A cardiologist caring for patients at Manchester Memorial Hospital said his group has been waiting for months to get paid by the hospital’s owner, the embattled private-equity firm Prospect Medical Holdings.
Dr. Dushyant Gandhi, partner at New England Cardiology Associates, said three other practices in the area of Manchester were also waiting to get paid by Prospect.
“Every group — the payments were delayed by several months,” Gandhi said. “We hired an attorney, he has been trying to help us with the payments. We are still usually delayed by two [to] three months even now.”
In a statement, Manchester Memorial Hospital did not directly address the concerns over delayed payments, saying it does “not comment on private business matters.”
Manchester Memorial is one of three Connecticut hospitals owned by Prospect. The hospitals are stuck in a messy sale deal to Yale New Haven Health. Yale sued Prospect to back out of the $435 million deal alleging mismanagement, and Prospect countersued earlier this year.
As Connecticut Public has reported, state investigations at Manchester Memorial and Waterbury Hospital, owned by Prospect, unearthed a pattern of alleged patient abuse and a failure by hospital staff to conduct timely investigations in accordance with hospital policy, according to public records.
Also, staffing problems at Waterbury Hospital continue to affect patients and practitioners, according to the hospital’s nursing and technicians union, as Connecticut Public has reported.
Unannounced state inspections last year found a staffing shortfall at the hospital’s emergency department. Public records obtained by Connecticut Public stated the department was understaffed by between one and four registered nurses on 80% of the reviewed shifts in October and November.
The hospital said it continues to work to recruit nurses, despite national shortages, and that it is in compliance with state and federal care guidelines.
Slow payments plague providers at Prospect-owned hospitals, doctors say
Manchester Memorial’s Gandhi said his colleagues in a different medical group at the hospital, Northeastern Pulmonary Associates, also have been working without pay for several months at the hospital.
“They used to have a group of intensivists who used to cover all the ICU patients,” he said. “They were in the same boat as we are, meaning they have to pay their staff, and they were not getting payments at all. And finally, they decided to leave. And they left.”
But Dr. James Castellone, chief medical officer at Eastern Connecticut Health Network (ECHN), which operates Manchester Memorial Hospital and Prospect-owned Rockville General Hospital, said the group of doctors contracted to work at Manchester Memorial left for other reasons.
“With one of the group’s physicians leaving the area and the added requirement to work 12-hour shifts, the group determined it was not a viable schedule for them to be able to cover with their outpatient practice,” he said.
Dr. Anasua Chakraborty, the pulmonologist who left the area, told Connecticut Public that the doctors who had employed her at Northeastern Pulmonary Associates — which cared for ICU patients at Manchester Memorial — had been paying her out of their own pocket since they themselves were not getting paid by Prospect.
“Doctors' offices do count on that money because they have to pay all their staff,” Gandhi said. “[But] we cannot just shut off our coverage because that will lead to patients suffering, because I don't think the hospital can have an open ER without any cardiology coverage. So that is the reason when our payments were delayed for many, many months, we were still providing coverage, and we are still doing that.”
ICU staffing changes also come to Manchester Memorial
There have also been staffing shake-ups in one of the most critical treatment areas on Manchester Memorial — its intensive care unit.
Nationally, intensive care units (ICUs) are typically lower-staffed on nights and on weekends with intensivists — doctors who sub-specialize in critical care.
Patients admitted to acute care units during intensivist off-hours — nights and weekends — are linked with higher mortality rates, studies show. Patients admitted to pediatric ICUs during the evening hours have higher odds of death than those admitted during the daytime, studies also show.
At Manchester Memorial, the pulmonology group that previously staffed the ICU was contracted to work part of the day at the ICU in what’s called an open-model ICU, Castellone of ECHN said.
The hospital has since moved to a “closed-model ICU.” That’s where a provider — not an intensivist or always a doctor — is on site at the ICU 24/7, but the ICU is staffed remotely at night by a tele-intensivist, a doctor board-certified in critical care.
Castellone said as a result, the hospital’s Leapfrog ICU index score increased from 63% to 94%, a standardized ICU rating. More than 2,000 hospitals nationally voluntarily participate in a survey by the nonprofit Leapfrog Group.
“We find it is better for patient care to have a physician on duty at night [remotely caring for patients], who is awake, immediately available and working a regular shift, instead of having to wake up an on-call physician in the middle of the night who needs to be at work in the morning,” he said.
“The tele-intensivist has access to the EMR [Electronic Medical Records] and connects to see the patient via video technology. Nightly patient rounds are held with the tele-intensivist and ICU onsite provider, also via video conferencing.”
Nationally, ICUs are moving toward a 24/7 staffed model, which they achieve in different ways, said Dr. Sneha Kannan, assistant professor of critical care medicine at the University of Pittsburgh.
She said some ICUs are staffed by intensivists 24/7, though in-person staffing is also offered overnight by providers that are not physicians, and physicians that are not intensivists.
“There has been an additional, national, concurrent rise in tele-ICU staffing providing intensivist and other specialist expertise where the intensivist [or] specialist is not physically located in the ICU,” she said. “There is substantial variation around the country. To date, there is evidence that outcomes in ICUs are improved by increasing staffing.”
Learn more:
Pattern of alleged abuse emerges following state inspections at 2 Prospect-owned CT hospitals
Staffing problems persist at Prospect-owned Waterbury Hospital, union leader says
