Doctors and nurses are no longer in charge

I read Dr. Andy Palchak’s recent opinion (April 25) in the Inter Lake. Oddly enough, I seem to have come to the opposite conclusion about our current local medical system (be it Kalispell Regional Hospital, Kalispell Regional Medical Center, Logan Health or whatever the current marketing moniker) even though Dr Palchak and I came to practice here just about the same time around 40 years ago. We both have seen the evolution of the medical care system from one with independent hospitals and medical staffs that provided checks and balances on each other to one now that is becoming ever more monolithic with most physicians being employees of the system and referred to as providers (a term aimed at diminishing the status of professional nurses and doctors). Gone are the days when the medical staff could just say no to hospital administration ideas to monopolize medical care...no need to guess what would happen to a “provider” now should he/she become a vocal opponent to the system. The target now seems to be maximizing the bottom line with delivery of medial care based on a business approach rather than the time honored system of medical professional integrity. The doctors and nurses are no longer in charge.

Over the years, starting I would say in the 1970s, the medical system in Kalispell grew to be a very advanced (for the time) delivery system based on this process of a strong independent medical staff and hospital. A lot of goodwill and trust by the community was built in this process. Then, around the turn of the century, the hospital became ever more powerful mostly due to changes in government and insurance regulations where in the hospital administration used this goodwill and reputation to great financial advantage. So much so that a $24 million fine to the hospital for manipulating the system could just be disregarded (there is plenty more money where that came from, right?). Now, and not surprisingly, a lot of that good will is long gone.

I say all this in lead up to the current nursing crisis at our hospital. I don’t agree with Andy that the hospital system is the sad victim of a malicious nursing staff that went out and unnecessarily brought in a union. I believe Logan Health brought this on by systematically exploiting the nursing staff to maximize their financial position. I can recall talk of unionization by the nursing staff back in the 1980s, which never happened due to reluctance of the nurses to proceed down that path unless given no real alternative.

I should say here that I feel guilty for not doing (or at least trying to do) more for the nursing staff back when as chief of staff I probably could have ... sorry. I did not pay enough attention to feedback from my good friend, retired nurse and public health advocate who would review her medical charges from the hospital (with a fine tooth comb I might add) and report to me the billing errors (that were frequent) never happened in her favor. I know now I was naive about the intentions of the hospital administration.

As far as the ever expanding influence of Logan Health on outlying hospitals I would just advise those people to be careful what you wish for. It may be a short-term solution to ever increasing government and other third-party intervention in health care, but at what price? I personally am pretty sure Logan Health has checked out the “bottom line” regarding who will likely benefit dollar-wise down the line. It was all pretty rosy here in Kalispell when the hospital began buying up independent medical practices at top dollar and giving large bonuses to physicians who would sign on as employees. But then there was that $20+ million fine for abuse of that process which ultimately comes out of the pockets of our patients (and that likely represented only a fraction of the benefit the hospital derived from doing it).

In summary, I do agree will Dr Palchak in lamenting loss of the “good old days” when the medical care system here was being built by the many good physicians and nurses (not providers) who did their level best to make the local medical care outstanding. I am not convinced that the current system is living up to that history.

—Dr. Harvey C. Swanson.