Private Docs: UVM limits access to operating rooms – BurlingtonFreePress.com

Dr. Jennifer Brown of Northeastern Reproductive Medicine in Colchester discusses the challenges she faces in getting access to the operating rooms at the University of Vermont Medical Center in Burlington. GLENN RUSSELL/FREE PRESS

Neurosurgery procedure with Dr. Tranmer at UVM Medical Center.(Photo: COURTESY OF UVM MEDICAL CENTER)

Several doctors in private practiceare pushing back against UVM Medical Center's claim that operating room time is readily available at the hospital, despite fearing what these doctors say could be serious consequences for speaking out.

"People are afraid of repercussions," Dr. Mark Healey said. "They do have a monopoly there and they have a history of playing rough. People want to speak up, but it can jeopardize their careers."

The issue of operating room access is front and center in the local medical community because of the long-running effort by a group of investors to open a private surgery center in Colchester, which would be an alternative to UVM Medical Center for certain surgeries and procedures.

Healey echos other independent doctors who agree with his assessment of UVM Medical Center's grip on the health care marketplace in Vermont, but would not speak on the record.

Healey joined UVM Medical Center in 1999 as director of the surgical intensive care unit and a trauma surgeon. He left the hospital in 2003 to set up a private practice in Colchester.

"The first thing they said was, 'We can't give you any scheduled OR time because there's no time available," Healey said.

Healey identified himself as an investor in the Green Mountain Surgery Center in Colchester. The names of most investors are unknown because the Green Mountain Care Board has agreed to keep themconfidential as the investors fear retaliation from the hospitals.

The Vermont Association of Hospitals and Health Systems and Northwestern Medical Center have opposed confidentiality, but the Care Board cited a number of state laws that support its position, including a case that authorizes confidentiality when disclosure might lead to "harassment or loss of employment."

The Care Board has been considering since July 2015 whether to grant permission for the surgery center to be built. A decision is expected in August.

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Healey left Burlington last year to work for Canton-Potsdam Hospital in New York. After 13 years in private practice he said it was becoming more frustrating and more futile to try to compete with UVM Medical Center.

Dr. Stephen Leffler, chief population health and quality chief at the University of Vermont Medical Center, discusses access to the Burlington hospital's operating rooms. GLENN RUSSELL/FREE PRESS

Dr. Stephen Leffler, chief population health and quality officer at UVM Medical Center, said he had no personal knowledge of Healey's claims, because he wasn't in an executive role at the time.

Leffler said in his six years as chief medical officer before taking on his current role he never heard a community doctor complain that he or shewas getting unfair treatment aroundblock time, as scheduled operating room time is known.

"I will tell you that surgeons in general can be frustrated with how the OR schedule runs with how busy they want to be," he said. "They're busy and they want to get their stuff done. I admit that."

Chris Oliver, vice president of clinical services at UVM Medical Center, made it clear in her testimony before the Green Mountain Care Board on April 13 that the hospital believes there is no need for the surgery center proposed in Colchester.

Dr. Stephen Leffler, chief population health and quality officer at the University of Vermont Medical Center in Burlington, at his office on Thursday, May 25, 2017.(Photo: GLENN RUSSELL/FREE PRESS)

Oliver told the Care Boardthe hospital's 17 main campus operating rooms were running at 74 percent capacity. The five operating rooms at the Fanny Allen campus were running at just 63 percent capacity.

"With our current volume, we can easily accommodate all urgent, emergent, and elective cases," Oliver testified. "If our volumes were to increase, we have substantial capacity and would simply increase our hours of operation."

Oliver also said the hospital has "no complaints from surgeons that couldn't get access, and nobody waiting to get access."

She said UVM Medical Center gives equal access to blocktimesfor both surgeons employed by the hospital and independent surgeons. There are about 120 hospital surgeons and about 34 independent surgeons, according to Oliver.

Dr. David Weissgold, an ophthalmologist in private practice in South Burlington, disagreed with that assessment.

Weissgold told the Care Board he could state "unequivocally" that the notion there have been no complaints from physicians about access to operating rooms is "kind of silly," and "just not true."

Members of the Green Mountain Care Board, from left, Con Hogan, Robin Lunge and Jessica Holmes meet in Montpelier on April 20, 2017.(Photo: APRIL MCCULLUM/FREE PRESS)

Weissgold said he had lost count of how many complaints he has made over the years about his inability to get into the operating room at UVM Medical Center.

"The thought that there's so much time available that surgeons can just call and request time and get in in a timely fashion simply isn't true," he said.

When scheduling urgent surgery that needs to happen within days, Weissgold said he isfrequently told his patient can go on the "add-on" list. That often results in surgery after hours, when Weissgold says conditions can be less than ideal.

"They're a monopoly for my surgery," Weissgold told the Free Press. "There is no other operating room in the state of Vermont that hosts retinal surgery."

