The situation between Dr. Jesse Cole and St. James Hospital started long before Dr. Anna Chacko arrived there. That said, Dr. Chacko accused Dr. Cole of threatening her over the phone. It wasn't the first such accusation and Dr. Cole has been vindicated with a $4 million settlement announced yesterday.
One of the concepts in play in the case was the idea that Doctors should be employed independently rather than by the hospital itself. Dr. Cole, along with two other radiologists, had hospital privileges but were self employed. Dr. Chacko came in with a team of four and all were employees of the hospital. Dr. Cole believes this creates a conflict of interest and it's one of the sources of conflict.
Here's how he explained the problem,
hospitals which employ doctors have too much power over the physician patient relationship. Employed doctors, exclusive contracts, etc. are euphemisms for corporate practice of medicine. What happened here in Butte was that the hospital justified what it did with no input from the medical staff. When the quality of care decliined, and it was brought to the hospital administrations attention...it covered up the problems, retaliated against employees who were making good faith complaints about the quality of care, and creating a second class, protected medical practice for it's employed physicians.
It is really a big problem nationwide that not enough attention has been paid to. The public thinks that hospitals adminstrations and doctors are on the same side...well...not always, and not exactly. The hospital administrations allegiance is to the bottom line.
You probably are familiar with the constant drumbeat the presumed conflict of interest and adverse effect on physicians that pharmaceutical companies have on doctors with drug representatives and payments to doctors to present talks on drugs.
So...if doctors shouldn't be allowed to accept a free Viagra pen and a pizza from a drug sale rep because it influences their practice...why is nobody asking what effect a hospital can have on a doctor it employs? What if an employed doctor wants to send a patient to another hospital or clinic which is in a competitor's hospital or practice? In theory, the hospital administration is not supposed to interfere...but I will tell you that if an employed physician starts sending patients to, say, an outpatient imaging center not owned by the hospital, because it provides better care...the hospital CEO will make it known to that doctor who signs the paycheck.
In other words, what's the greater conflict of interest? Getting a free Viagra pen, or answering to a hospital CEO who can influence how you practice if you want to keep your job?
The corporate medical practice model is being adopted by the government...which wants to pay hospitals for a patient's care, then it will be up to the hospital to decide how to allocate the money to pay the doctors. This is the ACO...accountable care organization...which is another in a long line of failed promises...PPO's, HMO's, etc. It is more dangerous because of the influence and power such a scheme necessarily hands over to a hospital.
Here's the full story of Dr. Chacko's time at St. James Hospital.