Doctor’s Diary May 30, 2021: A Decade of War by Hospital Administrators on the Practice of Medicine

A Decade of War by Hospital Administrators on the Practice of Medicine

Medical doctors are trained professionals trying to survive in a complex system that is increasingly hostile to their mission.

Because of our knowledge and skills, we have become useful tools—allowed neither an opinion nor a voice— for hospitals and government.

As a physician in private, independent practice for 40 years, I have found the last 10 years to be especially difficult.

It has been hard to bear hospital administrators without medical training, browbeating me to treat patients with cut-rate medicine that compromises good standards of care.

Seven years ago, I was elected to a hospital’s self-governing Medical Executive Committee (MEC). I hoped that I could reduce the threat to patient care from “the inside.”

My hope was unfulfilled.

The MEC was swallowed up by the board of directors and administration, which was routinely furious with us because of the way worthy patient care conflicted with their need for profit.

The voices of physicians who sought to protect patients became more faint.

Whistleblowers were left to defend themselves against bullying and attacks replete with insults and lies.

My only recourse and shield has been to become active at the keyboard and on social media to describe the war.

There were a few physicians around the country doing the same thing.

We networked to survive.

“Never give up” became our mantra of mutual encouragement.

In 2021, a law has been proposed in California’s state senate to bar hospital administrators from “practicing medicine without a license”:    https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB642. 

Many doctors are completely unaware of it.

California’s hospital association is fighting it.

In late April, I testified in support of this proposed law, Senate Bill 642, before the State Senate’s Health Committee. Here’s what I provided:

“Good morning, Mr. Chairman, and members of the California Senate Health Committee. 

My name is Gene Dorio. I am a geriatric physician in Santa Clarita serving my community for 34 years. 

Until two years ago, I was on staff at a local hospital, which is a non-profit, but run like a for-profit hospital.

For five years, I served on the Medical Staff Executive Committee in several leadership roles, including three years as Chairman of the Department of Medicine.  

During my time there, I witnessed administrators use manipulative, clandestine tactics to capture each voting facet of the health facility, including the Board of Directors, contracted physician groups, and the medical staff so business people could make patient-care decisions.

At my hospital, business community members were appointed to the Board of Directors and provided lucrative contracts in exchange for their vote.

Bankers were given hospital accounts.

A real estate agent was given property to rent

And a doctor was given space for a dialysis unit.

Exclusive contracts were signed by physician groups for emergency room care, radiology, and operating room anesthesia.

The hospital could not technically practice medicine, but they coerced these groups with the threat of severing contracts if they did not adhere to their orders, or vote as told.

Needless to say the administration got their votes, while the medical staff became only a shell of a self-governing body once devoted to improving patient care.

Eventually, the medical staff was taken over too, and our policies were changed to bring in more revenue—even when it was terrible for patients.

My patients are geriatric, and at times clinging to life. Nonetheless, I started to receive daily notes on my charts forcing me to discharge patients even though they were not ready to leave the hospital. These notes included a printed statement “Not a Part of the Medical Record” which was removed later by the Medical Records Department, erasing hospital culpability.

Hospital administrators also knowingly wrote orders, without doctor consent, for “palliative consults,” to place patients in hospice care, which financially benefits the hospital by getting them out of the hospital for care.

They also made decisions about medications patients could receive. They decided not to use insulin pens—as they were too expensive— and instead jeopardized diabetic patient care using multi-source insulin vials, which are less precise and easily contaminated.

The presiding CEO was released from his previous hospital after violating State Medi-Cal laws substituting inferior anesthesia in the Labor and Delivery Department.

Hospitals also hold regular ‘throughput’ meetings for physicians, where they publicly display the number of referrals, expensive tests, procedures, and overall revenue that each doctor is generating.

They talk about productivity and efficiency—not the quality of patient care.

Because I tried to advocate for my patients, my hospital privileges were constantly in jeopardy. Typically, privileges are renewed every two years. For me, it was every four months. 

If hospital administrator actions were truly to improve healthcare for our patients, I would have no qualms.

But instead, through abusive tactics and bullying, they interfere with physician decision-making, and ultimately increase administrator salaries, bankroll retirement portfolios, and yearly bonuses.

SB 642 is an important step to removing hospital administrators from practicing medicine without a license.

Their surreptitious plans taking over a non-profit hospital for their own personal benefit must be thwarted by this law.

Patients have entrusted physicians to be guardians of their health.

We are professionals that have taken a solemn oath to provide care in the best interest of the patient.

Therefore, SB 642 will serve Californians by putting medical decision-making back into the hands of patients and their physicians.

Thank you.”

I have never testified before a legislative body, but this is where my keyboard has brought me.  Faint voices must become louder to fight for patient care and diminish hospital administration power. 

Doctors must be part of the balance providing better healthcare to citizens of our country, but we must hear them speak! 

Follow that mantra, “Never Give Up!”

Gene Uzawa Dorio, M.D.