In 2010, when he was hired as medical director of Bakersfield Family Medical Center (BFMC), a professional network, and then, a year later, at another, Communities Physician Network (CCPN), Dr. John S. McGee had a pristine, 20-year reputation in internal medicine. The physician networks are intermediaries among managed care plans.
McGee did well with his new responsibilities—in 2011 he got a boost in salary and benefits.
So why, in June 2012, was he was fired?
According to a lawsuit he filed against the medical groups’ corporate parent, "Despite Dr. McGee's highly successful performance as medical director, defendants continuously threatened and pressured Dr. McGee and his staff to disregard patient safety in order to further increase profits," as reported by the Bakersfield Californian.
The suit, according to The Californian, enumerates several instances of the physician networks putting a priority on profits over patient care. It alleges that McGee and other employees were pressured to increase the denial rate for out-patient service requests "without consideration of the nature of services requested and utilized or their medical necessity."
In April 2012, McGee and his staff met with a corporate administrator to discuss their concerns that changes made by nonphysician employees and managers to were "compromising patient care" and, the paper says, increasing the risk of disease and death.
Some of the concerns were:
- Managers canceled McGee’s order to transfer a patient for surgery and, instead, sent the individual to a facility that couldn’t provide the needed care, delaying by days the transfer to the facility ordered by McGee.
- Managers and nonphysician employees regularly delayed or denied transfers of pediatric patients to a local hospital and instead tried to send them to facilities with which the company had contracts in cities several hours away.
- Managers and nonphysician employees delayed requests for air-ambulance transport to distant facilities, even in life-threatening situations. In the rare cases when air-ambulance transfer was approved, McGee and his staff were berated for using it.
After that grievance-airing, McGee was summoned to a meet with administrators, criticized and told to fire an experienced nurse case manager who had participated in the earlier meeting. The order appeared to be retaliation for expressing patient care concerns, and intended to drive a wedge between McGee and his staff. In short, it looked like a threat of termination for anybody who advocated for patients if it compromised profits.
McGee’s complaint says that the networks’ CEO “repeatedly and regularly challenged the medical decisions made by Dr. McGee and his staff, and directly confronted and debated treatment with the companies' hospitalists, the member's treating providers, and even the patients themselves directly, based exclusively on financial considerations."
California law prohibits employers from retaliating against employees who lodge complaints about patient safety. McGee says that in violating this law, the medical groups put artificial limits on patient care. "Dr. McGee went to bat with for those patients and was terminated for it," his lawyer told The Californian.
John Metz, executive director for the health-care advocacy group JustHealth, has seen this sorry scenario before. Although he could not comment on McGee’s case specifically, he told The Californian that plenty of medical gatekeepers make treatment decisions based on the financial interests of providers and their executives, not on best medical practice.
"We've been seeing this for decades," he said.
It’s impossible to know the extent of patient harm as a result of this mercenary approach to medical care, but it surely is considerable.