent providers who in any way retaliate against
medical professionals who go 'public' from seeking reimbursement from
all impacted patients until the provider individually certifies that such retaliation or
termination has not adversely impacted that patient's continuity of care, costs or risks.
Now we're talking something the corporation cares about.
Rand Dawson Siltcoos Lake Oregon