By Nathan Mayberg
ROCK HILL June 6, 2006 Dr. Hal Teitelbaum, Managing Partner of Crystal Run Healthcare, stepped up his attacks on Catskill Regional Medical Center last week during a press conference at his companys Rock Hill building.
Teitelbaum disclosed specific cases of how he believed the hospital was providing inadequate care and how faulty business practices have contributed to deficient health care.
There is a culture and climate of denial, cover-up and retaliation, he charged.
When his doctors brought forth their issues to officials at the hospital, they were threatened with retaliatory measures, he said.
At the core of the quality concerns Teitelbaum laid out was a lack of anesthesia being administered to patients who are suffering. The hospital has had an exclusive contract for many years with Dr. Hussein Omar and his group to provide anesthesia to patients. But Teitelbaum said it often takes a long period of time for the anesthesiologists to respond to pages. That can be critical during emergencies, he said. Furthermore, Teitelbaum cited instances where general anesthesia wasnt given at all to patients.
In one case, a C-section was performed on a woman whose baby was in fetal distress, an obstetrical emergency. But the anesthesiologists did not respond to several pages nor did the nurse supervisor with the keys to the medication box, said Teitelbaum. Instead, he said the obstetrician was forced to cut through the womans skin and abdomen while she was awake.
Catskill Regional Medical Center CEO Arthur Brien did not dispute most of the account but said the woman was given local anesthesia, which is far less powerful than general anesthesia Dr. Omars group provides. Brien said the woman was asked if she wanted more medication, and she refused.
It happens during troubled births, stated Brien.
He said the mother was happy with the service provided by the hospital.
Teitelbaum cited other cases where patients in severe distress were not given sedation. For example, he claimed a patient diagnosed with respiratory failure in the intensive care unit never received any sedation due to the pharmacy being closed at night.
But Brien defended the hospitals practices. He said CRMC has had four operations at the hospital using local anesthesia. Brien maintained however, that the anesthesiologists were responding to emergencies within 30 minutes, which is the mandated standard. Teitelbaum argued it takes them an hour at times.
In another example, Teitelbaum said a patient entered the emergency room complaining of chest pains and requested their doctor from Crystal Run. Officials at CRMC allegedly refused and ordered the patient to return in two weeks and have a stress test. After a visit with a Crystal Run a few days later, it turned out the patient actually had a heart attack. A stress test may have killed the patient, he said.
This past Memorial Day, Teitelbaum said the New York State Department of Health informed him that there were no cardiologists on call at CRMC. Teitelbaum offered his services, but the DOH said that would be up to CRMC, which never contacted Crystal Run.
The hospital only has two cardiologists on staff. When Crystal Run came on board, they brought six cardiologists. But Brien said the cardiologists rarely covered their calls. Teitelbaum called that accusation a lie.
Brien said the lack of resources the hospital has in a rural community, prevents them from meeting all of Teitelbaums standards. But Teitelbaum said it wasnt a lack of resources.
In another instance, a CRMC emergency room physician interpreted a CT scan of a patient as showing an old stroke. After a Crystal Run neurologist reviewed the scan, they determined there was evidence of bleeding in the brain, a potentially life threatening condition, according to Teitelbaum.
These are just some of the reasons why approximately 50 percent of Sullivan County residents go elsewhere for health care, said Teitelbaum.
There seems to be a pattern of behavior with CRMC doctors refusing to contact our doctors in [disregard to] the best interests of our patients. They dont want us to be involved in the hospital, he said.
In addition, he took pointed shots at questionable contracts with some of the head physicians at the hospital.
Specifically, he fingered Dr. Jacques Gulekjian, who until this year held an exclusive radiology contract with the hospital which paid him over $950,000 one year and approximately $800,000 in another, according to Teitelbaum and financial records he provided. Those numbers are way above market value, he said. On top of those figures, Gulekjian billed patients directly.
In most cases, hospitals have exclusive contracts with radiologists without any price or even a minimal one. When Teitelbaum was there, he witnessed only one other part-time radiologist working alongside Gulekjian.
In addition, Gulekjian is a non-voting member of the hospitals board of trustees and is the president of the medical staff.
Brien responded to Teitelbaums comments by stating, He has been bashing the hospital for a long time. ... We didnt have a problem until Crystal Run.
He called Teitelbaum paranoid.
At first, we thought it would go away. . . . We tried and tried and tried. He has now put Sullivan County patients at risk, said Brien. It is criminal. . . . Dr. Teitelbaum has caused a great problem in our community.
Brien denied that Crystal Run doctors were threatened with retaliation when they reported their problems and said the lack of resources the hospital has in a rural community prevents them from meeting all of Teitelbaums standards.
Despite all of the claims and concerns, Teitelbaum said, We are pro-hospital. We want to improve the conditions at the hospital. . . . This hospital has tremendous potential.
Since he announced that Crystal Run physicians will no longer be working at the hospital, Teitelbaum said he has received threats of retaliation from officials at CRMC, the New York State Department of Health and from local and state politicians.
The DOH is currently investigating two formal complaints made by Crystal Run. Teitelbaum claimed to have affidavits and sworn statements from patients and former employees of CRMC testifying to his claims.
Still, Teitelbaum was optimistic that he would return to CRMC in the long run maybe not in the next few months, but maybe in the next few years, he stated.
First, though, there has to be an acknowledgement by CRMC or the DOH that there are quality issues at the hospital, he explained. He claimed that DOH officials have admitted privately to him of such issues but have not done so publicly.
Constructive criticism needs to be accented, and more transparency is needed, he continued, and threats of retaliation need to end. Simply put, there needs to be a drastic change of culture, he said.
Teitelbaum also shot down any accusations that his leaving CRMC was a business decision due to any deals with Orange Regional Medical Center.
There is no truth to the statements, he said.
Furthermore, it would be illegal to have a relationship based on Crystal Run patients, he said.
Despite it all, Teitelbaum said, Crystal Run is in Sullivan County to stay.