Editors’ note: This article has been updated to clarify Vierra’s quote at the end of the article.
Dr. Benny Benzeevi took the stand today in a case brought by a group of doctors against Tulare Regional Medical Center (TRMC).
The case, which centers around the January 2016 removal of the hospital’s old Medical Executive Committee (MEC) and medical staff, concluded for the month.
Benzeevi, the CEO of Healthcare Conglomerate Associates (HCCA) the company which runs TRMC, testified that he, and others with the hospital, believed the removal was necessary and required to be done as fast as possible, based upon statements made by an inspector representing the Centers for Medicare and Medicaid Services (CMS).
Lawyers for the deposed MEC contend that the hospital’s administration and board did not give them a chance to remedy those concerns — or even involve them in the process leading up to their ouster — and that the removal was against state law and the hospital’s bylaws.
“Living Under A Rock”
Dr. Everett Davis was the CMS inspector who led hospital officials to believe that without immediate, sweeping action, the hospital’s future would be at risk, Benzeevi said.
Davis had called an impromptu exit interview on January 7, 2016, Benzeevi told the court, and at that point he gave a scathing assessment of the hospital’s medical staff.
“He said ‘[This] is a completely dysfunctional medical staff, and if this persists, the hospital will be no more,’” Benzeevi stated.
No one from the former Medical Executive Committee was in the room, all sides agree, when the CMS inspector, “angry [and] disgusted,” gave his view of the state of affairs at the hospital.
Benzeevi’s characterization of Davis mirrors that made by Dr. Parmod Kumar, a long-time hospital board member who was also present at the interview.
“What he told me, when he was insulting me as a board of director, he’s so disgusted, he was going to leave,” Kumar testified. “He was supposed to be here for two more days and complete the survey, and things are so bad here, he’s leaving.”
The hospital’s CEO said that he did not make an effort to invite any members of the former MEC to the interview with Davis.
“You don’t go to the problem to solve the problem,” Benzeevi told Michael Amir, a lawyer representing the former MEC.
After being questioned by Amir, Benzeevi clarified that while there was no clear indication that Davis would find any faults with the medical staff or MEC, he knew that Davis was regularly spending time in the medical office.
That led him to believe that Davis would likely find issue with medical staff or the MEC.
While Benzeevi did not offer for Davis to meet with the MEC during his time in Tulare, he claimed that Davis was a demanding figure — not open to discussion.
“Dr. Davis demanded things and wouldn’t allow you to speak,” he said.
After the impromptu exit interview, Benzeevi agreed that he had not informed the prior MEC of the upcoming January 26 vote or Davis’ statements – and that he was not aware of anyone who had informed them.
“You’d have to be living under a rock,” to not realize that the medical staff and MEC would not be involved somehow, Benzeevi said. “It was pretty obvious [Davis] was angry. It would be impossible to miss it.”
Benzeevi was asked about a follow-up survey from CMS in March, after the ouster of the former MEC — with Davis again emerging as a key figure.
“Literally, [he was] screaming and yelling like we were little children,” Benzeevi said. “He said we made it worse, not better.”
The day after the survey, HCCA officials wrote a letter responding to Davis’ statements, with Benzeevi’s signature attached.
Amir asked why the hospital hadn’t written a similar letter to CMS after its initial survey in January.
“The findings the first time were things we knew to be the case,” Benzeevi said.
Amir produced a copy of the letter, which claimed that Davis “did not care that [Judge Mathias] had found the disassociation was not a violation of applicable law or bylaws.”
At the time the letter was written, Mathias had only denied a request from the former MEC for a temporary restraining order preventing the new medical staff from being installed.
Benzeevi noted that some of the medical staff’s peer review files were “languishing,” going unresolved for “years to months.”
Peer review is a process that ensures quality care is being provided by physicians to patients at the hospital.
As a member of the hospital’s administration, he stated that he received reports that tracked how long peer review cases had been open, and if they had been closed or not.
He could not provide a specific number of cases that had not been closed in a timely manner, instead only stating that there were “a handful,” occupying “a half of a page” of paper.
Amir asked whether the physicians whose’ files were languishing were Dr. Rebecca Zulim, Kumar, or himself — and if they were languishing due to a lack of cooperation.
