Merging the Primary Care Clinic with the Medical Clinic of the LBJ Medical Center has prompted accusations of “reckless” and “undermining” authority against Chief Medical Officer Dr. Iotamo Salepaga, by Chief Executive Officer Joseph Davis-Fleming, while LBJ board chairman Mase Akapo has accused the CEO of being “obstructive” over the move to merge the two clinics.

These accusations and problems coming out of the hospital did not rest well with a handful of lawmakers who received copies of the communications between the top people at LBJ, as it was just last month that Mase told a House committee hearing that the working relationship between the board and the CEO is “100%”.

At the center of the latest LBJ drama is whether or not the merge has been approved by the board, whose chairman told a Senate committee last month that the Primary Care Clinic will not close but instead will be merged with the medical clinic.

As reported by Samoa News last Friday, the merge became official in an Apr. 7 letter from Saleapaga to all physicians, saying that the former Primary Care Clinic is now an extension of the existing Medical Clinic, as part of the Internal Medicine Department. (See Apr. 11 edition of Samoa News for details)

However, it appears not all physicians were happy with the merger, as hinted in Saleapaga’s Apr. 8 letter to two Primary Care doctors, who were told that a meeting had been held between members of the medical staff of Primary Care and physicians of Internal Medicine before the announcement of the merge, to discuss the proposed unification of the two units.

Responsibilities of one becoming a hospitalist and/or seeing patients at the medical clinic were divulged during that meeting, Saleapaga explained. (The term "hospitalist" refers to physicians whose practice emphasizes care for hospitalized patients, according to the University of California-San Diego’s Department of Medicine website)

“There was concern from your staff about not being comfortable with the responsibilities of becoming a hospitalist with Internal Medicine, and that concern was taken into great consideration by offering you a choice of seeing patients in the medicine clinic only,” Saleapaga wrote.

Based on the LBJ board “ruling” to merge the two units, “if you work with the Internal Medicine Department, you will work as one of the team members within the unit. That at any time the unit is short staffed with hospitalists you will be scheduled to take on calls,” he said.

“You will continue to see your scheduled follow up patients as well as the overflow of patients from the existing Medical Clinic,” he said and asked the physicians to allow time every day, from Monday to Friday, for walk-ins.

 “If at any time you are not happy with this decision there are options available,” he said but didn’t give examples of those options. Copies of the letter were sent to board members, the CEO and three other LBJ officials.

Davis-Fleming fired off a  response to Salepaga and Dr. Jerome Amoa, chief of Internal Medicine, saying that neither himself nor the board approved any final action on the proposed merge “between these two distinct speciality services, as currently reflected in LJB’s medical staff by-laws.”

“Apparently you have decided to bypass me as CEO anyway to implement this action that violates our hospital bylaws” as well as the terms of the employment contract of the two Primary Care physicians “by harassing them and threatening them to take Internal Medicine Call after hours, which they are neither credentialed nor legally obligated to do per their employment contracts,” Davis-Fleming wrote.

Further, Saleapaga’s action creates “a major human resources legal problem that LBJ does not need to be  burdened with, due to your reckless way of trying to force your will without taking the time to carefully outline a detailed plan for this proposed merger as I requested at the last... board meting,” he pointed out.

The CEO then told Saleapaga “to heed my warning and develop a detailed proposal that is compliant with our hospital bylaws and affected physician's legal employment rights.”

As far as Davis-Fleming is concerned, the merged clinics are “null and void” until the required details for the merger are submitted to the CEO and the board for review and consideration.

Davis-Fleming also said that the two Primary Care physicians have “graciously agreed” to take Internal Medicine patients and Emergency Room overflow patients, adding that this should be a big help until additional Internal Medicine specialists are recruited.

Additionally the two physicians “absolutely cannot be forced to take Internal Medicine after hours ‘On Call’ and to threaten to terminate them for not doing so is not only foolish in light of the fact that we are already short-staffed… [it] will only add to our medical staffing problems, not to mention result in disciplinary action against you per our existing HR policies and procedures.”

“...So I strongly advise that you heed my advice and cease and desist such actions,” Davis-Fleming said.

MASE’S REPLY

The following day, Apr. 9, Mase informed Davis-Fleming that this matter “was discussed and approved by the board” during a previous meeting when the issues were brought up by Saleapaga.

“Why do you continue to be obstructive on this issue?” Mase asked the CEO, who was also told to “do what is necessary to expedite this change.”

More in tomorrow’s edition on this hospital in-fight as well as the action a Senate committee plans to take following this latest fiasco at LBJ.