Alleged Elitism Among Staff at St. Joseph Hospital

I read “Fired Surgeon Takes On Hospital’s Elite” (Feb. 2) with great interest. I have been on the staff of St. Joseph Hospital for about 20 years and on the staff of at least 15 other hospitals in Orange County. I am in an excellent position to judge the quality of a hospital, and I believe that this institution has a legitimate claim to be one of the finest hospitals in this county. But it has had serious problems with elitism for as long as I have practiced in this county (since 1967).

In the late 1960s and early 1970s, medical staff applicants were rejected if their offices fell outside certain geographical limits. Thus, in 1967, when I opened my office in Anaheim as the second nephrologist in the county, I was excluded from staff membership, presumably to ensure that hospital beds were available to staff physicians of tenure, but excluding my area of expertise from St. Joseph patients. The other nephrologist, with an office in Garden Grove, was similarly excluded.

As entrepreneurial medicine became fashionable in the ‘70s and unoccupied hospital beds created a climate of increased competition, geographical boundaries appeared to melt away as unused bed capacity awakened a new spirit of egalitarianism. I was accepted for general staff membership without limitations on my staff privileges.

When St. Joseph opened a state-of-the-art dialysis facility in the early ‘70s, I, as a nephrologist, was cheered to contemplate the availability of this facility and this fine hospital to me and my patients. When I applied for these additional privileges, they were denied--not because I was unqualified but because my presence would disturb the routine of one set of orders for dialysis nurses. I might be detrimental to morale. To me, it was a very clear case of an elitist monopoly consolidating the potential for ongoing economic advantage.

I have always insisted that any institution that offered dialysis facilities be “open” to any qualified physician, and I had established such a policy at Palm Harbor Hospital, making it easy for any nephrologist to gain entry into the community and creating competition for myself in the process. Thus, with righteous indignation, I did the unthinkable--I sued this fine, charitable institution. And the unthinkable happened--I won!

What the courts said was that I had been denied due process. St. Joseph medical staff was forced to have a “fair hearing.” The chamber might have been filled by my peers, but it was filled with the hospital’s executive committee, composed in part of the heads of various departments who had acknowledged monopolies, such as pathology and anesthesia, and, by virtue of their privileged positions, were disposed to look favorably on monopolistic practices.

I was not present for the final vote, but I understand that it was uncomfortably close. Apparently, behind closed doors, some compromises were reached, for I was allowed to dialyze patients in the acute hospital but not in the chronic dialysis unit. It seemed that surgeons could operate in an operating room, giving direction to nurses without confusing them, but only one group of nephrologists could work in the St. Joseph dialysis unit.

When the county’s third renal transplant center opened at Western Medical Center-Santa Ana several years ago, it owed its enormous success to its policy of inviting all qualified nephrologists to apply for staff privileges. In an environment of free access to all physicians, such duplication of facilities would be unnecessary.

At a time when the country is being forced to confront a health care crisis that has been many years in the making, it is necessary for the public at large to understand the extent to which members of the health care industry, including many physicians, manipulate the environment in which they work and in which the public receives its medical care to their economic advantage, and how frequently this is disguised in elitist terms.

I again reiterate that St. Joseph Hospital is an outstanding institution with a highly qualified medical staff. I believe that its administration and governing body have been misguided in permitting members of that medical staff to create an environment inhospitable to ethical competition, allowing the all-too-comfortable cloak of elitism to shield and rationalize greed. The community and the nation have never benefited from this spineless abandonment of responsibility, and now we clearly can’t afford it! If not for principle, then for cold, hard cash!

LAURENCE LEWIN, M.D., Garden Grove