http://mv-voice.com/print/story/print/2007/07/27/catch-22-at-el-camino-hospital


Mountain View Voice

News - July 27, 2007

Catch 22 at El Camino Hospital

Doc: Administration did more harm than good in case of Jimmy Campbell

by Alexa Tondreau

Editor's note: Four weeks ago, the Voice reported that a patient at El Camino Hospital had been released after an unparalleled length of stay — five and half a years. Due to a technicality in his Medi-Cal coverage, Jimmy Campbell, 43, who has a degenerative neurological disease called spinocerebellar atrophy, was unable to receive full coverage for the 24-hour at-home nursing care that his doctor prescribed.

Without the full coverage, said Dr. Ron Hoffman, Campbell's neurologist and personal physician, Campbell would have died, most likely from choking, as he is unable to properly swallow on his own.

The Voice sat down for an interview with Dr. Hoffman soon after that article was published. He described the unusual predicament of a patient unable to leave the hospital for his home, and detailed the conflict between the hospital's administration and Campbell's family and physicians — a personal story that Hoffman believes has larger implications for a health care system under stress.

Beginning at age 29, when he was first diagnosed with the neurological disease that would eventually leave him debilitated, life was not easy for Jimmy Campbell.

According to Campbell's family and personal physician, administrators at El Camino Hospital, where he would spend the next five and half years, didn't make it any easier.

Soon after Campbell was admitted to El Camino, in January 2002, administrators began to put pressure on his family and his doctor, neurologist Ron Hoffman, to have Campbell moved to a nursing home, Hoffman said. But because Campbell was unable to secure coverage to pay for round-the-clock care, Hoffman refused to allow him to leave.

For Dr. Hoffman, it was always obvious what should be done.

"It was Medicine 101," he said. "This person can't fend for himself. He needs tube-feeding, suctioning and someone to attend to his basic needs. Left unattended, he would have died."

Besides attending to his medical needs, a bedside attendant would alleviate some of the internal pain and stress that he goes through as a result of his condition, which has degenerated his body to the point of complete immobility while leaving his mind intact.

"It would be stark terror for him to be alone. Jimmy can't call for help, push a call button or move his arms and legs in any purposeful way," said Dr. Susan Hansen, a neurologist who also cared for Campbell during his time at El Camino Hospital.

Despite this, Hoffman said, the hospital requested that he sign orders for Campbell to be transferred to a nursing home, which the doctor refused to do.

Campbell's parents, Jim and Glenna Cecchini, became so concerned that Campbell might be moved to a nursing home while they were gone, or be left unattended, that in the first year of his hospitalization they lived at El Camino for almost five months straight, often sleeping on the floor of his room.

"We packed up a lot of our stuff, and we moved our clothes in. We hardly ever went home," Glenna Cecchini said.

They also allege that administrative staff did not inform nursing home staff as to the full extent of Campbell's disabilities, or the limitations of his coverage, when the hospital was trying to find Campbell a place to go.

"The first two years was a tremendous strain on us" said Jim Cecchini. "During this time period Jimmy's cost was the primary concern, not his care."

Physicians make the call

While the hospital would not comment on any aspect of Campbell's case directly, citing confidentiality constraints, administrators did describe the general process they follow when a patient like Campbell has been stabilized and no longer requires hospitalization.

"Our responsibility as an acute care hospital and facility, when the patient no longer needs that level of care, is to help them find an appropriate placement," said Diana Russell, vice president of patient care services.

Russell said numerous discharge planners and care coordinators are employed on-staff, and that it is their job to "help the family and physician evaluate the alternative levels of care."

But Russell stressed that whatever their findings, hospital administration cannot legally act in noncompliance to a doctor's orders.

"A physician must write a discharge order before any patient is discharged," she said.

Given the average length of stay for patients at a hospital like El Camino — 4.3 days, Russell said — it didn't surprise the physicians watching over Jimmy Campbell that administrators wanted to see him moved.

"The hospital was not the normal place for him to be. It was not unreasonable for the hospital to want another venue," said Dr. Hoffman.

But despite Campbell's unusual predicament, Hoffman said, there was little in the way of constructive assistance, and mounting pressure to discharge him. It was this interference by administrators that caused so much friction.

By law, Hoffman said, "A physician cannot be unduly influenced and has to have undivided loyalty to his patients. The difficulty occurs when the administrative or insurance company overreach in effect alters the will and intent of the physician's directions on behalf of his own patient."

Dr. Hansen agreed, saying, "There was an attempt to make us do what was best for the hospital's bottom line."

Though the hospital could not say exactly how much it cost to board Campbell, one indication is the minimum amount of insurance coverage needed to provide him with 24-hour care — $250,000 per year, the Cecchinis said.

Within the first two years of Campbell's stay, the Cecchinis went to then-CEO Lee Domanico and asked if the hospital could help with grants to bring Jimmy home. They said they were told the grants were not for individuals, but for the community.

Two weeks later, the Cecchinis said, the hospital offered the family $30,000 to move Campbell elsewhere. The Cecchinis rejected the offer.

Russell could not confirm the offer, but said it is not uncommon.

