Once again, the Great and Mighty Gunpowder Chronicle is called upon to perform a public service in the name of defending the Great State of Maryland and its institutions from the deceitful and misinformed attacks of Southwest Delaware's most notorious convicted perjurer and woman beater, otherwise known on these pages as Sebaceous Puss. In his post "PRMC Takes a Page from Walmart", Sebaceous Puss displays his complete and utter lack of understanding of how health care works, the situation at Peninsula Regional Medical Center, and his complete unwillingness to do any confirmation or investigation of the stories he posts. For those of you who worship at the foot of the Sebaceous Puss throne, I suggest you re-evaluate your confidence in his over-inflated sense of self-worth, as the facts and the situation surrounding the anesthesiologists at Peninsula Regional is both much different and more complex than the convicted perjurer would lead you to believe.
Before I begin by destroying the premise of the Sebaceous Puss post, let me make a couple of points.
One, I have intimate knowledge of what anesthesiologists do and how important their services are to quality, effective, and successful health are. As a child, I spent more time in a hospital than a tonque depressor. Born with poloric stenosis, my first surgery came before I was a year old. When I was five, I had two major operations (heart and lung surgery) plus a major procedure (a trachiotomy) related to hemophilis influenza. That stay in the hospital was over a month. And when I was twelve, what was supposed to be a simple tonsillectomy turned in a life-threatening operation when a previously-undiagnosed condition -- cholinesterase inhibitor deficiency -- reared its head, and I had a very bad reaction to succincholine (a popular anesthesia in use at the time). A very skilled and very smart anesthesiologist saved my life -- and literally "breathed" for me for over an hour, as my entire respiratory system was paralyzed. The surgeon didn't pick up on the problem, and the scrub nurses didn't, either. But the anesthesiologist did, and saved my life. Had that doctor not been on his game that day, I would be dead right now. So, I know a little about the value they bring to the surgical suite.
Two, some will accuse me of carrying water for the hospital, knowing of my relationship to that facility. You couldn't be further from the truth. If I really wanted to "carry water" for the hospital or the administration, I could have done so long ago on any of the other insulting and stupid posts that Sebaceous Puss has posted about Peninsula Regional over the years. I am speaking up now because I am tired of Sebaceous Puss not getting the facts right and then trying to hide behind his claim of merely posting an opinion. The truth is an absolute defense. Opinion is not. Oh, and I am tired of the malicious and hateful comments directed at Peggy Naleppa, but more on that later.
Now, on to the premise destruction.
The Truth About the Practice
The current anesthesiology practice at Peninsula Regional -- Associated Anesthesiology Practice (AAP) -- is an independent sub-contractor of the hospital. They are not employees of the hospital. They are not owned by the hospital. Like most other critical care practices (cardiology, emergency room, etc.) they are and have been sub-cotnractors. As such, they operate under a negotiated contract that establishes quality measurements, outcome measurements, appropriate staffing and peformance levels.
For some time, AAP has been having severe internal operational issues that have negatively impacted the ability of Peninsula Regional to deliver quality care to its patients. AAP doctors will often refuse to perform epidurals in the OB-GYN service because reimbursement rates (set by insurance companies, not the hospital) are too low. This means that women in the community who are in labor are suffering through pain longer than they should. AAP does not provide significant dedicated coverage and call coverage for trauma services, increasing the time it will take to get critically injured patients into surgery and to be treated effectively.
You cannot perform major procedures without anesthesia. The days of a swig of whiskey and biting down on a stick are long gone. The inability of AAP to provide the services it was contracted to perform were due to internal operational issues in the practice itself. Peninsula Regional's leadership team, working hard to correct these issues earlier this year, even went so far as to sponsor mediation for the members of the practice. Note: this wasn't mediation between the hospital and the practice, but between the practice members themselves. That effort failed.
As a result, the leadership team was faced with a choice: continue to provide a level of care that did not meet the standards the hospital set for itself, or make a change so that the anesthesia leadership could be a more-integral part of the management of the surgical services division to make sure that the community was properly served.
While some want to frame this as some grand cost-cutting measure, it wasn't. Anesthesiology services are not, and have never been, a profit center for the hospital. If the costs for anesthesiology services are too high, it is the insurance companies and patients that pay those prices. The hospital does not get a cut, or make a profit, on the delivery of those services. This decision was totally about the quality of patient care. And that was the reason that the hospital's leadership team went searching for a more amenable solution to the delivery of anesthesiology services.
They chose Sheridan Healthcare because of their experience (55 years) and the size and scope of their abilities. Fielding nearly 500 anesthesiologists and over 400 CRNAs, it was determined that Sheridan was the best-positioned solution to meet the expectations demanded by Peninsula Regional's leadership team, the board, and the community as a whole. AAP was not able to meet those expectations.
Furthermore, as a self-insured entity, Sheridan Healthcare places their assets at risk for quality, meaning that there is actually a lower exposure to the hospital and the system as a whole. That is a significant improvement over the current situation, as it properly aligns the risk/reward ratio, and incentives both Sheridan and its practitioners to maintain proper, appropriate, and effective practitioner/patient ratios and quality controls. Sheridan practitioners are salaried professionals paid at very competitive wages, with contractual obligations to meet staffing levels, supporting ongoing cases, and maintaining proper on-call staffing.