Benzeevi stated that he had never “[had] an instance of noncooperation,” and stated that the files left open did not involve Kumar, Zulim, or himself.
Benzeevi had been subject to the peer review process in 2013 while running the hospital’s emergency department, a court filing shows, when Dr. Anil Patel, the former Chief of Staff of the old MEC, received a letter claiming that Benzeevi created a hostile work environment.
The document was filed in a separate lawsuit by Benzeevi against Dr. Abraham Betre, the last Chief of Staff of the former MEC.
“On or about March 13, 2013, while still in charge of running the Hospital’s Emergency Department, I was informed by Dr. Anil Patel, who was the current Chief of Staff of the Tulare Regional Medical Center Medical Staff (the ‘Former Medical Staff’),” Benzeevi’s declaration read, “that an anonymous letter accused me of creating a ‘hostile work environment.’ The letter was ‘signed’ Staff but otherwise provided no indication of who sent the letter or whether it was even sent by an actual member of the Hospital staff.”
An ‘ad hoc’ committee was created to investigate the letter further, and the matter was later sent to the Institute for Medical Quality, which found that the allegations were largely baseless.
“On November 27, 2013, the IMQ issued its peer review report regarding the allegations against me. With a single exception, the IMQ found that the various accusations against me were ‘unsubstantiated,’ and in some instances were contrary to the actual evidence,” Benzeevi’s declaration read.
“Additionally, IMQ criticized management and the Former Medical Staff for failing to ‘work as a cohesive team’ and stated that the ‘[Former] Medical staff peer review processes must be improved.’ Finally, the IMQ made some suggestions regarding how managers, including myself, could improve interpersonal relations with the nursing staff.”
The same document quotes a declaration by Kumar regarding his peer review process.
“I received a letter from Dr. Betre […] informing me that the [former] MEC was investigating me for using foul language in front of a subordinate on one occasion,” Kumar’s declaration read, “and for ‘backdating’ chart notes in three cases.”
“[…] the ‘backdating’ accusation was made after I had inadvertently listed the dates of my dictation as the dates of three patients’ physical examinations, at a time when I had performed approximately 150 procedures [in] 18 month[s].”
Dr. Anthony Vierra, an anesthesiologist based in Tulare, took the stand after Benzeevi.
Vierra was a member of the former MEC, he said, and a member of the credentialing and bylaws committees.
He stated that he while he was not directly involved in the former MEC’s peer review committee, he received reports from them due to his position on the MEC.
The MEC’s stand-alone peer review committee, Vierra explained, handles peer review cases for “high-profile physicians” and department chiefs — other peer review cases are handled by physicians’ own specialty departments.
Vierra gave insight into Kumar’s April 5 testimony regarding his peer review case.
Kumar claimed that he was not given due process, but Vierra claims that the MEC gave Kumar approximately a year to perform his required training.
“He did not do it time and time again,” Vierra said.
Kumar was given a final deadline, Vierra said, of approximately one to two days before the January 26, 2016, vote to disassociate from the old MEC.
“[It was] necessary for him to keep his privileges. If he didn’t do it,” Vierra said, contradicting Kumar’s prior testimony, “he would not have privileges [at TRMC.]”
The Medical Staff Clause
Jason Baim, a lawyer representing the old MEC, shifted gears to a controversial portion of HCCA’s Management Services Agreement, the contract governing the relationship between HCCA and the Tulare Local Healthcare District, the legal entity which owns TRMC.
The document allows HCCA to submit amendments to medical staff bylaws unless the individual recommendation is voted down by the hospital’s board of directors with a 4/5ths majority. The agreement also requires the board to provide a written notice “with good cause” after giving HCCA a “reasonable opportunity” to explain or justify the recommendation.
The agreement created “uneasiness among employees,” according to Vierra’s recollection of one MEC meeting.
At the same meeting, Tony Jones, a former CEO/Chief Restructuring Officer for HCCA, made a striking admission according to Vierra.
“He told of he was aware of the clause in there that said they were going to essentially disband the current MEC and appoint one,” Vierra said. “He was aware of that one and said that’s not my clause, not my contract, but I’m aware of it.”
The trial will resume on May 22 at 9:30am in Department 2 of the Tulare County Superior Court.