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In a suit filed last month against the Tulare Local Healthcare District and the hospital on behalf of the TRMC Medical Staff, Los Angeles-based attorney John Harwell said the district illegally acted to remove former leadership, replacing them with a new group without a formal vote.

While Tulare County Superior Court Judge David Mathias denied a request for a temporary restraining order against the new medical leadership — Professional Medical Staff of Tulare Regional Medical Center — last week, Harwell said the group plans to continue its fight against the district and hospital administrators.

“The [restraining order] request was like the opening dance at the prom,” he said. “We still plan to depose all of the people submitting statements for the district and will then go back to the judge for a ruling on the medical staff.”

District bond measure remains murky

The courtroom drama may impact the district’s $55 million bond initiative later this year. The measure is expected to go to voters as a mail-in ballot sometime in August and, if approved by district voters, would fund the long-delayed medical tower project at TRMC.

The five-story project was initially designed to be funded through an $85 million bond but the money dried up before the project was ever completed. A subsequent lawsuit between TRMC and project contractor Harris Construction was eventually settled for $7.9 million and the community has remained hesitant to pursue future funding on the project.

“There’s been some issues in the past with the original bond measure,” said Mark Watte, local farmer and member of a citizens’ steering committee for the new $55 bond measure. “There was some mismanagement, I’m not going to deny that. But the original tower project was always supposed to be $120 million and there was supposed to be savings or profit to help fill the gap.”

None of those extra funds materialized, however, leaving the tower partially completed for years.

“I can’t argue that the community is gun-shy. But it’s important to note the [original] funds weren’t misspent,” Watte said.

“If we don’t complete the tower now our hospital, by 2030, won’t be up to code and will go away. That’s over 500 good-paying jobs in our community that will go away.”

Watte doesn’t think the lawsuit helps the bond effort in anyway, but hospital officials are much more optimistic.

“I think [the case] will have a positive impact on the bond measure,” said Dr. Benny Benzeevi, chairman and CEO of Healthcare Conglomerate Associates (HCCA). The organization took over operations for TRMC in 2014.

He said the recent legal action against the district by the former medical staff leadership was meant “to scare the community” away from the bond measure and referred to the failed motion for a restraining order as “the last remaining thing” in the way of the $55 million bond’s path to approval.

Sherrie Bell, chairman and president of the district’s board of directors, agreed and said the community’s concerns over the medical leadership at the hospital can now be put to rest.

“There have been community concerns about medical leadership at the hospital for a while now,” she said. “I see this [decision] as having a very positive impact on the hospital’s bond measure.”

An ‘unprecedented’ case

While TRMC and the district have a tumultuous past, the most recent saga began in January, after the board of directors voted to replace the existing medical leadership staff with a new body. The move was made during the board’s Jan. 26 meeting, and new medical staff bylaws for the hospital’s 130-plus physicians were immediately introduced and ratified by board members.

Such a move violates state and federal law, which guarantees hospital medical staff the right to self-govern and select its own leadership, Harwell said.

“This hospital fired that entire group from that medical leadership staff and hired its own,” he said. “It sets a precedent that medical staff can now be discharged by the board whenever they feel like it.”

While all the physicians involved have retained their hospital privileges and continue to work at TRMC, Harwell said the new leadership group and bylaws for the body are illegal since the medical staff never had the chance to vote on the changes for themselves.

The initial complaint filed by Harwell in February also argues that the medical leadership shakeup has compromised patient safety at TRMC and imperiled hospital funding.

TRMC administrators disagree, however, and have taken the ruling as a sign that the district is operating within the law.

Benzeevi said the medical leadership switch is essential to ensuring the facility properly addresses several key issues noted in recent health grade reports. He specifically pointed to a 2015 site visit and survey from the Centers for Medicare and Medicaid Services (CMS), which he said found “across the board failures” at the facility.

“The CMS report cited significant failures with the medical leadership,” he said. “When that report came out, the board really had their backs against the wall.”

Benzeevi said the leadership change was therefore needed in order for the hospital to improve patient safety and maintain its financial health. In addition, he said his office has received positive feedback from 95 percent of TRMC’s medical staff regarding the switch from TRMC Medical Staff to Professional Medical Staff of TRMC and that he has personally received signed letters of support from a majority of doctors who treat patients at the hospital.

The California Medical Association (CMA) has strongly disapproved of HCCA and the Tulare Local Healthcare District’s actions, however, and is listed as a friend of the court in the civil case. CMA attorney Long Do said the medical staff restructuring is “unprecedented” and motivated by profit rather than patient safety.

“What the hospital has done is blatantly illegal,” he said. “The lawsuit is far from over and we plan to still move forward.”

While the “few doctors” disgruntled with the leadership change may continue to pursue legal action for as long as they want, Benzeevi said TRMC, HCCA and the District are continuing to improve as a result of the change.

“They claimed that it was an illegal move and clearly it was not,” he said. “I don’t think it will go much further.”

Amidst the legal battle, HCCA has expanded its operations to a new hospital site in Inyo County. Benzeevi said the organization was awarded the management contract for Southern Inyo Hospital in Lone Pine late last year, after senior leadership at walked out and the facility lost its license.

HCCA reopened the 40-bed hospital with a staff of 20 physicians on March 1, he said.

“Talk about a Cinderella story,” Benzeevi said.  “That’s the only health care facility in a 130-mile section of highway out there. It’s a very critical location to the community.”

Going forward, Benzeevi said he would oversee both the Lone Pine and Tulare hospital sites.