These ER medics said officials at the for-profit company pressed them to work despite showing symptoms of Covid

In January, Sonali Patel, an emergency physician at a major Houston hospital, fell ill while on duty. After testing positive for Covid, she said she told her boss she had the coronavirus and was going home.

“He insisted that I stay and finish the shift,” she recalled in an interview with NBC News and in a recent lawsuit. “I told him it wasn’t the safest thing to do. We have a ton of immunocompromised patients and we put them at risk. »

By requesting time off while ill with Covid, Patel breached an unofficial policy promoted by officials at the hospital recruiting firm she works for – American Physician Partners – according to the lawsuit filed against the company by she and seven medical colleagues.

These doctors say American Physician Partners officials pressured them to work while they were sick, even though they contracted Covid and could pass it on to patients and colleagues, according to the lawsuit filed in Harris County District Court, in Texas, in March. Doctors who worked while sick were celebrated, while those who stayed home with Covid had their salaries frozen, according to the lawsuit.

A medical director for American Physician Partners had a name for the unwritten policy on working while having Covid symptoms, the lawsuit alleges. It was “the 4 Ms”, which stood for “Motrin, mask, standing man and must not test”. When a doctor raised concerns about the practice, a superior told him that “it’s just the culture” of the company, according to the lawsuit.

American Physician Partners, founded in 2015 and based in Brentwood, Tennessee, staffs emergency departments at more than 150 facilities in 18 states, its website says. Eighteen are Houston Methodist system hospitals, according to the doctors’ lawsuit. The company is backed by BBH Capital Partners, the private equity unit of Brown Brothers Harriman, a New York-based investment firm.

A spokeswoman for American Physician Partners said it was company policy not to discuss pending litigation. A spokeswoman for BBH Capital Partners said the company does not comment on ongoing litigation at its portfolio companies.

Pushing doctors to work when they have Covid could happen when an emergency department is intentionally understaffed to save money, said Dr Mitchell Louis Judge Li, founder of Take Medicine Back, a movement aimed at eliminating corporate control over health care. Regardless of the motivation, he said, understaffing in an emergency room is dangerous.

“Understaffing or inappropriate personnel chosen by a society does not allow physicians enough time to be effective with their patients,” he said. “It’s a clear risk to public health.”

NBC News has not confirmed whether understaffing is an issue at the hospital.

A spokeswoman for the Houston Methodist Hospital System, which is not a party to the lawsuit, said in a statement that the litigation was an internal dispute that had nothing to do with care provided by the hospital system.

“We are not aware of any emergency physicians who have come to work after testing positive for Covid-19,” said the statement provided by Stefanie Asin. “Our hospital system’s quarantine and isolation policy aligns with CDC guidelines, which means employees and physicians should stay home if they test positive for Covid-19 during the lockdown period. quarantine required. Our emergency rooms saw at least a 50% increase in patient numbers during the worst of the pandemic, and all of our emergency physicians performed heroically and took great care of our patients when they needed them. most needed.

Private equity firms have taken over a wide range of healthcare entities in recent years. They use large amounts of debt to acquire businesses, with the goal of rapidly increasing their profits so that they can resell them for a profit a few years later.

Their forays into emergency medicine are transforming the field, analysts and health care experts say. Today, it is estimated that more than 40% of the country’s hospitals emergency services are supervised by for-profit health care recruitment companies owned by private equity firmsacademic research, regulatory filings and internal documents show.

Concerned about the potential danger these takeovers have on patient care, lawmakers in some states are proposing bills aimed at curbing healthcare acquisitions by for-profit and private equity entities. On June 16, Pennsylvania State Senator Tim Kearney, a Democrat, and several of his colleagues in the Legislative Assembly announced a package of bills aimed at “safeguarding the integrity of health care systems facilities and to protect patients from the repercussions of greedy and irresponsible hospital programs. made by private equity firms.

A bill would establish a two-year moratorium on the transfer of ownership of any hospital or healthcare system in Pennsylvania involving a for-profit entity; another would prohibit for-profit entities from owning or operating hospitals in the state.

“It all happens quietly, it never happens where people can see it and understand it,” Kearney said in an interview. “We hope to shine a light on this practice, empower people to understand what is happening to their healthcare and why it is happening.”

American Physician Partners is smaller than its two main competitors in emergency services staffing – Envision Healthcare and TeamHealth, which are also backed by private equity firms. In a November 2021 investor presentation reviewed by NBC News, American Physician Partners said it was “the industry’s low-cost provider” and described emergency services staffing as a 17-year-old market. billions of dollars. “As the elderly become a larger proportion of the population, the demand for intensive care in emergency departments increases,” the presentation noted.

The lawsuit against American Physician Partners is a sign of growing discontent among frontline healthcare workers over the impact they believe for-profit owners are having on patient care and hospital work environments. Another came earlier this month, when most emergency and anesthesia professionals at two Southern California hospitals, Corona Regional Medical Center and Temecula Valley Hospital, threatened to quit. if the project to hand over control of hospital services to Envision Healthcare succeeds.

A spokeswoman for Envision declined to comment.

The Houston-area doctors are seeking $1 million in damages in their action and allege that because of its practices, American Physician Partners failed to pay them as promised. As well as mooring compensation for days missed due to Covid, the doctors say the company deducted the costs from their compensation for services that were not provided and did not compensate them for treatment patients who decided to leave the hospital against medical advice, an event the doctors could not control.

American Physician Partners “attempted to artificially inflate its books to attract investors and avoid insolvency by maintaining cash flow at the direct expense of physicians,” the suit alleges.

Dr. Prasanth Boyareddigari is one of the doctors suing American Physician Partners. He is Academic Director of the Houston Methodist Emergency Department and Adjunct Clinical Professor of Emergency Medicine at Weill Cornell Medical College and Texas A&M School of Medicine.

American Physician Partners’ practice of forcing doctors to work when sick is the result of an attempt to save money by not having enough staff, Boyareddigari said in an interview. “If they lose one or two doctors to illness, they’re in a bind,” he said. “They use every measure possible to be financially efficient and to reduce costs, regardless of the outcome or the effect on patient care, which is the complete opposite of what we would do as physicians.” His views on this are also reflected in the lawsuit.

Dr. Robert McNamara is professor and chair of emergency medicine at Temple University’s Lewis Katz School of Medicine and a vocal critic of companies practicing medicine, which he says can lead to putting profits before profits. patients. More than 30 states, including Texas, have laws against practicing medicine in the workplace.

“The fundamental code of medicine is do no harm first,” he said. By asking doctors to work when they have Covid, “you’re asking someone to break that oath”.

Late last year, American Physician Partners warned investors that its earnings could be affected by the “no surprises law,” recently passed by Congress to reduce costly, out-of-network medical bills that patients may receive when are treated in hospital emergency departments. . In the November presentation, he cited “numerous ongoing cost reduction initiatives as part of the company’s continued focus on optimizing costs ‘to maintain profits’ if the ‘no surprises law’ results in downward pressure on prices.

The new legislation could cut $11 million, or about 9%, from American Physician Partners’ trailing 12-month operating income, according to the document. But cost-cutting efforts, such as cutting staffing hours and moving staff between higher-cost physicians and lower-cost mid-level practitioners “to match volume trends,” should offset the impact, the company said.

A spokeswoman for American Physician Partners declined to say whether the “No Surprises Act” hurt the company’s bottom line.

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