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11:10 PM Thu, Nov. 15th

KRMC, ortho doctors at impasse

KINGMAN – A dispute between officials at Kingman Regional Medical Center and physicians with Tri-State Orthopedic Institute could have repercussions on people brought to the hospital’s emergency room with broken bones.

Tri-State Orthopedic Institute has offices in Kingman, Bullhead City, Mohave Valley and Lake Havasu City. Robert Lock, Blake Stamper and Stan Allen are three of its doctors with staff privileges at KRMC.

“Between the three of us, we have provided 34 years collective service to KRMC and until December 2005 we took calls 24 hours per day, 365 days a year,” Lock said Tuesday. “We have been in continuous negotiations regarding different issues and have reached an impasse right now.

“However, I want to assure the community we intend to continue uninterrupted orthopedic care in Kingman, including surgical and outpatient care.”

The Miner received a report that the group transferred a patient out of KRMC last week.

Lock’s response to that was that in his 11 years of practice, he often has transferred patients to other medical facilities. It is not an unusual occurrence and is done to ensure a safe environment for patient care, he said.

Call coverage is the major issue involved in the dispute.

Lock forwarded a position statement from the American Association of Orthopedic Surgeons.

It states that in 1986, Congress enacted the Emergency Medical Treatment and Active Labor Act. EMTALA mandates that emergency departments provide medical screening examinations to everyone seeking treatment regardless of their ability to pay or whether it is the appropriate point of service. Hospitals have misinterpreted the legislation to mandate specialty care for all ER patients, including those with non-emergent problems, the statement said.

The statement goes on to say orthopedic surgeons on-call must respond to an emergency call or face fines.

“In most cases, orthopedic surgeons are not reimbursed by the hospital or managed care organizations for their on-call services,” the statement says. “No other business or occupation is required to perform mandated services without expectation of remuneration.”

Lock added his group is open to further negotiations with Larry Lewis, chief operating officer at KRMC.

Brian Turney, chief executive officer at KRMC, responded to questions Wednesday about the impasse.

Rural hospitals like Kingman generally require specialty physicians to provide 6-10 days of on-call coverage per month, he said.

Some doctors have balked at the requirement and negotiations with medical staff were held over the past year in an effort to reach a reimbursement agreement for treating patients without insurance. The needed two-thirds approval could not be gained and the effort stalled, Turney said.

A recent Medicare inspection of the hospital required addressing the on-call coverage issue.

“As a result of Medicare concerns, our medical staff approved a policy requiring five days of emergency room call coverage per physician per month if a particular specialty was not adequately covered on a voluntary basis,” Turney said. “The hospital board approved the policy April 25.

“Tri-State indicated to us they would not comply with the new policy unless their financial demands are met. They now are asking $1,000 per day in addition to whatever they may collect from patients and we don’t feel that request is reasonable.”

Two offers previously were made to the group, Turney said.

One was for compensation at 90 percent of the allowable amount paid by the Arizona Health Care Cost Containment System for uninsured patients.

The other was $1,000 per day from the hospital for anything above five on-call days per month.

Both offers were rejected.

Turney, Lewis and Dr. Donald Morgan, interim chief medical officer at KRMC, met with Lock, Stamper and Allen in their Bullhead City office for about 40 minutes Tuesday night. Turney said the orthopedists still refuse to comply with the KRMC on-call coverage policy without the aforementioned reimbursement figure.

The hospital now is trying to recruit new orthopedic surgeons to Kingman, but that will take time.

Patients coming to the emergency room now with broken bones and fractures will be given stabilizing treatment and then transferred to an appropriate hospital able to provide the needed specialty care, Turney said.

“If the group does not comply with the new policy, it mandates they will be administratively suspended,” he said. “It hasn’t happened at this point.

“We got an indication last night they would not cover our facility, so I will be working with medical staff leadership and legal counsel on taking the next step.”