Numerous past and present physician leaders at Community Memorial Hospital are rebelling against what they consider heavy-handed, and perhaps illegal, tactics by top administrators and the board of trustees at the Ventura medical center.
The doctors say executives at the 242-bed hospital have jeopardized patient care and violated physician rights, including the seizure of about $250,000 in medical staff funds, during the last year.
They also say that the hospital's confrontational approach, directed by veteran chief executive Michael Bakst, has poisoned relations with the medical staff and alienated the nonprofit hospital from the community it was founded to serve in 1901.
After months of discontent, a slate of doctors critical of the Community Memorial administration was elected 128 to 82 in November to lead the medical staff in 2004, after the terms of current officers expire. Now, physicians say, the administration is maneuvering to disqualify two of those new physician leaders from holding office or voting in staff elections.
"In my opinion, one reason this is going on has to do with the rather amazing extent to which Mr. Bakst has achieved a kind of fiefdom and believes he has unfettered authority and control to do whatever he wants," said Pasadena attorney Tom Curtis, hired recently by the hospital medical staff's executive committee. "He is accustomed to bullying his way through things.
"A second reason is the national phenomenon of hospitals attempting to limit the authority and power of medical staffs," Curtis said.
Bakst, the hospital's chief executive since 1979, would not comment Friday.
But other hospital executives and some physician leaders who have not joined the rebellion say that the current unrest is little more than a family argument and that Bakst should be credited with managing a strong hospital, not attacked personally.
They say that patient care has not been jeopardized and that dissident doctors have dwindled to a small minority as most physicians have tired of the argument. And they say the hospital has attempted to address staff concerns by hiring a mediator, former state appellate Justice Stephen Stone, only to have that process undermined by dissident physicians.
"Like any family, we're having a squabble that we're going to have to work out," said Dr. Richard Reisman, hospital medical director. But the hospital has done nothing that would harm patient care, he said.
Nor has the administration attempted to limit the role or authority of the medical staff, Reisman said. Rather, physicians have insisted on rights they don't have, he said. "I think certain dissident physicians were attempting to limit the role of the board of trustees."
The bitter internal conflict is only the latest controversy in the recent history of Community Memorial, which set records for local campaigns by spending more than $4 million combined in 1996 and 2000 to sponsor Ventura County ballot initiatives that divided the local health care community.
The current conflict reflects tensions that sometimes flare between hospitals and their medical staffs in this age of highly competitive managed-care medicine, as hospitals try to tighten controls over programs and costs and physicians bristle at any erosion of their rights as a self-governing branch of the hospital.
But a California Medical Assn. spokesman said the Community Memorial quarrel stands out and gives physicians cause for grave concern.
"When relations break down like this, the implications for the future of the hospital are ominous," said Jack Lewin, chief executive for the state physicians group. "This is something the board of trustees of this hospital are going to have to find a way to reconcile, and very soon."
Instead, the conflict escalated last week.
After a Monday mediation session the administration believed was productive, an anonymous Ventura Physician Newsletter critical of the administration was circulated to staff physicians.
That prompted Phillip Drescher, president of the board of trustees, to announce Tuesday the board's imposition of an 18-page Medical Staff Code of Conduct, a document first proposed last year but withdrawn because of protests.
Under the code, a physician may be banned from the medical center "whenever the hospital's Board of Trustees determines that any medical staff member engages in harmful or disruptive behavior ... "
At the same time, Drescher announced a new hospital policy declaring any doctor with a financial interest in a facility or service that competes with Community Memorial services ineligible to vote as a medical staff member or to hold office as a representative of the staff.
A letter Tuesday from hospital attorney Peter Goldenring gave current members of the medical staff executive committee 24 hours to sign a "statement of compliance" declaring any such purported conflict of interest.
Physician attorney Curtis then fired off a letter to Goldenring, challenging the trustees' legal right to unilaterally change medical staff voting eligibility rules.
In response, Goldenring informed Curtis that he would not be recognized as the lawyer for the medical staff, and asked him to identify his clients.
Curtis said the voter eligibility policy is aimed at new medical chief of staff-elect John Hill and at plastic surgeon Brian Brantner, part of the same leadership slate. Both surgeons have financial interests in facilities where they do surgery.
