Starkman: Beaumont Manager Moved to Sabotage Anesthetists’ Concerns About Critical Drug Pump Shortage

April 18, 2021, 9:01 PM

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

By Eric Starkman

Rebecca Moody

On the evening of March 29, when it became clear that nurse anesthetists at Beaumont Health’s flagship Royal Oak hospital had enough votes for union representation, senior surgical director Rebecca Moody fired off this text message she intended for Steve Papedelis, the manager responsible for anesthesia equipment and supplies.   

“Hi, just wanted to make you aware, the CRNAs have unionized. We will talk further when final votes are in. Please do not accept anything in writing from them, especially a form indicating equipment issues (I say this bc of Joes email). Please keep confidential.”

Moody mistakenly sent her text to a Royal Oak certified registered nurse anesthetist (CRNA) who was shaken by the message and shared it with his colleagues, including the Joe whose email Moody was referring to. The email expressed concerns about the critical need for more Alaris drug infusion pumps, which at Beaumont are in constant short supply because they often require repairs. Drug infusion pumps deliver nutrients or medicines, including cancer drugs, antibiotics and pain medication.   

Documenting Concerns

Joe was diligently doing his job: Hospital workers are expected to document all concerns and incidents relating to patient safety so there is a detailed data trail to follow and investigate if there is an adverse incident. 

I’m not identifying Joe by his full name because he is among the unsung CRNA heroes at Beaumont Royal Oak willing to risk losing their jobs calling out issues they feel endanger patient safety and care. These issues are what drove the CRNAs at Beaumont’s Royal Oak, Troy, and Grosse Pointe hospitals to overwhelmingly vote to unionize last month.

At Beaumont, speaking out about patient safety concerns can get an employee fired or furloughed.

Alaris drug infusion pump

The issues with the Alaris pumps are more serious and widespread than even Joe and his CRNA colleagues are likely aware, making Moody’s directive about equipment issues especially alarming. The manufacturer has issued nearly three dozen “tip sheets” advising on special precautions that must be taken to ensure the pumps operate properly. The manufacturer recommends the tip sheets be attached to the pumps, but CRNAs and nurses I’ve spoken with say they’ve never seen the tip sheets or been told about the advisory precautions.

FDA Warnings

The tip sheets were issued in connection with the more than a dozen recalls the FDA has issued in the past 15 months, including some identified as “Class 1,” meaning they involve risk of death or injury. In addition to frequently breaking down, Alaris pumps have been known to administer incorrect drug doses, an especially dangerous flaw because they are often used in intensive care units to treat critically ill patients.

Becton Dickinson, the manufacturer of Alaris pumps, is prohibited from continuing to sell them, but the FDA hasn't banned the product outright.

FDA filings reveal the pumps have been linked to more than 60,000 reported medical incidents, including more than 40 deaths and more than 325 injuries. Class action and personal injury law firms are chomping at the bit to profit from these mishaps. I’ve identified about a dozen law firms aggressively searching for patients who have been harmed because of Alaris pumps, including Weitz & Luxenberg, whose Detroit office is staffed by Paul Novak, a former Michigan assistant attorney general who worked under legendary AG Frank Kelley.

Written concerns about the Alaris pumps would likely be of great interest to these law firms. 

Another major flaw with Alaris pumps is they are easy to hack into. The Department of Homeland Security last year issued an alert about the pumps, giving them a 6.5 out of 10 on a vulnerability scale. A hacker accessing a drug pump can kill patients by altering the prescribed doses of medicines or simply shutting down the machines. The access could also allow the hacker to stroll through a hospital’s network, download all the stored patient records, and bring the facility to a standstill. Hospital records are pure gold on the dark web because they contain considerably more information than just social security numbers and identifying information.

Hospitals are notoriously unsophisticated about cybersecurity risks, which is why they are among the most targeted globally. Beaumont has been subject to at least three known data breaches in the past 12 months.

