Starkman: Beaumont Faces Threat of Nurse Anesthetists Strike Over Declining Patient Safety Standards

October 16, 2021, 7:18 PM

Eric Starkman of Los Angeles is a former Detroit News business reporter who blogs at Starkman Approved.

By Eric Starkman

The nurse anesthetists at Beaumont Royal Oak, Troy and Grosse Pointe hospitals, who are critical to keeping their facilities’ lucrative surgery businesses humming, are mad as hell and aren’t going to take it anymore. It doesn’t take a Beaumont brain surgeon to figure out that a strike could be in the offing if current contract talks don’t proceed smoothly.

It's wildly optimistic that a quick agreement will be reached given the tense relationship between Beaumont Royal Oak’s veteran certified registered nurse anesthetists (CRNAs) and NorthStar Anesthesia, the controversial outsourcing company Beaumont’s management pawned them off to without consultation in January. NorthStar recently further alienated the CRNAs by rejecting their proposal on how to recruit much needed experienced anesthesia staff. 

(Photo: Michael Lucido)

Adding insult to injury, temporary CRNAs employed by agencies at Beaumont’s flagship Royal Oak facility now outnumber full-time nurse anesthetists who have remained loyal to the hospital. Agency CRNAs can make as much as double what a Beaumont staff CRNA makes and aren’t required to work the overnight shift, be on call, or work weekends and holidays. As well, staff CRNAs are assigned the more complex cases.

Beaumont Royal Oak’s acute staff shortage will soon be exacerbated because nearly one-third of the hospital’s CRNAs gave notice they want to reduce their hours. 

Metro Detroit residents still willing to trust Beaumont for surgical procedures should be aware of the tense labor situation at the health system’s northern hospitals. CRNAs working there say the staff shortage has stretched them too thin and patient care is at risk. The situation is so dire that on multiple occasions recently it took more than 15 minutes before someone was available to respond to calls for emergency intubations.

Beaumont is a Tier 1 regional hospital, meaning it’s supposed to have sufficient staff readily available to handle every possible medical emergency round the clock.

Offering $40,000 Bonuses

Beaumont Royal Oak is short about the equivalent of at least 25 positions, which is forcing staff CRNAs to work nonstop and well beyond their designated shifts. The need is so dire that NorthStar is offering fresh-faced CRNA graduates a $40,000 signing bonus if they join the company and agree to work for two years.

Beaumont CEO John Fox

That could force other area hospitals to offer similar incentives, significantly driving up labor costs, particularly if an incentive war breaks out. 

Six months prior to NorthStar taking over, Beaumont Royal Oak’s CRNAs on average had more than 10 years of experience. The hospital historically maintained very high anesthesia standards. A former head of anesthesiology was James Grant, who previously served as president of the American Society of Anesthesiologists and the Michigan Society of Anesthesiologists. NorthStar’s corporate chief anesthetist is a CRNA who formerly headed the profession’s lobbying group.

Despite looking to recruit new graduates to fill positions once occupied by veteran CRNAs with extensive experience working alongside anesthesiologists from top medical schools, NorthStar insists the quality of Beaumont’s anesthesia staff hasn’t been compromised.

“It is insulting to imply that our team is unqualified in any way, especially given all the hard work and dedication they have shown on the frontlines to care for the patients of Detroit and the surrounding area,” spokesperson Simone Jackenthal said in a statement she issued on behalf of NorthStar.

“Additionally, it is categorically false to say that CPR requests received by CPR providers went unresponded to on Monday. The Anesthesia team has been appropriately staffed based on the requests from the Perioperative team and daily OR volume needs. It would be inaccurate to say otherwise.”

Though volumes are down significantly, Beaumont Royal Oak is still among the busiest surgical centers in the country. NorthStar also has a contract to manage anesthesia at Beaumont Troy and Grosse Pointe hospitals. NorthStar CRNAs at all three hospitals voted overwhelmingly to form a union earlier this year. Troy and Grosse Pointe also are experiencing CRNA shortages and nurse anesthetists at all three hospitals appear to stand in solidarity regarding what they say is an urgent need to improve patient safety.

Recruiting staff in Windsor

Recruiting in Canada

Beaumont Royal Oak, as well as the seven other hospitals in the company’s network, are so critically short staffed that CEO John Fox recently pleaded with the public to avoid the company’s emergency rooms except for critical medical situations.

