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New emergency in the ER: Summa loses accreditation to teach emergency medicine residents

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Summa Health System has been stripped of its ability to train up-and-coming emergency medicine physicians in its ERs July 1.

The Accreditation Council on Graduate Medical Education (ACGME) also put Summa on immediate probation, prohibiting the health system from starting new residency programs or increasing the size of those that already exist, Summa said.

The sanctions come about six weeks after Summa abruptly changed emergency room contractors — replacing its long-term provider with a Canton company after failed negotiations — and about two weeks after Dr. Thomas Malone, Summa CEO and president, submitted his resignation.

What prompted ACGME’s action is unclear. Summa officials Thursday declined to release ACGME’s findings or to disclose the reasons behind the action, but said they disagree with ACGME’s conclusions.

Summa officials said they will appeal within 30 days. Dr. Dominic Bagnoli — CEO of US Acute Care Solutions, the company now running Summa’s five emergency departments — said his group and Summa remain committed to medical education at Summa.

But others fear Summa’s emergency medicine residency program is over.

At least one outside observer — Dr. Robert McNamara, former president of American Academy of Emergency Medicine — said ACGME’s action to suddenly pull accreditation this week is a “death penalty” for Summa’s program.

At Summa and at ERs across the country, residents care for patients under the supervision of an attending physician.

Summa officials and Bagnoli on Thursday emphasized that residents’ primary mission at hospitals is to learn through treating patients and that Summa does not rely on residents to staff emergency departments.

About 30 residents now work at Summa’s emergency departments at Akron City Hospital and in Green.

For decades, Summa’s residency program has served as a sort of physician farm team, grooming medical-school graduates — many from Northeast Ohio Medical University in Rootstown — who end up taking root in Greater Akron.

That has assured a steady supply of physicians to Akron, Canton and areas to the south when similar-sized cities and towns across the United States struggle to recruit doctors.

Caitlin Donovan, director of outreach for the Patient Advocate Foundation — a Virginia group that helps patients solve insurance issues, gain access to health care and pay bills — said emergency rooms are often the primary interaction patients have with health systems.

“If I was [Summa], I’d make it clear why they’re losing their accreditation,” Donovan said Thursday. “If it’s not public, I want to know as a patient, why not.”

Summa spokesman Mike Bernstein said Thursday that the health system received ACGME’s “confidential written report” Wednesday night.

“Out of respect for ACGME and the appeal process, we will not share the report or discuss it publicly,” Bernstein said.

ER staffing switch

The accreditation action comes after weeks of turmoil at Summa that began during the final days of 2016 when last-minute contract negotiations between CEO Malone and Summa Emergency Associates (SEA) — which had served Akron City Hospital’s emergency room for more than 30 years — failed and Summa hired Bagnoli’s company, USACS, to fill the role.

The change inflamed simmering tensions between Malone and many area doctors, some of whom were in a bitter legal battle with Summa over the future of physician-owned Western Reserve Hospital.

A physician no-confidence vote followed by weeks of public scrutiny ultimately led Malone to resign in late January. He agreed to stay in the role for up to 60 days while Summa’s board of directors conducts a search for his successor.

Neither Malone nor any members of Summa’s board of directors agreed on Thursday to be interviewed for this article.

But spokesman Bernstein said Summa leadership was aware of the potential for ACGME sanctions when it abruptly switched emergency room contractors.

“We made the decision, however, to put patients first and we moved forward to ensure uninterrupted patient care in our emergency departments,” Bernstein said.

Bagnoli, whose USACS now staffs Summa’s emergency rooms, confirmed Thursday he had been in talks with Summa during the last week in December. But Bagnoli said he didn’t learn USACS was taking over until Malone called him at 5 p.m. Dec. 31 and said negotiations with the former provider, SEA, had failed and USACS needed to move in seven hours later.

USACS employs more than 3,000 clinicians at more than 160 sites across the county. Because it’s based in Canton, USACS had a network of local doctors it could tap to fill the immediate needs at Summa’s ERs.

USACS manages or helps manage nine other medical residency programs nationwide, none of which have been subject to corrective action by ACGME, a company spokesman said.

The first two days of January, Summa’s emergency medicine residency came to a standstill. Residents stayed home and there was no core faculty at Summa to teach them, Bagnoli said.

But in the days that followed, USACS quickly assembled a faculty for the residents and made plans to bring in Dr. Scott Felten as interim program director for Summa’s emergency medicine residency program.

Felten, who joined USACS in 2008, had been residency director working with residents at all nine USACS graduate medical education facilities. He started work at Summa Jan. 9.

The first week, Felten met with Summa staff and all residents. He also called medical students to assure them Summa’s residency program was up and running.

“He accomplished an amazing amount,” Bagnoli said.

Bagnoli said he knew ACGME might put Summa’s residency on probation. But Bagnoli, who said he had not seen the ACGME report, didn’t expect accreditation to be withdrawn.

“We were hoping [ACGME] would look at what was accomplished” after Felten and the USACS faculty arrived, Bagnoli said.

Future unclear

McNamara, the former president of American Academy of Emergency Medicine who is a professor and chair of emergency medicine at Temple University in Philadelphia, said Summa’s emergency medicine residency program was known as one of the nation’s “top-flight” programs for a community-based hospital system.

Stripping Summa of the program is devastating for the residents, patients and the future of Summa, he said.

Suddenly withdrawing accreditation is a “very uncommon move” by ACGME, he said. “To withdraw accreditation is the ultimate hammer. It’s a death penalty.”

The 10 residents in their final year of the three-year training program at Summa graduate in June and won’t be affected by the loss of accreditation.

The remaining 20 residents — 10 first-year and 10 second-year — must find a new hospital by July 1 to finish their training.

Summa won’t get a new round of residents without certification.

Summa and Bagnoli said Thursday they were confident the health system could win its appeal to retain accreditation. The appeal will be filed within 30 days; it’s unclear when ACGME will make a ruling.

But others were less optimistic.

Dr. Jeff Wright, who said his SEA group ran Summa’s emergency residency for 36½ years, called what’s happened to the training program tragic.

“The only answer is to bring our group, SEA, back,” Wright said. “No other option will work.”

On Thursday, however, Summa stood by previous statements that it won’t bring SEA back.

Amanda Garrett can be reached at 330-996-3725 or agarrett@thebeaconjournal.com. Betty Lin-Fisher can be reached at 330-996-3724 or blinfisher@thebeaconjournal.com. Staff writer Rick Armon contributed to this report.


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