John Fox and Carolyn Wilson

What’s uncertain is whether Moody’s directive was issued on her own accord, or as many Beaumont insiders speculate, she was following orders. Moody, believed to be in her late thirties, is said to be highly ambitious and eager to prove her loyalty to Beaumont’s top leadership, a prerequisite for advancement under the Soviet-style regime of CEO John Fox and COO Carolyn Wilson.  Moody previously oversaw Beaumont’s CRNAs, but when she was promoted to her current job to oversee surgical services last year, she “unfriended” them on Facebook.

Pattern Is Evident

Moody reports to Debra Guido-Allen, COO of Beaumont Royal Oak.

Dr. Jeffrey Fischgrund

Moody is not the only management person known to demand no written paper or electronic paper trails. Jeffrey Fischgrund, a spine surgeon and one of Beaumont’s highest-ranking executives, last year instructed orthopedic surgeons wanting to use alternative devices than those manufactured by Stryker needed his permission. Fischgrund insisted that all requests be made by phone, not in writing, an edict some orthopedic surgeons refused to comply with.

Beaumont’s orthopods, ranked by U.S. News & World Report among the best in the country, were angered by the edict because they considered the Stryker products inferior to their preferred devices.

Stryker offered Beaumont a controversial rebate if the hospital used its devices 75 percent of the time. Fischgrund was an advisor to Stryker, earning more than $930,000 in consulting fees over the years. After Deadline Detroit reported about Fischgrund’s mandate, Beaumont stopped enforcing its Stryker edict.

Dr. Samuel Flanders

Given the implications of Moody’s message, I tried contacting her directly. I also reached out to Dr. Samuel Flanders, Beaumont’s chief quality and safety officer, as well as Dawn Geisert, who oversees Beaumont’s “business ethics and corporate compliance” efforts. I expected that if any Beaumont executives had serious concerns about Moody’s text message, it would be Flanders and Geisert.

Unaware of Message

Mark Geary, Beaumont’s spokesman, replied to my message to Geisert last Sunday night at 10:44 pm: “Beaumont Health’s compliance department was not aware of this (Moody’s) text message. We will investigate using our established protocols.”

Below Geary’s message was an email Geisert apparently sent me, word-for-wordthe same as Geary’s. Geisert’s email was sent to my correct email address but I never received it, indicating perhaps Beaumont is blocking company emails to my address. I’ve got it on good authority that Beaumont places electronic tags on company documents so the company’s IT department can monitor where they are forwarded. I’m also told that Beaumont’s top management hopes to identify at least one of my sources in the hope of prosecuting that person and making an example.

Dawn Geisert

Geary last Monday issued a follow up statement: “Beaumont Health has well-established escalation procedures related to patient safety that are well known and have not changed. Beaumont continues to work closely with each member of our clinical team, including NorthStar’s CRNAs. We appreciate everyone’s commitment to patient safety.”

It’s unclear what “escalation procedures” Geary was referring to, since it seems reasonable to expect that the heads of patient safety and compliance would ultimately be responsible for issues relating to faulty medical equipment and the possible suppression of written warnings about repeated breakdowns.

Most of the CRNAs working at Beaumont’s Royal Oak, Troy, and Grosse Pointe Hospitals were Beaumont employees until Jan. 1 when they became employees of NorthStar Anesthesia, the outsourcing firm that took over the anesthesiology procedures at the so-called northern hospitals. I reached out to NorthStar CEO Adam Spiegel for comment about Moody’s text message, and received this response from Simone Jackenthal, a senior account manager at Trident DMG, one of at least two PR firms NorthStar retains.

There has been no change to our policies or processes regarding equipment as a result of the CRNAs’ decision to unionize.  As soon as we received a complaint from one of our CRNAs regarding responsiveness in these processes, we investigated the matter.”

Jackenthal didn’t respond to my follow-up questions.