In terms of staffing of patient/practitioner ration, Sheridan employs a "best practice" model called the Anesthesia Care Team, which provides a ration of 1 physician to every 3 CRNA, minimizing the impact of supervision and increasing the care coverage for patients and the availability to the surgical service. Unlike the current model, Sheridan will actually increase the staffing level by providing additional "float providers" as well as a higher level of dedicated coverage within Labor and Delivery.
None of this would be possible -- and is NOT happening now -- due to the internal issues with Associated Anesthesiology Practice.
What does that mean for the patients? It means that their care IS suffering (especially for women in Labor and Delivery!), their satisfaction is dramatically lower, and frustration is higher. With this change, the quality and quantity of care -- especially for more acute patients -- will dramatically improve, their satisfaction will increase (leading to better care outcomes), and the general frustration amongst staff should decrease significantly.
More importantly, from an operational standpoint, your average patient should notice no difference OTHER THAN AN IMPROVEMENT IN THE QUALITY OF CARE.
If someone wants to continue to assault the hospital leadership team over this issue, they must answer this question: why should the patients served by Peninsula Regional Medical Center be subjected to lower quality health care when better alternatives exist? We are constantly bombarded by pictures of gas station prices. If one should go for the lowest price on gasoline, why shouldn't one seek the best quality of care possible for their health?
Of course, all of this information would have been available had Sebaceous Puss made any effort to do any research. Make a call. Ask a question. But -- as with the posts on the SPD and FMLA, or the Pittsville EMS, or ... well, any other post on a daily basis by Sebaceous Puss, this was all about him. He has little to no interest in workign for or promoting better quality care for patients on the Lower Eastern Shore and in Southern Delaware. Sebaceous Puss will rail against Mike Pena for not going to city and county council meetings (bragging about how many hours he spends "blogging"). But I've never seen Sebaceous Puss help out with a fundraiser, or give money, or sponsor players in the golf tournament. He's never shown up to cover any of the dedications -- like the new Layfield Tower, or the Cancer Center, or the Guerrieri Heart Institute, or the Wagner Wellness Van. No, Sebaceous Puss is all about puffing up his own ego.
This is evidenced in his claim about the Cardiology Doctors. First, the Cardiology Practice is an independent sub-contractor, as I mentioned above. If their staffing levels are dropping, it is the responsibility of the practice -- not the hospital -- to recruit new physicians. And second, as someone who spends a fair amount of time visiting the hospital when I am in town, I have never seen a dearth of cardiologists. There are so many every time I visit, I'm afraid if I breathe hard or scratch my chest, Cal Nagle will put me in the Cath Lab. (Note: I have the utmost respect for Dr. Nagle. I have known him since he was President of the School Board when I was at Parkside, and while we don't share political views, he is a decent and kind man, and a fine physician.) As for "Code H", it isn't what you think it is.
Further to the point of the ego of Sebaceous Puss, his claim that "PRMC is in full damage control mode" is laughable. I doubt that the leadership team, or the board, pays much attention to anything that Sebaceous Puss does, thinks, or writes. If anything, he serves as comic relief to people who actually know what they are doing. And the notion that the board is a bunch of hand-picked friends of the President is a damnable lie. You obviously don't know anyone on that board to make that statement.
One final issue I want to address: for those sycophants of Sebaceous Puss (hereafter referred to as The Carbuncles) who have thrown in their lot by choosing to attack Peggy Neleppa, let me say a few things. First, I have known every President of Peninsula Regional going back to John Stevens. I've known quite a few of the other executives as well. I've eaten Christmas Dinner and shared a few drinks with most, if not all. Peggy Neleppa is one of the finest professionals at Peninsula Regional Medical Center I have ever known, and I have known some great ones. She is one of the most caring people I have ever known. She has a true heart for the patients treated in that facility, the community the facility serves, and the dedicated men and women who work there. Her focus and her passion and her vision is not on aggregating power and wealth and influence. Her focus in and her vision and her passion is on making Peninsula Regional Medical Center the finest medical facility possible. And it is not just her passion-- it is her family's. Her daughter Adrienne is an outstanding young woman who works tirelessly with the Foundation to raise the funds that make things like the Henson Cancer Center and the Guerrieri Heart Institute possible. Her husband Dan is a tireless supporter of the facility and the community. I truly admire Peggy and her family, and I think that the entire community should be thankful for the leadership and the vision and the heart she brings to her job.
Those trying to tear her down have a misplaced axe to grind. But, that is what we should expect from The Carbuncles that worship at the throne of the Sebaceous Puss.
After all, Sebaceous Puss is trying to grind an axe to draw attention to himself. Helping others? Not in the DNA of the Sebaceous Puss.
Update: An earlier version of this post improperly spelled Guerrieri Heart Institute. We have corrected it now, and apologize for the inaccurate spelling. No offense was intended.