Leffler said any time a case is scheduled as as add-on there's a "negotiation," taking into account the urgency of the case, the physician's schedule, and getting the right people and equipment into the OR.

"We do it every single day for all providers, both our employed medical staff and our independent doctors in the community," Leffler said.

Leffler said Weissgold had never complained to him, but that "surgeons in general don't like having to not get the case in when they want it."

"We do everything in our power most importantly to make sure all patients get the care they need, getting that person on that schedule in a time that's safe for the patient and works as best as we can with the surgeon's schedule," Leffler said.

Weissgold also took issue with Chris Oliver's claim that the hospital turns over operating rooms in an average of 24 minutes.

"Our turnarounds in my room range between 45 and 60 minutes," he said.

Leffler said turnaround times can vary.

"We're completely committed to having the room as it gets turned over be safe, clean and sterile for the incoming patient," Leffler said. "That takes as long as it takes. On average, that only takes 24 minutes, but for a very complex case, such as cardiac surgery, it could take more than 24 minutes."

Dr. Jennifer Brown, a reproductive endocrinologist at a private practice in Colchester, also has complaints about access and turnaround time at the UVM operating rooms.

Dr. Jennifer Brown of Northeastern Reproductive Medicine in Colchester discusses the difficulty of scheduling operating room access at the UVM Medical Center and the need for an ambulatory surgery center on Monday, May 22, 2017.(Photo: GLENN RUSSELL/FREE PRESS)

Brown now sends many of her patients to Northwestern Medical Center in St. Albans instead of the Burlington hospital for surgery.

"They are very efficient," Brown says of Northwestern. "There are fewer layers."

The most common procedureBrown performs is the removal of small polyps inside the uterine cavity that cause bleeding and can affect fertility.

"We do dozens of those a year, and they're very easy cases if you have the right equipment set up in the right way," Brown said.

After completing a fellowship at UVM Medical Center in 2012, Brown practiced in Colorado, where she performed her surgeries in a private surgery center such as the one proposed for Colchester. She said she would routinely perform surgeries to remove polyps on 15- to 30-minute intervals "because we just had a dialed-in system."

Brown describes the booking process at UVM Medical Center as "relatively arduous," and complains turnaround timesare unpredictable. As a result, Brown spends a lot of time waiting instead of doing surgery.

"You get good food at the new UVM Harvest Cafe," Brown said. "That's the positive side."

In written testimony, Dr. Scott Benjamin told the Green Mountain Care Board on April 20 that as a new private practitioner after 14 years practicing at UVM Medical Center he "strongly supports" granting a certificate of need to Green Mountain Surgery Center.

Amy Cooper is behind the effort to build the Green Mountain Surgery Center off Hercules Drive in Colchester. Here she stands at the site for the proposed center.(Photo: RYAN MERCER/FREE PRESS)

"Patients are losing choice in the state and are losing the community care that UVM is no longer able to provide because of its massive size, waste and bureaucracy," Benjamin wrote. "As a physician now leaving the UVM medical group, I can tell you that my patients feel that they get lost in the system and look forward to joining me in a private office. I would be one of the practitioners that would wish to use a new outpatient surgery center to provide care for my pediatric and adult special needs patients."

Benjamin declined to speak to the Free Press, writing via email on May 18 that he was "very busy with starting my private practice in 2 weeks."

Damian Albano, a registered nurse at UVM Medical Centerhas workedwith Benjamin, and also testified insupport ofthe private surgery center.

Albano said Benjamin uses a procedure room at UVM Medical Center to treat patients with cerebral palsy and brain injuries. The patients require injections under anesthesia every three months or they have increased pain and spasms.

Albano said she was told in April she would be unable to reserve blocks of time in the procedure room Benjamin was using. The rooms were nowon a "first come first serve basis."

"As a result I have booked patients through December 2017 to secure this space," she continued. "The unfortunate thing is that if there are new patients or changes on timing of visits due to illness or other treatments it will be extremely difficult to meet these needs."

Dr. Leffler said he was unfamiliar with Benjamin's case, but that there are some open blocksof time in the procedure rooms.

While Jennifer Brown is directing patients to Northwestern Medical Center in the interest of efficiency, she's not happy about it. Her patients often have to drive more than an hour roundtrip to go there, as well as pay facility fees for the hospital's overhead. Green Mountain Surgery Center has said its facility fees will be half of what UVM Medical Center charges.

Leffler maintains that while individual patients may pay less at the surgery center, should it be built, the facility would add to the overall cost of health care in Vermont.

"There's no way they can build that building and bring in all that goes with that, overhead, direct and fixed costs, and not cost the system more," he said. "It's not possible."

Amy Cooper, executive director of HealthFirst, and an investor in Green Mountain Surgery Center, responded by saying the surgery center "will improve patients' access to care and reduce costs for all."

Contact Dan DAmbrosio at 660-1841 or ddambrosio@freepressmedia.com.

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Private Docs: UVM limits access to operating rooms - BurlingtonFreePress.com