"We do have a hospital foundation that raises money for individual patients when it is needed. We have provided rent for patients, purchased wheelchairs and medicine for patients, and paid for hotel rooms for homeless patients," she said.

The bottom line

To Dr. Hoffman, a nonprofit hospital like El Camino has a mandate to provide charitable care in appropriate circumstances.

"It has to be remembered that it is a tax-funded hospital. They do not exist unequivocally to make a profit in every instance."

Hoffman believes the Cecchinis would have benefited from a concerted effort by the hospital to appeal to the state, the Medi-Cal system and charitable means to find Campbell coverage. As it was, the Cecchinis were finally able to secure financing for Campbell through the help of Assemblywoman Sally Lieber, who managed to amend the waiver that prevented patients like Campbell from getting full coverage.

After five and a half years, the Cecchinis were overjoyed to welcome Campbell home last month. But they said the experience has left its mark on them.

"I feel disillusioned about hospital care. I've seen behind the scenes, and what they were telling me is, 'Our bottom line is money. You're wasting our money, so get out,'" Glenna Cecchini said.

Drs. Hoffman and Hansen said bottom-line priorities are hardly unique in the health care industry.

"There's been a gradual erosion of physician authority in hospitals," Hoffman said. "There are interferences coming from every sector of the medical community." As an example, he said, "Insurance companies reserve the right to deny payment for tests deemed appropriate by the treating physician."

Hansen agreed, saying, "There needs to be a change in medicine. It is what the doctor orders that needs to happen. We bear the special burden and privilege of working to save a patient's life."

The Cecchinis site both doctors as their "heroes," and say the sixth-floor nursing staff where Campbell was stationed treated Campbell like family and provided him with excellent care.

Hoffman said he was just doing his job.

"It's such a simple story. A doctor gives orders and one would hope all dedicated to the execution of those orders would rally around it. There are no heroics here."

E-mail Alexa Tondreau at atondreau@mv-voice.com

Comments

Posted by Debbie, a resident of Cuesta Park
on Jul 27, 2007 at 9:29 am

No one should be surprised that the Administration at El Camino did more harm than good for this patient. The Board of Directors at El Camino Hospital has had greedy physicians like Ed Bough, MD and Dominick Curatola, MD on it for years, who were only acting in their own financial interests. Former CEO Lee Domanico only seemed to be interested in maximizing his own compensation, and keeping side deals with companies like Sensitron where he received stock options, and Vocera, where his wife secured a job, secret. He developed executive bonus plans based on the amount of money El Camino Hospital was making, not on whether patients were being well served. Diana Russell, VP of Patient Care Services, should really be VP of Patient NO-Care Service!


Posted by Bill K, a resident of Whisman Station
on Jul 27, 2007 at 10:05 am

Something has not been right at El Camino Hospital for the last several years. Good physicians have been leaving. Described by the El Camino Hospital District Board as one of the best and most talented physicians to ever practice at El Camino, cardiac surgeon Marc Pelletier, MD resigned last month. Also resigning last month was the El Camino Hospital Radiologists Group, which had been practicing exclusively at El Camino for 45 years! These resignations are not good for patient care. The El Camino Hospital District Board and administration don't seem to care.


Posted by Robert, a resident of Cuesta Park
on Jul 27, 2007 at 2:02 pm

"There was an attempt to make us do what was best for the hospital's bottom line."

Both Dr. Hoffman and Dr. Hansen should be given awards for standing up to the El Camino Hospital Administration, including former CEO Lee Domanico and VP for Patient Care Services Diana Russell. While Domanico and the District Board raised our taxes by hundreds of millions of dollars and are borrowing hundreds of millions more, they still don't know what business they are in - taking care of patients. This Board needs to have an extreme makeover, instead of the dishonest characters like Ed Bough, MD and Mark O'Connor making decisions effecting patient care.

Hats off to Drs. Hoffman and Hansen. Job well done!


Posted by Art Blackwell, a resident of Whisman Station
on Jul 28, 2007 at 7:54 pm

Ah, now a LOT becomes clearer! My FIRST stroke was in Colorado. That hospital made every effort to provide beginning rehab and care that was enough to go home. They did the basics: that took a total of THREE WEEKS and I was highly motivated. I was very lucky that my SECOND stroke was much milder when I was here for rehab at the REACH program ( I recommend it for ALL stabilized stroke patients. It is a service from Foothill College and DOCTOR recommended ).
I ended up at El Camino. The DOCS are great; the ADMIN was NOT. The DOCS delayed my release, the ADMIN people pushed it! I now get my services at STANFORD. I go out of my way for any ER stuff to go to STANFORD. We are far closer to El Camino, but I know that STANFORD won't cut corners when it come to care!

SHAME ON YOU, EL CAMINO! You are NOT serving your COMMUNITY!

HOORAY for the DOCS and SENIOR NURSES! BOOS for the ADMINS and the lower level nursing staff!

An EX-PATIENT!