Fox implied that unvaccinated Covid patients were responsible for the dire situation, but Beaumont insiders say it’s because of the hospital’s poor treatment of employees that have caused nurses and others to quit in droves. Beaumont is so desperate for nurses that it is actively recruiting in Canada and plans to recruit in the Philippines. A Windsor nurse told me that she’s been contacted by Beaumont recruiters multiple times on LinkedIn.

Beaumont offers nurses sign-on bonuses of $10,000 to join the troubled hospital system. Other area hospitals are recruiting in Canada and paying signing bonuses, but Beaumont’s situation is more extreme because of its reputation as being an awful place to work.

The announcement by former COO Carolyn Wilson a year ago last June that Beaumont Royal Oak, Troy, and Grosse Pointe hospitals would outsource anesthesia to NorthStar accelerated Beaumont’s implosion, which began when two nationally renowned cardiac surgeons bolted in December 2019 because of disgust with the leadership of CEO Fox and his deputies. Wilson expected that most of Beaumont’s fellowship trained anesthesiologists would accept lucrative signing bonuses to join NorthStar and that the hospital’s CRNAs would follow suit.

That proved to be a major miscalculation. NorthStar is pejoratively known as “Death Star” on industry message boards, a refence some people say refers to the company’s ambitious expansion plans while others say it refers to the quality of care some associate with the company.

About half of Royal Oak’s fellowship trained anesthesiologists rejected NorthStar’s lucrative bonuses to sign on with the company and opted to go elsewhere. Several of the anesthesiologists who resigned told me they wanted nothing to do with NorthStar, regardless of how much money the company offered. About 50 CRNAs quit as well.

The rapid turnover precipitated the departure of about a dozen top-tier surgeons, who had long and close relationships with Beaumont’s once close-knit anesthesia staff.

Beaumont board member John Lewis

The co-heads of Beaumont’s cardiology department sent a letter to then-Beaumont chair John Lewis warning they had “serious concerns” about NorthStar’s capabilities. It’s not certain that Lewis bothered to read the letter.

Within three weeks of NorthStar taking over in January, a patient undergoing a routine colonoscopy died because of an intubation complication and another landed in the ICU because of a pain medication overdose. An anesthesiologist and the CRNAs involved in the incidents were temps brought in from other area hospitals. A prominent anesthesiologist explained to me that relying heavily on temporary anesthesiologists and CRNAs is dangerous because they aren’t familiar with the hospital’s safety and emergency protocols.

Beaumont’s cardiac surgery department, once ranked in the top tier in the country, now ranks in the lowest five percent of U.S. hospitals in terms of safety.

NorthStar CEO Adam Spiegel has had a rocky relationship with Beaumont Royal Oak veteran CRNAs who worked at the hospital prior to NorthStar taking over. NorthStar gave the CRNAs a take-it-or-leave it offer at the outset, which they reluctantly accepted. But on the first business day of 2021, they filed a petition to organize.

Contract talks between NorthStar and Beaumont’s CRNA union are expected to begin next week. NorthStar doesn’t appear to have a lot of bargaining power because if CRNAs working at Beaumont strike, it would be difficult to recruit sufficient staff to keep Royal Oak’s operating rooms open.

Eroded Prestige

NorthStar CEO Adam Spiegel

Working in anesthesia at Beaumont’s flagship Royal Oak hospital once carried considerable prestige, but no longer. Given that CRNAs can make more working for temp agencies and ensure better hours and working conditions, it’s far from assured the majority of those working at Beaumont Royal Oak, Troy, and Grosse Pointe will stick around.

Amid a possible CRNA strike, a nursing shortage, and predictions of another pandemic surge, Grand Rapids-based Spectrum Health is awaiting approval to take over Beaumont, which has lost all the top management brought in by Fox except two Atlanta cronies who followed him from Emory Healthcare. Fox had hoped to bail from Beaumont this month, but the Federal Trade Commission, which must bless the takeover, is behind and might not reach a decision until early next year.

A responsible attorney general would never have allowed Beaumont to deteriorate to such an alarming degree, but Michigan’s Dana Nessel has yet to intervene despite being warned more than a year ago by a former Beaumont director and donor that Beaumont patient safety was at risk.

Still no word from Nessel, despite it being public record that Beaumont Royal Oak doesn’t have the staff to deal with a major area catastrophe as required of a Tier 1 regional hospital. 

Reach Eric Starkman at: Beaumont  Beaumont employees and vendors are encouraged to reach out, with confidentiality assured.

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