A former John Muir Health doctor alleges in a lawsuit that the nonprofit group, which operates hospitals in Walnut Creek and Concord, put money ahead of patient safety and ignored her warnings about surgical hazards that have resulted in illness and death.
Hospital officials dismissed the claims made by Dr. Alicia Kalamas in a lawsuit filed Wednesday in Contra Costa County Superior Court.
Kalamas, who worked at John Muir Health for eight years, said she has repeatedly raised red flags at executives about improper surgical practices, only to be ignored because she was viewed as a woman with “sharp elbows” or because officials feared that Changes that would signal past practices were dangerous.
In one example, she said she warned officials not to authorize complicated surgery on a child and told them other regional hospitals were better prepared to perform the surgery. But because the hospital group’s executives wanted to build a children’s brand, they ignored her concerns, she claims in the lawsuit. Surgeons from John Muir Health performed the surgery and the child died.
In their response to that claim, John Muir Health officials said Kalamas was not directly involved in the case and could not assess the “significant risks” of continuing or not having the surgery.
Kalamas, 50, of Piedmont, sued the nonprofit and its two top executives, Cal Knight, CEO of John Muir Health, and Taejoon Ahn, president and CEO of John Muir Medical Group, alleging the group violated its contract and forced her out of her position after labeling her a troublemaker.
“People at the top of the organization have lost their way,” Kalamas told The Chronicle. “They care more about the bottom line than patient safety.”
John Muir Medical Center on Wednesday, January 12, 2022 in Walnut Creek, California.
Santiago Mejia / The Chronicle
dr Russell Rodriguez, chief medical officer at John Muir Health, said that any feedback from employees is appreciated and that before executives decided not to renew Kalamas’ contract, they decided to restructure the program she administered to include “the better meet today’s patient needs”.
“The fact that the clinical consensus can differ from an individual physician’s views does not mean that he or she has been ignored,” Rodriguez said in a statement to The Chronicle. “Despite efforts to offer coaching and other support, Dr. Kalama’s reality and something she found difficult to understand and accept.”
He said that senior executives make patient safety their number one priority, noting that all the money John Muir Health makes is reinvested in the healthcare system.
Kalamas specializes in anesthesiology with a focus on perioperative medicine, which ensures that the many factors that influence surgical success – before, during and after an operation – are properly managed. In 2013, Kalamas was recruited from UCSF to join John Muir Health as medical director of the perioperative medicine program.
She quickly sought to fix the hospitals’ readmission rate for the highest-volume surgeries, which the lawsuit said was higher than the region’s 6.9% rate.
Her research found a simple problem, she says. When prescribing opiates as pain relievers after surgery, particularly for knee and hip replacements, there was no protocol to educate and provide medication to prevent constipation, resulting in patients returning to the hospital for a variety of issues.
“Millions of dollars were paid to JMH for failing to provide their patients with a 50-cent over-the-counter stool softener, a glass of water, and some basic advice,” Kalamas alleges in her lawsuit.
After her changes were implemented, the hospital saw a 27% decrease in readmissions for joint replacements, reducing costs for medical providers and taxpayers, she says.
Kalamas dealt with postoperative wound infections. Patients who have developed such infections are 60% more likely to be admitted to the ICU and five times more likely to be readmitted research. Yearly such problems costs the US health care system $3.5 to $10 billion.
In the past, John Muir Health has earned revenue from such complications and billed patients for the additional treatment, the lawsuit says. However, the federal government began to force the hospital to pay millions of dollars Punish, says Kalamas, eventually forcing it to improve. Still, Kalamas says executives and others ignored numerous emails she sent warning them that the lack of pre- and post-surgery blood glucose monitors was harming and killing patients.
The lawsuit cites an example of a diabetic who required a second operation after an infection. His heart wasn’t strong enough and he suffered a massive heart attack at home in front of his wife on the first day and later died, according to the lawsuit. Another young patient with kidney failure and diabetes did not have her blood sugar controlled and died shortly after receiving anesthesia; Her blood sugar was high when she coded, Kalamas says.
Rodriguez, John Muir’s chief medical officer, said eliminating postoperative wound infection is a “critical focus” and that restructuring the perioperative program will further reduce infections.
“Peroperative services needed to be made available to a larger proportion of the operated population, and care needed to be extended beyond the clinical setting,” he said.
Kalamas said her whistleblowing and criticism as a woman was bothersome or, as one manager told her, developed a reputation for “sharp elbows”.
“I’ve been in other institutions … and I’ve never felt dismissed,” Kalamas told The Chronicle. “I felt like at John Muir Health I was warning of very serious health and safety concerns and no one was paying attention.”
When she found out about the young child’s planned surgery, it fell outside of her area of responsibility at the hospital, but she felt compelled to speak out, she says. Due to medical privacy laws, neither Kalamas nor her attorney, Dan Horowitz, could provide details about the child and the procedure.
“The case should have been referred to a qualified medical center, which Dr. Kalamas strongly encouraged her,” the lawsuit reads. “In particular, Dr. Kalamas told medical leadership that she had extensive experience with similar cases at UCSF and that JMH was massively underprepared.”
She said she told John Muir Health executives if they did the surgery it would be a “clean kill.”
After the child died, Kalamas requested a review of the case by the Medical Executive Committee, which could result in disciplinary action for those involved, disclosure to parents, and other safeguards. In a 2021 email shared with The Chronicle, Kalamas was informed that the case never went to the committee.
She recalled her earlier concerns about the surgery in an email, explaining how liver transplant and anesthesia experts agreed with her reservations.
“I was angry that JMH misrepresented the capabilities of their clinicians and the institutions’ ability to provide parents (redacted) with safe care given that UCSF, Stanford and Oakland Childrens’ are all much better equipped to to handle cases of this complexity,” she wrote. She added that she was told that John Muir health officials wanted their new pediatric center and needed to avoid disruption.
Horowitz said the child’s parents are still unaware of Kalamas’ concerns to this day.
In response to the pediatric death, Rodriguez said some cases had “extremely advanced life-threatening conditions for which any intervention is a high risk and not having an intervention is also a high risk.” He said all options were discussed with the family before the operation and since Kalamas is not part of the treatment team she would not know all the details.
He said a post-case review was conducted through the peer review process, but Kalamas would not be aware of any assessment as it is confidential.
As of May 31, 2021, Kalamas said her contract was allowed to expire. Since then she has not returned to a hospital.
Matthias Gafni is a contributor to the San Francisco Chronicle. E-mail: firstname.lastname@example.org Twitter: @mgafni