Dangers of Raising Concerns

Challenging management and calling attention to patient safety issues is a known career-ending move at Beaumont, which was a major motivation for CRNAs at the hospital, and increasingly nurses around the country, to unionize. Studies show that nurse-sensitive patient outcomes improve when nurses unionize.

As I’ve previously reported, Brian Berman, the former head of pediatrics at Royal Oak, last year was fired and paraded out of the building in front of his staff by hospital president Nancy Susick after he protested cutbacks that he warned would imperil patient care. Another doctor was fired for protesting Berman’s firing.

Lisa Tribuzio, the CRNA of choice for many surgeons and the one Beaumont employees asked to work on cases involving their families, was furloughed last year after protesting issues involving an app called Mobile Heartbeat, which requires a cumbersome process to call for emergency backup help and sometimes doesn’t work because of spotty internet connections in surgical suites.

Sally Gribben (Facebook photo)

Tribuzio was asked to undergo a psych exam as a condition of being reinstated, but she declined the offer, resulting in Beaumont losing one of its most highly regarded CRNAs with more than two decades of exemplary job performance. Several other Beaumont staffers have told me there are serious communication issues with the app and that there have been numerous instances where emergency assistance couldn’t be readily summoned. When dealing with surgical cases, delays of even a few seconds can mean the difference between life and death.

Sally Gribben, the president of the Beaumont CRNA’s newly formed labor union, is known to have been particularly vocal about safety concerns at Beaumont. Gribben last year became a legend on Royal Oak’s surgical wards for having sent an email to CEO John Fox at the height of the pandemic admonishing him for various safety issues and suggesting he take a pay cut.

Gribben has paid a price for her outspokenness. After her email to Fox, she was subsequently placed on furlough by Rebecca Moody, the author of the errant text message. In the midst of the union voting period, Gribben was placed on paid administrative leave based on allegations her colleagues insisted were bogus. She was reinstated shortly after the union vote was completed.

Beaumont’s management is vehemently anti-union and spent nearly $2 million on union busting consultants to successfully thwart an attempt by Beaumont Royal Oak nurses to organize. Beaumont’s response was so fierce the Michigan Nurses Association declared it would never again seek to organize at Beaumont because of the company’s “climate of fear.”

CRNAs working at Beaumont are a fearless lot, and they won’t likely remain silent about patient safety issues. Indications are Beaumont’s management has no interest in listening to their concerns.

Barbara Ducatman, Beaumont Royal Oak’s chief medical officer, announced last week that her responsibilities had become too burdensome to shoulder alone and that she was forming a Royal Oak CMO Cabinet comprised of physician and administrative leaders. Ducatman’s announcement made no mention of CRNAs being included in her cabinet.

Ignoring patient safety warnings is becoming a common practice at Beaumont.

Beaumont Chair John Lewis

Last September, the co-heads of Beaumont Royal Oak’s cardiology department sent a notice to Beaumont chairman John Lewis that they had “serious concerns” about NorthStar capabilities. Within three weeks of NorthStar taking over in January, a patient undergoing a routine colonoscopy died from an intubation gone awry and another landed in the ICU because of a pain medication overdose.

Fox and Wilson faced no consequences for the incident, and they will likely face no consequences for Moody’s errant text message, or any other wrongdoing or questionable behaviors that will no doubt continue to emerge.

Beaumont last year lost more than a dozen prominent surgeons, about half of its anesthesiology staff, more than 50 CRNAs, and countless nurses because of Fox’s and Wilson’s management. Surveys revealed that a majority of Beaumont doctors and nurses had no confidence in them.  A Harvard-trained Beaumont cardiologist wrote a five-page letter to the board outlining a litany of patient safety issues and all but called Fox a liar.

Yet Fox and Wilson remain in their jobs.

Today marks the one-year anniversary of my first Beaumont article for Deadline Detroit and there’s one thing I’ve learned in the interim: Fox and Wilson are accountable to no one and they can do anything they damn well please.

Reach Eric Starkman at: Beaumont employees and vendors are encouraged to reach out, with confidentiality assured.

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