The other day I received this comment about a blog written in 2008 at the time of the closing of Muhlenberg.. Obvliously the commentator was browsing the internet It was a 2 part blog but might still be an interedting story and part of our area history..
Three
decades ago this area witnessed the closing of another acute care hospital.This is the tale of the Raritan Valley Hospital, and my intimate involvement .
By the early '60s there had been an extraordinary population explosion within the areas around Plainfield. There was pressure for building a new hospital in Edison and also to replace the antiquated and condemned privately owned Bound Brook Hospital.
Both objectives were completed by the end of the decade. The Edison hospital, JFK, ultimately in 1997 became the controlling partner in a union with Muhlenberg
A group had been formed to build a hospital in Green Brook Township close to Bound Brook. The intent was to able to better serve a large but developing rural area not easily covered by the hospitals in Somerville, Plainfield, New Brunswick, Morristown and Summit. There existed a good road network from the North, East and West of Bound Brook.
Unhappily, for unknown reasons, the new hospital, Raritan Valley Hospital was built on land within the Green Brook flood plane and was restricted to a two-story high building.
I had a substantial practice from the Dunellen and Middlesex area and obtained Staff privileges there in addition to Muhlenberg. ( Doctors made house calls in those days).
Although I did not like the fact that only a select five full-time employed physicians would have the sole power to act for the medical staff, there were many positive reasons for that choice.
I was particularly impressed with four of the full time doctors, who not only were extremely competent but also decent human beings. In my 45+ years in practice I can remember only a few other Radiologist who I held in as high regard as Raritan Valley’s.
The Internist, a qualified Cardiologist,was a warm and friendly individual who fortunately retained his position at NYU. The Pathologist was most knowledgeable and after leaving this hospital became professor of Pathology at a southern medical school. The Anesthesiologist was extremely competent.
The fifth full time physician, the Chief for Surgery, was not board certified.One of his qualifications was a distant relationship to the Chairman of the Hospital Board. This surgeon’s cases seemed to have an excessive morbidity rate. Also, regrettably, controversial medical care decisions in the "Medical Board” often resulted in a four to one vote, with the one vote being adopted by the Governing Board.
Ultimately, the other four members of the executive committee called for an open but informal staff meeting in the Hospital’s cafeteria to discuss the problem. I attended that meeting out of curiosity.
In the middle of that meeting, the Chairman of the Board entered the meeting room and interrupted the discussion. He said “This meeting is illegal. I will not have a hanging jury destroyed this brilliant young man. You are to leave at once."
The result was that no one left and an ad hoc volunteer medical staff was organized.
A steering committee was formed. Some one said "Yood you’re the senior person here (I was in my early 40s so that was a shock, I was getting old) you are going to be our President"! An astute Obstetrician from the Bound Brook/ Somerville area was the Vice President and chief motivator. Incidentally he had been born in Plainfield.
For the only time in my medical career, 100 percent of the physicians on the hospital staff contributed $100 to pay for legal action. We employed a lawyer recommended for his hospital expertise. Unfortunately we had little help from the State Society.
We met several times with the Executive Committee of the board and almost had straightened out for the problems when one of our steering committee members, a surgeon who had spent years in the army, unexpectedly spoke up saying "I charge this Board as deliberately trying to sabotage the medical staff."
The minute that doctor had opened his mouth, we all knew that the opportunity for any cooperation between the Board and Staff was lost.
At that point without hesitation a member of the Board of Governors jumped up almost hitting the ceiling and very apoplectically said this meeting is over, He not only was on the board of the bank that had underwritten most of the loans to the hospital, but was also one of the political bosses in Somerset County, thus a power in the state Republican Party. His political impact would ultimately determine the fate of the Hospital.
Although there would be no future talks, the entire staff continued to use the Hospital for selected patients. For most physicians that created no problem, since our surgical patients were referred to surgeons in our primary institutions . Soon after that episode, all four quality members of the medical executive committee resigned. Their replacements were second rate at best
The successor Radiologist had been fired from his Philadelphia Hospital, and there were X-rays that were misread. I was reluctant to trust his reports.
The Pathologist was adequate but did not compare either in personality or person with his predecessor.
The new Chief of Staff, an internist, had been associated with one of the New Brunswick Hospital as Director of Medicine, and supposedly was not popular with its staff. He was a very bigoted individual who stated that he would never have “any foreign legion”(meaning Korean or Indian doctors) in HIS hospital.
A good community hospital had become not only an uncomfortable but also an unsafe place to practice.
After the new Chief of Staff arrived, both the Obstetrician and I were called before the Board of Governors for a hearing, prior to removing our privileges.
I thought I was innovative by appearing with my attorney and a tape recorder which we placed on the center of the table and turned it on. Initially the lawyer on their Board sputtered about the recorder, but yielded to our insisting on having a record of the meeting. The hearing was brief and terminated without action or comment.
The next day I learned that the other doctor, at his conference with them the day before, had upstaged me by appearing not only with his attorney but also with a court stenographer to record his meeting.Incidentally, we had not communicated with each other prior to the hearings
Fortunately all members of the “Volunteer Medical Staff” could admit patients to other area hospitals. Confidence in the reliable in the interpretations of X-rays was lost and the quality of some labratory procedures seemed to be diminished. Therefore, most physicians proceeded to admit all but emergency cases to their primary institution.
The patient census fell below 50%. What was never publicized was to all intents and purposes for the first time, to my knowledge; physicians had literally boycotted a hospital. No hospital can survive with an occupancy rate below 70%. (See JFK's occupancy rate in its CN application). This ultimately ended with the hospital becoming bankrupt.
There were three exceptions. When the original cardiologist left, two young internists in partnership in Warren were awarded the EKG concession. They felt they could not afford to give up the hospital. However, when the Medical School assumed the operations these two joined Muhlenberg’ staff.
One primary care physician who had had his privileges suspended or revoke at St. Peters in New Brunswick and at Somerset Hospital accounted for almost 90% of admissions after the others had independently ceased using Raritan Valley. He was acceptable to the Medical School faculty since he referred all of his in patients.
Because of, the political influence on the hospital board, the State persuaded the Rutgers Medical School to abandon its plan to build a teaching hospital adjacent to the medical school. Instead, to convert RVH into its teaching hospital, even though it could not be adequately expanded and was quite a distance from the medical school. The taxpayers had again bailed out a politician’s blunder.
Perhaps the moral of this tale. if any, lies in the fact that in this case the Chairperson of the Governing Board felt that it was his prerogative to make all decisions relating to patient care, and his Board did not honor their fiduciary responsibility.
Similarly, one can surmise that in MRC’s situation, a CEO, whose Board had forgotten that he worked for them not the reverse. has made an decision based on economics rather than community health needs in an attempt to solve financial problems which might have been aggravated by previous operational decisions.
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