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Sunday, September 27, 2009

Dr. Chacko Comes to Butte

UPDATE: Please also check out my new book, The Definitive Dossier on PTSD in Whistleblowers, for only $3.95, in which I dedicate chapter four entirely to the exploits of Dr. Anna Chacko. 

Introduction: Before I relay the eventful fourteen months that Dr. Anna Chacko spent in Butte, Montana working at St. James Hospital as the head of radiology, here's a quick anecdote from Dr. Anna Chacko's memoir, A Journey Out of India. When little Anna was ten years old, her teacher in school gave the class an assignment to draw a butterfly. There was a girl in the class that was beautiful and Anna didn't like her. That girl brought in a perfect butterfly and the whole class loved it. Anna was sure that the girl had gotten her dad to draw it, and she went home and had her own father draw one. The butterfly he draw was so good that the teacher could tell that Anna didn't draw it. The teacher scolded her for having her parents do her homework for her. Anna was so flabbergasted that she went home, told her mother, and demanded that she get the teacher fired. That's exactly what her mother then did and the teacher lost her job.


Dr. Anna Chacko didn't arrive in Butte, Montana until July of 2007. By September of 2008, she, along with all the other radiologists at St. James, had moved on. Yet, her time in Butte was, shall we say, eventful. The fireworks started before she had arrived or even officially accepted a job. The radiology department as of the winter of 2006 was made up of three radiologists, Dr. Jesse Cole, Dr. Michael Driscoll and Dr. Dennis Wright. Dr. Wright and Dr. Driscoll had a combined sixty years of service at St. James Hospital. Meanwhile, Dr. Cole was the "newbie" and he'd only been there since 1996. Furthermore, none of the three were employees of St. James. Rather, they maintained privileges at St. James. This is a sophisticated medical characterization which doctors work at a hospital but maintain independence. As such, they bill separately from the hospital. The advantage, in this case, was that their three services cost the hospital nothing.

As part of a restructuring, Drs. Driscoll and Wright were let go at the end of 2006. This was part of an overall strategy to revolutionize the radiology department.

Kiser contends the community is going to be well- served by the additional staff. The goal is to recruit more than 30 physicians over the next several years. Along with radiology, the hospital can contract employees in pathology and anesthesia.

These contracts will make the hospital economically viable and allow it to expand, Kiser said.The financial goal of the hospital is to have a profit margin of 4 percent on the dollar. Kiser said last fiscal year, the hospital only had a profit margin of 1.5 percent on the dollar.

“We need to be 4 percent on the dollar to survive,” he said. St. James sees a much higher percentage of Medicare patients than a normal city. Much of the cost of services the hospital provides to low-income patients is never recovered.

Kiser wants the hospital to be a “regional hub” for health-care, but acknowledges there are difficulties in maintaining a hospital in a small town and staying profitable.

“We’re too small to be big, and too big to be small,” Kiser said.The hospital hopes to overcome its growing pains with the acquisition of its latest physician, Dr. Chacko. As head of the hospital’s radiology department, Chacko will be responsible for recruiting doctors, training and selecting equipment. Kiser promises the public there will be two to three radiologists on hand at the hospital all the time.

The firing of Drs. Driscoll and Wright became the subject of the first of four lawsuits that involved Dr. Chacko in Butte.

Dr. Anna Chacko was actually recommended to James Kiser, St. James' then CEO, by Scott Steinfeldt. Steinfeldt arrived at St. James about six months prior to Dr. Chacko. Steinfeldt and Chacko are friends, and they are also frequent business partners. They are principles on such companies as Radiology Solutions LLC and Chaco Corp and Moly99Montana. Another principle on many of these companies is Stewart Kirkpatrick, who's also Scott Steinfeldt's attorney. Steinfeldt is also the principle of his own company. Finally, Steinfeldt has had a long running tax dispute with the state of Montana.

