A Visalia doctor is attempting to pursue a lawsuit against the Tulare Local Healthcare District (TLHCD) after she claims she was retaliated against for speaking with investigators from the California Department of Public Health (CDPH).
Dr. Rebecca Zulim claims that she was forced to take a “voluntary leave” from the district’s hospital, the Tulare Regional Medical Center (TRMC) after she spoke with regulators about issues that would later result in a January, 2017 report taking the hospital to task for patient care and governance faults.
While Zulim’s filings only mention the healthcare district, which legally owns TRMC, the actions were allegedly committed by representatives of the hospital’s former management group, Healthcare Conglomerate Associates (HCCA).
The company’s attorneys deny Zulim’s allegations.
“To our knowledge we see no truth to these allegations. Accordingly, they will be vigorously defended,” Marshall Grossman, an attorney for HCCA, said.
By all accounts, Zulim took a leave after the state regulator raised an “immediate jeopardy” issue at the hospital on November 9, 2016.
An “immediate jeopardy” finding left uncorrected within a short timeframe would cause the hospital to lose its Center for Medicare and Medicaid (CMS) accreditation. The vast majority of the hospital’s funding comes from patients enrolled in Medi-Cal — California’s Medicaid program.
A report submitted to California regulators, submitted November 14, 2016, stated that Zulim, identified only as “the surgeon in question,” took a voluntary leave of absence for 10 days, and that her corrective action would be decided by the hospital’s Medical Executive Committee (MEC).
But Zulim’s suit contends the leave wasn’t voluntary.
In a letter to the California Department of Fair Employment & Housing, provided to the United States Bankruptcy Court, the surgeon claims that she was told on November 9 that she must take a “voluntary leave” in order to “‘appease’ the investigators” from the regulator’s office.
“[Dr. Ronald Ostrom] told me that he had some bad news for me as he had just gotten off of a conference call with TRMC’s CEO, CFO, CNO, and Ms. [Jennifer] Oros. Dr. Ostrum [sic] was instructed to tell me that I must go on a voluntary leave,” Zulim wrote. “Dr. Ostrum told me that there were state investigators at the hospital and that I would need to take a voluntary leave in order to ‘appease’ the investigators and to show them that Dr. Benzeevi (TRMC’s CEO) was ‘doing something’ even though Dr. Ostrum felt it was ‘not fair or right.’”
Zulim rejected the administration’s request to take that leave, though. She sent a letter stating the same to the hospital’s Medical Staff Office — one that wasn’t received well, she claims.
While officials with HCCA publicly disagreed with the January CDPH report’s findings publicly, Zulim alleges they expressed doubts privately while inspectors were at the hospital.
“Dr. Benzeevi told me that I was ‘stirring up the State’ and that the hospital might be closed,” she wrote. “Dr. Benzeevi then asked me to stay away from TRMC so that they could ‘hide’ me from the State investigators. [He] then told me that ‘he and his family have a lot of money, power and influence and a lot of top notch Attorneys.’”
She also claims that Benzeevi stated that he would “crush” her if she did not cooperate. She acquiesced and stated she would take a “vacation,” rather than a leave.
The hospital would later call the January 2017 report “the latest episode of the vicious attempts by a few disgruntled doctors set to vilify and destroy Tulare’s hospital,” and derided the complaints at the time as “frivolous” when it was published by the Voice in June, 2017.
Just Kind of Panicked
After initial confusion over her status — Zulim stated she accepted a “vacation,” while she claims a letter from the Medical Executive Committee stated she was on voluntary leave, a nursing supervisor stating she was suspended, and her scheduler claiming she was suspended, as well — she claims some hospital officials at least offered apologies.
Dr. Parmod Kumar, a former TLHCD board member and member of the hospital’s Medical Executive Committee, stated that officials “just kind of panicked because they thought that the State was going to close the hospital,” she claims.
“…maybe we didn’t think this through too well. It was not our intent to be so onerous, and it is evident that we have caused a lot of emotional distress that we didn’t mean to,” she claims Benzeevi said.
Zulim sought evaluations at the hospital’s request, and she claims that a doctor from UCLA Health Center concluded that she had “no contraindication from continuing her work as a surgeon at this time.”
Her “vacation” ended December 7, 2016, but she claims that a patient pre-registering at the hospital on December 20, 2016 was told their operation was cancelled.
“I called Dr. Ostrum, TRMC’s Chief of Staff, and was told that Dr. Benzeevi had told him that I was not allowed to operate,” she states.
Zulim was told she would be proctored for her next 25 surgeries, but that the surgeries must be completed within 120 days — she wasn’t able to meet that requirement because of her low number of surgeries operated at the hospital.
Documents the hospital provided to the California Department of Public Health state that she — identified as “MD 6” — had to complete those surgeries within 180 days.
Even if the hospital had already told the state what her outcome would be, Kumar and Benzeevi were willing to offer her a reprieve from the requirements, she claims.
“Dr. Kumar also told me that Dr. Benzeevi had agreed to ‘lift the ban’ on my ability to schedule surgeries and also said that if I completed 10 surgeries without complications, Drs. Kumar and Ostrom would request that the MEC conclude,” she wrote, “that I had complied with the proctoring requirement and ask that the investigation be closed and that I would then receive written confirmation that my privileges were no longer being restricted.”
She made it to nine before complications arose in August 2017 — from another, temporary, physician she assisted at the hospital’s request, she said.
“During surgery, I was able to stop the patient’s bleeding and their care was reverted back to the locum tenens physician. Unfortunately, the patient later passed away. Thereafter, I completed 4 more cases,” she wrote.
What Kumar gave, he later took away, after the MEC met to discuss the August surgery.
“I received a phone call from Dr. Kumar, who told me that the ‘deal was off’ and that I would need to complete 25 proctored surgeries because the State was now investigating the locum tenens physician’s patient on whom I performed surgery,” she writes. “However, [it] was impossible for me to fulfill this requirement as I was no longer receiving any referrals.”
“My practice has been destroyed”
After the January 2017 report was published in June of that year, the Voice and other local news publications identified Zulim as the surgeon involved in at least one death at the hospital.
The January report also quotes David MacDonald, the hospital’s then-operating room director, who claims Zulim worked complex surgical cases that backed up emergency cases while on-call at the hospital. Only one on-call operating room team was available after-hours at the time, causing a strain on the hospital’s resources.
Those reports, coupled with a “misinformation campaign” she claims has been waged by the hospital, have caused “irreparable” damage to her reputation and caused her to drain her savings in order to support her family, she claims.
Zulim’s attorneys have requested that the US Bankruptcy Court grant her an exemption from the temporary stay on new and existing legal proceedings, stating that any liability will be borne by the district’s insurance carrier, and that Zulim would not “look to [the district’s] property or bankruptcy estate” for any damages.
Zulim’s attorney did not return a request for comment. If a comment is received, this article will be updated.