Reisman said such highly profitable financial interests represent a conflict and drain revenue from the hospital.
"I think we have a number of physicians who have been fueling this controversy who are economically competing with the hospital ... like Hill, like Brantner," Reisman said. "This is a national dilemma for hospitals.... It's called carving out profit centers from the hospital."
Hill, a former president of the Ventura County Medical Assn., could not be reached for comment last week. But in a brief earlier statement he said he still hopes mediation works.
"We have acted in good faith," he said, "but I'm concerned the same diligence hasn't existed with the hospital. The mediator hasn't had access to members of the board [of trustees], without [Bakst] present, to do his job properly."
In an attempt to resolve their differences, doctors and hospital administrators have been meeting with Stone since Christmas.
But last week's developments only underscore the gulf that remains between them.
In his letter to the medical staff, trustee President Drescher said Stone felt "blindsided" by the physicians' newsletter, which he said undermined a Monday night oral commitment by all sides to "step back" from hostilities and seek a compromise.
Curtis said Bakst and the board are the ones who are inflexible.
The administration had already taken a number of actions -- including closed session hearings of physician leaders -- intended to muzzle them or remove them from office.
Reisman said doctors must remember that use of a hospital is a privilege granted by the hospital, not a right.
So, after nearly a year of conflict, a core of about 20 doctors -- including a majority of the 12-member medical staff executive board -- decided to hire Curtis. Dozens more doctors have contributed money to a legal fund, said San Francisco public relations specialist Noah Griffin, a spokesman for dissenting physicians.
Griffin said he was hired because the doctors fear loss of hospital staff privileges if they speak for themselves publicly.
Already, Griffin said, the hospital has taken punitive action against family practice Dr. Stanley Frochtzwajg, stripping him of a contract that allows Community Memorial employees to see him under their employee insurance plan. If they persist in seeing Frochtzwajg, any X-rays, laboratory tests or prescriptions he orders will not be covered.
Some leading doctors have not joined the dissenters. For example, chief of staff Robert Ryan III and James D. Woodburn III, the immediate past chief, have supported the administration.
In a December letter to colleagues, Ryan and Woodburn criticized the series of unsigned Ventura Physician Newsletters apparently endorsed by dissenting doctors and circulated since last May to the medical staff.
"The time is now for the medical staff to recapture a sense of propriety, professionalism and decency," they wrote.
At the same time, however, a group of retired Community Memorial physicians has weighed in on behalf of the rebellious doctors. Ten former chiefs of the medical staff appealed to the 21-member board of trustees to change course.
"The community cannot look favorably upon a community nonprofit hospital that has animosity toward a large segment of its very vital medical staff," they wrote in a Dec. 29 letter. "The board should be convinced that this is a major problem and not just brought up by a few disgruntled physicians."
The physician revolt began more than a year ago, when a six-doctor radiology group that had served the hospital for more than 50 years was told by Bakst that another physician would head the hospital's radiology department after the doctors' annual contract expired in spring 2002.
The doctors declined to work for another physician and got jobs elsewhere.
The move jolted some staff physicians, who had mostly paid attention to their own medical practices and problems, because they felt the new radiology chief and the doctors he hired were not as qualified.
Hill addressed the issue in a Dec. 24 letter to the hospital board, challenging purported comments by administrators that the former radiology group opposed working odd hours and being on call.
The truth is, Hill wrote, that the radiology group replacement is an example of the "administration's attempt to exercise complete control over all aspects of physician activity at the hospital in order to pursue economic benefits without being hindered by quality of care concerns."
Reisman said the new radiologist the hospital recruited, Dr. Duke Bahn, is a world-renowned expert who set up the hospital's new prostate center. Bahn has hired top-quality radiologists to join him, Reisman said. And the radiology department also has improved because of upgraded equipment, he said.
But Dr. Daniel Sommer, one of the displaced radiologists, said he saw the switch as a purge Bakst pursued for greater control over physicians.
"I don't think they were cheaper; I just think they were more controllable," Sommer said. "We had a group contract and were in charge of disciplining our own members. I think it was all about the hospital wanting more control."