Petaluma Valley doctors complain about management

As St. Joseph Health plans its departure from Petaluma Valley Hospital after operating the facility for 20 years, the company has recently failed to invest in critical infrastructure, making it difficult to retain doctors, according to a group of physicians who practice at the city’s hospital.

Several PVH doctors have signed a letter criticizing St. Joseph, which leases the facility, for what they described as neglecting the hospital. They contend that St. Joseph pays PVH doctors below the rate of other hospitals.

Todd Salnas, president of St. Joseph Health-Sonoma County, said that the company has invested $50 million in facility upgrades, new equipment and technology at the hospital during its tenure, more than three times the $14 million required in the lease. He acknowledged that smaller hospitals nationwide suffer from a physician shortage.

Doctors said circulating the letter was difficult during a holiday week, but at least 10 of the roughly 300 PVH doctors had signed on so far. In the letter, the local doctors said St. Joseph, which also operates Memorial Hospital in Santa Rosa, has anticipated its departure from Petaluma and has failed to invest in the hospital.

“We the physicians and surgeons of Petaluma Valley Hospital have witnessed a steady decline in Petaluma Valley Hospital while leased by St. Joseph Health Care. This decline has occurred either by neglect or by design to disable and cripple our hospital prior to the scheduled departure of St. Joseph Health Care, whose lease has expired,” the doctors wrote in the letter.

The letter comes at a time of transition for the hospital that is owned by the Petaluma Health Care District. After failing to negotiate an extension to St. Joseph’s operating contract, the district last year selected southern California-based Paladin Healthcare to take over operations at Petaluma Valley. St. Joseph has agreed to stay on until November.

In a statement, Salnas said St. Joseph has worked to aggressively recruit physicians to the Petaluma area.

“We are committed to ensuring the residents of Petaluma have dedicated professionals to meet their health care needs,” he said. “That said, there is a well-known national and local physician shortage, especially among smaller community hospitals driven by growing patient care demand and physician retirements. Despite this, we continue to actively work on solutions in order to recruit top specialists, including offering additional pay and incentives.”

The transition from St. Joseph to Paladin has been painstakingly slow, causing considerable unease among the local medical community. Health care officials say the process will require a new electronic medical record keeping system, which could take up to a year. Paladin recently withdrew its offer to lease the hospital and instead is seeking a management agreement.

Salnas said St. Joseph was committed to serving patients in Petaluma.

“We acknowledge that this is a stressful time for the Petaluma Valley Hospital community due to the uncertainty about its future operations,” he said in the statement. “This is especially true for the caregivers and physicians who practice at the hospital. While we look forward to hearing from the District and learning more about their plans for the future of Petaluma Valley Hospital, we want to make clear our commitment to the hospital and the Petaluma community.”

Dr. Peter Leoni, the head of general surgery at PVH, said he signed the letter because he was frustrated with St. Joseph’s management. He said St. Joseph has prioritized investment in Memorial Hospital at the expense of Petaluma Valley.

“The condition of the hospital has been static,” he said. “St. Joseph has not taken steps forward to really establish it as a marquee hospital in Sonoma County. We are subservient to Memorial.”

In the letter, the doctors claim that services at PVH have dropped off over the years. Angiography, a medical imaging technique, was cut and never restored, the letter said. Ultrasound-guided breast biopsies and nuclear medicine have also been cut, and MRI availability has been reduced to weekdays only, the letter said.

“This has resulted in the transfer of patients to Santa Rosa Memorial Hospital for these imaging studies and eventually to the loss of physician services at Petaluma Valley Hospital,” the doctors said in the letter.

The physicians said St. Joseph has failed to recruit doctors practicing several critical specialties at Petaluma Valley Hospital and pays less for on-call services at Petaluma Valley than at Memorial. This has resulted in the Petaluma Valley emergency department losing its on-call gastroenterologist, who treats emergencies such as bleeding ulcers, the letter said.

In addition, the letter said: “New pediatricians have not been recruited to our hospital to take the place of the established pediatricians who have decided to end their on-call commitment after years of dedicated service. This places the labor and delivery service at Petaluma Valley Hospital at risk of closing because there may not be a pediatrician on call. The orthopedic surgery service faces the same problem of insufficient funding for on-call services.”

Salnas said in his statement that St. Joseph has recruited specialists in several areas to practice in Petaluma.

“To date we have recruited infectious disease, neurology, ear/nose/throat, internal medicine, family practice, orthopedics, pediatrics, pulmonology and other specialties to the community in the past eight years,” he said. “We look forward to working with the medical community on this important issue in 2018.”

The doctors’ letter is addressed to Ramona Faith, CEO of the health care district. She said that a temporary agreement covering on-call doctor pay is in place, but said that a longterm agreement still needs to be reached.

“We appreciate the physicians and surgeons addressing concerns about their practice at PVH and their ability to serve the needs of their patients, and we know that the unexpected extended delay in securing a new operator for our hospital is causing an extremely unsettling environment,” Faith said in a statement. “We hear you and we are working for you and this community.”

Dr. Robert Harf, the chief of surgery, who has practiced at the hospital for 25 years, said St. Joseph’s lack of investment was only recently. He said the current conditions make it difficult to practice at the hospital.

“It’s almost as if St. Joseph is trying to drive some of these physicians out of town,” he said. “We need a good operator who has the community interest in mind.”

Dr. Michael Bozuk, a general surgeon at PVH, said that St. Joseph pays doctors at Petaluma Valley less than those at Memorial Hospital and Queen of the Valley Hospital in Napa.

“They treat staff at Petaluma differently than at Memorial or Queen of the Valley,” he said. “It’s like the way you treat a car that you rent versus a car that you own.”

The letter notes that St. Joseph has understaffed and underequipped Petaluma Valley Hospital.

“Basic equipment and products for surgeons are not maintained on our shelves,” the letter said. “Machines and equipment bought by Petaluma Valley Hospital have been borrowed by Santa Rosa Memorial Hospital and never returned. These acts by St. Joseph Health Care eliminate more services from Petaluma Valley Hospital and transfer them to Santa Rosa Memorial Hospital.”