Weeks prior to the removal of Drs. Driscoll and Wright, Dr. Chacko got herself entangled with the third radiologist at St. James, Dr. Jesse Cole. Dr. Chacko accused Dr. Cole of threatening her and filed an official complaint with the court. Dr. Cole was eventually ordered by the court to stay at least 500 feet away from Dr. Chacko. Dr. Cole has throughout contended that prior to her filing an official complaint he had one conversation with Dr. Chacko that lasted about fifteen seconds. He has since filed a counter suit that includes St. James, and its parent Sisters of Charity of Leavenworth. That suit continues to make its way through the Montana court system. That was the second of four lawsuits and Dr. Chacko was still six months from arriving in Butte, Montana.

As the article I referenced mentioned, Dr. Chacko was brought in to revolutionize the radiology department in St. James. Before she got to that, she revolutionized the pay structure of all the radiologists. She brought three radiologists with her, Dr. Bob Shah, Dr. William Arndt, and and Dr. Dan Orron. These four no longer simply had hospital privileges but were paid staff of the hospital, and their combined salaries were between $1 million and $1.5 million yearly.

Upon her arrival at St. James, Dr. Anna Chacko immediately began to target Kristi George, the radiology director. Dr. Chacko began to question her competence, made disparaging remarks about her looks, and spread lies about George throughout the hospital. Things got so bad for George that she filed suit against Chacko and the hospital all while both were still working together. This was lawsuit number three of four that involved Dr. Chacko at St. James.

Meanwhile, Dr. Chacko then began lobbying the hospital's CEO, James Kiser, to limit some of George's duties. Specifically, Dr. Chacko wanted to remove from George the responsibility of buying new radiology equipment. The radiology director is an administrator not a doctor. They are often folks with MBA's. Buying radiology equipment is an administrative task and it's time consuming. To do it right, one has to call all legitimate suppliers to schedule showings. Their prices and services must be compared. This takes tens of hours to do right. Doctors are supposed to treat patients, and normally, they wouldn't have that kind of time. Yet, Dr. Chacko lobbied successfully to remove that duty from George. Over the next year, Dr. Chacko bought in excess of $2 million worth of radiology equipment and all of it from General Electric.

It was also common knowledge among staff, because Dr. Chacko often bragged about it, that Joe Hogan, CEO of GE Health Care Services, was on her speed dial. On at least two occasions, she exerted her power using this relationship. On one occasion, a female GE technician was seen speaking to Kristi George. By then, this was no longer allowed because George's responsibilities were reduced to pure administration and she wasn't to have any contact with staff and colleagues. On another occasion, a GE salesperson refused to release equipment without paying. On both occasions, Chacko called Hogan who then called the GE employees in question and scolded them personally.

Kiser indicated that he was looking to bring in Dr. Chacko to transform the radiology department. This was curious since for years Kiser referred to the radiology department as a beacon. The year prior to Chacko's arrival the radiology department had about $5 million in revenues and more than a million in operating profits. To put this figure into perspective, as of October 31st of 2009, there won't be a radiology department at St. James. (more on that in the end) This transformation included a non profit/for profit partnership with local physicians originally dreamed up in 2005. St. James is a non profit hospital which, among many things, means they pay no taxes. They entered into a joint venture with local radiologists. This partnership eventually ended in failure and the venture collapsed. Dr. Chacko also dreamed of having St. James be the "hub" for radioactive elements for PET scans, to be produced by cyclotron . This means the hospital would harvest this highly specialized radiactive material and ship it off to hospitals all around the country. She even lobbied members of Montana U.S. Senate for funding, though it doesn't appear any was ever earmarked. The problem with her idea was that Butte has an airport, it's not nearly sophisticated enough to handle mass flight with radioactive material. The radiation has a limited half life and so logistically, it's nearly impossible to ship any on a mass scale to other hospitals. In fact, sources familiar with the inner workings of the hospital tell me that it was difficult enough receiving radiation from other hospitals let alone trying to ship it elsewhere.

