400 sign petition for fired ER doctor

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400 sign petition for fired ER doctor

Emergency room nurses back doctor's claims of overbilling

By

Odessa American

Four Medical Center Hospital emergency room nurses say they

witnessed some of the incidents that prompted Dr. Edgardo Valle to accuse a

hospital contracting company of unethical billing practices.

The nurses said Valle was actually relaying some of their

concerns when he confronted administrators.

Valle was fired Feb. 5. by Team Health, the company that

administers emergency room services for the hospital.

The termination came two weeks after Valle called for an

independent investigation of Team Health’s system, which he says encourages

doctors to pad patients’ bills with needless tests and bogus claims of supplies

used and services performed.

“I’ve seen it,” said a nurse who works in the ER. “The games

the doctors are playing are ridiculous.”

The nurse said he has seen physicians order full cardiac tests

for stomachaches. He said he believes some doctors have ordered unnecessary

tests only to “throw them away without using them.”

He said nurses should function as advocates for patients in

addition to being caregivers. He said he routinely questions some tests and

procedures ordered by some doctors, even though he is often overruled.

He also said he is disheartened by the problems at MCH, which

he said seem to be ignored by supervisors and administrators.

“They (Team Health) say Dr. Valle was terminated for missing a

meeting,” the nurse said. “But everyone knows that the real reason is that he

was trying to let people know what is going on.”

The nurse said it appeared to him that MCH and Team Health are

more concerned with stopping the complainers than fixing any problems. He asked

that he not be identified out of fear of losing his job, referring to what

happened to Dr. Valle after he spoke out.

“They fired the squeak instead of fixing the wheel.”

The nurse said he wanted to see the hospital end its contract

with Team Health.

Although doctors are contracted by Team Health, emergency room

nurses are employed by MCH.

A second nurse, who said she did not want to be identified

because she is afraid of a possible backlash from hospital administrators, said

she, too, has seen the sorts of abuses Valle cited.

“There was a lot of inappropriate billing that the nurses

witnessed,” she said. “I know it happens and continues to happen.”

She said “upcoding,” charging patients for more than what is

actually being done for them, and other actions resulting in overbilling grew

significantly worse with Team Health’s arrival more than a year ago.

Emergency room services at MCH have been administered by a

contractor for about 20 years. The contractor before Team Health was Fischer

Mangold, which was purchased by Team Health in 1997.

“They (Team Health) rearranged all of their billing,” the

nurse said. “I think some doctors weren’t making as much money, so I guess they

found other ways to make money.”

Among Valle’s complaints was the existence of a billing system

that ties doctors’ pay to the amounts they bill patients. Valle charges that

such a system improperly encourages overbilling.

The nurse said she believes the quality of care has slipped

because of the system, most notably a double standard of care between those with

insurance and those who are indigent.

She said a combination of the patient’s ability to pay and the

doctor on duty might mean the difference between immediate quality care and

hours of waiting for less aggressive medical attention.

She said some emergency room nurses miss Valle and feel partly

responsible for him losing his job.

“There was a lot of inappropriate billing by doctors that was

witnessed by nurses,” she said. “The nurses brought it to Dr. Valle, who was one

of the very few emergency room doctors that found it inappropriate. When he

attempted to bring it to the attention of the people who could do something, he

was fired.”

She continued, “(Valle) stood up for nurses, patients and the

patients’ bill of rights, and it cost him his job.”

A third nurse at the emergency room, who said he, too, feared

repercussions and did not want to be identified, supported Valle’s stance on

billing practices.

He said he and other nurses have given copies of incident

reports that detail overbilling to Valle. He said the incident reports document

“upcoding” and overbilling that he said should be investigated.

“Dr. Valle is just standing for what is right,” he said.

A fourth nurse, who spoke on the condition that she not be

identified, said she feared for her job.

“They may not be able to fire us all, but they can make it

ugly to work there,” she said.

She supported Valle’s claims of overbilling and upcoding.

“Dr. Valle has valid claims,” she said. “We’ve all seen it.”

The nurse said an emergency meeting was called Feb. 22 by

Trauma Director Phyllis Blanco to tell ER staff members that Dr. Valle had

contacted the Odessa American. Earlier that day, the Odessa American spoke with

representatives of the hospital, including CEO Bill Webster.

At that meeting, Blanco told the staff that anyone who signed

a petition supporting Valle would not be in jeopardy of losing his or her job.

The nurse acknowledged Blanco’s reassuring comments, but said

she still wanted to remain anonymous because talking to the newspaper would be

different than merely signing a petition.

After Valle was fired, about 400 people, mostly hospital

workers, signed a petition commending his skills and ethical standing, in

addition to urging that he be rehired.

The nurse said she expects an investigation by the federal

Health Care Financing Administration when Valle’s criticisms have been widely

aired.

“HCFA will come down like the hounds of hell,” she said.

She said she, too, believes Valle was fired for

whistleblowing, not missing a peer review meeting to further consider Valle’s

complaints, as Team Health officials asserted.

“The citizens of Ector County lost a tremendous supporter for

their health care when (Team Health) fired Dr. Valle,” she said.

She said she blames Team Health and some physicians equally

for the upcoding. “It’s a money thing,” she said. “I know money runs everything,

but patient care and patient concerns should be placed above that.

“Do you want a physician that cares about you and what you

need, or do you want one that cares about what he can bill you for instead?”

Other emergency room nurses and doctors did not return phone

calls made by the Odessa American.

Speaking about the fact that his supporters asked to remain

anonymous, Valle pointed to his own termination.

“People should not be afraid to talk when it comes to major

issues in the workplace,” Valle said. “But they are.”

He said procedures in place at MCH for employees to

anonymously report wrongdoing are ineffective. He said there is no follow-up

effort on problems aired on an ethics hotline or placed in the suggestion boxes

near the employee timeclocks.

MCH Compliance Officer Barbara Dingman said complaints from

each of the 26 boxes are picked up by her assistant about once a week and

logged. Each suggestion or complaint is then forwarded to the appropriate

department to handle.

Dingman’s assistant, Compliance Coordinator Gingie

Sredanovich, said only the issues that involve federal law are followed up on.

However, a follow-up may consist of a supervisor reporting

simply that “the issue has been dealt with,” Sredanovich said.

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