THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Thursday, August 15, 1996 TAG: 9608150328
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
DATELINE: NORFOLK LENGTH: 119 lines
Four cancer specialists are challenging the authority of Sentara Health System to control where and when they can see patients.
In the long run, the case might embolden or discourage other local doctors who want to test the health system's authority.
``This kind of opens the door for a lot more challenges,'' said Greg Mertz, a local health care management consultant.
In the short term, the case will affect the treatment of about 1,500 cancer patients getting chemotherapy in Hampton Roads.
The four doctors - Thomas D. Brown, Paul R. Conkling, J.R. Howard Jr. and Michael E. Lee - work in a practice owned by Sentara. Saying they are dissatisfied with the management of the practice and interested in working with other cancer specialists, the doctors will leave at the end of this week.
But Sentara plans to prevent them from joining or opening another practice in South Hampton Roads by enforcing a provision in the doctors' employment contract.
The contracts with Sentara contain a ``noncompete'' clause, which says three of the doctors cannot practice within a 25-mile radius of their current offices for one year after leaving. Lee, the newest member of the group, is barred for two years.
The doctors have filed suit, asking the court to void the noncompete clause so they can set up shop in South Hampton Roads. The case goes to trial in Norfolk Circuit Court in late September.
Whether the doctors will be able to practice in the meantime depends on a Circuit Court judge. Sentara has asked a judge to bar the doctors' practices pending the outcome of the trial. A decision on that request is expected this week.
The doctors handle the cases of about 1,500 patients, overseeing chemical treatments for cancer
at NDC Medical Center and Sentara Cancer Institute, both in Norfolk.
The source of their dispute, the noncompete clause, is common in many nonmedical businesses. The clauses also are used by independent doctors' practices to prevent a partner from leaving and taking patients.
But those involved say this is apparently the first local case between doctors and a large, full-service health care system such as Sentara.
And it could have larger implications. Sentara officials say the case could affect Sentara's ability to build and maintain the kind of all-inclusive networks it wants - networks that include doctors' practices, hospitals and insurance plans.
The case also illustrates the changing relationships between doctors and health care networks.
Physicians, by establishing practices in which they are in charge, tend to be independent.
But Hampton Roads is experiencing the growth of managed care, a type of health insurance that reins in costs partly by controlling patients' access to doctors. Now, some doctors are becoming employees because they believe survival depends on joining a large health care system that owns or has ties to an insurance company.
And some doctors are discovering they don't like it.
``Physicians just don't make good employees'' because of their traditional independence, Mertz said. Mertz runs The Horizon Group, a health care management consulting firm based in Virginia Beach. Although Mertz has worked with Sentara in the past, he is not involved in this case.
The doctors suing Sentara say they don't like way the company runs its doctors' practice, known as Sentara Medical Group. Their lawyer, who is answering all questions for the group, declined to specify what they don't like about the practice. They currently are the only oncologists, or cancer specialists, in Sentara's doctors' practice.
Although three of the doctors signed the contract in 1995 after Sentara bought NDC Medical Center - and the fourth, Lee, joined the practice later - they became disillusioned with the operation, said their lawyer, Gregory N. Stillman. He also says the Sentara doctors were given little time to review the employment contracts before they had to sign them.
Sentara officials say the doctors freely consented to the employment agreement.
``This was not something that was force-fed to any of the specialists,'' said Dr. David R. Maizel, medical director for clinical operations of the Sentara Medical Group.
If the doctors open a competing practice, their patients may go with them, abandoning Sentara's practice, he said. And the doctors' departures will affect the ability of Sentara to create and market a full-service system.
Sentara officials are trying to build large networks that include almost every type of health-care service a patient might need. Doctors, especially well-established doctors, attract patients not only to Sentara's medical practice, but also to its health maintenance organ-i-zations.
Yet most health care companies say the crucial doctors in the system are the general practitioners, who provide the bulk of the care, not specialists such as cancer doctors.
For that reason, this may not be a big loss to Sentara, Mertz said. But Sentara may need to fight, anyway. ``Can they really afford . . . to blink?'' he said.
Regardless of what happens, patients will be affected by the legal wrangling.
Sentara has hired three new cancer specialists. One will start this Monday, but the others can't start until September.
In the meantime, Sentara has contracted with two outside groups - Cancer Specialists of Tidewater, with offices in Virginia Beach and Chesapeake; and Mid-Atlantic Hematology and Oncology Specialists, with offices in Chesapeake and Norfolk.
Maizel says at least one doctor will be on duty at the NDC offices and at the Cancer Institute to see patients. Some patients may get treatment at the offices of the two outside groups. The details will be worked out by individual patients and the NDC staff.
``We're going to make whatever arrangement is most convenient for the patient,'' he said.
Sentara has designated a special task force to keep patients informed as the dispute goes on, Maizel said. He said patients will be notified of changes by phone and letter.
If Sentara loses the request to keep the doctors from practicing, and the doctors are allowed to do so until the September trial, the four doctors may make arrangements to see their patients somewhere else, Stillman said. They are waiting for the judge's decision before they decide, he said. MEMO: Patients seeking more information may call the NDC nursing
administration department at 466-5913 or 466-5667. ILLUSTRATION: Graphics
THE CASE
WHAT'S AT STAKE?
[For complete graphic, please see microfilm] by CNB