Physicians blast management as they split with Community Hospice of Modesto

Five physicians, including the medical director, have cut ties with Community Hospice of Modesto and are airing their complaints about top management of the organization.

The doctors detailed recent contract issues in a June 1 letter addressed to Community Hospice’s “staff and friends” and they leveled criticism at Chief Executive Officer DeSha McLeod.

The letter, shared with The Modesto Bee, bears the names of former medical director Centi Younan and doctors Edward Auen, Dana Buchanan, Erin Kiesel and Garfield Pickell.

“What really hurts me is that I got close to the employees,” said Auen, who devoted 16 years to Community Hospice. “The employees are scared for their jobs and (McLeod) has taken the organization down the wrong the path.”

Hospice representatives said the physicians’ exodus has not affected patient care. Substitute doctors and nurse practitioners have been handling their duties.

Two hospice board members said they tried to reach an agreement with the physicians.

“They had an opportunity to remain and they chose not to,” board member Tom Van Groningen said. “The organization is under good leadership and it is continuing to do the good work it has always done.”

Community Hospice serves people in several counties of the Northern San Joaquin Valley and Mother Lode, and has about 250 employees. Beside providing end-of-life care at patients’ homes and the Alexander Cohen Hospice House in Hughson, it offers grief support, resources for family caregivers and operates the Hope Chest thrift stores to help fund services.

The physicians worked under contracts with the hospice that varied person-to-person and were renewed automatically. Those with a greater number of years with the hospice actually were paid the least.

McLeod issued proposed new contracts to the doctors in April, which would have decreased pay for patient care, the physicians said.

In their own contract proposal, the five physicians asked for representation on the board’s executive committee and wanted to see more education provided to nurses.

Hospice leaders disagreed with giving them a board seat, but said the medical director would continue to have a place on meeting agendas to discuss issues with the board.

Board Chairman James Grothe identified a need for better cooperation within the organization in a May letter to Younan. The hospice plans to hire an outside consultant to create a clear definition of medical objectives and “achieve a culture of collaboration and trust within the clinical element of Community Hospice.”

Grothe wrote that the medical director’s job description should be clarified and efforts were needed to “improve the way the physicians, clinical staff and administration work together to provide services to our patients and their families.”

McLeod said her contract proposal would have increased administrative pay for the doctors. She said she is looking to sign a contract with a full-time medical director within a couple of weeks.

“It is upsetting that they would take these steps (to air their complaints),” McLeod said. “It just upsets our patients and staff and our donors needlessly.”

McLeod was hired in 2013 to replace Harold Peterson, the CEO for 17 years who developed the hospice into an organization with more than $16 million in assets. McLeod previously was CEO of a for-profit hospice based in Mississippi that had 14 branches in that state, Louisiana and Georgia.

Pickell, the former medical director, created a face for Community Hospice by making rounds in the hospice house with his golden Labrador retriever, Rosie. But relations with management have evidently eroded since he stepped down a year and a half ago and reduced his hours.

Younan said she heard from many disgruntled and unhappy employees when she took over as medical director. She tried to relate their concerns to top management but was rebuffed, she said.

“Every time I would bring it up, they said it does not affect you,” Younan said. “I felt the employees and nurses were not well supported. They were mistreated, and I found it very upsetting.”

In particular, employees complained that their evaluations were changed by top managers, which gave them smaller raises. McLeod responded that employee evaluations are not changed, saying “that is totally false.”

Younan said the board required McLeod to bring in management coaching, but the managers “did the opposite of what they were teaching us.”

In emails exchanged in recent months, the physicians suggested that patient care has suffered.

Buchanan noted a 94-year-old patient in cardiogenic shock in Memorial Medical Center’s emergency room was referred to Community Hospice. According to the email, a case manager assured that the woman could be admitted to the hospice house in Hughson, but two days later, Buchanan found the patient was still in the ER at Memorial.

“I do not want to refer patients from the ED to Community Hospice,” Buchanan wrote. “This was a complete disservice to the patient and the family.”

McLeod said she was not familiar with the woman’s case. She said the hospice takes severely ill patients that other agencies are not equipped to serve. “We do everything we can to provide services and support for families,” the CEO said.

The doctors also said many good nurses have left the hospice in the past two years, employees have no voice for airing concerns and the board needs to know more about internal conflicts.

Auen, who said he had donated more than $50,000 to the hospice, said he has gone to work for Optimal Hospice, a for-profit competitor of Community Hospice.

“I will not go back, not under that management,” Younan said. “I would only go back if there is an overhaul of management.”

Grothe said there are issues to deal with in any organization, but he does not believe there are significant issues with Community Hospice’s staff.

“I don’t see any employee push against administration,” he said. “I think the general feeling around the place is that it’s a good place to work.”

This story was originally published August 3, 2016 at 7:23 PM with the headline "Physicians blast management as they split with Community Hospice of Modesto."