How a group of doctors helped save the ECMC-Kaleida consolidation plan
Shame on us.
Those words stuck with Dr. Lawrence Bone as he listened to a colleague talk about the consolidation of Kaleida Health and Erie County Medical Center.
After years of panels and reports that argued persuasively for joining the institutions, the best chance ever to accomplish that goal was dissolving in a war of lawsuits and tit-for-tat advertising campaigns.
Buffalo was not just going to miss a once-in-a-generation opportunity to improve an inefficient hospital system. The legal actions and escalating threats on each side threatened to make matters even worse, and the doctors were sick about it.
“We can’t let this happen,” Bone told other physicians.
So began the unusual course of events that ended last week with a group of doctors helping secure an eleventh-hour agreement to join the rival hospitals.
The state’s Commission on Health Care Facilities in the 21st Century had ordered ECMC and Kaleida Health to form a unified, nonpublic governance structure that included the University at Buffalo. But negotiations on how to combine deteriorated into more than a war of words.
One legal action by ECMC and Erie County jeopardized $65 million in state aid.
Another by the county would have forced the state to close ECMC or Kaleida’s Buffalo General Hospital.
UB also threatened to move its residents — new doctors training to be specialists by working with veteran doctors — out of ECMC, a move that would have thrown medical services into chaos.
Meanwhile, all the parties faced a June 30 deadline, when the state law ordering the changes expired.
“I had worked all my life to build this department,” said Bone, who wears two hats as head of orthopedics at ECMC and chairman of orthopedics at UB. “I wasn’t going to lose it.”
In early June, he met Dr. David Dunn, UB’s vice president of health sciences, and asked if Bone could try to broker a deal. Dunn, worried that events were headed toward a crisis, gave Bone the go-ahead.
Dr. Merril T. Dayton, chief of surgery at Kaleida Health, was at the meeting, and offered to help. Their first step was a meeting with ECMC officials to nail down exactly what made them so reluctant to cooperate.
A full merger between the hospitals proved too difficult to achieve at this time because of political, financial, legal and labor issues. So the plan was to keep the hospitals separate, but with a unified governing board — with representatives from ECMC, UB, Kaleida and the community — that had authority over major decisions.
ECMC feared that without a binding agreement specifying the medical center’s services, its medical programs might be stripped away, despite assurances otherwise. ECMC also wanted support for its plans to expand operating rooms and the emergency room, as well as assurances that UB would not unilaterally remove residents. Others opposed the idea of guaranteeing services as a precondition, especially if one of the points of joining together was to organize services in a more rational way. In addition, making ECMC a center of orthopedics, an example of a service ECMC officials sought, would financially hurt Kaleida Health.
Despite hardened positions, Bone and a few others saw room for compromise.
With recommendations from Dunn, a group of 10 doctors came together, including Dayton; Steven Dubovsky, head of psychiatry at ECMC; Kevin Gibbons, a Kaleida neurosurgeon recently in the national spotlight for the care of Buffalo Bills tight end Kevin Everett; and Evan Evans, a Kaleida physician whose “shame on us” comment motivated Bone to take a leadership role.
The physicians came up with a proposal to create a committee of doctors, half from ECMC and half from Kaleida, that would work with the unified board on major decisions related to moving, starting or terminating medical services.
“We think doctors have a pretty good idea of what would work in Buffalo. Our basic idea was that the service lines should stay at the hospitals unless there is due process to move them,” Bone said.
They presented the proposal to ECMC the following day on June 18. Things didn’t go as well as the doctors had hoped. But ECMC’s attorney, Anthony Colucci III, agreed to help them get an audience with the judge handling the legal actions, Supreme Court Justice John M. Curran.
After hearing the arguments in the proceeding to close a hospital, Curran agreed to listen to the doctors. He liked what he heard but told them to work out the details of how the proposed physicians’ committee would wield its decision-making authority.
On June 21, the doctors regrouped with the judge and lawyers in the proceeding. Curran talked to the doctors alone. Then, one at a time, he brought in the attorneys to see if the proposal was something that might serve as the basis of a settlement of the legal actions and the consolidation.
Everyone seemed agreeable, but they had to act quickly. The June 30 deadline approached, and Curran was under pressure to make a ruling.
That afternoon, Curran ordered every key figure in the consolidation to appear the next day at UB’s Main Street campus. There were about 60 people, including hospital officials, County Executive Chris Collins, UB President John Simpson, the leaders of the UB medical school, the physicians’ group, an array of lawyers, and the members of the unified board, known as Newco. State Health Commissioner Dr. Richard Daines participated by phone.
Bone and the group of physicians gave impassioned pleas for change.
“I chaired a committee to find a new chairman of internal medicine, and everyone we interviewed said they would not come here,” Bone said. “They saw that we have four or five hospitals doing a little bit of heart surgery when we know that concentrating that service improves care.”
Like a diplomat, Curran shuttled from group to group during nine hours of speeches and negotiations, as each side demanded to know what it would get or what the other side was willing to give up.
At the end of the day, the doctors had an agreement in principle. Rather than trying to divvy up services between the hospitals, they established the physicians’ proposal for trying to make such decisions fairly.
“This whole thing was so acrimonious. People didn’t like each other,” said Dayton, after the agreement was announced Mon-day in court. “It seemed like a miracle.”