Posted by Dorothy Madison, a resident of Waverly Park
on Aug 1, 2007 at 10:11 am

The treatment of this patient is just an example of what the Hospital Administration and Board actually think about their community. This example is just the tip of a very large iceberg of mistreatment of patients for financial reasons. I predict that this Board and Administration will retaliate against these two fine physicians. The Board and Administration won't accept the negative publicity of their own actions, and will find a way to retaliate. They have done this in the past, and will spend whatever it takes to silence these and other physicians who complain about poor treatment of their patients.


Posted by Neil Jensen, a resident of Rex Manor
on Aug 2, 2007 at 6:33 am

Of course the administration people at El Camino Hospital have to be SOBs. That's their job, to make the cash flow in and out balance. Someone has to do it as long as health-care-for-profit exists as an industry. It reminds me gold-rush San Francisco. The city burned down five times in one year, so Sam Brannan organized a fire insurance company. If you bought his insurance, should a fire break out, he would send a team of fireman to fight it. If you didn't pay, then tough luck. Your house burned down. That's free enterprize. Brannan made a lot of money; and people must have been satisfied. After all, private industry always does anything better than government. Then the liberals gained control of the city government and instituted socialized firefighting, passing off the expenses by taxing the rich.


Posted by Robert A. Christensen, RN, a resident of another community
on Aug 3, 2007 at 9:00 pm

I have been a nurse at El Camino Hospital for just over 25 years. It is impossible to work somewhere that long and not form opinions about the physicians with whom one works every day. I would advise the public to be very cautious in describing physicians (and administrators) with words such as "greedy", "dishonest characters", "SOBs" and "boos to the lower level nursing staff". The vast majority of us (nurses, doctors, managers and administrators) work very hard to take good care of the patients who come to us for care. I hope the public will not be unduly influenced by name calling.


Posted by registered user, Don Frances, a resident of Mountain View Voice Editor
on Aug 6, 2007 at 10:08 am

Robert,

Thank you for weighing in here. I've worked at the Voice for two and a half years, and am amazed at the bitterness aimed at El Camino. It's way out of proportion to its benefits, and ignores the thousands of individual people who are working hard to provide top-rate medical care there.


Posted by Neal M, a resident of another community
on Aug 6, 2007 at 12:55 pm

Don, You weren't the editor when the Mountain View Voice filed a law suit against the El Camino Hospital District Board to force them to disclose the compensation of CEO Lee Domanico. However, the Voice itself got a payment from El Camino Hospital in the settlement of the law suit. This money was ill spent by the Board, as they were trying to cover up their lies about the compensation. As you may know, the Board had announced that Domanico was making $350,000 a year, when he was actually making nearly one million. The Voice did its part to raise the cost of health care for the whole district!


Posted by registered user, Don Frances, a resident of Mountain View Voice Editor
on Aug 7, 2007 at 11:08 am

Neal,

For the record, the Voice received nothing more than attorney's fees in its lawsuit against El Camino Hospital. The lawsuit's purpose was not money, it was full disclosure of Domanico's compensation, which we got.

It could be argued that the lawsuit saved El Camino money in the long run, since outrage over Domanico's compensation might have factored in the lower compensation package for the incoming CEO. Whatever the case, it's naive to assume that a single court settlement (even a significant one, like the $200,000 payout to Aaron Katz) results in a direct increase in "the cost of health care for the whole district."


Posted by eric, a resident of another community
on Aug 7, 2007 at 1:48 pm

Don, Im glad to see your level-headed comments above about ECH. I am a bit surprised, however, that you have not done anything about the personal attacks aimed at named individuals by the original poster.


Posted by Bill, a resident of Cuernavaca
on Aug 11, 2007 at 6:00 am

One would hope that the successful lawsuit brought by the Voice against the El Camino Hospital District would have lead to more accountability, and hence lower prices. I would agree there is a little more accountability, but this lawsuit did absolutely nothing to lower the cost of health care, even in the long run. The Board voted to raise prices of services at ECH last summer, despite announcing record profits and margins. At a community owned hospital, the Board should be looking for ways to decrease the cost of health care, not seeking ways to increase the prices to the owners (the residents of the District). A non-profit is given tax exempt status to provide for a common good, not to provide million dollar compensation to its executives! In Jimmy's case, common decency was sorely absent.


Posted by Harriet S., a resident of another community
on Sep 29, 2007 at 10:55 am

Have there been other suits brought against El Camino and/or former CEO Domanico re his compensation and/or conflicts of interest with Vocera and Sensitron? Domanico just resigned his position at the hospital system he went to after El Camino.


Posted by Mark, a resident of another community
on Oct 13, 2007 at 8:53 am

Harriet, Have you heard why Lee Domanico resigned at Legacy Health System in Portland? People are asking if Domanico did the same things up there that he did at El Camino Hospital - taking stock options in return for hospital business? While the El Camino Hospital Board did nothing except praise Domanico, the Board at Legacy actually seems to take its job seriously.


Posted by AJ, a resident of another community
on Jan 9, 2009 at 9:08 am

Thank you for posting these comments. My son was forced out of El Camino hospital vomiting. Staff lied and the doctor lied stating that he was not. Now he is dying. It was interesting to find out how the hospital works. Know any good attorney's to sue the hospital.