Is it a conflict of interest to run the emergency department at the local hospital and also be the doctor in charge of deciding where emergency patients are sent?
This is not a hypothetical question in the San Juan Islands where Dr. Michael Sullivan is employed by PeaceHealth as the Director of the Peace Island Medical Center (PIMC) Emergency Department and is also the county's Medical Program Director.
As medical program director, he is in charge of medical control. All of the EMTs and paramedics operate under his medical license.
Dr. Burk Gossom, who was formerly a medical program director, explained that responsibility to the county Board of Health last week. "It gets into big legal issues," he said. "The on scene physician can take control but he has to sign to take responsibility. The EMTS are authorized to do things via Dr. Sullivan's protocols. He is responsible for the entire county."
At its May 15, 2013 meeting, the Board of Health was discussing access to health issues in the county. Among the concerns were how emergency cases were being handled on Orcas Island.
Board member Dr. John Geyman said, "I talked with Dr. Shinstrom the other day on Orcas. His experience is quite negative on this point. The EMTs and the EMS on Orcas, they talk to Dr. Sullivan, they bypass the primary care doctors and patients are decided to be evacued that way. There is a sense by primary care doctors on Orcas that they've been denigrated by Dr. Sullivan."
PIMC CEO Jim Barnhart said, "That's an important piece to know. I think Dr. Sullivan has been made aware of that recently. I think some of that is circumstantial, a matter of circumstance over the years. I would hasten to add Dr. Sullivan is very interested in reestablishing a good medical coordination with medical practitioners on Orcas. There is some confusion over whether the patient should be sent directly to PIMC or whether, um, anyway. Communication is key. Dr. Sullivan is very interested in making sure he is working well with those Orcas practitioners."
Council member Rich Hughes said, "I've had discussions with both the fire chief and some of the practitioners there and it seems to me when I've gone to them and said 'how come you can't see anybody on weekends?'. They say 'well we totally can but nobody calls us. We feel there is an impression like the fire station is the ER on Orcas'. I would like to see a better partnership with doctors who are willing to do work after-hours." (The three county council members serve on the Board of Health.)
According to Sullivan one of the problems is Orcas physicians do not operate jointly in one clinic, and therefore individually provide after-hours care for their own patients only. "There are tons of instances where it just doesn't work," he said in an interview Friday, May 17.
Using the parking lot of the Eastsound fire station as the urgent care and after hours care is the best option according to Sullivan. Patients should knock on the door to seek treatment and EMTs and paramedics would tend to them.
"It is "100% untrue" that he is preferentially directing patients to PIMC Emergency Department. "I could count the number from Orcas in the palm of my hand," he said.
He said he is completely unaware of any concerns the Orcas Island practitioners have with him. He was recently at an Orcas Island Medical Foundation event and none of the physicians attended or contacted him. The practitioners have not contacted him with any concerns at anytime he said.
Referring to Sullivan's two roles Hughes said, "Where is the separation between the duality. I want to make sure the patient is being given the choice of where they want to go."
"It is. It is always the patient's choice," said Barnhart.
"It isn't always the patient's choice", said one of the doctors on the Board of Health. "It wasn't the patient's choice, it wasn't the primary physician's choice. It was Dr. Sullivan's choice and he was making the call from Bellingham."
"Who was the patient?" asked Barnhart.
"My wife," the doctor replied.
His wife was not transported. He signed an AMA (against medical advice) waiver to "get the EMTs out of my house."