By the spring of 2008, the radiology department had turned from solid black to deep red. In March of 2008, James Kiser announced his resignation citing the need for "a change in leadership". Meanwhile, there was a major schism occurring in the department. Dr. Chacko had relentlessly targeted Kristi George. One of the people she often complained to about George was Jeri Doyle. Doyle was George's immediate deputy and they were also best friends for years. Often in front of dozens of staffs, Dr. Chacko could be overheard telling Doyle that if she allied with her, Dr. Chacko would make sure that Doyle would soon get George's job. In February of 2008, that's exactly what happened. George still had her same job title but significantly less responsibility. Furthermore, after February, all employee complaints within the radiology department would wind up going through Doyle and not George. So, presumably, if someone complained about Dr. Chacko that complaint would wind up on the desk of Jeri Doyle.

By September, the radiology department and the hospital were both in trouble. At this point, Dr. Chacko, and all the other radiologists, announced they were leaving. Scott Steinfeldt stuck around for another couple months. In November, he fired Kristi George. The very next day he was fired. Jeri Doyle is now the Director of Radiology, the top administrator in the department. Her immediate boss is Gary Bailey, now the Executive Director of Radiology. Two years ago, Bailey was a tech in the department. He was often fraternizing with Steinfeldt and Chacko. Dr. Chacko maintains her residence in Butte. In November of last year, she visited St. James one weekend even though by then she was the head of radiology at the Pittsburgh VA. Earlier this month, Doyle sent out a memo to the entire radiology department. Everyone would be fired and all would be invited to apply for their jobs back. Normally, these decisions would be based on seniority. In fact, some of the radiology department is represented by the local Teamsters Union. The contract they negotiated would have had specific language that would have protected seniority. Yet, Doyle's correspondence makes seniority only one of several factors.

This is all very interesting because those that know Doyle say that she follows orders well but doesn't give orders as well. In fact, colleagues often remark on her propensity for repeating what others say. It appears as though someone is orchestrating a takeover of the department so that it will be run and staffed as much as possible by allies of Dr. Chacko. I called both the main office of the Teamsters and its local and so far have not received an answer about what, if any, action they are taking. It's also unclear if they received any complaints from their members about Dr. Chacko and what if anything they did about it. I can also confirm that a tech filed an internal complaint against Dr. Chacko as a "disruptive physician", however it was filed right before she left and appears to have gone nowhere.

Dr. Chacko is now the head of radiology at the Pittsburgh VA. She's been there since October of 2008. In March of 2009, an investigative board was convened to have her removed after repeated complaints of bullying and terrorizing behavior. In April, the board recommended that she indeed be removed. She subsequently reached out to Congressman Brad Miller of the 13th District in North Carolina. He subsequently reached out General Eric Shinseki, the head of the VA. Then, word came down from the General's office to keep her in her job. Congressional sources also say that Congressman Miller is only of several in Congress that lobbied on behalf of Dr. Chacko after she was removed. Miller claimed in letter he sent to General Shinseki that "the department's performance had 'begun to suffer under Chacko's leadership' was unfounded." It's unclear how much Congressman Miller knew about Dr. Chacko's performance at St. James prior to making this assertion. His office has not responded to multiple requests of mine to answer these and many other questions. The accusations against Dr. Chacko from colleagues at the Pittsburgh VA conform to the story I just relayed. In fact, they correspond to complaints made by many of her colleagues at hospitals all over the country.

Finally, the fourth lawsuit involving Dr. Chacko at St. James involves Linda Murphy, Dr. Chacko's secretary there. When she was fired, Scott Steinfeldt told her they needed to let her go because "you know too much about Dr. Chacko". That lawsuit continues to make its way through the court system.


Here's the full dossier on all of Dr. Chacko's exploits.


Anonymous said...

So, Mike, are you suggesting that Chacko is trying to get back into St. James? Yikes!

Also for those of us in the Northeast, how is Butte pronounced?

Hopefully the doctors of Montana can take some preventive action so that Chacko won't return in full disruptive glory.

Anonymous said...

Butte rhymes with cute or if you are dr chacko it rhymes with loot!

Anonymous said...

Someone must have missed clues on her curriculum vitae.

Anonymous said...

So why is this supposed Wacko-Chacko so powerful that she's above all the other regs that are used to harass us ordinary docs?