Starkman: Beaumont's Orthopedic Surgeons Outraged Over Forced Use of Medical Implant Devices

The writer, a Los Angeles freelancer, is a former Detroit News business reporter who blogs at Starkman Approved.

By Eric Starkman

One might expect that a practice of about 50 orthopedic surgeons ranked as the nation’s 11th best would be getting the kid gloves treatment from the hospital where they perform their surgeries. But at Beaumont Health, supposedly a not-for-profit hospital network, even the superstars aren’t immune to the margin boosting ways of CEO John Fox and COO Carolyn Wilson.

CEO John Fox and COO Carolyn Wilson

More than a year ago, Beaumont asked the trauma practice leaders of its Royal Oak and Troy hospitals to evaluate medical implant devices from Stryker Corp., a Kalamazoo-based medical technologies firm, to determine whether they were of sufficient quality to use for 75 percent of the hospital’s trauma procedures. The leaders said they weren’t.

Nevertheless, Beaumont moved forward with a contract requiring its orthopods to use Stryker products 75 percent of the time. Most surgeons resisted, declaring that rival company devices they’d trained with in their residencies and fellowships were far superior.

Beaumont then issued an edict. Jeffrey Fischgrund, a spine surgeon and a top Beaumont executive, last August sent an email declaring that going forward, any surgeon wanting to use alternative devices to Stryker’s must get his permission.

Notably, Fischgrund insisted that all requests be made by phone, not in writing. Several surgeons insisted on written requests to establish a paper trail.

Dr. Jeffrey Fischgrund

On July 9, Brett Whitbread, an MBA grad with Beaumont’s “value analysis” team, alerted orthopedic surgeons that they only used Stryker products 48 percent of the time in May, rather than the mandated 75 percent. As a result, Whitbread said Beaumont would no longer keep non-Stryker implant devices sterilized in advance, thereby pressuring surgeons to use readily available sterilized Stryker products.

“The Beaumont that John Fox has instilled in the past five years is all about profits, not patient safety,” said one Beaumont surgeon.

Whitbread’s decision sparked a massive uproar, as surgeons argued it would compromise patient safety. The pushback was so fierce that Firschgrund was forced to overrule Whitbread’s decision.

Still, Beaumont’s orthopedic surgeons are angered by the frequent lack of sterilized equipment they require. Thanks to chronic staff shortages because Beaumont pays its equipment sterilization staff poorly, often there is no one available to do the work.

Delays can be so lengthy that one Beaumont surgeon who recently began his day at 7:30 a.m. finished his last procedure at 11 p.m.

Canceling Procedures

He was among the more fortunate: Beaumont orthopedic surgeons increasingly are forced to cancel their procedures after several hours of delays because their preferred implant devices aren’t in stock. Adding insult to injury, the surgeons are personally required to inform patients and families of the delays and cancellations, rather than someone from administration.

Beaumont’s orthopedic surgeons are also angry about Wilson’s decision to award a contract to a deep discount outsourcing provider called NorthStar to oversee and manage anesthesiology services at most Beaumont hospitals. As a result, more than 100 of Beaumont’s current anesthesiologists, the majority of them fellowship trained, will be replaced. NorthStar relies more heavily on lesser trained Certified Registered Nurse Anesthetists.

Not surprisingly, many of Beaumont’s orthopedic surgeons are applying to join other hospitals or increasingly looking to perform their procedures at ambulatory surgical centers.

“They must be grinning ear-to-ear over at St Joseph Mercy,” said one surgeon, referring to the closest hospital to Beaumont’s flagship Royal Oak campus.

Beaumont’s orthopedic surgeons believe the hospital has a financial incentive to insist on the use of Stryker’s orthopedic implant products. The statement issued by spokesman Mark Geary implies that’s the case:

"The selection of the products we choose is done by panels of our expert physicians. Our selection criteria for any patient care product is driven by high-quality. After we identify the highest-quality product, we work to secure the product in the most affordable way. The industry uses many mechanisms for charging hospitals – including discounts and rebates. All of this is done in a legally appropriate manner using the highest ethical and legal standards. These types of arrangements are standard in the health care industry."

Stryker is a Fortune 500 company with a history of controversies. A subsidiary in December 2014 pleaded guilty to marketing and selling certain knee replacement products without government approval. The subsidiary’s CEO pleaded guilty to a felony charge.

In November 2014, Stryker agreed to pay $1 billion to resolve separate litigation over thousands of hip implants recalled in 2012 after patients complained of pain, swelling, and metal debris. Stryker’s knee implant device, featured on Beaumont’s website, also was subject to a product liability lawsuit.

Fleeing Surgeons

Beaumont’s elite orthopedic surgeons are hardly alone in their outrage and disgust with Beaumont’s business practices and what they say is Fox’s and Wilson’s prioritization of profits over patient care. More than 20 cardiac specialists at Beaumont’s flagship are known to be actively negotiating to join area hospitals and Alan and Julie Koffron, prominent liver and pancreatic surgeons, have let it be known they, too, plan to jump ship.

Last year, Marc Sakwa, chief of cardiac surgery at Royal Oak, and Jeffrey Altshuler, another prominent surgeon, resigned.

A Beaumont surgeon for weeks has been circulating a petition among doctors declaring no confidence in Fox and David Wood Jr., Beaumont’s chief medical officer. Many doctors were hesitant to sign because they feared management reprisals. Beaumont’s head of pediatrics is understood to have been fired and escorted from his office after objecting to policies he believed would harm patient care.

The Detroit Free Press and The Detroit News reported on the petition last week and Deadline Detroit has reported critically about Fox’s and Wilson’s leadership for several weeks. Beaumont’s board of directors held an emergency meeting Monday evening. The purpose isn’t publicly known.

In a possibly ominous sign, Beaumont’s doctors received a survey Wednesday asking various questions, including their confidence in Beaumont’s management and whether a proposed merger with Advocate Aurora would lead to improved patient care. Fox in June proposed merging Beaumont into Advocate Aurora, a reputationally inferior hospital network with dual headquarters in Illinois and Wisconsin.

Doctors have been assured their responses will remain anonymous, so it’s pretty much a given the findings will be quite damning. In the months I’ve been writing about Beaumont, I’ve yet to hear one Beaumont employee say something remotely positive about Fox, Wilson, or anyone else in senior management. Team leaders who execute management directives are derided by staff as having drank the “Beaumont Kool Aid.”

Separately, multiple Beaumont employees say Fox’s claim that half of the 2,400 employees Beaumont laid off in April have been called back is misleading. While the 50-percent callbacks may be true, insiders say that Beaumont continues to layoff other employees. In fact, 10 assistant nurse managers were let go at Beaumont Troy on Thursday.

Reach Eric Starkman at eric@starkmanapproved.com. Beaumont employees and vendors are encouraged to reach out, with confidentiality assured.

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