Physician faces off against Modesto hospital

Dr. Mark Fahlen isn't afraid to criticize what he calls "corporate medicine" and the pressures exerted on doctors working for large health care systems.

According to Fahlen, his complaints about nursing practices at Modesto's Memorial Medical Center got him in trouble with hospital administrators.

He is seeking reinstatement to the hospital's medical staff and won a battle last month when a judicial review panel reversed a decision to deny his hospital privileges.

He is now waiting to hear if he can continue treating patients at Memorial, an affiliate of Sacramento-based Sutter Health.

"I feel very happy that the (review committee) was strong enough to stand up to Memorial and stand up to corporate medicine and make the right decision," said Fahlen, a kidney specialist in Modesto for seven years.

Nurses at Memorial had their own complaints about Fahlen. And it appears hospital officials believed he was too confrontational with staff and that his conduct interfered with patient care.

Chief Operating Officer Steve Mitchell said in a written statement: "Under state law, the current proceedings involving Dr. Fahlen are privileged and confidential. The process is still ongoing and on advice of counsel, we will have no further comment until a final decision has been made, other than to note that Memorial Medical Center has a robust and effective peer and quality review system."

Fahlen said that instead of addressing his concerns about nursing practices and patient care, he was fired in May 2008 from the Gould Medical Group, a large physicians group closely aligned with Memorial.

In August 2008, Memorial's medical executive committee recommended denying his request for hospital privileges, or permission to treat patients in the hospital.

Fahlen exercised his right to appeal to a judicial review panel consisting of physicians appointed by Memorial. The six-member panel considered testimony and documentation at 12 evidentiary hearings before reversing the medical executive committee's decision.

Memorial can appeal the June 14 decision to the Sutter Health Central Valley Region board of directors.

Fahlen said he decided to go public to clear his name and exert pressure on Memorial to accept the panel's decision.

"I have spent $200,000 in legal fees since this started," he said. "I think the public has a right to know what the risks of corporate medicine are and the risks to doctors who are at-will employees.

"It is very hard to be a patient advocate in this type of environment."

Two incidents recalled

Fahlen, who started his own practice after leaving Gould, is known for more than being a loose cannon. He is serving a second year as director of the Department of Medicine at Doctors Medical Center and serves on Stanislaus County's Community Health Center board, an advisory panel for the county's federally qualified health clinics.

He said his specialty practice is thriving.

Fahlen tells of two incidents that led to his troubles with Memorial.

He confronted a hospital nurse who refused to use a defibrillator to resuscitate a kidney dialysis patient. The nurse insisted he first give sedation to the patient, who was in her 70s. But the medication would have lowered her blood pressure and reduced her chances of survival, Fahlen said.

Another nurse revived the patient, he said.

He said he strongly advocated for a second patient whose bowel had been perforated during a surgery. Although the patient appeared to be in septic shock, hospital staff declined to admit the patient to the intensive care unit, he said.

The patient got worse and suffered multiple organ failure, requiring her transfer to the University of California at San Francisco Medical Center, the doctor said.

Memorial officials said they could not discuss the care given to the patients, citing confidentiality laws.

From 2003 to 2008, Fahlen said, he filed numerous complaints with hospital administrators about nursing practices. Nurses, in turn, complained about Fahlen's behavior, leading to an in-house investigation in 2006, after which his relationship with the hospital and Gould deteriorated.

He said Gould fired him three months after he was given a raise from $212,000 to $274,000 a year. A Gould spokesman declined comment about Fahlen because it's a personnel issue.

After he started his own practice, Fahlen said, a Memorial hospital administrator suggested he leave town or he would face a hospital investigation and be reported to the California Medical Board.

Memorial officials did not respond to that allegation Wednesday. The hospital stressed that doctors are not muzzled at the hospital. Chief Operating Officer Mitchell's statement said that doctors and employees often have frank and thorough discussions about patient care.

Mitchell said confidentiality rules prevent the hospital from responding to Fahlen's opinions about patient care.

"It's one of those issues where the statements may or may not be accurate, and we can't say anything about it," he said.

Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or 578-2321.